Editor’s note: Iowans’ Ideas is a guest column featuring the views of different Iowans each edition of Iowa Ideas magazine. This column was featured in the Oct. 27, 2019, magazine.
Take a moment to picture a junkie. What is that person wearing? What is in his or her hands? Where is this person?
Chances are good that if you answer these questions honestly, your thoughts were less than positive.
Now picture an individual with an opioid use disorder. Do they look different? What do you see now?
Words are powerful.
How we talk about substance use disorders can stigmatize or empower those impacted by this medical condition. Words such as “junkie,” “druggie” or “addict” equate the person with a behavior as opposed to a person with an illness, and drive the stigma that continues to prevent many people from seeking treatment. Tackling the stigma is the “one thing” that I believe will have the most positive impact on the opioid crisis.
Reading about the opioid crisis, you may have thought, “My community doesn’t have a drug problem.” But Eastern Iowa has not escaped the national opioid epidemic. Effectively tackling the issue requires comprehensive prevention, treatment and recovery services, and the Area Substance Abuse Council, or ASAC, along with many community partners, is tackling it head on.
The Substance Abuse and Mental Health Services Administration developed a process called the Strategic Prevention Framework that communities use in their efforts to prevent and reduce the use and abuse of alcohol, tobacco and drugs.
The Strategic Prevention Framework includes assessing the community’s needs, building capacity, developing and implementing a plan, and evaluating efforts. Sustainability and cultural responsiveness are incorporated into each step.
One example of the Strategic Prevention Framework process for addressing opioids is the Linn County Opioid Action Plan, developed by the Linn County Opioid Steering Committee. The committee, led by Erin Foster, director of ASAC’s Prevention Services for Linn, Benton and Jones counties, and Andrew Olesen, assistant fire chief for Cedar Rapids, has included collaborative partners from health care, emergency medical services, law enforcement, criminal justice, public health and substance use disorder agencies.
“The goal of the committee was to bring together agencies working on various facets of the issue to discuss and identify gaps in services for target populations,” Foster explains. “By identifying gaps, the Opioid Steering Committee also can pinpoint solutions and create collaborations among agencies.”
As groups come together, communities begin to identify critical junctures for potential partnership and create solutions.
One such critical juncture takes place in the medical exam room. Health care providers are in a unique position to ask patients about drug dependence and connect them to appropriate treatment. Screening, Brief Intervention and Referral to Treatment — SBIRT — is an evidence-based early intervention approach being used across Iowa.
SBIRT is an effective method for identifying individuals who need more extensive or specialized treatment, then connecting them with the right provider.
Medication-assisted treatment is recommended for most individuals with opioid use disorder. ASAC partners with a number of prescribers to offer this evidence-based service both on and off ASAC’s campuses.
Medication, when used in conjunction with counseling, is more successful than either of these methods alone for treating opioid use disorders.
Iowa must continue its efforts to advocate for easier access to medication-assisted treatment through:
1. Ensuring third-party payers support long-term treatment for this chronic condition
2. Eliminating pre-authorization requirements for medication-assisted treatment services for all providers
3. Increasing the number of prescribers able to offer medication-assisted treatment, particularly in rural communities
4. Reimbursing telehealth for medication-assisted treatment therapy sessions.
One of the most important things that every one of us can do to address the opioid epidemic is to watch our own words and take a stand to promote “person-first” language. Person-first language focuses on the individual, rather than their disease.
A person with an opioid use disorder is someone with a medical illness. “Disease-first” language like opioid user, addict or junkie perpetuates stigma and stereotypes.
Individuals with substance use disorder are not bad people making bad decisions — they are people with illnesses who desperately want to be well. Taking a stand will involve all of us speaking up to those who refer to others as symptoms of their illness.
There are many ways that substance use disorders manifest: losing jobs, lying to loved ones, not succeeding in attempts to quit, or criminal activity. It’s time to understand these as symptoms of an illness and not character flaws.
Once we treat them as such, we can intervene as caring support systems. Effective campaigns to promote these messages on a large scale are critically important. Our communities need to understand that prevention works, treatment is effective, and recovery is possible.
While much has been done already, our communities need to continue working together to effectively meet the needs of individuals with opioid use disorders.
Melissa Walker, ACPS, is deputy director at the Area Substance Abuse Council.