Like many states, Oregon is a patchwork quilt of big cities, small towns, and wide rural expanses. And like many other states, its rural regions haven’t been spared from the opioid crisis.
“This is a complex issue with complex roots that requires complex solutions,” says OR – HOPE (Oregon HIV/Hepatitis Opioid Prevention and Engagement) principal investigator Todd Korthuis.
Oregon is one of eight states to receive funding through a national rural opioids initiative. The group has identified the state’s highest need rural counties, whose overdose and HIV rates equal and exceed rates in Portland, the biggest metropolitan area.
Oregon is a large state with a large rural population. “Many of the counties look a lot like Appalachia,” Korthuis says.
“Screening, treatment, and harm reduction services for opioid use disorder and HCV/HIV are scarcer than in urban areas. With the largest state-level increase in opioid-associated inpatient stays in the nation, and a substantial and diverse rural population, Oregon offers an optimal setting for implementing and testing new community response models for detecting and linking care for HCV and substance use disorder.”
OR-HOPE is a research study conducted through a partnership between Oregon Health & Science University, the Oregon Health Authority, Comagine, and HIV Alliance. The study’s aims include developing community programs to increase HCV/HIV testing and linkage to treatment; developing and evaluating rural community response plans that include peer care coordinators that link people to harm reduction and treatment services; and a peer-facilitated telemedicine hepatitis C treatment intervention.
During the study’s preliminary phase, researchers assessed communities by creating an action team made up of representatives from law enforcement, primary care providers, people using drugs, people in recovery, and faith-based representatives. They devised priorities and community action plans about how to best engage people.
Provider-level intervention includes rural buprenorphine waiver trainings and OHSU’s robust Project ECHO tele-mentoring network.
The next phase involved a just-completed syringe exchange pilot program that uses a special referral technique. One person using drugs refers three friends. The chains go deep into the community and begin to reach people who were previously completely out of the treatment community. Peers hand out harm-reduction “gift bags” containing needle exchanges, naloxone kits, rapid HIV and syphilis testing. “Most importantly, they reach people where they are, build relationships, and soon they’re able to ask about engaging in treatment.”
So far, 18 percent have done so. “That sounds low until you think about where they are. Many of these people hadn’t ever considered treatment before.” Korthuis explains. “Sixty percent of the sample has been homeless in the last six months.
Now that the pilot phase is complete, they’re working with the Oregon Health Authority to expand the project so peers will be involved in telehealth-delivered hepatitis C treatment.
OR-HOPE was a featured award winner in the 2019 Innovation Now project of the Addiction Policy Forum.