Imagine awakening to the news that a jetliner has crashed, killing all 115 men, women, and children aboard.

As shocking as the magnitude of such loss would be, this is equivalent to the number of Americans who die from opioid overdose every day.

As if the deaths of approximately 42,000 people each year weren’t sobering enough, the Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion annually, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.

“The rates of death as a result of opioid overdose are climbing, and they are over 50 percent greater in rural Southwest Virginia than for the state,” said Kathy Hosig, director for the Virginia Tech Center for Public Health Practice and Research and a specialist with Virginia Cooperative Extension, the outreach program for the state’s two land-grant universities: Virginia Tech and Virginia State University. “There is a clear role for Virginia Tech and Virginia Cooperative Extension to provide safety education and training at the community level to help stop the cycle of abuse.”

In June, Virginia Cooperative Extension was awarded a $1.28 million grant for collaborative opioid work through the U.S. Department of Agriculture’s National Institute of Food and Agriculture (NIFA). The grant was one of only six conferred nationally for addressing community needs.

opioid team

Pictured left to right: Maurice Smith, Crystal Tyler-Mackey, Bonita Williams, and Kathy Hosig.
Pictured left to right: Maurice Smith, Crystal Tyler-Mackey, Bonita Williams, and Kathy Hosig. Williams serves as national program leader with the NIFA division of youth and 4-H.

“By having Virginia Tech and Virginia State University partner on the project, we were able to double the funding,” said Crystal Tyler-Mackey, an Extension specialist in community viability, and co-project director, along with VSU’s Maurice Smith, a 4-H Extension specialist with the university.

Awarded by the USDA-NIFA Children, Youth, and Families At-Risk program, the five-year grant will support health education initiatives spearheaded by Extension aimed at preventing opioid abuse among vulnerable communities in Virginia. This work is a continuation of a $321,638 NIFA Rural Health and Safety Education grant awarded last fall to Virginia Cooperative Extension. Together, the efforts are reaching six counties: Grayson, Henry/Martinsville, Prince George, Orange, Sussex, and Henrico. 

“Southwest Virginia is especially vulnerable. We have communities that are suffering. They are struggling to find homes for children whose parents are impacted,” said Tyler-Mackey. “And across Virginia, social service agencies and schools are overwhelmed. Employers are having trouble hiring people who can pass drug tests. We felt compelled to find a way as community-level educators to do something to address the issue.”

The grants will enable Extension to deliver educational programming to prevent the abuse and misuse of opioids and other illicit substances to those most at risk and to host meetings and events that bring together people and organizations concerned about opioid misuse for collaborative discussion, learning, and planning.

The NIFA funding will be targeted to two distinct audiences: adult hospital patients and their families in clinical settings, and middle-school adolescents through evidence-based educational programs.

The goal in targeting hospital patients is to make them aware of the dangers associated with use of opioid pain medications and to provide access to support should they or a family member experience problems related to opioid use. This intervention will take the form of one-on-one conversations with patients and their loved ones through the High Risk Patient Education Program.

“There are different risks with opioids than with over-the-counter medications because opioids are so highly addictive,” said Tyler-Mackey. “Patients do not always know that what they are taking for pain management is an opioid. So, many don’t know the risk associated with its use. The education of medical patients will be on proper use of the medications and red flags to look for, such as taking medication sooner, or more often than prescribed.”

Curriculum for this program is being developed by the Virginia Rural Health Association for delivery to patients as they are waiting to see health care providers in their offices and will also be available on the Virginia Cooperative Extension and Virginia Rural Health Association websites.

The second goal for the NIFA grants is to provide prevention education for adolescents at a vulnerable stage in their development – middle school – in order to provide children and their families with the skills and support required to make healthy decisions about drugs. This will take shape through a program called PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER), an evidence-based model developed by Iowa State and Pennsylvania State universities to prevent alcohol and drug abuse in youth.

Through this model, which connects university-based prevention researchers with Virginia Cooperative Extension and the public school system, community teams are convened to oversee the implementation of family and school-based interventions. The family-based intervention program is called Strengthening Families 10-14, and the program offered to youth in middle schools is called Botvin Life Skills Training.

All three PROSPER programs include classroom sessions addressing social and psychological factors leading to drug experimentation through the use of games, discussions, role-playing, worksheets, online content, posters, and videos. Endorsed by the Surgeon General in a 2016 report, the program has produced successful results. According to one randomized study, youth participating in PROSPER had 21 percent less prescription opioid misuse seven years after the program.

“PROSPER communities have wonderful outcomes for youth,” said Tyler-Mackey, who is working to educate a cadre of certified trainers throughout the state. “We have a longer-term strategy to start with a few communities and expand. Other states have had success with PROSPER, so we want to continue with that.”

“Given the importance of this effort and the need for partnerships to address the opioid epidemic at all levels, we’re also working to coordinate efforts across the state and region by building relationships with other universities, state agencies, hospitals, schools, and institutions who have a role to play in the opioid epidemic,” said Hosig.

In May, Hosig and other experts from Virginia Cooperative Extension, the Virginia Tech Center for Public Health Practice and Research, and the Virginia Tech Institute for Policy and Governance brought together 71 higher education representatives from 23 colleges and universities across the region, along with community representatives from health departments, community services boards, and law enforcement for a day of conversations on how to jointly combat the opioid epidemic. Suggested next steps from the workshop include developing a common research agenda, formulating a regional approach, and integrating information on opioid misuse and abuse into the curricula at institutions of higher learning.

The workshop and NIFA awards would not have been possible without Virginia Cooperative Extension leaders Ed Jones, director; Cathy Sutphin, associate director of youth, families, and health; Karen Vines, an Extension specialist and assistant professor; and, Hosig, as well as colleagues at Virginia Tech, VSU, and the Virginia Rural Health Association. Jones' leadership was instrumental in helping to secure NIFA funding – funding that stands to help save many lives.

Virginia Cooperative Extension is also partnering with West Virginia Cooperative Extension to develop steps to address the epidemic.

“The good news is that the opioid crisis in this country is being attacked on all sides as people and agencies on federal, state, and local levels come together to fight this problem,” said Tyler-Mackey.
 

— Written by Amy Painter