{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:06:10Z","timestamp":1777896370946,"version":"3.51.4"},"reference-count":47,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Linacre Q"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>\n                    Although the opioid epidemic and fentanyl crisis are nationwide problems of immense proportions, calming the storm raging across the isolating geo-economic framework of Appalachia demonstrates the need for courageous, culturally effective programs that have the power to address and overcome the grave situation of addiction in this region. In the Appalachian region, unjust social structures are embedded in the communities\u2019 socio-economic conditions. As this reality poses even greater barriers to addressing the opioid epidemic in these communities, the restoration of social relationships within a community becomes vital to the development of a broader approach to social functioning and human flourishing.\n                    <jats:sup>1<\/jats:sup>\n                    Faith traditions and faith communities can play an important role in helping to establish and support such social cohesion\n                    <jats:sup>2<\/jats:sup>\n                    through attention to the individual, social, and spiritual needs of the community.\n                    <jats:sup>3<\/jats:sup>\n                    This essay explores the complex problem of the opioid epidemic compounded by the fentanyl crisis. It considers the importance of public health research within the regional geo-economic framework\n                    <jats:sup>4<\/jats:sup>\n                    of Appalachia to (a) inform policies that improve health inequities and promote social cohesion, (b) develop social solutions with a spiritual dimension, and (c) reveal remedies capable of informing moral norms in support of building a more just society.\n                    <jats:sup>5<\/jats:sup>\n                    Reflecting on the virtue of solidarity,\n                    <jats:sup>6<\/jats:sup>\n                    this essay also highlights the witness of the Catholic Church's response to the suffering experienced within the communities and the societies within the Appalachian mountains. While there may be considerable interest in viewing this article as a research document, foundationally, this essay utilizes a literary narrative approach through a Catholic lens to inform ethical deliberations, reasoning, and practice while supporting ethical reflection and consideration of the responses raised.\n                    <jats:sup>7<\/jats:sup>\n                    Further, the reader is strongly encouraged to reference the comprehensive footnote system provided for extension and verification of the data presented.\n                  <\/jats:p>","DOI":"10.1177\/00243639241245103","type":"journal-article","created":{"date-parts":[[2024,8,21]],"date-time":"2024-08-21T20:37:40Z","timestamp":1724272660000},"page":"353-372","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Appalachia - Bridging the Opioid Epidemic Amid the Fentanyl Crisis"],"prefix":"10.1177","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8712-799X","authenticated-orcid":false,"given":"Tammy","family":"Ann Fecci","sequence":"first","affiliation":[{"name":"Doctor Bioethics and Health Policy, Loyola University of Chicago, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"key":"bibr1-00243639241245103","unstructured":"American Academy of Family Physicians (AAFP). 2019. \u201cAdvancing Health Equity by Addressing Social Determinants of Health & Family Medicine,\u201d Position Paper: 1\u201315.\n                      American Academy of Family Physicians Foundation.\n                      https:\/\/www.aafp.org\/about\/policies\/all\/social-determinants-health-family-medicine-position-paper.html."},{"key":"bibr2-00243639241245103","unstructured":"Appalachian Regional Commission. 2023.\n                      Appalachian Diseases of Despair\n                      , NORC at the University of Chicago & East Tennessee State University. https:\/\/www.arc.gov\/wp-content\/uploads\/2023\/08\/Appalachian-Diseases-of-Despair-Update-July-2023.pdf)."},{"key":"bibr3-00243639241245103","unstructured":"Arlington Addiction Recovery Initiative (AARI) Newsletter, Edition #2. Winter 2023. https:\/\/www.arlingtonva.us\/files\/content\/public\/government\/programs\/health\/arlington-addiction-recovery-initiative\/aari\/2022-year-in-review-newsletter.pdf."},{"key":"bibr4-00243639241245103","unstructured":"Associated Press. 2019. \u201cMother Teresa\u2019s Nuns Return to her Rural Kentucky Mission,\u201d emphasis added, CRUX, December 25, 2019.https:\/\/cruxnow.com\/church-in-the-usa\/2019\/12\/mother-teresas-nuns-return-to-her-rural-kentucky-mission."},{"key":"bibr5-00243639241245103","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-05544-2_302-1"},{"key":"bibr6-00243639241245103","unstructured":"Catholic Community Services and Catholic Housing Services. 