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Welcome to the LINCS Panel Discussion on the Impact of the Opioid Epidemic on Adult Education

Welcome to the first day of our two-day discussion on the impact of the opioid epidemic on adult education. We’re fortunate to be joined by long-time adult educator, Paul Jurmo, Ed.D., family & preventive medicine physician, Richard Bruno, M.D., and corrections specialist, Jeffrey Abramowitz, J.D. in examining the issues impacting our learners, families, and programs.

To begin, I’d ask our panelists to share more on their background as it relates to the topic, and ask them to respond to the two questions below.  For those interested in a little background information on opioids, we have provided a brief overview of the different types of opioids, both medically prescribed and non-prescribed, and their impact on the body.  These are provided from resources available from the National Institute on Drug Abuse

Questions:

1.     What is unique about opioid addiction, in its short and long-term impacts on individuals, that is different from other types of addiction, such as alcoholism?  What is different in the approach to treating opioid addiction than other forms of addiction?

2.     Opioid addiction is a disease that alters the structure and function of the brain. Understanding how this disease impacts the brain is important for educators working with persons with a history of opioid use.  What should adult educators know, and what training do you recommend programs offer their staff to help them better understand these impacts?

Background information on Opioids:

Opioids are naturally found in the opium poppy plant. Some opioid medications are made from this plant while others are made by scientists in labs. Opioids have been used for hundreds of years to treat pain. 

Heroin is also an opioid but is not classified as a prescription medication. Fentanyl is a powerful prescription pain reliever that is 50 times more powerful than heroin.  It is sometimes added to heroin, leading many users to overdose.  One of the ways opioids work to relax your body is by slowing down your breathing. When misused, opioids can slow your breathing too much. This can cause you to stop breathing entirely and lead to an overdose. For some people, just one dose is enough to make them stop breathing.

Naloxone is used to counteract an overdose.  It works to quickly block the effects of opioids. It is available as an injectable solution, an auto-injector, and a nasal spray. Some states require a doctor to prescribe naloxone, but other states allow pharmacies to sell naloxone without a personal prescription.  

Our brain has receptors that receive signals from other parts of our body. Opioids attach to receptors on nerve cells in the brain, spinal cord, and other organs. This allows them to block pain messages sent from the body to the brain.

When the opioids attach to the receptors, they also cause a large amount of dopamine to be released in the pleasure centers of the brain. Dopamine is the chemical responsible for making us feel reward and motivates our actions. The dopamine release caused by the opioids sends a rush of extreme pleasure and well-being throughout the body. Over time, prolonged use of opioids causes harmful effects, like extreme sleepiness or insomnia, confusion, nausea, vomiting, muscle pain, constipation, heart infections, pneumonia, and addiction.

Prescription pain relievers and heroin are chemically similar and can produce similar effects. Heroin is sometimes cheaper and easier to get than prescription opioids. As a result, people who are addicted to prescription opioids sometimes switch to using heroin. Four out of five new heroin users report misusing prescription opioids before trying heroin.8 You can overdose on both heroin and prescription opioids.  Less than 4 percent of people who had misused prescription pain medicines started using heroin within 5 years.

Opioids can show up on a drug test within hours of being taken. Opioids, including heroin, can show up on a drug test for days, and in some cases weeks, after being taken.  How long they stay in your system depends on how long a person has been taking the drug, the amount of drug they use, or the person’s metabolism.

The most commonly used prescription opioids are oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine. Opioids also go by different names: oxy, percs, and vikes are slang terms for opioid pills.  Common names for heroin include Big H, Horse, Hell Dust, and Smack.

The brain gets so used to the opioids that when someone stops taking them, they can go into withdrawal. Withdrawal symptoms include sweating, shaking, vomiting, sleep problems, and diarrhea. The symptoms can be so severe that it can be hard for someone to stop using opioids, even if they want to. Quitting opioids can be hard, but it is possible.

There are three Food and Drug Administration approved medicines to treat opioid addiction. Medicines like buprenorphine and methadone bind to the same receptors in the brain as prescription opioids to reduce cravings. Naltrexone is another medication that treats opioid addiction by preventing opioids from having an effect on the brain. Additionally, an old medicine called clonidine, and a newer medicine called lofexidine, help lessen withdrawal symptoms for people who are trying to stop.  A combination of behavioral therapy and medication has proven to be the most effective in treating opioid addiction.

 

 

 

 

 

 

 

 

 

 

Comments

Karen Cimorelli's picture
First

We are trying to view the discussion and don't know how to access it. Can you help with some information?

Julie Neff-Encinas's picture
Ten

Is this a webinar or purely a text discussion?

Michael Cruse's picture
One hundred

Hi,  Julie -

This is an asynchronous panel discussion only.

Best,

Mike Cruse

michaelcruse74@gmail.com

Michael Cruse's picture
One hundred

Hi, Karen -

Please email me directly for support with participating in the discussion.

Best,

Mike Cruse

michaelcruse74@gmail.com

Julie Neff-Encinas's picture
Ten

We're a small adult ed program that is sponsored primarily by our county's Adult Probation Dept.  Just in the last year or so, we've had at least three students who we knew were on methadone treatment.  All of them struggled with drowsiness and actual sleep, some to the point of snoring in class.  It is very awkward to have to regularly awaken them and bring them back to the activity of the class. Their probation officers are happy that they attend class regularly so they don't perceive the problem in the same way.  We have counseled the students to talk with their medical providers at the methadone clinic about these impacts on their lives, but they hesitate to for whatever reasons.  I don't necessarily expect anyone to solve this for us, but it is one of the things that happen when people are in treatment.

