Escaping the Shadow of the Opioid Crisis
Simmons is expanding treatment options for communities caught by the epidemic.
It was only the fourth day of their social work internship, but Chantelle Romero ’19MSW and Emma Dreyfus ’20MSW—master’s students at the Simmons University School of Social Work—had plunged headlong into the nationwide opioid crisis.
Their field placement was at South End Community Health Center, a walk-in health clinic in Boston, and early in the morning they joined a team of doctors, nurses and other health professionals at a meeting about high-risk patients addicted to opioids. One patient had tested positive for heroin use. Another was a suicide risk. Someone else had been arrested—again—and there was concern he’d have an outburst when he went to court.
These were challenging, scary scenarios for newbies, yet the students seemed energized, almost exhilarated, to be part of the treatment team in a primary care setting, and by the chance to address one of America’s most intractable social issues.
“I am super interested in the substance use population,” said Romero, 28, who grew up in Boston.
“Substance use disorder crops up in every single population we work with, said Dreyfus, 30, a Brookline native. “Children. Parents. Old people.”
Social workers might seem like natural, even obvious, collaborators in the effort to address this national epidemic. Yet the profession as a whole has not traditionally prepared students to be on the front lines.
Simmons, which has long been committed to adding its graduates to this workforce, offers the only MSW program in Massachusetts with a required course in substance use disorders for its first-year students. “We are really making it a priority,” said Jennifer Putney ’12PhD, an assistant professor at the School of Social Work.
But now Simmons has increased resources to strengthen its program, thanks to two federal grants totaling $1.6 million. The first was awarded in 2018 and is funded for two years. The second was awarded in 2019 and is funded for three years. The grants from the Health Resources and Services Administration—an agency of the U.S. Department of Health and Human Services—will help prepare social work students to address the crisis associated with opiates and other substances. It will train social work students to provide prevention, treatment and recovery services in primary care settings in areas of the state with high opioid overdose rates and a shortage of providers.
Opioid misuse and opioid use disorders have been escalating for two decades, touching millions of Americans, with devastating impact.
An additional $1.6 million was granted to four Massachusetts health centers in high-need areas to support training and treatment. They are: South End Community Health Center, Codman Square Health Center in Boston’s Dorchester neighborhood, Outer Cape Health Services in Harwich Port, and Family Health Center of Worcester. “A couple of years ago, these opportunities, in these settings, might not have existed,” said Putney who led the school’s grant application. “Having behavioral health clinicians work alongside nurse and primary care physicians is a relatively new model in health care. To focus on opiate use disorders within the context of primary care is novel and is increasing access to care among populations that have been underserved.”
The challenge is greater than ever: Opioid misuse and opioid use disorders have been escalating for two decades, touching millions of Americans, with devastating impact.
The number of opioid overdose deaths grew eightfold between 2000 and 2017, reaching 46,298 in 2017, according to the National Institute for Health Care Management, or one opioid overdose death every 11.4 minutes. In Massachusetts the rate of overdose deaths exceeds the national average. There were 29.7 deaths per 100,000 in the state in 2017 compared to 21.7 in the United States. In the first six months of 2019, there were 611 confirmed opioid-related overdose deaths, according to the Massachusetts Department of Public Health, which estimates that there will be an additional 292 to 363 deaths this year.
Other consequences include compromised physical and mental health, newborns with neonatal abstinence syndrome, who can have long-term health problems, and the spread of infectious diseases such as HIV and viral hepatitis. Opioids shatter families and communities, leading to crime and violence, child neglect, and soaring health-care costs.
Initially, overdose deaths were related to prescription opioids such as oxycodone and hydrocodone that were widely sold by a handful of big companies. As the medical community restricted use of these highly addictive painkillers, many turned to heroin, which in turn set the scene for an explosive third wave of synthetic opioids such as fentanyl.
For a long time, many in the United States viewed addiction as a “moral failing or character flaw,” according to the 2018 Surgeon General’s report on opioids. Only recently has there been a more nuanced and compassionate shift in perception about addiction, and opioid use disorder has come to be seen as a chronic but treatable brain disease. There’s a recognition now that people can and do recover, albeit with setbacks, and that there is a “gold standard” for addiction treatment, according to the report, which combines medication-assisted treatment, counseling and therapy, and community-based recovery support.
But for a variety of reasons—a shortage of skilled providers, widespread social stigma, a tendency to frame the disorder as a social or criminal problem—few treatment options have been available to those in need. Only 12.2 percent of adults who need treatment for a substance abuse disorder receive any type of specialized treatment, according to the Surgeon General’s report on opioids. In October, 2017, the U.S. Department of Health and Human Services declared the opioid crisis a nationwide public health emergency and allocated more than $2 billion in grants to attack the problem, which includes the grant to Simmons to fund the Simmons Integrated Mental Health Primary Care and Clinical Training (SIMPACT) program and its work with partner health centers to treat substance use disorders.
“To focus on opiate use disorders within the context of primary care is novel and is increasing access to care among populations that have been underserved, ” said Assistant Professor Jennifer Putney ’12PhD.
