USDA Opioid Misuse Roundtable Reaffirms Importance of ‘Community’ Solutions

There’s a passage in Dreamland, the seminal book about America’s opiate epidemic, that has resonated with me since I first read it several months ago. In recalling their 24-year-old son’s death after a lengthy battle with addiction, a set of Ohio parents wrote: “They say it takes a community to raise a child. It takes a community to battle addiction.”

That same sense of “community,” in its broadest sense, was evident during a U.S. Department of Agriculture (USDA) rural opioid misuse roundtable held May 9 in Berea, Ky. Approximately a dozen panelists – from diverse organizations and all corners of our commonwealth – discussed local, regional, and statewide projects targeted at various aspects of this latest public health emergency.    

The USDA is focused on rampant opioid misuse because, as Assistant to the Secretary for Rural Development Anne Hazlett has said, “this is a matter of rural prosperity.” Indeed, the issue has very real negative consequences for quality of life and economic well-being across rural America. For instance, a December 2017 survey by the National Farmers Union and the American Farm Bureau Federation found that 74 percent of farmers have been directly impacted by opioid abuse.

Similar roundtables have been held in Pennsylvania and Utah (in March and April, respectively), with additional roundtables scheduled for Oklahoma (June 6) and Maine (July 11). Key topics have included the challenges associated with opioid use disorder; strategies for prevention, treatment, and recovery; and how these measures can be replicated to effectively address the epidemic in other rural communities.

While the crisis is widespread (more than 42,000 fatal opioid overdoses nationwide in 2016), perhaps no state has been hit harder than Kentucky (more than 1,400 overdose deaths in 2016, with the majority linked to opiods). Data from the Centers for Disease Control and Prevention suggest the rate of opioid-related deaths is highest in rural areas and that predominantly rural states, including Kentucky, have led the nation in prescribing painkillers. Furthermore, of the 220 counties the CDC has identified as being most at risk for outbreaks of HIV and hepatitis C from injection drug use (e.g., heroin), 54 are in Kentucky. The state with the second-highest number of at-risk counties is Tennessee, with 41.

During the Kentucky roundtable, there was general acknowledgment that the crisis has reached such a level that in isolation no single entity, and no single approach, can hope to impact it in a meaningful way. So, presented strategies ranged from preventive, to clinical, to rehabilitative. To my left, a physician from western Kentucky described a youth-focused initiative aimed at creating mentors and delaying (or hopefully preventing) the misuse of any drugs, including legal ones. To my right, a judge-executive from southeastern Kentucky discussed a Rides to Recovery program his county developed to remove transportation as a possible barrier for addicts seeking treatment.     

As director of the Northeast Kentucky Area Health Education Center (NE KY AHEC), I was invited to serve as a panelist because of my oversight of two opioid-focused grants. One, funded by the federal Health Resources and Services Administration, is providing approximately 20 educational activities (with an emphasis on medication-assisted treatment, or MAT, of opioid use disorder) to more than 500 health care providers and health professions students. Through this grant, we will be bringing Dreamland author Sam Quinones to Morehead, Ky., in September as part of a continuing medical education event.

Our second ongoing project will deliver prescription misuse prevention information to approximately 500 high school and college students, including participants in the NE KY AHEC’s health careers pipeline programs. Research indicates physicians, for instance, are no more likely than the general public to abuse alcohol or illegal drugs, but that they are more likely to misuse prescription drugs. A separate USA Today analysis found that “across the country, more than 100,000 doctors, nurses, technicians, and other health professionals struggle with abuse or addiction, mostly involving narcotics such as oxycodone and fentanyl.” Due to these findings, we believe prescription drug misuse prevention education is crucial for local students who are pursuing a health care career.

The NE KY AHEC has applied for a third grant-funded project, which is currently under review, to establish a Regional Opioid Crisis Response Network in partnership with our region’s largest rural hospital, a district health department, a regional mental health/substance abuse agency, and a federally qualified health center. Our proposed activities include: analyzing MAT certification among health care providers within an 11-county region; studying the feasibility of opening a long-term detoxification unit and a women’s rehabilitation unit, neither of which exists within the region; and assessing the likelihood of extending syringe exchange programs to the eight local counties that do not currently have one in place.    

Despite the NE KY AHEC’s recently heightened level of opioid-related programming, I realize we are just one piece of the overall puzzle. In fact, I left the USDA roundtable with an even deeper understanding of just how significant the opioid epidemic is in our state. But, after hearing a variety of possible solutions, I firmly believe our educational and collaborative activities – in combination with the other strategies that were discussed – have the potential to begin reducing the burden of opioid use disorder within Kentucky.

I am convinced it will take a similar all-in-it-together “community” approach to solve the problem across the rest of rural America as well.

David A. Gross, MPA, is administrative director for education and research at St. Claire HealthCare, based in Morehead, Ky. His duties include directing the Northeast Kentucky Area Health Education Center. Gross has been a member of the National Rural Health Association since 2003, is a former NRHA Communications Committee member, and served on NRHA’s Rural Health Congress from 2016-’17.

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