Overdose Response Strategy Newsletter | August 2020
The ORS is Expanding Nationally
Going Forward the Program Will Include Drug Intelligence Officers in Every State and Territory
CORRECTION: An earlier version of the newsletter mischaracterized Utah, Arizona and New Mexico. These three states all include both PHA and DIO positions.
Earlier this month the White House Office of National Drug Control Policy (ONDCP) announced that they were awarding funds to hire 30 new Drug Intelligence Officers (DIO) in the coming year and expand the ORS to every High Intensity Drug Trafficking Area (HIDTA) region in the country.

This award will significantly expand the reach of the ORS and provide support to dozens of agencies building public health/public safety partnerships. The goal of this expansion is to increase support for overdose prevention efforts across highly affected regions of the U.S.

Going forward, the ORS will include DIOs in all U.S. states, the District of Columbia, and Puerto Rico. The program will continue to include 30 Public Health Analyst positions in existing ORS states.
PHA and DIO positions
DIO only
Welcome to Our New ORS Team Members!
Lindsey Bartholdi, Minnesota Drug Intelligence Officer
Lindsey joined North Central HIDTA in August 2020 as the Drug Intelligence Officer. She received her Master’s Degree in Criminal Justice from Saint Cloud State University in December of 2016. Lindsey comes to North Central HIDTA from Minnesota’s Bureau of Criminal Apprehension where she served as a Criminal Intelligence Analyst for Narcotics. Her primary duties assigned were on the Anti-Heroin Task Force working opioid in Indian Country Cases and Overdose Deaths. Aside from Narcotic case support, Lindsey also served as the statewide Overdose Detection Mapping Application Program (ODMAP) Coordinator. Lindsey partnered with various Public Safety and Public Health partners on implementing the ODMAP program in Minnesota.
Mark "Eustace" Scroggins, New Mexico Drug Intelligence Officer
Mark “Eustace” Scroggins joined the New Mexico HIDTA as a DIO in July 2020 after retiring from a law enforcement career of 30 years. He also served in the U.S. Army. Eustace started as a patrol officer with the Santa Fe Police Department. Throughout his career, he held various positions including K-9 officer, detective, field sergeant, instructor at the New Mexico Law Enforcement Academy, SWAT operator, scout sniper and task force officer with the FBI. He spent 21 years of his career as a narcotics agent, primarily in an undercover capacity infiltrating major drug trafficking organizations in New Mexico. In 2008, Eustace was awarded the Medal of Valor by the New Mexico Attorney General for heroic action taken during an undercover operation. Now, the good stuff. Eustace met his lovely bride during a federal investigation involving drug and financial crimes; she is a special agent with the U.S. Department of the Treasury. They have a son, Garrett, who is interested in pursuing a federal law enforcement career. The family resides in the countryside and recently established a small herd of red angus cattle.


Upcoming ORS Trainings and Events
ORS VIRTUAL CONFERENCE
November 16th-19th from 1:00 PM to 4:30 PM EST
The ORS will be moving it's annual meeting online!
Please hold these times on your calendars. More information will be available soon.
Upcoming ORS All-State Team Calls

FRIDAY, AUGUST 28TH @ 1:00 PM ET
Updates from Maine, Vermont, and New Hampshire

FRIDAY, SEPTEMBER 25TH @ 1:00 PM ET
Updates from South Carolina, North Carolina and Tennessee

FRIDAY, OCTOBER 23RD @ 1:00 PM ET
Updates from Connecticut, Rhode Island, and New Jersey
Upcoming ORS Webinars

COVID-19 Impacts & the Role of Syringe Services Programs (SSPs) in Overdose Response
Friday, September 11th: 1:00 pm - 2:30 pm ET
Please join us for presentations and discussions with Lucy Slater, the Senior Director for HIV, STI, and Viral Hepatitis at the National Association of County and City Health Officials (NACCHO). This webinar will describe the critical role of syringe service programs (SSPs) in the Overdose Response Strategy, the challenges that SSPs are currently facing as they try to maintain service delivery during the COVID-19 pandemic, and the impact of disrupted services on people who use drugs. It will also provide an example of how the Connecticut ORS state team has supported the New Haven Innovative Community Engagement (NHICE) initiative, which offers a multi-tiered approach to increasing engagement with the substance use community.

SPECIAL WEBINAR: ORS Communications Update
Wednesday, September 23rd: 2:00 pm - 3:00 pm ET
Jessica Wolff, our ORS Public Health Director, will lead a webinar to cover new ORS communications materials, and discuss new standardized program messaging.
Overdose Fatality Review: Train the Trainers
The ORS is piloting a new train-the-trainer series focused on developing effective overdose fatality review teams (OFRs). This training series has been developed in coordination with the Institute for Intergovernmental Research (IIR) and the Bureau of Justice Assistance (BJA).

