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CREW: From the campus of the University of Kentucky, you’re listening to Behind the Blue.
KODY KAISER: University of Kentucky researcher April Young and her team have spent the last two years in Eastern Kentucky communities working to assess and gather information on substance use in those areas for a project known as Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic, or CARE 2 HOPE. Now with an additional $4.2 million from the National Institute on Drug Abuse to continue their work, Young and her collaborators will take what they’ve learned in the field and focus the next three years on developing comprehensive approaches to prevent and treat consequences of opioid injection.
The new grant brings CARE 2 HOPE’s total funding to over $5.5 million. Young and associate professor of epidemiology in the UK College of Public Health and faculty member of UK’s Center on Drug and Alcohol Research and Center for Health Equity Transformation grew up in rural Georgia and understands the struggles smaller communities can face in addressing health crises.
I’m Kody Kaiser with UK PR and Marketing. On this episode of Behind the Blue, Young talks with UK PR’s Allison Perry about working with a community based staff, the creative tactics used to build connections and trust, and the complicated layers of challenges these communities face from unstable housing, food insecurity, and more that require what she terms wrap around care.
ALLISON PERRY: Today our guest is April Young. And she is an Associate Professor of Epidemiology in the UK College of Public Health, and also carries a faculty appointment for the UK Center on Drug and Alcohol Research known as CDAR. And April’s here to tell us a little bit about her research and her work and some exciting news about a new grant coming. Right?
APRIL YOUNG: Right.
ALLISON PERRY: How are you doing?
APRIL YOUNG: Good. Thank you for having me.
ALLISON PERRY: I first want to start just kind of like let’s talk a little bit about how you ended up at UK. So you’re from Georgia, correct?
APRIL YOUNG: Right. I’m from a small town in central Georgia. And I ended up in Lexington because I went to Transylvania University first. And I was recruited for basketball, which is how I found out about Transy. I came up and did my biology degree and then worked at UK for a year. And then did my masters at UK and went back home shortly to Atlanta to go to Emory, and then returned. A faculty position opened up just in time as I finished my PhD. And I came back in epi.
ALLISON PERRY: So it sounds like you wanted to come back to Kentucky.
APRIL YOUNG: Yes. Yes. I was dying to come back. So I actually worked at UK the entire time I was at Emory doing work on substance use.
ALLISON PERRY: And tell me briefly kind of a general overview of what you do here, your research, what you’re focused on.
APRIL YOUNG: So my research focuses on substance use mainly in rural communities. And we look at outcomes related to substance use like hepatitis C, HIV, overdose, and other related harms. And we try to understand the factors that are affecting drug related behaviors and try to find solutions to those that are community grounded.
ALLISON PERRY: What drew you to this particular branch of research?
APRIL YOUNG: So growing up in a small town, I often felt like small towns were neglected in terms of health services and important assets that they need to address their health issues. And in Kentucky, that’s also the case.
And so I felt like there was also a lot of resilience and potential in rural communities that was not being tapped. And so when I was a master’s student, I had a chance to work with Jennifer Havens and the College of Medicine. And I worked with her on a study about opioid use in Appalachia. And I just fell in love with the topic.
And it also was related to issues I was seeing among people I loved who were struggling with substance use in small towns. And so it was a great way to merge my personal interest with my research interests. And also, it related well to what I teach.
ALLISON PERRY: OK. Let’s go ahead and get into a little bit about the project here. So it has a long title. But it’s known as CARE 2 HOPE. Can you kind of tell me what that stands for and generally what that means?
APRIL YOUNG: Sure. So it’s just the abbreviation for the study is Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic. And it’s a five-year project. It started with a two-year phase focused on assessment, so trying to understand the issues happening in rural communities and how they relate to substance use, and also their readiness to implement interventions.
The final three years are focused on intervention. And that’s the phase we just began. And all of this is funded by band NIDA, the National Institute on Drug Abuse.
ALLISON PERRY: Let’s talk about the first two years. When you say assessment, can you kind of explain a little bit more about what that means? I know it involves talking to people and surveying people.
APRIL YOUNG: It was quite intense, two years. So we surveyed people who are actively using drugs. We also interviewed people who are actively using drugs to get their stories about how they began and barriers that they encounter when trying to access the treatment that they need. We did interviews and surveys with stakeholders that were county leaders, such as mayors and pastors, judge executives, all types. And we also built up these coalitions that guide our entire research project. We also created two advisory boards of people who had lived experience with substance use to help guide the project and keep it grounded in reality.
ALLISON PERRY: Did you have any trouble for people who are currently, actively using drugs, getting them to talk to you about their habits? Like how did you go about doing that and kind of a really sensitive and compassionate way?
APRIL YOUNG: It’s difficult because of the stigma and also criminal justice involvement. And they at first have a hard time trusting folks. And so what we did was just tried to create a very welcoming environment in our field office. We hired local staff who had connections locally that they could trust.
