Mind and Body

Task force on ODs maps out strategic plan through 2021

Future strategies to be fueled by approximately $50 million in federal grants

Photo by Richard Asinof

There was a full house at the Oct. 10 meeting of the Governor's Task Force on Overdose Prevention and Intervention to discuss the draft of a new, three-year strategic plan, but no other reporters attended save for ConvergenceRI.

By Richard Asinof
Posted 10/15/18
The lack of news coverage about the state’s three-year strategic plan for overdose prevention and intervention, funded with some $50 million in federal grants, might be termed “a deadly experiment” in news reporting.
Why are deaths from alcohol and suicide left out of the conversation around strategies to prevent and intervene in drug overdose deaths? Could the strategy deployed in Central Falls to change the opening hours of stores selling alcoholic beverages, which have resulted in a decrease in EMS runs for alcohol intoxication, be replicated in other communities? What is the current status of 3,000 fentanyl test strips ordered by the R.I. Department of Health for distribution by recovery community advocates? Could one of the benefits of breastfeeding be the reduction of stress in the brains of young infants, suspected to be a potential link to future substance use disorders? How transparent will state agencies be in detailing what the money in the federal grants are spent on, such as comparing the resources for recovery housing vs. medication assisted treatment?
On Sunday, Oct. 28, from 1 p.m. to 4 p.m. at the Knight Campus of the Community College of Rhode Island, there will be a symposium to explore how non-pharmacological pain treatment can be part of the solution to Rhode Island’s opioid crisis, with the goal of changing the culture of pain management.
The larger question that hovers around this approach is reimbursement: can things such as yoga become reimbursable from health insurers? There is plenty of evidence-based metrics that show the effectiveness of yoga in recovery. The other question is one of accessibility: what are the opportunities for those communities who are uninsured or under-insured to access treatments such as acupuncture?
Finally, there is also the elephant in the room, which is that many older citizens, particularly women, are using marijuana as an alternative pain management treatment. In California, where recreational marijuana use is legal, dispensaries regularly sponsor free transportation to their shops for seniors. According to NPR, the fastest-growing age group of marijuana users is people over 50, with especially steep increases among those 65 and older.

PROVIDENCE – Consider this a multiple choice news quiz: What was the biggest news story last week?

Behind door number one: Was it the fact that Nordstorm announced it was pulling out of the Providence Place Mall in January, which resulted in GoLocal Prov announcing in apocalyptic tones that the move marked the death of the Providence Renaissance and the beginning of the city’s Dark Ages, in an unsigned “news” story?

Behind door number two: Was it the decision by Rhode Island Public Radio to re-brand itself as “Public’s Radio,” an awkward phrasing at best, to embrace the fact that it will be hosting a new broadcast location in New Bedford, Mass., making the former name inaccurate?

Behind door number three: Was it the devastation caused when Hurricane Michael slammed into the Florida panhandle and southwestern Georgia, Virginia and North Carolina, fueled by the ever warming waters of the Gulf of Mexico, leaving a path of destruction in its wake?

The bigger story, perhaps, was why so many reporters and meteorologists found it difficult to connect the severity of the storm with the reality of man-made climate change and rising ocean temperatures, given the release of the Intergovernmental Panel on Climate Change on Monday, Oct. 8, three days before the storm made landfall, where scientists warned that if greenhouse gas emissions continued at the current rate, the atmosphere will warm up by as much as 2.7 degrees Fahrenheit above pre-industrial levels by 2040, inundating coastlines and intensifying droughts and poverty.

Translated, to avoid the end of the world as we know it, the scientists warned, would require transforming the world economy at a speed and scale that has “no documented historic precedent,” as reported by The New York Times.

The head of the U.S. National Guard, Air Force Gen. Joseph Lengyei, a member of the Joint Chiefs of Staff, responded with a peculiar kind of ostrich-like, head-stuck-in-the-sand response to reporters’ questions about the connection between climate change and the increase in severity of storms: “The climate is changing, I don’t know why,” as reported by Alex Ward in Vox. Lengyei added that he had not yet discussed the threat that climate change poses to Americans with President Donald Trump. What was Lengyei waiting for?