Katherine L. Cavanaugh's picture
First

Hi Julie,

I appreciate your comments as it helps me to see some of the challenges for adult students. I work with reentry adults who are in class because it is part of their probation requirements, or part of their recovery program under the state Department of Rehabilitation and Disabilities. Last year I encountered what you mentioned with some students and did not fully realize the potential (and/or actual) impact of treatments such as methadone on daily activities. I find your comment about hesitation on the part of the student to talk with their medical providers and wonder why this is the case? For example, I am more of a 'root cause' person, meaning I like to address the issue at the basic level. How can we prevent or address if we do not know the root cause. In the case of not asking questions, perhaps it is too risky for the student to talk with medical staff for a variety of reasons. Thoughts?

Jeffrey Abramowitz's picture
Ten

One of the realities of drug and alcohol treatment following prison is the fear that asking for help or support will lead to additional supervision, retribution or additional monitoring. It is important for returning citizens to understand that they can and will receive confidential and unconditional support, if they comply with their program, participate and stay dedicated to overcoming the challenges that they will be facing.

Susan White Ahl's picture
First

I wonder, too, how much shame plays a part in this fear. One of the things I encounter as an educator is a need to help individuals recognize and build resilience as they practice self-advocacy. 

Jeffrey Abramowitz's picture
Ten

Shame most certainly plays a huge part in the process of reentry in general. Many men and women who have successfully completed the sentence imposed by the courts, now face a sentence imposed by society as the barriers and challenges of employment, housing, basic needs and addiction all must be tackled in a relatively short period and with often little support or direction for appropriate services.

We need to recognize the multitude of barriers that face the men and women leaving our prison systems and find a holistic way to provide those wrap around support services that our so badly needed. I believe that education, skill development and helping men and women find a career pathway will go a long way in changing the system. Unfortunately, as with addiction issues, this process needs to begin the very first day of contact with our criminal justice system, not merely upon release. 

Julie Neff-Encinas's picture
Ten

As the program director, I have no idea why this is an issue.  I don't know the one most recent student that well and her teacher has gotten nowhere with talking to her about it and offering ideas as to how to remain more alert.  She's a kind, bright woman when she is alert.  One of the others ended up burning all his bridges and was reincarcerated, and one continues to plod along trying to learn, but I fear her brain is struggling to learn due to the 20 or so years of chemical abuse.

Tami Kenyon's picture
First

As an educator who works in adult education at a BOCES part time site but also as a Vocational Educator/Case Manager in an inpatient Substance Abuse facility full time, it is important to treat a Methadone student just as we would treat a student with a disability who struggles with organization or even an individual with say narcolepsy.  The medication they take is to assist them at having a healthy lifestyle. If the individual is struggling to stay awake in the classroom they should be offered accommodations within the classroom setting to get them through the day. One of these I can suggest is to offer frequent breaks so that they can get up and walk around, put water on their face or simply get fresh air. They can also be advised to speak with their provider to lower the dose a little bit to help with sedation.  They need to be praised for wanting to change their lives and for coming to class. Taking the step to be clean and also trying to gain an education are positive ways for them to change their life and eventually ween off of the methadone all together but this all comes with time.  The same accommodations we make for those4 with physical, learning or emotional issues should apply with those with methadone treatment. If we don't offer these accommodations they will stop coming because they feel stigmatized and then this could lead to relapse. They need support and school becomes a structured support that provides hope for them.

Michael Cruse's picture
One hundred

Thanks, Tami, for sharing your experience with us.  Your work with learners in recovery gives me a real sense of issue from the learners' perspective.  You're right that we need to encourage and support these learners, regardless of their disability status, under the Americans with Disabilities Act (ADA), and Section 504 of the Rehabilitation Act.  As educators, good teaching means meeting our learners where they are, and providing resources - within our capacity - that encourages and supports access to our programs.

For those who are interested in how a person becomes qualified as an individual with a disability, you should read, When is a Drug Addiction a Disability Under Federal Disability Rights Law? This document from the U.S. Department of Health and Human Services (DHHS) outlines the essential eligibility requirements for receipt of services or participation in programs, activities, or services receiving federal financial assistance from DHHS.  It also clarifies a point regarding individuals who currently engage in the “illegal use of drugs”, stating that they are specifically excluded from the definition of an individual with a disability.

Dr. Bruno mentioned the use of MAT, or Medication Assisted Treatment (MAT), as an effective treatment to address opioid misuse and addiction.   DHHS also makes clear that "persons receiving MAT cannot be, by virtue of that fact, excluded from protection under federal disability rights laws. Because MAT related medications are prescribed and are taken under the supervision of a licensed health care professional, MAT is not the illegal use of drugs".

Thanks again for highlighting the needs of persons with disabilities who are working to use our programs as part of a structured support system.  Your examples point to our ability to make the difference that will help keep them on the path of treatment and recovery.

Best,

Mike Cruse

 

 

Katherine L. Cavanaugh's picture
First

Good Morning,

As a professional educator working with reentry populations of adults with addition issues, I am wondering how to promote open-ended discussions among adult learners and still protect their privacy rights? For example, how do we introduce curriculum related to the "Impact of the Opioid Epidemic on Adult Education" in the classroom? Since personal health information (PHI) is protected and individual addiction challenges can only be discussed if 'self disclosed' how do we as educators solicit personal experience, views, and questions from students? Granted, some of my students are open to sharing their health history, others are not and may find such curriculum topics 'invasive.' What should be the role of the educator to avoid 'preaching' and practice 'teaching to reach and help' reentry adults learn more effectively?

Thanks!

