New UNL Research Center to Study Rural Midwest Drug Addiction

April 24, 2019, 4:45 p.m. ·

UNL Rural Drug Addiction Research Center director Kirk Dombrowski. (Photo courtesy University of Nebraska-Lincoln)

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A new grant will help fund a unique research center at the University of Nebraska-Lincoln to study what has become a drug epidemic in the rural Midwest. The five-year, nearly $12-million grant from The National Institutes of Health will establish the Rural Addiction Research Center at UNL to understand and address drug addiction in the Midwest. Lead researcher and center director Kirk Dombrowski spoke with NET’s Jack Williams about the new research center.

NET News: This is a big step for addiction research in the Midwest. How will this new center fill a need for more data and insight into what seems to be a growing problem in Nebraska and other Midwest states?

Kirk Dombrowski: Most of the attention to drug use historically is focused on cities and most of the recent opioid crisis has taken place on the east coast and Appalachia. The patterns of drug addiction in the Midwest are different but just as challenging. Overdose rates in the Midwest are climbing while other areas have plateaued, but our overdose rates are more likely related to stimulants than they are to the opioid crisis.

NET News: How does a rural drug addict differ from any other kind of drug addict. Is there another layer here that makes research on drug addicts in the rural Midwest more difficult than other addiction research?

Dombrowski: Rural Midwestern drug users tend to adopt higher rates of what we call polysubstance use. That’s using more than one kind of drug in succession or simultaneously. And in the past, this was thought to result from unevenness in drug markets, but our research has shown that this is not the case, that drug availability, rural and urban, across Nebraska, is relatively similar. So we hypothesize that these differences are due to what sociologists call homophily, the tendency of people to take on the habits of those around them.

NET News: How do you even know there’s a rural drug addiction epidemic? Have overdose rates gone up compared to other regions?

Dombrowski: The CDC tracks overdose rates nationally and while overdose rates throughout the country have relatively plateaued over the course of the recent crisis, overdose rates in the Midwest are actually still rising. One of the highest rises we saw was in Nebraska itself. And we can also track the data through hospital admissions. A lot of people don’t realize that places like Iowa and Nebraska are among the highest per capita rates of hospital admissions for methamphetamine in the country.

NET News: Is that something that surprise people? I don’t suspect most people would think the Midwest is a hotbed for drug addiction.

Dombrowski: For a long time, overdose rates remained low and unlike a lot of urban drug use, it’s not particularly visible on the streets or on corners or affecting whole neighborhoods. It tends to be much more spotty and uneven and to take place in private homes and in more private settings. For a lot of the last ten years while drug use rates have been climbing, their visibility has been very low.

NET News: You’ll find out more when you begin your research, but what do you suspect is the biggest reason drug addiction in the Midwest is getting worse?

Dombrowski: Services are a lot less available and that’s particularly true for drug treatment and for mental health treatment. We know that Nebraska, Iowa, some of the Midwestern states, sort of the focus of our research, have very low ratios of drug treatment availability to drug use need in areas like medically-assisted opioid treatment.

NET News: I understand you’re going to track a fairly large group of MIdwest drug users as part of this research. What kinds of tools are you going to use to gather data from them?

Dombrowski: Our research core director has developed a unique cellphone software platform that will allow us to survey active users in real time and adjust survey questions on the fly to track changes that we’re seeing and better adjust our questions to what we’re learning.

NET News: Are you looking for treatment solutions or just answers to why this is happening?

Dombrowski: Our approach is very comprehensive, so we’re trying to look at the full range of addiction science, from synapse to society, with the aim of creating more effective treatments for these kind of complex problems, like polysubstance use, so as part of the center, we’re actually going to be developing a translation and treatment core facility that will try to take what we’re learning in the labs and out and work with our cohort and translate that into actionable kinds of treatment possibilities for this specific population. We’ve taken a lot of steps in recent years towards precision medicine within the body, but we haven’t done a great job as a science of incorporating the social, contextual, behavioral, interpersonal factors that really have a large impact on the success and failures of these actual treatments in the body.