How One City Went “All In” to Fight the Opioid Epidemic

In 2014, the city of Worcester, Massachusetts, saw nine deaths from opioid overdoses in a six-day period. Here’s how the city took an all-hands-on-deck and all-of-the-above approach to saving lives.

ARTICLE | Mar 14, 2016

In 2014, the city of Worcester, Massachusetts (population approximately 182,000), confronted this reality: nine deaths from opioid overdoses over the course of six days. The overdoses, explains City Manager Edward Augustus, “were an issue that had been rippling through the community for some time.” The city of Worcester isn’t alone. The New York Times reports that in 2014, nationally, 125 people a day died from drug overdoses, 78 of them from heroin and painkillers, otherwise known as opioids. Small towns, big cities, and rural communities are seeing the tragic effects of this addiction in the most public of places, and there’s no sign of the trend slowing down.

Augustus was ready to do anything to keep people alive, and determined to slow down the epidemic in his community. After the nine deaths, the city of Worcester immediately convened a town hall meeting with local service providers and the substance abuse advocacy community, and together they created a game plan that municipal government could run with.

As a result, the city instantly began implementing strategies—from public education and awareness programs to unwanted prescription medication drop-off kiosks—to counter the opioid epidemic. ICMA recently interviewed Augustus about those tactics. Here’s what we learned:

It takes collaboration and coordination.

You can’t fight this epidemic alone. It takes collaboration from all parts of local government as well as working with other services to explore options for programs, policy, and funding to reduce opioid use, abuse, and overdose.

The city of Worcester collaborates on several initiatives, including:

  • The Regional Response to Addiction Partnership Coalition, coordinated by the Worcester Division of Public Health, consists of many individuals, organizations, and municipal partners from the Central Massachusetts Regional Public Health Alliance (Worcester’s public health district) and hosts “Substance Abuse Awareness and Resource” fairs as well as other initiatives to raise awareness about substance abuse, especially among youth and parent populations.
  • To assess the reach of substance abuse, the Worcester Division of Public Health has agreements with Worcester Public Schools and with member communities of the Central Massachusetts Regional Public Health Alliance to survey high school and middle school students on perceptions and health behaviors, which will help identify trends and program needs for this population.
  • Aids Project Worcester, in partnership with the city, has hired staff to conduct outreach across Worcester to engage with homeless individuals to collect used syringes that these staff have found in parks, on streets, and in other public locations—in other words, in places where the used syringes pose a danger to public safety.

Another benefit of collaboration can be mutual funding and sharing of resources. You might, for example, locate partners willing and able to donate services or resources. Finding ways to use existing resources in creative ways or “cobbling together,” as Augustus put it, additional resources can be a collective effort. Like any new endeavor, it takes innovative thinking and, of course, some risk taking.

Massachusetts FY2016 Substance Abuse Service Expansion Awards

On March 11, Health and Human Services announced $94 million in Affordable Care Act funding to 271 health centers in 45 states, the District of Columbia, and Puerto Rico to improve and expand the delivery of substance abuse services in health centers, with a specific focus on treatment of opioid use disorders in underserved populations. The city of Worcester has been awarded $352,083 from the $94 million investment.

Just start doing stuff.

“Anything and everything we thought we could do to keep people alive,” is what Augustus says he and his team decided would be the best approach in combating the epidemic. The city started by training and supplying its police and fire departments with the opioid overdose reversal drug, Naloxone (Narcan). The Massachusetts Department of Public Health Bureau of Substance Abuse Services awarded the city of Worcester police and fire departments a “First Responder Naloxone Grant.” The funding (applied to those municipalities that met a certain criteria) is for the prevention of overdose and supports facilitating the purchasing, carrying, and administering of Narcan. The funds also support components of community outreach and training.

To take it a step further, the city provided front-line employees who work in municipal buildings and who are most impacted by opioid overdoses with training on how to recognize and respond to an overdose, including how to administer Narcan. “Having trained employees who themselves have and can administer Narcan expands the safety net,” explains Augustus. This training applies to local government staff whose jobs put them in contact with the public on a regular basis—for example, employees at senior centers and libraries and people who are doing code enforcements to inspect homes and businesses, as well as employees in city hall.

Remove the potential for gateway drugs.

According to a 2010 study by researchers at the University of Buffalo, opioid prescription drugs are the most common type of gateway drug for illicit drug addicts. The study’s researchers noted that more than half of the opioid-addicted patients reported that legal prescription drugs were their first drug of abuse. To prevent drugs from homes in the community from becoming gateway drugs to illicit drugs, Worcester created two initiatives that lead to the collection of unwanted prescription drugs.

First, the city worked with police departments in adding kiosks that collect unwanted prescription medications from community members who simply need a place to get rid of them. Our directive, says Augustus, is “Don’t throw it in the trash can, don’t flush it down the toilet, drop it off at the police station, no questions asked.” In addition, Augustus noted, a benefit of having the kiosk at the police station is that it’s open 24 hours a day, seven days a week.

Second, through Neighborhood Watch programs, certain individuals are authorized to collect unwanted prescription drugs from people who attend those meetings. Again, no questions asked.

Ultimately, the steady rise of opioid abuse and overdose is a nationwide public health crisis. According to a tracking poll from the Kaiser Family Foundation, more than 56 percent of the public has been personally affected by opioid abuse, and 50 percent of the public believes that state officials should make combating the problem of opioid abuse one of their top priorities. In the same poll, large majorities of the public say that policies to reduce prescription painkiller abuse would be at least somewhat or very effective.

Augustus and the city of Worcester have effectively figured out a way to create programs and policies that work to reduce prescription painkiller abuse in their community. The prescription drug take-back initiative has collected 450 pounds of prescription drugs and over-the-counter medications. In addition, Worcester police and fire department personnel have reversed more than 200 overdoses with the use of Narcan. In a report developed by Augustus written to the Worcester city council, he states:

Addressing the stigma while working together at the federal, state, and local level to address substance abuse prevention, intervention, treatment, and recovery will continue to reduce the numbers of people being lost to the epidemic. This is an all hands on deck, all of the above approach to saving lives. From prescription take-back days to our public safety personnel carrying lifesaving Narcan – there is a space for everyone to get involved, get educated, and save a life.

When asked whether he would do anything differently, Augustus quickly replied, “Start earlier.” The words of someone determined to make a difference.

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