By Fred Rottnek
As a good Catholic kid growing up in St. Louis, and now as a faculty physician at Saint Louis University, I like to know my chaplains. They know stuff — lots of stuff. They usually live at the intersection of people, policy, staff, and administration of the institution. And they almost always have their fingers on the pulse of the institution through relationships they cultivate among all stakeholders. Chaplains wear lots of hats. They translate, they advocate, they normalize seemingly abnormal experiences, and they can promote hope even in the worst of times.
The opioid epidemic now seems like one those worst of times. And the epidemic rages in most of the institutions in which you’ll find a chaplain, and where a chaplain will be sought to make sense of the suffering and death around the opioid epidemic.
While this is not our nation’s first epidemic, it had hit our society hard — in all ages, all races, and all social-economic levels. The current U.S. landscape of substance abuse is different from past epidemics in several ways.
- The supply of opioids is unlike any supply we have seen before. Opioids — both natural, like heroin and codeine, and synthetic, like fentanyl and oxycodone — have been available for decades on street corners and in physician and dentist offices. Illicit manufacturers and dealers are disguising their products as tablets and capsules. And manufacturing techniques are simpler and distribution networks more extensive than ever.
- With the conveniences of texting, overnight delivery, and social media, deliveries can be made all over the country. No longer are illicit drugs solely an urban issue; suburban and rural communities are also common markets. Previous addiction epidemics were easy to ignore as someone else’s problem and disproportionately affected the poor and those with least access to care.
- These drugs are more potent, purer, and cheaper than ever before. People can drop dead from their first use or from what they think is their standard hit when supplies of heroin are laced with other synthetic opioids such as fentanyl — a synthetic opioid up to 50 times stronger than heroin, gram for gram.
The opioid epidemic is intimidating. It is frightening. But it is not hopeless. And chaplains are in a unique position to keep hopefulness front and center.
Now is a time for chaplains to step forward as change agents by working their systems, reframing situations, and promoting hope through evidence, encouragement, and relationship building.
- Normalize conversations around pain, substance use, and addiction. People with these conditions often feel isolated and diminished. Don’t be afraid to have a conversation. Ask them about their experiences. You don’t need to problem-solve. Just allow space for connection and conversation.
- Remind stakeholders that addiction is a treatable condition, and usually, a highly preventable condition. Know your institution’s resources — as well as some community-based resources separate from your institution — for addiction treatment and behavioral health treatment. You don’t have to be an expert if you know the experts. Too often, people struggling with addiction feel as if they have no alternatives and no resources. That is almost always not the case, but you can provide hope by suggesting a conversation with people who care. Chaplains often know the back channels, and you shouldn’t be afraid to use them.
- Support people in recovery, in the path that works for them. Advocate for evidence-based practices in your institution. For instance, housing should not be restricted from people who are on medications for opioid use disorders. Likewise, the Americans with Disability Act protects employees on the same medications. Ensure barriers are minimal and policies are accommodating.
- Promote the health of the whole person, and seek assistance when needed. Always promote services — or collaborate with agencies that provide services — to support all your stakeholders. Employees and students might be food insecure—provide a food pantry. Stakeholders might have experienced a disproportionately large share of trauma — provide trauma-informed education and services. Likewise, partner with community agencies to educate stakeholders, their families, and your community about evidence-based models of addiction prevention, addiction treatment, and how to sustain recovery into human thriving.
- Advocate for institutional policies that promote health, well-being, and community among all stakeholders. In addition to promoting services, advocate for sustained change in your institution with policy review about substance use and misuse, access to addiction services, and support for stakeholders in treatment.
Chaplains are visible symbols of history and mission in our Catholic institutions. But they can also be the prophetic voice that we require moving forward in battling the opioid epidemic — and whatever epidemic comes next. Your unique position allows you to occupy the worlds of many stakeholders and bridge the gaps to pursue holistic approaches to healthy communities. Keep us on track, and keep us hopeful!
Fred Rottnek, MD, is director of community medicine at Saint Louis University Doisy College of Health Sciences.