#teamoverdose

Due to the geographical isolation, financial hardships, and the stigma associated with opioid addiction found in Harnett County, it is very difficult for those addicted to find the treatment they need. The lack of treatment availability found in Harnett County could be a contributing factor to the rate of opioid overdoses seen in the area. To help decrease the potential opioid overdoses, research was conducted on what was being done in other rural areas to help addicts receive the treatment they need.

One of the most interesting programs found is being conducted by the Michigan State Police and is called the Angel Project. This program is a voluntary, non-arrest program, and allows the police to offer referrals to detoxification and rehabilitation treatment programs. Additionally, the police departments ensure that those who want treatment will have immediate transportation to a treatment center. To aid in transportation to the treatment centers, volunteers throughout the community are available to provide transportation to an appropriate treatment center. The volunteers are also available to meet with the addict and discuss the treatment options that are best for them. The Angel Project has been effective for Michigan rural counties and has served 87 participants through 100-125 volunteers in November of 2018. This program could also be quite effective in Harnett County, however, there is still the concern for the treatment to be affordable to addicts once they arrive at the treatment center and the cost of transportation for the Angel volunteers and police officers.

To implement such a program, the Harnett County Sheriff’s Office can seek aid through a nonprofit organization known as the Police Assisted Addiction and Recovery Initiative (PAARI). PAARI seeks to help spread the Angel Project (and other programs like it) throughout the United States. The non-profit organization helps Sheriff’s Offices and police departments fund programs like the Angel Project through the money obtained in drug busts, and by helping the police force partner with treatment facilities in the area. By partnering with PAARI, the Harnett County Sheriff’s Office could resolve the financial issue seen if they were to implement the Angel Project alone.

In addition to partnering with PAARI to implement the Angel Project, other recommendations have been offered to the Sheriff’s Office to help with fighting the opioid crisis in the community. To gain a better understanding of the dispersion of opioid overdoses in Harnett County, the Sheriff’s Office (along with the other police departments in the county) should upload their overdose incidences to a national system that tracks overdoses in real-time. By doing so, the deputies can have a better understanding of where the “hot spots” are, and where intervention may be the most helpful. As mentioned with the Angel Project and PAARI, the Sheriff’s Office should consider partnering with many other organizations in the community. Partnering with EMS, the fire department, churches, schools, and hospitals can help with providing transportation for those seeking treatment and with the possibility of implementing an opioid addiction awareness program for the community. The Sheriff’s Office should also consider partnering with those in recovery and with those who were addicted to opioids in the past. Doing so can provide those seeking treatment with a peer to discuss treatment with, as well as a person who understands what they are going through.

Advocacy Campaign

From this semester my group and I have gained a great deal of knowledge surrounding the opioid epidemic within the United States. With Harnett County specifically in concern, our research led us to some barriers that community members face when it comes to opioid addiction. These barriers include lack of sufficient treatment and support programs that are easily accessible for individuals struggling with addiction and their families to reach. With these barriers in mind we spent a majority of the semester trying to determine a plan that would be attainable for the county to implement but also one that community members would be willing to partake in. The difficulties we faced in determining how to properly help this community were frustrating, but it also provided us the opportunity to grow and really understand the dynamics when trying to implement a program, especially a community that lacks in a great deal of resources.

With discussions from our preceptor, Lieutenant Christensen, we learned that though the Sheriff’s Office is aware of the opioid epidemic, the lack of funding and general acceptability from community members it is hard to address the problem head on. For rural communities in particular the fact that “everyone knows everyone”, lack of transportation and general resources at arms reach it is just easier for those struggling with addiction to stay on the drugs and isolate themselves in an effort to avoid public scrutiny. With the obstacles at hand we began research to see if any other rural communities had devised a plan to deal with opioid issues.

