Using Timely Overdose Data to Address a Spike in Nonfatal Overdoses and Inform a Coordinated Community-Level Response in Rhode Island, 2019

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 24S-30S ◽  
Author(s):  
Leanne Lasher ◽  
Benjamin D. Hallowell ◽  
Laura C. Chambers ◽  
Jennifer Koziol ◽  
James McDonald ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Rhode Island ◽  
Community Response ◽  
Community Level ◽  
Opioid Overdose ◽  
Fire Departments ◽  
Community Partners ◽  
Department Of Health ◽  
Recovery Resources ◽  
State And Local

The Rhode Island Department of Health (RIDOH) uses emergency department data to monitor nonfatal opioid overdoses in Rhode Island. In April 2019, RIDOH detected an increase in nonfatal opioid overdoses in Woonsocket, Rhode Island, and sent an alert to state and local partners (eg, fire departments, emergency departments, faith leaders) with guidance on how to respond. To guide community-level, strategic response efforts, RIDOH analyzed surveillance data to identify overdose patterns, populations, and geographic areas most affected. During April–June 2019, nonfatal opioid overdoses in Woonsocket increased 463% (from 13 to 73) when compared with the previous 3 months. Because of the sustained increase in nonfatal opioid overdoses, RIDOH brought together community partners at a meeting in June 2019 to discuss RIDOH opioid overdose data and coordinate next steps. Data analyses were essential to framing the discussion and allowed community partners at the event to identify an unexpected increase in cocaine-involved nonfatal opioid overdoses in Woonsocket. Many patients with cocaine-involved nonfatal overdoses also had fentanyl in their system, and input from community partners suggested that many patients were unaware of using fentanyl. Community response actions included targeting harm reduction services (eg, distribution of naloxone, mobile needle exchange); deploying peer recovery support specialists to overdose hotspots to connect people to treatment and recovery resources; placing harm reduction messaging in high-traffic areas; and targeted social media messaging. After the meeting, nonfatal opioid overdoses returned to pre-outbreak levels. This case study provides an example of how timely opioid overdose data can be effectively used to detect a spike in nonfatal opioid overdoses and inform a strategic, community-level response.

Unknown and Under-Researched: The Anatomy of Drinking Under Control Programs

2017 ◽  
Vol 63 (5) ◽  
pp. 277-288
Author(s):  
Harald Klingemann ◽  
Justyna Klingemann
Keyword(s):  
Quality Of Life ◽  
Harm Reduction ◽  
Evaluation Studies ◽  
Mission Statements ◽  
Community Response ◽  
Limited Resources ◽  
Admission Criteria ◽  
Control Programs ◽  
Institutional Order

Abstract. Introduction: While alcohol treatment predominantly focuses on abstinence, drug treatment objectives include a variety of outcomes related to consumption and quality of life. Consequently harm reduction programs tackling psychoactive substances are well documented and accepted by practitioners, whereas harm reduction programs tackling alcohol are under-researched and met with resistance. Method: The paper is mainly based on key-person interviews with eight program providers conducted in Switzerland in 2009 and up-dated in 2015, and the analysis of reports and mission statements to establish an inventory and description of drinking under control programs (DUCPs). A recent twin program in Amsterdam and Essen was included to exemplify conditions impeding their implementation. Firstly, a typology based on the type of alcohol management, the provided support and admission criteria is developed, complemented by a detailed description of their functioning in practice. Secondly, the case studies are analyzed in terms of factors promoting and impeding the implementation of DUCPs and efforts of legitimize them and assess their success. Results: Residential and non-residential DUCPs show high diversity and pursue individualized approaches as the detailed case descriptions exemplify. Different modalities of proactively providing and including alcohol consumption are conceptualized in a wider framework of program objectives, including among others, quality of life and harm reduction. Typically DUCPs represent an effort to achieve public or institutional order. Their implementation and success are contingent upon their location, media response, type of alcohol management and the response of other substance-oriented stake holders in the treatment system. The legitimization of DUCPs is hampered by the lack of evaluation studies. DUCPs rely mostly – also because of limited resources – on rudimentary self-evaluations and attribute little importance to data collection exercises. Conclusions: Challenges for participants are underestimated and standard evaluation methodologies tend to be incompatible with the rationale and operational objectives of DUCPs. Program-sensitive multimethod approaches enabled by sufficient financing for monitoring and accompanying research is needed to improve the practice-oriented implementation of DUCPs. Barriers for these programs include assumptions that ‘alcohol-assisted’ help abandons hope for recovery and community response to DUCPs as locally unwanted institutions (‘not in my backyard’) fuelled by stigmatization.

