South Dakota State University has been awarded a $1 million federal grant to implement a three-year project as part of the Rural Communities Opioid Program.
Funding comes from the Health Resources and Services Administration, which is an agency of the U.S. Department of Health and Human Services. The grant, which begins Sept. 1, targets Brookings, Codington and Hughes counties. SDSU is partnering with seven agencies to optimize access to prevention, treatment and recovery services to patients and families affected by opioid use disorder.
The project is co-directed by Aaron Hunt and Erin Miller, both with the SDSU College of Pharmacy and Allied Health Professions.
Hunt, an assistant professor, is just entering his second year as the Coordinator of the Master of Public Health program within the college’s Department of Allied and Population Health. Miller, also an assistant professor, began her tenure within the department in January.
The program will use the expertise of the following partner agencies: Brookings Behavioral Health and Wellness, Center for Family Medicine, Sioux Falls; Project Recovery, Rapid City; Face It TOGETHER, Sioux Falls; Lutheran Social Services, Sioux Falls; and Capital Area Counseling Services, Pierre.
The program has been named START-SD (Stigma, Treatment, Avoidance and Recovery in Time.) Hunt said the program has a three-pronged approach to address prevention, treatment and recovery and will begin in Brookings County the first year followed by Codington and Hughes in years two and three, respectively.
“This is an investment to remove barriers to treatment and change perspectives on addiction in general,” Hunt said. “We want to reduce the stigma so people are willing to go for treatment and increase the medical providers who are trained to provide medication-assisted treatment and willing to take on new patients, which is a key barrier in rural locations.
“We need to educate the public that this is a disease and there are ways to treat it.”
Program estimates 2,523 in need of service
Based on the National Survey on Drug Use and Health for South Dakota, an estimated 5% of adults misused pain reliever medication.
“That equates to 1,190 in Brookings County, 816 in Codington County and 517 in Hughes County,” Hunt said.
He added that those 2,500 people is “mostly likely underestimated due to underreporting and stigma. Access to evidence-based, medication-assisted treatment provided by trained clinicians in all three target counties is limited at best. Our goal is to begin to move the needle by reducing stigma and increasing access to services in the target counties.
“In addition, the group will work to address disparities seen among Native Americans with higher rates of opioid misuse. We will be working to establish relationships with tribal groups in year one and two before implementation in Hughes County in year three to ensure community inclusion.”
Medically assisted treatment a key
Within the college, Hunt is joined by Yen-Ming Huang, an assistant professor in the Department of Allied and Population Health, and Jennifer Ball in the Department of Pharmacy Practice. Ball, an assistant professor, also is a medication-assisted treatment expert with the Center for Family Medicine.
“One of the most effective treatments for people with opioid-use disorder is to get on this medication (buprenorphine). In rural areas, there are not enough doctors taking on new patients and prescribing these medications. This program hopes to increase the number through training and mentorship,” Hunt said.
A first step in implementing the grant will be bringing training programs to local health care providers, Hunt said.
The amount of training required to become eligible to provide medication-assisted treatment varies by position—eight hours for a physician and 24 hours for a physician assistant or a nurse practitioner. Clinics also need follow-up training on how to bill for the service, how to refer patients for counseling and how to keep patients coming back for appointments, Hunt explained.
The other issue is getting prescribers to add patients with opioid-use disorder to their patient load.
“A lot of providers will complete the training but are hesitant to take on patients due to the stigma associated with this disease. Many providers assume these patients will be difficult to treat, will often miss appointments and may cause issues with other patients. However, that is a misconception. Most patients want to get better and need assistance,” Hunt said.
Telehealth reduces barriers to rural residents
People with opioid-use disorder who enroll in the program will also be asked to participate in peer coaching, where patients are paired with a trained coach who has overcome addiction. “This provides shared experiences and improves patients’ outcomes. The service will be offered in person or via video calls through the partner agency Face-It TOGETHER,” Hunt said.
Face-It TOGETHER is a nationally focused addiction wellness nonprofit that provides professional peer coaching to those impacted by addiction, including loved ones. It will expand access to peer recovery coaches, either in person or via video conferencing, for active patients and providing intervention sessions at hospitals. (https://www.wefaceittogether.org/)
“Utilizing peer recovery coaches is a promising best practice with potential to improve outcomes,” Hunt said.
Lutheran Social Services, one of the largest private nonprofit human service agencies in South Dakota, also will help with recovery. “They have a wide network of offices throughout the state and will greatly enhance the ability to provide screening and referral to needed services. We will also be partnering with local and state partners to improve discharge and referral to services,” Hunt said.
He said START-SD hopes to serve at least 50 people in Brookings County the first year through counseling and peer recovery sessions.
'Hundreds of lives will be impacted'
The program also will focus on removing cost and transportation barriers.
Sharrel Pinto, head of the Department of Allied and Population Health, said the grant award is an excellent example of a department within a land-grant university doing its part by giving back to the community.
“We expect hundreds of lives will be impacted through this project. This coordinated approach offers a huge opportunity for South Dakotan lives to be made whole. We are fortunate our college has the expertise that enables us to bring teams together to write grants and receive funding that ultimately impacts the community and the state for the better.
“I congratulate Dr. Aaron Hunt, Dr. Erin Miller, Dr. Yen-Ming Huang and Dr. Jennifer Ball on this $1 million award … The project would not have been possible without the work done by several members across our campus working on the planning grant these past couple years,” Pinto said.
The planning grant, that paved the way for obtaining the $1 million award, was a two-year effort that included faculty from the College of Pharmacy and Allied Health Professions, the College of Nursing and the College of Arts, Humanities and Social Sciences' Department of Sociology and Rural Studies.
Prevention ed targets middle schoolers
In addition to an anti-stigma education campaign, there will be an opioid misuse prevention campaign aimed at middle schoolers. This will utilize evidence-based educational materials and presentations that will be culturally appropriate throughout the target communities, Hunt said.
“We will implement the evidence-based Positive Action Program among middle school students enrolled in after-school programs. This program focuses on developing and maintaining positive behaviors and has been implemented in similar rural communities. The program has been shown to reduce substance use and lower personal acceptability of substance use among students completing the program,” Hunt said.
James Clem, head of the Department of Pharmacy Practice, is excited by the collaborative approach of the program and the role pharmacy students can have in promoting it as well as in executing a planned survey of South Dakota pharmacies to ensure they are stocking naloxone, a medication designed to reverse opioid overdose.
“I am excited that a faculty member from the Department of Pharmacy Practice is a part of the project team. This is also a great opportunity for students to become involved in aspects of research and community service,” Clem said.