Local Health Departments and the Implementation of Evidence-Based Policies to Address Opioid Overdose Mortality

Abstract

Background In the context of the opioid overdose crisis, local health departments are on the front lines, coordinating programs and services and translating state and federal policies into community action. While media reports describe growth of Overdose Education and Naloxone Distribution (OEND) programs among local health departments, little is known about program features, scope, and target populations. Methods We surveyed health departments in 180 United States counties with high overdose mortality rates. Results Among health officials from 54 counties (30% response), many counties reported implementation of evidence-based practices, with a high degree of programmatic variation. The majority of responding health departments (94%) conducted overdose education and naloxone distribution (OEND) programs. Programs were heterogeneous in scale, with a reported median of 250 naloxone kits (range 1–25,000 kits) acquired for community distribution. In addition, four in five respondents were aware of their state's standing order policy for increasing naloxone access. While the majority of respondents reported county-level availability of at least one form of evidence-based medications to treat opioid use disorder (MOUD), many reported no availability of buprenorphine (33%) or methadone (43%). Conclusions Local health departments are vital to reducing opioid overdose mortality, and many are implementing relevant evidence-based practices. To support further adoption of potentially life-saving strategies, health departments need adequate funding and staffing as well as policies and guidelines to support implementation.

Substance Use and Overdose in Public Libraries: Results from a Five-State Survey in the US

“…Past research found that state rates of pharmacy-based naloxone dispensing were not correlated with state opioid overdose death rates [ 23 ]. Thus, naloxone uptake in public libraries may reflect variation in features of state/local overdose response programs, [ 24 ] as well as policy barriers to/facilitators of naloxone access, rather than state-specific overdose death rates [ 23 ]. (For example, although anyone in CO and FL can obtain naloxone at a pharmacy without an individual prescription through a standing order, only CO permits community-based organizations to distribute naloxone directly to lay people [ 25 ].)…”

Urban‐Rural Disparities in Opioid Use Disorder Prevention and Response Activities: A Cross‐Sectional Analysis

“…4 The results of this study support such claims as the proportion of nonmetropolitan counties is lower than that of metropolitan counties for implementing policy and program activities, especially for those concerning harm reduction, criminal justice, and emergency response. An initial step in OUD prevention and harm reduction in rural areas may be to focus on implementing evidence-based activities such as syringe services and medications to treat OUD 28 that are underutilized yet within the limits of what is currently feasible.…”

Co-producing evidence-informed criminal legal re-entry policy with the community: an application of policy codesign

“…Similarly, the Substance Abuse and Mental Health Administration (SAMHSA) has produced several toolkits and fact sheets and supports a limited number of state technical assistance projects a year (SAMHSA, 2020). Information from federally-funded dissemination efforts is distributed to health-related systems and communities (Hale et al, 2016), with local health departments playing a key role in community implementation (Feuerstein-Simon et al, 2020).…”

“…In response, local public health departments have coordinated efforts to distribute evidencebased services to address opioid overdose. A recent, national survey of local health departments found that nearly all health departments responding to the survey (30% response rate) had access to naloxone, and over 50% of them had implemented programmes for medications for opioid use disorder (MOUD) (Feuerstein-Simon et al, 2020). However, these efforts have not extended consistently into to the criminal legal system.…”