The Northwest Rural Opioid Technical Assistance Collaborative (NW ROTAC) is a partnership between Washington State University’s Center for Rural Opioid Prevention, Treatment, and Recovery (CROP+TR) and Oregon State University’s Coast to Forest with the goal of developing and disseminating training and technical assistance (TTA) to rural communities for prevention, treatment, and recovery from opioid misuse. NW ROTAC provides rural Region 10 (Oregon, Idaho, Alaska, and Washington) communities with the high quality TTA they need to combat the opioid epidemic and build local capacity. This is done by 1) serving diverse and rural communities, 2) providing TTA spanning the health continuum from health promotion through recovery, and 3) leveraging relationships with state Cooperative Extension Systems and other Substance Abuse and Mental Health Services Administration supported efforts. NW ROTAC has the potential to impact the lives of the more than 1.2 million people living in the 60 rural counties and over 270 federally recognized tribes in this diverse geographic area.
While increases in both drug poisoning deaths and fentanyl / methamphetamine use in rural Region 10 parallel national trends, each state has unique needs. For example, opioid and stimulant poisoning deaths are rising at alarming rates. Between 2020 and 2021, overdose deaths increased by 12%, 16%, 34%, and 37% in ID, WA, OR, and AK, respectively. [i] In fact, OR and AK have some of the highest increases in poisoning deaths nationwide.
These trends are impacted by the increased availability of low cost, high potency methamphetamine. Rural and historically marginalized communities experience both a higher prevalence and more severe consequences of methamphetamine use. [ii] Increases in fentanyl and methamphetamine use have been particularly harmful to American Indian / Alaska Native communities in Region 10.[iii]
Rural areas are disproportionately impacted by the opioid crisis and related consequences and experience limited access to treatment, transportation barriers, and slow adoption of evidence-based approaches. A recent needs assessment of northwest rural-serving opioid prevention, treatment, and recovery providers identified their top five barriers as 1) stigma about opioid use, 2) lack of community knowledge/awareness of opioid use disorder, 3) access to behavioral health resources/services, 4) access to prevention programs, and 5) access to financial support for prevention, treatment, and recovery services.
A Snapshot Across the Region
In each state in Region 10, state health departments and public health researchers are making efforts to understand and address the impacts of the opioid epidemic. According to their findings:
In Washington drug-caused deaths involving opioids between 2020-2022 had increased by 190% since 2003-2005; and there were nearly twice as many opioid drug overdose deaths in 2021 as there were in 2019. [iv] At the same time, “some of the highest death rates and largest increases are seen in rural counties, such as Okanogan, Yakima, Clallam, Grays Harbor, and Mason.” [v]
In 2021, there were 745 unintentional opioid-related deaths in Oregon. This is a major increase from 2019, when there were 280 deaths, and the numbers are predicted to continue to rise. [vi]
According to the Idaho Healthy Youth Survey, “14.2% of high school students in Idaho reported misusing prescription pain medicine at least one or more times during their lives.” [vii]
In Alaska, overdose death rates among American Indians and Alaska Natives was 77.7 deaths per 100,000. This number is considerably higher than the overdose death rate among White Alaskans, 28.8 deaths per 100,000. [viii]
NW ROTAC Response
Together, CROP+TR and Coast to Forest have leveraged their resources to form a powerful collaboration, aimed to serve the needs of rural regions across Washington, Oregon, Alaska, and Idaho.
CROP+TR drew upon the goals set by the Washington state executive order ‘Addressing the Opioid Public Health Crisis,’ which directed the implementation of a state opioid response plan. This plan outlined goals to prevent, identify, and treat opioid use disorders, reduce opioid-related morbidity and mortality, and use data to monitor and evaluate interventions. CROP-TR addressed each of these goals within rural communities.
Coast to Forest was also influenced by statewide public health policy. Driven by the prevalence of mental health issues and substance use disorders in Oregon, its goals were to improve mental health and wellbeing, expand training tools and technical assistance through the OSU Extension Service and College of Public Health and Human Sciences, and to build capacity in rural Oregon to prevent and reduce opioid and stimulant use disorders and their consequences, and move people to recovery.
