Rural Health Conference

Substance Abuse Topic of Rural Health Conference

Substance abuse in Alabama and the US was the topic of the 19th Annual Rural Health Conference held April 25-26 at the Bryant Conference Center on The University of Alabama campus. The annual Rural Health Conference is hosted by the College of Community Health Sciences and its Institute for Rural Health Research.

This year’s conference, “Substance Abuse in Alabama: When it Hits Home,” featured several keynote speakers, as well as breakout sessions and a community resource panel. Below are highlights from the keynote addresses.

The annual Rural Health Conference is attended by health care professionals, community leaders, researchers, government officials and policymakers working together to share information and knowledge and make a difference in the health of rural communities.

Dr. Holly Hagan, professor, New York University’s Rory Meyers College of Nursing; co-director, NIH Center for Drug Use and HIV Research:

In 2016, there were more than 64,000 drug overdose deaths, exceeding motor vehicle accident and gun fatalities. “And there are no signs of it leveling off. We can expect to see increases over time. Opioids are heavily and deceptively marketed in areas with a high prevalence of chronic pain and a large manual workforce.” The immediate consequences of the US opioid crisis are overdoses and deaths, neonatal abstinence syndrome, and an increase in rates of Hepatitis C, HIV, and sexually transmitted infections. Longer-term consequences include lifelong struggles for individuals with opioid use disorder, stress in families and communities, a negative impact to the workforce, incarceration and stigmatization. The total cost of the US opioid epidemic in 2015 was $500 billion.

Stephanie McCladdie, director, Substance Abuse and Mental Health Services Region 4, Atlanta; director, Prevention Services, Alabama Department of Mental Health:

Factors that contribute to substance abuse in rural America include poverty, unemployment, poor education, high-risk behaviors and isolation. For rural Americans with substance abuse issues, drug treatment and behavioral health services are not readily available, and rural hospital emergency room personnel and first responders have limited experience caring for patients suffering from drug disorders or overdoses. “Substance abuse can be especially hard to combat in rural areas due to limited resources for prevention, treatment and recovery.” There are 2.1 million people in the US with an opioid use disorder, but only 20 percent receive addiction treatment. What’s needed? Strong public health surveillance, improved practice of pain management, increased access to treatment and recovery services, and support for cutting-edge research. “There’s an urgent need to prepare the workforce to deliver treatment and recovery services.”

Dr. Richard Spoth, F. Wendell Miller Senior Prevention Scientist; director of Partnership in Prevention Science Institute, Iowa State University:

In rural areas, one-half of adults say they have been directly affected by the opioid crisis. “They’ve lost a family member, used or abused themselves, or they know someone who has. This is when it hits home.” Still, in 85 percent of US rural counties, behavioral health and prevention services are sparse or non-existent, and opioid and other drug problems continue to escalate. “We need to build on accessible infrastructure and resources – public school systems, extension services and public health programs. And we need evidence-based interventions off the shelf and into the hands of people who need it.”

Dr. Stefan Kertesz, professor, UAB Division of Preventive Medicine:

Opioids accounted for two-thirds of drug overdoses in 2016, and many overdose deaths involve multiple substances, including synthetic opioids. The Centers for Medicare & Medicaid Services (CMS) implemented a prescription dose limit for 2018 that requires insurers to deny payments to patients prescribed a total morphine equivalent of 90mg. This proposal is designed to reduce older individuals’ risk of becoming addicted to or overusing opioids, and ultimately to reduce the oversupply of the drugs. But, most overdose deaths are happening in people who are receiving a low-dose prescription. “We don’t fully understand the event we call overdose if most of the problem is happening at a low dose.” Overdoses occur primarily among tolerant older users, and most deaths involve people using multiple drugs… Overdose is more like a poisoning event.” As opioid prescriptions are limited, those addicted turn to other drugs like heroin or fentanyl to fill the gap. The CMS prescription limit faces clinicians with an ethical dilemma: “Do we take nonconsensual action on patients who are adherent and stable, and there is absent strong evidence for those actions that sometimes result in the patient’s death?”

Baltimore Ravens Linebacker C.J. Mosley Praises Dr. Robinson

Dr. James Robinson, endowed chair for Sports Medicine for the College of Community Health Sciences and team physician for the UA Athletic Department, was mentioned in a recent episode of Bama Cuts, a series of casual conversations between UA football players, coaches and former players at the barbershop inside the Mal Moore Facility.

In an episode that aired April 11, Baltimore Ravens linebacker C.J. Mosley, who played at UA from 2010 to 2013 (winning national championships in 2011 and 2012), talked about his time at the University and what Robinson and other football trainers and coaches mean to him.

“I’ve had multiple injuries since I’ve been in the NFL and I’ve done a lot of my rehab here with everybody here who are part of the staff,” Mosley said. “Dr. Robinson, if I get sick, I go to see him.”

Mosley said he has a special gratitude for the resources at UA, the training staff, the facilities and the coaches. “Just being around them – it’s an extended family. I always come back here. I feel welcome. I feel at home.”

