Welcome to new ORS team member, Rebecca Taylor!
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Rebecca joined the New England HIDTA as Maine’s Public Health Analyst in early September, bringing a background in clinical medicine, academic research, and health data analytics. She holds a BS in Economics and a BA in Communications from Purdue University in West Lafayette, Indiana. Rebecca attended medical school at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania, where she also trained in public health, biostatistics, and research methodology. After completing a research fellowship with the National Institutes of Health and serving as a clinical researcher on several large-scale academic medical studies, Rebecca and her family decided to move from Pittsburgh to Maine five years ago. Prior to joining New England HIDTA, Rebecca served as Director of Health Data Analytics at a startup company based in Portland, Maine. Rebecca lives in beautiful Yarmouth, Maine with her husband, Seth (an Emergency Medicine physician), and three children: Annabel, 14; Eliza, 7; and Sebastian, 3.
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Upcoming ORS Cornerstone Project Dates and Deadlines
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Thank you to all PHAs and DIOs who participated in the Cornerstone check-in calls this week. As a reminder, here are a few upcoming deadlines for the 2019 ORS Cornerstone Project.
October 9th at 10:00 AM:
Webinar on Qualitative Interviewing
October 10th:
Finish mapping activity and submit jail tracker
October 15th:
Disseminate survey link
October 24th:
Second check-in call
If you have any questions about the ORS Cornerstone Project timeline or data collection components, please reach out to Nancy Worthington (
ous8@cdc.gov
) or Sasha Mital (
ggu4@cdc.gov
).
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ORS Pilot Project Request for Applications is Open
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With support from the Centers for Disease Control and Prevention (CDC), National Association of County and City Health Officials (NACCHO) is pleased to offer a funding opportunity for the planning and implementation of pilot projects in Overdose Response Strategy (ORS) states. Through this funding opportunity, NACCHO and CDC will award up to 7 states (up to 5 new, and up to 2 continuing proposals), which will be awarded as planning or implementation projects. One of the following funding awards will be available for ORS sites in different stages of their response to the opioid overdose epidemic.
Eligibility Criteria:
- Applicants must be an ORS state with a PHA in place by November 12, 2019.
- Applications must be state-based, not HIDTA-based. If a HIDTA would like to submit applications for two or more states, they must submit an independent application for each state. For example, if NEHIDTA wishes to propose 2 states from New England, the ORS State Teams in each of those states would submit a separate application.
- All applications must target their pilot project to counties/cities/communities. Collaboration with a local public health partner is required (i.e. hospital or health systems, harm reduction organization, public health department, and/or other key authorities involved in their work).
Several resources are available to assist sites with the application process, including work plan templates, budget one-pagers. Application requirements and full details of the project are available in the RFA below. Questions about the RFA and application process can be directed to NACCHO’s Overdose Prevention Team, at
opioidepidemic@naccho.org
.
Applications are due on September 25th, 2019.
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Combating Opioid Overdose through Community-level Intervention Initiative (COOCLI) Subaward Application is Open
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On September 16, 2019, through a competitive process, the Office of National Drug Control Policy awarded the University of Baltimore (UB) a grant to fund the Combating Opioid Overdose through Community-level Intervention Initiative (COOCLI).
Through the COOCLI, the UB will solicit subaward applications for the
purpose of:
- Undertaking research activities that entail implementing and evaluating community-based efforts to fight the opioid-involved overdose epidemic; and
- Supporting and promoting the partnership of law enforcement and public health agencies, whose collaboration is critical to reducing overdose and other harms of opioid-involved (mis)use.
The UB will convene the COOCLI Board in mid-November. The Board will assess proposals and recommend funding levels to the UB. Based on Board recommendations, the UB will issue subawards to successful applicants in December 2019. Funding is for 12 months and awards will likely range between $50,000 and $500,000.
The NOFA details the application process and sets forth the requirements for proposals. A
ll applications must include a letter of support/commitment signed by a sponsoring HIDTA Director to receive consideration for funding.
HIDTA Directors are encouraged to weigh the merits of each proposal and only sponsor those they deem to be of value. HIDTA Directors can support more than one proposal.
Applications are due on November 1st, 2019.
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Western States Opioid Summit, November 7th-8th
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The San Diego HIDTA is hosting the 2019 Annual Western State Opioid Summit in collaboration with the U.S. Department of Justice, the Drug Enforcement Agency and the San Diego County Rx Drug Abuse Task Force.
Topics will include
- Effective Dark Web Investigations & Overdose Prosecutions;
- Bringing MAT to the Criminal Justice System;
- Groundbreaking Steps to Combat the Opioid Crisis,
- Breaking the Stigma Barrier;
- Changing the Culture through Lived Experiences; and
- Creating & Delivering Opioid-Related Messages that Work
This event will be held at the San Diego Westin. Hotel reservations must be booked by October 7th in order to qualify for the summit rate.
