TY - JOUR
KW - Analgesics, Opioid
KW - Appalachian Region/epidemiology
KW - Epidemics
KW - Humans
KW - Ohio/epidemiology
KW - opioid epidemic
KW - Appalachia
KW - MOUD
KW - Opioids
KW - Community health
KW - evidence-based treatment
KW - Rural Health
KW - Stigma
KW - substance use
KW - Trauma
AU - C. A. Schalkoff
AU - E. L. Richard
AU - H. M. Piscalko
AU - A. L. Sibley
AU - D. L. Brook
AU - K. E. Lancaster
AU - W. C. Miller
AU - V. F. Go
A1 - 
AB - Background: Ohio's opioid epidemic continues to progress, severely affecting its rural Appalachian counties-areas marked by high mortality rates, widespread economic challenges, and a history of extreme opioid overprescribing. Substance use may be particularly prevalent in the region due to interactions between community and interpersonal trauma. Purpose/Objectives: We conducted qualitative interviews to explore the local context of the epidemic and the contributing role of trauma. Methods: Two interviewers conducted in-depth interviews (n = 34) with stakeholders in three rural Appalachian counties, including healthcare and substance use treatment professionals, law enforcement officials, and judicial officials. Semi-structured interview guides focused on the social, economic, and historical context of the opioid epidemic, perceived causes and effects of the epidemic, and ideas for addressing the challenge. Results: Stakeholders revealed three pervasive forms of trauma related to the epidemic in their communities: environmental/community trauma (including economic and historical distress), physical/sexual trauma, and emotional trauma. Traumas interact with one another and with substance use in a self-perpetuating cycle. Although stakeholders in all groups discussed trauma from all three categories, their interpretation and proposed solutions differed, leading to a fragmented epidemic response. Participants also discussed the potential of finding hope and community through efforts to address trauma and substance use. Conclusions: Findings lend support to the cyclical relationship between trauma and substance use, as well as the importance of environmental and community trauma as drivers of the opioid epidemic. Community-level and trauma-informed interventions are needed to increase stakeholder consensus around treatment and prevention strategies, as well as to strengthen community organization networks and support community resilience. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1887248.
AD - Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; The Ohio State University College of Public Health, Ohio State University, Columbus, Ohio, USA.; The Ohio State University College of Public Health, Ohio State University, Columbus, Ohio, USA.; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; The Ohio State University College of Public Health, Ohio State University, Columbus, Ohio, USA.; The Ohio State University College of Public Health, Ohio State University, Columbus, Ohio, USA.; The Ohio State University College of Public Health, Ohio State University, Columbus, Ohio, USA.; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
BT - Substance use & misuse
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 5
DO - 10.1080/10826084.2021.1887248
IS - 5
JF - Substance use & misuse
LA - eng
M1 - Journal Article
N2 - Background: Ohio's opioid epidemic continues to progress, severely affecting its rural Appalachian counties-areas marked by high mortality rates, widespread economic challenges, and a history of extreme opioid overprescribing. Substance use may be particularly prevalent in the region due to interactions between community and interpersonal trauma. Purpose/Objectives: We conducted qualitative interviews to explore the local context of the epidemic and the contributing role of trauma. Methods: Two interviewers conducted in-depth interviews (n = 34) with stakeholders in three rural Appalachian counties, including healthcare and substance use treatment professionals, law enforcement officials, and judicial officials. Semi-structured interview guides focused on the social, economic, and historical context of the opioid epidemic, perceived causes and effects of the epidemic, and ideas for addressing the challenge. Results: Stakeholders revealed three pervasive forms of trauma related to the epidemic in their communities: environmental/community trauma (including economic and historical distress), physical/sexual trauma, and emotional trauma. Traumas interact with one another and with substance use in a self-perpetuating cycle. Although stakeholders in all groups discussed trauma from all three categories, their interpretation and proposed solutions differed, leading to a fragmented epidemic response. Participants also discussed the potential of finding hope and community through efforts to address trauma and substance use. Conclusions: Findings lend support to the cyclical relationship between trauma and substance use, as well as the importance of environmental and community trauma as drivers of the opioid epidemic. Community-level and trauma-informed interventions are needed to increase stakeholder consensus around treatment and prevention strategies, as well as to strengthen community organization networks and support community resilience. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1887248.
PY - 2021
SN - 1532-2491; 1082-6084; 1082-6084
SP - 650
EP - 659
EP - 
T1 - "Now We Are Seeing the Tides Wash In": Trauma and the Opioid Epidemic in Rural Appalachian Ohio
T2 - Substance use & misuse
TI - "Now We Are Seeing the Tides Wash In": Trauma and the Opioid Epidemic in Rural Appalachian Ohio
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 33678117
U3 - 10.1080/10826084.2021.1887248
VL - 56
VO - 1532-2491; 1082-6084; 1082-6084
Y1 - 2021
ER -