And we also put ourselves out there. So I used some discretionary money that I had to literally buy a grill and a tailgating tent. And we set it up in a parking lot and cooked hot dogs, and brought drinks, and just welcomed whoever wanted to stop by to stop by.
And at first it was just local residents stopping by to talk with us. And they thought we were weird and set up in the parking lot. And so it drew a lot of interest. But over time, those people referred people who were actively using. And we got to know them. And we gave them opportunities to refer their friends into the research study. And so then about nine months, we had 300 people who are actively using, just in one county alone.
ALLISON PERRY: How many field offices do you have?
APRIL YOUNG: We have two field offices, one of Morehead and one in Hazard. So we have really amazing partners in the departments of health, local and district. And we focus on the Gateway District, which is five counties, and then the Kentucky River District which is seven counties.
ALLISON PERRY: I don’t know, can you talk about anything you may have learned from these first two years that are really going to be driving the next three years?
APRIL YOUNG: Sure. So I mean some of the surprises that I encountered, even after having done this work for about five to six years previous to this study. I was shocked at the resurgence of methamphetamine use. And so I think we hear a lot about opioids and we knew meth was there still. But the emergence of crystal methamphetamine and also injection of meth was really concerning. Because we’re not quite where we are with opioids on treatment and services. So that’s a real gap we’ve noticed we need to fill.
The other thing that was shocking to me was the level of homelessness. So we found that about 33% had experienced some homelessness in the past six months. That’s couch surfing and living in abandoned trailers. But it’s also people literally living in forest. And so that was important for our research because it’s hard enough to get people into treatment who have stable situations. And then you add to that unstable housing and food and security, and you really have to provide some sort of wrap around care for them.
So those were the shocking things. And then the positive things that we learned is there a lot of community activities already going on to mobilize people around substance use that we can leverage. So we didn’t need to come in and create something from scratch. We could tap local expertise and build on that.
And the people who were actively using drugs, they are as committed as anyone to seeing a change in their community. And people who come and meet with us as part of our advisory boards can demonstrate that and set aside their fears and come just to contribute to the project.
ALLISON PERRY: So the first two years, was it just over $1 million to kind of get the project up and running? And then basically, we’ll give you more money proving that you can do these first two years? Is that kind of how it worked?
APRIL YOUNG: Right. Yes. This mechanism is pretty complex. So after two years, you have to meet certain milestones. And you have to apply for a competitive extension, essentially, to move into the final three years. The first two years were smaller in terms of funding. And then the final three years will be somewhere between $3 and $4 million. And we’ll roll out the intervention over those three years.
ALLISON PERRY: Is that $3 to $4 million over three years, or per year?
APRIL YOUNG: Total. Total. So I mean, if you think about a community level trial of 12 of the hardest hit counties in the entire country, we need much more than $3 to $4 million. And so we try to get creative with involving student interns, with leveraging other resources from the state, for example, to be able to meet our goals, just so that we can demonstrate an effect over these three years with a pretty small budget.
ALLISON PERRY: So what are the next three years going to look like, with all that you’ve learned from the first two years?
APRIL YOUNG: Yeah. So over the next three months, we’re hiring and getting ready for this project. We try to push as many jobs out into the community as possible and keep the operation at UK pretty lean. And we’ll be hiring people who will deliver the intervention. And so the intervention that our communities chose is a reentry intervention for people leaving jail.
So what we’ll do is when someone is nearing release from their local jail, we’ll meet with them and we will do an intensive workup about their needs and how they plan to transition into the community. And then when they get out, they’ll continue meeting with us in person and by phone.
And we’ll be based in the health department, which is a strength, because it allows them to link to services there. And we basically help them navigate that really risky transition period into the community and link them to the treatments and services they need. And for six months, we’ll evaluate the impact of that in an intervention group compared to a more basic overdose education group.
ALLISON PERRY: Would you be able to comment a little bit, you know last week I spoke to Michele Staton, one of your colleagues, who’s doing some work specifically for women who are about to be reentered into the community. And can you talk a little bit about that risky, that kind of window where people who’ve been incarcerated and kind of been forced to become sober, they’ve lost their tolerance. So you’ve really got to give them a little extra help when they re-enter the community to make sure that they can stay healthy, essentially.
APRIL YOUNG: Right. Yeah. I mean, so when people go into jail or prison, as you mentioned, they stop using in general. And so when they come out, their tolerance is low. And they may think that they can go back to using the same amount they were using before. But that could be a lethal dose once their tolerance is so low.
But that doesn’t have to be the case. If they’re initiated on medication for opioid use disorder, or if they’re given a Vivitrol injection, or something of that nature to transition them back into the community, because in the age of fentanyl, even if they take half the dose that they were taking before they went to jail, if it’s adulterated with fentanyl, then that could be a lethal dose.