Behind door number four: Was it how the Saudis allegedly lured an American journalist Jamal Khashoggi into their consulate in Istanbul, Turkey, then tortured him, killed him and dismembered him, with the gruesome scene recorded on Khashoggi’s Apple Watch?

Behind door number five: Was it the 11-day bus strike that was settled this past weekend?

Behind door number six: Was it the latest episode of “True Crime” in Cranston, with a police report from 1975 detailing that independent candidate for Governor Joe Trillo was once charged with [and found not guilty of] striking current Speaker of the House Nicholas Mattiello repeatedly with a caulking gun, an incident hyped by Cranston Mayor Allan Fung to show why Trillo’s candidacy should be rejected by voters?

For many, given so many worthy contenders, making such a choice would prove to be a difficult decision. Perhaps a more apt question to ask would be: what was the biggest news story last week that was not covered by the Rhode Island news media?

The answer is easy: the presentation of the draft strategy by the Governor’s Task Force on Overdose Prevention and Intervention for the next three years through December of 2021.

The news that doesn’t fit into print, radio or video
The continuing epidemic of opioid drug overdoses may be the biggest public health crisis in Rhode Island and the nation, but the public release of the draft of the state’s three-year strategic plan at the monthly meeting of the Governor’s Task Force on Drug Overdose Prevention and Intervention on Wednesday, Oct. 10, was not covered by any other news media outlets in Rhode Island, save for ConvergenceRI.

The actions and strategies detailed in the three-year plan, which outlined the state’s overdose response strategy through December of 2021, are to be fueled by approximately $50 million in federal grants.

Nearly 100 people attended the meeting on the second floor on the Department of Administration building, including legislators, doctors, nurses, insurance executives, expert consultants, members of the Task Force, law enforcement, labor leaders, state agency directors, recovery community advocates, and community health center professionals – but no cameras or reporters, even in an election year.

In a world where newsworthiness is often measured on the scale of mayhem and anxiety, such meetings are dismissed as boring and yawn-producing; if there is no outrage or drama to pump up the volume on, there is no story worth covering, even if the policies being addressed are matters of life and death.

Hit the refresh button
The slide show of the new strategic plan, called a strategic refresh, said that the new three-year plan will keep the focus on the strategic pillars of the previous strategy: prevention, rescue, treatment, and recovery, with a continued priority on saving lives, but with new emphasis on moving upstream to address the root problems of the overdose crisis.

The presentation began with the admission that the ambitious goal of the first strategic plan adopted in 2015 – to reduce the number of overdose deaths in Rhode Island by one-third – had not been met. Still, the “experts” tasked with writing the new strategic plan framed the conversation by saying that Rhode Island was one of the few states where the number of overdose deaths had declined, which suggested “we are getting something right.”

For the record, the number of overdose deaths reached 336 in 2016, and declined to 323 deaths in 2017, much, much higher than the projected goal of the first strategic plan of roughly 180 deaths.

The big picture
The major actions in the new strategic plan featured significant new investments in what was termed critical areas of overdose response:

Scaling up “evidence-based, primary prevention programs” in schools.

Designing a “recovery success” metric that reinforces the pathway to successful recovery.

Creating new pathways for people to get good jobs and pursue careers.

Building a new model of “treatment on demand.”

Leveraging community infrastructure to serve diverse communities, incorporate harm reduction strategies and “confront social determinants of health.”

In many ways, the presentation of the new strategic plan sounded much like a business plan. Each of the critical areas had a discussion of how the core principles were to be implemented.

Data would be integrated to inform crisis response, to understand what was working and what wasn’t.

Efforts would be undertaken to change and reduce negative public attitudes about addiction and substance use disorders, with the goal of reducing stigma and negative attitudes about medication-assisted treatment.

Engagement with diverse communities to remove barriers for veterans, women and communities of color would be undertaken.

Incorporation of harm reduction by putting health and well being first, creating a low threshold of entry into care.

A need to confront the social determinants of health as a long-term policy issue, including housing, community environment, employment and education – beyond the clinical and medical interventions.

The ability to harness “the predictive power of big data” to determine what works and what doesn’t.

Questions, questions
As is often the case at the monthly Task Force meetings, the presentation took most of the allotted time for the 90-minute meeting, leaving about 10 minutes for questions and public comments. [The entire November meeting of the Task Force is slated to be a question-and-answer feedback session about the new strategic plan.]

