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.
Below you will find promising overdose response strategies identified by public health stakeholders in Kent County. 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 Collaboration
Public health stakeholders in Kent County act as a neutral convener to bring together a variety of community-based organizations. Together, these groups work towards the common goal of decreasing opioid overdose in the community. The partnerships among public health, public safety, treatment providers, and outreach and prevention specialists are vital to public health’s role in assessing the health of the community and ensuring that services are available and accessible to its citizens. Public health stakeholders in Kent County help facilitate coalitions such as the Kent County Opioid Task Force (KCOTF), which serves to bring all community stakeholders together in their efforts to prevent overdose. While collaborations amongst stakeholders are already in place, strengthening partnerships among community organizations and members is a promising strategy for enhancing local overdose response. Public health stakeholders envision strengthened connections positively impacting already existing projects in the community, as well as facilitating the development of new projects.
Barriers to Community Collaboration
- Community disconnect: Public health stakeholders have identified the absence of a cohesive, community-focused response to overdose as a barrier to collaboration efforts among community organizations. Stakeholders identified that the feeling of disconnect among community organizations in recent years is partially due to the coronavirus pandemic and the strain it has placed on organizational resources. This has resulted in the decreased ability for organizations to actively engage in community coalition work and to prioritize the creation and funding of new initiatives to reduce opioid use and overdose.
- Stigma surrounding opioid overdose strains community connections: Pervasive stigma surrounding opioid use and overdose persists as a barrier to the community collaboration public health stakeholders envision for Kent County. Stigma from the public, as well as stigma based in the illegality of substance use, greatly contributes to public health stakeholders’ inability to accomplish a cohesive community response to opioid use and overdose.
Near Real-time Data Impact on Community Collaboration
- Create unique community-based overdose prevention initiatives: Public health stakeholders in Kent County use SOS to inform a new initiative based in community collaboration. This project titled ‘I Can, Narcan’ focuses on encouraging local businesses to stock naloxone for community use and to advertise its availability to the public. SOS has been used in this initiative twofold: 1) Public health stakeholders have used SOS data to identify locations in greatest need of increased community naloxone supply, and 2) SOS data is being used to educate business owners on the prevalence of suspected overdose in the area. Through the aspects of this project focused on community member education and encouragement of carrying naloxone, public health stakeholders are hopeful that stigma in the community may also be reduced.
- Reduce stigma through the focus on locations over-burdened with overdose: Stigma reduction efforts by public health stakeholders will be further informed by SOS near real-time data through internal discussions regarding how best to address locations with a higher burden of overdose. Conversations among public health stakeholders have been generated regarding best practices for integrating near real-time data into stigma reduction efforts, with plans to continue these conversations moving forward.
- Shared access to data sources to inform overdose response and prevention: With the use of near real-time data provided by the System for Opioid Overdose Surveillance (SOS), stakeholders across the county have gained access to the same data. Stakeholders can interpret the data on their own, utilize it for their organizational needs, and then come together with other stakeholders to develop larger, community-based initiatives focused on opioid overdose prevention.
“We are planning to use more neighborhood level maps from SOS for our ‘I Can-Narcan’ program, so we have a packet of frequently asked questions and information about naloxone administration that we’re going to be giving to business owners who are interested in having naloxone available at their place of business in case an overdose is happening nearby…and so I see the maps as actually generating a lot of quality conversation about how we talk about this issue, and that’s going to inform a lot of our anti-stigma initiatives in the future.”
Public Health Stakeholder
Promising Strategy 2: Policy Development and Advocacy
Public health stakeholders in Kent County identify changes to opioid policy and improved regulation of illicit opioids as a promising strategy in overdose response efforts. Stakeholders express the difficulty of preventing opioid use and overdose under policies that support both medical treatment for substance use disorders, as well as the criminalization of substance use. This juxtaposition creates difficulty in creating a truly cohesive and effective response to OUD and overdose.
Furthermore, public health stakeholders discuss how illicit opioids continue to be largely unregulated, with fentanyl present in much of the illicit opioid supply and the increasing production and use of novel opioids. Novel opioids in the United States pose a great challenge to overdose response and prevention efforts due to the low price and absence of laws currently preventing their production and distribution.
“The health issues that we address at our program and we see in our program are really simple things that could have really easily been solved if somebody just went to the doctor right away and had a trusting relationship with their doctor, but because of the stigma people experience when accessing medical services, people don’t go for medical services until it’s way too late, so we have to do something about that stigma if we’re ever going to progress in this realm.”
Public Health Stakeholder
Barriers to Policy Development and Advocacy
Stigma of opioid overdose in the community: Stigma was identified by public health stakeholders as the greatest barrier to policy changes. The stigma of substance use disorder, opioid use, and overdose in the United States instills fear of mistreatment and legal repercussions in those who use opioids. This may have the dangerous result of those not seeking medical assistance in the event of an emergency, as well as not seeking medical services for routine appointments or minor health concerns. Public health stakeholders recognize the need for decreasing stigma in their community, and the greater United States, before impactful new policies are possible.
Near Real-Time Data Impact on Policy Development and Advocacy
- Near real-time data provides evidence for the creation of new policy and law: Public health stakeholders believe the use of near real-time suspected overdose data can provide support for new policies or laws that would positively contribute to reducing the stigma that surrounds opioid overdose. Data can be used in discussions with local, state, and federal officials, to communicate the extent of the issue and to illustrate why new policies are needed.
- Incorporate data into community education opportunities: Public health stakeholders feel there is a substantial lack of understanding surrounding those who use opioids and overdose, leading to increased stigma. Suspected overdose location data allows stakeholders to tailor community education to specific communities for public awareness and the promotion of the need for improved substance use policies.