Our research conducted it led to the discovery of the Angel Project. This was first implemented within a small town in Massachusetts and its goal was to allow anyone in search of help with an opioid addiction to come to the police station without fear of arrest to reach out for help. With the aid of the police department individuals were able to receive detoxification and rehabilitation. This was possible because the police department made sure that individuals had access to treatment by ensuring transportation. There were also individuals, Angel Volunteers, who were assigned to a person in need as a support system and another resource in finding proper treatments. The funding for this program came donations to the program and in 2018 eighty-seven participants were helped.

After analyzation of this program it was determined by all group members that this would be a beneficial program to work towards implementing within Harnett County. This is because there is already a foundation and evidence in helping another rural area within the United States. We believed the values and goals of this program would have a positive impact on those living within Harnett County and would be a step in the right direction of reducing the stigma surrounding drug addiction.

Stigma is a major issue we discovered throughout this semester. Even when someone has the ability to reach treatment they often shy away because they are afraid of the social backlash from their community members. The Angel Project would be a vital part in turning this issue around because it brings back positivity into a very dark situation. It allows people to feel more comfortable about their addiction and understand that it does not have to define their future. One of the major problems around addiction is that most people look at it as the end of someone’s ability to thrive and recover from.

With the Sheriff’s Office not having a real idea on an action plan to really turn this problem around within Harnett County it left us a little lost in determining an action plan. Though we hit some road blocks along the way in the end we were able to find this Angel Project which gave us all some hope to a brighter future for those living within Harnett County.

Our presentation to the Harnett County Sheriff’s Office concluded our work as Team OVERDOSE. I am honored to work inter-professionally with a group devoted to law enforcement. One would not think there would be many crossings of professional lines when thinking of the roles of a Sheriff’s Office and public health. However, they do intersect in the duty of serving the people in the community in which they work and live and protection. Although our focus of protection differs, with public health focusing on protecting health and law enforcement protecting from harm and maintaining safety, we both aim to influence social determinants of health in a positive manner. We had to make some changes to our first advocacy ideas, which suggested the use of medication-assisted treatment (MAT) for those who are in jail or prison in Harnett County. Lt. Christensen informed us of the difficulties with implementing this program: most justice-involved persons are not in Harnett County Detention Center for long periods of time, they cannot start MAT here and discontinue it upon arrival at another location, and the diversion of medications could pose a threat. We had to switch direction, even though jail-based MAT is recommended by the National Sheriff’s Association and continues to be the gold-standard for opioid use disorder treatment. We wanted to incorporate something which was gaining traction around the country, using a network of services to lead people to treatment following an overdose.

Our advocacy program fed off of the Angel Program. This program links addicts to treatment by allowing law enforcement to lead people directly to treatment with the help of a person in recovery, or Angel. It utilizes resources in the community to help those who seek treatment and does not punish addicts for having illicit substances on them. It is voluntary and can be seen as an alternative to arrest or the public health approach to getting people treatment who need it.

In many cases, law enforcement will aim to arrest the way out of a problem that can be solved with treatment and therapeutic interventions. The punitive nature of jails and prisons are not necessarily helping addicts. In fact, our data showed an instance where an addict did overdose directly after leaving jail. This is a common occurrence, as addicts think they have the same tolerance and try to use the same amount, which leads to an overdose because their tolerance has decreased while remaining abstinent in lock up. If Harnett County Sheriff’s Office were to adopt a form of the Angel Program, it would require addressing access to care barriers and health care challenges. There simply are not the treatment options required to make this happen; there is no detoxification facility in Harnett County, and if addicts could detox successfully at home, they would not be addicts. Of course, resources do exist to provide a referral to other areas, but those resources are already strained. The form that could be adopted would lead to linking people who overdose with those who are in recovery, using a peer recovery specialist to help this person who just almost lost their life. Developing this connection could lead to more stories being shared, conversations being started, and possible reduction in denial that plagues addicts.

