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 Washtenaw County. Each promising strategy is detailed below, along with stakeholder identified barriers to accomplishing the proposed strategies, and how the System for Opioid Overdose Surveillance (SOS) may assist stakeholders’ ability to accomplish each promising strategy.
Promising Strategies
Expanding Harm Reduction
Harm reduction strategies aim to reduce the occurrence and severity of the negative consequences commonly associated with substance use such as overdose, spread of communicable disease, and death. This is done by adopting the more practical approach that abstinence is not realistic for everyone considering their unique individual and environmental factors that could be contributing to their substance use.15 Common harm reduction methods include syringe exchanges, safe injection sites, and the use of overdose reversal drugs such as naloxone.15
One local harm reduction organization has a mobile unit that offers services such as syringe exchange, education, and testing for infectious diseases. This organization suggests increasing the number of areas their mobile unit visits, targeting geographic localities with high suspected opioid overdose incidents based on the reports. The report visualizations, including the map of suspected opioid overdose incidents, and frequency table by zip code and city, allows for a more targeted response. Previously, the main data source used by the organization was anecdotal.
“That’s one in [city name] where we take the mobile unit…you know, take the mobile to. Are there neighborhoods close by in the vicinity that maybe we could park the mobile unit? Do we need to maybe offer syringe access more than just on that particular day? So, these are things that we can use this information, the maps, to try and help figure out.”
Community Organization Stakeholder
Assertive Outreach
In order to expand and enhance response strategies and other efforts such as education and prevention, stakeholders involved in outreach and prevention suggest involving non-traditional entities and organizations in these efforts. Schools, churches, and libraries are the most common non- traditional establishments suggested by stakeholders to be involved in efforts.
Suggestions of expanding collaboration also include expansion of collaboration with organizations that traditionally work in the area of substance abuse. Stakeholders propose pin-pointing organizations with similar efforts in neighboring communities in order to collaborate in providing resources and services, but to also increase knowledge and awareness around the efforts of each organization and where individuals seeking help can be referred to. Specifically, one stakeholder involved in outreach and prevention proposes what she refers to as “assertive outreach.” She elaborates with “So you know, so that we have a monthly meeting in an area that’s pretty concentrated with overdose. So, we’re kind of bringing services to people rather than waiting for folks to come to us.” Assertive outreach involves holding collaborative meetings each month in an area where suspected overdoses are most concentrated with resources and services ready to be distributed. This approach can be useful as it helps to decrease some of the barriers that people experience when trying to access substance use services and resources.
Barriers
One of the most prevalent barriers surrounding how stakeholders respond to and treat substance use is the presence of stigma surrounding the issue. Some communities are not accepting of harm reduction methods such as syringe access and overdose reversal drugs as they see them as enabling factors to those who abuse substances. In areas where these attitudes are present, delivering services becomes a challenge. For example, one of the outreach organizations involved states that they would like to take their mobile units to new areas where suspected overdoses are prevalent based on the opioid overdose reports, however, some communities have shown great resistance towards harm reduction methods.
Near Real-Time Data Impact
The report visualizations, including the map of suspected opioid overdose incidents, and frequency table by zip code and city, allows for a more targeted response. Previously, the main data source used by the organization was anecdotal. During an interview where the stakeholder was asked about current data sources, they state, “If I had to break it down to percentage, I would probably say about 65 percent just listening to the community” thus showing the need for data to complement and supplement current sources.
“You know, HIV prevention, syringe access work, syringe access programs aren’t puppies and old people; don’t tend to move a lot of people you know, so we may have to…we’ll need to come up with some soft sell if you will, elevator speeches to help sell what it is that we do, our mission here at the agency. Churches is another one. I’m sure we got lots of churches around these darker pin spots here [referring to overdose incidents]. There may be some resistance there based on their religious dogma, so.”
Comunity Agency Stakeholder