Appalachian health researchers discuss work, with three sessions on drugs, and are urged to engage more closely with communities

Joyce Bells-Berry of the Mayo Clinic, keynote at the
Appalachian Translational Research Network Summit

By Melissa Patrick
Kentucky Health News

A big step toward improving health in Appalachia would be closer relationships between residents of the region and researchers — who often drop in, gather data and leave.

That’s what researchers were told last week as they gathered in Lexington to talk about their work in Appalachia, ranging from opioid disposal programs to air and water quality.

Joyce Bells-Berry of the Mayo Clinic said at the eighth annual Appalachian Translational Research Network Summit that it was time for Appalachian researchers to stop “helicopter” research and truly engage with communities in the region.

“Community engagement allows us to get to the why so that we can answer our research questions in a way that is pivotal for changing the lives of those around us, in a way that builds partnerships and mutual respect, while taking into consideration the needs of those around us, not just our needs as the academics,” said Bells-Berry, a professor of epidemiology.

Scott Lockard, director of the Kentucky River Health Department, who is collaborating on a syringe-exchange project with the University of Kentucky, said he agreed.

“We don’t like helicopter researchers,” said Lockard, a native of Wolfe County. “We’ve been studied enough.”

Lockard said Appalachian Kentucky is “ripe for collaboration” with researchers who will come to the region to work with residents and help communities find their own solutions to health issues, and be prepared to answer this question: “At the end of the day, does our research improve the lives of everyday Kentuckians?”

And, for that matter, all Appalachians. The Appalachian Translational Research Network is nine institutions in the major Appalachian states (Kentucky, Ohio, Pennsylvania, North Carolina and Tennessee) that collaborate to strengthen research and training efforts in the region. Its stated mission is to “catalyze translational research among partnering institutions serving Appalachian communities to synergistically improve the health of these communities.”

Drug disposal programs questioned

One of the many presentations at the summit, held Sept. 20-21, involved researchers from UK and Wake Forest University who are working on finding ways to improve prescription-drug disposal programs in Appalachia. These programs include drop boxes, organized take-back events and drug-deactivation products that can be used at home.

Mark Wolfson, co-director of Wake Forest’s Center for Research on Substance Abuse and Addiction, told the group that “best estimates” show that only 30 percent of all medications with abuse potential are used as prescribed, leaving 70 percent either unused or inappropriately used.

Kentucky has embraced organized drug-disposal programs as part of its strategy to curb the opioid epidemic. The state Office of Drug Control Policy says Kentucky has 198 drop boxes in 116 counties, with sites being added daily; many locations participate in twice-yearly national take-back days for prescription drugs, with the next one on Oct. 27.

A new state law requires pharmacists to tell customers how to safely dispose of controlled substances, and either provide or offer to sell them a product designed to neutralize drugs for disposal — or provide on-site disposal. Kentucky is participating in a pilot program to provide drug deactivation pouches in Floyd, Henderson, McCracken and Perry counties.

But research indicates that the program is not effective. Wolfson said a study by East Carolina University, using Kentucky data, found that less than 1 percent of controlled medications that were unused were being collected in drop boxes.

Donald Helme, professor in the UK College of Communication and Information, is working with Wolfson. He has found through focus groups, moderated discussions of a few people, that hardly anyone knows about the drop boxes — and even if they do, there is great skepticism about handing over drugs to government agencies, which house most of the drop boxes.

“One of the main things that came up” in the focus groups, Helme said, is “Do not use law enforcement, do not use EMS, do not use the fire department to promote this, because they don’t trust them.”

Helme and Wolfson will design and test a drug-disposal messaging campaign for the five counties in the study, in hopes of justifying a bigger campaign in the future. It is being conducted in conjunction with health departments in Bell, Whitley and Floyd counties in Kentucky and Burke and Wilkes counties in North Carolina.

Environmental health issues explored

Along the theme of community-engaged research, Ellen Hahn, deputy director and community-engagement core leader at UK’s Center for Appalachian Research in Environmental Sciences, or UK-CARES, talked about her efforts to “match-make” researchers who are working on air and water quality issues with Appalachian communities.

Hahn, a nursing professor and director of BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments), said part of their efforts involve citizen science projects. As an example, she pointed to an air-quality project conducted by students and teachers at Perry County Central High School and UK, described in a video:


Keeping pre-diabetes from becoming diabetes

Dr. James Keck, assistant professor in UK’s Department of Family & Community Medicine, talked about his research around increasing access to the Diabetes Prevention Program, an evidence-based lifestyle program that helps people with pre-diabetes to keep the disease from progressing.

Keck said that like the rest of the nation, about one in three Kentuckians have pre-diabetes, a condition that increases the likelihood that a person will eventually be diagnosed with diabetes without preventive intervention.

He said the one-year prevention program has been hamstrung by a general lack of knowledge about it by both patients and clinicians, as well as its cost, which runs about $700 a year. But he added that more and more insurance plans, including UK health insurance and Medicare, now pay for it.

Recognizing the challenges of bringing such a program to rural Kentucky, Keck said his next project will be to to determine if a free, six-week diabetes program offered by Kentucky Homeplace community health workers is as effective as his year-long program.

Studying syringe exchanges

Hilary Surratt, associate professor at UK’s College of Medicine, is researching syringe-exchange programs in Appalachian Kentucky.

In collaboration with the Clark, Knox and Pike county health departments, Surratt’s research includes  injection-drug users who use the exchanges as well as those who don’t. It will also include interviews with community stakeholders, who are both for and against the exchanges. The goal of the research is to understand the many barriers to access and to identify strategies to increase uptake.

Surratt found that among 175 exchange participants, 46 percent said their primary drug of injection was crystal methamphetamine; 27 percent said buprenorphine ( a drug typically used to combat drug addiction), and 17 percent said heroin.

Of particular concern was that more than one in three said they had shared needles and syringes with other injection-drug users in the past three months. And the average number of times they said they had injected in the past month was 80, while the median number of syringes they reported getting was only 50.

One of the main purposes of a syringe-exchange program is to prevent the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among injection-drug users.

Surratt also found that nearly 40 percent of the exchange participants said they had a personal history of overdose, but only 14 percent said they had access to Narcan, an anti-overdose drug.

She showed a map with the ZIP codes of the interviewees, representing 10 counties, illustrating the great distances drug users mist travel to get clean needles.

“When I see something like this, it says to me that we need to think of innovative kinds of solutions to keep engaging people,” she said. “Because we know over time that distance is a barrier to consistent use of these programs.”

Members of the Appalachian Translational Research Network are UK, Wake Forest, East Tennessee State University, The Pennsylvania State University, The Ohio State University, Ohio University, the University of Cincinnati and Marshall University in Huntington, W.Va.