Stemming the Opiate Epidemic through Education and Outreach (2017-2018)

Background

In recent years, the incidence of opiate overdose deaths, opiate addiction and the resurgence of heroin use has been much in the news. The current crisis is the result of a complex combination of changing pain-medication prescribing practices, changing demographics of opportunity and a disconnected society.

This Bass Connections project began in 2016 with the goal of understanding the current epidemic and sharing knowledge with the public to alleviate this problem in Durham. Team members found a much more complex problem than expected, and have begun to find ways to take small steps toward making tangible, constructive change. They performed a comprehensive survey of the opiate addiction and overdose epidemic in North Carolina and across the United States, and met with representatives from the medical, recovery, law enforcement, harm-reduction, epidemiology and policy communities.

Project Description

Building on this experience, the 2017-2018 project team will employ a combination of approaches involving the medical and law enforcement communities. The main project will be to work with the Duke Hospital Emergency Department to establish a program in which providers give the opiate-overdose-reversal drug Naloxone free of charge to at-risk patients. The team will aim to partner with the manufacturer of Naloxone to pilot a direct-distribution program in which patients can exit the Emergency Department with Naloxone in hand, rather than being required to fill a prescription at a pharmacy, thereby removing a significant obstacle to this life-saving intervention.

After implementing the program, the team will evaluate its uptake. How many Naloxone kits are distributed? Are providers giving it to the correct patients? Do patients understand how to use it?

Once appropriate uptake is established, team members will examine patient-oriented outcomes. What are the demographics of at-risk patients? Which risk factors are most common? Do patients report using Naloxone? What are rehospitalization rates for these patients? 

The team’s second project involves a collaboration with Durham County’s Crisis Intervention Team (CIT) Collaborative, a group of first responders who are trained to respond to citizens in mental health and/or substance use crises. They work to divert these citizens from jail and assist in getting treatment and other necessary services through a partnership with Durham’s Recovery Response Center. CIT will provide data for a detailed cost-benefit analysis of the program, in collaboration with Duke’s Data+ summer research program. Questions asked in this analysis will include: Does the CIT program reduce crime in Durham? Does it save money compared to the previous policy of incarceration? Does it reduce recidivism?

Anticipated Outcomes

Implementation of the Naloxone distribution program in the Duke Hospital Emergency Department; data collection to assess the program’s effectiveness; publication describing the successful intervention or work to improve it as needed

Student Opportunities

Students will learn the principles of community engagement; the neurobiology, epidemiology and clinical practice of drug addiction and specifically opiate addiction; medical systems and processes; writing and speaking skills; and skills necessary for effective teamwork. A project manager who is a graduate student or postdoc will learn principles of group leadership and interpersonal management skills. We anticipate having three undergraduate students, with interests as varied as neuroscience, pre-medicine, public policy, medical systems and others. 

At weekly meetings, each student will be assigned action items to complete for the following week, and will receive feedback.

Students may be interested in a related Data+ summer project, Mental Health Interventions by Durham Police (May 22 – July 28).

Timing

Summer 2017 – Spring 2018

  • Summer 2017: Six-week intensive summer program, May 17 June 29: learn about basic principles driving the project; create implementation and data collection plan for Naloxone distribution in the Emergency Department; develop educational materials for ED staff and for patients who receive Naloxone; finalize IRB approval
  • Fall 2017: Data collection to assess implementation and uptake of the Naloxone distribution program
  • Spring 2018: Data collection to assess patient-oriented outcomes of the program

Crediting

Independent study credit available for fall and spring semesters; summer funding

See earlier related team, Stemming the Opiate Epidemic through Education and Outreach (2016-2017).

Faculty/Staff Team Members

Caroline Freiermuth, School of Medicine - Emergency Medicine, Department of Surgery
Alexander Limkakeng, School of Medicine - Emergency Medicine, Department of Surgery
Andrew Muzyk, School of Medicine - Psychiatry and Behavioral Sciences*
Nicole Schramm-Sapyta, Duke Institute for Brain Sciences*

* denotes team leader

Status

Active