East Tennessee State University College of Nursing professor Dr. Judith Rice has worked with people experiencing homelessness for nearly two decades, giving her insight into how substance abuse and the region’s opioid crisis have affected them.

Rice recently presented a webinar for health care and homeless service providers about the prevalence of substance abuse and opioid use disorder among the homeless population. She focused on treatment options, such as medication-assisted treatment, and the general need for increased accessibility.

Rice said she started her series of webinars to educate service providers about different substance abuse treatment options, as well as how to help provide some of those options to the homeless population.

“The opioid crisis has been particularly devastating to homeless populations,” she said. “Many are dying on our streets from overdoses, while others are criminalized for having an illness.”

Rice said she’s specifically focused on the medications used for medication-assisted treatment, which include buprenorphine, methadone and some non-narcotics. If used correctly and “together with counseling,” she said they can be effective and can save lives.

“There are a lot of misconceptions about them,” she later added. “A lot of people don’t understand the differences between methadone and Suboxone. They’re used for the same disorder, but they’re two very different medications, so we talked about the differences, safety issues with these medications … Many don’t agree with this treatment because they think it’s just substituting one narcotic for another, so I provided some research and data showing it can be effective if used appropriately.

“One of the bigger ones, though, that is really good assistance is Vivitrol, which is not a controlled substance,” she continued. “For my patients that don’t have insurance, I am able to get them that if they meet income requirements, and most of them do. They’re able to get that free.”

Rice is the primary investigator of the PATH program grant at the university. PATH is a Substance Abuse and Mental Health Services Administration formula grant introduced in 1990 and distributed annually to all 50 states.

Through PATH programs, Rice said the Johnson City Downtown Day Center, managed by the university’s College of Nursing, is able to “provide essential services that may not be supported by mainstream mental health programs to people with serious mental illness who are experiencing homelessness.”

The center provides access to medical and mental health services, counseling, case management, washer/dryer services, shower services and clothes. In 2018, Rice said more than 1,300 people came to use the services at the center, and each year, about “75 to 80%” of those who visit the center are struggling with some sort of substance abuse issue, including opioid use disorder.

The center usually receives about $170,000 a year, but this year, Rice said it received $137,241 through the grant program.

Rice said she hopes to continue using the PATH program to assist the homeless population through their struggles with substance abuse and mental health disorders.

“I’ve always been cognizant of people living in poverty from a very, very young age. I did go into nursing to become a psychiatric nurse practitioner, so I knew very early on that I wanted to work with people with psychiatric disorders,” she said. “I think a lot of times in society, they don’t treat people experiencing homelessness with the respect they deserve, so I really feel I’m blessed to be able to work with them.” 

Rice was asked to present several other webinars later this year.