An Outreach Program for People in Philadelphia Opioid Use Disorder

1. Assess the data needed to design the program and collection method.

Opioid use disorder has become a growing concern in the United States. The Centers for Disease Control and Prevention have declared it a public health epidemic due to the rise in accidental overdose deaths from opioid use, particularly the increase of fentanyl and synthetic opioids (Langabeer, et al, 2020). Treatment for opioid use disorder through medication-based methods has been recommended, but many individuals with the disorder do not seek treatment voluntarily, even after an overdose. Cognitive theories suggest that patients who have survived an overdose may be more willing to engage in treatment if presented with options (Langabeer, et al, 2020; Curley, 2020).

Outreach programs involve deploying specialized teams to the homes of high-risk populations to motivate them to engage in treatment. Pilot studies have shown that peer outreach networks can improve the linking of individuals to treatment. Using data surveillance systems between hospitals and first responders can provide useful information to guide outreach efforts (Langabeer, et al, 2020; Curley, 2020). A study has been conducted in a major metropolitan city to pilot an intervention that combines outreach efforts guided by the hospital and first responder data to engage and retain patients in a treatment program. The objective is to find innovative ways to motivate individuals with opioid use disorder into treatment and improve access to healthcare services. The data needed to design the outreach program will be assessed, and a collection method will be established. The inclusion criteria for the program will focus on serving uninsured and underinsured low-income clients in Philadelphia. However, the city does not support “another free clinic.”

2. Summarize the steps in the process that will identify the priority needs of the program.

A program was established to provide outreach services to individuals in Philadelphia who struggle with opioid use disorder. The program is a non-profit that aims to serve uninsured and underinsured low-income clients who cannot access the necessary healthcare services. Despite objections from the city, the program is still in the design phase, with an interdisciplinary team leading the effort. The inclusion criteria for the program are centered around individuals who have recently experienced an opioid overdose and have not enrolled in any opioid use disorder treatment. Participants must be adults over 18 years old, able to speak/write English, motivated to begin treatment, and not incarcerated (Langabeer, et al, 2020).

Potential participants are identified through two sources, the emergency department of the local Hospital and the Philadelphia Fire Department emergency medical services. The program aims to reach those in the community who have experienced an overdose but may not have received treatment. Patients who overdose in the emergency department are approached by their treating physicians or on-duty research associates. Their readiness for change is assessed through a visual analog scale, and a minimum level of 3 has been established as a cutoff for lack of readiness. Participants who have consented and have been discharged from the emergency department are entered into the surveillance system for next-day home outreach (Langabeer, et al, 2020).

Patients who overdosed and were treated with naloxone (Narcan) were recorded in a surveillance system. An outreach team consisting of a peer recovery coach and a licensed paramedic was dispatched to their locations. The peer recovery coaches provided non-clinical support and were certified by the National Association of Alcoholism and Drug Abuse Counselors. At the same time, the paramedics were part of the agency’s community paramedicine team (Langabeer, et al, 2020).

Outreach was performed directly to the individuals’ homes, where motivational interviewing techniques were used to screen, inform, and motivate them to choose treatment. Patients had to present themselves to the primary research office for all enrollment paperwork and a no-charge medical examination. The medical examination confirmed the diagnosis of OUD and obtained baseline clinical information such as vital signs and drug use history. All patients underwent the enrollment process, which included the medical examination and collection of data on demographics, contact information, and prior history of OUD treatment, family, and mental health (Langabeer, et al, 2020).

The team followed up on individuals regularly to monitor progress and provided them with information about local treatment programs, opioid use disorder, Naloxone reversal medication, and contact information. Participants provided signed informed consent forms before enrolling in the program. Enrolled individuals were rapidly inducted into the program using buprenorphine by emergency medicine physicians who were waivered by the 2000 Drug Addiction Treatment Act. The type of ongoing treatment was not limited to buprenorphine and could include any of the three approved medications. The physicians, who were part of the HEROES research team, provided same-day prescriptions to prevent a prolonged physical withdrawal period and increase the likelihood of success (Langabeer, et al, 2020).

The program offered free services, including weekly counseling sessions that included one-on-one meetings with addiction counselors, group counseling led by peer recovery coaches, and educational groups that discussed addiction and strategies for recovery. Participants were encouraged to utilize these resources for support. After enrollment, research coordinators facilitated placement into an ongoing, outpatient-based MOUD treatment clinic. Patients and their outpatient providers decide which medication to use for ongoing treatment. The study’s social worker assisted with linkage to care, and in case of delays, the physician would provide a bridge prescription to prevent withdrawal. The model for utilizing emergency medicine physicians to initiate MOUD was developed at Yale School of Medicine (Langabeer, et al, 2020).