2022. \u201c\n                      Catholic Social Teaching\n                      .\u201d https:\/\/ccsww.org\/about-us\/catholic-social-teaching\/."},{"key":"bibr7-00243639241245103","unstructured":"Catholic Extension. 2022. \u201cCatholic Communities are a Lifeline to the \u2018Poorest of the Poor\u2019 in Eastern Kentucky,\u201d emphasis added, October 19, 2022. https:\/\/www.catholicextension.org\/stories\/catholic-communities-are-a-lifeline-to-the-poorest-of-the-poor-in-eastern-kentucky\/."},{"key":"bibr8-00243639241245103","unstructured":"Christian Gina. 2017. \u201cGrays Ferry Priest Brings Power of the Sacraments to Heal the Addicted,\u201d\n                      Catholic Philly.com\n                      , September 8, 2017. https:\/\/catholicphilly.com\/2017\/09\/news\/local-news\/grays-ferry-priest-fights-addiction-with-sacramental-power\/."},{"key":"bibr9-00243639241245103","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2020.1765805"},{"key":"bibr10-00243639241245103","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.304187"},{"key":"bibr11-00243639241245103","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.01052"},{"key":"bibr12-00243639241245103","unstructured":"Ford Thomas. 1962. \u201c\n                      The Southern Appalachian Region: A Survey\n                      \u201d. Appalachian Studies, University of Kentucky: vol. 303, chapters 1\u201313. https:\/\/uknowledge.uky.edu\/upk_appalachian_studies\/13. https:\/\/core.ac.uk\/download\/pdf\/232571735.pdf."},{"key":"bibr13-00243639241245103","unstructured":"Fraga Brian. 2019. \u201cChurch Responds at the Front Lines of the Nation\u2019s Opioid Crisis, July 31, 2019. https:\/\/www.osvnews.com\/2019\/07\/31\/church-responds-at-the-front-lines-of-the-nations-opioid-crisis\/."},{"key":"bibr14-00243639241245103","doi-asserted-by":"crossref","unstructured":"Gold Mark S., Baron David, Bowirrat Abdalla, Blum Kenneth. 2020. \u201cNeurological Correlates of Brain Reward Circuitry Linked to Opioid Use Disorder (OUD): Do Homo sapiens Acquire or Have a Reward Deficiency Syndrome?\u201d\n                      Journal of Neurological Science\n                      418(117137): 1\u201314. https:\/\/doi.org\/10.1016\/j.jns.2020.117137.","DOI":"10.1016\/j.jns.2020.117137"},{"key":"bibr15-00243639241245103","unstructured":"House of Representatives. \u201c\n                      Fentanyl: The Next Wave of the Opioid Crisis, Hearing Before the Subcommittee on Oversight and Investigators of the Committee on Energy and Commerce,\u201d\n                      March 21, 2017, Serial No. 115-16, https:\/\/www.govinfo.gov\/content\/pkg\/CHRG-115hhrg25507\/html\/CHRG-115hhrg25507.htm)."},{"key":"bibr16-00243639241245103","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02252-2"},{"key":"bibr17-00243639241245103","unstructured":"Income & Poverty, U.S. Census Bureau QuickFacts: Letcher County, Kentucky. https:\/\/www.census.gov\/quickfacts\/fact\/table\/letchercountykentucky\/INC910221#INC910221."},{"key":"bibr18-00243639241245103","unstructured":"Kemsley Tamarra. 2017. 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Arlington diocese launches addiction support for families,\n                      Catholic News Agency\n                      , Arlington, Va., Apr 24, 2019. https:\/\/www.catholicnewsagency.com\/news\/41118\/arlington-diocese-launches-addiction-support-for-families."},{"key":"bibr29-00243639241245103","unstructured":"Pope Francis. 2013. \u201cEvangelii Gaudium.\u201d\n                      Dicastero per la Comunicazione - Libreria Editrice Vaticana\n                      , (November): 58, 186\u2013216. https:\/\/www.vatican.va\/content\/francesco\/en\/apost_exhortations\/documents\/papa-francesco_esortazione-ap_20131124_evangelii-gaudium.html."},{"key":"bibr30-00243639241245103","unstructured":"Pope Francis, 2016. \u201cAmoris Laetitia\u201d,\n                      Dicastero per la Comunicazione\u2014Libreria Editrice Vaticana\n                      , 290 (March): no. 37\u201328. https:\/\/www.vatican.va\/content\/dam\/francesco\/pdf\/apost_exhortations\/documents\/papa-francesco_esortazione-ap_20160319_amoris-laetitia_en.pdf."},{"key":"bibr31-00243639241245103","unstructured":"Pope Francis. 2023. Catechesis on Discernment. 14.\n                      Spiritual Accompaniment\n                      , General Audience, Paul VI Audience Hall. https:\/\/www.vatican.va\/content\/francesco\/en\/audiences\/2023\/documents\/20230104-udienza-generale.html\n                      )\n                      ."},{"key":"bibr32-00243639241245103","unstructured":"Popovich Nadja. 2014. \u201cA Deadly Crisis: Mapping the Spread of America's Drug Overdose Epidemic,\u201d\n                      The Guardian\n                      , May 25, 2016. https:\/\/www.theguardian.com\/society\/ng-interactive\/2016\/may\/25\/opioid-epidemic-overdose-deaths-map."