Rural Appalachia and the Opioid Epidemic: Overcoming Current Barriers with New Solutions

Olivia Croft

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Kristin Shargots, DNP, RN, CNE

Amanda Pribble, MSN, RN, FNP-C

Laura Kicklighter, PhD

What is Appalachia?

• Communities surrounding the Appalachian Mountains
• Many rural communities
• Appalachian poverty: 17% of population vs. National: 12.7% of population
• Long history of substance use and abuse: moonshine and marijuana

What is the Opioid Epidemic?

• Drug Overdose- A leading cause of death in the U.S.
• 187 people die everyday from an opioid-related overdose
• In 2020, 75% of all overdoses were opioid-related
• Early 2000’s- JCAHO pushed “pain” as the new 5th vital sign
• Emphasized need for more stringent pain control
• Early 2000’s- Pharmaceutical companies created “safer, less addictive” opioids
• Providers prescribed more opioids beginning in early 2000’s
• Opioid prescriptions per 100 people increased by 35%
• Amount of oxycodone and hydrocodone per prescription increased by almost 70%

Why Focus on Appalachia?

• Disproportionately affected
• Opioid overdose death rates are higher
• HIV contraction rates are higher
• Neonatal Abstinence Syndrome rates are higher
• Lack of Resources
• 10% have access within 15 minutes
• Only 20-50% of this population has access to Naloxone
• Accessibility Issues
• Computer Access- Appalachia: 17% do not have access, compared to 9% nationally
• Internet Access- Appalachia: 75% have access, compared to 85% nationally

The Harm Reduction Framework

• Four Elements
• Non-judgement
• Empowering patients to participate in treatment
• Improving quality of life
• Patient Safety

• Positives and Negatives
• Germany- Interventions introduced in early 2000’s
• Reduced HIV infections
• Now the golden standard of treatment
• U.S.- Individuals are more likely overdoses with access to naloxone
• 40-60% of individuals in recovery will relapse

Current Intervention and Findings

• Public naloxone (Narcan) distribution
• Opioid antagonist- reverses opioid overdoses
• Opioid-related overdose rates diminished (14%)
• Opioid agonist treatment centers
• Methadone and Buprenorphine- Opioid Agonists
• Risk of relapse diminished (80%)

Current Barriers

• Naloxone Legality Issues
• Prescription Required
• Education
• Class Required- REVIVE
• Treatment Deserts
• Only 10% have access within 15 minute drive

New Solution

• Improved Naloxone Distribution
• Distribute at pharmacies, health departments, clinics
• Nationwide standing order policy changes
• Improved education format
• Educational pamphlet
• Verbal directions
• Return demonstration

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New Solution

• Opioid Agonist Treatment Mobile Clinic
• Base Area- supplies, administrative offices, logistics
• Hire understanding and supportive staff
• Communities with greatest need would be served
• Provide opioid agonist treatment and distribute naloxone
• Contains all necessary health monitoring equipment (Vital signs, cardiac monitoring, AED’s)

Final Takeaway

• “The only qualification for getting into long term recovery is you have to be alive” - Jan Radar, Huntington Fire Chief

References

Allen, S. T., White, R. H., O'Rourke, A., Grieb, S. M., Kilkenny, M. E., & Sherman, S. G. (2019). Take-home naloxone possession among people who inject drugs in rural West Virginia. Drug and alcohol dependence, 204, 107581. https://doi.org/10.1016/j.drugalcdep.2019.107581

American Addiction Centers. (2022, October 21). Drug rehab success rates and statistics. American Addiction Centers. Retrieved February 24, 2023, from https://americanaddictioncenters.org/rehab-guide/success-rates-and-statistics

Appalachian Regional Commission. (2022, September 27). Computer and broadband access in Appalachia. Appalachian Regional Commission. Retrieved May 3, 2023, from https://www.arc.gov/computer-and-broadband-access-in-appalachia/

Center for Disease Control and Prevention. (2022, June 1). Understanding the opioid overdose epidemic. Centers for Disease Control and Prevention. Retrieved May 3, 2023, from https://www.cdc.gov/opioids/basics/epidemic.html

Erwin, P. C., Meschke, L. L., Ehrlich, S. F., & Lindley, L. C. (2017). Neonatal Abstinence Syndrome in East Tennessee: Characteristics and Risk Factors among Mothers and Infants in One Area of Appalachia. Journal of health care for the poor and underserved, 28(4), 1393–1408. https://doi.org/10.1353/hpu.2017.0122

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References

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References

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References

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