As the opioid epidemic has become a growing public health crisis in New York and the greater United States, it is incumbent upon health care centers to expand our ability to treat those in need. As of one the largest Federally Qualified Health Centers (FQHC) in New York State, providing integrated primary and behavioral healthcare to more than 100,000 patients each year, regardless of insurance status, the Institute for Family Health has responded to the epidemic in a number of ways. In addition to providing medication assisted treatment with buprenorphine, The Institute is a New York State Opioid Overdose Prevention Program (OOPP), supporting the provision of overdose responder trainings and dispensing naloxone kits to patients and their loved ones, as well as members of our greater communities. This article aims to describe successes and challenges of The Institute for Family Health’s efforts to integrate naloxone distribution into care and encourage other organizations to develop similar programs.
In New York state, many health, substance abuse, governmental, and educational programs, as well as pharmacies, are eligible to become an OOPP. Programs are provided with free naloxone and supplies to distribute within their communities. Through Substance Abuse and Mental Health Services Administration grant funding, The Institute has been able to provide training and technical assistance with organizations interested in becoming their own Opioid Overdose Prevention Programs (OOPP).
Our Program Director noted during an interview, “What stands out most to me about our ability to dispense naloxone is our sheer reach. We have the opportunity to make a great impact. Not only do we see a lot of patients, many of our clinics are serving communities with the highest rates of overdose deaths in NYC and New York State.” The overarching goal of the naloxone distribution program is to reduce the rates of fatal overdose by opioids among patients and in our communities.
The Institute has been distributing naloxone as an OOPP for three years throughout our community Health Centers and within their surrounding communities in New York City and the Mid-Hudson valley. Our Program Director highlights, “Over the past 3 years, interest in training and obtaining kits has increased a lot among staff and patients. We have heard many stories of personal experiences, staff and patients being impacted by overdose through loss of family, friends or a patient, and through the news.”
When developing our OOPP, the Institute team faced some challenges which we have also been able to overcome. Challenges range from programmatic workflows to identifying and addressing attitudes and perceptions of how overdose prevention fits into care. The first step to establishing a workflow is an organizational wide policy. This policy displays our commitment to overdose prevention and details steps to distributing naloxone. While policy is organizational wide, at the program level, workflows can have some nuances. Over time, we have learned that having a champion at each site has been helpful. Programmatic staff collaborate with champions to ensure adequate supplies, organizing staff trainings, and addressing any challenges that are identified.
Workflows can be a concrete challenge but, understanding attitudes and beliefs around overdose prevention can be a more subtle barrier to successful integration. Our Program Director elucidates, “When we approach distribution as something only for those most at risk of overdose, the tendency is to not give many kits away. Our goal is to move towards offering kits as part of the standard of care. Integrating distribution of kits into patient care allows us the opportunity to provide education and address misconceptions about why someone would want to have a kit and broaden the understanding of who may be at risk of overdose.” Participating in department and clinic staff meetings has been a helpful forum to provide training to staff as well as supporting open dialogue around questions and concerns related to overdose prevention. In total, 347 Institute for Family Health staff have become trained overdose responders.
Since July 2018, nine individuals have reported successfully responding to an overdose with an Institute dispensed kit, five in New York City and four in the Mid-Hudson Valley. As eight of the overdose responders have been Institute staff either within a health center or the community, there is potential that many more of the kits distributed have been used. While the importance of communicating back when a kit has been used is emphasized during training, although it is likely that does not always happen. These overdose reversals have taken place both at our clinics within the community. Each report of an overdose reversal should be celebrated—it is a profound act to intervene and also provides learning opportunities on how we can improve and increase naloxone distribution. In an effort to ensure access to naloxone kits to those most in need, Institute staff have conducted overdose responder trainings for medical students who provide services at the Institute’s free clinics. These clinics capture a particularly important group, as many of the patients are not eligible for insurance and would not be able to receive naloxone for free at a pharmacy.
Additional efforts we have seen effective in increasing kit distribution include tabling events in waiting rooms of our health centers, signage around sites, introducing best practice alerts in electronic health records, and participation in community events such as International Overdose Awareness Day.
If you would like to establish an OOPP at your organization, please visit https://www.nyoverdose.org/ for more information. Author Contacts: Thomas McCarry (firstname.lastname@example.org) and Marva Greer (email@example.com) to learn more.