The funding seems already to be making a difference. “It changed my entire trajectory of what I want to do in my career,” said Susan Hart ’19MSW, 23, who graduated from the School of Social Work after interning at Outer Cape Health Services. “I did not think I would get into substance use work. I wanted to do mental health with adolescents. To be quite honest, when I was first placed on Outer Cape, I was like, ‘Oh, dang.’ But then I became so passionate about it.”
As an intern, Hart interviewed and assessed patients, did individual counseling, and connected patients to therapeutic services, all under the same roof. “The old way, I’d have to call a recovery center. Or a detox center,” she said. “People would have to wait for a bed, or availability. But we worked with people who would otherwise never seek treatment for substance use. They come in and establish a relationship with one place. I don’t think there is a better way to help people.”
Hart even helped start and facilitate a support group. “I would not have done that if I didn’t have the experience I had with the grant,” she said. “I wouldn’t have felt comfortable with it, and I wouldn’t have known enough about substance abuse.”
An added bonus: The federal grants also provide 95 graduate students over three years with a $10,000 stipend to “incentivize people to go into this area of work,” said Putney. “Each makes a commitment to seek employment that aligns with the missions of the grants after they graduate.”
Hart said the stipend was hugely helpful and directly impacted her studies. She’d been working 40 hours a week at a clothing store in Chatham, Mass., on top of going to school and doing her placement. The stipend enabled her to cut back her hours at the store. “It helped me put 100 percent of myself into social work,” she said.
The grant’s benefits are being felt beyond Simmons. “It has allowed us to reshape the culture of the center,” said Richy Villa, behavioral health operations director at South End Community Health Center, which has been granted $200,000 per year for two years. There are currently four social work interns from Simmons at the health center, each of them working three days a week. Their responsibilities include assessing and diagnosing patients, helping them develop behavioral strategies to reduce symptoms and ways to cope, reduce stress, and manage their addiction.
Working with social workers “allows us to be better collaborators,” said Vanessa Loukas Ryan ’16MSN, a nurse practitioner at the health center and clinical lead for its addiction support program. Historically, “neither behavioral health nor medicine has really owned responsibility for caring for this disease state. And these patients are challenging.”
South End Community Health Center serves a high-risk neighborhood; it’s located near a jail, two homeless shelters and a methadone clinic. “Patients often come with complex trauma,” she said. “They may have been exploited physically, emotionally, sexually, or abused at some point in their lives.” For social workers in training, access to real patients is critical. “Otherwise, you feel hopeless,” Villa said. “You think: ‘I don’t know how to treat this person.’”
Simmons was well-positioned for the work the grants support. Since 2014, the School of Social Work has a successful track record of implementing multiyear, federally funded training grants to develop cutting-edge teaching methods.
Founded in 1904, it was the first institute of higher learning in the United States to offer training to clinical social workers, and it remains a single concentration clinical program which means “we are singularly focused on training the next generation of social workers,” Putney said. “Our students are in their field placements three days a week in their foundation year and their advanced year, which is more than many other schools of social work.”
The Simmons MSW program is the only one in New England to use hired actors as part of its curriculum. Social work students have the opportunity to interview actors who role-play patients, such as a man who comes into a primary care clinic with concerns related to substance use, homelessness and hepatitis C. Simmons also uses virtual patient simulation training so students can sharpen their communication and interview skills by training online with actors whose responses have been prerecorded.
“As a university we’re small and humble, but we have a really dynamic shop here at Simmons,” said Melinda Gushwa, director of the School of Social Work, and an associate professor.
It’s oriented towards helping students become “more empathetic and responsive to people … We really want to educate our social work students to tap into empathy and the dignity and worth of the person.”
Part of this involves teaching about the connection between social work and social justice—making students aware of how racism is a strong undercurrent in the opioid epidemic, according to Gary Bailey, a social work professor and assistant dean for community engagement and social justice. For example, Black opioid users have historically been treated like criminals and incarcerated at high rates, whereas white opioid users are viewed more as victims deserving of help. “The deck has been stacked against segments of the population,” he said.
“Part of the overall training is really understanding some of the differences between those who are underserved and those who are not,” said Tamara Cadet ’12PhD, an associate professor of social work at Simmons. “Don’t assume that because I’m an opioid user, I’m not motivated to get help. It’s about the distribution of opportunities and helping students understand the barriers to getting help. Some people are going to community health centers, and some people are going to spas in Arizona. There are disparities in treatment which are huge for those who have versus those who don’t have.”
It hasn’t helped that there’s been a stigma associated with working in the field of addiction. “There’s a pecking order in health care, a hierarchy of respect,” said Jim Hiatt ’03MSW, ’03C, director of substance use initiatives at the Massachusetts League of Community Health Centers and a social worker who trained at Simmons. Medicine and mental health work are at the top, and addiction is at the bottom.
“I would actually hear people say they don’t want to work with people with substance abuse disorders because it’s too hard. But it’s incredibly rewarding work. You get to watch people literally transform their lives, make progress with housing instability, food security, relationships and support them as part of a team doing that. And Simmons is stepping up to the challenge.”
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1.281 million. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.