Opioid Crisis Response and Resilience: Results and Perspectives from a Multi-Agency Tabletop Exercise at the Pennsylvania Emergency Management Agency

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alexander Siedschlag ◽  
Tiangeng Lu ◽  
Andrea Jerković ◽  
Weston Kensinger
Keyword(s):  
Public Health ◽  
Emergency Management ◽  
Health Care Professionals ◽  
Resource Sharing ◽  
Crisis Response ◽  
Community Response ◽  
First Responder ◽  
Management Agency ◽  
Opioid Crisis ◽  
State And Local

Abstract This article presents and discusses, in the new context of COVID-19, findings from a tabletop exercise on response and resilience in the ongoing opioid crisis in Pennsylvania. The exercise was organized by [identifying information removed] and held at the Pennsylvania Emergency Management Agency (PEMA), in further collaboration with the Governor’s Office of Homeland Security, the Pennsylvania Department of Health, and with the participation of several additional agencies and institutions. It addressed first-responder and whole-community response and resilience to the ongoing opioid crisis. More than 50 experts participated in the one-day program that involved state and local agencies, first-responder organizations, as well as academia in a discussion about effectuating comprehensive response to overdose incidents. Participant experts represented a wide array of backgrounds, including state and local law enforcement agencies; emergency medical technicians; public health and health care professionals; and scholars from the fields of law, security studies, public policy, and public health, among other relevant areas. Participants addressed specific challenges, including resource sharing among responders; capacity-building for long-term recovery; effective integration of non-traditional partners, such as spontaneous volunteers and donors; and public education and outreach to improve prevention. The exercise aimed to strengthen the whole-community approach to emergency response.

scholarly journals Which Strategies Improve Physicians' Experience with Health Information Technology?

ACI Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e47-e53
Author(s):  
Jacqueline Haskell ◽  
Brittany Mandeville ◽  
Emily Cooper ◽  
Rebekah Gardner
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Rhode Island ◽  
Response Rate ◽  
Physician Burnout ◽  
Health Records ◽  
Effective Strategies ◽  
Department Of Health ◽  
Part Time

Abstract Objectives While electronic health records (EHRs) have improved billing efficiency and note legibility, they may also disrupt clinical workflows, affect patient interactions, and contribute to physician burnout. This study aimed to identify effective strategies, as reported by physicians, to mitigate these EHR shortcomings. Methods The Rhode Island Department of Health administers a health information technology (HIT) survey biennially to all physicians in active practice statewide. The 2019 survey asked physicians about strategies implemented personally or by their practice to improve their experience working with HIT. Physicians who identified at least one strategy were then asked if each implemented strategy was “actually useful.” Results The 2019 survey was administered to 4,266 physicians, with a response rate of 43%. Both office- and hospital-based physicians most commonly reported that their practices had implemented voice-recognition dictation software (48 and 68%, respectively). Office- and hospital-based physicians identified self-care as the most commonly implemented personal change (48 and 47%, respectively). However, 26% of office-based and 15% of hospital-based physicians reported reducing clinical hours or working part-time to improve their experience working with HIT. The strategies identified as “actually useful” varied by practice setting and were not always the most widely implemented approaches. Conclusion Most physicians reported that both they personally and their practices had implemented strategies to improve their experience with HIT. Physicians found some of these strategies more helpful than others, and the strategies identified as most useful differed between office- and hospital-based physicians. From a workforce and access perspective, prioritizing strategies that physicians find “actually useful” is critical, as many physicians in both settings reported reducing clinical hours to improve their experience.

scholarly journals Exploring the Association Between the “Big Five” Personality Traits and Fatal Opioid Overdose: County-Level Empirical Analysis (Preprint)

2020 ◽  
Author(s):  
Zhasmina Tacheva ◽  
Anton Ivanov
Keyword(s):  
United States ◽  
Big Five ◽  
Psychological Factors ◽  
The United States ◽  
Community Level ◽  
Opioid Overdose ◽  
County Level ◽  
Psychological Traits ◽  
Wide Range ◽  
The Relationship