This series has been developed and is being led by:
  • Mallory O'Brien, MS, PhD, Founding Director, Milwaukee Homicide Review Commission and DataShare
  • Melissa Heinen, RN, MPH, Senior Research Associate, Institute for Intergovernmental Research (IIR)

Both Melissa Heinen and Mallory O’Brien are the authors of the toolkit, Overdose Fatality Review – A Practitioner’s Guide to Implementation. Financial support for this toolkit was provided by the Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice and the U.S. Centers for Disease Control and Prevention.

The series consists of six modules. The first 45 minutes of each session will be live training with our OFR experts and the following 45 minutes are available for those interested small-group breakout discussion and practice.

MODULE 2: PLANNING OFR MEETINGS
Wednesday, September 2, 2020 @ 2:00pm – 3:30PM EST

MODULE 3: FACILITATING OFR MEETINGS
Wednesday, September 16, 2020 @ 2:00pm – 3:30PM EST

MODULE 4: COLLECTING DATA
Wednesday, September 30, 2020 @ 2:00pm – 3:30PM EST

MODULE 5: BUILDING A RECOMMENDATION PLAN
Wednesday, October 14, 2020 @ 2:00pm – 3:30PM EST

This series is already underway. Recordings of Modules 0 and 1 are available. If you have any questions, please reach out to Lindsey Kato (qct5@cdc.gov).
Recently Published Reports
The Opioid Crisis and the Hispanic/Latino Population: An Urgent Issue
As Congress, federal agencies, state and county
health and behavioral health departments, and
community stakeholders mobilize to address the
opioid epidemic, what is happening within the
Hispanic/Latino communities?

This issue brief aims to convey a snapshot of how this population is impacted. Specifically, it will:
  • Provide recent data on the prevalence of opioid misuse and opioid overdose death rates in the Hispanic/Latino population in the U.S.;
  • Discuss contextual factors that impact the opioid epidemic in these communities, including challenges to accessing early intervention and treatment;
  • Highlight innovative outreach and engagement strategies that have the potential to connect individuals with evidence-based prevention, treatment, and recovery, and;
  • Illustrate the importance of ongoing community voice and leadership in the development and implementation of solutions to this public health crisis.

Responding to an Overdose Spike: A Guide for State Health Departments
This guide from the Association of State and Territorial Health Officials (ASTHO) aims to help state health officials prepare for a rapid response to an opioid overdose spike event. Key components of an effective response include forming an overdose spike response team (OSRT) and overdose spike action plan (OSAP). This guide consists of potential action steps and factors for success, for each phase of the
planning and response process. These tips are followed by sample job action sheets
and other resources meant to support each phase of the process.

State Strategies to Improve The Use of Prescription Drug Monitoring Programs to Address Opioid and Other Substance Use Disorders
States have implemented many different strategies to address opioid use disorder/substance use disorders (OUD/SUD) and promote safe prescribing practices. One of these strategies is maintaining prescription drug monitoring programs (PDMPs) to inform clinical decisions and help support referrals to OUD/SUD treatment. PDMPs serve as information tools for many providers and public health and safety professionals who use the data to address OUD/SUD through improved clinical decision making, enhanced public health interventions, and faster detection of prescription fraud and diversion.

This toolkit was developed to highlight state practices in PDMP policy and identify opportunities to improve access and ease of use by health care providers. The toolkit includes a series of 10 considerations, highlighting different approaches states have taken to implement those strategies. Because PDMPs are already widely adopted and utilized among states and providers, the considerations in this toolkit reflect opportunities for state leaders to share best practices and make enhancements to advance functionality and improve utilization as part of a broader data-driven approach to promote the health and wellbeing of state residents. It also serves as a primer for individuals interested in learning about how PDMPs can advance initiatives to address OUD/SUD.

External Webinars
The 2020 Handle With Care Conference is going virtual this year with one 90 minute session every week. Model Handle With Care programs promote school-community partnerships aimed at ensuring that children who are exposed to trauma in their home, school or community receive appropriate interventions to help them achieve academically at their highest levels despite whatever traumatic circumstances they may have endured.
If a law enforcement officer encounters a child during a call, that child’s name and three words, HANDLE WITH CARE, are forwarded to the school/child care agency before the school bell rings the next day. The school implements individual, class and whole school trauma-sensitive curricula so that traumatized children are “Handled With Care". If a child needs more intervention, on-site trauma-focused mental healthcare is available at the school.