The goal of NW ROTAC is to provide opioid misuse prevention, treatment, and recovery TTA for rural communities throughout SAMHSA Region 10. NW ROTAC is grounded in 1) serving diverse and rural communities, 2) providing TTA spanning the health continuum from health promotion through recovery, and 3) leveraging relationships with state Cooperative Extension Systems and other Substance Abuse and Mental Health Services Administration supported efforts. Using this foundation, we provide multiple levels of TTA to meet rural-serving providers where they are on topics important in their communities.
Our TTA falls within three levels, each with greater intensity and tailoring. At the broadest level, universal approaches include information provided for all audiences and across the health continuum. This includes our newsletter and online repositories. Targeted approaches are the next focused level where information is tailored for specialized groups. This includes things like multi-session trainings on delivery of evidence-based programs. Finally, intensive approaches are the most focused, often where individualized coaching is offered. Here, we include program-specific communities of practice.
NW ROTAC is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and led by faculty from the WSU College of Agricultural, Human, and Natural Resource Sciences, the WSU Elson S. Floyd College of Medicine, the College of Nursing, WSU Extension, OSU Center for Health Innovation, and OSU Extension.
[i] Baumgartner JC, Radley DC. Overdose deaths surged in the first half of 2021, underscoring urgent need for action. The Commonwealth Fund. February 7, 2022. Accessed June 10, 2022. https://www.commonwealthfund.org/blog/2022/overdose-deaths-surged-first-half-2021-underscoring-urgent-need-action.
[ii] Han B, Compton WM, Jones CM, Einstein EB, Volkow ND. Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths among US Adults. JAMA Psychiatry. 2021;78(12):1329-1342. doi:10.1001/jamapsychiatry.2021.2588.
[iii] Han B, Cotto J, Etz K. Methamphetamine overdose deaths in the US by sex and race and ethnicity. JAMA Psychiatry. 2021;78(5):564-567. doi:10.1001/jamapsychiatry.2020.4321.
[iv] University of Washington Addictions, Drug and Alcohol Institute. (2023, May 17). Opioid trends across Washington state. Washington state opioid trends.
[v] University of Washington Addictions, Drug and Alcohol Institute. (2023, May 17). Opioid trends across Washington state. Washington state opioid trends.
[vi] Oregon Health Authority: Public Health Divison. (2022, December 21). Opioid overdose public health surveillance update. OHA 2296 Public Health Surveillance Update (oregon.gov).
[vii] Idaho Office of Drug Policy. (2021). Prescription opioids fact sheet. Prescription-Opioids-Fact-Sheet-2021.pdf (idaho.gov).
[viii] Alaska Department of Health: Division of Public Health. (2022, July 25). Alaska facts and figures: 2021 drug overdose mortality update. 2021 Drug Overdose Mortality Update (alaska.gov).
Supporting Communities in Doing What We Know Works
Spanning the health continuum
We provide training and support every step of the way, across the behavioral health continuum from health promotion and harm reduction through prevention, treatment, and recovery.
We leverage the infrastructure and relationships within each state’s Cooperative Extension System to reach rural communities. Extension supports people in using research-based knowledge to improve their lives.
At the universal level, we provide resources you can access with minimal assistance from staff. These include newsletters, web libraries of resources and tools, and county-level resource guides.
Serving rural and diverse communities
Recognizing the unique needs of our region, we are committed to collaborating with tribal organizations, as well as organizations serving other diverse populations such as agricultural workers, youth, people in recovery, and people with co-occurring mental health and substance use challenges.
At the targeted level, we provide focused support through trainings and events for those interested in specific programs or approaches. This includes trainings, resources, and support for specialized groups of providers.
At the intensive level, we focus on stable, on-going relationship to support changing policies, practices, operations. This includes training and coaching within communities of practice.