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

Reprinted from UVAToday, 9/22/17, by Katie McNally **

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.

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 helped 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 was an extension of those earlier events.

The conference, “Best Practices in Community Mobilization in Response to Substance Use Related Epidemics Conference,” held September 26-27, brought 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 purpose was to share past strategies that have been successful in combatting the opioid epidemic, as well as to brainstorm opportunities for success.

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 discussed 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.”