For Jennifer Tourville, it started with babies.
Before joining the University of Tennessee, Knoxville, College of Nursing as a clinical assistant professor in 2015, she was a pediatric nurse practitioner in her hometown of Sevierville, Tennessee. She made nursery rounds at LeConte Medical Center and saw babies born with neonatal abstinence syndrome (NAS). Their mothers had misused opioids during pregnancy, and Tourville worked amidst a double heartbreak: suffering babies and the mothers who loved them but often couldn’t care for them.
“They’re completely vulnerable, both of them,” Tourville says.
Tourville listened to the stories of mothers who had suffered incredible physical and emotional abuse. The problem was cyclical. And she came to a conclusion: without considering everyone—the babies, their mothers, and the many other lives touched by the devastating effects of opioid addiction—progress was impossible.
“You don’t get anywhere if you don’t care,” Tourville says. “It takes people who understand substance use disorder and are compassionate to go out there and do the work if we’re going to make a difference.”
Tourville is not alone in her mission at UT. More than a dozen faculty members throughout the university are conducting research and working to better understand the impact of substance misuse on individuals, families, the economy, crime and incarceration rates, and other areas. Each has a story for why they’ve dedicated themselves to this work.
Laurie Meschke, professor of public health, was raised in a town of 700 people in Minnesota and witnessed the effects of alcoholism on families in a culture where everyone knew what was happening but chose to remain silent. Liem Tran, professor of environmental geography and the father of a daughter who is legally blind, empathizes with the pain of parents who may not always know how to help their children. Larry Kessler, research associate professor in the Boyd Center for Business and Economic Research, has lost family and friends to overdoses. The joy of seeing others whose lives have been transformed by recovery is what keeps him going.
Together these faculty members and others make up UT’s Substance Misuse Community of Scholars, a research collective launched in February by the Office of Research and Engagement and led by Tourville. The group’s efforts focus on a broad range of issues related to opioid use, among them youth prevention, recovery programs, and NAS.
“We’re bringing people who are passionate about a similar topic together to produce something greater than we ever could if we were just doing this work on our own,” says Laura Miller, associate professor of communication studies.
And ultimately the benefit extends beyond campus to the entire state of Tennessee.
What the Research Shows
Five years ago, Matt Murray, director of UT’s Howard H. Baker Jr. Center for Public Policy and associate director of the Boyd Center, was speaking to a chamber of commerce in Sevier County. He fielded questions from employers trying to understand why so many jobs were left unfilled. Some had read about opioids and the effect they were having in communities like their own and wondered if there might be a connection.
The Boyd Center decided to take on the project. A team including Harris and Kessler reviewed county-level prescriptions of opioids in Tennessee and nine other states and compared the data to county unemployment numbers, labor force participation rates, and employment-to-population ratios. They shared their findings in the 2018 Tennessee Economic Report submitted to then-Governor Bill Haslam.
“The increases in opioid use per capita can explain over half of the decline in labor force participation since 2000,” the report stated. In 2018 alone, the researchers found nearly as many pain prescriptions in the state as residents, more than 20,000 nonfatal overdoses, and 1,304 overdose-related deaths. With a 10 percent decrease in opioid prescriptions statewide, Tennesseans would increase their personal income by more than $800 million, they concluded.
These and other findings were published last year in the Journal of Human Resources. Following the report, the state unveiled a $30 million plan to address the opioid epidemic.
Harris and Kessler soon realized, however, that it wasn’t just opioid availability that was the problem.
“There were efforts made to reduce prescribing and availability that didn’t take into account how individuals would respond,” Harris says. These included, in 2010, the reformulation of OxyContin—among the strongest opioids prescribed—to make it harder to misuse. Databases tracking prescriptions were created in several states, with requirements that doctors prescribing opioids first check to learn if patients had open prescriptions from other doctors.
As they dug into the data, Harris, Kessler, and a third colleague, Mary Evans of Claremont McKenna College, found a sharp increase in child maltreatment nationally, according to reports from child protection agencies. Without adequate policies or programs to support those who had developed substance misuse disorders, children and families suffered. The failure of those in positions of influence to see opioid use as what researchers increasingly agree that it is—a disorder, not a moral failing—was part of the problem. Another was the stigma of drug use.
Jenny Crowley, assistant professor of communication studies, researches how communication contributes to that stigma, and how it can help support those coping with stigma. She teamed up with Miller earlier this year for two studies focused on how family communication affects opioid use. One study, published in the Journal of Family Communication, features stories of opioid users’ complex relationships with their families—some of which had long histories of substance use—and how those relationships influenced their own usage and recovery.
“What was clear in talking to participants is that they don’t cope alone,” Miller says. “They do it in relationships.”
