This is the second of two stories about UT’s efforts to understand and address opioid use disorder. Read the first story.
Back home in West Virginia this past summer, Jason Trautwein was working as a clerk for a circuit court judge not far from where he grew up in Huntington, a city dubbed by the national media as the overdose capital of America.
“I thought I understood the level of chaos opioids had unleashed on southern West Virginia,” says Trautwein, a second-year law student at the University of Tennessee, Knoxville. “I didn’t know a quarter of it.”
Trautwein saw people in the courtroom he recognized from high school. More than 90 percent of the cases, he estimates, had some connection to opioid or substance use. One in particular he cannot shake from his memory: During a custody hearing, a mother struggling with addiction sobbed uncontrollably as she voluntarily relinquished rights to her young daughter. The judge asked questions to make sure she understood the finality of her decision.
Trautwein was struck by the duality: a mother losing her daughter while at the same time saving her from the chaos that might come further down the road.
“It was tough,” he says. “Really tough. I just can’t imagine.”
After returning to campus this fall, Trautwein began a graduate research assistantship with the UT System’s Substance Misuse and Addiction Resource for Tennessee (SMART) Policy Network, which seeks to prevent substance misuse by informing public policy and promoting effective treatment and recovery support services. He is currently studying recidivism and incarceration rates in Tennessee, where more than a quarter of all prison admissions are for nonviolent drug offenses.
Undergraduate and graduate students in nursing, social work, public health, and other disciplines are also taking advantage of experiential learning opportunities offered by the university to address the opioid crisis in Tennessee.
“It’s critical to have people working within these disciplines who are educated about substance use disorders,” says Jennifer Tourville, a clinical nursing professor who leads UT’s Substance Misuse Community of Scholars and directs the SMART Policy Network. “The more exposure we can give them prior to beginning their careers the better.”
Not Everything is Black and White
Chelsea Smith Hardin’s parents never shied from difficult conversations at the dinner table. When it came to substance misuse, they taught her to listen and be compassionate. She was curious: What causes people to become addicted? Through her undergraduate nursing and psychiatric mental health courses, she learned how opioids activate receptors in the brain, block pain signals, and release large amounts of dopamine throughout the body.
“When the dopamine stops, your brain is literally withdrawing,” says Hardin, a Knoxville native who graduated with her BSN in 2018. “The effect is horrible. It may not kill you, but it’s torture what these people are going through.”
That feeling of torture is what drives them back to the drugs. Which led her to another question: If it’s such torture to leave, why even start?
In classes with now-retired nursing professor Sharon Davis, Hardin learned how a range of childhood events—abuse, neglect, violence between parents, substance misuse, mental illness, incarceration, separation, and divorce—influence negative health consequences in adulthood. As part of her undergraduate thesis for the Chancellor’s Honors Program, Hardin researched what parents knew about these adverse childhood experiences (ACE) and their connection to substance misuse.
“Parents had no idea,” says Hardin. Of those surveyed, less than half could define an ACE. Nearly half felt either neutral or uncomfortable talking to their kids about substance misuse.
This past fall, Hardin, who works as a registered nurse in a Knoxville area hospital, started UT’s Doctor of Nursing Practice program. She also began working as a graduate research assistant with Project HOPE, overseen by Tourville and Laurie Meschke, a professor of public health. The project, funded by a $1 million grant from the US Health Resources and Services Administration, works to decrease opioid use disorder and overdoses in rural Tennessee counties by working with and educating youth, communities, and health care providers.
As part of the community-focused working group, Hardin helps provide training in the use of naloxone (Narcan), participates in drug takeback days, and assists with events like a recent expungement clinic in Scott County run in partnership with the UT Legal Clinic.
Undergraduate nursing students are involved with similar efforts. Cierra Widener, a senior from Athens, Tennessee, and Keegan Walker, a senior from Knoxville, have spent 30 hours in each of the past three semesters volunteering with Choice Health Network’s harm reduction program, which provides syringe access and needle exchange, wound care, and HIV and hepatitis C testing to East Tennesseans.
During exchange days, the students load vans with supplies and drive to sites where they set up canopies for participants to show up for help. On busy days, they see up to 100 people.
“People like to profile or stereotype who would be participating in the program, but you see all walks of life,” Walker says.
When they find out Walker and Widener are nursing majors, some have commented, “Oh great, you understand how it works. If we ever go to the hospital and you’re our nurse, you’ll be nice to us.”