Jeffrey Abramowitz's picture
Ten

HI. Thanks for your questions. Working with reentry students who are battling addiction issues pose very unique challenges. I believe that having peer mentoring with men and women that have traveled down a similar path is very helpful in keeping students engaged and aware of the challenges that lie ahead. Often students are in classes not because they want the support, but because it's mandated by the probation/parole system. I find that contextualized learning that brings a student into a career sector that he/she is passionate about, often helps keep them engaged and participatory. As educators, thinking outside the box and being creative with role playing, technology and activities may go a long way in helping returning citizens learn, explore and grow. Jeff A

 

Julie Neff-Encinas's picture
Ten

Peer mentoring is a key component of most highly successful treatment programs and I'm guessing that our students have such mentors in their treatment programs.  However, in probation, clients are typically restricted from forming tight relationships with others with a criminal history unless it is in controlled settings.  We can't even have student group assignments that require students to meet outside the classroom to work together as a team.  So, we are not able to create these mentoring relationships ourselves. 

As I said originally, I don't perceive there to be "a solution" to this issue beyond clients having conversations with their medical providers regarding the impact of the treatment on their daily activities and we cannot be involved in it as educators.  That is purely between patient and provider.

Kathy_Tracey's picture
One hundred

Hi all, 

I think you may find this PBS Resource as meaningful to this strand. http://www.pbs.org/wned/opioid-epidemic/for-educators/

I see two distinct conversations from this strand thus far. First, the role of the teacher in the classroom and secondly, the role of the support services we provide students. Often, these intersect as the teacher is often the first person aware of the student needs and then makes the referrals. Yet, we are entering unprecedented times, with the opioid epidemic touching all of us in some form. 

A part of the solution is awareness, education, and intervention. So, let's start with the awareness. Professional development for all staff could be a start. Helping educators and support staff develop a full understanding of both the epidemic and local resources is a great place to start. Then, integrating reliable information into the classroom can help educate students on those same topics. The PBS link I shared is a starting point for ideas. 

Kathy Tracey

Tami Kenyon's picture
First

There are now people in the addiction field that actually are in recovery and can guide a newly sober person through the steps they can take to gain long term sobriety.  These are called Peer Advocates and can often be found in the outpatient substance abuse programs that many students with an opiate addiction and seeking help are attending or you can actually google for them.  These individuals do just that peer mentor.  I like the idea of someone within the classroom with similar issues assisting others but this also is all about "self disclosure" which some do not want to share.

Michael Cruse's picture
One hundred

Hi, Tami -

I'm interested in hear more about the use of Peer Advocates for persons in recovery.  Do you know whether this is part of a regional, or national effort to support learners in the classroom?  I also wonder how this is working with the issue of disclosure.  It must require either a self-contained learning environment, where learners are all members of a treatment community, or a very high degree of disclosure by participants.  If you have other resources to share about this role, please let us know.  It sounds like a valuable opportunity to support learners in our programs.

Best,

Mike Cruse
 

Susan White Ahl's picture
First

Hi, 

I wonder if there is a recovery community in your area which may have individuals interested in sharing their stories? Our community has a very active Peer Recovery network, individuals who are supporting others in their journey and who are also actively advocating for new policies for harm reduction, etc. You might find that having volunteers, who have "been there" and who are active in Recovery, available will open up the discussions and create a safe place for learning and exploration. I think it's important to introduce resources, even when individuals may not be ready to fully participate. It often takes hearing a message many times, many ways--keep faith that you are planting seeds. If there isn't an obvious recovery community center in your area, you can locate NA or other recovery meetings or contact local LADAC counselors who might be able to help build a network of individuals working as peer support? 

Paul Jurmo's picture
Ten

Thanks, everyone, for the thoughtful questions and suggestions posted so far.  

There isn't "one solution" that will work for all of the clients and contexts adult educators work with. I am an adult educator who, among other things, took the lead in setting up a special prisoner re-entry initiative in an urban county in NJ. Our community college worked over 2-3 years with other service providers (parole office, a day-reporting center where recently released former inmates came for a a variety of service, county workforce center, local non-profits and religious organizations...) to better coordinate services and to expand access to education services for the clients).

Based on this and other related experience, I'll jump in here now and make some suggestions about general things adult educators might do when trying to serve people with opioid and other substance abuse problems:    

  • Staff should educate themselves about the issue of opioid abuse generally and how it can impact adult learners and adult education programs. Staff should understand that solving this problem is also complex, with many components.  Adult basic educators can be part of the solution but shouldn’t be expected to do this all by themselves. 
  • Staff should also be careful not to take on tasks (e.g., providing drug counseling to substance abusers) that they are not equipped or legally allowed to do.
  • Staff can:
    • Develop/strengthen relationships with agencies (e.g., healthcare, public safety, prisoner re-entry) dealing with this issue.
    • Get training for staff from those partners (about symptoms of opioid abuse to look for, how educators can respond helpfully and appropriately to abusers and their families, etc.)
    • Develop referral relationships with those other partners.
    • Incorporate discussion of the opioid abuse issue into basic skills classes under the heading of “health literacy” and/or “family literacy.”  Activities might include a combination of:
      • Guest lectures or videos by subject matter experts.
      • Project based learning in which learners develop understanding of this issue and what they can do if it impacts them personally, their families, and/or community members. 
      • Reading and discussion of information available on reliable handouts and web sites. 
      • Other health literacy activities that help learners engage in healthy behaviors.
    • Seek additional funding (possibly with the health agency or other partners) to strengthen the adult education program’s ability to respond to this issue.
    • Review whether and how this issue might impact program’s security and, if so, what steps might be taken to ensure security for learners and staff.
    • Add new staff (e.g., social workers, health educators…) to help learners deal with this issue.
    • Revise intake and other assessments/case management activities to facilitate confidential communication with learners about this issue. 
    • Join community/county/state task forces or coalitions that are trying to deal with the opioid abuse issue in a comprehensive, systematic way. 

