Rural grant program combats opioid overdose epidemic

Rural grant program combats opioid overdose epidemic
Rural grant program combats opioid overdose epidemic

Students, police officers and community members of Princeton, W.Va., release balloons in remembrance of overdose victims at an Overdose Awareness Day event in August 2016. Credit: Erica Ellis Bartling of Community Connections, Inc.

While the opioid epidemic exists throughout the country, with 33,091 fatal opioid overdoses nationwide in 2015 alone, according to the Centers for Disease Control and Prevention (CDC), a recent CDC study found that the rate of opioid overdose death was 45 percent higher in rural areas compared with urban areas.*

According to a 2016 study by the Maine Rural Health Research Center, rural opioid users are more likely than urban opioid users to be age 19 or younger, low-income, unmarried, uninsured, and have less than a high school education.** These sociodemographic vulnerabilities may limit people’s ability to seek treatment and recover. Additional barriers like isolation and a lack of public transportation and treatment providers make accessing treatment for opioid-use disorder especially difficult.

Emergency medical service (EMS) response times are also much longer in rural counties, especially in isolated places where the first person to arrive may be a police officer, who may have little to no training on how to respond to an overdose. A recent CDC Morbidity and Mortality Weekly Report cited delayed access to treatment for trauma and drug poisoning as a factor explaining the wide gap in rural-urban death rates for unintentional injuries.***

Rural Opioid Overdose Reversal Program

In FY 2015, the Federal Office of Rural Health Policy, located within the Health Resources and Services Administration, developed the Rural Opioid Overdose Reversal (ROOR) program. This program awarded funds to 18 rural community partnerships across the country. Comprised of local emergency responders and other local nonprofit and for-profit entities involved in the prevention and treatment of opioid overdoses, these partnerships utilized federal funding to train and distribute emergency naloxone devices to law enforcement, health care providers and other community members.

Naloxone quickly reverses the effects of opioid overdose and can be administered by injection or nasal spray to individuals who are not breathing, unresponsive, and assumed to have overdosed on prescription opioids or heroin. While naloxone has traditionally been administered by paramedics and licensed health care providers, an increasing number of jurisdictions are loosening naloxone restrictions to allow law enforcement, as well as friends and family of individuals with opioid-use disorder, to administer the drug in emergency situations. 

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Erica Wegrzyn, a pharmacy resident at MaineGeneral Medical Center in Augusta, Maine, talks about the pilot naloxone program in June 2016. Credit: Joe Phelan of the Kennebec Journal

As a result of participating in the ROOR program, Sheriff Paul Sigsworth of Erie County, Ohio, notes that “deputies have been able to immediately administer [naloxone] to preserve the individual’s life until the arrival of paramedics.” Sigsworth’s office was part of a sevenorganization partnership that received funding under the ROOR program and reported training 456 people to administer naloxone.

According to preliminary program data, between September 2015 and December 2016, ROOR grantees reported purchasing over 9,500 doses of naloxone; training over 4,500 individuals, including nearly 3,000 law enforcement officials, to recognize signs and symptoms of opioid overdose and administer naloxone; and reversing 378 overdoses. As Bradley Burck of Pleasant Valley Hospital in Point Pleasant, W.Va., states, the success of the ROOR program was not limited to the community’s ability to increase the use of naloxone: “Money for [naloxone] is important, but bringing people together is the first step in addressing the [opioid] epidemic.”

Partnerships important to success

Erica Ellis-Bartling, Program Coordinator at Community Connections, Inc. in nearby Princeton, W.Va., agrees, observing that success began when “partnerships began to form and everyone [got] on board, [which] put pressure on others to get on board too.” Princeton’s Project Renew involved a variety of participating organizations such as substance abuse prevention coalitions and emergency first responders, including three divisions of the West Virginia State Police, as well as local recovery groups, county health departments and educational institutions like Bluefield State College. Together, these partners reported that they were able to train 358 law enforcement officers in three rural counties during 25 training sessions that were conducted both in person and online.

Several ROOR grant recipients note that once law enforcement became willing participants, partners such as health care providers, social service counselors, school systems and other community members were more inclined to join hands and do their part in response to the opioid epidemic.

Naloxone, however, is only one piece of the puzzle. As Timothy Pieh, MD, Medical Director of Emergency Medicine, Maine General Medical Center, explains, “[Naloxone is] a bridge to protect them from death, and what we need to do is continue to support other efforts.”

One of these efforts is expanding access to treatment in rural areas, where there exists a shortage of substance abuse treatment providers. According to researchers at the WWAMI Rural Health Research Center, of the U.S. counties that had no physicians who could prescribe buprenorphine, a Food and Drug Administration-approved medication often used in the treatment of opioid-use disorder, 82.1 percent were in rural areas.† Many ROOR grant recipients are hopeful that expanded federal regulations under Section 303 of the Comprehensive Addiction and Recovery Act will increase the availability of treatment within rural primary care practices by allowing physician assistants and nurse practitioners to apply for a waiver to prescribe buprenorphine.

As communities continue to work together to combat the opioid epidemic, sharing and pursuing creative and innovative solutions to overcoming the unique obstacles and barriers facing rural areas is important. As Kenneth Miller of Down East AIDS Network in Ellsworth, Me., states, “We can do a lot of good by thinking out of the box.”

Michael Blodgett is a Public Health Analyst with HRSA’s Federal Office of Rural Health Policy.

* Source: Centers for Disease Control and Prevention, https://www.cdc.gov/media/ releases/2015/p0424-naloxone.html

** Source: Maine Rural Health Research Center, http://muskie.usm.maine.edu/ Publications/rural/Rural-Opioid-Abuse.pdf.

*** Source: Centers for Disease Control and Prevention, Morbity and Mortality Weekly Report, https://www.cdc.gov/ mmwr/volumes/66/ss/ss6602a1.htm?s_ cid=ss6602a1_w.

† Source: Annals of Family Medicine, https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4291261/pdf/0130023.pdf.

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