Responding to the opioid epidemic and HIV/AIDS outbreak in Indiana

Indiana, like many other states, is in the midst of an opioid epidemic. The National Institutes of Health reports that more than 2 million Americans suffer from substance abuse disorders involving this class of drugs, which includes illegal substances like heroin as well as frequently prescribed painkillers such as oxycodone and codeine. Hospital emergency departments in Indiana are handling nearly 400 overdoses a week, according to the Indiana State Department of Health, and more than 600 Hoosiers died in 2016 due to opiates. In addition to these direct effects, opioid users are also at increased risk of contracting blood-borne infections as a result of sharing needles used to inject these drugs.

Carrie Lawrence

School of Public Health-Bloomington visiting assistant scientist and alumna Carrie Lawrence (B.S.’05, M.S.’08, Ph.D.’14) is among the front-line public health professionals addressing this crisis.

Following a teaching post at Indiana State and several years working with nonprofits and social services, Lawrence decided to return to her hometown and alma mater in early 2015 to complete a post-doctoral fellowship with Associate Professor Beth Meyerson . Lawrence’s intention was to study HIV systems of care, but those plans changed, when, in February of that year, an HIV outbreak was reported in rural Austin, Ind. Between December 2014 and February 2015, 30 new cases of HIV were confirmed in Scott County, an area that typically sees less than five HIV cases each year.

As a self-described “practitioner-academic,” Lawrence became very involved in the state’s response to the outbreak and helped lead the school’s involvement in managing the crisis.

“I was able to take my professional experience and academic degrees and apply them to a complex public health issue,” she says.

Lawrence, Meyerson and a team of School of Public Health-Bloomington faculty and students have since been working with communities in Indiana and around the U.S. to assess local needs and build community capacity to reduce harms associated with injection drug use. Lawrence emphasizes the importance of working collaboratively with community members to create sustainable solutions that both address the immediate crisis and improve population health over time.

Beth Meyerson
“There’s no infrastructure for drug user health,” Lawrence says. “I’m a big believer in community-based participatory research. I want to empower communities to leverage existing resources for solutions that will be able to be maintained over the long term.”

Since the 2015 outbreak in Scott County, Lawrence has worked with 20 other Indiana counties and seven states on similar public health issues with the main goal of helping communities proactively address opioid drug abuse.

In addition to these community collaborations, Lawrence continues to research different approaches to this public health crisis to identify the most effective solutions. Her research primarily focuses on community capacity in reducing health disparities, drug user stigma, and barriers to health, among other topics. With her unique background in social services and academia, Lawrence wants to evolve the traditional concept of public health.

“As a public health advocate, I do research to ensure that we keep health and social issues that require our attention on the front burner. Our school has broad disciplines under one roof which gives us the ability to innovate health strategies. Even though evidence-based programs and best practices exist, one size doesn’t fit all, so it’s essential we use and build new evidence to innovate to meet present needs,” she says.

Currently, Lawrence is focusing on the power of stigma in the context of health equity and accessibility. Understanding and reducing stigma, she says, is “critical to ensure people have the opportunity to live and live a healthy life.” Additionally, her research with the Indiana Minority Health Coalition identifies factors that contribute to health disparities and ways to reduce disparities through empowering marginalized populations and building community capacities.

“Substance misuse has been around for decades. This is not a new problem; however, it has become a new normal now and should be emphasized in the public health narrative. We’ve been doing this work, but the magnitude of our opioid crisis is such, that now we need all hands-on deck,” Lawrence says. “It’s about saving lives. We want to prevent disease, keep people healthy but also prevent death.”