Still, in the short time allowed, there were probing questions asked by Task Force members.

Jonathan Goyer, even though he had participated in the writing of the new strategic plan, performed in his frequent role of truth-teller, asking a number of "impertinent" questions:

Why was recovery housing not an explicit priority in the new strategic plan, given that the waiting list for recovery housing is so high, with more than 400 people currently on the list?

Why weren’t substances such as cocaine addressed in the plan?

Why weren’t the difficulties in accessing medication-assisted treatment by the uninsured being addressed in the new strategic plan?

Why was the Recovery Navigation Program, a pilot diversion program in Providence that had been shut down in July, without any apparent replacement in sight, not addressed in the strategic plan?

Others asked questions about data for the actual numbers of patients being seen as part of the 14 Centers of Excellence that were created under the first strategic plan, as well as the flow of payments.

After Tom Coderre, senior advisor to Gov. Gina Raimondo and a co-chair of the Task Force, offered details on the sources of some $50 million in federal funding for the opioid crisis response, a Task Force member asked whether those funds could be used to help create a sustainable resource, different than depending on insurance reimbursements to underwrite efforts. Good question.

The federal grants include:

$3.2 million over four years, through 2022, to the R.I. Department of Health through CARA, the Comprehensive Addiction and Recovery Act, to make naloxone available to the law enforcement community, and to train first-responders – 1,900 municipal police officers, 5,000 EMS providers and 4,500 firefighters

$3.7 million for one year, through August of 2019, to the R.I. Department of Health from the Centers for Disease Control and Prevention’s Center for Health Promotion, including support for new and expectant parents of substance-exposed newborns, the creation of a rapid-response telehealth system linking high-risk populations with evidence-based medication assisted treatment facilities, and to conduct a census-tract-level assessment to measure vulnerability to overdose and blood-borne infections, because of unsterile injection drug use.

$375,000 over three years, through September of 2021, to the R.I. Department of Health for evidence-based mental health curriculum to targeted stakeholder groups, including training to groups of individuals that regularly interact with high-risk populations – EMTs and families of Rhode Island military service members.

Two ongoing grants, one with some $600,000 left through August of 2019, the other with some $330,000 left through August of 2019, to the R.I. Department of Health for work on the Prescription Drug Monitoring Program.

$25.2 million over two years, through September of 2020, to the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, through SAMHSA, to create a treatment on demand model where any referral links people seamlessly to ongoing care, increasing access to medication-assisted treatment.

$3.9 million over two years, through June 30, 2020, to the R.I. Department of Labor and Training, to provide career and training services for residents impacted by the opioid crisis, as well as education and services for workers in the workforce.

$1.8 million over two years, through September of 2020, to the Rhode Island State Police, in support of the HOPE initiative to develop mobile outreach teams to conduct residential visits of identified, at-risk individuals.

What is missing?
As much as the new strategic plan explicitly seeks to address root causes of the opioid epidemic, there is no explicit mention of what is often referred to as the diseases of despair, including alcohol and suicide the mix of overdose drug deaths. Rhode Island continues to have one of the highest rates of mortality for residents between the ages of 25-34 for suicide, alcohol and drugs.

Alcohol intoxication continues to be a major driver of Emergency Medical Services requests taking patients to emergency departments at hospitals across Rhode Island, yet there is no apparent discussion of this known co-morbidity for substance use disorders. The work in Central Falls to change the opening hours for stores selling alcoholic beverages has had a measured impact in lowering the number of emergency transports for alcohol intoxication, according to preliminary data.

Also missing is an articulation of the long-term nature of recovery as opposed to the short-term rescue approach of preventing and intervening with drug overdose deaths.

Another missing gap is a better definition of the potential practical applications of harm reduction strategies beyond naloxone – in particular, the role that fentanyl test strips can play in changing the behaviors of substance users. A larger conversation around the potential of safe-injection sites, which is happening nationally, should at least become part of the discussion addressed by the strategic plan, even if it does not become part of the plan.

A further omission in the strategic plan is creating the evidence-based data link measuring the connection between domestic violence, sexual assault and child sex abuse to future substance use disorders. As a starting point, the strategic plan could address the importance of trauma-informed care as a core principle.


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