Access and Anti-Racism in Opioid Treatment: What Cities Need Now

Held on October 13, 2021
Watch a full recording of the event, or scroll down to read a recap and watch event highlights.

Recap by Diya Ashtakala

On Wednesday, October 13th, 2021, the Boston University Initiative on Cities (IOC) and the BU Center for Innovation in Social Work & Health (CISWH) hosted a virtual panel with community leaders, policy advocates, and research experts to discuss opioid use, systemic racism, treatment options, and the way forward.

Moderated by Christina Lee, Research Core Director at CISWH and Associate Professor, BU School of Social Work, the event featured Mayor Nan Whaley of Dayton, Ohio; David L. Rosenbloom, Professor at the BU School of Public Health; Miriam Komaromy, Medical Director at the Grayken Center for Addiction at Boston Medical Center and Professor at the BU School of Medicine; and Drew Carpenter, Recovery Support Navigator & Substance Use Counselor in the Complex Care Program at Bay Cove Human Services.

The speakers addressed how cities can address opioid addiction and tackle systemic barriers.

Need for Black representation 

“We need representation of the community in the decision-making and service provision process,” said Dr. Komaromy. She explained that getting insights from those in an affected community help us to better understand addiction issues the community faces, noting for example that many Black patients prefer a Black member on their treatment team. Dr. Komaromy emphasized that part of the problem is existing public literature; comparing using it to understand opioid use to “barking up the wrong tree.” Mayor Whaley spoke of the Community Overdose Action Team (COAT), a program created in 2016 to address Montgomery County, Ohio’s opioid problem. Despite the program’s success and community approach, it failed to reach Black women and struggled with that community.

Drew Carpenter highlighted that in a majority white state, Black people get the “short end of the stick” when it comes to treatment. He emphasized how the need for certain certifications block the way for Black specialists, and that removing barriers to certification would help. Carpenter believes that advocates within the community need to speak up more, noting the need for a long-term and ongoing process. “It is not a Black and white thing. It’s a life and death thing.”

Rosenbloom agreed with the need to hire a more representative workforce. “I think using some of the money to train a new workforce that is more culturally attuned to the patients they’re going to be treating is an appropriate use of the money.”

Funding at structural levels

Mayor Whaley discussed opioid addiction services funding in the American Rescue Plan of 2021 (ARPA). In general, “for opioid addiction services, the Medicaid portion is taken care of, but longer care is not funded. ARPA can give communities this [funding].” There has been a significant rise in opioid use during the COVID-19 pandemic and 2020 saw a rise in accidental overdose deaths. Mayor Whaley explained that that ARPA makes investments in places where there has been significant disinvestment in the last 5 decades. However, she noted that ARPA and Sackler settlement money are just one-time sources and not a long-term solution.

Regarding funding in Massachusetts, David Rosenbloom believes the state and state-funded providers have failed to ensure that funding goes to the right place. “If there is no structural change and bids out to provide contracts, the money won’t go to the groups needing high priority.” He said that the money from the Sackler opioid settlement and ARPA should reach representative groups from all parts of the community, with new partnerships and community-based strategies monitoring the use of funds. Rosenbloom also spoke about structural changes in areas such as housing, explaining that investing in housing can lead to stability and long-term recovery. Mayor Whaley agreed, saying that the housing issue is important to address.

Treatment options

Dr. Komaromy mentioned Dr. Ayana Jordan at Yale University who collaborates with churches for faith-based treatments. “She’s a really powerful, talented, Black psychiatrist.” Dr. Jordan is looking at the impact of partnering with Black churches and offering screening services at churches. She hypothesizes that there will be a significant impact and her early studies indicate that Black people are willing to engage in life-saving treatment. Dr. Komaromy said that working with religious leaders who can vouch for treatment provide affirmation to the community about seeking it.

Rosenbloom discussed evidence-based treatment, including the use of medication. Carpenter elaborated that medication is not the only solution, citing the success of the 12 step program. “One addict best understands another addict.”

Mayor Whaley summarized the need to have better treatments. “It’s not having the person that is sick with this disease fitting themselves into the treatment but bringing the treatment to where the person is and [for] how long the person needs.”