Fighting for Our Lives

FIGHTING FOR OUR LIVES

IN A REGION GRIPPED BY OPIOID ADDICTION, UNIVERSITIES ARE CRITICAL IN THE SEARCH FOR SOLUTIONS.

WE HAVE A PROBLEM.

Our population is besieged by an epidemic that’s taking our children, parents and grandparents. It’s irrespective of race, career, age or any of the other socially constructed differences we use to easily categorize one other. The problem is addiction. In the 1990s, pharmaceutical companies embarked on a massive trust campaign, reassuring the health care community against concerns over the addictive properties of prescription painkillers. The resulting uptick in painkiller prescriptions ignited a firestorm of potentially fatal dependencies on prescription opioids. And although the truth about opioids’ massive addiction potential is now broadly understood, the fallout persists with prescription opioid, heroin and fentanyl deaths in America.

How bad is it? Overdose deaths now outnumber fatalities from car wrecks. According to the National Institute on Drug Abuse, in 2015, some 2 million Americans suffered from a substance use disorder related to prescription opioid use, while almost a million people in the United States reported using heroin in 2016. Here in the Greater Cincinnati region, fentanyl has become the name of the drug game. The Cincinnati Enquirer reports that usage of the synthetic super-opioid—it’s at least 50 times as potent as heroin—has exploded in recent years, and Hamilton County deaths from fentanyl overdoses are up 1,000 percent since 2013.

Our region is in the eye of the opioidaddiction storm. Kentucky’s drug overdose death rate is the third-highest in the U.S., and 2017 saw an 11.5 percent increase over

2016—part of a total 40 percent increase over five years.

Traditional approaches to addiction— legislation, law enforcement, emergency response, treatment centers, awareness campaigns—are all critical components of managing the epidemic, but a crisis this big calls for a comprehensive approach. Universities across the nation, as repositories of intellect, research-based solutions and skilled care, offer a wealth of resources for helping in the fight against the opioid crisis. And Northern Kentucky University, in the heart of a Midwest area struggling for survival, is giving all that and more in the fight against addiction fatalities.

In the following pages, we’ll take a look at just a few examples of how, campus-wide, NKU is putting all of its resources into the fight for our population’s health.

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ESTABLISHED IN 2018, NKU’S INSTITUTE FOR HEALTH INNOVATION (IHI) WAS DESIGNED AS A CENTRAL HUB FOR THE UNIVERSITY’S WORK ON POPULATION HEALTH. Helming the IHI is St. Elizabeth Healthcare Executive Director and Vice President for Innovation, Dr. Valerie Gray Hardcastle, who was hired to bring the institute’s goals into reality.

“I think of myself as kind of a nudge and a convener, then a support system,” says Hardcastle. “What I can do, particularly with people working in the public service industry, is help them do their job more efficiently. We can study and crunch the data, see what works and what’s most effective.”

Conceived as an engine for improving population health, the institute exists to serve three defined purposes. The first is to engage the entire university, across multiple colleges and departments, in an “all-handson-deck” approach—Hardcastle likens the institute to the College of Informatics in this multidisciplinary methodology. The second is, quite simply, to make a difference in Kentucky’s population health by working directly with the community and helping to secure project funding. Finally, Hardcastle is tasked with serving student success, from attracting students to NKU all the way through graduating adults who are ready to serve their communities in a health-related capacity. This final point includes initiatives to identify challenges, such as housing insecurity, hunger and mental health, that commonly derail academic experiences and future careers.

With Kentucky in the grips of an addiction epidemic, much of the IHI’s work focuses on opioid use in the Commonwealth. Though she’s only been at NKU for a short time, Hardcastle is already elbow deep in plans to provide aid where Kentucky needs it most, starting with the recent receipt of a $200,000 federal planning grant from the Health Resources and Services Administration to help underserved areas struggling with addiction.

