Keys to fighting opioids in Appalachia: reducing stigma, educating the public and physicians, getting success stories in news media

The stigma of opioid addiction in Appalachia "not only keeps some from seeking help, but follows those who did — putting them at risk for relapse," the Knoxville News Sentinel's Kristi L. Nelson reports, on a six-month study that interviewed residents and held discussions with them.

“We interviewed people who had been in recovery for 20 years, and they said they were still viewed in their community as a ‘junkie’ and an addict and can’t get a job,” said Jennifer Reynolds of Oak Ridge Associated Universities, which did the study. “They have gone through this incredibly different process to change their life, and in the view of their community, they’re right where they were, at the beginning — and that’s really disheartening.”

Jennifer Reynolds and Kristin Mattson of Oak Ridge Associated
Universities discuss their report on communication about opioids
in Appalachia. (Photo by Brianna Paciorka, Knoxville News Sentinel)
Reynolds and ORAU colleague Kristin Mattson "found grass-roots community organizations — some made up of people in recovery or families who’d lost loved ones to addiction — are having some impact on the stigma," Nelson reports, but the two said, “We still have a long way to go.”

"The researchers noted some cultural attitudes that contribute to the problem," Nelson reports. "They include an expectation of privacy that keeps neighbors or friends from intervening; a willingness to 'share' pills with someone else experiencing pain; a lack of other opportunities, especially for younger people; and a normalization of dealing with pain by taking pills obtained from a doctor. . . . Some people, they found, don’t realize prevention efforts are aimed at them." One said, “I’m not taking opioids, I’m taking hydrocodone.” That's an opioid. “So they dismissed the message,” Mattson said.

Physicians and rural isolation are part of the problem. "Every focus group had members who said physicians provided them or family members, including children, larger-than-necessary quantities of opioids; a few said they’d gotten 'pushback' from doctors when refusing pills, even when patients told doctors they were in recovery for opioid addiction," Nelson writes. "The researchers found few, if any, recommended pain-control alternatives exist in smaller rural communities."

“There’s no physical therapy, there’s no massage, there’s no acupuncture,” Mattson said. “These alternatives are not available, and even if they were, there wouldn’t be insurance coverage to pay for it.”

The residents said physicians need more training — "Out of 47 community members who said they’d been prescribed opioids, two said they’d been given information by a provider," Nelson reports — and communities need more places to dispose of drugs, better education about drugs, how to properly use opioids and what to ask doctors. Some also called for "random drug testing of youth — to link them with services, not punish them; better access to treatment, including medication-assisted therapies such as suboxone and methadone; peer support for those hospitalized after an overdose or jailed after a drug crime; and more nonjudgmental messages framing addiction as a long-term health problem rather than a moral failing."

The discussion groups also "suggested sharing detailed stories that could make a difference: how it feels to have your child removed because of your drug use; why your mother might be relieved you’re in jail because she knows — at least that day — you aren’t dead; how a legally obtained prescription from a doctor can lead to addiction; and how people do find a way back."

News media need to play a role, too, said Reynolds, who is ORAU's section manager for health communication. She said news reporting on crime and overdose deaths “really adds to this feeling of, ‘Well, prevention’s not working in our community,’ and that’s not really true. “We have many people entering recovery all the time, and we do have success stories. If we could start reporting on those, I think that would make such an impact.”

At least one recovering addict in Appalachia is being very proactive in taking his story to the public through local newspapers. Phillip Lee of Albany, Ky., writes a column for the Clinton County News and other area newspapers, free of charge.

Reynolds and Mattson's report, "Communicating About Opioids in Appalachia," was produced with two other federal agencies, the Appalachian Regional Commission and the Centers for Disease Control and Prevention. It is based on interviews with 25 people in 12 of the 13 ARC states and a dozen focus groups in the Central Appalachian towns of London, Ky.; Kingston, Tenn.; Oneida, Tenn.; and Princeton, W. Va.

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