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For Sarah Blevins, finding better ways to treat opioid use disorder is personal. “Coming from Appalachia, I feel like those are my people,” she said.
Blevins, who grew up in Abingdon, Virginia, is one member of a small group of researchers at the University of Kentucky working on a multidisciplinary plan to treat those with opioid use disorder (OUD). It’s a plan, they say, that could work well treating those with OUD in rural areas.
Since 2018, the researchers have been treating patients who entered the health care system with endocarditis (a condition where germs enter the bloodstream and travel to the heart) associated with injection drug use. The group wanted to find solutions that would address the patients’ addiction, as well as their infection.
The researchers hope to be able to curb opioid use disorder by providing patients at infectious disease clinics with access to mental health therapists, relapse prevention services, and medications.
“Our intervention is about linking patients with IV-drug-use-associated infections to outpatient addiction treatment services,” said Blevins, a pharmacist and lead researcher on the study. She likened the approach to the way HIV is treated.
The new opioid treatment is based on approaches spelled out in the groundbreaking HIV-treatment legislation called the Ryan White Care Act. That HIV treatment model provides not only medical care but mental health care, case management, social workers, and others.
Providing help with everything from housing to jobs to mental health services and prescriptions helps the team treat the whole patient, and not just the infection, said Alice Thornton, M.D., one of the study’s authors.
“All of this goes back to the addiction problem,” Thornton said. “We have to step back and see the whole person and the root of the problem.”
The team works with individuals who are eligible to enter into the program (they must be opioid drug users and they cannot be incarcerated) and treats both their endocarditis and their addiction.
Whether it’s finding treatment providers closer to a patient’s homes, providing transportation assistance, or even providing mental health services through telehealth appointments, the treatment model focuses on the whole patient and what they need.
So far, she said, out of the 270 patients who were referred to the program, only 167 were eligible to participate. Of those, about half decided to participate in the program. Of those that have entered the treatment program, she said, about 17% have died from causes related to their opioid addiction.
Participants are located all across the state, Blevins said, but most come from rural eastern Kentucky.
According to Bevins, in rural areas, the treatment approach could be a model for success because it helps the team offer specialized services that individuals with opioid use disorder may not have in their areas.
“In some of the more rural areas, to continue treating that infectious disease, whether it be follow-up for their endocarditis or continued HIV care or hepatitis C care that may not be available where they are, we still provide that treatment,” she said. “But also, we have this separate group that helps them stay within their (sobriety) journey or to start on their journey to sobriety.”
Nationally, rural areas of the country continue to see higher rates of opioid overdose deaths, despite lower incidents of drug use. According to the Centers for Disease Control and Prevention (CDC), the rate for drug overdose deaths involving natural and semisynthetic opioids was 4.9 per every 100,000 residents compared to 4.3 per every 100,000 residents in urban areas. However, rural areas see lower rates of drug use, 20 per every 100,000 residents, than urban areas (22 per every 100,000 residents).
For Blevins and the University of Kentucky team, it’s not just about numbers. It’s about the people.
“We’re very passionate about it, because all of us on the team except maybe one, are from Appalachia,” Blevins said. “We’ve seen it – the opioid crisis. It’s hard to be in Appalachia and grow up there and not have at least one person that you know that’s overdosed. And I think that speaks to the enormity of the problem.”
So far, the program is young, she said, and there’s not a lot of hard data to draw conclusions from. But Blevins believes results are promising. Some of those who have entered the program are approaching a year in recovery and have been able to hold down jobs, get custody of their children back or clear up legal problems.
Others, however, have not.
“That’s kind of how it goes with sobriety,” she said. “It’s a continual process of trying to get stable.”