At its worst, relational communication serves as an inhibitor to recovery. “Sometimes the support that we think we’re providing is actually quite ineffective,” Crowley says. For example, the researchers found that downplaying the stress experienced by those with histories of substance misuse with comments such as “It’s not as bad as you think it is” or “This will pass” dismisses very real feelings and concerns.
At its best, however, communication serves as a key motivator for seeking treatment.
“Many family members feel stigmatized, so they appreciate when family members focus on their positive qualities or attributes,” Crowley says. “Loneliness is also a trigger to use drugs, so support that reaffirms the relationship and emphasizes connection is helpful.”
In 2019, Meschke and Professor of Nursing Sharon Davis, who has since retired, received a $1 million grant from the US Health Resources and Services Administration to directly address opioid use disorder in five rural Tennessee counties: Campbell, Claiborne, Cocke, Jefferson, and Scott. The project is called Healing Opioid Use Disorder through Prevention and Expertise.
Project HOPE, for short.
The project consists of three working groups, all focused on using partnerships with local community and faith leaders to ultimately decrease opioid use disorder and overdoses. Meschke leads the youth component, while Tourville oversees the community group. Brian Winbigler, a pharmacy professor in the UT Health Science Center, works with health care providers.
“In small communities, everyone knows everybody’s business, but no one talks about it,” Meschke says. “By working to reduce stigma, the hope is we’ll see communities rallying around people instead of pointing fingers. By providing information to young people much earlier, we’ll also empower leaders who can step up and really make a difference for these communities.”
Earlier this year, Meschke was awarded a second three-year $500,000 grant from HRSA for NOW: Nurturing Options for Women. With service efforts concentrated in Claiborne and Scott Counties, its focus is to eradicate NAS in rural communities through prevention, treatment, and recovery. In 2019, more than half of Tennessee’s 769 NAS births occurred in the Appalachian region of East Tennessee. UT’s College of Social Work will place up to seven clinical students with the project. “Now you’ll have all these young girls who had no access to behavioral social support getting it every week,” Meschke says.
Because of COVID-19, many of Project HOPE’s initiatives, including drug takeback days, trainings on naloxone (Narcan) and other overdose prevention, and parenting skills classes, have been adapted for social distancing or transitioned online.
In October, Tourville and her community working group partnered with the UT Legal Clinic to hold an expungement event in Dandridge, Tennessee, for residents of Cocke and Jefferson Counties. In total they helped 70 individuals, many with criminal histories linked to substance use.
“These are individuals who can now regain their driver’s licenses and reenter the job market,” Tourville says. “This is a very big deal.”
What Lies Ahead
Around the time of the expungement clinic, the UT System announced the formation of the Substance Misuse and Addiction Resource for Tennessee (SMART) Policy Network, whose steering committee includes leaders from the East Tennessee State University Addiction Science Center, Knoxville’s Metro Drug Coalition, UT’s Institute for Public Service, and the state judicial system. Involved in the policy network are several members of the Substance Misuse Community of Scholars, including Kessler, Tran, and Tourville, who serves as its director.
The network partners with communities to identify and share balanced perspectives for informing sustainable evidence-based policies that both prevent substance misuse and promote effective treatment and recovery support services. For this year’s legislative session, the group is specifically focused on criminal justice reform and exploring telehealth services for Tennesseans with opioid use disorder both now and beyond the pandemic.
Tran, a data scientist, has worked with UT System Director of Strategic Planning and Policy Katie Singer to develop interactive dashboards using Tennessee Department of Health information on SMART’s website. A visitor to the site can easily search for a broad range of county-level information, such as the number of opioid prescriptions and patients, the location of treatment centers, and drug-related morbidity and mortality statistics.
“The next step is to overlay this information and find connections,” Tran says. “We can look for where the hot spots are—where the state should invest its money. In time, we can look at homelessness and crime data to see what the connection is to opioid use.”
Like every other researcher in their community, Tran thinks about what the numbers mean—for the state economy, health care costs, and the babies and families impacted by opioids.
“Behind the numbers is a story,” Tran says. “There’s a human life.”
The kind of meaningful difference these UT researchers hope to make requires collaboration. It requires commitment. And whether it happens in a virtual classroom, a hospital room, a government office, or a conversation across a table at a community clinic where a person has the chance to begin getting their life back, it leads to hope.
“We have to keep everybody working diligently together, across disciplines, across the state, and slowly we will make a difference,” Tourville says. “That’s what all of us are here to do.”
This article is the first in a series about UT’s efforts to understand and address opioid use disorder. The Substance Misuse Community of Scholars meets via Zoom on the third Thursday of each month from noon to 1 p.m. If you are interested in attending, email Diana Moyer with the Office of Research and Engagement.
Brian Canever (865-974-0937, email@example.com)