All 45 sessions will be delivered on most Wednesdays from August 2020 through June 2021 from 3:00pm to 4:30pm. You will be able to register for individual sessions at $10 each. If you would like to purchase all 45 sessions for $150 and pay by check, contact Lisa Carmelia - lisa.w.carmelia@wvsp.gov. If you like to pay by credit card, contact Jenny Lancaster - jenny@terzettocreative.com.


Public Health Peer Support Models
AUGUST 26TH @ 1:00 PM ET
Peer recovery support services (PRSS) are increasingly offered across diverse criminal justice settings to address opioid and other substance misuse, and to achieve positive outcomes. The power and potential of PRSS comes from the unique roles that peers play, promoting both hope and pragmatic steps for change.

This session will:
  • Present models of peer recovery support from community health and public health settings.
  • Explore the commonalities and differences between the philosophies, purposes, and tasks of community health workers and peer recovery support specialists.
  • Describe how programs can use the strengths of each model to better serve people who have been arrested, adjudicated, incarcerated, and/or released from incarceration.

Overdose and Drugs in the News
OPINION: Using Telemedicine to Treat Opioid Addiction
COVID-19 has made life much harder for people with opioid addiction. But the response to the virus has also revealed a way forward that could radically expand effective treatment and reduce overdose deaths. Until now, getting effective treatment depended on where you lived. Forty percent of American counties — much of Appalachia, for example — have no providers licensed to prescribe buprenorphine, the most successful treatment so far. But the pandemic has made it possible to see a licensed provider from home, and that could make buprenorphine treatment available anywhere.


U.S. Border Officials are Seizing More Meth, Showing How the Coronavirus is Changing the Drug Market
The recent seizure of $16 million worth of methamphetamines by US customs officials underscores rising seizure and overdose trends in the United States — with the coronavirus pandemic having likely increased the drug's profit potential.


Opioid Overdoses Have Skyrocketed Amid the Coronavirus, but States are Nevertheless Slashing Addiction Treatment Program Budgets
Drug overdoses have skyrocketed and demand for addiction treatment medicine has soared as the coronavirus pandemic continues. But many cash-strapped states are nevertheless slashing budgets for opioid crisis programs.


Extended Shelf Life Approved for Narcan Nasal Spray
The Food and Drug Administration (FDA) has approved an extended shelf life for Narcan® (naloxone hydrochloride; Adapt Pharma) Nasal Spray, increasing it from 24 months to 36 months.


Leading the Nation, Michigan's Opioid Treatment Ecosystems Save Lives through Holistic Model
Opioid overdoses killed 18 times more Michiganders in 2018 than they did in 1999, and putting addicts in jail isn't helping the problem. Studies have found that people released from incarceration are 129 times more likely to die of an overdose. However, a new initiative of the Wayne State University Center for Behavioral Health and Justice (CBHJ) is working to change the cultural landscape around substance use disorder and decrease overdose deaths through prevention, treatment, harm reduction, and sustained recovery.


One Doctor is Working to Fight D.C.'s Opioid Epidemic, Even as a Pandemic Rages
At his office on Benning Road in Northeast Washington, Edwin Chapman treats about 275 opioid addicts a month. They get counseling, a modified physical exam and buprenorphine, a drug that suppresses the craving for potentially lethal opioids such as heroin and fentanyl. “They don’t have the luxury of waiting days for inpatient treatment,” Chapman said. “That next hit of fentanyl could be their last.”

Recently Published Peer Reviewed Research
"It's Gonna be a Lifeline": Findings from Focus Group Research to Investigate What People Who Use Opioids Want from Peer-based Post-overdose Interventions in Emergency Departments
Postoverdose interventions that deploy peer recovery support specialists to emergency departments (EDs) are a promising response to opioid overdoses among patients presenting in EDs. The objective of this study was to elicit patients’ perspectives regarding the feasibility and acceptability of such an intervention and to ensure that their perspectives are represented in intervention design, implementation, and evaluation. In 2019 the study investigators conducted focus groups with people who use opioids to elicit perspectives about a postoverdose intervention delivered in the ED by using a semistructured interview guide that asked about feasibility, acceptability, perceived benefits, and concerns. Focus groups were digitally recorded, transcribed, and analyzed for emerging themes. Nine focus groups with 30 people who use opioids were conducted. Key findings that could improve feasibility and acceptability of the intervention include the following: the importance of balancing the urgency of seeing patients quickly with a need to accommodate the experience of precipitated withdrawal symptoms; the need to address privacy concerns; and the need to address concerns related to cost, insurance coverage, and sustainability. Perceived benefits of the intervention included the ability of the peer recovery support specialist to provide advocacy and support, serve as a model of hope and encouragement for behavior change, and fill key service gaps. Postoverdose interventions in the ED provide the opportunity to integrate harm reduction–based interventions into traditional biomedical care facilities. These interventions can fill gaps in services and provide additional care and comfort for people who use opioids, but design, implementation, and evaluation should be informed by a patient-centered care perspective.


