Progress of Four Programs from the Comprehensive Addiction and Recovery Act (2021) / Chapter Skim
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3 OD Treatment Access and FR-CARA Programs
3 OD Treatment Access and FR-CARA Programs
Pages 45-70
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-approved drugs or devices for the emergency treatment of opioid overdose. To this end, the funding opportunity announcement (FOA)
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. METHODOLOGY The committee received one type of outcome data report for both the OD Treatment Access and the FR-CARA programs, along with one additional data report that pertains only to the OD Treatment Access program.
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years or other cost- • Use the SAMHSA Opioid Overdose Prevention sharing for Toolkita as a guide to develop and implement such drugs or a comprehensive prevention program to devices. reduce the number of prescription drug/opioid overdose–related deaths and adverse events." No more than 20 percent Allowable Activities of the total • "Collaborate with health care providers and award can be pharmacists to educate them on overdose used for data dangers, and to recommend that they consider collection, providing standing orders for FDA-approved performance overdose reversal drugs to patients and measurement, individuals who support persons at high risk and for overdose.
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. Summary Report from the CSAP Division of State Programs Management Reporting Tool (DSP-MRT)
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These two pieces of context led the committee to tentatively presume that the DSP-MRT summary report for the OD Treatment Access program covers program activities undertaken during the reporting periods of FY2018 and FY2019. The summarized nature of the material in the DSP-MRT summary reports presented additional limitations.
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The reporting period covered by the OD Treatment Access reporting form report is unclear, and will be addressed in the limitations section. The report was sent to the committee by SAMHSA in May 2020.9 As previously discussed, the committee contacted SAMHSA with a list of questions about the information provided on the OD Treatment Access program in the two reports.
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Relatedly, the summary reports suggested that all four grantees did directly distribute overdose reversal drugs and devices during the reporting period. The reports describe a great number of efforts around this activity, but due to the aggregating of some sections, it was not possible to confirm that two of the grantees distributed kits; however, the committee can confirm that those same two grantees purchased kits.
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grantees are reflected in the summaries Report from the OD OD Treatment Access Unclear reporting period Unclear how much progress may have Treatment Access (OD Treatment Access) been accomplished before/after that may Reporting Tool not be reflected in summary Material summarized Unclear how many grantees reported a across grantees, redacted given activity; aggregated quantitative (some subsections of data prevents analysis OD Treatment Access Reporting tool included disaggregated, verbatim responses; limitation does not apply for these few responses)
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. The extent to which these best practices were directly implemented by grantees or their partners was not always clear in the summary reports.
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These data were inconsistent with the data provided by the DSP-MRT summary report, with the latter reflecting significantly lower numbers. According to the data provided by the DSP-MRT summary report, grantees held "up to 96 trainings"12 in 9 different locations, reaching 1,870 participants (DSP-MRT)
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Required Activity 3: Establish Protocols to Connect Patients Who Have Experienced a Drug Overdose with Appropriate Treatment, Including Medications, Counseling, or Behavioral Therapies Protocols for Connecting Overdose Survivors to Treatment The OD Treatment Access reporting form asked the grantees to describe their efforts around this required activity,14 and the summary report that SAMHSA shared with the committee broke down these answers granteeby-grantee. Box 3-2 lays out the processes and protocols described by each grantee.
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. Quantitative Data on Connections to Treatment The OD Treatment Access form report provided quantitative data on the number of overdose survivors who were connected to and initiated various types of treatment during the reporting period.
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Grantee 4 • Attended meetings for city effort to "provide warm hand-offs to addiction treatment" to overdose survivors; the city hospital's emergency department will include them in their list of direct referrals. • Created an arrangement with the local EMS such that the grantee will be notified of the location of recent overdoses; the grantee states that they then connect with "the individuals who endured or were impacted by the overdose" and, using their toolkit, shares information about treatments.
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There are a number of confounds that make it difficult to interpret these quantitative data. First, the data provided in the summary report did not include a clear denominator representing the number of overdose survivors, in total, who were in contact with the grantees (SAMHSA Responses: OD Treatment Access)
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. The DSP-MRT summary report also noted that grantees reported having struggled to find alternative funding sources.
