Faculty: Dr. Chandra Speight

Nursing professor innovates strategies to reduce opiate addiction

Dr. Chandra Speight knew early that she was on a mission to make North Carolina better, but it took a few degrees and living a bit of life to find her true north – reducing the devastating harm of addiction, particularly for mothers in rural and medically underserved parts of the state.

Speight, an assistant professor in the College of Nursing’s Department of Advanced Nursing Practice and Education, was raised in Greensboro, but her family is from eastern North Carolina. After graduating from East Carolina University with a bachelor’s degree in English and being honored with the Chancellor’s Award for Excellence, she traveled north.

With a master’s degree in political science at Penn State University complete, she took a consultant position working on women’s health policy for the U.S. Agency for International Development in Washington, D.C.

Her time working for the federal government was short, but the experience planted a seed. She moved back to Greenville and taught political science at ECU. One of the perks of being employed by the university is being able to take classes for free, so she embarked on a second master’s in English, which she completed and used to teach in the English department.

Dr. Chandra Speight, an assistant nursing professor, previously taught political science and English at ECU.

Her political science background, and the experience of being a part of the solution at U.S. AID, gnawed at her. An abiding interest in health care policy spurred her to pursue a nursing education degree so she could transition from thinking about and teaching public policy to being an agent of change rather than an onlooker on the sidelines.

So she quit teaching and went back to school.

“My plan was always I was going to be a nurse, a nurse practitioner and then get a Ph.D. in nursing and study health policy,” Speight said. “I understood nurse practitioners to be key to the provision of health care in rural areas and I wanted to be one before I started studying them.”

Over time, Speight’s interest narrowed – how do advanced practice registered nurses ease the challenges of health care in rural areas, especially the ways that addiction impacts individuals and then spiderwebs disfunction into communities.

“I began to understand the opioid crisis as the biggest health care access crisis that we face in the United States – definitely here in eastern North Carolin – so I shifted my research to the area of opioids, substance use disorder and how nurse practitioners can impact that,” Speight said.

Speight was flummoxed by the disconnection between nurse practitioners having an outsized role in rural health care delivery, as is the case in eastern North Carolina, and federal restrictions on nurse practitioners (NPs) being able to prescribe Suboxone, a powerful medication that can help opioid users reduce their dependence.

The restrictions were lifted in 2016, allowing NPs to finally prescribe Suboxone, which is associated with a 50% reduction in all-cause mortality for those dealing with opioid use disorder.

“That’s unheard of, you just don’t have medications that effective,” Speight said.

Seeing how effective use of treatment options could reduce dependency directed her research and service work into understanding the barriers that nurse practitioners face in treating substance use disorder. She then wanted to know how to translate that research into effective and effectual education programs for her fellow health care providers, especially advanced practice registered nurses (APRNs).

Speight is collaborating with peers in nursing and allied health sciences, as well as clinical partners in the region, to create a multidisciplinary team to research and tackle substance misuse in eastern North Carolina head-on.

She and the team have secured hundreds of thousands of dollars in grants – and have requested much more – to extend their research into nontraditional clinical spaces like centers that feed food insecure populations and the few needle exchange programs in rural eastern North Carolina.

One of the team’s goals is to create a perinatal substance use disorder clinic because the eastern region is the only part of the state without a dedicated clinical resource to help mothers reduce or end substance misuse prior to, and up to a year after, giving birth.

“A lot of women, or pregnant people, are motivated to decrease use during pregnancy but postpartum that motivation oftentimes goes away, and then there’s a lot of stress and people will experience a return to use and they’ve lost tolerance,” Speight said.

Speight’s research and clinical experience have shown that the problem isn’t going to seek her out to find solutions – she has to go where the need is, which is often in her own backyard.

“Eastern North Carolina has some of the worst opioid and substance related outcomes in the nation. In the county where I live, Craven County, overdose death rates are over twice the state average in North Carolina, and about 40% of children in foster care are there because they have a parent with a substance use disorder,” Speight said.

North Carolina has abysmal maternal health statistics, Speight said, with about half of maternal deaths in a recent study resulting from overdoses, most often from opioid misuse.

“A key tenet of harm reduction is that we meet people where they are and let them set their goals. Their goal may be to enter into treatment or continue to use, and if they choose to continue to use, we try to help them understand ways that they could use more safely, with the goal being to keep folks alive,” Speight said.

Part of the solution that Speight is working to achieve, through the grants she has secured, and the education and clinical partnerships she has fostered, is building a sustainable framework that will attract like-minded students to learn how to carry the baton into succeeding generations of harm reduction care in rural parts of the state.

When an underfunded substance treatment network is coupled with a highly stigmatized population, teaching students how to broach the taboo topic of addiction with patients is difficult. But Speight believes that her partners at ECU and in the community are finding ways to teach future nurses how to overcome their own biases and stigma to best serve the people who rely on them for care.

“When I look at the opioid crisis in eastern North Carolina and I see that we have a lack of prescribers, we have to grow our own solutions to the problem,” Speight said. “We have the dental school, the medical school and all of the APRN programs, and we have the only nurse midwifery program in North Carolina, South Carolina or Virginia – we are right here to create this workforce.”

Speight said she sees that workforce growing in the students she teaches and mentors, which is one of the points of light in an otherwise dim horizon of harm reduction care in coastal North Carolina.

“It’s incredibly rewarding to hear from students who are out in their communities, that they are screening for and treating substance use disorder – and they are enjoying the work and finding it satisfying,” Speight said. “They’re teaching doctors and NPs that they work with – helping to break down barriers because that’s what’s going to save lives.”

FAST FACTS

Name: Dr. Chandra Speight

Title:  Assistant professor

Hometown:  Jamestown, NC though I spent a lot of my childhood in eastern NC with my grandmother in Grifton and my mom’s family in Edgecombe County

Colleges attended and degrees:  ECU – BA English; Penn State – MA Political Science; ECU – MA English; ECU – MSN Family Nurse Practitioner; ECU – PhD Nursing

PIRATE PRIDE

Years working at ECU:  13 total (3 in the College of Nursing)

What I do at ECU: I am an Assistant Professor in College of Nursing in the Department of Advanced Nursing Practice and Education,  I teach in the Doctor of Nursing Practice program.

What I love about ECU: I love the College of Nursing and its commitment to preparing Pirate Nurses to provide evidence-based care in underserved regions. I strive to ensure my research is driven by our college’s mission to serve as a  national model for transforming the health of rural, underserved regions.

Research Interests: Rural health care access; substance use disorder; opioid use disorder

What advice do you give to students?  Words are powerful and can be healing or destructive. Think carefully about the words you use to describe people and the disease processes they experience!

Favorite class to teach?  Anything related to harm reduction, health care policy, and medications for opioid use disorder

QUICK QUIZ

What do you like to do when not working?  Hiking with my family in the North Carolina mountains; playing crossword puzzles and other word games

Last thing I watched on TV:  The Incredibles (with my kiddos)

First job: Belk Teen Board

Guilty pleasure: I love fancy fizzy water – the bubblier the better!

Favorite meal: Anything my husband cooks for me – he’s an awesome chef.

One thing most people don’t know about me:  I have held faculty positions in three ECU Departments: The Department of English, The Department of Political Science, and the College of Nursing’s Department of Advanced Nursing Practice and Education.

 


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