“One of the challenges of our rural areas is there’s just not enough access to health care,” she says, pointing to Owen County, site of the proposed Owen County Collaborative Addiction Treatment Initiative, which has only

Dr. Valerie Gray Hardcastle, St. Elizabeth Healthcare Executive Director and Vice President for Innovation, converses with a colleague in the Institute for Health Innovation offices.

three full-time physicians and no dedicated behavioral health provider. “Anything related to addiction treatment beyond some minimal one-on-one counseling gets referred out of the county,” she says. “But there are no major roads that go through there, so that’s a big ask. Then if you’re working in a job that pays hourly, you’re going to have to take off a lot of hours to travel out of the county to get help—you can see the problem.”

In an area lacking sufficient population numbers to sustain profitable health care practices, finding a way to provide care is key to improving outcomes. “My hope is that we can set up clinical sites there,” says Hardcastle, “so we can have a health care provider there overseeing it, but then our students can rotate through as they need to for their internships and practicums and so forth. That could be a good way to provide low-cost or no-cost health care in areas of significant need.”

Another goal of the grant is training programs to help teachers and workers in Kentucky middle and high schools recognize and respond to student opioid use. “One of the things that we know now about the opioid epidemic, at least in this area, is that younger and younger people are showing up in the emergency department with an overdose,” she says. “A lot of money is being dumped into prevention, the ‘Just Say No to Drugs’ avenue, and a lot of money is being dumped into what happens when you overdose and we get you into treatment and you get healthy. But there’s this whole middle range of when people are

using but they’re not in trouble yet. If we can catch them then, perhaps we can divert them from a very expensive tour through our health care industry.”

Hardcastle is also involved with the Ohio River Valley Addiction Research Consortium (ORVARC), which focuses on neonatal abstinence syndrome, the in-utero effects of opioids on fetal development. “We’re starting to work with St. Elizabeth on analyzing some data,” she says, “because now we’ve had enough children born and we’ve followed them around long enough that we can at least look at their diagnoses and see if we can find patterns. Then we can hopefully work together to find what is the best thing to do.”

With the daunting task of saving lives before her, it’s natural to wonder what Hardcastle’s personal benchmark for success would be. With the total elimination of addiction an unlikely scenario, what percentage would make her say, “Mission accomplished?”

“I don’t know that I can tell you, well, if we cut opioid deaths by 20 percent I would die happy,” she says, “I feel like that kind of work is never done. But if people could really understand that addiction is a chronic illness, like diabetes or heart disease, and should be treated as such, then I would say, ‘OK, I can die happy.’ People would not think of addiction as something you can just get over. So I think if somehow I could engineer this cultural shift on how we approach addiction, then I could say, ‘Yes, we’ve actually made a permanent difference.’” —Rodney Wilson (’00)

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AN EDUCATOR AT LARGE

AS A PROFESSOR, THE LAST THING YOU WANT TO SEE IS A STUDENT NODDING OFF DURING ONE OF YOUR LECTURES.

In 1999, Dr. Perilou Goddard, a professor in the Psychological Science department specializing in addiction science, was teaching her drug policy course when she noticed one of her students dozing off. She was disappointed—were her lectures that uninteresting?—but then the student approached her afterward to explain why he kept falling asleep. He didn’t struggle to stay awake because he found the class boring, but, rather, had started methadone treatments after back surgery left him addicted to opioids. He was tired because he was still adjusting to the doses.

Dr. Goddard’s mood changed from disappointment to joy over her student feeling comfortable enough to discuss his disorder with her.

“We should make a connection on a human level,” Dr. Goddard says. “Instead of treating you like vermin, I see you as a human being trying to get better.”

The experience emboldened her, but it wasn’t until 2013, as the nation’s opioid crisis reached a boiling point (the U.S. Drug Enforcement Administration would officially declare two years later that opioid-related overdose deaths had reached “epidemic levels”) that Goddard’s life changed when a second student, Mary Jo Schmidt, approached her after class with a challenge.

“She said ‘Dr. Goddard, you can’t just sit in your classroom anymore,’” Goddard remembers.

That’s when Goddard’s real-world activism began. She started booking public speaking appearances, presented a Six@Six lecture called “Heroin Hits Home” and got involved in any other area she could find. “I won’t change the world,” she says. “But I think I can make a bigger difference talking about it.”

