University of Cincinnati

Highland County, Ohio is a rural, medically underserved area (MUA) in southwestern, Ohio, located less than 60 miles from Portsmouth, Ohio, a city considered an epicenter of the opioid pill epidemic. Residents of this area are predominantly of Appalachian decent, a population that has seen a steady increase in substance abuse for the past two decades and continues to experience higher rates of opioid use disorder and overdose deaths than non-Appalachian areas. This county fits the historical Appalachian profile. It is ranked in the bottom 15% of counties in Ohio for health outcomes (#74 of 88) and the bottom 25% (67 of 88) for health factors including health behaviors, access to healthcare, socioeconomics, and education. Highland County is ranked #196 on the list of the top 220 counties identified by the Centers for Disease Control and Prevention as being at risk for HIV and hepatitis C infections due to injection drug use According to the Ohio Substance Use Monitoring Network (OSAM), our region is facing the following: increased methamphetamine availability, opiate users switching to methamphetamines, decreased availability of prescription opioids, and fentanyl added to every drug. Family Recovery Services (FRS) reports that in 2020, 85 clients reported psychostimulants as their drug of choice compared to 81 for opiates. This is a reversal from data from previous years where opiates were the drug of choice. In addition, surgical services are reporting an increase in positive psychostimulants screens and obstetrical emergencies related to psychostimulants. Our proposed approach for this HRSA RCORP psychostimulant project is to build on our momentum and previous successes. Our plan begins with the strong foundation forged from (1) the comprehensive community analysis and strategic planning completed during the RCORP-Planning phase and (2) the RCORP-Implementation project activities. These have produced a strong consortium of partners with established community stakeholder relationships. Our overarching goals for this HRSA RCORP Psychostimulant Project were developed using evidenced based and innovative solutions and include • “Providing effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs” per the HHS CLAS Standards • Providing evidence-based, culturally competent education to this rural, Appalachian population to increase both community members and providers understanding of evidence-based prevention, treatment, and recovery strategies for psychostimulant misuse • Educating the community and all levels of providers to decrease bias and stigma against those with SUD • Recruiting, training, and mentoring interdisciplinary SUD clinical and social service and community-based providers who can identify and treat psychostimulant misuse and use disorders using evidence-based methods. This includes utilizing telehealth when possible to expand access to care providers • Enhancing discharge coordination for people in treatment and recovery to ensure connection with home and community-based services, social support, and peer support • Expanding peer recovery support services • Implementing strategies to prevent the spread of infectious disease in people who inject drugs and providing screening for testing and support and referrals to specialists for those testing positive • Expanding SBIRT to include psychostimulants