Despite limited resources, a small town rallies community partners around prevention.
Rural communities have been hit hard by the opioid crisis. No longer regarded as mainly an urban problem, opioid misuse has negatively impacted the lives of people in rural communities across the U.S. Death and injury from non-medical prescription opioid misuse is concentrated in states with large rural populations,1 and rural admissions for substance abuse treatment are more likely than urban admissions to report use of non-heroin opiates (10.6 vs. 4.0 percent).2
At the same time, rural communities face particular challenges in preventing substance use and misuse. Many have limited resources and lack the trained personnel to carry out prevention initiatives across the country miles. With the need great and resources limited, some small towns and rural counties are finding creative ways to accomplish their prevention goals. So when tiny Tekoa, Washington (pop. < 900) wanted to increase public awareness and education about opioid misuse prevention, they didn't let limited resources or winding backroads stop them.
Confronting the Opioid Misuse Problem
Surrounded by mountains, Tekoa is a small farming community in Whitman County, in southeast Washington State. "It takes an hour to drive anywhere like a shopping mall or a large grocery store," says Diane Harp, Community Coordinator for the Healthy Tekoa Coalition. The coalition was formed in 2012 as a volunteer group to promote healthy choices and reduce underage access to alcohol and drugs. Its members include parents and other concerned citizens, as well as representatives from law enforcement, business, the church, health care and social services providers, and youth organizations. "We have a very caring community," Harp says.
Tekoa has a friendly, small-town charm. Its official website describes it as a place "...where the noon whistle signals lunch time every day; where everything is within walking distance." Everyone knows each other, and neighbors look out for neighbors. But like so many rural communities, Tekoa began to experience the devastating negative effects of opioid misuse.
"We needed a prescription drug misuse program because we had quite a few things going on in our community," Harp says. This included one attempted and one completed student suicide using opioid drugs, and a rise in opioid-related break-ins and robberies, including a pharmacy robbery. "We knew we had a big problem on our hands, and we had to do something about it."
Establishing an Rx Drop Box
Healthy Tekoa’s first priority was to educate Tekoa's residents about opioid misuse prevention. They believed that setting up a prescription drop-off box in town would be a good starting point—one that could serve as a catalyst for greater awareness and community engagement. There was also a practical reason: The nearest prescription drop-off box was an hour away at the Whitman County Sheriff's Office, so residents did not have a convenient place to dispose of unused or outdated medications.
In 2016, with funding from a SAMHSA Partnerships for Success (PFS) grant, the Healthy Tekoa Coalition invested in one prescription drug drop-off box. "We’re a tiny town, so we were lucky to have a pharmacy to place the Rx drop-off box in," says Harp, noting residents would be more comfortable bringing medications to their local pharmacy, rather than travelling to the sheriff's office to do so. They were also fortunate that, despite a recent robbery, the pharmacist was willing to host the drop box for the good of the community. "She was willing to step up, knowing we'd have the support of the Whitman County Sheriff," Harp says. Once a month, the sheriff agreed to make the one-hour drive back and forth to Tekoa to empty the drop box and transport the medications for incineration.
Navigating Curves in the Road
The Rx drop box program occasionally hits a speedbump. "The biggest challenge we have is to make sure the prescription drop box can get emptied," Harp says. By law, the sheriff is the only one who can pick up and transport the medications for disposal. "Our sheriff is very busy, and one day he was out of town on business and the box needed to be emptied," Harp recalls. "He came the next day, and we had a large garbage-sized bag of prescription drugs to be [disposed of]. It was a blessing to have the sheriff there."
To spread the word about the program, the coalition created flyers and posters, and the pharmacist made bright pink neon prescription bag stickers. The community got on board: "The drop box collects about 25 pounds of medications a month," Harp says. But establishing and promoting the Rx drop box was just the first step in Tekoa’s work. "You can't just have one drop box," she says. "You have to get information out to the community." To do that, the coalition needed to engage more local partners in prevention.
Rallying Partners in Prevention
Building on the success of the drop box program, the Healthy Tekoa Coalition hosted a brown bag event to educate the public about safe medication usage, storage, and disposal. "We wanted to work in combination with the pharmacist to make sure patrons were using their prescriptions safely," Harp says. They wanted to make the public aware of the importance of safely storing and disposing of unused or expired medications, as well as educating people about the warning signs that someone else may be misusing their medications. Residents were invited to bring their unwanted prescriptions in brown bags for safe disposal at the pharmacy.
To pull off the event, the coalition partnered with Molina Healthcare, which donated 80 medication lock boxes to give away to participants. Tekoa was experiencing an increase in home break-ins where prescription opioids were stolen. In addition, youth were getting access to opioids from their parents and family members, who did not know the importance of keeping opioid medications locked up and safe. The lock boxes provided a way for families to keep prescription and over-the-counter medications away from teens, adolescents, children, and grandchildren—acting as a deterrent to accidental poisonings, medicine theft, and misuse.
In addition, a registered nurse and the Tekoa pharmacist volunteered their time at the event to review participants' medications with them and answer their questions in a private setting. "We had one [event participant] who was overdosing with their medication, and another who was using medications that worked against each other," Harp says. "We may have saved two lives with just that one encounter."
Small Town Strong: Looking to the Future
Harp says the real work to fight opioid misuse is just beginning. But where the Tekoa community may lack resources, they make up for it with heart, commitment, and concern for each other. This means getting creative when it comes to prevention. "We're a rural town, so most of our [promotion] is through posters, flyers, and word of mouth," Harp says. "We don't have a local TV station. We don't have a local radio station. We don't have a local newspaper. So we do whatever we can to get the word out about prevention."
For example, the City Council runs notices about coalition programs and activities in its community newsletter. The coalition also partnered with the Tekoa Medical Clinic, which attracts patients from other communities. The clinic agreed to distribute information about the pharmacy Rx drop box, spreading awareness of the program to patients in town and those living beyond Tekoa's borders.
Harp looks forward to the Healthy Tekoa Coalition forging additional partnerships with community members and organizations. She hopes to share her lessons learned in the Rx drop box and brown bag education programs with prevention coalitions and other organizations in surrounding communities. "We work every day to make our community better and to help us all make healthy choices," she says. "It's not just one caring person, but it's a bunch of us. We want to make sure that our kids have the opportunity for a successful future."
1. Katherine M. Keyes, PhD, Magdalena Cerdá, DrPH, Joanne E. Brady, SM, Jennifer R. Havens, PhD, and Sandro Galea, MD, DrPH. American Journal of Public Health. (February 2014.) Understanding the Rural–Urban Differences in Nonmedical Prescription Opioid Use and Abuse in the United States. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935688/
2. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (July 31, 2012.) The TEDS Report: A Comparison of Rural and Urban Substance Abuse Treatment Admissions. Rockville, MD. Available at https://www.samhsa.gov/sites/default/files/teds-short-report043-urban-rural-admissions-2012.pdf