It Takes a Village: Finding Community Strategies to Combat the Opioid Crisis

America’s sweeping opioid crisis has reached epidemic proportions in recent years, dominating national conversations on health care policy and politics. Expanding levels of addiction have had a noticeable impact on communities around the country, but there’s one underappreciated aspect of the epidemic that has become particularly troubling to infectious disease doctors.

“We’re seeing people with substance use disorder in the inpatient setting and we’re seeing them when they get diagnosed with HIV or hepatitis C transmitted through intravenous drug use,” said Dr. Kate McManus, an assistant professor of infectious diseases and international health at the University of Virginia.

McManus and her colleague at the UVA School of Medicine, Dr. Rebecca Dillingham, witnessed firsthand these parallel crises of serious infectious diseases spread via intravenous drug use and addiction. Dillingham, who directs UVA’s Center for Global Health and is an associate professor of infectious diseases and international health, explained that one of the big hurdles of the opioid crisis is that it’s often treated in parts, rather than approached as a whole.

“Often we fragment people into different times in their life and different parts of their body,” she said. “Severe, life-threatening infections are where infectious disease doctors touch a piece of the puzzle that is the opioid epidemic, but then we don’t have enough connections to behavioral health initiatives in the communities, particularly in the breadth of communities that we serve here in the hospital, to be able to have a hand-off.”

In an effort to build greater lines of communication between the many community partners and health care specialties who deal with different aspects of the opioid crisis, McManus and Dillingham are helping host a two-day public symposium on the topic, put on by UVA’s Center for Global Health, Center for Global Inquiry & Innovation and Center for Health Policy.

The UVA Health System previously held a symposium on the opioid epidemic in November 2016, and the opioid epidemic was the focus of the spring 2017 Population Health Summit. This conference is an extension of those earlier events.

Beginning Tuesday, the conference, “Best Practices in Community Mobilization in Response to Substance Use Related Epidemics Conference,” will bring together faculty, staff and students from across UVA Grounds, plus health care professionals, policymakers and community leaders from Virginia and beyond – including representatives of Canada’s First Nations – to discuss coordinated approaches to combating this epidemic. The public is invited to attend and participate.

The purpose of the symposium is to share past strategies that have been successful in combatting the opioid epidemic, as well as to brainstorm opportunities for success.

In advance of the conference, Dillingham and McManus offered a preview of some of the community strategies that have already been successful in Virginia and Canada.

Treatment Across a Lifespan

When infectious doctors treat a patient who has contracted hepatitis C as a result of intravenous drug use, for example, they’re treating one piece of a whole problem. It’s just a piece of the puzzle Dillingham described. She explained that health care providers must start forming more regular teams and community follow-up connections in order to fight the epidemic as a whole.

“That idea of prevention and treatment across the lifespan is particularly important, especially beginning in a health system,” said Dillingham. “When people come to us with life-threatening infections secondary to drug use, we have to monitor how well we’re doing at referring them and linking them to behavioral health care afterwards, because that’s what’s going to save their life ultimately. We save their life in the short term, but in the long term, what’s going to kill them is addiction.”

Deploying behavioral and community resources can be important in treating primary and secondary problems related to drug use.

Education

“Not only do we need to educate community members, but we need better education in the medical sphere for health care providers in general. We need to revamp the way we teach pain management in U.S. schools,” McManus said.

They’ll be discussing medical education at the conference, but also the role the community plays in starting substance abuse education as early as high school.

“Our Canadian colleagues have seen positive results from making education a big part of their plan early on. They went to the schools, held community fairs and really made sure that the community was educated about substance abuse and the infections that can go along with it,” she said.

Reducing Stigma

The stigma associated with drug addiction is closely tied to the need for education and awareness. McManus and Dillingham explained that shame and pressure to keep addictions secret can often prevent people from getting the treatment they need.

“A lot of people don’t recognize that this is a highly stigmatized disease, but it is a disease,” McManus said. “We need to be as compassionate with people with substance abuse issues as we are with everyone else in the health care system.”

The symposium will include participants from the Louisville, Kentucky Metro Public Health & Wellness, who will talk about their successful efforts to start a syringe exchange program and how they encouraged residents not to be afraid to use it.

Access

“Some areas of Virginia that we serve are very rural, and I think we can learn a lot from our Canadian colleagues in terms of what they did when they faced issues of isolation in their communities,” McManus said. “Before they started setting up local treatment centers, there were people who had to go 80 miles to the nearest city to get any kind of substance use treatment or any kind of HIV testing or medication.”

She added that parts of rural Virginia were flagged in a recent study by the Centers for Disease Control and Prevention that highlighted areas of the country most at risk for HIV or hepatitis C outbreaks due to intravenous drug use.

McManus and Dillingham hope that connections made at this symposium will help local leaders, law enforcement and health care providers think of new ways to make addiction care and treatment available to communities that are far removed from the state’s major hospitals.

They said they are looking forward to expanding the conversation to all interested parties and brainstorming new solutions.

“Creating spaces where we can all come together is always valuable and for this particular issue, it’s essential,” Dillingham said.

The conference begins Tuesday at 9 a.m. in the Rotunda. The full schedule and registration details are available here.