The Need

Need

As clearly illustrated in the ARC supported report "Appalachian Diseases of Despair," substance abuse and its sequelae are widespread, increasing, and much higher in Appalachia versus non-Appalachian areas. Within Appalachia, deaths from alcohol, prescription drug, and illegal drug overdose; suicide; and alcoholic liver disease/cirrhosis of the liver, and in particular drug overdose deaths, are particularly heightened in Central Appalachia. For example, the opioid-related overdose mortality rate for Virginia Appalachian counties was 19.6 deaths per 100,000 (compared with 16.5 deaths per 100,000 for non-Appalachian U.S. counties). This increase in substance abuse, particularly opioid addiction, presents numerous challenges to rural Appalachia communities in Virginia, particularly as it relates to services needed, and often not available, for persons in recovery. Virginia Rural Health Association has been a leader in addressing the opioid crisis in Virginia. They currently have programs designed to support behavioral health and substance abuse services for rural health care facilities across Virginia, with an emphasis on the Southwest region. More specifically, VRHA has developed and is currently implementing a training program to increase capacity for preventative interventions at health care facilities, including strategies for identification of high-risk patients, patient education, medication assistance, and naloxone training for patients and family members. VRHA is currently working to support career path development activities for persons in recovery, specifically by identifying and supporting steps for persons in recovery to become certified as Peer Recovery Support Specialists. VRHA is also a recipient of a HRSA-funded Rural Communities Opioid Response Planning Grant, that assists Substance Use Disorder coalitions in the region to operationalize strategic plans developed in and by those communities.

As part of defining the scope of the project two additional partners were identified. The New River/Mount Rogers Workforce Development Board and the New River Valley Regional Commission have also identified specific recovery to work needs within the New River Valley. Marty Holliday, Executive Director of the New River Valley Workforce Development, has identified employer drug-testing and criminal history policies, and recovery resources available from employers or at employment locations, as important issues in addressing re-entry into the workforce for persons in recovery. Kevin Byrd, Executive Director of the New River Valley Regional Commission, identified housing and transportation as primary barriers for persons in recovery to receive care and to find reliable work.

The New River Valley, also referred to as the NRV, is a five jurisdiction area in Southwest Virginia near the border of West Virginia, as you can see by this map. The current opioid crisis has taken hold of Appalachia, ground zero of the opioid epidemic.

In the U.S., emergency department visits involving misuse or abuse of prescription opioids increased by 153% between 2004 and 2011. As shown on this graph the rates of death from prescription-opioid overdoses nearly quadrupled between 2000 and 2014. 

When it became evident that patients were becoming dependent on prescription opioids, access began to be restricted and finally in 2016, the CDC released guidelines on prescribing opioids for chronic pain to warn the public and health professionals. Heroin overdose deaths have dramatically increased during this period as well, partly due to patients turning to heroin once access to prescribed opioids was restricted. 

In order to focus our research topic, our class consulted the Appalachian Regional Commission’s substance abuse advisory council’s August 2019 recommendations and worked with key partners including the NRV Workforce Development Board and the Virginia Rural Health Association to understand frameworks for supporting recovery-to-work efforts. We learned that specific barriers to recovery could occur at the individual, community, institutional, and policy levels and that effective and sustained recovery requires integration across these levels within this ecosystem model.