If you would like more information about the agenda, please reach out to Paul O'Rourke at
pjorourke@nhac.org
.
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SAMHSA Manual: Data Collection Across the Sequential Intercept Model
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In September the Substance Abuse and Mental Health Services Administration (SAMHSA) published a manual for tracking and understanding data cross the intercepts in the Sequential Intercept Model (SIM). The SIM is used to identify resources for people with mental and substance use disorders at each phase of interaction with the justice system, beginning with Intercept 0 (crisis response) and ending with Intercept 5 (community corrections). Each section lists data points and measures that are essential to addressing how people with mental and substance use disorders flow through that intercept. The sections also cover common challenges with data collection and ways to overcome them, along with practical examples of how information is being used in the field.
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Overdose and Drugs in the News
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Purdue Pharma Tentatively Settles Thousands of Opioid Cases
Purdue Pharma, the creator and distributor of OxyContin, have reached a settlement with thousands of municipal governments and nearly two dozen states for its role in the opioid epidemic In this deal, Purdue will pay $3 billion over seven years but is not required to admit any wrongdoing. However, most states will not participate in this settlement and have chosen to sue Purdue Pharma separately.
Courtroom showdowns still face OxyContin maker Purdue Pharma and the family that owns it, the Sacklers. But after a tentative settlement reached Wednesday with thousands of local governments and more than 20 states, the fight will be less about the damage done by the company and more over how to divide its assets.
Purdue Pharma made, then ditched, plans for opioid-treatment nonprofit
OxyContin maker Purdue Pharma LP nixed plans earlier this year to launch a foundation to fund opioid-addiction treatment and research as the company rethought its strategy amid hundreds of lawsuits and a possible bankruptcy filing. Purdue's board of directors approved the project in early 2019, but the company tabled it by March.
China says has only 'limited' cooperation with U.S. on fentanyl
The United States and Chinese governments continue to disagree on the integrity of Chinese efforts to prevent the production and transportation of fentanyl into the United States. The Chinese government argues that it is not the main source of fentanyl in the United States and places responsibility on the United States to reduce demand.
130 Americans die each day from opioid overdoses. Experts are asking why a lifesaving treatment isn't widely available without a prescription
Why isn't the opioid overdose antidote naloxone, which is a prescription medication, as widely available as over-the-counter products like Advil and Plan B? The FDA, which regulates medications and other products, has been working to encourage companies to make an over-the-counter naloxone product because it is an important public health advancement.
As drugmakers face opioid lawsuits, some ask: Why not criminal charges too?
Purdue Pharma, facing a mountain of litigation linked to the opioid epidemic, filed for bankruptcy in New York. The OxyContin manufacturer and its owners, the Sackler family, have offered to pay billions of dollars to cities and counties hit hard by the addiction crisis. But that's not good enough for critics such as U.S. Rep. Max Rose.
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Don't forget our frontline caregivers in the opioid epidemic
America's opioid epidemic will go down in history alongside the Spanish flu, typhoid, polio and AIDS as one of our worst public health disasters. The impact on our health care system and our hospitals has been staggering. Since 2001, it is estimated that the opioid epidemic has imposed more than $216 billion in health costs, with more to come, as people continue to live with addiction and the lingering health effects of opioid abuse. This has directly affected our nation's hospitals, which provide billions of dollars of unreimbursed care.
Inside the drug industry's plan to defeat the DEA
Newly unsealed documents in a landmark civil case in Cleveland provide clues to one of the most enduring mysteries of the opioid epidemic: How were drug companies able to weaken the federal government's most powerful enforcement weapon at the height of the crisis?
The DEA shares blame for the opioid crisis
The Drug Enforcement Agency's role in the opioid crisis makes clear that law enforcement shouldn't be regulating medicine. The Drug Enforcement Administration (DEA) has one job: to keep controlled substances out of the hands of people who might misuse them. Admittedly, it's an impossible job, given that the choice of which drugs are prohibited wasn't made rationally and they're left to enforce laws that are routinely flouted by nearly half of the adult population.
What an opioid settlement would mean for treatment
NPR's Lulu Garcia-Navarro with Laura Jones, who runs a free clinic in West Virginia, about what a settlement with Purdue Pharma and the Sackler family would mean for programs like hers.
How to teach future doctors about pain in the midst of the opioid crisis
The next generation of doctors will start their careers at a time when physicians are feeling pressure to limit prescriptions for opioid painkillers. Yet every day, they'll face patients who are hurting from injuries, surgical procedures or disease.
