Addressing Opioid Use in Rural Communities Across Michigan

Overdose deaths involving opioids have increased by more than eight times since 1999 according to the Centers for Disease Control and Prevention (CDC), and many rural communities across the United States are particularly affected by high rates of substance use disorder (SUD) and opioid use disorder (OUD).

With nearly 20% of Michigan’s population living in rural areas, the team at the Michigan Center for Rural Health (MCRH) knew something had to change with SUD/OUD rates in the state. The northern region of Michigan’s Lower Peninsula is historically affected by many socioeconomic factors that contribute to intergenerational poverty, said John Barnas, executive director of the Michigan Center for Rural Health. The team knew they had to understand the daily realities of people in these communities to provide sustainable pathways toward recovery.

MCRH applied for and was awarded a Rural Communities Opioid Response Planning Grant in 2019, funded by the Health Resources and Services Administration (HRSA). The planning grant, and subsequent implementation grants, allow for the Northern Michigan Opioid Response Consortium (NMORC) to bring together 50 partners to address the opioid epidemic across a 25-county northern region in Michigan’s Lower Peninsula. MAP

These partners cover a range of expertise and sectors, including health care facilities, community mental health agencies, local public health agencies, prevention and harm reduction organizations, counseling centers, treatment centers, recovery community resources, law enforcement and emergency medical services.

Peer recovery coaches

NMORC leverages the lived experiences of people dealing with SUD/OUD for communicating, leadership development or peer recovery coach academy trainings, explained Joyce Fetrow, project director of the organization. In fact, more than 1,000 peer recovery coaches work as volunteers in northern Michigan helping others find some level of wellness or recovery throughout their substance use.

These coaches help encourage people to stay in treatment when they start missing their homes, families and pets. Because these coaches are often serving in counseling centers or treatment centers, they support workforce shortages in social work and behavioral health, which is especially needed to fill the health care deficits in rural Michigan, Fetrow said. They can also work in hospital emergency rooms to provide guidance and support to individuals with diagnosed or undiagnosed substance use disorders.

“We kick off every single meeting that we run with a person with lived experience, sharing the recovery story, not their addiction story, to spread messages of hope,” Fetrow said.

Harm reduction strategies

While providing the kits is crucial, the NMORC team complements this work by communicating the need of harm reduction strategies to the public and partnering with providers who are willing to provide medications that can aid in recovery or wellness plans.

One harm reduction strategy is to increase the use and education of naloxone kits throughout communities. The program has provided over 200 naloxone safety kits in public spaces throughout the 25-county region, including libraries and schools.

Continuum of services

When an individual has recovered from SUD/OUD, they may face a new set of challenges with assimilating back into a healthy lifestyle. NMORC collaborates with schools, counseling centers, law enforcement and criminal justice advocates to plug those individuals into resources so that they don't fall back through the cracks.

“We've promoted and supported expungement clinics for individuals with blemished backgrounds because we know that misdemeanors and felonies sometimes prohibit them from employment where they live, or present other barriers,” Fetrow said. “There's not one thing that we haven't touched on in our attempt to make the 25 counties healthier.”

Another resource NMORC advocates for in Michigan is recovery housing. “We can get everyone into treatment, but if they leave treatment and go back to their sick and toxic environment, they're most likely to return to use,” Fetrow explained.

In 2019, there were only two recovery houses in the region NMORC serves. Today, there are over 15. However, the need is still severe — the current number of available beds in recovery housing is 800 when 8,000 are needed, she said.

“You wouldn't take a house plant that was in a living room with no windows or no sunlight and not getting any water and put it in a better environment for 30, 60 or 90 days, and after those 90 days, put it back in the dark room where it doesn't get light and water again,” Fetrow said. “So why have we done that over and over with people?”

The NMORC continues to increase recovery capital in the counties it serves. The resources are more accessible than ever, from telehealth/telemedicine services to the new recovery community center — a drop-in space where people can find meaningful support to connect them to social services, such as getting a driver’s license or social security card. This is especially important for individuals recently discharged from jail or leaving an unsafe environment and need to get back on track.

Stigma reduction

Using appropriate language when speaking about these issues is a key component of what the NMORC does throughout Michigan. Rather than referring to people as “addicts” or “alcoholics,” they should be referred to as “persons in recovery,” or third person language is used to identify a person with alcohol use disorder, substance use disorder or mental health concerns. “Words matter,” Barnas said.

