Discuss recommendations of the ASPPH Task Force on Public Health Initiatives to Address the Opioid Crisis. Learn from members of the academic public health community other/alternative public health initiatives to address the crisis.

The opioid crisis has accounted for 770 000 deaths in the United States over the past 20 years, a number approximately equal to the first 20 years of the AIDS epidemic.1 A substantial portion of these deaths were the direct result of overprescription of opioids, and many others were caused by former prescription opioid users migrating to less expensive and easier to obtain heroin and synthetic opioids, such as fentanyl and its analogues. The opioid crisis has contributed to the decline in US overall life expectancy for 3 consecutive years; the first 3 year-on-year decline in US life expectancy since the 1918 flu pandemic.

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Recent research indicates that pregnant women in rural communities are at increased risk of experiencing IPV and comorbid illicit opioid use compared to urban-residing pregnant women. Few studies of the interactions among rurality, substance use, and victimization in pregnant women exist. The current study sought to examine the relationship between IPV and opioid use and the interaction effects of rurality in Appalachian pregnant women. A convenience sample of pregnant women who were enrolled in a smoking cessation research study was used for this analysis. Participants included 488 pregnant women from five prenatal clinics in South-Central Appalachia. Data were from self-reported assessments and semi-structured interviews on substance use and IPV conducted from first trimester of pregnancy through eight months postpartum. Four hundred and ten participants reported experiencing any form of IPV in the past year. Logistic regression results indicated that physical IPV was associated with opioid use, but sexual and psychological IPV were not. The moderation model indicated direct effects between IPV and opioid use, but were not moderated by rurality. This study suggests a need to further understand the relationship between substance use, IPV, and rurality in pregnant women. The specific subtopic of opioid use by pregnant women living in rural communities, and its relationship to IPV victimization and adverse fetal and maternal health outcomes, continues to be an understudied, but critically important area. Limitations and future directions pertaining to IPV screenings and interventions for pregnant women are discussed.

While chronic pain is an increasingly prevalent condition in the United States, it is twice as common among the military veteran population. As many Vietnam War era veterans are aging and experiencing comorbid medical conditions, their chronic pain is becoming increasingly complex. Policies enacted in response to the ‘opioid epidemic’ have in some ways made treatment of pain safer, but have also left remaining questions regarding how to properly provide care. There are three fields of complexity that interact within this topic: patients with a clear need for care and pain management, providers committed to helping patients, and structural barriers that unintentionally interfere with the provision of care. The lived experience of chronic pain and receiving care through the VA healthcare system combined with a common military culture exemplifies a lifeworld centered on pain—which I call a ‘painworld.’ This painworld is seen in the illness narratives of older, white, male veterans with chronic pain. Examining the way a single VA site provides pain care shows the providers are dedicated to treating veteran patients and offer a large number of treatment options. While the need for pain management services is clear from both the patient and provider perspectives, translating the lived experience of these veterans and their medical needs into a hierarchical bureaucratic structure is difficult. Furthermore, the bureaucratic nature of a large federal organization creates gaps in the healthcare system. This leads to the creation of informal systems through systems-correcting praxis to fill the gaps and attempt to prevent siloing and slippage throughout. Together, these fields of complexity are organized into three chapters, building the argument that the convergence of veteran painworlds, pain care, and bureaucracy can contribute to miscommunication, leading to unintended slippage through the system and inadequate care, despite good intentions of staff. Furthermore, the VA system and structure of providing pain care both influences and is part of the painworld, as are the interactions that occur between veteran patients and staff.

The state of Mississippi is undergoing a prescription opioid epidemic that mimics national trends in which prescribing rates are dropping, yet overdoses involving opioids remain high. In response to the state’s crisis, the PReventing Opioid Misuse In the SouthEast (PROMISE) Initiative was created to provide education for preventing the misuse of prescription opioids. A mail survey and post card intervention were distributed in six Appalachian counties in the state to gather the self-reported attitudes, norms, and perceived behavioral control of residents as it related to using a prescription drug take-box. Descriptive and multivariable analyses indicate the intervention did not increase intention to use prescription drug take-back boxes as a method of disposal. Lack of awareness and inconvenience remain common themes among individuals who chose not to use take-back boxes. Thus, researchers recommend future interventions incentivize prescription disposal.

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