Facing opioids with facts and education

Opioid misuse and overdoses are a serious public health crisis across Washington state and nationwide. 

From 2019 to 2021, the annual number of opioid drug overdose deaths in the state nearly doubled. About 55 people in America die each day from an overdose of prescribed or illicit opioids, including fentanyl and heroin.

It’s crucial to get real information and education on opioid use to communities. Washington State University faculty and staff, including assistant professor Nicole Rodin at the College of Pharmacy and Pharmaceutical Sciences, have teamed up with colleagues across Washington to get accurate and useful facts out to people and try to prevent overdoses. 

They’ve focused on rural communities hit hard by opioid use, often with limited medical facilities and support.

Rodin talks with Washington State Magazine editor Larry Clark about the scope of the opioid epidemic, effective education, reducing stigma, and how we can all lend our support.

There’s a need to treat substance use disorders as health care, Rodin says. “It is a disorder. It is a medical condition, and we have yet to treat it that way as a society.”

Read more about WSU efforts on curbing substance use and addiction in the Spring 2024 issue of Washington State Magazine.

Other resources:

Rural Opioid Technical Assistance Collaborative (Northwest Region 10)

Opioid Overdose Prevention, Recognition, and Response (Washington State Department of Health)

How to talk about substance use (Washington State Magazine, Spring 2024)

