Opioids: a multi-tiered approach to a multi-faceted problem

By Scott Robertson

At some point in the last five to ten years, workforce became the most important factor in business site selection, outpacing location, available infrastructure and incentives. At some point in the last two to three years, opioid-related issues became the most important factor in workforce disqualification, outdistancing education. The effort to stem the opioid crisis, until recently only a crusade to save lives in extreme rural areas, is now a nationwide effort to stop what already threatens to drive a dramatic slide in workforce participation.

“A lot of the reason there is a difference in workforce participation vs past years has to do with disability,” said Dr. Robert Pack, associate dean for Academic Affairs & professor of Community & Behavioral Health at East Tennessee State University. “It’s unknown exactly what proportion of it, but a lot of that disability is secondary to the overuse of opioid pain relievers.”

In Northeast Tennessee and Southwest Virginia multiple organizations are working to address the issue. From academia to healthcare providers to not-for-profit institutions and the faith-based community, a wide range of approaches is being taken – with mixed results – to lessen the impact of this complex, multi-faceted problem.

The longtime experts

Frontier Health has been dealing with addiction-related issues since the organization’s inception. Today Frontier provides services along the entire continuum from in-school prevention programs for young children through residential and crisis services.

The prevention programs create the greatest cost savings by keeping individuals from ever developing costly addictions in the first place. “Those programs are better funded in Virginia, not so well in Tennessee,” said Dr. Teresa Kidd, CEO. “In Virginia we have professionals involved in helping communities develop their own drug coalitions to provide education, outreach and peer support.”

Between prevention and crisis on the continuum, are traditional outpatient and residential services. Chad Duncan is director of adult outpatient addiction services at Frontier. Part of that service is an assessment of a patient’s readiness for change. An individual referred by a family member or employer may not believe he or she actually has a problem, and must work through a process of realization.

“We have motivational groups for people who may not be ready for more intensive group work,” Duncan said. “Sometimes you have to meet people where they are. Often by their third session in, they’ll be like, ‘Oh, I do have a problem.”

From there they can enter intensive outpatient services for a minimum of three days a week and three hours each day for 20-35 days.

Sherri Feathers, senior vice president of Specialty Services has oversight for Frontier Health’s addiction and depression residential program which performs medically monitored detox and residential treatment. Those services are offered for individuals who are beyond intensive outpatient services. Frontier offers mobile crisis services to crisis stabilization to a walk-in center and a 23-hour observation program in addition to outpatient sites in all eight counties of Northeast Tennessee.

Many opioid dependent patients, Feathers said, are those who have reached a point where they are afraid for their own survival. “Those folks present in crisis, seeking service. And we have a 24-hour triage center, 365 days a year.”

Frontier does around 800 assessments every month, Feathers said. “Over the last two or three years the number of people presenting in crisis coupled with opioid addiction have really increased.”

The young blood

Students at ETSU’s Gatton College of Pharmacy are taking an active role in saving lives by offering free naloxone training at events throughout the region. Students show seminar attendees how to administer the drug, also known as Narcan, to individuals overdosing on opioids.

Sarah Melton, professor of Pharmacy Practice, oversees those community training events, though the Gatton College students provide the instruction. “It doesn’t matter if it’s oxycodone, heroin – if these opioids overwhelm the receptors in the brain, they cause the body to respond by not breathing as much until the heart stops. But within 30-45 seconds of being administered, Naloxone reaches the brain’s receptors and bonds so tightly it kicks the heroin or oxycodone off the receptor. For 30-45 minutes, that allows the person to start to breathe again.” That generally gives first responders time to arrive and begin more robust treatment.

While community stigma generally associates Naloxone with individuals with substance abuse disorders, the training is beneficial to anyone with a family member who has been prescribed opioids and could accidentally overdose, Melton said. “It’s really for the community in general.”

Stepping up in Southwest Virginia

The United Way of Southwest Virginia made headlines with its IGNITE workforce education and training initiatives in 2017. This year that organization is turning its focus to addressing the opioid issue. “We hope this year to announce a new phase of IGNITE to be deployed in high schools,” said Travis Staton, CEO. “Phase one is research, curriculum development and pilot project. Phase two is scale. The program and curriculum we will use is highly effective and evidence-based. It has a return right now averaging around $22 for every dollar invested.” With those numbers, if the United Way could raise $250,000 the return could be greater than $4.5 million. “Mostly, it’s going into the high schools and doing prevention,” Staton said.

            

Ms. Hagamann goes to Nashville

Angela Hagamann, the Diversity-promoting Institutions Drug Abuse Research Program (DIDARP) director for ETSU’s College of Public Health, recently met with Bobby Rolfe, Commissioner of Economic and Community Development for the state of Tennessee. With Rolfe’s boss, Governor Bill Haslam, having just announced the state’s plan for addressing the opioid crisis (TNTogether) on Jan. 22, Feb. 19 seemed a good time for Hagamann to visit Nashville to pitch the Team Awareness concept already in use in Northeast Tennessee.

Back in 2014, the First Tennessee Development District (FTDD) had asked Hagamann to introduce Team Awareness and other opioid-related initiatives to the region’s city and county mayors. Since then, “We’ve spent the last three-and-a-half years trying to get folks to adopt that here,” Hagamann said. “To date, no business has really fully implemented it.”

Unfortunately, the meeting with Rolfe yielded no direct positive results. “We were told to go to the commissioner because they had a pot of money,” Hagamann said. “The commissioner told us in a very short answer that they did not have money, but that they would try to help us get it from somewhere else.”

Mobilizing the faithful

Appealing to a higher power may produce better results. The Holy Friendship Summit, a gathering of clergy, clinicians and congregants is scheduled for May 18 and 19, and is hoped to be the jumping-off point for what organizers Lottie Ryans of the FTDD and Roger Leonard, former chairman of Wellmont Health System, say will be two years of “innovative, faithful and transformative practices to provide Christian support and encouragement to all who suffer within the church and community due to the opioid crisis.” The objective is to have 1,000 clergy and lay delegates representing 500 churches in Southwest Virginia and Northeast Tennessee.

Those numbers are attainable, based on the growing prevalence of opioid dependency. “If you look at workforce issues of those who have addictions, 70 percent are working,” Ryans said. “So every day, employers likely have someone who is walking through their doors who is dealing with this or has a family member who is dealing with this. It is prolific.”

The crisis has no easy solution because it includes many different problems, from legal to medical to ethical to practical. But the region is not lacking in individuals and organizations ready to address whatever facet of the problem they can.