In addition to the counseling and treatment services, a peer recovery specialist and social worker assisted participants in finding stable, free housing. The team helped find employment opportunities and provided financial literacy training for those without employment. The program was designed to support individuals in their journey to recovery and help them achieve stability and independence (Langabeer, et al, 2020).

The program aims to have a high engagement rate with patients, defined as their willingness to participate and attend the medical and behavioral treatment program and to have a high retention rate through the 30- and 90-day endpoints. The program will also measure the number of subsequent relapses and overdoses among enrolled patients. The data for engagement and retention will be collected through attendance records and follow-up evaluations. In contrast, data on relapse incidents will be collected through patients’ reports during interviews and phone surveys. The priorities of the outreach program are to increase patient engagement and retention in the medication and behavioral treatment program. This is done to ensure that patients receive the care they need and can stay in the program long enough to achieve their desired outcomes. Additionally, the program aims to reduce the number of subsequent relapses and overdoses among enrolled patients, as these incidents can seriously harm the health and well-being of those who struggle with opioid use disorder (Langabeer, et al, 2020).

3. Compare and contrast models that guide program development, select a model for this program, and support your decision.

Medication-assisted treatment (MAT), similar to methadone and buprenorphine, has been proven effective in reducing opioid use and associated negative health outcomes. However, there are numerous barriers to accessing MAT, including limited treatment capacity, financial barriers, regulatory barriers, geographic barriers, negative attitudes toward medication-assisted treatment, and logistical barriers. A study showed that only 26.2% of injection drug users sought drug treatment after an overdose and that the odds of entering treatment were higher if they spoke with someone about it (Scott, Grell, Nicholson, & Dennisd, 2018).

Attempts to link individuals with OUD to treatment after an overdose have mainly focused on screening patients in hospital emergency departments or inpatient settings. Still, many individuals refuse to go to an ED or leave before receiving any effective intervention or referral to treatment. Without treatment following an overdose, the likelihood of resuming opioid use and the risk of death increases. Individuals at risk for multiple overdoses need assistance, as they typically have co-occurring mental health problems, lack resources, and report polysubstance use (Scott, Grell, Nicholson, & Dennisd, 2018).

To guide program development, it is necessary to compare and contrast different models and select one that best fits the program’s goals and objectives. The selected model should consider the barriers to accessing MAT and the need for more assertive mechanisms to facilitate treatment entry after an overdose. It should not be forgotten that the opioid epidemic is being addressed by implementing harm reduction programs and strategies (Milaney, Haines-Saah, Farkas, 2022). Harm reduction originated as a movement led by drug user activists and sought to challenge the oppressive and criminalized views of drug use. It now focuses on minimizing harm from drug use and working with individuals who use drugs toward positive change rather than solely focusing on abstinence. This approach differs from traditional medical approaches by prioritizing user empowerment and positive change (Milaney, Haines-Saah, Farkas, 2022).

The therapeutic communities model provides long-term residential care for individuals with drug use disorder. These communities were created in the late 1950s and early 1960s and used staff and peer confrontations to challenge residents to live without drugs. The length of stay was long, with a focus on modifying behaviors and developing daily living skills. Over time, these practices moderated, but the legacy of tough love remains in some drug treatment services provided in penal institutions (McCarty, Priest, & Korthuis, 2018).

The opioid agonist therapies model involves drugs that attach to and activate opioid receptors to prevent withdrawal. These therapies started with morphine dispensations and later included methadone and buprenorphine. Despite their effectiveness in treating opioid use disorder, these therapies have been met with controversy and stigmatization. Moreover, Motivational Interviewing (MI) is a client-centered counseling approach that seeks to enhance intrinsic motivation to change. MI recognizes that behavior change is a process and involves exploring and resolving ambivalence. MI is being increasingly used in substance abuse treatment and has been established to be effective in reducing substance use and improving treatment outcomes (McCarty, Priest, & Korthuis, 2018).

In designing an outreach program for people in Philadelphia with opioid use disorder, it is important to compare and contrast various models that guide program development to select the most appropriate model. This can include harm reduction, therapeutic communities, opioid agonist therapies, and motivational interviewing (McCarty, Priest, & Korthuis, 2018). The selected model should align with the program’s goals, including serving low-income, uninsured, and underinsured clients while considering the city’s stance on creating “another free clinic.”

