The Opioid Response Project is a framework to address the opioid epidemic in our region and reduce the burden this crisis places on families and communities in our region. It is an opportunity to use practical, evidence-based approaches to prevent initiation of use by changing the way opioids are prescribed by doctors in the region, change the way providers engage with drug users with trainings and education, create protective factors for youth and families, prevent overdose deaths by expanding access to naloxone, increase access to medically assisted treatment (MAT), and increase recovery supports to help people get their lives back.
Metrics for this project are currently in draft form and are being updated by the Health Care Authority. The metrics under consideration include:
• Substance Use Disorder Treatment Penetration (Opioid)
• Outpatient Emergency Department visits (per 1000 member months)
• Inpatient hospital utilization
• Patients with concurrent sedatives prescriptions
• Number and locations of buprenorphine prescribers
• Number and locations of mental health and SUD providers delivering acute care and recovery services
• Health care providers trained/supported for opioid prescribing guidelines
• Syringe exchange programs
• Providing naloxone, education, and protocols for distribution and use
• Access points for MAT
Successful Opioid Response will create coordinated and integrated systems of care that engage with people who have OUD in a respectful way: meeting them where they are in their readiness to change their behavior and giving them the tools they need to survive (i.e. information, education, naloxone, clean injection supplies). CPAA aims to facilitate a process for people who use drugs to move along a continuum of treatment to address acute health issues, induction into MAT (if chosen by the patient), supporting them in stabilization of other behavioral and physical health issues, and connecting people to other resources to improve their lives and enhance recovery.
Harm Reduction Principles:
a. Pragmatism: result-based and cost effective
b. Focus on harm: drug user, community, public safety
c. Human Rights focused: non-judgmental, equity, and dignity-based treatment
d. Maximizing intervention options: increase use of SSP to engage in health services
e. Priority of immediate goals: treatment on demand, no coercive withholding of services
f. Involvement of people who use drugs: recognition of expertise of drug users in the development of services
Medication Assisted Treatment (MAT): medication assisted treatment, including opioid treatment programs, combines behavioral therapy and medications to treat substance use disorders
Recovery Support Services:
a. Health – overcoming or managing one’s disease(s) or symptoms
b. Home – have a stable and safe place to live
c. Purpose – conducting meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society
d. Community – having relationships and social networks that provide support, friendship, love, and hope
• Opioid Use Disorder (OUD)/Substance Use Disorder (SUD) treatment providers
• Tribal communities
• Social service agencies
• Concerned community members
• People in recovery and their families
• People who use drugs and their families
Project Work Group is working on:
1. Current state assessment
2. Identify Domain 1 strategies that support project
3. Finalize target populations and evidence-based approaches
4. Determine partnering providers
5. Complete implementation plans
6. Plan describing regional transition to fully-integrated managed care
Project Implementation in 2019, and scaling-up in 2020.
Social Determinants of Health are particularly relevant when addressing substance use disorder (SUD):
1. Homelessness: Runaways, homeless youth, and youth who have become dependent on drugs are at high risk for HIV infection if they exchange sex for drugs, money, or shelter. Adult drug users also experience these risks. Gender identification and sexual orientation exacerbate this vulnerability.
2. Inadequate HIV prevention/health education: Young people and adults are not always reached by effective HIV interventions or prevention education, especially young gay and bisexual men, because some sex education programs exclude information about sexual orientation
3. Feelings of isolation: Gay and bisexual high school students may engage in risky sexual behaviors and substance abuse because they feel isolated and lack support. Stigma is one of the greatest contributing factors to the isolation that drug users experience.
4. Age: Youth are more vulnerable. An estimated 70% of the world’s drug users are under 25, and at least half in urban areas start injecting in their teens. Of these young people, 3% are living with HIV.
5. Legal Issues: The “war on drugs” approach forces people who use drugs into the shadows, away from services that can help them. Drug felonies make it more difficult, and at times impossible, for people to access housing, education funding, and employment. Incarcerating drug users likewise fuels HIV transmissions, especially in overcrowded prisons where syringe sharing and unprotected sex is more common. It is estimated that 56-90% of drug users will be imprisoned at some point in their life. Laws that criminalize drug possession and use restrict people who inject drugs (PWID) access to HIV services, prohibit antiretroviral treatment (ART) for HIV positive people, and restrict the provision of sterile injection equipment.