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Disrupting stigma about addiction important in communicating about opioid crisis

New report focuses on key messages, best practices to help find solutions to prescription pain medicine epidemic

OAK RIDGE, Tenn.—Media coverage and communication about the opioid epidemic in Appalachian communities tend to focus on awareness of the public health aspects of the crisis, and often concentrates on the number of overdoses and fatalities.

A new report reveals, however, that general awareness of the epidemic and the various health impacts attributed to opioid addiction is not an issue in Appalachia. Rather, the messaging used to communicate about the crisis need to change.

"We hear so much about awareness. Federal and state agencies have launched opioid awareness campaigns, but many communities in this region are already aware there is a problem. They have been personally affected by this crisis, whether someone they love is struggling with addiction, or has overdosed, or because they work in fields like healthcare or education," said Jennifer Reynolds, ORAU section manager for health communication.

Reynolds was lead author of Communicating About Opioids in Appalachia: Challenges, Opportunities and Best Practices. She and project lead Kristin Mattson, ORAU project manager for health communication, conducted research for the newly released report, which , was a joint effort of ORAU, the Appalachian Regional Commission, and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control. The report is based on ORAU research conducted throughout the Appalachian Region intended to establish best practices for communicating about opioids in the Region.

"Appalachians are dealing with the profound impacts of opioid misuse and abuse every day," Reynolds said. "There are things people don't know and should know about the causes of opioid addiction, prevention and treatment and how we raise awareness about those things, not simply the problem itself, is important."

"The biggest takeaway from our research was the need to address the stigma around addiction," Mattson said. "We heard a lot about how people who were in recovery—even those who had been sober for 20 years—were still treated as second-class citizens. This negative stigma makes people want to hide their addiction. It is keeping people from seeking treatment, and we need to talk about that."

The report recommends key messages promoting education about the risks of taking prescription opioids, which drugs are considered opioids, and encouraging people to ask questions when they are prescribed medications for pain.

"We heard from many people who said their doctors didn't tell them what they were prescribing and very few were counseled about how their medications can be addictive," Mattson said. "There are instances where people are taking opioids and they don't even know it."

The report also recommends key messages encouraging community members to become actively engaged in local efforts to address the opioid crisis, as a means of challenging apathy and fostering community support.

"The opioid epidemic looks different from community to community," Reynolds said. "This is a local issue, and some of the most impacted communities in Appalachia are the least resourced for dealing with this issue."

Reynolds pointed to two community organizations that assisted the research project, the Roane County Anti-Drug Coalition and STAND in Oneida, which are doing exemplary work at the community level despite limited resources and threats to their funding.

"After building partners and infrastructure over the last 10 years, we are now beginning to see the acceptance of the value of our coalition," said Trent Coffey, CEO of STAND. "Sadly, the funding is closely coming to an end. We would ask that continued support and consideration be given to the pioneers of rural communities that are beginning to see true positive community change in areas that are many times forgotten."

Sarah Harrison, CEO of the Roane County Anti-Drug Coalition, echoed Coffey's sentiments, particularly with respect to opioid abuse prevention.

"Although prevention work often doesn't get the attention it deserves, if we don't find new funding sources to augment our current grants, the citizens of both Roane and Scott counties will most certainly become aware of the positive effect prevention has had on their community," she said.

Other recommendations in the report include messages:

  • Describing proper use, storage and disposal of prescription opioids;
  • Promoting that help is available for those facing addiction;
  • Describing the signs and symptoms of addiction, including early warning signs; and
  • Promoting hope and the fact that people can and do recover from substance use disorders.

To disseminate these key messages, the report recommends specific communication channels to use depending on the intended audience, and sharing personal stories of individuals who have battled addiction and are now in active recovery. Research found that pairing "before" photos of someone at the low point of their addiction with "after" photos of that person living in recovery would be a powerful way to depict both the consequences of addiction and the hope and benefits of recovery. Traditionally, other substance abuse campaigns have depicted this in the opposite order.

"Such stories could help shift the narrative, which overwhelmingly focuses on overdose deaths and other negative consequences, to show that recovery from addiction is possible," Mattson said.

Information from the report was included as part of testimony to the House Subcommittee on Economic Development, Public Buildings and Emergency Management on December 12, 2017. Earl Gohl, ARC federal co-chair, and Nancy Hale, CEO of Operation Unite, both referenced the report in their testimony to the subcommittee.

"Opioid related deaths are 49 percent higher in Appalachia than in the rest of the country. Knowing the numbers are important, but we need more than awareness to make a difference," said Earl Gohl, federal co-chair of the Appalachian Regional Commission. "This report is a step forward in that process by offering concrete suggestions for crafting effective public outreach campaigns which will give Appalachian families and communities the information, tools and resources to counter addiction."

To develop Communicating about Opioids in Appalachia, ORAU conducted interviews and focus groups to explore best practices for communicating about opioids in the Appalachian region between January and June 2017. Twenty-four subject matter experts representing diverse organizations in 12 Appalachian states were interviewed by phone. Twelve in-person focus groups involving 47 community members were held in four Appalachian communities: London, Ky; Kingston and Oneida, Tenn., and Princeton, W.Va.

To learn more about Communicating about Opioids in Appalachia or to read the complete report, including recommendations for communicating with youth, parents and caregivers, and people struggling with addiction, visit

About ORAU

ORAU provides innovative scientific and technical solutions to advance national priorities in science, education, security and health. Through specialized teams of experts, unique laboratory capabilities and access to a consortium of more than 100 major Ph.D.-granting institutions, ORAU works with federal, state, local and commercial customers to advance national priorities and serve the public interest. A 501(c)(3) nonprofit corporation and federal contractor, ORAU manages the Oak Ridge Institute for Science and Education (ORISE) for the U.S. Department of Energy (DOE).

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