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Recently Published Research
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Changes in Opioid-Involved Overdose Deaths by Opioid Type and Presence of Benzodiazepines, Cocaine, and Methamphetamine — 25 States, July–December 2017 to January–June 2018
From July–December 2017 to January–June 2018 in 25 states, opioid deaths decreased 5% overall and decreased for prescription opioids and illicit synthetic opioids excluding illicitly manufactured fentanyl (IMF). However, IMF deaths increased 11%. Benzodiazepines, cocaine, or methamphetamine were present in 63% of opioid deaths. Continued increases in IMF deaths highlight the need to broaden outreach to persons at high risk for IMF overdoses and improve linkage to risk-reduction services and evidence-based treatment. Prevention and treatment efforts should attend to broad polysubstance use/misuse.
Increases in Methamphetamine Use among Heroin Treatment Admissions in the United States, 2008‐2017
Due to their small sample sizes, geographic specificity, and limited examination of sociodemographic characteristics, recent studies of methamphetamine use among people using heroin in the U.S. are limited in their ability to identify national and regional trends and to characterize populations at risk for using heroin and methamphetamine. This study aimed to examine trends and correlates of methamphetamine use among heroin treatment admissions in the U.S. Longitudinal analysis of data from the 2008 through 2017 Treatment Episode Data Set. Descriptive statistics, trend analyses, and multivariable logistic regression were used to examine characteristics associated with methamphetamine use among heroin treatment admissions. Primary measurement was heroin treatment admissions involving methamphetamine. Secondary measurements were demographics of sex, age, race/ethnicity, U.S. census region, living arrangement, and employment status. The percentage of primary heroin treatment admissions reporting methamphetamine use increased each year from 2.1% in 2008 to 12.4% in 2017, a relative percentage increase of 490% and an annual percent change (APC) of 23.4% (p<0.001). During the study period, increases were seen among males and females, and across all demographic and geographic groups examined. Among primary heroin treatment admissions reporting methamphetamine use in 2017, 47.1% reported injecting, 46.0% reported smoking, 5.1% reporting snorting, and 1.8% reported oral/other as their usual route of methamphetamine use. Methamphetamine use among heroin treatment admissions in the United States increased from 1 in 50 primary heroin treatment admissions in 2008 to 1 in 12 admissions in 2017.
Touchpoints – opportunities to predict and prevent opioid overdose: a cohort study
Medical care, public health, and criminal justice systems encounters could serve as touchpoints to identify and intervene with individuals at high-risk of opioid overdose death. The relative risk of opioid overdose death and proportion of deaths that could be averted at such touchpoints are unknown. The authors of this study used 8 individually linked data sets from Massachusetts government agencies to perform a retrospective cohort study of Massachusetts residents ages 11 and older. For each month in 2014, they identified past 12-month exposure to 4 opioid prescription touchpoints (high dosage, benzodiazepine co-prescribing, multiple prescribers, or multiple pharmacies) and 4 critical encounter touchpoints (opioid detoxification, nonfatal opioid overdose, injection-related infection, and release from incarceration). The cohort consisted of 6,717,390 person-years of follow-up with 1,315 opioid overdose deaths. The authors identified past 12-month exposure to any touchpoint in 2.7% of person-months and for 51.8% of opioid overdose deaths. Opioid overdose Standardized Mortality Ratios were 12.6 (95% CI: 11.1, 14.1) for opioid prescription and 68.4 (95% CI: 62.4, 74.5) for critical encounter touchpoints. Fatal opioid overdose Population Attributable Fractions were 0.19 (95% CI: 0.17, 0.21) for opioid prescription and 0.37 (95% CI: 0.34, 0.39) for critical encounter touchpoints. These touchpoints are potential targets for development of overdose prevention interventions.
Preference for drugs containing fentanyl from a cross-sectional survey of people who use illicit opioids in three United States cities
Death from fentanyl-related overdose is now a leading cause of mortality among US adults. We sought to characterize fentanyl preference among street-based people who use drugs (PWUD). Cross-sectional surveys were administered to PWUD (N = 308) who illicitly used heroin or prescription opioids in the prior six months in Baltimore, Boston, and Providence. Preference for nonmedical use of fentanyl was reported by 27% (n = 83) of the sample. Fentanyl preference was associated with non-Hispanic white race (adjusted risk ratio (ARR) = 1.68, 95% confidence interval (CI):1.18–2.40), daily illicit drug use (aRR = 2.2, CI:1.71–2.87), and overdose ≥1 year ago (aRR = 1.33, CI:1.18–1.50). Age (in decades; aRR = 0.77, CI:0.61–0.98) and overdose <1 year ago (aRR = 0.92, CI:0.87–0.97) were associated with a decreased likelihood of preference. In our model excluding sociodemographics, initiating opioid use with non-prescribed opioids was associated with fentanyl preference (aRR = 1.48, CI:1.26-1.73). In three cities with high levels of opioid use and overdose, a quarter of street based PWUD reported preferring fentanyl. An opioid use age cohort effect and disproportionate access to prescription opioids by race could be contributing to preference. Frequency of opioid use, not route of administration, was associated with preference.
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The articles and studies linked in this newsletter are included for information only. Their inclusion does not imply support or advocacy.
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