Addiction is not a new phenomenon. While the particular drug of choice may vary between time and place, the behavior of becoming habituated to a substance is constant among a portion of any population.
Public policy often becomes involved with trying to remedy the issue of substance abuse within communities. This article highlights the work done by one local government to address the current opioid epidemic.
New Council Tackles Addiction Challenge
Broome County, New York (population 200,600), includes 1 city, 16 towns, and 7 villages.
Broome County’s government is led by a full-time elected county executive and a 15-member legislature. Much like the rest of the nation, Broome County has had an increase in opioid overdose deaths in recent years. The number of deaths has steadily increased from 10 in 2011 to 31 in 2014, falling slightly to 30 in 2015.
In December 2014, the increase in rates of addiction and deaths influenced the county executive to establish the Broome Opioid Abuse Council. BOAC’s mission is preventing future opioid addiction, mitigating rates of overdose death, and improving access to treatment for currently addicted individuals within the community.
This mission is accomplished through multidisciplinary collaboration between elected officials, public health agencies, emergency medical services, law enforcement, and substance abuse and mental health service providers, along with community stakeholders.
In order to pursue its ambitious goals, BOAC formed four committees—community education; law enforcement; education of medical professionals; and treatment, prevention, and harm reduction—that have been able to contribute toward the larger response to the epidemic.
BOAC held 8 public awareness events during 2015 and 11 events in 2016 by the time this article was written. Records maintained by county staff members report that thousands of county residents have attended these educational events. They feature a panel consisting of law enforcement, treatment providers, family members of addicted individuals, and individuals in recovery.
Attendees receive information on how to prevent opioid addiction, how to identify behaviors indicative of addiction, and how to seek treatment options for opioid-addicted individuals. Community education has also involved creating a support group for affected parents and grandparents of addicted individuals.
Law Enforcement Response
Broome County’s law enforcement officials recognized that the opioid epidemic is a social problem that cannot be solved solely through the criminal justice system. Law enforcement has increased its efforts to dismantle distribution networks through a countywide task force, crime analysis center, and acquisition of federal grants to support its work.
While law enforcement continues to aggressively diminish the supply of illicit drugs available, it has also sought to provide services rather than incarceration for drug abusers. The Sheriff’s Assisted Recovery Initiative now provides assistance with obtaining access to rehabilitation services within the county.
An important aspect of the law enforcement response is supplying information. A public service announcement was developed and aired to inform people of New York State’s Good Samaritan Law, which was passed in 2011, and bars arrest and prosecution for personal possession of drugs, paraphernalia, or underage drinking when someone calls for help to save the life of an overdose victim.
Patrol officers from all county agencies are distributing informational cards on the law and the resources for treatment to individuals being resuscitated with the medication naloxone, which is used to reverse the effects of an opioid overdose and allows the body to resume its natural respiratory effort.
Information is also being provided on medication take-back events offered by the sheriff’s office. These are considered important interventions because an abundance of excess prescription opioids within the community creates the opportunity for their misuse.1
Another aspect of the law enforcement response was for all law enforcement agencies within the county to train officers on how to administer the medication naloxone. The administration of naloxone by law enforcement officers, who are often the first to arrive on the scene, has helped reduce the overall number of overdose deaths in the county. From January 2015 through the end of June 2016, law enforcement officers within Broome County had administered naloxone 62 times.
Promoting Outreach to Clinicians
BOAC has sought to improve adherence to evidence-based opioid prescribing guidelines. Clinicians prescribing higher doses of opioid medication have been shown to correlate with increased overdose deaths among prescription holders, and one study found 60 percent of the originally prescribed amount of opioids was later returned unneeded during medication take-back events.2
Providing clinical updates to health care providers can be challenging because they often face pressures to see more patients, rather than spend time in a seminar. Due to this reality, the most effective method identified for providing clinical updates to providers is through a practice called “detailing.”
Detailing is a brief educational visit provided to a clinician within that clinician’s practice setting. The person performing the detailing will often have a standing meeting with the clinician in the hallway of the patient care area.
The detailer will typically have three minutes or less to deliver his or her message and provide any leave-behind materials for further reading. This method of provider education is frequently used by pharmaceutical sales representatives.
BOAC was able to acquire a grant for $35,000 from a local foundation to hire a detailer to spread the message of evidence-based opioid prescribing. The individual hired is a retired pharmaceutical sales representative with 29 years of industry experience.
Since this initiative—Opioid Prescription Reduction by Academic Detailing (OPRAD)—began in April 2016, the project’s detailer has met with over 130 prescribing clinicians within their practice settings.
BOAC has also worked to increase treatment resources and client navigation. The committee secured numerous grants to expand services; medication-assisted treatment using methadone, a drug which reduces symptoms of opioid withdrawal, offered by one provider was increased from 85 to 150 individuals.
A contract with one service provider was amended to require client intake within five business days of an individual requesting treatment services. Requests have also been made to state licensing agencies to increase the number of treatment beds available locally.
Grant funding was also used to begin a new governmental and nongovernmental partnership program between Broome County and the YWCA of Broome County called The Bridge.
The Bridge offers residential living quarters with around-the-clock staffing to eight women in recovery and their infants who were born addicted to opiates. The women receive mental health and substance abuse counseling, case management services, and vocational training services.
Collective Action Is Key
The county’s comprehensive approach uses every evidence-based practice currently identified within the medical and public health literature for a local community to respond to this issue. The most important benefit that has been observed by BOAC members themselves is the collaboration across many disciplines.
This initiative has brought public and nonprofit organizations together to produce meaningful action on a community problem. BOAC’s efforts are now being expanded into regional projects that include bringing in a nationally known substance abuse speaker and participating in a multicounty, presumed-opioid-overdose tracking database.
The main lesson learned from this initiative is that no matter the size of the community, it is the collective action of numerous partners rather than discreet efforts that provide the most effective level of service for the population. This model of action can be scaled to the size and capabilities of any local government seeking to address this serious problem.
Endnotes and Resources:
1 Welham, G. C., Mount, J. K., & Gilson, A. M. (2015). “Type and Frequency of Opioid Pain Medications Returned for Disposal.” Drugs—Real World Outcomes, 2(2), 129–135. Overdose-related deaths. Journal of the American Medical Association, 305(13), 1315–1321.
2 Bohnert, A.S., Valenstein, M., Bair, M.J., Ganoczy, D., McCarthy, J.F., Ilgen, M.A., & Blow, F.C. (2011). “Association between Opioid Prescribing Patterns and Opioid Overdose-related Deaths.” Journal of the American Medical Association, 305(13), 1315–1321.