Substance abuse continues to be a public health crisis. With legislative changes and creation of MAT programming in Vermont, access to behavioral health services for substance abuse treatment has shifted community response and perceptions. As Little Rivers Health Care houses both a MAT program and is a naloxone distribution site, a community event was organized to help train community leaders on how to administer naloxone and provide an avenue to form community partnerships.https://scholarworks.uvm.edu/fmclerk/1398/thumbnail.jp

Waller, Brianna F

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UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2018Combatting Opioid-Related Deaths in RuralVermont Through Community PartnershipBrianna F. WallerLarner College of MedicineFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationWaller, Brianna F., "Combatting Opioid-Related Deaths in Rural Vermont Through Community Partnership" (2018). Family MedicineClerkship Student Projects. 334.https://scholarworks.uvm.edu/fmclerk/334COMBATTING OPIOID-RELATED DEATHS IN RURAL VERMONT THROUGH COMMUNITY PARTNERSHIPBRIANNA F. WALLERLITTLE RIVERS HEALTH CARE (WELLS RIVER, VT)PRECEPTOR: DR. FAY HOMANFEBRUARY 2018PROBLEM IDENTIFICATION AND DESCRIPTION OF NEED In 2016, opioids were involved in 42,249 deaths.1 New Hampshire’s rate of drug overdose deaths was 39 out of 100,000 while Vermont’s rate was 22.2.  To combat this, Vermont has developed legislation to increase availability of naloxone by providing emergency medical services with this medication and allowing it to be prescribed to the patient, family members and friends. Naloxone is often available by prescription or with standing orders from pharmacies. Naloxone can be obtained from one of 36 distribution sites throughout the state. 2 New Hampshire has followed suit with having distribution sites and making naloxone available with or without a prescription from local pharmacies.3PUBLIC HEALTH COST AND UNIQUE COST CONSIDERATIONS IN HOST COMMUNITY  Little Rivers Health Care initiated a MAT program starting in 2016 and currently has a panel of 37 patients. LRHC is also the only naloxone distribution site available in Orange County,  Vermont.4 Availability of naloxone in local pharmacies was assessed:  75% of local pharmacies reported stocking Narcan nasal spray.  One pharmacy only had two boxes of Narcan in stock while several pharmacies had never filled a prescription for it. While VT Medicaid covers the cost of Narcan, for those without insurance a single two-pack box of naloxone costs between $50-147. COMMUNITY PERSPECTIVE ON ISSUE AND SUPPORT FOR PROJECT LRHC developed the MAT program in response to the growing need for mental health and addiction services. “Our program has been around since the summer of 2016. I believe that the hope is that as our patient numbers grow, we would have more providers to manage the patients [as] we no have three providers…We are trying our best to do more promoting of Narcan for patients, family members [as] there has been one fatal overdose in the program to date.” –Tiffany White, LICSW It was imperative that the programming would emphasize the spoke side of the Vermont hub-and-spoke model to address concerns with transportation.  Acceptance of these services by the local community and setting it within a primary care clinic helped destigmatize those who sought MAT services. Administration of naloxone by bystanders has been shown to improve outcomes6, 7 and there are no differences in outcomes if naloxone is administered by basic or advanced EMS providers.8 One MAT provider- Michael Brandli, BA, AAP- emphasized the need to engage the community in naloxone training and is currently doing community outreach to disseminate information about LRHC behavioral health services. INTERVENTION AND METHODOLOGY: NETWORKING EVENT   As LRHC houses both the MAT program and is a naloxone distribution site, it was felt that forming a community partnership and training leaders in different community sectors would be beneficial for the community. Key leaders of the community were invited to learn how to administer naloxone, create an open dialogue about mental health services and addiction, and to assess if other locations would be interested in becoming a distribution site.  Local school officials: principal, guidance counselor, nurses, school psychologist First responders Local clinics and counseling services  Librarians  Church leaders Local government: Chamber of Commerce and Board Members in Newbury and Wells River, VTRESULTS The community networking event was held on March 8, 2018 from 6pm-8pm.  Fourteen of thirty community members attended the event.  Several suggestions came out of this event:  Partnering with local EMS to enhance their supplies of Narcan.  Creating and distributing business cards with mental health services and addiction treatment programs to those who were administered Narcan by EMS.  Holding a community CPR training event to help improve bystander response to overdose resuscitation attempts as EMS personnel have arrived at the scene with no initiation of CPR. Organizing a public forum for the larger community to learn about Narcan and the MAT program. Five two-pack boxes of Narcan were available at this meeting and all were distributed to interested community leaders. EVALUATION OF EFFECTIVENESS AND LIMITATIONS Effectiveness Those who attended felt that this was a worthwhile use of their time.  Several leaders suggested future meetings and public forums to continue outreach measures and help reduce stigma within the community.  Limitations Inclement weather and unsafe traveling conditions prevented several community leaders from attending the meeting.  LRHC serves patients from both New Hampshire and Vermont, but this was event was targeted to community leaders within Newbury and Wells River,  VT. FUTURE DIRECTIONS Continue networking events with community leaders to identify further needs. Organize a public forum to address opioid-related complications within the community and the availability of Narcan.  Offer naloxone kits or place standing orders to the patient, family members, and friends. Provide assistance in coordinating naloxone distribution to local EMS. REFERENCES 1. Drug Overdose Death Data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/data/statedeaths.html2. Narcan/Naloxone Overdose Rescue. Vermont Department of Health. http://www.healthvermont.gov/response/alcohol-drugs/narcan-naloxone-overdose-rescue3. Anyone, Anytime Campaign: New Hampshire Department of Health. https://anyoneanytimenh.org/4. “Naloxone Distribution and Administration in Vermont- Data Brief.” Vermont Department of Health, 2018. http://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Naloxone_Data_Brief_1.pdf5. “Drug-Related Fatalities in Vermont.” Vermont Department of Health, 2018. http://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Data_Brief_Drug_Related_Fatalities.pdf6. Giglio, R., Guohua, L., DiMaggio, C. (2015). Effectiveness of Bystander Naloxone Administration and Overdose Education Programs:A Meta-analysis. Injury Epidemiology, 2(1): 10. 7. Walley, A., Xuan, Z., Hackman, H., Quinn, E., Doe-Simkins, M. Sorensen-Alawad, A., Ruiz, S., Ozonoff, A. (2013). Opioid Overdose Rates and Implementation of Overdose Education and Nasal Naloxone Distribution in Massachusetts: Interrupted Time Series Analysis. The BMJ, 2013: 346.8. Gulec, N., Lahey, J., Suozzi, J., Sholl, M., MacLean, C., Wolfson, D. (2017). Basic and Advanced EMS Providers Are Equally Effective in Naloxone Administration for Opioid Overdose in Northern New England. Prehospital Emergency Care 22(2):163-169.9. Brooklyn, J., Sigmon, S. (2017). Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact. Journal of Addiction Medicine 11(4): 286-292 INTERVIEW CONSENT FORM  Thank you for agreeing to be interviewed. This project is a requirement for the Family Medicine Clerkship. It will be stored on the Dana Library ScholarWorks website. Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview Yes _X_/No___ Tiffany White, LICSW at Little Rivers Health Care in Wells River, VT Michael Brandli, BA, AAP, Substance Abuse Recovery and Trauma Coordinator  If not consenting as above: please add the interviewee names here for the department of Family Medicine information only

Combatting Opioid-Related Deaths in Rural Vermont Through Community Partnership

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Combatting Opioid-Related Deaths in Rural Vermont Through Community Partnership

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