Measuring Success in Substance Use Grant Programs Outcomes and Metrics for Improvement (2020) / Chapter Skim
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2 Prevention Programs
2 Prevention Programs
Pages 19-38
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From page 19... ...
-approved drugs or devices for the emergency treatment of opioid overdose. Specifically, the grant program provides support for organizations or prescribers to develop best practices for prescribing and co-prescribing these drugs and devices, facilitates training for community stakeholders about drug overdose and overdose reversal drugs, and 19
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Project location, scope, and anticipated population effect vary by project. The OD Treatment Access program requires that grantees use the funding to: • Establish a program for prescribing a drug or device approved by FDA to treat opioid overdose; • Train and provide resources for health care providers and phar macists on the prescribing of such drugs or devices; • Establish protocols to connect patients who have experienced a drug overdose with appropriate treatment, including medica tions, counseling, or behavioral therapy; • Develop a plan for sustaining the program after federal support has ended; • Use SAMHSA's Opioid Overdose Prevention Toolkit2 as a guide to develop and implement a comprehensive prevention program to reduce the number of opioid overdose-related deaths and adverse events; and • Better understand and prevent overdose by patients on prescribed opioids (e.g., document and address potential drug interactions, any reductions in prescription dose, and evaluation for other substance issues, such as alcohol use disorders)
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Under this funding mechanism, FRs include "firefighters, law enforcement officers, paramedics, emergency medical technicians, or other legally organized and recognized volunteer organizations that respond to adverse opioid related incidents."4 To be eligible for FR-CARA funding, a potential awardee must be a state, tribal organization (e.g., American Indian tribe, consortia of tribes, Alaska Native tribe) , or local government (e.g., municipal, county, city, 3 A majority of states have passed Good Samaritan laws, also referred to as "overdose immu nity laws," which provide legal immunity (e.g., from arrest for controlled substance possession or possession of paraphernalia)
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a practitioners dispensing overdose: narcotic drugs 2018 Awarded: • Partner with other prescribers at the community level to 5 (up to $200,000 develop best practices for prescribing and co-prescribing each) c FDA-approved overdose reversal drugs; • Use the Substance Abuse and Mental Health Services Up to 5 years Administration's Opioid Overdose Prevention Toolkitd and other resources to train other prescribers in key community sectors (e.g., health care providers and pharmacists)
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• Indicate the amount of grant funds spent and the number of kits purchased on drugs or devices for emergency treatment of known or suspected opioid overdose. • Indicate the amount of grant funds spent on copayments and other cost sharing associated with drugs or devices for emergency treatment of known or suspected opioid overdose.
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The 49 total projects are a mix of recipient organizations: Native American tribes; emergency medical response service organizations; state, county, and local health departments; medical centers; health and wellness centers; municipalities; substance use treatment facilities; and a university. The required activities under FR-CARA are to: • Provide FRs and certain members of the community with drugs or devices to treat opioid overdose; • Train and provide resources to those individuals to encourage proper administration of the drugs or devices; and • Establish processes, protocols, and mechanisms to refer patients to treatment and recovery communities.
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This assessment is designed to promote continual grantee improvement and help grantees determine whether they are meeting their goals, objectives, and outcomes, including on behavioral health disparities. Grantees are allowed to use up to 20 percent of the federal funding for data collection, performance measurement, and performance assessment expenses and up to 10 percent of grant funds for administrative costs.
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key community sectors to administer a drug or device approved or cleared under the Federal Food, Drug, and 2018 Awarded: Cosmetic Act for emergency treatment of known or 28 (between $250,000 suspected opioid overdose; and $800,000 each) • Train and provide resources to FRs and members of other key community sectors at the local governmental Up to 4 years and tribal levels on carrying and administering a drug or device; and • Establish processes, protocols, and mechanisms for referral to appropriate treatment and recovery communities.
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• Lac du Flambeau Band of Lake Superior Chippewa Indians (Lac du Flam beau, WI) • Mental Health, Addiction and Recovery Services Board of Lorain County (Lorain, OH)
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(Monessen, PA) BOX 2-4 Center for Substance Abuse Prevention Division of State Programs Management Reporting Tool The Division of State Programs Management Reporting Tool (DSP-MRT)
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In addition, grantees must write about any accomplishments achieved or barriers faced in sustaining their efforts. • Overdose Outcomes: Grantees must report grantee-level data on emer gency department and other hospital visits involving opioid overdose.
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Fentanyl One required activity under the OD Treatment Access grant program is that grantees must "develop and implement a comprehensive prevention program to reduce the number of prescription drug/opioid-related deaths." Despite the DSP-MRT's focus on education and training (for FRs and in high-need communities) , there is no explicit focus on education for overdose due to fentanyl (though grantees are required to use Appendix B to report the cause-of-death code for various opioids, including synthetic opioids)
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should ensure that in education and outreach efforts across SAMHSA programs, including activities funded by the First Responder Training program and the Improv ing Access to Overdose Treatment program, a key outcome is the degree to which providers, first responders, and members of the public understand the danger associated with fentanyl and its ana logues. SAMHSA should facilitate the distribution of fentanyl test strips along with naloxone -- especially to regions with above-average overdose rates and in regions with relatively low penetration of fen tanyl already -- and should collect data on how many test strips were distributed and used.
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In addition, the supplemental OD Treatment Access -- Reporting Form has a section devoted to "connection to appropriate treatment." As described for the FR-CARA program mentioned above, there are a range of available OUD treatments, some with more evidence to support them than others. "Connection" to treatment is a largely unquantifiable metric.
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Recommendation 2-4: The Substance Abuse and Mental Health Ser vices Administration should provide support to grantees to engage survivors of overdose in a full range of harm-reduction services (including syringe services programs and naloxone distribution ser vices) and collect data on how many of these individuals end up engaging in harm-reduction services (e.g., number of individuals receiving a naloxone kit following an overdose event)
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Recommendation 2-5: The Substance Abuse and Mental Health Ser vices Administration should require information on insurance cov erage and housing (or lack of coverage and housing) as additional metrics to be reported in grantees' disparity impact statements in the Division of State Programs Management Reporting Tool.
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of trained individuals who feel confident administering naloxone in the case of an overdose, the Substance Abuse and Mental Health Ser vices Administration should support grantees that focus on training laypeople or a community organization/agency/staff in measuring 7 See http://www.odmap.org (accessed April 21, 2020)
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should assess first responder job satisfaction and rates of compassion fatigue or turnover due to over dose prevention as key outcomes of the First Responder Training
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Furthermore, SAMHSA should support grantees in establishing mechanisms for maintain ing job satisfaction and preventing compassion fatigue among first responders.
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