Fighting the Opioid Epidemic: Transforming Community Health and Social Connections in Rural Areas of the U.S.

Dolores Albarracín, the Amy Gutmann Penn Integrates Knowledge University Professor, has long studied how to curb disease and improve health.

Now, Albarracín, and her team in the Social Action Lab, a collaboration between the Annenberg School, the Annenberg Public Policy Center, and the School of Arts and Sciences, are working with people in the parts of the United States most vulnerable to HIV and Hepatitis C (HCV) infection spread — rural communities in Appalachia and the Midwest, the frontlines of the substance use and methamphetamine disorder epidemic.

In partnership with a network of leaders from state health agencies, county health departments, and local nonprofits in these areas, Albarracín, her research team and local community members have spent five years preparing and a year testing an intervention to promote HIV and HCV prevention, increase well-being and reduce the stigma of substance use in these areas.

Research That Reaches People

“When we first conceived of the research project, it began with the idea of creating a massive community advisory board to be connected with communities that were all affected by the substance abuse disorder epidemic,” Albarracín said. “That particular pattern of substance use was causing outbreaks of HIV in areas that had never seen anything like it. In 2015, an Indiana town went from fewer than five infections of HIV a year to around 190 a year. In these areas, the opioid crisis has been compounded by a lack of access to healthcare as well as social stigma, resulting in major health risks.”

The research was made possible by an Avant-Garde Award from the National Institute of Drug Abuse that Albarracín was awarded in 2019. The grant “supports exceptionally creative scientists conducting high-risk, high-reward research on HIV in the context of substance use and substance use disorders. The award encourages innovative approaches that could lead to new avenues for prevention and treatment of HIV.”

After receiving the award, Albarracín and her team began to recruit advisory board members from regions most vulnerable to HIV and HCV infections: the rural Midwest and Appalachia. The team of leaders from these areas — called the Grid for the Reduction of Vulnerability (GROV) — advised on future research projects.

Albarracín and her team soon called upon the GROV board to help craft a social intervention to address the substance use disorder crisis and increase community well-being in these regions. The intervention lasted the course of a year, from February 2024 to December 2024. Throughout the year, groups of participants from regions represented by GROV met online over Zoom to craft individual social and health goals. Participants included both people who use substances and the community at large.

The goal was to foster connections between individuals and communities of people near and far. “Social connections can foster the right context for behavioral change, and help pave the way for better community health,” said Devlin O’Keefe, former research coordinator with the Social Action Lab. But social connections alone are not sufficient, so the intervention relies on setting and implementing goals with support from others, said co-investigator Man-pui Sally Chan, research associate professor at the Annenberg School. “By fostering social connections with intergroup discussions on health, participants seem to be more willing to share their health needs (regardless of their substance use status), better able relate to one another, and able to become more supportive within their networks,” she said.

These meetings were facilitated by eight members of the research team and GROV, and supervised by Marta Durantini, former Research Director at the Annenberg Public Policy Center. Additionally, the intervention included a private social media platform created by the research team under the leadership of Chan. In this moderated, secure platform, participants and leaders could have conversations to support their personal goals. Participants could also request free HIV and HCV testing kits and Narcan from the research team. “Therefore, the intervention attempted to address the dearth of one-stop-shop comprehensive services in the rural counties,” Chan said.

“When we first conceived of the research project, it began with the idea of creating a massive community advisory board to be connected with communities that were all affected by the substance abuse disorder epidemic,” Albarracín said.

Meeting People Where They Are, From Afar

“One of the benefits of having an online study is that it lets people in relatively isolated communities expand their social connections and reach out to people in communities who have very similar problems and can share different solutions,” said O’Keefe.

One participant from Virginia agrees: “I had the expectation that I would have nothing in common with these people from around the country, but I was really surprised at how quickly and how easily I was able to form connections with them,” they said.

Working together, the study provided a platform for community members to support one another: “It was absolutely helpful in realizing that I could feel like I belong in a community, and not be some outsider,” said one participant. “Especially in more rural areas, you don’t really feel like you have that sense of community.

Realizing I can interact with these people that I might not necessarily know anything about made me start to realize that I can form new friendships. I can be a part of society again.”

As the co-creator and supervisor of the intervention Durantini saw these types of changes first-hand.

“I was struck by how quickly people stepped in to help others with their problems and share their own, even with those who had been complete strangers just the day before,” she said.

“Across the more than 100 sessions I attended, I often heard participants say, with relief, ‘I appreciate everyone’s honesty and the fact that no one judges anyone.’ I watched as they discovered common ground with people whose lives were vastly different from their own — those who had never used drugs forming bonds with others striving to rebuild their shattered lives,” said Durantini.

Fred Wells Brason II is President and CEO of Project Lazarus, a nonprofit organization that provides training and technical assistance to communities and clinicians addressing prescription medication issues in Wilkes County, North Carolina. He is also the co-chair of the GROV Community Advisory Board.

As someone with decades of experience assisting community members struggling with addiction, Brason was happy to share his expertise with researchers. “In our community, we realized the only way to change the individual was to change the village. And that’s essentially what we did,” he said. “Not every community knows what to do around the issue, and to me, this research is an avenue to provide evidence-based ways to fight the opioid crisis.”

What’s Next

The team has submitted the results of their Cluster Randomized Controlled Trial (RCT) testing of the program for publication (the outcomes are embargoed until publication). The goal is not just to understand what works, but to create a replicable blueprint for future efforts. “Additionally, we need to consider how to expand it for effective implementation by local nonprofits and other researchers,” Chan said.

For Albarracín and her team, this is a model for what community-collaborative research can look like: programs that work because they are co-created by the people they aim to serve. Its strength lies in its partnerships — between scientists and residents, health professionals and harm reduction advocates, and between Penn and the people living in some of the country’s most underserved areas.

“Communities are already ready for this, and I think what’s necessary next is funding for similar interventions that similarly harness the strengths of these communities to increase well-being,” O’Keefe says.

This is more than a research project to Albarracín — it’s a commitment to ensuring that the tools of communication research are used not just to understand human behavior, but to improve health, especially where the stakes are highest.

“I cannot comment on the intervention results yet, but this project is part of a decade focusing on understanding how behavior is regulated in social contexts,” Albarracín said. “Simply bringing people together is unlikely to produce changes without a social psychological understanding of how groups can help achieve personal goals.”

“This multifaceted intervention is likely to improve that understanding and bring together the psychology of self-regulations, the science of norms and communication processes,” concluded Albarracín.