I'll stop here for now and look forward to further dialogue on this important and complex issue.

Paul Jurmo

www.pauljurmo.info  

 

Jeffrey Abramowitz's picture
Ten

Paul, your comments are insightful and spot on! Working with returning citizens on a daily basis reminds me that there is much I don't know about addiction and I remind my staff that this is an opportunity to learn and most importantly rely on the experts in this field to helps us understand how we can better serve the reentry population. Thanks for chiming in. Jeff A

Andrew Pleasant's picture
Ten

I would hope, personally, that the prevention of opioid abuse would receive as much attention (and thus funding) as the response and treatment after the abuse has emerged in individual lives and communities. 

Andrew Pleasant

Jeffrey Abramowitz's picture
Ten

https://www.researchgate.net/publication/233813962_Substance_Abuse_Treatment_Gap_Among_Adult_Parolees_Prevalence_Correlates_and_Barriers

The above link to Substance Abuse Treatment Gap Among Adult Parolees: Prevalence, Correlates and Barriers is chock full of information, data and related studies that provide some guidance on best practices and treatment for men and women coming home and battling ongoing addiction issues.

Jeff A

jeffrey.abramowitz@jevs.org 

Jeffrey Abramowitz's picture
Ten

Interesting. In a study done by FAMM, Families Against Mandatory Minimums (2017), it was found that 2/3rds of the inmates who responded said that they had a drug or alcohol addiction when they entered prison. Of those participating in the RDAP (Drug program behind the walls), 76.5% found the program very helpful.

Just a few nuggets of knowledge.

Jeff A

Michael Cruse's picture
One hundred

I'm glad you bring up the topic of prevention as being key to addressing the epidemic, Andrew.  I agree, it deserves at least equal attention to recovery in terms of our response.  This U.S. Health and Human Services's resource library is aimed at prevention-related services, which adult educators should be aware of in helping promote opioid prevention.   What are other prevention-focused spaces that others are familiar with for sharing prevention education resources?

Mike Cruse

michaelcruse74@gmail.com
 

Michael Cruse's picture
One hundred

I'm glad you brought up the issue of disclosure, Katherine.  It's a topic that impacts persons with many different types of disabilities.  Addiction is a protected status under the Americans with Disabilities Act (ADA), and the U.S. Commission on Civil Rights does a good job of outlining these protections.  You may also find some more general advice on disclosure with adult learners from the Learning to Achieve resource, which is a research-based collection of professional development materials focused on increasing the achievement of adults with learning disabilities. While the disability categories are not the same, many of the strategies for working with learners are the same. 

I'm curious if anyone knows about disclosure resources specifically targeted to the needs of persons managing opioid addiction?

Mike Cruse

michaelcruse74@gmail.com

Elizabeth McDowell's picture
First

Why can't I see the interview and comments?  It's 10 minutes into the session and I see nothing. please guide me to the right place.

Thanks

Jessica Dapsis's picture
First

Have you had any luck finding the interview?

Michael Cruse's picture
One hundred

Hi, Jessica -

Please email me directly for support with participating in the discussion.

Best,

Mike Cruse

michaelcruse74@gmail.com

Michael Cruse's picture
One hundred

Hi, Elizabeth -

You are in the right place.  The panel discussion is taking place in the same thread where you posted your comment.  Our panelists will be joining us shortly with their responses to the opening questions.  Please email me directly if you need additional support with participating in the discussion.

Best,

Mike Cruse

michaelcruse74@gmail.com

Jessica Dapsis's picture
First

I am also new to this- where do we access the main discussion?

Michael Cruse's picture
One hundred

Hi, Jessica -

Please email me directly for support with participating in the discussion.

Best,

Mike Cruse

michaelcruse74@gmail.com

J.Harris's picture
First

I am very unfamiliar with this topic and have found the introduction and comments insightful. Thank you. 

So far I have seen many comments regarding students (and possibly teachers) who have experienced addition to opioids.

Can you speak to preventative methods to avoid addiction and also ways to identify when a person is in the beginning stages of addiction (i.e. what will we notice in students who may not have previously used these chemicals, but have started).

 

Michael Cruse's picture
One hundred

Hi, Jamie -

Thanks for your comment and question about resources for prevention.  The U.S. Drug Enforcement Agency (DEA) and Discovery Education have created Operation Prevention's classroom resources, which provides educators with curriculum aligned to national health and science standards. Through a series of hands-on investigations, these resources introduce learners to the science behind opioids, and their impact on the brain and body.  Operation Prevention has reached over 1M individuals nationwide, and is available in English and Spanish. While its primary audience is K-12 learners, the high school curriculum is also applicable to adult education populations. 

I'd also recommend checking out the LINCS Resource Collection's links to Operation Care.  While they don't have materials specific to opioids, they have relevant materials on addiction, alcoholism, and depression that connect with many of the same issues experienced by individuals with opioid dependence and addiction.

Best,

Mike Cruse

michaelcruse74@gmail.com

 

J.Harris's picture
First

I am very unfamiliar with this topic and have found the introduction and comments insightful. Thank you. 

So far I have seen many comments regarding students (and possibly teachers) who have experienced addiction to opioids.

