Dr. Devin Oller, Kayla Strother, and Kate Roberts, Overcoming Substance Use Disorder Stigma in Appalachia

We’ve been blaming Appalachia for a healthcare crisis it didn’t create. 

Addiction in Appalachia isn’t what you think. This episode unpacks the nuanced reality of substance use disorder in a region that’s been stereotyped, ignored, and misunderstood for too long. Through powerful stories and clear strategies, it reveals how healthcare professionals, community leaders, and people with lived experience are fighting against systemic stigma and rebuilding trust.

Dr. Devin Oller, a primary care and addiction medicine physician at the University of Kentucky, and Kayla Strother, a certified advanced practice nurse specializing in adult geriatric primary care, join Kate Roberts to lay out the layered social, political, and economic drivers of treatment resistance in Appalachia. From language shifts and provider education to jail protocols and peer-led movements, this episode is a roadmap for changing care where it matters most.

Learning Objectives

• Review a framework for exploring Appalachian patients’ beliefs and knowledge about SUD
• Examine patients’ experience within the larger narrative about SUD in Appalachian communities
• Identify ways to address internalized stigma in healthcare settings and the community

Key Takeaways

1. Stigma in Appalachia isn’t just social—it’s systemic, and it directly blocks access to treatment through regulation, perception, and fear.
2. Positive portrayals and community-first approaches, like peer support and harm reduction, are transforming how addiction is treated.
3. Federal policy shifts are not enough without local engagement and context-aware delivery of care.

Timestamps:

[02:59] History and media’s role in shaping Appalachian stigma

[07:00] The SNL skit that encapsulates a harmful stereotype

[10:55] What "Demon Copperhead" gets right about addiction

[14:58] The real transportation problem in rural Kentucky

[17:59] State regulations vs. patient needs

[23:55] Misconceptions around "treating one drug for another"

[27:00] Role of harm reduction and community orgs

[31:00] Inside the Healing Communities Study

[34:00] The impact of lived experience campaigns

[42:55] Language changes that can change everything

Links

• AMERSA
• Demon Copperhead, by Barbara Kingsolverhttps://bookshop.org/p/books/demon-copperhead-barbara-kingsolver/18506689?ean=9780063251984
• Ramp Hollow, by Steven Stollhttps://bookshop.org/p/books/ramp-hollow-the-ordeal-of-appalachia-steven-stoll/8907054
• State alignment with federal regulations in 2022 to relax buprenorphine 30-patient waiver requirements, Anita Silwal, et. Al.https://pmc.ncbi.nlm.nih.gov/articles/PMC10206439/
• Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities, Ramin Mojtabai, et. Al.https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.05162
• Film: Harlan County, USA (1976)

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.