‘The wild west right now’: Report on Kansas substance use disorder examines system gaps, strengths

University of Kansas researchers Janine Hron, left, and Silke von Esenwein appear on the Kansas Reflector podcast to share what they learned about the gaps and strengths in the state's substance use disorder system. (Kansas Reflector screen capture)

TOPEKA — An intensive look at the Kansas substance abuse disorder system reveals gaps in services that can be addressed to provide better care and support statewide, university researchers said.

The University of Kansas Center for Public Partnerships and Research gathered data, talked to 2,000 Kansans and explored evidence-based tactics that could change the substance abuse system.

The result was the United to Transform report, a needs assessment that was shared with the Kansas Fights Addiction Board after being commissioned by the Sunflower Foundation.

“Substance use disorder actually encompasses a range of substances, from alcohol, tobacco to opioids, amphetamines, the whole package,” said Silke von Esenwein, research lead for the project, on the Kansas Reflector podcast.

The funds from Kansas Fights Addiction were from the opioid settlement, so there was a strong focus on that class of drugs.

“But the truth is that people use a lot of things at the same time,” von Esenwein said. “It usually goes hand-in-hand with mental health issues and so we made it a point to be pretty inclusive of all the substances that people are using out there, because they’re part of the context and they’re part of what’s happening in Kansas.”

Janine Hron, co-principle investigator on the project, said she was shocked at the prevalence of substance use in Kansas. The National Survey on Drug Use and Health reported that one in five Kansans meets the clinical criteria for substance use disorder, she said.

In addition, 95% of those people do not believe they need to change their behavior or need support in doing so, the research found.

“In that way, substance use disorder really is a factor affecting the lives of all Kansans because those one in five are people that you know,” Hron said. “They are a part of our family, they’re in our workplace, the general community structures, our faith communities, our social networks. It’s an everyday part of everybody’s life.”

The estimate of use may be an underestimate, von Esenwein said, because the survey doesn’t include people who are unhoused or incarcerated.

A needs assessment is a comprehensive look at the substance use disorder throughout the state, von Esenwein said.

“You try to identify gaps and weaknesses, but you also try to identify strengths in a system, what you can build on,” she said. “You see where do people fall through the cracks? What are the big burning fires? What are rising issues? We added a component, which is called futures work. We’d not only ask what is happening now, but we also did a lot of work (on) what do people want to see in the future.”

Data and information gathering were critical to the process, and the report also explored potential strategies and priorities, von Esenwein said.

Gathering information from multiple networks in communities throughout Kansas wasn’t as simple as creating focus groups, Hron said. They used strategies that allowed communities, through exercises and activities, to interpret for themselves what is happening, she said.

“We’re gathering the information about the ‘what,’ but we’re also understanding deeper about the ‘how does this manifest’ in the community,” Hron said. “For me, that was reinforcement for the exceptionally important local level kinds of look that we needed to take and how we would marry that with the very important systems-level initiatives that were going to be required.”

The substance use disorder system is large, Hron said, and involves many different players.

“That’s our challenge,” she said. “It’s the wild west right now. We, very early on, started looking at both the systems level and the local levels, and the interdependencies between those.”

 

Strengths

Hron and von Esenwein said strengths in the Kansas system showed up throughout their work. For instance, they found that while there still can be stigma around having a substance use disorder, that opinion is shifting.

“People are talking about this topic,” von Esenwein said. “There’s a really vibrant peer movement going on in Kansas that took it to the streets. They literally took it to the streets and said, ‘We are dying, and nobody cares.’ And they’re very vocal. The advocacy is much stronger.”

They also talked to clinicians who said it used to be a “‘party conversation stopper” to talk about their profession and now people respond positively, she said.

Hron said insights from a group of eight people — they called them the “accountability cohort” — who had lived experience with substance use were helpful in shaping questions and how researchers looked at the individual experience and community-level supports.

“They were the ones who really articulated for us what that individual journey looks like, and this lack of mattering, it was really heartbreaking to me,” she said, referring to individuals who felt like they didn’t matter to anyone.

“They also talked about the point where something clicks and the process of change started, and what that took, the hope, the connection, the community that is required to do that successfully,” Hron said.

 

Challenges

The report highlights key findings, including:

• Most (93 of 101) hospitals in frontier and rural Kansas communities are financially unstable, and they offer opportunities to meet substance use disorder (SUD) needs. In 2023, 29% of all SUD patients required emergency or crisis services.
• There is a severe lack of access to medical detoxification and Medications for Opioid Use Disorder (MOUD). These medications are essential and are considered gold standard for treatment. Kansas 2023 medical claims data show treatment including medical detoxification in less than 1% of all people receiving care, and use of MOUD occurring in fewer than 4% of cases.
• Pharmacies operate in 103 out of 105 counties, making them one of the most accessible health care points for individuals seeking care.

“The role of our hospitals, particularly in the rural parts of the state, is absolutely essential,” Hron said. “Right now, they are triaging and dealing with emergencies and that sort of thing, but there’s a much bigger role that they could be playing.”

Hospitals and pharmacies could be touchpoints for people with SUD, but in general, the system is fragmented, von Esenwein said.

“That’s not news, right? Like, people know that, but we were able to find much more details that give us kind of entry points,” she said. “We know, for instance, that youth and the elderly population, over 65, have a particularly hard time finding care. We also were able to identify where care breaks down after people come out of treatment, and what is not there right now to make people successful.”

Von Esenwein said the lack of evidence-based practices being used and failure to use medical detoxification drugs in Kansas was “stunning” to the team.

“That kind of evidence-based practice — we know what works — isn’t really happening in Kansas,” she said. “We know medications for opioid use disorder are the No. 1 way to save lives. We know it’s very effective. Less than 5% of people that are in treatment are getting it.”

Medication-assisted withdrawal can make all the difference for someone trying to stop using drugs, and von Esenwein said that’s not happening in the state. Instead, social withdrawal, meaning stopping use without medication supports, is typically what occurs.

“That might be in a medical setting, but without a medication that we know makes it easier to come out of it,” she said.

 

Community matters

Every community is different, and the people and systems there have different needs, Hron and von Esenwein said.

The Kansas Fights Addiction board will have numerous opportunities to meet needs in Kansas based on what researchers found, she said.

“I think the board has a chance to really support what we know works, which is strong prevention efforts, medications for treatment, treatments that are not in residential settings for three months that nobody can afford, that are way too expensive, and people can’t just leave their children, parents, whatever, behind to go,” von Esenwein said.

Creating a continuum of care that supports people with substance use disorder is possible, she said.

“We are really pleasantly surprised by the energy and the readiness of people throughout the state to do something about this,” von Esenwein said. “This is usually a topic people kind of shy away from and are reluctant to talk about, but people are fired up and they’re ready to talk.”

Webinars pulling together people in the SUD system from across the state were a special highlight of the process, Hron said. People were excited to share information and to compare what was happening in other communities.

“Kansans are resourceful and they’re practical,” von Esenwein said. “I think that we can really capitalize on that. I think people are ready. We talked to lots of people with lots of connections, and we’re in a pretty good position to actually move forward and do something. It made us very optimistic.”

Correction: The age of elderly population in Kansas was updated to 65 years.