This section of the toolkit was developed using information gathered through interviews and focus groups with treatment provider stakeholders, who represent individuals working in the realm of in- and out-patient substance use disorder treatment facilities.
Below you will find the promising overdose response strategies identified by treatment providers 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: Increased Collaboration
Treatment providers emphasize the need for increased collaboration between different providers and the merging of treatment efforts. A treatment provider explains, “I’m seeing [zip code] and I’m like I know what I wanna do or it’s some distance, the familiarity is not as great as the provider that’s there, but maybe I should be on the phone with that provider saying, hey…you represent [zip code 1]. I represent [zip code 2]. You represent [zip code 3]. The three of us, if the prevalence is my area, then I need you to come over. If the prevalence is in your area, then we need to concentrate there because the impact needs to be made where…I mean, the difference needs to be made where the impact is, so if we just…if we were just policing our own areas and our own area is good, then we’re like we don’t have to do anything, but that’s not what we want as a team.” This illustrates the need to plan and execute collaborative efforts and combine resources to mitigate the epidemic.
Barriers to Increased Collaboration
A stakeholder involved in treatment states that interest in participation and funding are the main barriers to increasing collaboration and developing a community level response. This shows how competing interests and availability of funding can impede collaboration. In metropolitan areas, there are often many competing priorities that need to be addressed. With limited human capacity and funding, individuals and organizations often have to devote time and resources to other issues.
Near Real-Time Data Impact
With the overdose reports providing stakeholders with a day-by-day breakdown of fatal and non-fatal suspected overdoses, stakeholders can provide funders with more timely and granular data in an effort to receive more funding in highly impacted areas. As one stakeholder notes, “Well, here’s my thinking, that real-time data would help in terms of us being able to say to our funding sources you know, here’s what’s going on in our facility or in our zip code, we need more funding in this area.” This quote highlights how near real-time data can be used to emphasize the need for additional funding, which can be used to expand service capacity and create new collaborative responses with other community organizations to better address high incidences of overdoses in their areas.
Promising Strategy 2: Targeted Response and Prevention
Community stakeholders providing treatment through their organizations discuss that while most of them see patients after they have overdosed, knowing where overdoses are occurring generally would be critical to their efforts. One treatment provider said, “Actually, you know what? This is really good for my harm reduction truck. What areas we can concentrate.” This demonstrates how broader information of overdose trends in the community would provide stakeholders with knowledge of where to concentrate efforts and responses.
A related strategy that treatment stakeholders propose is distributing naloxone through a concept known as a pop-up shop. Pop-up shops are typically mobile stores that sell items in busy metropolitan areas. The stakeholder elaborates on this strategy by explaining that since many stakeholders see this issue as a moving target and it is common practice for people who administer drugs to move around, a response strategy that can move along with this target and suppliers is a necessity for the community. She goes on to say, “I just think that those pop-up Narcan [shops]…when we get those trends…cuz the dope man’s gonna move. As soon as you get 10 body counts, he gonna move somewhere else cuz he ain’t trying to get caught, so you know… that real-time information is very, very helpful and very important.” This statement shows the need for an intervention that has the ability to move with the changing epidemic.
Stakeholders also propose using the near real-time data to inform the placement of educational billboards that inform the community of nearby resources and treatment services. The stakeholder explains further by saying, “So, in terms of intervention you know, you have [organization name] down the street. You could say something like [organization name] is 4 blocks away from this billboard you know, that kinda thing cuz now it’s providing that direction to… you know, there’s a treatment center right down the street.” This strategy increases the community’s awareness of treatment services and provides a physical location of where to go to obtain services, with the goal of saving lives.
“…I kind of thought about pop-up shops for Narcan dispensaries. If you know you have a high-trend area and this is where the overdoses are happening, as soon as we get that real-time information, we can be in that area and provide those Narcan kits you know.”
Treatment Provider Stakeholder
Barriers to Targeted Response
A challenge faced by treatment organizations when trying to target response strategies is sharing with the community how and where they can access treatment services. One stakeholder states, “Just because you see folks using … in the community doesn’t mean that they know everything about their community and what’s down the street and what’s next door, that kinda thing or where they can go for help.” In order to successfully target response strategies, it is key that the community is aware of the resources in their local area and educated on how to access them.
Lack of support and engagement from the community is another challenge for treatment providers. A stakeholder explains, “People don’t want to come forward, especially the church groups that are faith-based communities and all that. We’ve been having issues with that. Support, funding, and all those things do contribute.” In addition to the stigma that surrounds substance use and substance use disorder, there is also stigma surrounding some of the efforts of local treatment providers. For example, many stakeholders speak about the backlash organizations face from providing services such as syringe exchange or medication for opioid use disorder (MOUD).
“Some people consider being on medications is not drug free – you’re still using some kind of illegal dope – but it’s taking you and it’s improving your quality of life, so I think we should encourage that, and evidence has shown and all the researchers, MAT works best.”
Treatment Provider Stakeholder
Near Real-Time Data Impact
Through the near real-time overdose reports and dashboard, community stakeholders have access to data that visually displays which areas have the greatest incidences of suspected opioid overdoses. These tools also highlight which zip codes have the greatest incidences of suspected overdoses, which allows stakeholders to conduct targeted responses.
The SOS reports can help reduce stigma by demonstrating how opioids widely impact all populations, regardless of age, sex, or race. As far as stigma related to treatment methods such as MOUD, the ability to evaluate how opioid overdoses may change after employing these methods could further help to reduce stigma.