Funding the fire, EMS response to the opioid epidemic

This past April, Health and Human Services Secretary Tom Price, M.D., announced that the HHS will provide $485 million in grants to help states combat opioid addiction. The funding has been allocated to all 50 states over two years through the State Targeted Response to the Opioid Crisis Grants provided in the 21st Century Cures Act.

Every EMS agency in the country has been impacted by opioids, and their effect on first responders has been just as varied the calls themselves. This is confirmed by data from NEMSIS, opioid prescriptions, and mortality records that confirm substantial geographic variation in the availability and harm from opiates, even across counties within the same state, suggesting that local communities are at different stages of the epidemic.

Funding for EMS response to the opioid crisis will revolve around comprehensive community-based approaches. This public health-based model is built on the premise that overdose deaths are preventable and all communities are responsible for their own health. These are the leading strategies for EMS and fire departments along with upcoming funding for curbing the opioid epidemic in America.

Expanding access to opioid treatment

Opioid addiction is a chronic medical condition that is receptive to effective treatment and recent federal legislation, and many state policies have been shown to be effective at increasing medication-assisted treatment (MAT) use. Policies and programs that improve delivery of this therapy, such as those currently being considered by CMS and AHRQ, could be just as important as expanding treatment.

• Substance Use Recovery Response Teams
  By creating links to treatment, St. Charles County Ambulance District developed a referral system for substance abuse overdose patients seen by EMS. SCCAD worked closely with treatment centers, local hospitals and substance abuse specialists to fill the gap in the access to treatment for overdose patients. 
• Collaborative Community Programs
  Project Lazarus features key components including overdose prevention, data surveillance and monitoring, community activation, and increasing availability of Naloxone. This effort was developed through a strategic partnership between the regional network of health providers, substance abuse taskforces, EMS, state Harm Reduction Coalition and public health departments. This coalition received funding from private foundations such as Kate B. Reynolds Trust, along with state funding from the NC Office of Rural Health.

Many EMS, fire and law enforcement agencies have been coming together to address opioid addiction and recovery by filling the gaps and expanding access to care for many underserved populations throughout the United States.

Expanding availability of naloxone

Despite a push by the prior administration to expand access to naloxone as part of its opioid initiative, there remains considerable debate amongst clinicians, policymakers and researchers about whether providing education and naloxone kits does in fact save lives, or instead discourages treatment and causes harm (by reducing interactions with emergency health care providers and/or encouraging increasing risky behavior).

However, one study looked at training and distribution programs adopted within specific communities in Massachusetts, and found the programs did in fact reduce annual community levels of opioid-related mortality with no statistical increase in the rate of acute care hospital utilization, suggesting the programs were effective at reducing overall harm.

Another study from the National Bureau of Economic Research found that state adoption of naloxone laws was associated with a 9-11 percent reduction in opioid-related deaths overall. The 2017 fiscal year budget request includes:

• $12 million for SAMHSA’s Grants to Prevent Prescription Opioid and Heroin Overdose-Related Deaths, which will help equip first responders with naloxone and provide education on its use.
• $10 million for HRSA’s Rural Opioid Overdose Reversal Grant Program to enable 30 rural communities to purchase naloxone to rapidly reverse the effects of opioid overdoses, and to train licensed health care professionals and emergency responders on its use.
• In Pennsylvania, $10 million that will distributed through the Pennsylvania Commission on Crime and Delinquency to provide naloxone to first responders and law enforcement across the state.

In previous years, SAMHSA have allowed distribution of funds by the states at their discretion. This is particularly beneficial to states with large rural and urban populations, such as North Carolina and Massachusetts. The 21st Century Cures Act of the State Targeted Response to the Opioid Crisis Grants allocated $12 million to Massachusetts and $31 million to North Carolina. The grant builds on the collaborative work already being done across the states to fight the opioid epidemic.

Expect previous programs like the Rural Opioid Overdose Reversal program that funded local emergency responders and other community programs in rural communities to distribute and train providers on naloxone administration and substance abuse awareness. Additionally, many public health departments have grant programs already in place for distribution and expansion of naloxone among first responders.

Public health based models for combatting the opioid epidemic

Many states are providing funding for integrated approaches with a public health model that is based on the twin premise that overdose deaths are preventable and that all communities are responsible for their own health. This includes funding and engaging public safety and first responders into these models:

• Scarborough Police Department in Maine Operation HOPE (the Heroin-Opiate Prevention Effort) that is supported by state grants and private foundation funding.
• Vermont’s Project Vision in coordination with Rutland City Police Department brings together a number of social service organizations, many of which are now co-located at the police department, to help address the opiate epidemic amongst many other issues underlying criminal activity.

With all states receiving funding from the federal government to expand efforts in prevention, access to treatment and recovery, and to implement best practices, look to partner with state harm reduction coalitions, public health non-profits, and substance use professionals for funding, resources and support.

For rural communities facing gaps in the availability of substance use treatment services and limited resources for EMS and law enforcement, utilizing evidenced-based programs tailored to the needs of rural communities will be essential to receiving allocated funding. Agencies must engage key rural stakeholder organizations such as state rural health organizations for funding to implement these programs.

As states begin to disseminate their federal dollars, state offices and leaders will be looking toward regional leaders for collaboration, coordination, cooperation, support and partnerships between public health, non-profits, first responders and public safety. Organizations that build coalitions and take community-based approaches will see funding through state health departments, office of emergency medical services and bureau of justice assistance.

Additional Resources

• Department of Health and Human Services. The opioid epidemic: By the numbers. Available at: www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf
• Governor Cooper announces $31 million grant to fight opioid epidemic in NC. Available at: www.ncdhhs.gov/news/press-releases/governor-cooper-announces-31-million-grant-fight-opioid-epidemic-nc
• National Rural Health Association Policy Brief. Rural communities in crisis: Strategies to address the opioid crisis. Available at: www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/RuralCommunitiesinCrisisStrategiestoAddresstheOpioidCrisisPolicyPaperApril2016.pdf.aspx