Innovative Approaches for Overdose Prevention
March 20, 2019 | ASTHO Staff
For several years, state opioid overdose prevention efforts have focused on a narrow set of strategies and policies such as morbidity and mortality surveillance, prescription drug monitoring programs, provider education and guidelines, and increasing access to naloxone. According to Martha Yeide, ASTHO’s senior director for social and behavioral health, “States have focused on implementing the strategies with the most available evidence or data suggesting efficacy in addressing the opioid epidemic. At this point, now that states have several years of experience in addressing these issues, we are realizing that we need to expand our focus to continue stabilizing and driving down overdose rates.”
With this expanded focus, states are seeking new approaches to improve surveillance, promote harm reduction, create linkages to care, and educate providers. Yeide notes that “it is exciting to see how states are innovating to find new approaches and strategies to address the opioid epidemic and widening the net for new stakeholders and partnerships.”
Improving Surveillance
Improving surveillance around opioid overdose prevention efforts is integral to understanding the scope of the epidemic and identifying effective approaches. States, territories, and localities are applying innovative strategies to improve surveillance by partnering with public health laboratories for improved morbidity data, establishing overdose fatality reviews, and identifying overdose spikes and clusters.
States participating in the National Violent Death Reporting System and the State Unintentional Drug Overdose Reporting System have greatly enhanced the quality and timeliness of their fatal and non-fatal overdose data. However, challenges surrounding workflow, resources, and capacity have made it difficult to obtain timely and accurate lab testing to confirm which drugs are involved in an overdose, particularly in non-fatal cases. Partnering with public health laboratories to conduct biosurveillance of nonfatal opioid overdoses and developing sentinel or pilot sites for testing have proven a novel approach to building capacity for timely opioid morbidity data.
Additionally, while existing surveillance systems can provide counts, rates, and some demographic data, most surveillance systems lack an effective means for identifying the social determinants of substance misuse and addiction. Nine states have established overdose fatality reviews or “social autopsy” processes to better understand the social context surrounding fatal overdoses. These processes can be used as a means of examining adverse childhood experiences and other traumatic events, as well as systems gaps leading to an overdose.
Finally, by partnering with colleagues in preparedness and High Intensity Drug Trafficking Areas (HIDTA), states and territories are finding innovative methods for identifying and responding to overdose spikes and clusters. The Overdose Detection Mapping Application Program, developed by the HIDTA for Washington, D.C., Virginia, Maryland, and West Virginia, provides real-time overdose surveillance data across jurisdictions to support public safety and health efforts to respond rapidly to overdose spikes and clusters. This kind of surveillance tool can also identify high-risk populations in need of immediate linkage to care.
Harm Reduction
Harm reduction strategies can reduce overdose deaths, promote linkages into care, and reduce the stigma associated with opioid misuse and addiction. Novel approaches to harm reduction include distributing and tracking naloxone, supporting syringe service programs, and integrating harm reduction principles into opioid response programs.
States have supported creative methods and partnerships to distribute and track naloxone, a medication that quickly reverses an opioid overdose and restores normal breathing in a person experiencing an overdose. While some federal funding sources cannot be used to support the purchase of naloxone, funds can be used to support related services and strategies. Examples of innovation in the distribution and tracking of naloxone include Alaska’s drive through naloxone event, New Mexico’s use of Medicaid and syringe service program (SSP) data to track naloxone distribution, and Massachusetts’ Overdose Education and Naloxone Distribution Bystander program.
Similarly, though some grants cannot be used to purchase needles or syringes, some federal funds can be used to support SSPs, which provide access to sterile needles and syringes to those who inject drugs. This reduces the risk of contracting and transmitting HIV, viral hepatitis, or other blood-borne infections. Some SSPs additionally provide fentanyl testing strips to allow persons who inject drugs to assess the safety of their supply. SSPs reduce the risk of opioid-related harms while also connecting persons who use drugs with a trusted community and facilitating access and linkages to care.
More broadly, harm reduction refers to strategies that meet people who use opioids where they are, whether that means supporting safer use, managing use, or abstinence. Strategies for safer use include using one drug at a time, using less after any period of abstinence or decreased use, testing the strength of the drug, and using with a friend. Disseminating information on safe use can save lives.
Establishing Linkages to Evidence-Based Treatment and Recovery Services
State, local, and territorial health agencies and partners can leverage their touchpoints with people who use opioids to link them to evidence-based treatment and recovery systems, reducing their risk for overdose. Establishing linkages to care across a variety of settings and educating providers about evidence-based treatment increases the likelihood that individuals will be able to access effective care.
Linkages to care can be established across a wide array of settings to create opportunities for referral into treatment and recovery services. The Howard Center Safe Recovery program in Vermont has reported that individuals utilizing their SSP are significantly more likely to be successfully linked to treatment and recovery services. Public safety and emergency departments are also touchpoints for successful diversion or linkage into care.
Additionally, academic detailing has proven to be a promising tool to educate providers about the risks of prescribing opioids. Utilizing this model to educate providers about effective treatment options and wraparound services could serve the dual purpose of reducing stigma through one-on-one education and increasing access to evidence-based treatment. Hub and spoke models like Project ECHO similarly offer an innovative method for educating providers and improving access to evidence-based treatment and recovery services.