We presented our advocacy ideas, which focused on this social issue, to the Sheriff’s Office with instant feedback. Lt. Christensen seemed to be receptive to the idea. There was no direct talk of starting this policy any time soon, but we did challenge the stigma of addiction as a moral failing. If it were simply a moral failing and someone could easily quit, there would not be reimbursement from insurance companies for substance use disorder, AA/NA would not exist, treatment centers would cease to operate, and the American Medical Association would have been wrong about calling alcoholism/addiction a disease for over 50 years now. We can only hope that starting the conversation is only the beginning of helping this community and leading more people to treatment and into recovery. This experience, I hope, allowed law enforcement to see this a public health issue and not something which punishment can solve. We hope to see an adoption of some form of the Angel Program or utilizing the social capital of persons in recovery to link addicts who are using and dying to treatment. This activity allowed us to successfully meet competency F14: Advocate for political, social or economic policies and programs that will improve health in diverse populations. Our diverse population includes addicts who have overdosed across Harnett County, which represented both sexes, multiple races, and community members just like you and me. This is an issue which we all must see as a family disease, now that drugs have reached suburban and rural areas, we have the chance to switch from arresting people to meeting them where they are and walking with them when they are ready for treatment.

As mentioned before, our project is heavily weighted on data input and analysis. After taking approximately 4 weeks to input data into a shared excel spreadsheet, the data was compiled and uploaded into SPSS to better assess the trends seen in the incident reports. To begin the analysis, overdoses, in general, were analyzed, after which the overdoses that resulted in death were examined. Of overdoses in general, the sex (male vs female), race, and age were analyzed of the victims in the incident reports. Most of the victims of overdoses were identified as male (56.9%), white (82.16%), and between ages 26-31 years old (23.57%). These demographic trends are as expected because the majority of Harnett County’s population are white males, and the officers at the Sheriff’s Office have noticed a trend in drug users being mid-twenties to early thirties. Also analyzed were the zip codes where the overdoses occurred. The top four zip codes were: 28390 (Spring Lake), 27546 (Lillington), 28326 (Cameron), and 27332 (Sanford), respectively. The zip codes encompassing Spring Lake, Cameron, and Sanford are all located in the southeastern part of the county. The clustering of these three counties may indicate that this area of the county is a target population, and may be more at risk for overdoses than the rest of the areas in Harnett County. However, the clustering may also be due to the lack of local police found in other areas of the county (Dunn, Erwin, Angier, etc.). Because of the lack of local police stations, the three areas listed are relying solely on the Sheriff’s Office to respond as law enforcement to overdoses.

When analyzing deaths, similar demographic patterns are seen. Of the males in the reports, 22.4% died, while only 8.5% of the females in the reports died. After splitting races into white and non-white for simpler analysis, it was seen that 17.3% of whites in incident reports died, and 13.9% of non-whites died. However, the zip codes housing the most overdose deaths were quite different than the ones home to the most overdoses in general, except for the #1 spot. The top zip code was 28390 (Spring Lake), while the second-highest spot was tied with four zip codes: 27546 (Lillington), 27501 (Angier), 27526 (Fuquay-Varina), and 28334 (Dunn). The four zip codes tied for second are clustered in the northern part of the county, the opposite side where the most overdoses, in general, seem to occur. This result may be due to an underlying issue with lack of treatment facilities and/or access to providers, however, it is also possible that the Sheriff’s Office was called in when an overdose case was seen to be particularly dangerous. The more dangerous opioid overdoses are also more likely to result in death, meaning the incident reports ending in deaths would be concentrated in those areas. As mentioned previously, the top zip code for the most overdose deaths (Spring Lake) is also the top zip code for the most overdoses in general, providing serious evidence that this area may be the most at-risk geographical area for opioid overdoses.