Trends in Characteristics of Individuals Who Use Methamphetamine in the United States, 2015-2018
Prevalence of self-reported methamphetamine use has remained relatively stable over the past decade; however, deaths and seizures involving methamphetamine have been increasing. Research is needed to determine if select subgroups in the US are at increased risk for use. We examined data from individuals ages ≥12 from the 2015–2018 National Survey on Drug Use and Health (n = 226,632), an annual nationally representative cross-sectional survey of non-institutionalized individuals in the US. Log-linear trends in past-year methamphetamine use were examined, stratified by demographic and drug use characteristics. Methamphetamine use increased in the US from 2015 to 2018, including among those reporting past-year use of ecstasy/MDMA (6.1 % to 10.8 % [p = .018], a 78.2 % increase), cocaine (8.4 % to 11.8 % [p = .013], a 40.1 % increase), and among those reporting past-year prescription opioid misuse (5.4 % to 8.0 % [p = .019], a 49.2 % increase). Increases were particularly pronounced among those reporting past-year use of heroin (22.5 % to 37.4 % [p = .032], a 66.2 % increase) and LSD (5.1 %–= to 10.3 % [p = .002], a 100.4 % increase). Small increases were also detected among heterosexuals (0.6 % to 0.7 % [p = .044], a 16.2 % increase), those with a high school diploma or less (1.0 % to 1.2 % [p = .020], a 22.0 % increase), and among those receiving government assistance (1.4 % to 1.8 % [p = .046], a 26.2 % increase). Methamphetamine use is increasing among people who use other drugs with sharp increases among people who use heroin or LSD in particular, and this could have serious public health consequences. Results may signal that methamphetamine use may continue to increase in the general population.


Police Officers' Views of Naloxone and Drug Treatment: Does Great Overdose Response Lead to More Negativity?
Police officers and emergency personnel are on the frontlines of the opioid crisis. This research examines police officer attitudes about naloxone administration, drug treatment, and their role in handling drug-related incidents through an online survey. Although officers view themselves as adequately trained in administering naloxone/Narcan, almost half (43%) believe there should be a limit on how often someone who overdoses receives Narcan and the majority (83%) view naloxone/Narcan as providing an excuse to continue drug use. Officers also view drug treatment as ineffective. Negative attitudes differed as a function of frequency of overdose responses; officers who responded to more overdose calls and administered naloxone more frequently demonstrate more pessimistic attitudes toward drug treatment and the use of naloxone/Narcan. Officers more frequently exposed to drug overdoses need education and training about drug addiction issues to decrease stigma and elicit greater empathy toward people struggling with addiction.


Prevalence and Disparities in Opioid Overdose Response Training Among People Who Inject Drugs, San Francisco: Naloxone Training Among Injectors in San Francisco
Expanding naloxone training stands to reduce opioid-related overdose deaths. The current study assessed the prevalence of overdose response training and use of naloxone among people who inject drugs (PWID). Data were from a survey of PWID in San Francisco in 2018, recruited by respondent-driven sampling (RDS). Eligibility criteria were age over 18 years, injected non-prescribed drugs in the last year, San Francisco residence, and referral by another participant. Interviews collected demographic characteristics and injection-related behavior. The sample (N=458) was majority male (67.5%) and over 45.5 years. Over three-fourths (76.0%) injected primarily opioids. Overall, 62.9% received overdose response training and 68.8% owned a naloxone kit. A majority (77.9%) had witnessed an overdose in the past year, of whom 55.8% used naloxone the last time they witnessed an overdose. Receiving overdose response training was significantly lower among persons of non-white race/ethnicity compared to whites (adjusted odds ratio [AOR] 0.43, 95% CI 0.27, 0.69) and higher among those who owned naloxone (AOR 6.29, 95% confidence interval [CI] 3.95, 10.02) and used syringe exchange programs (AOR 3.51, 95% CI 1.41, 8.79). While the majority of PWID have had overdose response training, gaps and disparities persist in promotion of naloxone use.