Can you speak to preventative methods to avoid addiction and also ways to identify when a person is in the beginning stages of addiction (i.e. what will we notice in students who may not have previously used these chemicals, but have started).

 

Michael Cruse's picture
One hundred

I want to thank Paul and Jeff for sharing some of their knowledge and experience with how addictions impact adult learners, and adult education programs.   I'm hoping we can talk more about how family literacy programs can be part of the response from adult educators, and also discuss whether there are any important difference in how the epidemic is impacting urban vs. rural communities.

Members, you're also encouraged to share your thoughts and experiences with us, as we to try and answer these questions.

Questions:

3.   Many adult education programs include family literacy services. What information is available for these programs to help educate children, and young adults about the disease, pain management alternatives, and precautions for families who may have prescription opioids in their home, for a family member’s prescribed use?

4.   The opioid epidemic impacts individuals from urban areas to more rural environments. Where do you see the greatest need where you are, and are there differences in services needed for different communities struggling with opioid addiction?

Mike Cruse

michaelcruse74@gmail.com

Paul Jurmo's picture
Ten

As I mentioned in my earlier comment, adult educators need to approach this issue of opioid abuse in well-informed and systematic ways, to both be helpful and to avoid doing harm.  

Many adult basic skills programs already provide instructional and other activities that help learners deal with family issues.  (Equipped for the Future cited "family" as a key role for adult learners.)  Many adult learners might now be dealing with the opioid issue, possibly for themselves but also possibly as it impacts members of their families and communities.

As I mentioned in my earlier comment, those programs might (individually and collectively)  work with local health agencies  dealing with opioid issues to (1) educate themselves about the opioid and other substance abuse issues; and (2) develop collaborative arrangements with those agencies,.

These collaborations can take the form of the education program referring learners to health agencies; bringing in guest speakers and counselors from health agencies;  making suitable  pamphlets, videos, web sites and other health education resources  available at the program site; conducting training for adult education staff; and seeking funding the supports this work.  (It is not fair or effective to simply add this kind of work onto already-overworked adult educators.)

As stated earlier in comments by various people,  work around the opioid issue also needs to be done with sensitivity, confidentiality, and with respect for good medical practice.  

Lots to think about!  And hence the need for individual programs and the field more broadly go about this systematically, especially because this crisis will likely be impacting the communities adult educators serve for some time.

Paul Jurmo, Ed.D.                                                    (www.pauljurmo.info

Kathy_Tracey's picture
One hundred

As we have discussed the variety of issues, complexity of disclosures, and expectations of staff, I think this article is relevant. The article explores the new front lines on the role of professionals as first responders.
https://www.usnews.com/news/health-news/articles/2019-01-28/opioid-epidemic-creates-new-first-responders

How many programs address training for staff members along this theme?

I'd love to hear your thoughts.
Kathy

Richard Bruno's picture
First

Hello everyone, 

Thanks, Michael, for the invitation to join you in this discussion. I'd like to give you a quick background on the work I do, and hopefully engage on some of the questions posed so far. I'll preface my responses by saying that I can't provide medical advice, but will speak generally about the opioid crisis and work being done to prevent and treat opioid addiction.

I'm a family physician in Baltimore, Maryland, and prescribe Suboxone (buprenorphine/naloxone) for people with opioid use disorder. I'm also active with our state medical society and chair the public health committee, where I write and give testimony to our state legislature on many bills, including, most recently, expanding addiction treatment in jails and prisons in Maryland. 

Like many communities in the US, the opioid crisis touches every neighborhood in my city, and has been a product of a complex interweaving of multiple factors, from pharmaceutical manufacturers, to medical practitioners, to law enforcement. Unfortunately we have failed on many levels to curb the epidemic, and the crisis has taken such a toll on people in the US that life expectancy has gone down. Over 42,000 people overdosed on opioids in 2016, with almost half of those being from synthetic opioids. 

I think what's important about this forum of adult educators is that you are seeing people who may be struggling, and are at critical junctures to educate people and also recommend further evaluation. I'll frame the work of opioid interventions into Upstream, Midstream, and Downstream interventions. Upstream is primary prevention—it's working to prevent people from falling into the river of addiction in the first place, by erecting barriers at the water's edge, and cutting down on opioid prescriptions from medical providers (no one needs 90 oxycodones when they get their wisdom teeth extracted), as well as stymying the influx of Mexican heroin and Chinese fentanyl into communities. Midstream, we are putting up a net to catch people before they fall off the waterfall and overdose. This can be harm reduction strategies for active users, like clean needle exchanges and safe consumption spaces and fentanyl testing strips for people can test their heroin for deadly amounts of fentanyl, Medication Assisted Treatment (or MAT: methadone, Suboxone, Vivitrol) to help people with their addiction, and substance use counseling. Downstream, we must have the antidote naloxone (Narcan) readily available so people can save the life of someone who has overdosed and may drown at the bottom of the waterfall. Unfortunately, this figurative life preserver is made out of paper and will dissolve in 15 minutes, so we have to our best to rescue the person by pulling them out of the water and getting them into treatment to avoid overdosing in the future.

In response to Michael's posed questions:

1. Drug dependence is usually characterized by chronic use and withdrawal symptoms upon rapid cessation. This is different from addiction, which is characterized by compulsive use despite harm and cravings. Both opioid and alcohol use disorder are characterized by DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) criteria for substance use disorder, some of which include increasing tolerance (having to use more of the substance to achieve the same effect), wanting to cut down but not managing to, and spending a lot of time to get, use, or recover from use. Substance use counseling is similar for both opioids and alcohol use disorder. The medication treatments are different (since the two substances affect different receptors in the brain).