So we really need to help these folks transition, and not just for their drug related issues, but also so that they don’t cycle back into jail. And so if they come out, they don’t have an income source and they’re desperate, and they do something that lands them back into jail, then that only strains the system.
ALLISON PERRY: And Sarah Johnson from the Department of Corrections, she kind of stated this as a fact, which I had never thought about before. But she is like, the jail system is basically the biggest provider of substance abuse treatment just by default. Because so many people are in the system.
APRIL YOUNG: Yeah. I mean I think that, unfortunately, has grown to be that case. But that doesn’t need to be the case, nor should it be the case, that our criminal justice system is providing treatment. People should have access to treatment before they enter the criminal justice system. Because once they enter that, they have difficulty getting jobs, they may lose their children, they disrupt families. So if we can treat people before they get entangled in a legal mess, then that is a much smarter approach.
And in other countries that is the approach. So I would say what Sarah described is probably true in some of the states in the US, not all. But it shouldn’t be just a given fact that we accept.
ALLISON PERRY: Do you have specific goals for the next three years? Like when this project is complete, what are you hoping to have seen that you’ve accomplished?
APRIL YOUNG: Sure. So I think we have a few goals. First, we want the intervention to be effective at reducing substance use related harms among people in the intervention. I also want to see communities empowered to implement these interventions on their own. So when our grant ends, I don’t want to see these programs end. I would hope that the Department of Corrections or the cabinet or local communities see the value--and we’re also doing a cost analysis to help them determine the value--and that they pick these up and implement them long term.
And I also want to see, just in general, reduced stigma and more compassionate attitudes toward people who are using drugs or people who have struggled with addiction, in a broader sense, beyond our study, and in the community writ large.
ALLISON PERRY: Why do you do what you do?
APRIL YOUNG: Well, obviously I’m very passionate about a lot of this. And a lot of it is because of the compassion piece of it. I feel like for the past two years, we’ve mainly been doing surveys and interviews with people who are using drugs. And we’ve had people talk about how this project has changed their lives. Yet we haven’t even done an intervention.
And when we ask them about that, they say, well, it’s because you guys treat me as a human. And you act as if you care. And when I was in jail, you came to see me, for follow up visits. And that just speaks to what they’re encountering just in the community in general is a complete lack of compassion.
Not across the board, occasionally there are people who are willing to step out and remove that stigma. But they are up against really insurmountable odds. And I just have a heart for that. And I want to see our research make a difference.
ALLISON PERRY: All right. And I kind of forgot to mention this in the intro, but you are one of the researchers on UK’s biggest grant of all time, the HEAL Grant. What do you think about the role the UK is taking in tackling the opioid epidemic?
APRIL YOUNG: I’m so proud to be at UK. I mean, for a few reasons. I think for a long time, way before that grant, UK was among the national leaders and research on substance use, and especially rural communities. And the other reason I feel like UK is leading in this area is because they’re very community engaged. So the people I work with who are doing substance use research are not doing research for the sake of research sake.
They’re not looking to build their resumes. They’re looking to actually make an impact and hoping to work themselves out of a job. And it is just really motivating to be a part of a community like that at UK, or researchers. And not just researchers, but also students who join these teams and really care about the mission.
ALLISON PERRY: Are there any other projects besides this one specifically that you’re working on that you think are particularly interesting that you want people to know about?
APRIL YOUNG: So we’re involved in several different projects. The biggest, obviously, are the Healing Communities Study and CARE 2 HOPE. But I’m also leading another study that focuses on how we can better retain people in, for example, clinical trials or in treatment, in rural communities. Because loss during treatment is a major issue attrition out of treatment.
And so I’m partnering with Oregon and Ohio to lead that study, which is called PROUD-R2. And it’s also partially based in Morehead. So we have a lot of really interesting projects going on beyond those two large ones.
ALLISON PERRY: April, so what’s the next immediate action step for CARE 2 HOPE?
APRIL YOUNG: So after we do the hiring over the next few months, we’ll be ready to launch in local jails starting in around November or December. And we’ll be rolling out first in four jails, mainly in the Kentucky River District but also one in the Gateway District. And then every six months, we’ll start in four new jails. And so it’ll build up from there. And we’ll move through the study that way, looking at overdose education and also the actual intervention for the reentry program.
ALLISON PERRY: Well, thank you so much for joining us today, April. I really appreciate it. And if you want more information on CARE 2 HOPE, you can go to their website at care2hope.org, C-A-R-E-2-H-O-P-E dot org. And yeah. Thanks for coming in.
APRIL YOUNG: Thank you for having me.
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CREW: Thank you for joining us on this edition of Behind the Blue. For more information about this episode or any other episode, visit us online at uky.edu/behindtheblue. You can send questions or comments via email to behindtheblue@uky.edu or tweet your questions using #behindtheblue. Behind the Blue is a joint production of University of Kentucky Public Relations and Marketing and UK HealthCare.