},{"key":"bibr34-00243639241245103","unstructured":"Saint Pope John Paul II. 1984. \u201cReconciliatio et Paenitentia,\u201d\n                      Dicastero per la Comunicazione\u2014Libreria Editrice Vaticana\n                      , 1984, (December): 16, https:\/\/www.vatican.va\/content\/john-paul-ii\/en\/apost_exhortations\/documents\/hf_jp-ii_exh_02121984_reconciliatio-et-paenitentia.html."},{"key":"bibr35-00243639241245103","unstructured":"Saint Pope John Paul II. 1987. 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Morbidity and Mortality Weekly Report\n                      67 (5152): 1419\u20131427\n                      .\n                      https:\/\/doi.org\/10.15585\/mmwr.mm675152e1.","DOI":"10.15585\/mmwr.mm6751521e1"},{"key":"bibr38-00243639241245103","unstructured":"Substance Abuse and Mental Health Services Administration. 2021. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63 Publication No. PEP21-02-01-002. Rockville, MD: Substance Abuse and Mental Health Services Administration.\u00a0https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK574910\/."},{"key":"bibr39-00243639241245103","unstructured":"Seervai Shanoor. 2021. \u201cIt\u2019s Really, Truly Everywhere: How the Opioid Crisis Worsened with COVID-19,\u201d\n                      The Dose\n                      , June 2021 Podcast, 25:05. https:\/\/doi.org\/10.26099\/3d62-cv07, https:\/\/www.commonwealthfund.org\/publications\/podcast\/2021\/jun\/its-really-truly-everywhere-how-opioid-crisis-worsened-covid-19."},{"key":"bibr40-00243639241245103","doi-asserted-by":"crossref","unstructured":"Singu Sravani, Acharya Arpan, Challagundla Kishore, Byrareddy Siddappa N. 2020.\n                      \u201c\n                      Impact of Social Determinants of Health on the Emerging COVID-19 Pandemic in the United States,\n                      \u201d Public Health Frontiers\n                      8 (406): 6. https:\/\/doi.org\/10.3389\/fpubh.2020.00406.","DOI":"10.3389\/fpubh.2020.00406"},{"key":"bibr41-00243639241245103","unstructured":"Tarmac Trade Law Center NPC. 2017. \u201cWorld\u2019s Most Marginalized Still Left Behind by Global Development Priorities.\n                      UNDP Report\n                      ,\u201d March 22, 2017. https:\/\/www.tralac.org\/news\/article\/11436-world-s-most-marginalized-still-left-behind-by-global-development-priorities-undp-report.html."},{"key":"bibr42-00243639241245103","doi-asserted-by":"crossref","unstructured":"Taylor Jessica L., Johnson Samantha, Cruz Ricardo, Gray Jessica R., Schiff Davida, Bagley Sarah M. 2021. \u201cIntegrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings: Harm Reduction in Outpatient Addiction Treatment,\u201d\n                      Journal of General Internal Medicine\n                      36 (12): 3810\u20133819. https:\/\/doi.org\/10.1007\/s11606-021-06904-4.","DOI":"10.1007\/s11606-021-06904-4"},{"key":"bibr43-00243639241245103","unstructured":"Tilton Shane. 2017. \u201cThe Appalachian Discourse: A Critical Analysis of the Network Communication within the Appalachian Region of the USA.\u201d\n                      Multimedia Journalism\n                      (April): 1\u201329, https:\/\/www.academia.edu\/32254971."},{"key":"bibr44-00243639241245103","doi-asserted-by":"crossref","unstructured":"Townsend Tarlise, Kline David, Rivera-Aguirre Ariadne, et al. 2022. \u201cRacial\/Ethnic and Geographic Trends in Combined Stimulant\/Opioid Overdoses, 2007\u20132019,\u201d\n                      American Journal of Epidemiology\n                      191 (4): 599\u2013612, https:\/\/doi.org\/10.1093\/aje\/kwab290.","DOI":"10.1093\/aje\/kwab290"},{"key":"bibr45-00243639241245103","doi-asserted-by":"crossref","unstructured":"Tsai Alexander C., Kiang Mathew V., L Michael, Barnett, et al. 2019. \u201cStigma as a Fundamental Hindrance to the United States Opioid Overdose Crisis Response,\u201d\n                      PLoS Medicine\n                      , 16 (11): 1\u201318. https:\/\/doi.org\/10.1371\/journal.pmed.1002969.","DOI":"10.1371\/journal.pmed.1002969"},{"key":"bibr46-00243639241245103","unstructured":"United States Conference of Catholic Bishops (USCCB). \u201c\n                      Justice, Peace & Human Development: Seven Themes of Catholic Social Teaching,\u201d\n                      https:\/\/www.usccb.org\/beliefs-and-teachings\/what-we-believe\/catholic-social-teaching\/seven-themes-of-catholic-social-teaching."},{"key":"bibr47-00243639241245103","unstructured":"United States Conference of Catholic Bishops, (USCCB). 2019.\n                      Catechism of the Catholic Church\n                      , 2nd edition, vol. 3, no. 229: 552. https:\/\/www.usccb.org\/sites\/default\/files\/flipbooks\/catechism\/554\/)."}],"container-title":["The Linacre 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