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(the number was unclear in the summary report) had cited low response rates as a challenge, and were working on a plan to improve their data tracking in the next reporting period (DSP-MRT)
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. Required Activity 5: Use SAMHSA's Opioid Overdose Prevention Toolkit19 as a Guide to Develop and Implement a Comprehensive Prevention Program to Reduce the Number of Opioid Overdose-Related Deaths and Adverse Events The OD Treatment Access reporting form asks grantees to describe "in what ways is your training curriculum informed by or consistent with" SAMHSA's Opioid Overdose Prevention Toolkit.20 However, neither this tool nor the DSP-MRT reporting tool asked that grantees comment on how the toolkit influenced other components of their "comprehensive prevention programs" (e.g., establishing prescribing programs, connecting survivors to treatment)
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. Allowable Activity 3: Provide Public Education on Any State "Good Samaritan" Laws Related to Drug Overdose Although no grantees reported having conducted additional educational programming specifically focused on Good Samaritan laws (see Box 3-4 for more information on Good Samaritan laws)
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The grantees reported varying levels of protection from legal consequences for possession of a controlled substance: 14 said that their jurisdiction provided protection from arrest, 18 protection from charge, and 16 protection from prosecution. For drug paraphernalia, 11 grantees reported that their jurisdiction's Good Samaritan laws provide protection from arrest, 14 from charge, and 13 from prosecution.
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Required Activity 1: Make a Drug or Device Approved or Cleared Under the Federal Food, Drug, and Cosmetic Act for Emergency Treatment of Known or Suspected Opioid Overdose Available to Be Carried and Administered by First Responders and Members of Other Key Community Sectors The primary goal of the FR-CARA program is to allow first responders and members of other key community sectors21 to administer a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose (SAMHSA, 2017e)
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The following are the remaining activities highlighted in the summary report that do not align as clearly with the First Responders program grant's required and allowable activities: • "Mobile medical outreach for the fire departments to reach out to shelters" • "Developing a workflow between the stakeholders" • "Naloxone training being taught to emergency medical system (EMS) by EMS" The following are three additional activities highlighted in the Division of State Programs Management Reporting Tool summary, the first under "accomplishments on sustainability" and the others under general accomplishments: • "Worked with partner agencies to put in place restorative, harm-reduction based policies and proce dures, which took into consideration stigma, drug addiction and treatment utilization" • "Accessing prevention needs assessment surveys, behavioral risk factor surveillance systems, hos pital discharge data systems, overdose death data, emergency department visits, and emergency medical services data sets" • "Collaborating with the Department of Human Services and State Drug Director's office to access multiple community needs assessments for a large population of the state residents" SOURCE: DSP-MRT.
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Required Activity 2: Train and Provide Resources for First Responders and Members of Other Key Community Sectors on Carrying and Administering a Drug or Device All FR-CARA grantees who submitted progress reports confirmed that they facilitated training and technical assistance activities during the grant period. In total, the grantees conducted 624 training sessions during the reporting period (DSP-MRT)
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Of those overdose survivors receiving treatment, 12 were receiving MOUD, 7 were receiving counseling, 16 were receiving behavioral therapies, and 53 were receiving "other treatments."23 The report stated that 188 overdose survivors were receiving treatment, but the committee is unclear on whether this number is correct, because the subtotals do not add up (DSP-MRT)
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may have included education on Good Samaritan laws. As noted in that section, grantees conducted 624 training sessions in the reporting period and 6,605 laypersons participated (DSP-MRT)
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SAMHSA reported that, overall, grantees had developed 17 new strategies for referring overdose survivors to treatment and recovery services; at the time of reporting, grantees had distributed information about treatment options to 570 overdose survivors and families, and many reported that overdose survivors were receiving various types of treatment, including MOUD, counseling, and more. Twenty grantees had held meetings with advisory councils that they had joined or that were newly established during the reporting period.
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