BACKGROUND Opioid-related deaths constitute a problem of pandemic proportions in the United States, with no clear solution in sight. Although addressing addiction—the heart of this problem—ought to remain a priority for health practitioners, examining the community-level psychological factors with a known impact on health behaviors may provide valuable insights for attenuating this health crisis by curbing risky behaviors before they evolve into addiction. OBJECTIVE The goal of this study is twofold: to demonstrate the relationship between community-level psychological traits and fatal opioid overdose both theoretically and empirically, and to provide a blueprint for using social media data to glean these psychological factors in a real-time, reliable, and scalable manner. METHODS We collected annual panel data from Twitter for 2891 counties in the United States between 2014-2016 and used a novel data mining technique to obtain average county-level “Big Five” psychological trait scores. We then performed interval regression, using a control function to alleviate omitted variable bias, to empirically test the relationship between county-level psychological traits and the prevalence of fatal opioid overdoses in each county. RESULTS After controlling for a wide range of community-level biopsychosocial factors related to health outcomes, we found that three of the operationalizations of the five psychological traits examined at the community level in the study were significantly associated with fatal opioid overdoses: extraversion (β=.308, <i>P</i>&lt;.001), neuroticism (β=.248, <i>P</i>&lt;.001), and conscientiousness (β=.229, <i>P</i>&lt;.001). CONCLUSIONS Analyzing the psychological characteristics of a community can be a valuable tool in the local, state, and national fight against the opioid pandemic. Health providers and community health organizations can benefit from this research by evaluating the psychological profile of the communities they serve and assessing the projected risk of fatal opioid overdose based on the relationships our study predict when making decisions for the allocation of overdose-reversal medication and other vital resources.

Barriers and Facilitators of HIV and Hepatitis C Care Among People Who Inject Drugs in Nairobi, Kenya: A Qualitative Study with Peer Educators

2021 ◽  
Author(s):  
Natasha Ludwig-Barron ◽  
Brandon L Guthrie ◽  
Loice Mbogo ◽  
David Bukusi ◽  
William Sinkele ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Law Enforcement ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Community Level ◽  
Barriers And Facilitators ◽  
Peer Educators ◽  
Prevention Education ◽  
Individual Level ◽  
Policy Level

Abstract Background: In Kenya, people who inject drugs (PWID) are disproportionately affected by HIV and hepatitis C (HCV) epidemics, including HIV-HCV coinfections; however, few have assessed factors affecting their access to and engagement in care through the lens of harm reduction specialists. This qualitative study leverages the personal and professional experiences of peer educators to help identify HIV and HCV barriers and facilitators to care among PWID in Nairobi, including resource recommendations to improve service uptake. Methods: We recruited peer educators from two harm reduction facilities in Nairobi, Kenya, using random and purposive sampling techniques. Semi-structured interviews explored circumstances surrounding HIV and HCV service access, prevention education and resource recommendations. A thematic analysis was conducted using the Modified Social Ecological Model (MSEM) as an underlying framework, with illustrative quotes highlighting emergent themes. Results: Twenty peer educators participated, including six women, with 2 months to 6 years of harm reduction service. Barriers to HIV and HCV care were organized by (a) individual-level themes including competing needs of addiction and misinterpreted symptoms; (b) network-level themes including social isolation and drug pusher interactions; (c) community-level themes including transportation, mental and rural healthcare services, and limited HCV resources; and (d) policy-level themes including nonintegrated services, clinical administration, and law enforcement. Stigma, an overarching barrier, was highlighted throughout the MSEM. Facilitators to HIV and HCV care were comprised of (a) individual-level themes including concurrent care, personal reflections, and religious beliefs; (b) network-level themes including community recommendations, navigation services, family commitment, and employer support; (c) community-level themes including quality services, peer support, and outreach; and (d) policy-level themes including integrated services and medicalized approaches within law enforcement. Participant resource recommendations include (i) additional medical, social and ancillary support services, (ii) national strategies to address stigma and violence and (iii) HCV prevention education. Conclusions : Peer educators provided intimate knowledge of PWID barriers and facilitators to HIV and HCV care that were described at each level of the MSEM, and should be given careful consideration when developing future initiatives. Recommendations emphasized policy and community-level interventions including educational campaigns and program suggestions to supplement existing HIV and HCV services.

Narcan as biomedical panic: The war on overdose and the harms of harm reduction

2020 ◽  
pp. 136248062096477
Author(s):  
Philip R Kavanaugh
Keyword(s):  
Public Health ◽  
Drug Treatment ◽  
Harm Reduction ◽  
Drug Users ◽  
Opioid Addiction ◽  
The State ◽  
Opioid Overdose ◽  
State Response ◽  
Drug Companies ◽  
The Us