Addressing stigma with law enforcement, court systems and throughout the general community is also key. The NMORC team often presents to community organizations, like rotary clubs or chamber events.

“We want to make sure we’re reaching the entire population because many people suffer in silence every day, based out of stigma, afraid of losing their jobs,” Fetrow said. “But there hasn’t been anyone I’ve ever met that hasn’t been affected in some way or another, whether it's from a neighbor, friend, partner or coworker.”

The team has also helped launch programs to mend the often-tense relationship between those dealing with SUD/OUD and the legal system. An individual who may be facing criminal charges can call Hope Not Handcuffs — a national organization — and seek treatment, so when they go to court, they are well and in somewhat of a stable recovery. In addition, the Angel Program allows an individual who is struggling with substances to surrender themselves to the Michigan State Police Post, no questions asked. They will then be guided by an angel volunteer to go to treatment.

Often, repetitive charges and punitive action is associated with SUD/OUD, but these “no questions asked” programs help connect people to safe, compassionate care. “SUD/OUD is a disease, and you wouldn’t stop a diabetic from getting his insulin,” Barnas said.

Rural Michigan Opioid and Substance Use Summit

The NMORC team launched the Rural Michigan Opioid and Substance Use Summit to meet the need they found for coordinated activities to address prevention, treatment, recovery and workforce efforts across rural Michigan. Held in July, this annual summit brings together rural programs addressing SUD/OUD and provides relevant education on topics related to SUD/OUD. The event creates a space to share current projects, promote networking and develop collaborative program partnerships — all while prioritizing the lived experience of people facing SUD/OUD.

“There is a lot of great work happening in the region and state, but the majority is happening in silos where, if it were shared, it could impact many more communities positively,” said Jeanne Marriott, project associate of NMORC. It takes time to develop programs and narratives, so by building on the work of others, there is expediency in delivery to the people who really need help — and hope — today, she added.

This summer’s summit kicked off with Rodasi Campbell of the Community Recovery Alliance (CRA), whose journey in recovery has included returns to use over the last 16 years. This year, she is approaching nine years consecutively of time in remission.

“I offer my story as a demonstration that recovery is possible, and that living as a person in recovery creates character shifts that allow one to both enjoy life and to contribute to society in meaningful ways,” Campbell said. “The hope in sharing with the general public is to potentially dissolve stigma — the greatest barrier for those not yet seeking help with their SUD.”

Campbell is passionate about educating the public on what SUD/OUD is from a physiological perspective and how recovery could look for different individuals. Her sister passed away eight years ago of an overdose after an arduous journey with SUD. Campbell does this work in honor of her and “all those we’ve lost in active use.” She believes that this kind of advocacy is critical for clearing up “deeply ingrained, widespread, erroneous beliefs in hopes of reducing biases, stigma and shame.”

Campbell added that there isn't just one way to do recovery. “We need you to step on this path and begin to walk in a good way,” she said. “You do deserve it, no matter what you've done, no matter what you have not achieved. You deserve it. We are here waiting for you.”

New at this year’s summit is the Rural Recovery Hero Award, presented to Tory Werth. The award recognizes a recovery advocate who works tirelessly to reduce stigma, change cultural norms, increase access to treatment and build a better living environment for those affected by SUD/OUD in rural Michigan.

“I am delighted and proud to formally acknowledge the hard work and dedication represented throughout Tory’s nearly three decades of work in recovery,” said Fetrow. “A true hero, he does his work quietly out loud — walking the walk every single day without fanfare or accolades, without judgment or expectation. Thank you, Tory!”

Learn more about the work of the MCRH at mcrh.msu.edu.

For substance use services, visit the MSU Health Promotion AOD Program’s website. You may also explore the many student resources through the MSUCOM Office of Wellness and Counseling, including the MSUCOM CARE Team and personal counseling services

By Elexi Dailey

This story appeared in the January 19th, 2024, edition of the Michigan State Universities College of Osteopathic Medicine, a digital publication focused on peer recovery coaches, harm reduction services, continuum of services, stigma reduction, and the Rural Michigan Opioid and Substance Use Summit that addresses opioid use in rural communities across Michigan. 

MCRH is a proud underwriting partner of MSU COM.