2. Because both opioid and alcohol use disorders affect people's lives, their relationships, their work, their education, it's important to recognize changes in folks and confront them about it in a non-judgmental way. Providing resources (and recommending medical evaluation) may be helpful. It's important to use person-first language, such as PWID (people who inject drugs), people struggling with addiction, etc, and avoid inflammatory language like addict or abuser.

 

Jeffrey Abramowitz's picture
Ten

Thanks Richard for your insights.

Unfortunately, our criminal justice and social service agencies continue to struggle with how to address the challenges that face the men and women returning home from incarceration. As some may be aware, I was a trial lawyer for twenty years before some very poor choices led to a federal indictment and a five year stay in a federal penitentiary. It was however my return home and my mandatory stay for over nine months in a halfway house that was the most challenging part of my journey. I resided in a home where there were more illegal drugs than you could possible imagine. A home where illegal drugs were sold out in the open and where drug overdoses were the norm, not the exception. I lived in fear of making the choice to report an overdose and possibly save a life, or face the possibility of inmate retaliation and even worse, return to prison. It was like putting a carrot in front of a rabbit that had not eaten in months or years, without him knowing that it was laced with arsenic. I fought this by advocating for the closure of the place that was my home, and eventually this facility was closed by the federal and state government agencies. As I travel the country and speak with men and women in halfway houses, this is the sad reality of today and something that must change. Drug and alcohol addiction is a disease which needs to be treated and not buried because of the challenges it poses to those most effected.

Unquestionably, the issues presented and raised in this discussion are complicated, involve specialized medical considerations, and require much education for educators and administrators alike. It will only be through on open and frank dialogue and discussion, as we have seen in this thread, that we can begin to face the challenges that lie ahead. 

Thanks for everyone's input and voice.

Jeff A 

Michael Cruse's picture
One hundred

Jeff,

Thank you for sharing your personal story with us, and highlighting how it influences your work.  I wonder if you can shed any light on your work across the country, and what - if any - differences you see in working with communities in urban and rural areas?  Do you see different needs across these environments, different avenues for approaching the issues of prevention, as well as recovery and return-to-work?

Mike Cruse

michaelcruse74@gmail.com
 

Jeffrey Abramowitz's picture
Ten

As I travel the country the one thing that I see is "discussion". Finally, people in both rural and urban areas are recognizing the need to address the issue of drug addiction head on. Educating our communities about the realities of addiction, recognizing that this is not a black or brown issue but a societal issue, and beginning to talk about possible solutions are all good first steps. Legislators across the country, and at all levels, are beginning to provide funding and support to the men and women challenged by addiction issues and now more than ever we as educators and administrators need to step up and lead the charge for wider programming options, employment and skill training opportunities, and medical support for all who are struggling. I am blessed with the ability to work with passionate people across the country who advocate for change and now we all need to step up our game.

The needs of those in the rural setting are remarkably similar to those in the urban setting. It is the approaches and programming which is often the difference. Drug courts and diversion programs are now becoming more commonplace as we are understanding the reality that locking someone away does not solve the underlying problem. Targeting youth (18-24) year old individuals has become a priority in many communities. One of the most needed areas of support lies in the employment of men and women with addiction issues. Employers need to begin to open their doors wider for those battling addictions and recognize the value of the workforce that they have mistakenly overlooked for years due to fear of liability and misunderstanding. The Society for Human Resource Management (SHRM) has dedicated their 2019 campaign to educating employers on hiring returning citizens. It is these small steps that will help people obtain a living wage and opportunity for advancement.

We have a long way to go, but we are all in this together and we must all work to find a solution.

Thanks

Jeff A 

Kathy_Tracey's picture
One hundred

Hi all, 
As Jeff mentions, employers need to open their doors for individuals with opioid and other addiction issues. Here are a few examples of states stepping in: 

The Opioid Workplace Safety Program will provide up to $5 million over two years to help employers in Montgomery, Ross and Scioto counties hire, manage and retain workers in recovery from an opioid addiction.  https://www.daytondailynews.com/business/employment/pilot-program-encourage-employers-hire-recovering-addicts/RBCRy95fVIFcmjwFMeBVBL/ and Operation Hope Shot http://www.ncnewsonline.com/news/fighting-opioid-addiction-linked-to-filling-vacant-jobs/article_ca826874-61f8-11e8-b6ed-9bc783a9b8f7.html 

I hope you find these useful. 
Kathy 

Michael Cruse's picture
One hundred

Dr. Bruno -

Thank you for joining us and sharing your perspective as a primary care physician dealing with the epidemic in Baltimore.  Your framework analogy of Upstream - Midstream - Downstream prevention and treatment is a powerful visual to help us think about the different entry points that adult educators can have in working within communities.  I want to share Dr. Bruno's Prezi on Deconstructing the Opioid Epidemic: Piecing Together What Works for People Struggling with Addiction.  This presentation format really lends itself to visualizing the different access points for those invested in this work to think about how they can take action. 

Members, have a look at the Prezi by clicking on the blue hyperlink of the title above.  What thoughts do you have about how the upstream-midstream-downstream analogy can help us better frame our work as adult educators?

Mike Cruse

michaelcruse74@gmail.com

Michael Cruse's picture
One hundred

 

We have time for one more panel question, and I want to again invite members to share their comments with us.   The economic cost of the opioid crisis is significant, and continues to grow in terms of medical treatment, unemployment, and lost wages. 

