“Now to me, that means that there are nearly 81,000 deaths that could have been prevented,” U.S. Director of National Drug Control Policy, Dr. Rahul Gupta said. “We know that there are significantly more nonfatal overdoses than fatal ones, of which there are 100,000 a year. We also know that experiencing a non-fatal overdose is one of the most important predictors of a future fatal overdose.”
For University of Houston researcher Dr. Lauren Gilbert, Ph.D., exploring all the perspectives and factors related to the opioid crisis is part of her quest as a community-based investigator. Gilbert’s pilot grant is entitled “Exploring the provider and organization level barriers to Medication for Opioid Use Disorder (MOUD) treatment for Black Americans.” Gilbert was awarded $50,000 for the project in 2021 as part of the HEALTH-RCMI Pilot Grants Program (PI: Dr. Ezemenari Obasi).
Gilbert is specifically looking at how providers are truly addressing the needs of minoritized communities which are grappling with opioid addiction.
“One of the big takeaways for me is that the providers understand the opioid crisis within sort of the framework of prescription opioids—for example, making sure that people don’t get addicted through their doctors through safe prescribing guidelines,” Gilbert said. “There is less information about how the opioid crisis has shifted—thinking about the shifts to Fentanyl and how it’s become contaminated in other drug supplies, which has fueled the increases in unintentional overdoses. People don’t even know that they are taking fentanyl, or how much is in their drug.”
Ultimately, Gilbert hopes to address the knowledge gap through the development of timely, relevant educational materials for providers. Gilbert adds that some providers do understand trauma-informed care and recognize that co-occurring mental disorders also need to be addressed.
“My thought has been to create some sort of continuing education for pharmacists and medical providers as well, to share information about the evolving opioid crisis,” Gilbert said. “The question becomes— how can we have this real-time education for providers but also leverage that into meaningful research at the same time? Balancing those two has been something that I am working through at this point.”
Gathering “lived experiences” from those who have struggled with opioid addiction is one of the more promising approaches which has given Gilbert rich research data and a springboard for real-time solutions.
“I have developed a “lived experience project”,” Gilbert explained. “If participants are willing to share, it starts with one-on-one interviews. Then, they are invited to a a photo-voice project where they document their experience through photos. Some of the photos and the stories that have come along with them have given us such rich data and points that were not touched on in the first interview. From a data collection point, sharing their stories in very meaningful ways has been so eye-opening. I'm excited to see where that project leads. The ultimate goal of that one is to create an awareness campaign.”
Gilbert plans to weave these “lived experiences” in prospective grants, sharing how certain social determinants of health are keenly felt and critical to decision making.
“For my future grants, I want to expand out opioid use and other co-occurring disorders to fully capture everything that’s going on,” Gilbert said. “The social determinants of health have played into the “lived experiences” interviews--including issues of transportation, housing, job security, and economic stability. It is so important we recognize those--how do we prioritize those? How do we accurately address them?”
Gilbert emphasizes it’s also important to engage in team science when addressing the opioid epidemic.
“This crisis is not happening in a vacuum, and our solutions and strategies should also not be happening in a vacuum,” Gilbert said. “There are many researchers who are addressing different aspects of the opioid crisis from the basic sciences all the way to the clinical treatment--and then researchers like myself who are examining the social and cultural factors contributing to the issue. I think it is important that we continue to break down our silos and work in interdisciplinary teams, so we can use all the tools we are developing to address the problem and underlying causes to treat individuals holistically. Also, we know that many people are struggling with other chronic conditions, not just opioid use disorder.”
Misconceptions and misinformation have been palpable obstacles in getting the right treatment for those struggling with opioid use disorder, Gilbert explained.
“In Black communities, it’s very stigmatized,” Gilbert said. “There are a lot of misconceptions--stigma around opioid use disorder. It’s something that is not talked about. People are very ashamed to let people know. A lot of participants have told me, ‘My family does not understand why I’m on medication for this drug. They just think I'm substituting one drug for another. They tell me I should just be strong enough to stop using opioids without any medication.’
As Gilbert underscored, opioid use disorder is a chronic condition, just like hypertension or diabetes.
“We don’t have the same kind of judgment around those patients using medications to manage their disease,” Gilbert said. “There’s misinformation that we need to correct, so I really want to use those individuals who have the lived experience, who know what it’s like, who have been through those things to help create an education campaign.”
One of the most significant barriers in harm reduction with opioid use disorder is that the community simply is not getting the critical messages they need which will truly help them, according to Gilbert.
“From a research perspective, we know about the harm reduction benefits of Narcan, Naloxone. It literally saves lives. Everyone should have access to these,” Gilbert said. “But there is a gap. The messages are not getting to the community who needs it. For example, we have Narcan--this overdose antidote that can save people experiencing an opioid overdose. It comes in easy nasal spray bottle, but many people in the community didn’t know about it.”
Even after individuals experienced overdoses and had to be revived by EMS personnel, they don’t recall being educated on or offered Naloxone, Gilbert explained.
“How do we change that narrative? How do we get this life saving drug into the hands of people who need it most?” Gilbert said. “Especially with Fentanyl being found in so many other drug supplies, it is not only for people who actively using opioids or heroin anymore. How do we make it acceptable to have naloxone with you or in the house in case of an accidental overdose? If someone’s overdosing, we know what to do. It’s about overcoming that stigma and lack of awareness and the access to the medication.”
Gilbert believes that there are two overarching goals in moving the research forward into meaningful dissemination throughout the community—provider education and culturally-tailored messages and interventions for the community.
“The first thing to address is provider education--what kind of training can we do to address provider stigma and how can we bring it specifically for these providers working with this community?” Gilbert said. “The other one is with harm reduction. This community is not getting that message. How can we tailor these messages and reach people where they are at? How do we take these tools, messages and translate it into something that is culturally relevant and culturally tailored and is informed by lived experiences in a way that resonates with the community? I think we’re in early discussions of designing an intervention.”
--Alison Medley
If you would like more information about this topic, please contact Alison Medley at 713.320.0933 or email aemedle2@central.uh.edu
