HRSA-funded project to target five high-risk counties

By David Miller

A female university researcher speaks with a colleague.
Dr. Hee Yun Lee and a multi-disciplinary team of UA researchers are combatting the opioid crisis by strengthening opioid education and emergency and prevention training in rural Alabama counties that have high rates for opioid prescriptions and overdoses.

TUSCALOOSA, Ala. — Following a year of community engagement and assessments of health and rehabilitation services across rural Alabama, a University of Alabama-led team of researchers is ready to implement a robust opioid prevention, treatment and recovery network in the state.

The Health Resources and Services Administration has awarded UA researchers $1 million for the Greater Rural Opioid Wellness in Alabama Project (GROW Alabama), which aims to connect healthcare providers, emergency services and community members to deliver opioid education, resources and outreach. GROW Alabama will target Franklin, Marion, Winston, Lamar and Fayette Counties, areas identified by HRSA as “high-risk” for opioid-related mortality or morbidity, said Dr. Hee Yun Lee and Dr. Josh Eyer, UA researchers and co-principal investigators for GROW.

Since mid-2019, UA’s multidisciplinary research team has executed the first stage of the project, a “planning” grant from HRSA to identify gaps in services and urgent needs to address in GROW Alabama, a three-year project that is already underway.

Opioid abuse and misuse are nationwide crises that are magnified in Alabama, which, in 2018, had the highest opioid prescribing rate in the country – a rate that has declined in recent years but is nearly twice the U.S. average – according to drugabuse.gov.

GROW Alabama’s green light comes at a pivotal time, as COVID-19 has had a “particularly devastating” impact to those suffering from opioid use disorders in the state, according to Dr. Matthew Hudnall, associate director of the Institute of Business Analytics at UA and a co-investigator for GROW Alabama. Hudnall said that opioid-related emergency room visits statewide increased by by 81% from the end of January through July.

Lee says her team has a “true pulse” of rural communities after extensive interviews, surveys and focus groups. Additionally, the 12-member consortium developed over the last year includes a variety of community leaders, including CEOs and executive directors of community agencies  and clinics  and their “passion and effort” are powering GROW Alabama.

“Health care professionals all talk about needing ongoing education for their profession,” Lee said. “Currently, there’s no ongoing education about how to work with opioid-addicted people; health care workers go to a once-per-year conference, and that’s it.

“Additionally, we learned that healthcare professionals want peer recovery specialist education for community members, who can help lessen the stigmas around opioid use.”

Peer recovery specialists are people who are in recovery from substance use who are certified to provide counseling and support to others battling addiction. In GROW Alabama’s three-year plan, peer recovery workers will team with community volunteers to staff health outposts, a public health concept in which workers are trained to treat basic medical conditions and prevent life-threatening events. In this instance, these community health workers will be trained to deliver intranasal naloxone, a rescue medication that interrupts opioid toxicity, and how to refer people for care at partnering clinics. These health outposts can be located in a variety of common, high-traffic areas, such as churches, public libraries and clinics.

“You may think that the librarian is only there for books, but because of the web they have within the community, they know the community,” Lee said. “So they’re being trained on how to work with people in addition crisis.

“But it can be others, like school teachers and pastors – if they’re well known and reachable by community members, we’ll train them, and we’ll work with them to create space for opioid related resource centers and will train them as a paraprofessional for opioid crisis intervention.”

In addition to the health outposts and peer recovery network, the project will implement two other key strategies. The GROW ECHO program, a collaborative health provider network that will provide continuing education about opioid use and abuse, and the GROW App, a web application created by Dr. Jeffrey Carver, professor of computer science at UA, that will provide residents of this region with local information about opioids and opioid prevention, treatment, and recovery resources.

Other UA co-investigators include Carver, who will be developing the innovative web app for the project; Dr. Rebecca Allen (Department of Psychology); Drs. Monika Wedgeworth and Mercy Mumba (Capstone College of Nursing); Dr. Martha Crowther (College of Community Health Sciences), and Dr. Jason Parton (Institute for Business Analytics).

This project also grows from a robust community consortium in the previous planning grant: Northwest Alabama Mental Health Center; Lakeland Community Hospital; the Departments of Human Resources for several of the counties; PRIDE of Alabama; Five Horizons Health Services; Drs. Sonya Heath and Ricardo Franco at UAB Medicine; Alabama Medicaid; the Alabama Department of Public Health; and the Alabama Department of Mental Health. This project was also informed by a community advisory board made up of Rob Alley (UA); Marisa Giggie, MD (CCHS); Billy Kirkpatrick (Five Horizons); and Gwen Thomas-Leblanc (NWAMHC).