Envisioning a future community-wide system to break the cycle of opioid addiction

Written by Bruce Tonn, President, Three3

In April 2018, East Tennessee Foundation granted local research nonprofit, Three3, the incredible opportunity to convene a workshop for community leaders and subject matter experts connected to the opioid epidemic in East Tennessee. The goal of the workshop was triple-aimed. It served to better understand contributing factors of the epidemic and to identify opportunities for further cross-sector collaborations at the community-level. The second aim produced a conceptual diagram that displays a typical community network operating from within and on the periphery of the existing opioid epidemic. Understanding the system of interactions at the community level provides a pathway to the third and long-term objective; to develop collaborative interventions that achieve meaningful outcomes for those both directly and indirectly affected by the opioid crisis.

As a result of the ETF grant, Three3 was able to conduct a wide review of research articles, media reports and testimonials. Taken together with the inputs from thought leaders at the workshop, Three3 produced a network diagram that maps various connections between agencies and key players within critical sectors within or adjacent to local communities. For example, the public health sector is responsible for tracking opioid use and misuse and related deaths. These data are drawn from the medical sector and municipal services responsible for not over-prescribing opioids, urgent care of infants and children exposed to opioid misuse, and for emergency treatment of opioid-related overdoses–including distribution of the life-saving drug, Naloxone. Monitoring of the safety and care of these exposed children, and for the public, falls upon the state departments, school systems, and the legal sector through criminal, drug, family, and juvenile courts. All of these agencies are responsible for referring and supporting individuals directly and indirectly impacted by the opioid epidemic through formal behavioral and mental health treatment and through community and neighborhood support groups. The state is further responsible, alongside healthcare insurance companies, for funding medical, behavioral, and mental health treatment for all those suffering from the crisis. Further research to better understand the epidemic and test new interventions is often funded by foundations, such as the work conducted herein granted through ETF. Finally, access to secure and adequate standard of living– including housing, higher education and supportive work environments–provide both purpose and hope.

In October 16, 2018, ETF staff hosted a philanthropic leadership series entitled Breaking the Cycle of Opioid Addiction on October 16, 2018. The main objectives of the philanthropic leadership series on the opioid epidemic were to:

  • inform community leaders and philanthropists on the benefit of applying a ‘systems approach’ to better understand and solve complex social problems;
  • identify and characterize existing collaborative programs or efforts related to substance misuse prevention and recovery in the East Tennessee region; and
  • explore new interventions (i.e., additional programs or solutions) to strengthen the system.

Dr. Mark McGrail, Director of Addiction Medicine at Cherokee Health Systems, kicked off the series with background on the progressive disease of addiction, which he defines as “a chronic disease with biological, psychological, social, and spiritual manifestations”. Dr. McGrail stated that the path to addiction often involves losing meaningful relationships with friends and family. This path tends to involve feelings of guilt, shame, and self-hatred which further contribute to the cycle of substance misuse. Because of the complex nature of the disease, a person that becomes addicted will likely require long-term ‘wrap-around’ care to reduce the obstacles leading to recovery–further underscoring the benefit of a network or systems approach for addressing the epidemic at the community-level with external support.

A panel moderated by Brandon Hollingsworth, News Director at WUOT, featured Dr. Robert Pack of East TN State University, Dr. Carole Myers of UT, Knoxville, and Charlene Hipsher and Phillip Martin representing a non-profit in the 9th District called Align9. Panel members shared their challenges and successes spearheading community-level collaborative efforts to counteract this epidemic. In addition to her teaching and research roles at UT, Dr. Myers produces HealthConnections, a weekly podcast featuring topics related to the opioid epidemic. She emphasized that the healthcare system accounts for roughly 20% of good health outcomes; but that economic policy, housing, transportation, and other community-level factors influence the rest. Dr. Pack heads the ETSU Center for Prescription Drug Abuse Prevention and Treatment, which conducts research, trains health professionals, and provides evidence-based clinical care. The center also convenes stakeholders monthly to discuss current efforts and identify opportunities for collaboration. Hipsher and Martin with Align9 have “reached across the aisle” to align local resources to support an individual’s recovery efforts. These resources include the following sectors: housing, transportation, job placement, mental and physical health, recovery and faith-based support, financial planning/life skills, law enforcement, and the justice system. Martin emphasized that all these resources are critical but overcoming stigma and productively channeling volunteers’ passion remain top priorities. Dr. Meyers’ and Dr. Pack’s efforts focus on scalable and sustainable solutions, including capacity-building within communities. Dr. Pack closed the panel by noting that preventative measures, such as life skills and parenting training, produce positive outcomes as well. He pointed to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Communities That Care model, a risk and protective factor approach to substance misuse prevention, as a resource.

Lastly, the attendees participated in a facilitated discussion to identify opportunities to support community level efforts related to prevention and recovery. Participants identified increased understanding and destigmatization of addiction as critical factors, as both upstream (prevention) and downstream (recovery) efforts. Creating a hub and spoke system of referrals that includes law enforcement (e.g. drug courts) and improved wraparound services were also priorities. From these discussions, participants generated potential next steps that ETF could take in fostering solutions to the opioid epidemic in East Tennessee.