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HRSA Takes on Rural Substance Misuse

HHS Deputy Secretary Eric Hargan applauded HRSA-funded substance use recovery efforts least week at a conference in Washington, D.C. He highlighted how the health center program and and the Federal Office of Rural Health Policy have contributed to the first decline in overdose deaths in almost three decades.
HHS Deputy Secretary Eric Hargan applauded HRSA-funded substance use recovery efforts least week at a conference in Washington, D.C. He highlighted how the health center program and and the Federal Office of Rural Health Policy have contributed to the first decline in overdose deaths in almost three decades.

 

After somberly recounting overdose deaths in his own family, HHS Deputy Secretary Eric Hargan delivered a moving appreciation  last week of local community leaders and clinicians for quickly responding to a set of HRSA initiatives that have brought care and treatment to small town rural America where once there was none.

Starting in 2015 with fewer than 20 grantees distributing Narcan overdose-reversal kits in remote towns, HRSA's Federal Office of Rural Health Policy (FORHP) has grown its recovery effort into the Rural Communities Opioid Response Program. It now involves nearly 250 grantees with counselors and outreach workers in 1,000 communities in 47 states.

So far, the office has invested $330 million into ongoing recovery projects.

Among some 650 attendees last week were representatives from more than 30 universities and over 100 rural hospitals and heath centers, along with dozens of county health departments and multiple federal  and state agencies -- so great has the  FORHP network grown in just five years.

"Americans living in rural areas have higher rates of overdose from opioids and psychostimulants like methamphetamines," Hargan told a packed ballroom, noting that President Trump has declared the drug scourge a nationwide Public Health Emergency.  "But back in the early 2000s, addiction really wasn't on the national radar."

It had, however, "already penetrated into areas ... where I'm from" in rural southeastern Illinois, he said.

"Many of you who were working in rural communities saw the emerging threats, because it had already been infecting towns like my home town ... where a close relative of mine died after a long struggle with prescription opioids. And she wasn't the last in my family to die of this."

His remarks elicited nodding affirmations throughout the audience.

 

FORHP's Michael McNeely (left) and attorney William Davis of OFAM led an early-morning session on Thursday to explain HRSA rural programs to a throng that included many first-time HRSA grantees and prospective applicants.  Asked by FORHP's Megan Meacham for a show of hands, dozens of attendees acknowledged that they had never before received a federal grant of any kind. HRSA's rural office is accepting new applications for rural opioid recovery grants until April 24. At least two more rounds of grants are planned for this spring, Meacham said.
FORHP's Michael McNeely (left) and attorney William Davis of OFAM led an early-morning session on Thursday to explain HRSA rural programs to a throng that included many first-time HRSA grantees and prospective applicants.  Asked by FORHP's Megan Meacham for a show of hands, dozens of attendees acknowledged that they had never before received a federal grant of any kind. HRSA's rural office is accepting new applications for rural opioid recovery grants until April 24. At least two more rounds of grants are planned for this spring, Meacham said.

 

"This is the public health crisis of our lifetime," said Anne Hazlett, Senior Advisor for Rural Affairs in the White House Office of National Drug Control Policy, who has visited nearly every state in the nation and found "treatment gaps" in rural areas throughout the country.

That's largely because widespread drug misuse in rural America is virtually unprecedented in U.S. history, explained researcher Jon Zibbell, an Emory University scholar and former CDC epidemiologist. Rehabilitation facilities barely existed across swaths of the country when the wildfire of substance use disorder swept through rural communities in the eastern states and began moving west.

Overprescribing of legal opioid painkillers created a culture of drug dependency that quickly opened the way for heroin and far more powerful -- and potentially lethal -- synthetic opioids like Fentanyl across the Midwest, Zibbell said.

"Ohio is ground zero for Fentanyl," he added. "But it's everywhere now. It has replaced heroin east of the Mississippi."