To that end, the U.S. Department of Labor, Employment and Training Administration funded the National Health Emergency Dislocated Worker Demonstration Grant Pilot Program to Help Communities Fight the Opioid Crisis.  This $21million fund is enabling six states to retrain workers in communities impacted by the widespread opioid use, addiction, and overdose. These states are: Alaska, Maryland, New Hampshire, Pennsylvania, Rhode Island, and Washington.  The $21 million dollars from the grant funding to these six states will likely be used to create resources and programs that will be replicated across the U.S. to address the long-term impact on communities. 

Maryland recently released guidance on the implementation of workforce solutions to address Maryland’s opioid crisis. This is supported by other efforts in the state aimed at the prevention of opioid use as early as K-12.  The Maryland State Department of Education's Heroin and Opioid Awareness and Prevention Toolkit is a another example of efforts aimed at addressing the epidemic at multiple levels, in order to improve communities that have been most adversely impacted by this epidemic.

Questions: 

5.  What opportunities do you see under WIOA for addressing the opioid epidemic’s impact on the U.S. workforce? 

6.  What do you hope states will prioritize as part of their efforts to address the epidemic's impact on the workforce, and the employment opportunities of individuals directly affected by the epidemic?  

 

Mike Cruse

michaelcruse74@gmail.com

Jeffrey Abramowitz's picture
Ten

I believe that over the next few years you will see more emphasis on educational support, skill training and intensive wrap around supports in the workplace. It is my hope that WIOA will become tool to help people change the direction of their lives. Apprenticeships and on the job training will give way to the untapped labor pool of people with disabilities and barriers and we will begin to right this sinking ship.

Paul Jurmo's picture
Ten

National, state, and local policy for adult basic education should aim at creating and sustaining high quality systems for using ABE as a tool for helping adults succeed in work, family, and civic roles.  

But “work roles” (and hence work-related basic education) should not be narrowly defined.  We need to recognize that individuals not only need technical basic skills and relevant credentials to attain suitable jobs and then perform the material and social tasks required by those jobs. If they are to then retain, succeed in, and advance in employment, learners also need particular skills, knowledge, and credentials to manage the many non-work-specific responsibilities (e.g., transportation, housing, health, personal finances, legal . . . ) that adults must perform.   Managing one’s own health and that of family members (i.e., children, elderly, disabled) is one of those responsibilities.

This is where opioid and other forms of substance dependency come in.  We can now see that the illegal use of opioids is impacting adult learners, their families and communities, and adult education programs.  Policy makers and funders for adult basic education and related fields like public health, public safety and criminal justice, and employment need to step up and acknowledge the complexity of this issue and how it relates to personal health, the well-being of families and communities, public safety, and employability.  (Employers, labor unions, and advocacy organizations for various segments of the workforce also need to be part of this discussion.) 

Policy and funding should support creative and collaborative efforts across sectors, to equip adult education to effectively help adult learners deal with the opioid issue in their personal lives, families, and communities so they can then succeed in academic, work, family, and civic roles.

The good news is that policymakers in adult education, criminal justice reform, public health, and other fields have already been supporting cross-sector systems. Adult basic education has for some time been supporting the building of systems that integrate adult basic education with other supports (e.g., healthcare, workforce and economic development, technical training) to help learners move along particular career pathways.  Criminal justice advocates have also tried to build systems for helping formerly incarcerated individuals deal with the many obstacles (e.g., legal, education, health, housing, transportation, employment, family relationships . . .) that block former inmates from transitioning into more constructive lives.  

Adult educators should now be working with representatives of the other stakeholders mentioned above that are also impacted by the opioid issue.  We should collectively be monitoring what’s working in our respective fields and consider how current policies and practices can be improved to allow us to collectively respond more effectively.  This brief LINCS dialogue been a good example that others can learn from and expand on.   Thank you, everyone!

Paul Jurmo.                                                                                                                   (www.pauljurmo.info)

 

Richard Bruno's picture
First

I think one area that is in need of major culture change is the workplace attitude toward employees who are struggling with addiction. Instead of punishing people who fail drug screening tests by firing them and sending them into a tailspin of self-destruction, employers could provide access to rehab and treatment. Return on investment has been shown to be $1,538 for every employee undergoing over 60 days of treatment. This leads to reduced absenteeism, tardiness, conflicts with managers and coworkers, and productivity lost.

The Therapeutic Workplace program at Johns Hopkins Bayview Medical Center is a novel employment-based intervention that uses, "access to employment and wages to reinforce therapeutic behavior change. Under this intervention, unemployed adults living in poverty earn the opportunity to work and earn wages by meeting treatment goals such as maintaining drug abstinence and adhering to prescribed medications." A number of publications have shown the effectiveness of this type of intervention—the principles of which could be applied in many industries. 

 

Michael Cruse's picture
One hundred

I want to extend a thank you to our panelists, Jeff Abramowitz, Paul Jurmo, and Richard Bruno for joining us for this discussion.  Members, let's continue to think about the questions and perspectives raised here, and continue thinking about the role adult education should play in addressing the impact of this epidemic on our learners.  I invite you to use this space as a platform for sharing your challenges and successes.

I will be posting a summary of the last two day's conversation in this thread by Monday, March 11th.  Again, thank you everyone for your engagement and participation.

Mike Cruse

michaelcruse74@gmail.com

Michael Cruse's picture
One hundred

Summary of the LINCS Discussion on the Impact of the Opioid Epidemic on Adult Education

Julie Neff-Encinas shared the challenges of counseling students to talk with their medical providers about the impact of their treatment on their ability to function in classroom, and the hesitation for undisclosed reasons.  Similarly, Katherine Cavanaugh shared her work with reentry adults who are in class because it is part of their probation requirements, or their recovery under the state’s vocational rehabilitation system.  She also wondered how to promote open-ended discussions among adult learners and still protect their privacy rights? She asked, “What should be the role of the educator to avoid 'preaching' and practice 'teaching to reach and help' reentry adults learn more effectively?”