WSU PEAR—Program of Excellence in Addictions Research

WSU APPL—Analytics and PsychoPharmacology Laboratory

Transcript

Larry Clark: 
Opioid misuse and overdoses are a serious public health crisis across Washington state and nationwide. From twenty nineteen to twenty twenty one, the annual number of opioid drug overdose deaths in the state nearly doubled. That includes both prescribed and illicit opioids like fentanyl and heroin. Real information and education about opioids are crucial. 
That's why Washington State University faculty and staff, including Nicole Rodin at the College of Pharmacy and Pharmaceutical Sciences, team up with colleagues across Washington to get accurate and useful facts to people.
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Welcome to the Washington State Magazine podcast. We bring you stories of WSU research, outreach alumni, and more. I'm Larry Clark, editor of the magazine. 
Rodin talked with me about the scope of the opioid epidemic, effective education, reducing stigma, and how we can all lend our support. 
Nicole Rodin:
My name is Doctor Nicole Rodin and I am currently an assistant professor within the pharmacotherapy department at Washington State University College of Pharmacy. So I specialize in substance use disorders. 
Larry Clark:
Can you tell me how big is the substance use and addiction problem? Maybe especially with opioids? 
Nicole Rodin:
Yeah, it's pretty massive. And I think twenty seventeen, the HHS actually declared it a public health emergency because of the opioid epidemic. So this is a problem we've seen for decades now. And it's only gotten worse since we've seen illicitly manufactured fentanyl come on the scene a couple years ago. 
Larry Clark:
Unfortunately, yeah, we see it in the news a lot. You know, we hear a lot of stories. And I think it's touched almost everybody that I know, you know, in some way. I understand that you're part of a group that's involved with outreach and education on drugs, substance use. Can you tell me a little bit about that? 
Nicole Rodin:
Yeah. So I'm part of two groups at WSU. One is the APPL lab or the Analytics and Psychopharmacology lab. Kind of a mouthful. And they're doing a lot of work for new and novel treatments of substance use disorder. And then I also work with another interdisciplinary group that focuses on outreach. So we kind of see what's happening in science and that evidence based practice and we try and translate that into everyday work in our community. So really turning science into practice. So with that group, we do a lot of community presentations and harm reduction strategies as well. 
Larry Clark:
It's exciting work. Uh, is there an area that you concentrate on? You know, is it particular communities? 
Nicole Rodin:
We try to focus on a vast majority, but for the group now, it's really focused on rural communities. So it's the Rural Opioid Technical Assistance Collaborative. So we try to reach communities that may not otherwise have access to some of this information. 
Larry Clark:
Yeah, I've read that fentanyl in particular and other substance use has really hit rural communities hard and maybe harder proportionally. Is that the case? 
Nicole Rodin:
It's interesting because a lot of the news stories come out of big cities because it seems to be happening more frequently, but there's just more people for it to kind of happen to. And unfortunately in rural communities we see a different fallout. So because they are more rural, it's harder to get emergency services to emergency situations. It's harder to get those reversal agents on the scene if they're not already there. And sometimes there can be this safety blanket of knowing everybody around you kind of thinking that mentality of it won't happen to me. So trying to really provide that education on what to look for and what the case might be if it does happen to you. 
Larry Clark:
Are there some challenges or problems that are specific to rural communities that make it hard to get help there? 
Nicole Rodin:
Yeah. Honestly, just the distance. I think it's hard to find access to services if you realize there is a problem or if you want to even just know more about the problem, sometimes it can be difficult to reach out in a non-stigmatizing way in those rural communities. So really trying to find that neutral third party or even a physician or treatment services. Once that becomes a need. 
Larry Clark:
So how do you and the others involved with the outreach program overcome some of those barriers and get the information where it's needed? 
Nicole Rodin:
Yeah, I think we've really capitalized on the use of Zoom and other webinar type technologies since Covid. And so I record a lot of on demand trainings. And so my theory has always been or my motto has always been, informed consumers are always better. So we know the problems out there. We know that just saying no doesn't work. But if people can understand what these drugs do in the body, they can recognize some of these signs and symptoms of an emergency situation. And if they know the benefits to some of these harm reduction strategies and actually understand it, then we have a better chance of making a difference and moving the needle in the right direction. So in using that that webinar type technology, we're hoping to get more information out to more people in a much more sustainable way. 
Larry Clark:
That's great. And what are some of those harm reduction methods and some of the things that that have been found to be effective in helping people? 
Nicole Rodin:
So in describing harm reduction methods, we look a lot at reversal agents. So for opioids specifically things like heroin or fentanyl, having everyone keep Narcan on them, especially if you're in a rural place that it might be more difficult to get emergency services on site. I am a firm believer that everyone should carry Narcan. I keep it in my house, keep it in my purse. It's on my desk at work, just in case. Because you never know, right? Just like any other emergency medication, like an EpiPen, you hope and pray you never have to use it. But when the time comes, you're really glad you have it when you need it. 
Larry Clark:
Yeah, and they certainly seem to be a lot more accessible now. Are there some barriers to, say, getting Narcan out to to people in rural areas or just in general? 
Nicole Rodin:
I would say probably the biggest barrier is stigmatization. Washington state in general does a great job of providing access. There's a lot of programs through the Department of Health, through local nonprofits that provide Narcan shipped directly to you. But you have to ask for it, right? And to ask for it, you kind of have to see a need for it. And so trying to destigmatize what this reversal agent is, like I said, you hope you never have to use it. But just in case you do, having it on hand is super helpful. So convincing someone that it doesn't cause a drug addiction, or that it doesn't let people continue using substances or what other misconceptions might be, can be a little bit more of a challenge sometimes. 
Larry Clark:
What's been the response to some of your outreach and education efforts? Do you have any stories of of people who have been impacted? 
Nicole Rodin:
Yeah, we've had a really positive response. The last webinar I did with a colleague over at the University of Washington, um, we co-presented on fentanyl and xylazine, um, and just giving information on what it is. She was a provider that primarily focused on treating adolescents with substance use disorders. And and so we kind of tag teamed it and we had over nine hundred people register for the webinar. And so we saw a really big reach. And over five hundred people actually show up to the webinar, which is huge too. So some of the questions that came out of that really reinforced what we're doing. And and it was a little motivating to continue to provide this information because we got really good questions and we got to answer them in real time. And I think that was really promising. 
Larry Clark:
