Laura Palombi

Driven to End Substance Abuse in Rural Minnesota Communities

Assistant Professor Laura Palombi partners with rural Minnesota communities to enhance opioid prevention and intervention efforts, build systems and supports to reduce overdoses, and expand understanding and options for treatment.

Through her community education, community forums throughout northeastern Minnesota, focus groups and naloxone trainings, she gathers data on what the community believes to be the problem.

“Stigma is one thing that always comes up, which is not surprising,” she said. “Only 11 percent of people with substance use disorder ever end up in treatment. Stigma is one of the reasons that happens, especially in our rural areas, where people are afraid to admit that they have a problem. They’re in a community that isn’t very supportive of them. A lot of our communities are convinced that addiction is a moral failure rather than a disease state. If I could work on one thing that would make a huge impact, it would be reducing stigma in our communities.”

According to Palombi, community pharmacists have an opportunity to engage with patients who might be at risk of opioid use disorder or of overdose.

 “A survey of all pharmacists practicing in Minnesota included questions on their attitudes toward substance use disorder and pharmacist utilization of the tools available to them, such as naloxone protocols, authorized take-back legislation, and syringe access. The vast majority agreed that there is a role for pharmacy in the opioid crisis,” she said. “We also need to get our providers and our pharmacists used to having conversations about opioid usage in a professional manner. We give them practice while they’re in school, so that we’re not hearing, later on, that it’s an awkward conversation. It shouldn’t be an awkward conversation if the pharmacist calls the provider, or vice versa, to express their concern for the patient.”

 Palombi recommends that the language used when talking about substance use disorder needs to change.

 “We’ve been working with folks in recovery for a long time, and we still use words that are stigmatizing and moralizing: clean versus dirty, junky and addict, urine drug screens that come back positive or negative,” she said. “The words we use are important, and each of us should be aware of how we’re actually talking about the issue and whether we frame it as a medical issue or as a moral failure.”

 To address issues of social disparities when developing solutions to the opioid epidemic, Palombi recommends listening to what those populations have to say and understanding that different populations have different ways of doing things.

 “For example, in our work in northeastern Minnesota with some of our tribal nations, we put the power in the hands of the tribal nations,” she said. “We ask them what they need, what they want to see. We work on the strengths in that community and the strengths of that culture. This has gone a long way in the healing process. We need to take the time to listen and to see why those disparities are occurring, and dig deep into that.”

 So what are the most important things to do to bring the opioid epidemic under control?

 Palombi says, “We must look at the root causes. We have a lot of people who have suffered a lot of trauma. Opioid use disorder has been called a disease of despair. Just as we’re not going to point fingers and say that this is any one group’s problem, we also need to know that we all need to be a part of the solution. It’s not just health care, it’s not just law enforcement, it’s not just public health, and it’s not just the community. It requires a multimodal and multipronged approach.”