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Missouri Opioid Response

Explore the extent of the opioid crisis in urban and rural Missouri, initiatives like MO-HOPE and MORE, and collaborative opportunities for RCORP grantees. Learn about barriers to overdose responses and potential solutions for first responders.

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Missouri Opioid Response

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  1. Missouri Opioid Response Karen Wallace Brandon Costerison Philip Horn, MSW, MPH Claire Wood, PhD

  2. Presentation Objectives • Describe the extent of the opioid crisis nationally and in Missouri, highlighting differences in rural and urban areas • Discuss the MO-HOPE and MORE projects, including services provided in rural areas and the potential for collaboration with RCORP grantees • Underscore the barriers to overdose responses particularly by first responders and in rural areas and suggest potential opportunities for RCORP grantees

  3. Introduction • Between 1999 and 2017, almost 400,000 people died from an opioid overdose nationally. • On average, 130 Americans die every day from an opioid overdose nationally. • Between 2008 and 2018, over 7,600 people have died from on opioid overdose in Missouri alone. Source: CDC, Understanding the Epidemic

  4. Missouri was above national rates for drug, opioid, and heroin deaths in 2017 Source: CDC, NCHS, Drug Overdose Deaths in the United States, 1999-2017; CDC Wonder Reported rates are age-adjusted per 100,000 population; Missouri rates based on 2013-2017 are age-adjusted per 100,000

  5. Source: CDC, NCHS, Provisional Drug Overdose Death Counts https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

  6. Missouri Opioid Overdose Deaths Source: Missouri Vital Statistics Reported rates are crude rates per 100,000

  7. Opioid Deaths by Race and Gender Source: Missouri Vital Statistics Reported rates are crude rates per 100,000

  8. Opioid Deaths by County 2013 - 2017 2014 - 2018 Source: Missouri Vital Statistics Reported rates are crude rates per 100,000

  9. Overdose Death Rates and Naloxone Administrations by EMS 6,582* 4,695* 1,887* *NOTE: Naloxone administrations by EMS agencies do not accurately reflect the total number of naloxone administrations statewide. There are a number of counties for which data does not exist. Additionally, data on available counties may not be reflective of all naloxone administrations in that county by EMS personnel due to missing data on EMS agencies. Source: Missouri Vital Statistics; DHSS Bureau of EMS Reported rates are crude rates per 100,000

  10. Overdose education and naloxone distribution are just pieces of the puzzle

  11. MissouriOpioidSTR.org

  12. Missouri Opioid-Heroin Overdose Prevention and Education (MO-HOPE) • Awarded September 2016 • 5 year grant, funded through SAMHSA • Began training emergency responders • Shift toward prioritizing Overdose Education and Naloxone Distribution (Overdose Prevention)

  13. Is free OEND important in rural areas? • Presence of fentanyl • Longer response times • Less access to resources • Fewer pharmacies • Harder to access treatment

  14. How can MO-HOPE help? • Train on how to conduct overdose prevention • Provide technical assistance on outreach strategies • Potentially provide some naloxone/rescue kits

  15. OEND Training Curriculum • Substance use disorder as a brain disease • Background of the opioid crisis • Discussion of interventions and legal changes in MO • How to conduct OEND either from social service or medical provider

  16. Contact • Brandon Costerison • Bcosterison@ncada-stl.org • 314-962-3456 xt 367

  17. Missouri Overdose Rescue and Education Project (MORE) • - funded through SAMHSA • - 4 year project • - provide training and education for first responder agencies with a focus on rural communities in Missouri

  18. Eligibility • -Non-ambulance based first responder agency • Law Enforcement • Fire Department (both paid and voluntary) • Conservation Agents • Probation and Parole officer • Park Ranger • -Not currently carrying or being supplied naloxone • -Must complete required Overdose Education and Naloxone Distribution (OEND) training • -Must enter into a memorandum of understanding with DHSS.

  19. Training curriculum and content • Curriculum content: • Addiction and the brain • Recognizing and responding to an opioid overdose • Recent legislation related to naloxone • Completing the online field report

  20. Options for Training • Train the trainer • In person trainings • Online training curriculum

  21. OEND training is provided to first responders by the following EMS training entities: Marion County Ambulance District Atchison Holt Ambulance District Central Jackson County FPD University of Missouri EMS Newton County Ambulance District St. Francois County Ambulance District South Howell County Ambulance District

  22. Naloxone for first responder agencies Two requirements to be eligible to obtain naloxone • Must complete required Overdose Education and Naloxone Distribution training • Must enter into a memorandum of understanding with DHSS.

  23. Naloxone Distribution • Contract directly with Adapt Pharma to purchase naloxone • Distribution centers have been established in each county • Typically this is the local public health department; however there are some exceptions Nalxone is ordered and shipped to the local distribution center for pick-up by the first responder agency After initial distribution, first responders return to the local distribution center to re-supply as needed

  24. Naloxone Leave Behind Project • Specifically targeting ambulance service providers • Provides kits for EMS personnel to leave behind with overdose survivors, family members or loved ones following an opioid overdose • Training is provided by online training video • Target date for implementation is October 1, 2019

  25. Collaboration • Assist with promoting and increasing awareness of the MORE project • Host/coordinate a training for first responders in your county • Promote and increase awareness of online training curriculum • Assist with making connections at the local level • Educate on the need for increase access to naloxone

  26. For more information • https://health.mo.gov/safety/ems/more/ • Or contact Karen Wallace at: • Karen.Wallace@health.mo.gov • (573) 751-6839

  27. Barriers from First Responders and Potential Solutions

  28. Barriers to overdose response in rural areas Barriers cited include: • Reluctance to call for medical help • Lack of support from local government • Attitudinal barriers • Response times and response protocols • Access to and availability of treatment • Not knowing treatment options and resources

  29. Attitudinal Barriers “Not all responders agree with administering Narcan as they have had to go back to the same residence many times and feel like they are just giving the patients an excuse to keep doing the drugs because we will bring them back if they screw up.” “Officers tend to believe that it enables the subject who overdoses, thereby allowing them to do it again. Officers often wonder why there is not something more that can be done for subjects.”

  30. Response Times and Protocols “We can generally get to a location within 10 minutes or so, but higher life support services such as ambulances are often 25 to 30 minutes away.” “We have a very large area that we cover so our response times and staging for law enforcement can delay treatment quite often.” “Law enforcers are having too many things piled upon them. Cops are expected to do so many things, but are largely poorly paid and educated relative to the expectations heaped upon them.”

  31. Access to and Availability of Treatment “There are very few treatment centers in our area and the ones we do have are usually full so there is a long wait to get help. Also, we have a very large elderly and low income population so a lot of times they cannot afford it if they can get in.” “Our region has few options for treatment. If someone is serious about seeking treatment, they would have to travel over an hour away to seek help.”

  32. Other Constraints We have found other constraints during the MORE grant, including: • Inability to provide naloxone to general public (grant limitations) • Lack of knowledge about availability of training and naloxone options • Lack of knowledge about existing resources in rural communities

  33. How RCORP grantees can assist • Improving community referral and warm handoffs to care/promote existing resources • Examining department protocol and education to ensure all first responders are prepared to field overdose response calls and provide treatment resources • Assessing community infrastructure and resources, and advocating for increased funding for addiction and mental health services • Connecting with other partners in area that can distribute naloxone • Facilitating buy-in at multiple levels of government Your ideas are welcome You are the ones who know your communities the best

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