Tuesday, January 31, 2017

Solving The Opioid Epidemic With Infrastructure


Hello Everyone:

Before we get started on today's topic-the opioid epidemic-Blogger would like to send a big hello to all of the people fleeing the countries named in that ill-conceived executive order, hoping to enter the United States.  To the families and friends of the detainees: please make sure you find a good lawyer to advise you.  To the protestors: love will triumph in the end.  To former Acting Attorney General Sally Yates: you are a hero.  Shall we get started on opioid addiction and infrastructure?

Abandoned house
Wilson Ring/AP
Addiction to opioids, defined as a synthetic compound prescribed to treat pain (http://www.drugabuse.gov; date accessed Jan 31, 2017), has reached epidemic levels in the United States.  According to the Centers for Disease Control (http://www.cdc.gov; date accessed Jan 31, 2017), 91 Americans died from opioid overdose everyday.  Since 1999 the number of overdose deaths involving opioids has quadrupled.  (Ibid)  Rural towns and smalls cities have been acutely affects by this epidemic.  Research conducted by the National Institutes of Heal found that people in states with a larger rural population (i.e. Kentucky, West Virginia, Alaska, and Oklahoma) have higher rates of drug- and drug-poisoning related deaths (http://www.ncbi.nlm.nih.gov; date accessed Jan 31, 2017).

Housing Ast. Council on Twitter
Ellie Anzilotti of CityLab reports, "At the recent HAC Rural Housing Conference, national policymakers proposed a decidedly urban solution to the addiction epidemic: infrastructure."  In her article, "How the Opioid Epidemic Is an Infrastructure Issue," former U.S. Department of Agriculture Secretary Tom Vilsack cited the lack of housing as a primary engine of the epidemic.  Admittedly, it sounds odd that the  USDA would get involved in the opioid addiction epidemic however, since it is concentrated in the rural areas, it falls under the USDA's purview.  Over the summer, The Department outlined a plan to finance transitional housing for people in drug rehabilitation treatment programs in 22 states.  Other speakers at the conference called for the federal government to invest in more affordable housing development in rural communities.

CityLab spoke with Alan Morgan, the director of the National Rural Health Associate, about why housing infrastructure is important in the battle against the opioid epidemic.  Below are excerpts from the interview.

Man walking down the dark path of addiction
CL: What is your perspective on the scope of the opioid addiction in rural America:

AM: The opioid crisis has impacted the whole country, but Secretary Vilsack and even former President Bill Clinton have acknowledged that this is uniquely a rural issue...it's a growing problem.

It's not just in the emergency rooms-you really see the effect in the life expectancy data.  From 1990 onwards, the life-expectancy rate has risen in urban areas, but there's actually been a decline among rural populations (for more information, please go to http://www.countyhealthrankings.org)...This for a number of reasons: smoking, cardiovascular disease, and cancer...,but overdose deaths and suicides are a big part of the problem, which is unusual, because these behavioral health issues...

Opioid crisis infographic
CL: What's driving the disparity between urban and rural health, particularly when it comes to addiction?

AM: When you look at the prevalence of behavioral health specialists and mental health specialists, there's a clinical shortage when it comes to these types of professionals in rural areas.  So you've got a self-perpetuating systems where the most in need of health care services have the fewest options available...

In urban, you've got treatment centers, you've got behavioral health professionals.  You have drug-recovery programs and protocols.  In rural communities, you might not have that safety net available, but health care options are built around prescription opioids...without good follow-up treatment...And  often, this is a transportation issue-the nearest health care facilities can sometimes be hours aways, and when sustained treatment and follow-up is inaccessible, addiction takes the place.

A typical opioid
CL: The opioid addiction crisis has been at the forefront of a lot of discussion this past year, but it still seems as though there are many challenges to worked through-especially housing.  How does affordable housing intersect with the opioid epidemic in rural communities?

AM: We have an unfortunate tendency to silo our sectors.  When it comes to the opioid epidemic, we can no longer afford to do that.  It's a health issue, but there's a transit component, and there is certainly a housing component.  People need to be in a stable, drug-free environment to complete the recovery process...in rural areas, there's a real shortage of affordable housing that is safe and drug-free.  If people get into treatment then are released back into the same housing situations where they have access to opioids, then it just exacerbates the issue.

So what often happens is that people struggling with addiction fall into homelessness: Around 35 percent of homeless individuals nationwide struggle with drug abuse...rural homelessness doesn't have the same visibility as it does in urban areas...the transient nature of homelessness is not a visual cue that people understand.  It's been hard for communities to come up with a solution to problems they can't see.

Former USDA Secretary Tom Vilsack
CL: Secretary Vilsack and the USDA have piloted a program to increase the amount of transitional housing in rural America.  What needs to happen in order to ensure that's successful?

AM: It's going to have to be a cross-agency coordinated approach as we move forward...I have to add a cautionary note.  The federal government is redirecting resources at a national level to address this crisis: The partnership between the USDA and the Rural Housing Service will get more people into stable living situations, and the agency is devoting more funds toward awareness and treatment programs.

The problem that we face is that when you have a national effort like this, it involves investing a lot of resources and funds, and you want to be able to demonstrate that those efforts have a significant impact.  You want to show that the programs have dramatically reduce the prevalence of addiction and made headway in addressing the crisis.  In short, you want numbers.  But the most striking numbers will still come from urban areas.  It's always going to be harder to demonstrate need with rural populations, where the numbers are in general smaller.

HUD Secretary-designate Ben Carson

CL: Especially with Ben Carson appointed to lead the Department of Housing and Urban Development (HUD), it's hard to ignore the intersection between housing and health.  How do you see rural communities working to integrate the two over the next several years?

AM: The key will be to connect the dots between health services and social services at the community level.  That has play out at the federal level under the current administration (i.e. under President Obama)-and hopefully the next-but it's got to happen locally.  How does the community hospital step up as a leader and integrate services with local housing agencies?  There's got to be a social structure in place to tackle this crisis, but it will require support from federal departments: the USDA, the Department of Transportation, HUD, the Department of Veterans Affairs.  We'll have to talk across sectors and engage all levels of government.

If you, a friend, or loved one is struggling with opioid or any addiction, please consider attending a 12-step meeting.  Below are some links:

Alcoholics Anonymous: http://www.aa.org
Narcotics Anonymous World Service: http//www.na.org
Cocaine Anonymous: http://www.ca.org

For more information on addiction recovery, please go to http://www.addictionrecoveryguide.org

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