 

Describing the arc of the current rural drug crisis were (from left) Anne Hazlett, White House Office of National Drug Control Policy (formerly USDA); Danielle German, Johns Hopkins; Jon Zibbell, former CDC researcher and drug policy consultant.
Describing the arc of the current rural drug crisis were (from left) Anne Hazlett, White House Office of National Drug Control Policy (formerly USDA); Danielle German, Johns Hopkins; Jon Zibbell, former CDC researcher and drug policy consultant.

 

The relatively recent arrival of methamphetamines in small towns with little or no prior exposure to the highly addictive compound represents the "Fourth Wave" of the crisis, Zibbell said. Many experts at the conference warned of a resurgent rural "meth epidemic" on the heels of the opioid crisis.

Complicating the equation,  members of the community who fell prey to the epidemic early on found themselves socially abandoned -- like "aliens ... from another planet," said Danielle German of the Johns Hopkins Bloomberg School of Public Health. Driven underground, with little or no access to health services, those with drug misuse disorder soon found themselves part of a secondary epidemic: infectious disease outbreaks linked to IV drug use.

"Per capita, we had a problem," said Robert Zellner of Awakenings Recovery Center in Hagerstown, Md., speaking in a breakout session about the unforeseen consequences of stigma. "We don't have that many people in our community. In our county, I think we have 155,000, going off the Census." So rising rates of HIV, syphilis, hepatitis C and other infections were immediately noticable.

"What we were doing was not working," Zellner said.

Zellner became one of the first volunteer peer counselors in his town. And he quickly discovered "things I could not imagine" when he was living on the street. Police and faith ministers, hospital administrators and paramedics, were all looking at the epidemic from different angles and reaching the same conclusions: Law enforcement and incarceration were not going to solve the problem.

But Narcan distribution, medication-assisted therapy, community outreach, church listening sessions and an education campaign that included local schools -- all hallmarks of the FORHP opioid recovery programs and others like it sponsored by states -- have begun to turn the tide.

"Even when it seems like it isn't possible," Zellner said, "I'm here to tell you that Washington County, Md., is testament that it is possible."

 

From left, peer counselor Robert Zellner; Prof. Robert Cooper of the Meharry Medical College;  HRSA Deputy Administrator Diana Espinosa reminded attendees that the fight against rural HIV is their fight, too, as both epidemics are spurred by the same social conditions and public health concerns. Last month, the agency awarded some $117 million to expand access to HIV care, treatment, medication, and prevention services in mostly rural areas under the Administration's Ending the HIV Epidemic: A Plan for America (EHE) initiative.
From left, peer counselor Robert Zellner; Prof. Robert Cooper of the Meharry Medical College;  HRSA Deputy Administrator Diana Espinosa reminded attendees that the fight against rural HIV is their fight, too, as both epidemics are spurred by the same social conditions and public health concerns. Last month, the agency awarded some $117 million to expand access to HIV care, treatment, medication, and prevention services in mostly rural areas under the Administration's Ending the HIV Epidemic: A Plan for America (EHE) initiative.

 

Prof. Robert Cooper of the Meharry Medical College in Nashville, Tenn. -- one of six National Centers on Medical Education funded by HRSA --  noted that the opioid epidemic has demonstrated the power and necessity of community health centers and primary care providers on the ground. Echoing Deputy Secretary Hargan, Cooper said that the drug crisis is but one of many manifestations of care scarcity in rural communities.

There is no replacement, Cooper said, for "a physician coming in and grabbing patients and doing very short visits with them to find out what's going on" in the community. As with any epidemic, early detection is key -- and medically assisted treatment and peer-counseling can stop an isolated problem from becoming an epidemic.

"You find that small things in the wrong situation can wreck patients," he said.

 

Brought to you by: The three-day conference was managed and facilitated entirely by FORHP staff, including (from left) Sabrina Frost, Sarah O'Donnell and Senior Advisor Megan Meacham.
Brought to you by: The three-day conference was managed and facilitated entirely by FORHP staff, including (from left) Sabrina Frost, Sarah O'Donnell and Senior Advisor Megan Meacham.

Date Last Reviewed:  March 2020