Resistance remains to tackling opioid crisis in Appalachian region

The opioid crisis has hit many communities in the Appalachian region with unyielding fury, but too often the response to this onslaught has been tepid and characterized by prevalent stigma. Input from subject matter experts and community leaders that shaped a new report indicates that knowledge of the crisis has too infrequently translated to community-wide discussions of solutions.

At the extremes, the report states, there was a widely shared perception that even individuals with a decade or more in recovery are still being treated as second-class citizens in the region's communities.

The report, Communicating About Opioids in Appalachia: Challenges, Opportunities and Best Practices, was coordinated by Oak Ridge Associated Universities, the Appalachian Regional Commission and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control. The president and CEO of one of the subject matter expert organizations that was interviewed for the report says the findings underscore the importance of the organization's work in bringing together the law enforcement, treatment and prevention/education communities to combat the opioid epidemic.

“One of these entities by itself cannot tackle this,” Nancy Hale, CEO of Kentucky-based Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) tells Addiction Professional. Operation UNITE is a guiding presence at the annual National Rx Drug Abuse & Heroin Summit, which this year will take place from April 2-5 in Atlanta.

Consistency in comments

The report's researchers conducted phone interviews with 24 subject matter experts in 12 states, and held 12 in-person focus groups with community members in locations in Kentucky, Tennessee and West Virginia. The Appalachian region, stretching from New York to Mississippi, is characterized by economically distressed conditions in 20% of its counties, as well as significantly higher than average drug overdose mortality rates in the adult population.

The researchers reported that the assessments from experts and community members were quite similar, with these among the highlights:

• The public health impact was the most frequently cited concern related to the opioid crisis. The issues went well beyond overdose alone, to include impacts such as communicable disease outbreaks, cases of neonatal abstinence syndrome, dental issues, and malnourishment.

• The economic impacts of the crisis are widespread, where it is even thought that industry cannot be attracted to the region because of the perception that addiction has stunted workforce development.

• Despite the efforts of some community organizations, the drug crisis remains a topic too often ignored in local communities. Several participants referred to addiction as “the new leprosy.” Hale and Operation UNITE communications director Dale Morton point out the need for faith-based groups to reach out to a greater degree on this subject. “It is probably the number one problem within their churches,” Hale says of the opioid crisis.

• Overprescribing of dangerous opioids remains a problem in communities. Only 2 of 47 community members who participated in the focus groups said they ever received counseling from a provider when they were given an opioid prescription.

• Community members shared powerful stories of the struggle to access substance use treatment services in the region, particularly when individuals do not have funds to pay upfront for care.

• The argument for prevention funding remains an uphill battle at the political level, where lawmakers appear to prefer quick-fix solutions. “That is the same mindset that got us into the problem,” Hale says.

Many of the individuals who contributed input for the report cited the importance of efforts of local anti-drug coalitions in bringing leaders together to devise community-level solutions. Many believe, in fact, that local organizations are in the best position to combat the crisis because they understand the varying circumstances in local communities.

Hale adds that another factor that should bring about change at the community level is the increased willingness of people in long-term recovery to share their stories publicly. This should, for example, shape perceptions among employers that might hesitate to hire someone with an addiction history.

“They make your best employee,” Hale says of individuals in stable recovery. “They realize the blessings of a second chance.”