Goddard’s not-so secret weapon is awareness, and discussing addiction with both the general population and those undergoing the challenge is central to how she tackles the opioid crisis. And, as a psychologist, she makes sure her communication about the issue is backed by science,

which she’s always eager to help people understand.

“I can read the science and translate for them,” Dr. Goddard says.

She’s passionate about the need to adjust how we think about addiction, which is often wrongly assumed to be based in choice, minimizing how humans struggle with the disease. Goddard explains that numerous factors in a person’s life can lead to addiction, from a genetic disposition to past experiences of trauma. She cites ACEs (Adverse Childhood Experiences)—traumatic experiences that happen before the age of 18—as similar to PTSD (Post Traumatic Stress Disorder) in how they can create internal “voids” that opioids too-easily fill.

In addition to bringing awareness to the realities of addiction, Goddard also spreads the word about options available to people with substance-use disorders, including controversial programs such as needle-exchange outreaches. “[People say] that’s enabling,” she says. “But research shows it doesn’t lead to more injecting.”

She also encourages people to carry naloxone (Narcan), a nasal spray that can be used for the emergency treatment of suspected opioid overdose. And there are other ways to help people who have overdosed; one of Dr. Goddard’s students used rescue breathing techniques to help someone before emergency vehicles arrived.

Goddard refers to herself as NKU’s “Educator at Large” when it comes to opioid problems, and her talks have created additional opportunities for the university. A new post-graduate certificate program in Addictions Research and Practice was, in fact, recently launched for students with a bachelor’s degree who want to learn more about addiction and innovative ways to offer treatment.

Unfortunately, the opioid crisis isn’t going away anytime soon—too many lives have been affected to right the ship overnight. But with people like Goddard working on raising awareness and educating the next generation of addiction specialists, there’s every reason to hope things will soon start to improve.

—Lizzie Kibler (’16)

TOP: Dr. Perilou Goddard gives a presentation about the science behind addiction struggles.

ABOVE: “I can read the science and translate for them."

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Debbie Moak at the 2016 Think Tank series.

“I WON’T CHANGE THE WORLD, BUT I THINK I CAN MAKE A BIGGER DIFFERENCE TALKING ABOUT IT.”

DR. PERILOU GODDARD

Breaking the Silence

DEBBIE MOAK’S (’85) LIFE WAS TURNED UPSIDE DOWN WHEN HER SON BECAME ADDICTED TO COCAINE and spent months between three different rehabilitation programs. Moak and her husband, Steve, created notMYkid as a way to share their family’s story and help other families struggling with substance abuse. So far, she has shared her personal story with thousands of families in the U.S. and internationally. She has created several programs focused on substance abuse prevention through notMYkid and led two national drug awareness campaigns.

“What I’ve experienced in these 17 years after founding notMYkid is that there is an epidemic around drug use,” she says, “but we keep perpetuating a myth that everything is OK because families are too ashamed to talk about it.”

—Jayna Morris

Visit notMYkid.org for more information.

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LIFE-SAVING MEASURES

IT’S A DISCUSSION NOBODY WANTS TO HAVE, BUT FOR TOO MANY NORTHERN KENTUCKY RESIDENTS, OPIOIDS ARE NOW PART OF EVERYDAY CONVERSATION. As overdoses ravage families and neighborhoods across the region, communities wonder aloud if these tragedies could, in some way, have been prevented.

The Kenton County Detention Center (KCDC) is taking on the task of prevention with an innovative new program. Funded by a 3-year, $300,000 grant from the Department of Justice, KCDC recently launched the Kentucky Overdose Prevention, Education, and Pre-arrest Diversion Project aimed at preventing overdose through enhanced treatment access.

The project structures community-based policing via Quick Response Teams (QRTs)— collaborations between law enforcement, community behavioral health agencies and other first responders. QRTs connect overdose survivors with appropriate care, and the project covers all eight northern Kentucky counties (Kenton, Campbell, Boone, Grant, Owen, Carroll, Pendleton and Gallatin).

