Opioid Use in Southern Appalachia: How Drug Education Framing can be Informed by Local Perceptions, Attitudes and Worldviews
Opioid analgesics (painkillers) are extremely effective and commonly prescribed medications for pain management but, as mu-opioid agonists, they also have high abuse liability and are able to induce rapid neurobiological tolerance. These factors, in combination with ease of access and perceived safety, can contribute to escalating drug use and increased risk for dependence or addiction. While pain is one of the most common medical diagnoses in medicine, the number of active opioid prescriptions in Tennessee is one of the highest in the country. This project explores the psychosocial, cultural, and logistical factors contributing to opiate use amongst pain patients in rural Southern Appalachia. A combination of qualitative approaches, developed in consultation with FrameWorks Institute, and quantitative approaches, including a pilot study run out of local outpatient medical facilities, will be used to explore (a) patients’ perceptions and attitud es toward various approaches to pain management, (b) how patients think and make decisions about opioid use and other pain management approaches, with respect to their perceived choices, and (c) how patients frame issues related to pain, pain management, and opioid use. Ultimately, this project will help to identify opportunities and challenges related to pain management and drug use in our local community, and provide recommendations for framing drug education initiatives.
Project Alignment with the Collaborative for Southern Appalachian Studies
Drug education is an important component of public health education and awareness. The topic is relevant to a wide range of ages (pre-teen to elderly), though this specific project will focus on adults. Key topics/ideas like drug tolerance apply to drugs used in medical and non-medical contexts and are often important for making informed healthcare decisions. Further, the extent to which logistical, economic and sociocultural factors unique to southern Appalachia contribute to individuals’ perceptions, attitudes, and decision-making with regard to drugs has not been systematically explored in the literature. By learning more about the worldviews of our local community, we can carefully consider how framing might allow us to develop more effective approaches/tools to drug education. This framing-related research may also extend to other healthcare fields/decisions in southern Appalachia.
As stated above, the specific research objectives/goals of this project include:
a. Understanding prevalent perceptions, assumptions and worldviews about pain, pain management, and opiate drugs amongst chronic pain patients in Franklin and Grundy Counties
b. Identifying major psychological, sociocultural, economic and logistical factors contributing to patients’ decisions to use prescription opiates for pain management
c. Developing valid quantitative and qualitative tools to measure chronic pain patients’ perceptions and attitudes toward their pain and toward potential treatments/therapies, including drug-based and non-pharmaceutical approaches and complementary and alternative treatments
d. Collecting pilot data from chronic pain patients related to pain and opiate use, as described above, to guide a future, larger-scale study and to inform future lines of inquiry and research questions
e. Using these data to develop data-driven approaches to drug education that could be implemented in the local community
Expected project outcomes include: documented, semi-structured interviews with local community members, in consultation with FrameWorks staff (a-b); production of an informal situation analysis that can act as a Collaborative resource (a-b); new questionnaires, informed by these qualitative data, to be used in survey-based research (c); pilot data from quantitative/qualitative to be presented at relevant scholarly conferences (d); refined research strategies and approach to developing educational tools applicable to a subpopulation of the local community (e). As these outcomes are interrelated, they can be worked on in parallel.
Together, I anticipate that this project will help to identify opportunities and challenges related to pain management and drug use in our local community, and provide recommendations for related framing decisions. Ultimately, I hope that the work can be translated into effective, targeted drug education initiatives that can be implemented in the local community.
Documents and data produced in the course of this study will contribute to the Collaborative’s repository of information. These materials will also hopefully be useful, in some form, to medical practitioners in the local community. Educational resources developed based on these data could have the potential to impact a large number of community members prescribed opiate drugs for acute (post-surgical) or chronic non-cancer pain. Presentations and, eventually, publications that come from this work would contribute to a larger body of scientific research on opioid use, pain management, and Appalachian studies. Students in my courses (see below) would have the opportunity to learn more about and engage with important issues in their surrounding community. My post-baccalaureate research assistant would have the opportunity to extend her work on this project, which she helped conceive of last fall.
I teach two courses into which I’d like to incorporate new curricula informed by the proposed study.
1. I currently teach PSYC349 Drugs & Behavior on an annual basis. Currently, my course materials include units on abuse/addiction, opiate drugs, drug education initiatives, and policies to minimize drug diversion. I plan expand this course, in part through my work with the Office for Civic Engagement as a Civic Engagement Faculty Fellow (2017-2018), by adding a laboratory component to the course (three additional contact hours per week). The laboratory would constitute a new experiential component that would focus on researching and developing data-driven drug education initiatives. For instance, in a semester-long project, students would research different approaches to drug education in the existing literature, evaluate their efficacy, and propose a way to apply these data-driven findings to a new drug education initiative designed for a subpopulation of our local community. A local health educator or health council representative could consult with the class to discuss the nee ds and opportunities that they perceive in the local community. In the first iteration of the course, this project would focus on identifying and evaluating relevant research and proposing data-supported approaches. In subsequent iterations, this project could incorporate an applied endpoint and students could design, say, educational pamphlets to distribute. I plan to propose this course change for university approval (via CAPC) so that it can be taught in the 2017-2018 academic year.
2. I have already received departmental and university approval for a new upper-level seminar, PSYC419 Addiction, that I proposed in spring 2016. The approaches and knowledge gained in this project’s design and execution will certainly inform my approach and thinking about this course. This course will usean interdisciplinary approach to exploring drug dependence and addiction; I envision incorporating knowledge gained via this research project, as well as a potential service-learning component, into this course curricula, as well.