Video: Better Together With the D.C. Dream Center

Overdose deaths among African Americans have skyrocketed in recent years, especially in Washington, D.C.

“In Washington, D.C., less than 15% of Black people with opioid use disorder are getting effective treatments, and most people who die from overdose have never been in treatment,” says HEAL researcher Richard Schottenfeld, M.D., from the Department of Psychiatry and Behavioral Sciences at Howard University. Working together with D.C. communities hard-hit by the opioid crisis, Schottenfeld and his team launched the “Better Together” community-based initiative.

As a first step, the team created a Community Advisory Board representing various segments of the community to help researchers ask the right questions when talking to community members about addiction treatment. The board includes leaders of faith-based organizations, neighborhood health council representatives, community outreach workers, and people with lived experience.

They asked, for example, about the impact of opioids and other drugs on the community; views of opioid use disorder and its treatment, including medications; and recovery from drug use. The responses are important for figuring out how to help people avoid or survive overdose as well as find a path to recovery that works for them.

• Stigma is rampant, even from community leaders and healthcare workers, which can keep people out of treatment.
• Respondents often opposed the use of medications for opioid use disorder that are proven to reduce opioid-involved overdose deaths and communicated misconceptions about how these medications work. This was particularly true of methadone, exemplified by statements such as, “With methadone, you trade one high for the next.”
• Effective treatment plans are tailored to individuals’ needs and preferences, and long-term inpatient or abstinence-based 12-step programs remain valuable tools for many people in and entering recovery. However, many respondents promoted the misconception that the availability of such programs means medication treatment is not needed or valuable. As one respondent said, “There are hundreds more people who go by the 12 steps.”
• Many respondents believed that nothing can be done to help people get into or stay in treatment, noting, “We don’t have the tools. We’re not equipped, and we don’t know how to deal with their pain.”

These responses are even more disheartening because in recent years, the D.C. government has worked to eliminate many of the barriers that typically keep people from getting treatment, such as lack of insurance coverage, need for treatment preauthorization or co-payments, or lack of providers. To overcome remaining barriers, Schottenfeld’s team is working with the Community Advisory Board to develop culturally appropriate interventions that make it easier for African Americans to begin and stay in treatment. Their program, “Community Is the Cure,” focuses on collaborative interventions that can be delivered by or in cooperation with trusted community resources, or “credible messengers.”

“We need to counter hopelessness with realistic understanding,” Schottenfeld says. “Treatments aren’t perfect, but they are effective.”

The team is currently conducting an initial study at a faith-based nonmedical community center, the D.C. Dream Center. The goal is to help people with opioid use disorder get evaluation, treatment planning, medication treatment, recovery coaching, and other services, delivered by peers in a welcoming, non-stigmatizing environment and to educate the community about effective treatments.

This work is funded by the National Institute on Drug Abuse through the NIH HEAL Initiative^®.