Meet the Expert: Amanda Latimore
Amanda Latimore, Ph.D., leads AIR’s Center for Addiction Research and Effective Solutions (AIR CARES). She also teaches social epidemiology as an adjunct assistant professor at the Johns Hopkins Bloomberg School of Public Health. Before joining AIR, Latimore held leadership roles with the Baltimore health department and behavioral health authority.
POSITION: Director, Center for Addiction Research and Effective Solutions (CARES)
AREAS OF EXPERTISE: Substance Use Disorders Epidemiology; Social Determinants of Health; Health Equity
YEARS OF EXPERIENCE: 13+
Q: Can you give us a bird's eye view of evidence-based approaches to address substance use, particularly around opioids?
Amanda: One of the most important evidence-based treatments for opioid use disorders is medications, like buprenorphine and methadone. Those treatments have a strong evidence base; time and time again, they’ve proven themselves in research studies to be effective. People with opioid use disorders are 50% less likely to die of an overdose when they receive these treatments.
However, much of the country does not have access to these medications. Of the 1,000 counties in the U.S. with great need, only about half have adequate capacity, and the shortage is particularly acute in rural communities. There are numerous barriers to access, like stigma and physician training, but our main priority should be investing in this workforce and lowering regulatory barriers to these medications.
Q: What are some good examples of states, organizations, and groups successfully using evidence to address substance use?
Amanda: Using medications in criminal justice facilities is a huge issue. In Rhode Island, research demonstrates that when people who are incarcerated receive medications to treat opioid use disorder, they are less likely to overdose when they reenter society. This is good news because once someone with substance use disorder is released from incarceration, they’re 40 times likelier to die from an overdose than someone without substance use issues.
There are operational challenges that explain why many criminal justice facilities don’t offer medications for opioid use disorder, but there are also barriers that shouldn’t exist. For example, diversion is when a patient receives a medication but doesn’t take it as prescribed; they either sell it or give it away. In criminal justice facilities, there are a lot of concerns about diversion, misuse, and general misunderstandings about the medications. But buprenorphine in particular is very safe, and in a criminal justice facility that I’ve worked with, they saw that diversion went down when people received access at the appropriate dose. When people are seeking medication outside of health care professionals, it’s usually because they need the treatment; it’s a roundabout way of seeking care.
On an ethical level, it’s really important that criminal justice facilities provide those life-saving resources. But I've also heard from our jail partners about how the medications help reduce suicides, violence, and noise. Of course, it's not just those in criminal justice settinigs who need access to these medications. People shouldn’t have to get arrested in order to access treatment, but if they’re there, they should receive the same standard of care as those not involved with the justice system.
Q: How is the COVID-19 pandemic affecting substance use treatment and care, and what is it revealing about this issue?
Amanda: The bright spot is that the pandemic has really forced us, as a country, to consider how we deliver services. Some regulations around the ways that practitioners can deliver services have been relaxed. Our next step is to provide evidence that those lower barriers to care produce positive outcomes, so that they remain in place after the pandemic is over.
At the same time, many people are suffering. Historically, during economic downturns and unemployment, higher rates of overdose tend to follow. Prior to the pandemic, projections suggested the increase in overdose deaths was leveling off, at least for some subsets of the population. Then the pandemic hit, and now we’re expecting a 24% increase in overdoses over last year. That’s why it’s never been more important to focus on behavioral health.
At CARES, we’ve been really interested in the intersection of COVID-19, behavioral health, and the racial justice movement. Existing, systemic racial health disparities have led to higher rates of COVID-19 among Black individuals, who are twice as likely to die from the disease as their white counterparts. At the same time, Black communities face over-policing and higher rates of death when they have contact with the police. Combined with the existing opioid epidemic, all these crises together show us that there are systemic issues that need to be addressed. We must start thinking at a higher, macro level, because the conditions of the world demand it.
Q: Social determinants of health has a role in all aspects of wellness. How does CARES intend to address social determinants of health in its work?
Amanda: We're focusing on five social determinants of health: the education system, the employment system and workforce development, housing, health care, and social and community context. These are all areas in which AIR has a wealth of experience and expertise. I want CARES to use the social determinants of health lens to engage in projects that will improve the health of those who have substance use disorder, or those that are impacted by it. How do we create better outcomes around addiction in those settings?
For example, how can CARES support employers who want to hire individuals in recovery? There’s evidence to suggest that employers are pretty hesitant to hire those who have a criminal justice history, or who have gaps in their work history that might be due to a residential treatment stay. We want to help employers overcome some of those concerns and help them provide recovery-friendly workplaces.
Quality schools are one of our best assets in preventing future substance use disorder. When kids stay in school, when they’re engaged, and when they’re reaching age-appropriate academic and social milestones, they’re much less likely to experience substance use disorder. We would really like to promote positive youth development and support schools in implementing evidence-based programming, like the Good Behavior Game, to achieve those positive outcomes.
We want to support the evidence base for effective policies in housing. The “housing first” treatment model gives individuals experiencing homelessness or unstable housing a place to live, with no strings attached. In that model, the housing itself has proven to be an effective form of treatment. Once an individual is housed, they can focus on recovery instead of worrying about basic needs; they have access to wraparound supports and treatments—but the treatments are not mandatory. This model has been shown to have substantial positive impact on recovery.
When it comes to health care, we’re thinking a lot about how to expand access to supports for vulnerable populations. This includes treatment, but it goes way beyond that. We’re very interested in developing trusted connections for vulnerable populations—like peers, peer recovery specialists, community-based health workers, or telemedicine providers.
The final determinant of health is social support and community. We want to work with our colleagues across sectors to consider, for example, how trauma and adverse childhood experiences fold into addiction. Overall, we’re very interested in multidisciplinary, multigenerational interventions, because they work.
Q: Where can we find you on a typical Saturday afternoon?
Amanda: I’m usually watching my seven-year-old son’s soccer games. I’m also feeding my five-year-old daughter many, many snacks, and narrating the events on the field like an announcer to try to keep her attention!
Q: What book would you suggest everyone read?
Amanda: Michelle Alexander’s The New Jim Crow. It’s a great summary of the systemic issues that are at play in the social determinants of health. It contains a lot of evidence, and it provides a really strong backdrop for considering the challenges to addressing substance abuse in this country and equity.