This article is the twelfth in a series about the epidemic of opioid addiction and how NEOMED is training future physicians and pharmacists to help. Thomas Weiner, a third-year College of Medicine student, contributed this article, based on his work in the 2017 NEOMED Summer Research Fellowship Program.
Much of what we have heard about the opioid epidemic comes from urban areas. What some people may overlook is how the same issue takes a new shape in a rural setting.
As a third-year College of Medicine student in the Rural Medical Education (RMED) Pathway here at NEOMED, I am continuing my longtime interest in rural health and its unique challenges. During the summer of 2017, I was able to work with Amy Lee, M.D., M.P.H., M.B.A., professor of family and community medicine; and with Leann Cline, who was then the Carroll County health commissioner, to investigate the opioid epidemic in this very rural county. This research project was one of the many summer research fellowships available that year, and I was able to present the research at the annual poster symposium held at NEOMED. (Editor’s note: This year’s Summer Research Fellowship Poster Day will be Friday, August 24, in the NEW Center.)
Our research focused on adolescents—a population that is sometimes overlooked and underrepresented when solutions to the opioid crisis are discussed.
Located in east central Ohio, part of the Canton-Massillon metropolitan area, Carroll County does not currently have as large a problem with opioid abuse as some other counties in Ohio. Commissioner Cline wanted to be one step ahead of the game, working to prevent adolescents in her county from falling victim to opioid abuse.
This specific county poses an interesting set of circumstances, some of which make it very different from other Ohio counties. Only one percent of Carroll County is considered urban, which means that people are very spread out and hard to reach. This makes it difficult to contact and treat those who may need help.
In order to better assess the issue, Dr. Lee and I spoke with the Carroll County Children and Families First Council (CCCFFC), which is composed of representatives from many different agencies that interact with adolescents on a day-to-day basis. Agency representatives were from the Carroll County Department of Job and Family Services, the Tuscarawas/Carroll Alcohol, Drug Addiction and Mental Health Services Board, the Carroll County Health Department and many more. From the focus group, we discovered five key themes that impacted adolescents the most:
- Cultural Influences –Appalachian culture seemed to act as a barrier to reaching Carroll County adolescents. Pride was said to get in the way of seeking help and reaching out for assistance. The group thought that these feelings would stop a person from reaching out for themselves, or someone they care about, for help. Since pride and stigma surround opioid addiction, people are reluctant to speak up and aid others because it is not their problem. They want to retain the privacy for others that they would prefer if they were in the same situation.
- Familial Factors – Parents can control the environment their child is exposed to and help them get treatment. But even if parents have the best intentions, medicines can remain accessible to adolescents. For example, drug take-back programs are not as common in rural areas as urban areas, which means prescription drugs may be left available in the home. Families may also have limited resources for needs such as transportation. This is a much larger problem in rural areas because most locations are not within walking distance.
- School’s Influence – Most adolescents attend school, so educating them there about addiction is an important way to reach them. Lessons need to be engaging or the students will not learn.
- Community Connections – People can only “use what is there,” and what they know is there. Some programs exist to help adolescents and families (job and family services, CCCFFC and employment opportunities), but not all community members are aware of them. Advertising these programs to everyone in the county is difficult because people are so spread out, geographically. On the other hand, no major highways go through Carroll County, which limits the movement of opioids. It is a benefit that adolescents there do not have the same easy access to opioids as their urban counterparts.
- Attitudes – Most adolescents do not think opioid addiction applies to them, so they tend to not care about it. Adolescents tend to follow their popular peers, so getting them to buy in is critical. With tighter-knit communities in rural areas, trends travel quickly, and attitudes can change overnight.
From these five themes, we saw potential solutions to counter barriers in helping adolescents. The next step in Carroll County is to interview adolescents to see if any new themes arise. This information may then be used for any future implementations. Some ideas may include a public health campaign educating the public on opioid abuse and how to get help, as well as an in-school campaign to make adolescents aware of the issue.