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Interdisciplinary Health Care Professionals’ Perceptions of the Causes and Consequences of the Opioid Crisis - Developing Rural Community Partnerships to Increase Access to Naloxone
Journal of Community Engagement and Scholarship
Volume 14 Issue 1, Article 19
September 2021
Laura C. Palombi
University of Minnesota
Stephany Medina
Kelsey Ronayne
University of Minnesota
Ashley Dahly
Heather Blue
University of Minnesota College of Pharmacy
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Recommended Citation Palombi, Laura C.; Medina, Stephany; Ronayne, Kelsey; Dahly, Ashley; and Blue, Heather (2021) “Interdisciplinary Health Care Professionals’ Perceptions of the Causes and Consequences of the Opioid Crisis: Developing Rural Community Partnerships to Increase Access to Naloxone,” Journal of Community Engagement and Scholarship: Vol. 14 : Iss. 1 , Article 19. Available at: https://digitalcommons.northgeorgia.edu/jces/vol14/iss1/19
This Research From the Field is brought to you for free and open access by Nighthawks Open Institutional Repository. It has been accepted for inclusion in Journal of Community Engagement and Scholarship by an authorized editor of Nighthawks Open Institutional Repository.
Cover Page Footnote
This study was supported by St. Louis County Public Health and Human Services’s State Targeted Response to the Opioid Crisis Grant. All authors contributed to the research and manuscript, and none of the authors have conflicts of interest to disclose. The authors would like to acknowledge Jake Mertz for assistance in editing and community partners and coalition members throughout northeastern Minnesota for their lifesaving work.
Abstract
Opioid overdoses kill thousands of people each year, and overdose rates continue to increase. Community-university partnerships are desperately needed to provide the multipronged and multiagency responses demanded by the opioid crisis. In this study, community and university partners used a consensual qualitative research approach to analyze survey results from continuing medical education sessions in rural communities. The health care providers surveyed had variable attitudes toward the opioid crisis, ranging from empathy for patients’ situations to denial that an opioid crisis exists. The voices of these professionals are critical to community partners’ ongoing work to address the opioid crisis. Data from this study supported the formulation of subsequent programming for health care professionals and community members as well as the launch of fruitful opioid-focused partnerships. Understanding health care professionals’ perceptions of the opioid crisis will allow public health and university teams to provide effective interventions in opioid prescription, naloxone distribution, and stigma reduction to ultimately lessen opioid dependency and overdose.
In 2019, nearly 50,000 people died of an opioid overdose in the United States, and 73% of those deaths involved synthetic opioids (Centers for Disease Control [CDC], 2021). The opioidrelated mortality rate rose from 0.4% of all deaths in 2001 to 1.5% of all deaths in 2016 (Gomes et al., 2018). Counties in northeastern Minnesota face some of the highest mortality rates among people who have a mental health condition and/ or opioid use disorders (OUDs) compared to other Minnesota counties (Dwyer-Lindgren et al., 2016). Health care providers’ negative attitudes toward patients with OUDs are common and are known to contribute to suboptimal care for these patients (Haffajee et al., 2018; Mendiola et al., 2018; van Boekel et al., 2013). Providers face a number of barriers to delivering appropriate treatment for OUDs, including lack of support from health care systems and employers; poor coordination of care; stigma among fellow providers; inadequate reimbursement; and insufficient education, training, and experience (Andraka-Christou & Capone, 2018; Deering et al., 2011; Mojtabai et al., 2014; Peckham et al., 2018). It has been estimated that only 11–40% of people with a substance use disorder (SUD) receive evidence-based treatment for this chronic disease state, while the remaining individuals suffer in silence (Deering et al., 2011; Peckham et al., 2018; Substance Abuse and Mental Health Services Administration, 2014).