All of Us Bus

All of Us Research Program at University Medical Center

The College of Community Health Sciences kicks off its participation in the national All of Us Research Program on May 10 at University Medical Center. All of Us is part of the National Institutes of Health’s effort to advance research into precision medicine. The CCHS kickoff, scheduled from 2 pm to 6 pm, features the All of Us Journey Bus, a traveling education experience that brings the project to local communities. The goal of the All of Us project is to enroll one million individuals living in the US and gather their health information and other data over time. The data will be used to learn more about the health impact of differences in lifestyle, environment and biological makeup.

Lilanta Joy Bradley

From Research to Action: Taking Your Research Beyond the Journal

Dr. Lilanta Bradley, a post-doctoral fellow with the Institute for Rural Health Research, participated in a Robert Wood Johnson Foundation funded symposium that brings together scholars from historically underrepresented groups working in fields that intersect with health and health care.

The Institute for Rural Health Research is part of the College of Community Health Sciences.

The New Connections Symposium Bradley attended, titled “From Research to Action: Taking Your Research Beyond the Journal,” was held in February at Drexel University in Philadelphia.

The RWJF, the nation’s largest philanthropy devoted to public health, built the New Connections program to create a broad network of early career researchers interested in the foundation’s goal of building a national “culture of health” that enables everyone in society to lead healthier lives. New Connections currently supports a network of more than 900 underrepresented investigators, and through the symposium they are offered practical and meaningful ways to enrich their professional and research skills, advance their scholarship and build their careers. They learn from senior faculty, researchers and community leaders, build relationships and establish opportunities for collaboration.

Bradley said she learned during the symposium how she can disseminate her research in actionable ways. She said she had always planned to translate into action her research around children, youth and adolescents but did not realize the different communications tactics available.

“It’s (the symposium) given me a lot of thought about how to communicate my work, how to be more community engaged and how audiences are going to benefit,” she said. Bradley is now focused on sharing her research through social media and op-eds.

Convocation recognizes rural Alabama students working to become rural doctors

Eleven students who want to become physicians and practice in rural Alabama communities were recognized May 6 at a convocation for the Rural Medical Scholars Program, which is operated by the College of Community Health Sciences.

The program is exclusively for rural Alabama students and includes a year of study, after students receive their undergraduate degree, that leads to a master’s degree in Rural Community Health and early admission to the University of Alabama School of Medicine (UASOM). Rural Medical Scholars spend the first two years of medical school at the School of Medicine’s main campus in Birmingham and then return to CCHS for their final two years of clinical education. The 11 Rural Medical Scholars begin medical school this summer.

“Alabama is a disproportionately rural state and programs that develop rural health professionals are vital,” CCHS dean Dr. Richard Streiffer said in his welcoming remarks. “If you want rural health professionals, you need to start with rural individuals.”

Dr. Craig Hoesley, senior associate dean for Medical Education for the School of Medicine, provided the convocation keynote address. Hoesley oversees the undergraduate, graduate and continuing medical education programs of the School of Medicine.

Hoesley said Alabama has 284 medically underserved areas, more than any other Southeastern state, according to the US Health Resources Services Administration. “We have entire counties without a provider of any kind.”

He said the UA School of Medicine’s mission is to provide physicians for Alabama, but “we’re not successful at this point. The Rural Medical Scholars Program has done this better than any other program in the history of our state.”

He told the Rural Medical Scholars being honored at the convocation, held at the Hotel Capstone on the UA campus, that they are a voice for the program and to “continue to extol the virtues of primary care. You are an inspiration to others.”

Approximately 200 students have entered the Rural Medical Scholars Program since its founding in 1996. Dr. James Leeper, medical director of the program, said three-quarters of Rural Medical Scholars specialize in family medicine and other primary care disciplines.

Also during the convocation, the Rural Medical Scholars Program Distinguished Service Award was presented on behalf of Dr. Neil Christopher, who has been a rural family medicine physician, primary care advocate and Alabama health care leader for more than four decades. Christopher served as chair of the Alabama Academy of Family Physicians and was chosen as its Family Doctor of the Year in 1993. He was also founding chair of the Alabama Family Practice Rural Health Board and received the prestigious Samuel Buford Humanitarian Award from the Medical Association of the State of Alabama.

Christopher was unable to attend the convocation, but Susan Guin, associate director of the College’s Rural Scholars Program noted that he was “committed and devoted to improving rural health care in Alabama. Based on his support for our program and his advocacy for rural health, we recognize him.”

2017-18 Rural Medical Scholars:

  • Austin Brooks
  • Jeb Cowen
  • Charity Cypert Donaldson
  • McKenzie Donald
  • Kathryn Gray
  • Bailey Bryant Gregory
  • Brionna McMeans
  • Peyton Powell
  • Kristin Pressley
  • Ashlyn Shields
  • Robert Weaver

TLC2 Students Visit Montgomery

Three third-year medical students participating in the College’s Tuscaloosa Longitudinal Community Curriculum traveled to Montgomery March 30 to learn about government relations and physician leadership. They met with Dr. Robert Moon, medical director of the Alabama Medicaid Agency, and with representatives of the Medical Association of the State of Alabama. The TLC2 program places third-year medical students in communities for their clinical training, pairing them with physicians to care for patients over the course of the year and through various specialties – a departure from the traditional model of clinical education delivered at hospitals through separate rotations.

Pictured from left: Andrew Elson, Rachel Daniell and Josh Price.