David All's 'Recovery Deserts' project gets academic backing in new Ohio State study
The social entrepreneur co-authored a new paper identifying areas in Franklin County where geographic barriers to opioid treatment services exist.
Back in 2016, social entrepreneur David All was called on to work with the Neighborhood House, a former social-services center in the King-Lincoln District. At the time, the Neighborhood House didn’t have the proper level of certification to treat community members with opioid use disorder.
Charles Wheeler, the former head of the center, told All he wanted to reach people struggling with more severe addiction issues. “[Wheeler] said, ‘David, we're turning away people from the community all the time. They come, they try to get help, but … there's nothing we can do,’” All said.
All and his team brought in a clinical director and opened intensive outpatient clinic WellHQ at the Neighborhood House. Right away, folks from the community came through the doors and told stories about their attempts to get help.
“I would go and sit with them and talk to them, and I was asking, ‘Where did you go before the Neighborhood House?’ And they were like, ‘There’s nowhere to go,’” All said. “It was a real eye-opener for me. Without what we just did, this person would be stuck in this [cycle of] addiction, and it's not their fault. They don't have the means to go anywhere else. They don't have cash to go to one of these pop-up clinics. They don't have private insurance to go out to Dublin and stay in a nice place. So what do they do?”
The experience reminded All of “food deserts” — geographic areas where residents don’t have access to fresh food. What if the same place-based approach was applied to treatment and recovery services for those struggling with addiction? Anecdotally, it seemed as though Franklin County contained “Recovery Deserts,” which All eventually defined as an area or neighborhood lacking access to opioid use disorder treatment and recovery facilities. (All told Alive about the Recovery Deserts project back in 2017, when he was named one of the publication’s People to Watch.)
To test the concept, All needed data, so he approached Dr. Harvey Miller, a professor in Ohio State’s Department of Geography, who then coordinated with Dr. Ayaz Hyder, assistant professor at Ohio State’s College of Public Health, along with social worker and Ohio State lecturer Dr. Gretchen Hammond of Mighty Crow and others. After years of gathering data, the group revealed its findings in a study released this week, “Opioid Treatment Deserts: Concept development and application in a US Midwestern urban county,” which is accessible for free via PLOS ONE. The paper is co-authored by All and the team of professors and researchers from Ohio State University.
The study found disparities in access to opioid treatment in specific neighborhoods across racial groups in Columbus. The authors located these “Opioid Treatment Deserts,” defined as “an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder,” using local public safety data, namely EMS runs.
According to Dr. Hyder, the study revealed that Opioid Treatment Deserts aren’t always in the areas we might assume they would be. “They exist within our cities. They exist within the suburbs. They exist within the outskirts of the county, because overdoses are happening in all of those areas,” Hyder said.
Hyder also noted disparities across different racial groups. “It's an ongoing issue that needs to be addressed through addressing racism as a public health crisis,” he said.
The next step, Hyder said, is to help local agencies act on the data. “When a treatment provider goes to the Franklin County ADAMH board, now the ADAMH board will be able to very precisely give them the information about where to close these gaps, because now we know where they are,” Hyder said. “It’s replicable across the state, across the U.S. The data sources that we used are certainly available. The challenging part is being able to harmonize those data sets. In Franklin County, we have 21 different EMS agencies.”
Locally, some of that hard work is now done. Hyder said they can now track treatment deserts in real time. “We'll be able to be proactive about closing these gaps in terms of access to treatment,” he said. “Now the challenge is, how do we operationalize this into the day-to-day work of the public health agencies and the behavioral health agencies, the treatment community? How do we get this information out to them and what are the ways that they can act upon it?”
For David All, who’s now in Seattle, the publication of the paper is a full-circle moment. “I felt like I owed it to Columbus to close the loop on this,” All said. “There's a whole movement around food deserts now, but for addiction, there's nothing. It's this place where there's no data, there's no collaboration, there's no consensus, and instead it's political.”
It’s All’s hope that the publication of this collaborative study will lead to a new vision for Franklin County — one in which no one remains stranded in a treatment desert.