As the opioid overdose crisis in the US persists, governments have coordinated with drug companies to propagate the overdose reversal drug naloxone (Narcan) as a ‘kinder/gentler’ state response, deriving from a supposedly progressive harm reduction ethos. Drawing on Derrida’s deconstruction of pharmakon, I show how Narcan is rendered paradoxical and terminal, diverting attention from the structural antecedents of opioid addiction and resources for drug treatment while reproducing corporeal suffering in those revived. I further highlight how Narcan is positioned in a wider array of regressive governing practices that legitimate the state’s punitive drug war and demonization of drug users. Narcan thus provides a useful opening between the state and contemporary biomedicine to theorize how harm reduction and public health unfurl in insidious and corrosive ways.

scholarly journals Application of STORMTOOLS Coastal Environmental Risk Index (CERI) to Inform State and Local Planning and Decision Making along the Southern RI Shoreline

2020 ◽  
Vol 8 (4) ◽  
pp. 295
Author(s):  
Malcolm L. Spaulding ◽  
Annette Grilli ◽  
Chris Damon ◽  
Teresa Crean ◽  
Grover Fugate
Keyword(s):  
Sea Level Rise ◽  
Sea Level ◽  
Rhode Island ◽  
Environmental Risk ◽  
Structural Damage ◽  
Risk Index ◽  
Atlantic Coast ◽  
Wave Model ◽  
Flood Plain ◽  
State And Local

STORMTOOLS coastal environmental risk index (CERI) was applied to communities located along the southern coast of Rhode Island (RI) to determine the risk to structures located in the flood plain. CERI uses estimates of the base flood elevation (BFE), explicitly including the effects of sea level rise (SLR); details on the structure types, from the E911 emergency data base/parcel data, and associated first floor elevation (FFE); and damage curves from the US Army Corp of Engineers North Atlantic Coast Comprehensive Study (NACCS) to determine the damages to structures for the study area. Surge levels and associated offshore waves used to determine BFEs were obtained from the NACCS hydrodynamic and wave model predictions. The impacts of sea level rise and coastal erosion on flooding were modeled using XBeach and STWAVE and validated by observations at selected locations along the coastline. CERI estimated the structural damage to each structure in the coastal flood plain for 100 yr flooding with SLR ranging from 0 to 10 ft. The number of structures at risk was estimated to increase approximate linearly from 3700 for no SLR to about 8000 for 10 ft SLR, with about equal percentages for each of the four coastal communities (Narragansett, South Kingstown, Charlestown, and Westerly, Rhode Island (RI)). The majority of the structures in the flood plain are single/story residences without (41%) and with (46%) basements (total 87%; structures with basements are the most vulnerable). Less vulnerable are structures elevated on piles with 8.8% of the total. The remaining are commercial structures principally located either in the Port of Galilee and or Watch Hill. The analysis showed that about 20% of the structures in the 100 yr flood plain are estimated to be damaged at 50% or greater. This increases to 55% of structures as SLR rises to 5 ft. At higher SLR values the percent damaged at 50% or greater slowly declines to 45% at 10 ft SLR. This behavior is a result of the number of homes below MSL increasing dramatically as SLR values moves higher than 5 ft and thus being removed from the structures damaged pool. Generalized CERI risk maps have developed to allow the managers to determine the broad risk of siting structures at any location in their communities. CERI has recently become available as a mobile phone App, facilitating the ability of state and local decision makers and the public to determine the risk of locating a selected building type at any location in their communities.

Harm Reduction in Prisons

2018 ◽  
Author(s):  
Kathryn Snow ◽  
Michael Levy
Keyword(s):  
Harm Reduction ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
International Human Rights Law ◽  
Negative Consequences ◽  
Human Rights Law ◽  
Community Settings ◽  
First Line ◽  
Exchange Programs ◽  
History Of

Interventions intended to minimize the harms of injecting drug use, particularly drug overdose and exposure to blood-borne viruses, have a long history of implementation in some community settings but are frequently unavailable in prisons. The denial of harm reduction measures to prisoners who inject drugs violates their right to non-discriminatory healthcare, as well as other facets of international human rights law. Evidence is available from several programs in diverse settings which demonstrates that it is possible to implement many harm reduction interventions in prisons, that such programs can reduce the risk of drug-related harms, and that concerns regarding unintended negative consequences of such programs are often unfounded. This chapter provides an overview of the key harm reduction measures relevant to the prison setting, with a particular focus on the provision of sterile injecting equipment to prisoners via needle and syringe exchange programs, and on the provision of the opioid antagonist naloxone as first-line treatment for opioid overdose to people while in prison and on leaving prison. The chapter reviews the legal basis for providing these and other harm reduction measures to prisoners, outlines the evidence that supports specific interventions, and highlights topics on which further research is needed.

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