Illinois medical universities to study factors affecting rural opioid epidemic

The 16 counties in southern Illinois known as the Illinois Delta Region
The 16 counties in southern Illinois known as the Illinois Delta Region

Southern Illinois University School of Medicine and the University of Chicago Medicine will use a $1.13 million federal grant to study the opioid epidemic affecting the state's 16 southernmost counties. The joint effort will initially focus on learning how and why people use opioids such as heroin, fentanyl and prescription painkillers for non-medical reasons and examine the impact on health. People with opioid use disorder, particularly those who inject the drugs, are more vulnerable to outbreaks of HIV, hepatitis and other infections.

The researchers hope their work sheds light on the region's non-medical opioid use, which will then help create more effective interventions, treatment and recovery programs. "There's such a diversity in how people get exposed to opioids and how they get addicted, all of which matters when it comes to figuring out the fundamental question of how to help them," said UChicago Medicine's Mai Tuyet Pho, MD, MPH, an infectious disease expert and assistant professor of medicine. "It's a dangerous prospect to think just one narrative leads people to substance use. That's why we want to make sure we understand what's going on."

The team hopes their work also makes it easier for people struggling with addiction to get medical care. Pho and Wiley D. Jenkins, PhD, MPH, science director of the Office of Population Science and Policy and associate professor of family and community medicine at SIU School of Medicine, are co-principal investigators of the grant. They will lead the project, working closely with officials from the Illinois Department of Public Health and other partners.

Opioids have killed nearly 11,000 people in the state since 2008, including almost 1,900 people last year, according to IDPH statistics. State officials unveiled the Illinois Opioid Action Plan last month, which includes a goal of reducing opioid deaths by 33 percent in three years. "The opioid crisis affects people from all walks of life small towns and big cities, the wealthy and the poor, young and old. It is not something that can simply be solved with more treatment, increased prevention, or more arrests. It will take all of us, in all capacities to end the crisis," said IDPH Director Nirav D. Shah, MD, JD. "Grants like this will help identify high-risk areas and activities and solutions to help alleviate them." The 16 counties in southern Illinois, known as the Illinois Delta Region, are considered particularly vulnerable. These rural areas are among the state's most economically depressed, with limited health services and drug treatment options.

The region is also where epidemiologists note particularly high rates of hepatitis C and opioid overdoses, especially among people aged 25 to 44. In addition, the region has unusually high rates of neonatal abstinence syndrome, which affects newborns who were exposed to the drug while their mothers were pregnant. "Programs designed for large cities do not necessarily transfer well to rural areas," said Jenkins. "With this grant we have a great opportunity to explore the factors that influence individual injection drug use and then take that information and use it to provide services that will make a difference in southern Illinois." Initially, the team will talk to community stakeholders and hopes to interview several hundred people in the Delta Region who inject drugs. They'll also use public health data to create detailed "hotspot maps" to show particular areas of vulnerability. Those results will determine what strategies from needle exchanges to telehealth support are most appropriate for the community. The biggest challenge, Pho said, may be finding a way for people to overcome the stigma associated with substance abuse disorder. "People in the Delta Region are at an amplified risk from the disease itself and from an absence of community support and treatment," she said. "Having a better understanding of who is vulnerable will be an important part of trying to change mindsets to show we're dealing with a biological disease that we should treat like a medical disorder."

The two-year grant, which includes an option for a three-year extension to implement targeted interventions, was one of eight awarded by the National Institute on Drug Abuse in cooperation with the Appalachian Regional Commission, the Centers for Diseases Control and Prevention and the Substance Abuse and Mental Health Services Administration.