This section of the toolkit was developed using information gathered through interviews and focus groups with community outreach and prevention stakeholders, who represent organizations involved in overdose outreach work such as community naloxone administration, housing support, and harm reduction services.
Below you will find the promising overdose response strategies identified by outreach and prevention stakeholders in Detroit. Each promising strategy is numbered, along with stakeholder identified barriers to accomplishing the proposed strategy and how the System for Opioid Overdose Surveillance (SOS) may assist stakeholders’ ability to accomplish each promising strategy.
Promising Strategy 1: Community Outreach & Organizing
Targeted Public Health Messaging
Increasing community outreach and linking individuals to necessary services and resources is a recurring theme among outreach and prevention organizations. This includes linking individuals to available resources they may not be aware of or know how to access. A stakeholder who currently oversees an agency that performs outreach, prevention, and treatment services states, “We may be able to go out. Even if we can’t set up an educational or syringe access site or anything like that, we may be able to do a little more outreach in terms of going out and if we wanted to put out a pamphlet for the trainings here or if we wanted to go out to block clubs or businesses and say, hey, we’d like to do some education with your folks or tell your folks about what we’re doing here.”
This highlights the need among these stakeholders for increased outreach and education within the community.
Stakeholders note that they could directly impact the community by engaging nontraditional entities and the individuals using substances. Equipping stores, barbershops, and other common places community members visit with overdose education increases the chances of this information reaching the substance use community.
“Your friends are gonna be some strange friends. It’ll be the community member, it’ll be the store if there’s a store around. It’ll even be the dope dealer because even though we’re trying to get people in treatment, their views are we’re keeping their consumers engaged.”
Community Outreach & Prevention Stakeholder
Barriers to Community Outreach & Organizing
Within the city of Detroit, it can often be a challenge for outreach and prevention organizations to implement community outreach and organization efforts. Systems and legislations such as the Detroit Drug Paraphernalia Ordinance classifies objects such as needles and syringes as contraband. If an individual is found in possession of one of these objects they can be arrested and jailed.14 Some organizations, especially those specializing in delivering harm reduction, have been granted an exemption from this ordinance. However, leaders of these organizations often find themselves advocating for clients that have been arrested for possessing clean syringes provided by their programs.
Near Real-Time Data Impact
Stakeholders plan to use the overdose reports when speaking to city officials and other policy makers to highlight the need for syringe exchange programs and other harm reduction efforts. When looking at stigma, just as it has been discussed in previous stakeholder sections, the overdose reports provide data that gives stakeholders a visual representation of how the epidemic impacts their community. Additionally, as we discussed with MOUD efforts, the ability to show policy makers and other stakeholders potential decreases in overdose stemming from harm reduction efforts in an area could help to decrease stigma towards those efforts.
Many of the outreach and prevention organizations also use the suspected opioid overdose data to plan outreach strategies they can only be deployed with near real-time data. For example, the data allows stakeholders to deploy the Detroit based opioid mobile units to these areas to work directly with individuals who are directly impacted by overdoses and provide resources (naloxone kits) and education.
A stakeholder elaborates with, “If you’re doing outreach…like, our organization has people that could canvas that area with prevention, with messaging, with awareness, with offering services.” This shows how access to near real-time data provides organizations with the necessary information to perform more timely and geographically targeted outreach.
“What I tell people is that the real first responder is the person that’s doing the dope because one person can administer to…4 or 5 people in a room and they’ve done that, so they’re…the first responders has to be different and they’re less likely to give us naloxone than to law…we’ve trained law enforcement before, but they view us a little different because we’re a syringe exchange program. It’s kinda crazy.”
Community Outreach & Prevention Stakeholder
Promising Strategy 2: Resource Identification
Stakeholders highlight the need to create networks of care for individuals within the community to increase capacity. While discussing overdose numbers, a stakeholder states, “As those numbers start to go down, it… helps us increase our capacity because people who are interested in the work that we do and fund and sustain our work would say, alright, obviously you’re doing something right, let’s move on to another locale.” This quote speaks to the spirit of collaboration among outreach stakeholders in Detroit, explaining that organizations can work together to form coalitions that could service these areas. This is particularly important in areas where services and resources are scarce despite high overdose incidence.
Barriers to Resource Identification
Organizations taking a more “boots on the ground” approach to opioid overdose response and prevention discuss how historical data is often misleading. One stakeholder describes the process and challenge to working with and employing efforts using previous data sources, “By the time we get the boots on the ground, it’d be nice to know that the area that we’re gonna target, it’s trending up and we can stop it or by the time we get the boots on the ground, it’s trending down and we’ve just pulled our crew together to kinda canvas that area, but the good heroin that was over there that everybody’s OD’ing is not there anymore.” Without timely data, it is difficult for stakeholders to definitively know where high overdose incidence areas are located in Detroit.
Near Real-Time Data Impact
A barrier due to the use of outdated data is directly mitigated by near real-time opioid overdose data reports, which provide stakeholders direct and timely access to EMS and ME data. The reports include geographic maps as well as incident city and zip code information so that stakeholders can refine their efforts to specific geographic locations.
Promising Strategy 3: Alternatives to Opioids for Pain Management
There are a number of evidence-based pain management treatments that can be effectively used to treat and manage acute pain. Expanding education and awareness of non-opioid alternatives for acute pain management by targeting practitioners and consumers, is especially important in high risk areas. This includes, but is not limited to non- opioid pharmacological options that utilize a multimodal approach to acute pain management especially for individuals facing surgery. Acute postsurgical pain is a predictive factor for the development of chronic pain. Optimal pain relief following surgery may reduce the risk of transition to chronic pain that could lead to opioid addiction. The demonstrated benefits of multimodal therapy include but are not limited to: reduced doses of painkillers in the treatment plan; better pain relief than with a single painkiller; less pain during rest and activity; improved function; reduced length of stay and improved patient satisfaction.
In a multimodal approach, non-opioids (nonsteroidal anti-inflammatory drugs, local anesthetics, alpha-2-agonists, gabapentinoids, and acetaminophens) are the first painkillers used at or around the time of an operation for the management of pain. Opioids are added for moderate to severe pain.15-19 Other non-pharmacological options that complement traditional painkillers for addressing acute pain management include, along with patient education, ice, elevation, compression, aroma therapy, deep breathing, heating pads, and cognitive behavioral modalities. Acupuncture, chiropractic services, and physical therapy are other viable alternatives.
Barriers to Alternatives to Opioids for Pain Management
Lack of education, information, and accessibility create barriers to alternative pain management options for consumers. Legislation and accessibility create barriers for practitioners, sometimes prohibiting immediate access and wide spread utilization. Medicare is the largest insurance provider in the United States and they have policy limits on accessing non-opioid treatment options. Most commercial provider/payers usually follow Medicare’s lead on medical coverage. Since 2015, physician-administered pain management drugs and devices are not eligible for separate reimbursement to treat post-surgical pain.20 However, Detroit Wayne Integrated Health Network supports and pays for various alternatives including acupuncture.
Near Real-Time Data Impact
Near real-time data allows organizations to target communities and practitioners who serve communities in high risk areas with education on alternatives to opioids for acute pain management, utilizing primary prevention strategies to “go up stream.” Mobile units are deployed to targeted areas along with a coordinated focus on providing both consumers and practitioners with information, education and availability of alternatives to non-opioid choices.