Research has shown that rural communities suffer disproportionately from SUDs (CDC, 2017) and often have limited access to treatment facilities (Brown et al., 2018). Studies have also demonstrated that opioids are more likely to be overprescribed in rural areas than in urban areas (García et al., 2019). Social determinants of health, including economic distress and social isolation, play a significant role in addiction-related and opioid-related disparities in rural communities (Rigg & Monnat, 2015; Zoorob & Salemi, 2017). While rural communities have their own challenges, they also have unique opportunities to build strong and lasting partnerships to address substance use (Palombi et al., 2017).
Rural communities in northeastern Minnesota, the focal region of this study, show many of the same trends seen in rural regions nationally and stand out with some of the highest opioid overdose rates and overprescription rates in the state (Minnesota Department of Health, n.d.). Results from community health assessments (CHAs) and research conducted with individuals in SUD recovery in this study’s partner communities have indicated that negative attitudes are indeed prevalent in the study area and serve as a barrier to SUD treatment (Palombi, Hawthorne, et al., 2019). Negative attitudes, biases, and stigmas are also held by the medical community (Palombi, Hawthorne, et al., 2019).
While individuals and communities in rural Minnesota have faced hardship due to the opioid epidemic, residents remain proud of the local work ethic within industries such as mining (Saxhaug, 2014) and of the natural environment that attracts tourists from across the state and nation (U.S. Department of Agriculture Forest Service, n.d.). Hunting, fishing, snowmobiling, and other outdoor activities are popular regional hobbies. While these activities can serve as protective factors for residents at risk of developing SUDs transportation issues within the region can inhibit participation and promote feelings of isolation (Temple, 2019). However, local public health departments, university faculty, health care providers, and coalition members have committed to being a part of the solution to supporting individuals with SUD by connecting resources, building partnerships, implementing evidencebased programming, and providing relevant training sessions.
Local public health departments in Minnesota and across the nation have devoted entire positions and teams to addressing substance use through interdisciplinary, interagency, and multipronged approaches. Most public health departments serve as liaisons with or leads for grassroots community coalitions that strive to reduce substance use through prevention, intervention, recovery support services, and harm reduction. Champions from health care systems are sometimes members of these coalitions or lead their own coalitions focused on substance abuse. Interestingly, university faculty and staff are usually not represented in these coalitions and have not engaged in this collaborative work; the partnership described in this project is therefore unique but replicable.
In a 2018 statement entitled Facing Addiction in America: The Surgeon General’s Spotlight on Opioids, U.S. Surgeon General Jerome Adams stressed that the most effective way to address the opioid crisis is to work on achieving better health through stronger partnerships (U.S. Department of Health and Human Services [HHS], 2018). While the statement issued many recommendations targeted toward different groups of people working to address the opioid crisis in various ways—including health care professionals, health care systems, governments, educators, family members, and community members—several key recommendations were especially valuable to rural teams. The statement urged health care professionals and health care systems to “create stronger connections across behavioral health providers and mainstream medical systems” (HHS, 2018, p. 29). It urged federal, state, local, and tribal governments to “improve coordination between social service systems and the health care system to address the social and environmental factors that contribute to the risk for substance use disorders,” and it also urged educators and academic institutions to “enhance training of health care professionals” (HHS, 2018, p. 30). The underlying message of the statement was the importance of interprofessional and interagency partnerships and a multipronged, multifactorial approach, recognizing that
the responsibility of addressing opioid misuse and opioid use disorders does not fall on one sector alone, and the health care system cannot address all of the major determinants of health related to substance misuse without the help of the wider community. (HHS, 2018, p. 28).
Apart from this guidance from the surgeon general, a gap in the literature currently exists regarding interprofessional health care providers’ perceptions of the causes and consequences of the opioid crisis. Research in this vein is needed to ensure that the medical community can work collaboratively with community partners to address the needs of patients with SUDs and to reduce the impact of the opioid crisis. This gap in knowledge is especially problematic for rural communities, where resources are fewer and disparities are greater. While studies have demonstrated communityuniversity partnerships to be effective when organizations are working toward a common goal, such as decreasing disparities in rural communities, published examples of how these partnerships have been created, developed, and sustained to reduce the impact of the opioid crisis are lacking.