The top drugs involved in overdoses were also of interest and were split into two groups: those involved in overdoses in general, and those involved in overdoses that resulted in death. The top five drugs involved in overdoses were heroin, fentanyl, cocaine, and a tie between Xanax and alcohol. Heroin held the top spot by far, as it was listed in 91 of the incident reports where drugs were listed. Regarding the reports that resulted in death, heroin also held the top spot by being listed in 15 of the incident reports. The other drugs were fentanyl, cocaine, and alcohol, respectively. However, it must be noted that the second most mentioned response for drugs being involved in the overdose death reports was “unknown” (listed in 13 of the reports). This observation means that the Sheriff’s Office is unsure of what caused or was taken prior to the overdose that resulted in the death of the victim.

The APHA annual conference gave me some much-needed motivation to push to the end of our group practicum as an abundance of research is being formulated on the opioid crisis.

For our project in particular it has been weighed heavily on analysis. This is due to the nature of the information presented to us, and though it sounds monotonous it has provided me with some of the most eye-opening experiences that has also led to some major alterations at how I look at life and the moments that we are given.

              To begin our journey we were given incident reports from the years 2016-2019. From here, we divided the years into groups in order to retrieve the data in a timely manner so that we could begin analysis of our findings. The data was input into a Google spreadsheet so that we all had access to the information from each year. We were also provided death reports, but they excluded 2016. After a few weeks of data entry we were able to move on to the next phase.

              The next phase proved to be a bit tricky because though we were together when inputting the data we all had some different interpretations of short hand, timing, etc. We learned very quickly that the knowledge of codebooks would have been good for us to have known in the beginning, but either way we were able to get the job done. Katlyn took on the single man job of making sure that all of the entries for the different years matched and then worked with Dr. Rich in order to properly utilize SPSS.

              From the beginning we had decided that we wanted to look at certain parts of the data. These parts included: sex of the individuals, age, race, zip codes, and whether or not there are relationships between demographics and overdoses. The data for all of the years were combined to get an over view for each section. The following were found: 117 females, 152 males, 42 Black, 221 White, 5 Unknown had overdosed for the years 2016-2019. Next we looked at ages in the following ranges: 0-19(28), 20-25(43), 26-31(62), 32-37(49), 38-43(29), 44-49(26), and Over 50(26). The final section of demographics were zip codes with the top four being: 28390(49), 27546(42), 28326(41), and 27332(34). We were also able to determine the top drugs that affect Harnett County: Heroin(91), Fentanyl(16), Cocaine(12), Xanax(7) and alcohol(7). Abuse of prescription drugs were also a focal point: hydrocodone(2), morphine(3), oxycodone(5), oxymorphine(4), Percocet(4), and fentanyl(16).

              Now, what does all of this data mean. For us it gave us the info we needed to provide back to the Sheriff’s office about people who are being heavily affected with opioid addiction. Though there were no major differences when considering age it was found that those in the age ranges of 20-37 have the highest risk making up 58.55% of those who overdosed between 2016-2019.  It was also very clear that race played a big role in overdoses with the white population making up 82.16% of those who overdosed in Harnett County for 2016-2019. Out of the 20 zip codes recorded from the incident reports the four previously stated had substantial heights over the other 16 and proved to be hotspots for overdoses. With these demographics the Sheriff’s Office has a clearer idea of those being affected in their communities. With the zip code information in particular, the Sheriff’s Office can target aid in these areas. When going into the types of drugs that were most prevalent for those who had overdosed the Sheriff’s Office already had a good idea of the most popular drugs that individuals with substance abuse issues tend to go for. We were able to put these assumptions into real numbers though. The amount of fentanyl recorded for those who has overdosed was only 16 and from discussions we were anticipating a much higher number for this particular drug. With that being said, finding heroin as number was very anticipated due to the fact that it is the drug that most people go to after addiction begins from prescription drugs. The one that surprised me the most was Xanax; I did not expect this particular drug to make the top list. Of the prescription drugs reported, there was no shock in finding hydrocodone, oxycodone, oxymorphine and Percocet as some of the most popular drugs of choice for individuals.