For coordinator Jason Merrick, himself a recovered addict, the jail’s program is something of a passion project. After finally getting clean following years of addiction, he earned an undergraduate degree in social work in 2014, followed by a graduate degree in social work in 2016—both from Northern Kentucky University. He now works as the director of addiction services at KCDC, where nearly 85 percent of inmate incarcerations are directly or indirectly tied to drugs. The purpose of the project, Merrick says, is not only to save lives but also to usher abusers away from the correctional system and into treatment.

KCDC partners with organizations across the community, including northern Kentucky’s Heroin Impact Response Task Force, St. Elizabeth Healthcare, NKY Hates Heroin, People Advocating for Recovery, Brighton Recovery Center for Women, Transitions, the Addiction Services Council, the Kenton County Police Department, the Alexandria Police Department and the City of Independence.

NKU is another community partner, and all it took was a phone call to Merrick’s former professor, Dr. Suk-hee Kim, to bring

Jason Merrick ('14, '16) , director of addiction services at the Kenton County Detention Center, joined Northern Kentucky University and journalist Sam Quinones to discuss the heroin crisis and the stigma of addiction in April 2016.

her on board. Kim, an assistant professor in the social work program, has a particular interest in how addiction affects brain health and environment across the lifespan and in the aging process.

“My main interest is in the frontal lobe and upper area of the cortex of the human brain. It carries out higher mental processes, which is where we use our frontal lobes daily,” she says. “The brain and mental health have a drastic impact on behavior. Addiction has a strong tie into the frontal lobe because it takes over thinking, decision making, organization, critical thinking and problem-solving skills.”

She wants to find new ways to reduce the number of opioid-associated deaths and believes that community involvement isn’t just an option—it’s a responsibility.

“Changing the world doesn’t start with big ideas,” Kim says. “It starts with building trust and relationships. I consider myself a community member, and I cannot disregard what the community is experiencing—overdoses, broken family relationships and people living without hope. NKU is a vehicle and resource to help our own community’s issues.”

Merrick hopes to bridge the gap between overdose and treatment—the same assistance he once needed to escape addiction. One way the project does this is through a grant that places an intern from NKU’s Master’s in Social Work (MSW) program at KCDC to intern with Merrick, which Kim says is one of the greatest assets NKU can offer.

“This partnership allows students to be key players,” Kim says. “They have brilliant and innovative ideas, and they’re building critical skills and applying knowledge learned in

the classroom to big, real-world ideas. They’re a part of the community-helping process.”

Bethany Ball, a 2017 MSW graduate and KCDC substance abuse counselor, is at the jail every week, working closely with inmates trying to get back on their feet.

In fact, she coordinates the START STRONG COR-12 Treatment and Reentry Program, which was created by the Hazeldon Betty Ford Foundation. KCDC is the first jail in the nation to launch the 12-step reentry plan for opioid-addicted inmates. The hope is that comprehensive opioid response (COR) can be completed in 12 steps— through 90 days of residential treatment and then six months of job training.

“We serve the innovative approach to corrections by offering a substance abuse program to county as well as state inmates,” Ball says. “Our clients are also referred to our community partner, The Life Learning Center, which provides continuing support as they transition back to the community.”

The ultimate goal is to reduce overdoses as abusers transition away from incarceration and into recovery. Kim hopes the partnership will reach beyond the region, providing an example for other cities dealing with addiction.

“Our aim is to create a model that other states can adopt. We’re demonstrating this task force in eight different counties, and each county’s dynamics are different. But if one model works for eight counties here, it can certainly be duplicated elsewhere,” Kim says. “The opioid epidemic isn’t just local. It’s a national problem—one that’s bigger than everyone realizes. Now is the time to work together to rescue and restore our people and community.” —Jayna Morris

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A HEALING APPROACH

IT TAKES MORE THAN A MONTHLY DOSE OF A MAINTENANCE THERAPY DRUG AND A POSITIVE ATTITUDE TO TREAT ADDICTION, especially when a substance use disorder masks undiagnosed health issues. Experienced health professionals can make all the difference for addicts entering recovery, and Lynn Brown and Joan Ziegelmeyer know that nursepatient relationships are critical to patient care. That’s what makes their roles at the Brighton Recovery Center clinic so important.