“It’s heartbreaking,” says Walker of emergency room visits and other experiences he’s been told of where patients are made to feel worthless. “As future health care workers, it’s drilled into our heads—holistic care, holistic care, holistic care—from the beginning. To see that sometimes people don’t get that compassion—that just doesn’t sit well with me.”
Working with support groups, Widener has heard the range of stories of how people were first exposed to opioids. Some were overprescribed by doctors. Others suffered from chronic pain, felt trapped, or made mistakes. But many have taken advantage of the help they’ve received and gone on to change roads. “We have people who come by who don’t even participate in the program for themselves anymore,” she says. “They come to get supplies for other people or to say, ‘Hey, you know, you haven’t seen me in a while. I went to rehab—I’m clean now.’”
It’s helped her understand that not everything in life is black and white.
“Addiction is a disease,” Widener says. “A lot of people don’t treat it that way. But us being involved, seeing it all firsthand, it’s given us insight to be better nurses and to provide better care to this population of people.”
Opportunities to Give Back
The work students are doing to better understand substance misuse extends into other areas across campus.
In the Early Experiences Laboratory in the Department of Child and Family Studies, student researchers working under Professor Julia Jaekel are studying the consequences of opioid use during pregnancy. Clinical students in the College of Social Work are providing counseling services to Scott County youth as part of a program to prevent alcohol and drug use and promote wellbeing . Other social work students serve as researchers for a One UT Collaboration and Innovation grant overseen by Tourville and Associate Professor of Social Work Shandra Forrest-Bank that aims to provide academic, behavioral, and social support to Knox County high school students on a path to recovery from substance misuse.
Like Trautwein, Jeremy Kourvelas (’14), a Master of Public Health student from Memphis, is a graduate research assistant for the SMART Policy Network. After earning his bachelor’s degree in psychology from UT, he spent four years working as a medical scribe at a hospital where he regularly encountered the effects of opioids on patients. He knew that he wanted to study either mental health or substance misuse in grad school.
“The fact that a research position opened up was too good to pass up,” Kourvelas says. “It’s been really amazing—the connections I’ve made, the people I’m working with.”
Currently, Kourvelas is compiling data on telehealth and its pros and cons for patients with substance issues. Since he began this past fall, telehealth services have been largely covered by insurance companies because of COVID-19.
“Some of the things I’ve seen that have excited me, as far as it pertains to substance use disorder, is that so far randomized trials have shown health care outcomes just as good, if not better, than standard in-person visits,” Kourvelas says. Wait times have been eliminated. Rural patients or those with limited access to vehicles no longer need to drive distances of up to 50 miles to appointments.
The fall of his senior year, Michael Richards (’20) also had the opportunity to get involved with substance misuse research. His course on geographic information systems in the community with Professor of Geography Liem Tran partnered with the UT System to conduct research on opioid use in Tennessee, create story maps, and provide resources for the Summit for Opioid Addiction and Response, held in the Student Union on UT’s campus in August 2019.
Richards grew up three hours west of Knoxville in Cross Plains, Tennessee, a city of less than 2,000 people.
“Coming from Robertson County, I saw UT as full of opportunity,” Richards says.
After his class with Tran, Richards was hired by the UT System as a research associate for its institutional effectiveness unit, where he works with undergraduate business student Griffin Judy on a team that is placing resources such as treatment center locations, opioid prescription figures, and drug-related mortality numbers into interactive dashboards. These visual maps take information previously scattered across web pages and Excel spreadsheets or PDF documents and put them in one place for policymakers and others seeking to better understand the issue.
While he had always felt the culture of volunteering and giving back was an important part of campus life, Richards hadn’t been sure how, as a GIS programmer, he would play a part in it. Then came the unexpected opportunity to do work that might impact the lives of Tennesseans for years to come.
“I feel like I’m actually making a difference,” Richards says.
Trautwein was in a similar position before he started law school. After losing his job at a nonprofit due to budget cuts, he took a sales position and struggled to connect with the purpose of the work. When he decided to study law, he knew there were two paths he could take. The first would lead to financial prosperity. The other might not make him as much money but would allow him to help people like the classmates from West Virginia whose lives have been ravaged by opioids. At UT, he would not only see faculty conducting research and doing work that serves his neighbors. He could play a part, too.
“I don’t have to be a legacy Ivy League student to get opportunities that actually mean something and make a difference for me personally,” Trautwein says.
Brian Canever (865-974-0937, email@example.com)