Polysubstance Use Patterns Among Justice-Involved Individuals Who Use Opioids
The current study explores pre-incarceration polysubstance use patterns among a justice-involved population who use opioids. Design: Setting: Data from prison and jail substance use programing in the state of Kentucky from 2015–2017 was examined. Participants: A cohort of 6,569 individuals who reported both pre-incarceration use of opioids and reported the use of more than one substance per day. Measurements: To determine the different typologies of polysubstance use involving opioids, latent profile analysis of the pre-incarceration thirty-day drug use of eight substances was conducted. Multinomial logistic regression predicted latent profile membership. Findings: Six unique profiles of polysubstance use involving opioids and other substances were found; Primarily Alcohol (9.4%), Primarily Heroin (19.0%), Less Polysubstance Use (34.3%), Tranquilizer Polysubstance Use (16.3%), Primarily Buprenorphine (7.8%), and Stimulant-Opioid (13.2%). Profiles differed by rural/urban geography, injection drug use, physical, and mental health symptoms. Conclusion: Findings indicate the heterogeneity of opioid use among a justice-involved population. More diverse polysubstance patterns may serve as a proxy to identifying individuals with competing physical and mental health needs. Future interventions could be tailored to polysubstance patterns during the period of justice-involvement.


Examining the Neighborhood-level Socioeconomic Characteristics Associated with Fatal Overdose by Type of Drug Involved and Overdose Setting
Fatal drug overdose in the United States is a public health crisis fueled by increased opioid and polysubstance use. Few studies have compared the neighborhood-level socioeconomic characteristics associated with overdoses of various substance classes and, to our knowledge, no investigation has yet assessed these factors in relation to polysubstance overdoses. Further, no study has determined whether socioeconomic conditions predict other contextually relevant aspects of overdoses such as whether they occur at-home or out-of-home. Overdose data (2015–2018) were obtained from the Coroner/Medical Examiner’s Office of Jefferson County, Alabama. The toxicology results of decedents with a known overdose locations (N = 768) were assessed for the presence of synthetic opioids, natural and semi-synthetic opioids, heroin, stimulants, benzodiazepines, and alcohol. Socioeconomic characteristics were obtained from the Unites States Census Bureau at the census tract level. Stimulant overdoses occurred in neighborhoods with the highest rates of disadvantage relative to other substance and polysubstance overdose types. The majority of included overdoses occurred at-home (63.7%) and an index of socioeconomic disadvantage predicted overdose rates for both at-home and out-of-home overdoses. Heroin overdose deaths were more likely to occur at-home while polysubstance stimulant-heroin overdoses were more common out-of-home. An index of socioeconomic disadvantage was generally predictive of overdose, regardless of the setting in which the overdose occurred (in-home vs. out-of-home). The associations between neighborhood-level socioeconomic characteristics and fatal overdose can be tailored by substance type to create targeted interventions. Overdose setting may be an important consideration for future policy efforts, as overdoses were nearly twice as likely to occur at-home.


Developing Interagency Collaboration to Address the Opioid Epidemic: A Scoping Review of Joint Criminal Justice and Healthcare Initiatives
With the current opioid epidemic impacting well over half of all counties across the United States, initiatives that encourage interagency collaboration between first responder organizations appear necessary to comprehensively address this crisis. Police, fire, and emergency medical services (EMS) are in a unique position to identify substance users and provide necessary resources to initiate treatment, yet there is not sufficient evidence of joint collaborative programs between law enforcement/first responders and healthcare providers. In this scoping review we examine the current state of joint criminal justice and healthcare interventions, specifically, opioid and substance use pre-arrest initiatives via emergency first responders and police officers. We relied on data from the last 10 years across three major databases to assess the extent of criminal justice (CJ) and healthcare collaborations as a response to individuals with opioid use disorder (OUD). We specifically focused on interventional programs between criminal justice first responders (pre-arrest) and healthcare providers where specific outcomes were documented. We identified only a small number (6) of studies involving interventions that met this criteria, suggesting very limited study of joint interagency collaboration between law enforcement first responders and healthcare providers. Most had small samples, none were in the southern states, and all but one were initiated within the last 5 years. Although studies describing joint efforts of early intercept criminal justice responses and healthcare interventions were few, existing studies suggest that such programs were effective at improving treatment referral and retention outcomes. Greater resources are needed to encourage criminal justice and healthcare collaboration and policies, making it easier to share data, refer patients, and coordinate care for individuals with OUD.

The articles and studies linked in this newsletter are included for information only. Their inclusion does not imply support or advocacy.