Brown, a parish nurse, and Ziegelmeyer, a nurse practitioner, dedicate much of their time to the residence-based addictionrecovery program for women in Florence, Kentucky. The clinic, which opened in July 2014, is one of several locations operated by Northern Kentucky University’s Nurse Advocacy Center for the Underserved (NACU) program, which places experienced

nurses in the region’s underserved communities.

“The Brighton Center is our busiest and one of our most important places that we serve,” says Mary Kishman, NACU’s director. “The goal is to get the women clean, so the nurses have to keep them healthy for them to be able to focus and make this happen. The nurses deliver primary care while they’re in the program, but the women often do not really know how to navigate the health care system, so health education and guidance is really what many of them need.”

While NACU is a clinic, the Brighton Recovery Center is not a medical facility. There are no electronic medical records or care plans like in traditional facilities. Brown and Ziegelmeyer treat everything from the common cold to the flu to hepatitis, and they refer patients externally for counseling to treat depression, anxiety and bipolar disorder.

Sometimes bigger issues surface, too.

“There are many medical conditions that have to be managed,” Brown says. “Once the opioid wears off, they’re hypersensitive to everything. They start to feel pain, but they don’t take care of their medical conditions. They don’t know what’s serious or what they should pay attention to. They don’t know what’s common to the human condition anymore.”

In addition to typical nurse duties, Brown and Ziegelmeyer serve as advocates for women who come through the program.

“These women come in completely broken. They’re not even a personality anymore. They’re just an addiction wearing scrubs,” Brown says. “They don’t know how to maneuver, and they feel alone. We say, ‘Let’s talk through it. How will you be more comfortable? How do you settle in?’ Over time, we see their personalities come out. We watch them progress and grow. It’s

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Support the work of these NKU programs by visiting nku.edu/givenow

“THE BRIGHTON CENTER IS OUR BUSIEST AND ONE OF OUR MOST IMPORTANT PLACES THAT WE SERVE,”

MARY KISHMAN

beautiful to watch that happen.”

Graduation typically comes nine months after a patient enters recovery. For some, it takes longer if they run into trouble and need to restart, or if they leave and come back later. Some don’t the finish the program at all—they leave and relapse, a scenario that too often results in death.

“The hardest part is when you hear later that they’ve overdosed,” Ziegelmeyer says. “Those drugs are so strong, and they pull you back.”

This could have been the case for Davita Riggs, a trained phlebotomist who slipped into addiction and twice sought help at Brighton. When Riggs was admitted in 2013 for the first time, there was no nurse or clinic on site. She had to find and arrange transportation for herself whenever she needed to leave the treatment facility—which was often—to treat her thyroid condition and other illnesses. Leaving the facility put her

behind in life skills classes, which extended her time there.

But during her second admission to the program, Riggs was introduced to NACU. She remembers being high and mean during her intake session, but Brown and Ziegelmeyer were patient with her. This compassion, she says, made all the difference.

“When outside doctors would see that I was an addict, they would treat me differently,” she says. “You don’t get treated the best when people find out who you are and what you’ve done. It was nice to have two people who were professional, educated and treated me like a human being.”

Now, after successfully moving through the program, Riggs works as Brighton’s in-house phlebotomist. She was hired to the position by an outside company after her graduation and now works alongside the two NACU nurses who helped her when she needed it most. Riggs is just one example of

the women whom Brown and Ziegelmeyer get to work with every day.

“It’s crazy how it came full circle and now I work with them. I’ve never loved a job like I love this one,” Riggs says. “If I didn’t have my job here, I wouldn’t be sober. I remember laying in those beds. I remember girls cleaning up my vomit because I was detoxing so hard. I don’t want to be that person anymore.”

NACU’s clinic at the Brighton Recovery Center doesn’t just benefit the women who are recovering—it has a profound effect on the nurses as well.

“We get attached to them,” Ziegelmeyer says. “Sometimes it helps to have someone on the outside to process everything with. We know the program and can encourage them to do the right thing.”

“It’s easy to love this job,” Brown says, “because you love the girls.”

—Jayna Morris

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