Coordinated action by Connecticut’s municipalities, a statewide effort and grant funding that increases screening, brief intervention and referral to treatment (SBIRT) training could start to change the tide for a state on the verge of declaring an emergency over its opioid epidemic.
Opioid Use Skyrockets in 2016
In 2016, fatal drug overdoses increased by 26 percent in Connecticut driven in part by a dramatic rise in abuse of fentanyl, a synthetic opioid painkiller that is 50-100 times more powerful than morphine, according to the Economist.
The Agency for Healthcare Research and Quality Hospital found that opioid-related visits to Connecticut’s emergency room soared by 35 percent between 2009 and 2014, ranking it 5th-highest among 30 states. And while Connecticut saw one of the largest increases in heroin overdose from 2014 to 2015, the Centers for Disease Control & Prevention recently placed the state second in the nation for synthetic opioid overdoses.
The rise in use of opioid drugs like fentanyl is now responsible for roughly half the state’s emergency room visits related to drug overdose. Connecticut’s Chief Medical Examiner James Gill said that fentanyl-related deaths nearly surpassed the number of heroin deaths last year.
Patch.com tracked the state’s overdose-related deaths in 2016, finding the highest numbers in Connecticut’s larger cities.
In August, the Connecticut Conference of Municipalities called the opioid epidemic a statewide emergency and developed the toolkit “How Local Leaders Can Combat Drug Abuse” to help municipal officials lead a charge in drug abuse prevention in their communities. The top 10 recommendations are:
- Dedicate time to understand substance abuse and the drug epidemic in your community.
- Take the lead to increase public awareness and engagement.
- Designate a municipal point person or contact regarding substance abuse.
- Encourage community, regional and statewide collaboration.
- Develop a one-page fact sheet and resource guide for residents.
- Promote alternative programs – for both teens and adults – aimed at prevention and intervention.
- Partner with schools on prevention programs and curriculum.
- Provide first responders and increase public awareness regarding naloxone.
- Create safe disposal sites to discard prescription drugs.
- Become an advocate towards policy change.
Under the direction of the governor, the state’s Alcohol and Drug Policy Council released its road map, the Connecticut Opioid REsponse Initiative, in October.
The plan discusses key strategies and tactics to coordinate substance abuse prevention and treatment. The following six strategies are outlined in the report:
- Increase access to treatment, consistent with national guidelines, with methadone and buprenorphine.
- Reduce overdose risk, especially among those individuals at highest risk.
- Increase adherence to opioid prescribing guidelines among providers, especially those providing prescriptions associated with an increased risk of overdose and death.
- Increase access to and track use of naloxone.
- Increase data sharing across relevant agencies and organizations to monitor and facilitate responses, including rapid responses to “outbreaks” of overdoses and other opioid-related events.
- Increase community understanding of the scale of opioid use disorder, the nature of the disorder and the most effective and evidence-based responses to promote treatment uptake and decrease stigma.
One tactic that supports the first strategy is further development of programs that provide addiction-focused community outreach workers and health advocates more ways to link patients to treatment.
Advocates have partnerships with treatment programs and providers in their areas that provide screening, intervention and referral when possible, along with myriad other key tasks like educating staff, following up with patients and assisting with overcoming barriers to accessing treatment.
7,000 Free Licenses for Adolescent SBIRT Training
Previously, the Connecticut SBIRT program screened 69,521 patients through August 2016 with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Substance Abuse Treatment (CSAT).
The CORE road map notes, “The major challenge in the area of prevention is that there are few scientifically valid and proven programs that have demonstrated success in preventing prescription opioid and heroin initiation.”
And while scientific literature has not yet demonstrated that programs like SBIRT alone are effective for prevention, according to CORE, the Connecticut Department of Children and Families and Department of Mental Health and Addiction Services is using new CSAT grant funding to open access to free virtual learning on adolescent SBIRT (A-SBIRT) through Kognito Simulations for 7,000 through August 2018.
There are three courses available:
- Screening and Brief Intervention with Adolescents
- Screening and Brief Intervention Skills Assessment
- At-Risk in Primary Care
The training is available to Connecticut school nurses, community paramedicine professionals, EMTs, community advocates and other providers that can deliver early intervention and treatment services for adolescents with or at-risk for substance use disorders. Continuing education credits for CME, CNE and NASW are available.
Yale’s Buprenorphine Treatment to Go National
CORE was led by Dr. David Fiellin of Yale’s School of Medicine, and Yale affiliated doctors Drs. Robert Heimer, William Becker and Gail D’Onofrio, who is medical director of Yale New Haven Hospital emergency department.
These doctors have been studying use of buprenorphine treatment, a partial opioid agonist that may suppress withdrawal and decrease opioid cravings.
According to the County Times, Fiellin and D’Onofrio’s 2015 study found that emergency room patients who received buprenorphine and continued it were twice as likely as other opioid users to stay in treatment within 30 days. Yale will use grant funds to pilot buprenorphine intervention at four other U.S. hospitals.
Connecticut Senators Seek to Tax Prescription Opioids
According to WNPR, Connecticut Senators Chris Murphy and Richard Blumenthal are co-sponsoring the Budgeting for Opioid Addiction Treatment Act — or LifeBOAT Act — that would establish funding for opioid abuse treatment by taxing prescription opioids.
“It’s a small fee. A one cent per milligram fee on prescription painkillers would net a billion dollars a year,” said Murphy.