This section of the toolkit was developed using information gathered through interviews and focus groups with public health stakeholders, who represent those working to impact health at the community level and work at the local health department.
Below you will find the promising overdose response strategies identified by public health 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: Allocation of Resources
When resources and capacity are limited, accurate and timely allocation of resources becomes imperative to maximize response efficiency and effectiveness. This applies to both secondary prevention among those who have had overdoses and primary prevention of new overdoses. For example, public health officials propose increasing post-overdose care staff in emergency departments (EDs) around the city of Detroit during times of increased overdose cases. More specifically, they mention staffing of peer recovery coaches who work with patients at a critical point of intervention in order to link them to services and resources.
Another strategy proposed by public health officials to better guide service and resource allocation is to implement a text hotline where individuals can submit alerts of an overdose to a number monitored by public health officials and first responders. Due to conflicting attitudes towards law enforcement and fear of punitive action, individuals would be able to anonymously alert first responders and public health officials of an overdose.
Barriers to Allocating Resources
Historically, the health department has worked with outdated data, which poses a barrier to implementing relevant and effective response and prevention strategies, including allocation of resources. A stakeholder elaborates on the challenge with, “…Sometimes we get the data by the … we get it, but it’s really old data and then we implement our projects and how we’re gonna … overcome this issue or address it based on that data, but it’s not real-time.”
According to our stakeholder, working with older data poses a barrier to implementing up-to-date and effective response strategies.
Delays in near real-time data can also negatively impact how funding is allocated, making it more difficult to have the resources needed to implement overdose response and prevention strategies. A public health stakeholder states, “We know that those [overdose] numbers have probably increased and sometimes it affects funding because I think when funders see data that is not you know, real-time data, they kinda go off of what you show them and we know currently that that number could probably be higher like, the number I’m doing with overdoses. So, that’s a-a big issue.” This highlights how using outdated data may not accurately convey how an issue is impacting the community.
“An app where they can report nonfatal overdoses so that community groups or the health department would know that took place. [Stakeholder name] has talked about a text number before with reporting that we could promote in a way that at least lets us know where the activity is taking place so we can saturate it with resources, but then they don’t also have to identify themselves if they’re not ready to engage with a larger health system.”
Public Health Stakeholder
Near Real-Time Data Impact
Public health stakeholders note the SOS reports are useful in assessing the severity of the opioid epidemic in the city of Detroit, informing what efforts and strategies should be used to combat the epidemic. They discuss the importance of having access to near real-time suspected opioid overdose data to target specific areas where enhanced resource and service allocation is needed. The data can be used to target areas with high incidence of suspected opioid overdoses with education, resources, and services.
In addition to the near real-time data available through SOS, community stakeholders at the local health department look at retrospective SOS data to analyze overdose trends by day of the week and time of day. The local health department is actively using these data to inform staffing of peer recovery coaches in the EDs. SOS facilitates collaboration among public health officials and emergency room departments in pinpointing days and times where post-overdose resources are most needed.
Near real-time data reports can also be used to evaluate changes in overdose trends following the saturation of community overdose interventions in specific geographic localities to see if changes in resource allocation were effective.
“So one, we could better strategize on how…where to go and two, do the trainings or provide resources or any types of services that we wanna implement to address this issue. So having real-time data really would help inform the work.”
Public Health Stakeholder
Promising Strategy 2: Policy Briefings to Community Members
Public health stakeholders in the city of Detroit educate other stakeholders on relevant policies and legislation related to the opioid epidemic and promote compliance with these policies. Individuals working at the local health department encourage local pharmacies to comply with the Naloxone Standing Order. Visiting pharmacies in high need areas to see if providers are aware of and registered under the Naloxone Standing Order would help identify priority pharmacist education and registration areas. Those already registered but not participating under the order would be educated on the importance of maintaining a stock of naloxone. If the pharmacy is registered under the naloxone standing order, public health stakeholders would inquire about their stock of naloxone and encourage them to keep naloxone on hand if they were under or out-of-stock.
Barriers to Sharing Policy Briefings with the Community
Lack of resources is an ever-present challenge for public health stakeholders. One stakeholder states, “I think it’s usually resources and that’s…been the main issue with a lot of our [community] stakeholders and I mean, concerns even that we got within the work that we’ve been doing is the lack of resources.” These resources include funding as well as human capacity to conduct policy briefings in the community, such as visiting all local pharmacies to educate on the Naloxone Standing Order.
Near Real-Time Data Impact
The SOS reports display visual locations and frequency tables of incidents per zip code, which easily allows stakeholders to view where the most overdoses are occurring. This feature is useful in targeting certain geographic areas to enhance awareness and compliance around the Naloxone Standing Order. This aids in finding local pharmacies in the closest proximity to some of the city’s high incidence areas. The feature allows the health department to strategically plan these education efforts. Finally, not only is the health department able to use the near real-time overdose reports to locate areas of high suspected overdose incidences, they can also easily share the SOS reports with pharmacists to increase collaborative efforts and demonstrate the need for the Naloxone Standing Order in their local area.