Well, it's great, you know, that people can interact, you know, and ask the questions they might have. And speaking of questions, can you tell listeners a little bit what it was, what xylazine is that what it's called?
Nicole Rodin:
Xylazine, unfortunately, is an additive we've been seeing in other illicit substances, primarily with illicitly manufactured fentanyl. It was originally a vet medication. It tried to go through FDA approval as a blood pressure medication for humans, but because of safety concerns, it never made it through. Instead, it became a really good anesthetic, typically for bigger animals like horses. And we saw it a while ago, I want to say in like two thousand and eight, in Philadelphia, being added to the heroin. And it really kind of prolonged the effects of it, but it also really increased the respiratory depression. So you kind of saw this spike in overdoses because of it. And then it started causing a lot of skin wounds. So if you've ever heard of like zombie heroin or zombie Tranq, that's what it was referring to. And so I started to see an uptick of that. So it was declared an emerging threat by the DEA recently. And it jumped from being almost impossible to find to being an almost seven percent of the drug supply. So that's something we're keeping an eye on and making sure people are at least aware of. 
Larry Clark:
So you were talking about the education and that sounds really great. I know there's a lot of misinformation out there. And how do you combat misinformation, in particular what people might hear on TikTok or other social media that's really just not good when it comes to drug use? 
Nicole Rodin:
Yeah, that's a tough one because it's just so pervasive. And the way that algorithms are kind of tailored to what you are wanting to see, it kind of creates this echo chamber, right? So once you hear misinformation that you are engaged with, you kind of hear it over and over again. At least my approach and our approach as I work with some of these groups has just been really transparent communication, really digestible and understandable because with especially this generation of younger students or kids. They've always had information in their pocket. And so when we had this previous generation that was maybe a little bit more patriarchal in their approach, right? Do as I say, not as I do. Listen. Listen to the words. Under my roof, my rules. That kind of approach just doesn't really work anymore. Because as educators, we get fact checked all the time, right? So we want to be clear and we want to state the risks that are happening. But we also want to be transparent in what these drugs are doing and and why people are using them. I mean, you can get high. It can feel good, but it's at the cost of some of these risks like overdose or addiction and what that fallout might become. So really being a trusted source that can be verified in a way that people understand what you're saying, I think is, is one approach we're taking and hopefully it's working. 
Larry Clark:
So why is it important for WSU and for you personally to do this kind of work, this education and outreach to communities? 
Nicole Rodin:
I think you hit the nail on the head when you introduced this topic of just everyone has been affected by this. It's pretty rare to find someone who has not been personally affected by some type of drug addiction or the opioid crisis specifically. Um, I saw this firsthand with a few of my friends in high school. I continued to see it to this day with family members that are addicted to different substances, and I think we see it pretty prevalently within our community, specifically within Spokane. So it is really pervasive in my life personally. And so I always kind of had this idea that I wanted to help it and that I wanted to make a difference wherever I could. And I've been fortunate with WSU to find a group of clinicians and researchers that had that same mission and goal in mind, and have been really lucky to help forward their mission on and kind of contribute in any way I can. 
Larry Clark:
Yeah, I hear that. You know, I know I personally have known people that have suffered from addiction and even overdose. How did you end up working in pharmacy? What drew you to this field? 
Nicole Rodin:
Honestly, it was very serendipitous. When I was in high school, I had to do a month long internship in order to graduate. And my friend said, my mom's a pharmacist at this hospital. Just do it with her. It'll be fun. And I was like, okay, easy enough. And so that kind of sparked my interest in it. And then when I got into pharmacy school, I had a fabulous mentor who did a lot of outreach in substance use disorder, and I kind of joined her student group, and I think she cultivated not only my passion for engaging in this space, but also my passion for just teaching in general. The fulfillment, I guess, that  you have when you share your knowledge and you hopefully make a difference with it. 
Larry Clark:
What are a few ways that people like me or other listeners can help out? 
Nicole Rodin:
Yeah, that's a tough question because it's such a systemic problem. I always encourage people to really understand how addiction works and specifically how treatment for addiction works. We don't treat it the same like other health conditions, which can really create a barrier to people receiving treatment for it. So because it's seen as something extra or as some type of moral failing, it's not usually included in your health insurance benefits. It is very separate and it's usually very religion based, which can be a very good thing for certain people. For others, it can be a really big barrier to actually engaging in some of those services. So I always encourage people to advocate for the coverage of these services under everyday health insurance. And to know what policies are going into effect once we have our legislative cycles every year. Sometimes things get snuck in there that make it really difficult for people to treat substance use disorders or to educate on them as well. Or there's something that doesn't get passed that could really benefit the world of substance use disorders and the engagement of that patient population. But it's hard to identify what those are, and it's hard to understand it. So kind of takes a little bit of work or finding a group that is doing some of that work to better understand what we're voting for and putting in place. 
Larry Clark:
It's a really good advice. Is there anything else that you think listeners should know about your work or about substance use generally? 
Nicole Rodin:
I would just reinforce over and over again that it's not a moral failing. What might start as a choice, just like many other chronic diseases, does end up a disease, a chronic condition. And it's okay to ask for help. It is okay to not have to go through it alone. It's also okay to not have to support someone alone. So if you are experiencing a family member, a friend, a loved one, or you yourself are experiencing substance use issues, kind of seeking out that peer support can be a huge, huge benefit to recovery, success, mental health, all of the above. Specifically for family and friend caregivers, if you've never been to an Al-Anon group, you can find them online. They're all over the state, even in rural populations and or something like it. It can be a really useful tool to kind of get through some of the toughest spots of being a loved one to someone who is suffering through a substance use disorder. 
Larry Clark:
Well thank you. That's really helpful. And thank you for all the work that you do and the rest of the group. 
Nicole Rodin:
Yeah. For sure. 
Larry Clark:
Thanks for listening. You can find links to resources on opioid use and overdose prevention, magazine stories and more in the show notes. If you want to hear more WSU stories about interesting alums, campus life and research. Please subscribe on your favorite podcast directory and please rate the podcast and spread the word. If you have an idea for an episode, let us know at magazine.com. This episode was produced by me, Larry Clark. Our music is by WSU emeritus music professor and composer Greg Yasinitsky.
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