 

Jeffrey Abramowitz shared that the realities of drug and alcohol treatment following prison is the fear that asking for help or support will lead to additional supervision, retribution or additional monitoring. It is important for returning citizens to understand that they can and will receive confidential and unconditional support, if they comply with their program, participate and stay dedicated to overcoming the challenges that they will be facing.  Jeff also highlighted the impact that shame plays in the re-entry process of formerly incarcerated adults. He noted that having successfully completed the sentence imposed by the courts, they next face a sentence imposed by society through barriers and challenges of finding employment, housing, and accessing addiction treatment.  He connected this need to implement holistic wrap around support services that provide contextualized learning as a way to bring students into career sectors that they are passionate about in building new futures.  Jeff commented that having peer mentoring with men and women that have traveled down a similar path is very helpful in keeping students engaged.  

 

Julie Neff-Encinas also commented that peer mentoring is key to creating highly successful treatment programs, but noted that probation often restricts persons from forming tight relationships with others with a criminal history, unless in controlled settings.  She noted that this is an obstacle to creating mentoring relationships for learners. Susan White Ahl wondered if a recovery community may have individuals interested in sharing their stories. 

 

Kathy Tracey shared the PBS resource Understanding the Opioid Epidemic for Educator as a resource to consider in answering the questions raised.  Jeffrey Abramowitz shared Guidelines for Successful Transition of People with Mental or Substance Use Disorder from Jail and Prison: Implementation Guide.

 

Paul Jurmo commented on the need to develop relationships with agencies to:

  • Train staff on symptoms of opioid abuse, and how educators can respond.
  • Develop referral relationships with those other partners.
  • Include discussions on opioid abuse into basic skills classes.
  • Review program security and plan steps to ensure learner and staff safety.
  • Revise intake assessments/case management activities to facilitate confidential communication. 
  • Join community/county/state task forces or coalitions dealing with issue in a comprehensive, systematic way. 
  • Seek funding to strengthen adult education’s ability to respond to this issue.
  • Add new staff to deal with addiction-related issues.

 

Andrew Pleasant commented that the prevention of opioid abuse should receive as much attention and funding as response and treatment.  Michael Cruse shared the  U.S. Health and Human Services's resource library, aimed at prevention-related services, and general advice on disclosure with adult learners from the Learning to Achieve resource, a research-based collection of professional development materials focused on increasing the achievement of adults with learning disabilities.

 

Jamie Harris asked about preventative methods to avoid addiction and also ways to identify when a person is in the beginning stages of addiction.  .  Michael Cruse shared Operation Prevention's classroom resources, which introduces learners to the science behind opioids, their impact on the brain and body, and is available in English and Spanish.  He also highlighted the LINCS Resource Collection's links to Operation Care, which has relevant materials on addiction, alcoholism, and depression that connect with many of the same issues experienced by individuals with opioid dependence and addiction.

 

Richard Bruno shared the analogy of Upstream-Midstream-Downstream Preventions. Upstream is primary prevention, which works to prevent people from falling into the river of addiction in the first place. Midstream is putting up a net to catch people before they fall over the waterfall and overdose, and includes harm reduction strategies for active users, like clean needle exchanges, safe consumption spaces, fentanyl testing strips, Medication Assisted Treatment to, and substance use counseling. Downstream is administering the antidote naloxone (Narcan) to someone who has overdosed and may drown at the bottom of the waterfall.

Richard noted that drug dependence is characterized by chronic use and withdrawal symptoms upon rapid cessation, which is different from addiction, which is characterized by compulsive use despite harm and cravings.  Opioid use disorder is characterized by DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) criteria for substance use disorder.  Richard suggested that providing resources – to include medical evaluation - may be helpful. He also noted the importance of using person-first language, such as PWID (People Who Inject Drugs) to refer to people struggling with addiction, and avoiding inflammatory language like ‘addict’ or ‘abuser’.

 

Michael Cruse connected the conversation to the U.S. Department of Labor, Employment and Training Administration’s National Health Emergency Dislocated Worker Demonstration Grant Pilot Program to Help Communities Fight the Opioid Crisis.  This $21million fund is enabling six states to retrain workers in communities impacted by the widespread opioid use, addiction, and overdose. These states are: Alaska, Maryland, New Hampshire, Pennsylvania, Rhode Island, and Washington.  The $21 million dollars from the grant funding to these six states will likely be used to create resources and programs that will be replicated across the U.S. to address the long-term impact on communities. Using Maryland as an example, he highlighted recently released guidance on the implementation of workforce solutions to address Maryland’s opioid crisis. This is supported by other efforts in the state aimed at the prevention of opioid use as early as K-12, through the Maryland State Department of Education's Heroin and Opioid Awareness and Prevention ToolkitKathy Tracey also highlighted the Ohio Bureau of Workers’ Compensation’s Opioid Workplace Safety Program, which will provide up to $5 million over two years to help employers hire, manage and retain workers in recovery from an opioid addiction.

 

Richard Bruno cited research that the return on investment has been shown to be $1,538 for every employee undergoing over 60 days of treatment, noting that this leads to reduced absenteeism, tardiness, conflicts with managers and coworkers, and productivity lost.  He highlighted the therapeutic workplace program at Johns Hopkins Bayview Medical Center as a novel employment-based intervention that uses, "access to employment and wages to reinforce therapeutic behavior change”, and concludes that this type of intervention could be applied across many industries. 

randomness