Opioid addiction affects people from every walk of life – but some have better access to care than others.
Assoc. Prof. Wilson Palacios is conducting research on ways to reach those especially vulnerable groups: people who face economic or cultural barriers to treatment, suffer from multiple health problems or have difficulty with housing.
Right now he’s working on a project that aims to reduce overdoses by Lowell residents who inject drugs and to slow the spread of serious diseases, including HIV/AIDS and hepatitis C, through needle-sharing. The research is a partnership between UML, the Tufts University School of Medicine, and city agencies and nonprofits.
“A lot of police officers will tell you, ‘We can no longer arrest our way out of this,’” says Palacios, who teaches in the School of Criminology and Justice Studies. “Now we’re talking about harm reduction, where police are often the first stop on the road to treatment instead of the first stop on the road to jail.”
Robin Toof, director of the university’s Center for Community Research and Engagement, says doing research that benefits the community is a crucial part of UMass Lowell’s mission – and faculty research on the opioid epidemic is a prime example.
“At the same time, we couldn’t possibly do this kind of research without community partners who can provide hands-on insights and expertise – and then implement possible solutions based on our findings,” Toof says.
Palacios has made research that helps people who use drugs his life’s work. Asst. Prof. Angela Wangari Walter, a new faculty member in the Department of Public Health, shares his dedication. Her research addresses opioid use disorders among fishing industry workers in New England and other under-served groups.
“We know that the opioid epidemic does not discriminate,” Walter says.
Palacios, a faculty associate of the Center for Community Research and Engagement, has worked with Toof and evaluation specialist Melissa Wall on several grants involving the City of Lowell, treatment service providers, first responders and other academics – as well as people who actively use injection drugs.
“If you just talk to people, they’ll tell you what’s happening on the street,” he says. “Epidemics aren’t static. They’re always changing.”
The biggest recent change is the introduction of fentanyl, a synthetic opioid that’s 50 to 100 times stronger than morphine. It is showing up mixed with heroin and other street drugs, including cocaine and marijuana.
A grant from the Centers for Disease Control and Prevention and the state Department of Public Health funded an intensive, weeklong survey last year of people in Lowell who use injection drugs – known as a Rapid Assessment of Consumer Knowledge (RACK) – by Palacios, along with Asst. Prof. Thomas Stopka from Tufts and medical and graduate students from Tufts and Boston University.
They focused on learning as much as they could about how people who inject drugs are affected by fentanyl, the rise in HIV/AIDS and hepatitis C infections, and policies designed to stem the epidemic, including restrictions on prescription opioids and the state’s “good Samaritan” law.
Based on the information they gleaned – including finding out that young users know far less about the dangers of sharing contaminated needles than older users who lived through the height of the AIDS epidemic – Palacios, Stopka and their community partners won another multiagency federal grant to design innovative strategies to intervene.
Under the $130,000 Lowell PEERRS (Peer Education and Risk Reduction Services) grant, they have helped find a home for a free and confidential needle-exchange program at the Life Connection Center, expanding it and making it a gateway to educate clients and help them obtain services. They are also training peer health advocates – people who use injection drugs themselves – to educate other users in the community.
The research team, which includes applied psychology and prevention science doctoral student Rianna Grissom, will then evaluate whether those interventions are slowing the spread of injection-related diseases and overdoses.
For the next community survey, under a second RACK grant, Palacios will be involving UML graduate students in criminology, public health and psychology.
Palacios, Toof and Wall are working with the Lowell Police Department and other community agencies on two other major grants. One expands a pilot program in which teams of police, firefighters, emergency medical technicians from Trinity EMS and addiction specialists from treatment provider Lowell House Inc. respond to every overdose to help survivors get treatment and ensure that any minor children in the home get counseling and other services.
Meanwhile, Walter, a behavioral health specialist and research affiliate of the UML Center for the Promotion of Health in the New England Workplace, conducted research in partnership with the nonprofit Fishing Partnership Support Services to provide a basis for industry-specific interventions.
She says fishing industry workers can’t easily avail themselves of traditional treatment when they’re at sea.
“While the rest of us on land can call 911 and an ambulance will show up, if you’re at sea, that won’t happen,” Walter says. “If you’re out at sea, you’re not going to be able to make your counseling appointments, or get to peer support meetings, or take methadone or other medications that may require you to get every single dose at a clinical location.”
Walter and graduate student Cesar Morocho, who worked with her on the project, say fishing industry workers deal with unique stresses. Their jobs involve intense physical labor under conditions that can lead to serious musculoskeletal injuries. If they’re prescribed legal opiates for an injury and continue to experience chronic pain, they’re at risk for developing a substance use disorder.
The seasonal nature of their work and fluctuating incomes can also cause economic stress – and make enrolling in health insurance very difficult, which in turn affects their ability to access treatment, she says.
Finally, there’s the stigma associated with addiction disorders.
“The stigma piece is huge and has caused some resistance within the industry,” Walter says. “Some fishing industry workers might not think of addiction as an illness, or they think they don’t need training in recognizing the symptoms of addiction. Often they’ll say, ‘Our boat is clean. My crew is clean.’”
Using the research findings by Walter and her colleagues, the Fishing Partnership Support Services is working with multiple agencies to address the opioid epidemic, including training fishing industry workers to administer naloxone to counteract an overdose.
Currently, Walter and Asst. Prof. of Criminology Jason Rydberg are working with Middlesex County District Attorney Marian Ryan and Lowell House Inc. on a diversion program that would offer treatment instead of prosecution to people who have substance use disorders or are at risk for addiction.