In conclusion, the opioid epidemic presents numerous barriers to accessing medication-assisted treatment (MAT) for individuals with opioid use disorder (OUD). To effectively guide the development of an outreach program in Philadelphia, it is important to consider various models, such as harm reduction, therapeutic communities, opioid agonist therapies, and motivational interviewing, and choose the one that aligns with the program’s goals and objectives. The selected model should also consider the city’s stance on creating “another free clinic” and serving low-income, uninsured, and underinsured clients. With the right approach, the outreach program has the potential to significantly reduce opioid use and associated negative health outcomes while empowering individuals with OUD to make positive changes.

4. Develop short-term, intermediate, and long-term objectives using the “SMART” method.

The short-term objectives using the “SMART” method would be specific, measurable, achievable, relevant, and time-bound goals that can be accomplished within a year or less. The intermediate objectives would be goals with a timeframe of 3 to 4 years, and the long-term objectives would be goals with a timeframe of 5 years or more. These objectives should align with the overall goal of the outreach program for people in Philadelphia who have an opioid use disorder and should aim to improve access to healthcare services and prevent opioid misuse, abuse, and dependence (Joudrey, Bart, Brooner, 2022).

GOAL 1: The outreach program for people in Philadelphia aims to prevent opioid misuse, abuse, and dependency through improved prescribing practices. This is part of the program’s broader goals, which are focused on addressing the opioid epidemic in the city.

GOAL 2: One of the goals of the outreach program is to expand access to treatment for individuals struggling with opioid abuse and dependence. This goal aligns with the interdisciplinary team’s mission to serve low-income, uninsured, and underinsured clients who need healthcare services.

GOAL 3: The outreach program also focuses on preventing overdose deaths by educating individuals about the signs of an overdose and expanding the distribution of naloxone. This aligns with the team’s aim to provide comprehensive and evidence-based care to individuals struggling with opioid use disorder.

GOAL 4: To ensure the effectiveness of the outreach program, the team plans to use existing data and enhance data collection efforts to inform the selection of strategies. This will help the team to detect opioid and other illicit drug misuse/abuse and make informed decisions based on scientific evidence.

GOAL 5: The outreach program will also focus on identifying and implementing innovative strategies to reduce the risk of overdose to individuals and communities disproportionately affected by the opioid epidemic. This goal aligns with the team’s aim to reduce stigma and provide comprehensive and inclusive care to those in need (SMART Objectives, 2019, 2020).

5. Summarize the expected barriers and challenges in developing the program and develop an action plan. Include operational and support issues.

A team of interdisciplinary professionals is developing an outreach program to serve people in Philadelphia with opioid use disorder (OUD). Despite the established efficacy of medication-assisted treatment (MAT) in cutting down opioid use and its adverse impact, accessing this treatment is hindered by several barriers, including limited treatment capacity and financial, regulatory, geographic, attitudinal, and logistical barriers. A study showed that the odds of entering treatment are higher among individuals who have spoken with someone about drug treatment after an overdose, highlighting the need for more assertive mechanisms to facilitate treatment entry (Scott, Grell, Nicholson, & Dennisd, 2018).

Many efforts to link OUD patients to treatment following an overdose have been focused on screening patients in hospital emergency departments or inpatient settings, with some preliminary evidence of success. However, many individuals who overdose do not go to the emergency department or leave before any effective intervention or referral to treatment. The risk of death increases with successive overdose experiences, and individuals at risk for multiple overdoses typically have co-occurring mental health issues, lack of resources or support, and report polysubstance use (Scott, Grell, Nicholson, & Dennisd, 2018).

The outreach program aims to serve uninsured and underinsured low-income clients who cannot receive the necessary healthcare services. However, the city does not support “another free clinic.” As a result, it is critical to consider the potential barriers and challenges in developing the program, including operational and support issues (Greene, 2021).

The success of the outreach program will depend on overcoming these barriers and addressing the needs of the target population. This can be achieved through partnerships with existing healthcare providers, leveraging community resources, and addressing the financial, regulatory, geographic, attitudinal, and logistical barriers to accessing treatment (Greene, 2021).

In conclusion, the outreach program for people with OUD in Philadelphia faces several challenges, including city opposition to “another free clinic” and barriers to accessing treatment. Addressing these challenges will require a comprehensive approach that leverages community resources, partnerships with healthcare providers, and solutions to the financial, regulatory, geographic, attitudinal, and logistical barriers to accessing treatment (Greene, 2021).

Action plan

There are proposals to address the opioid epidemic, including prescription guidelines and standards promoted by public health institutes like the U.S. Centers for Disease Control and Prevention. These guidelines address when to initiate or continue opioid use, selection and dosage, and assessing risk and harm. Providers must make individual clinical decisions based on each patient’s circumstances (Hoffman, Ponce Terashima, & McCarty, 2019).

The aim is to find a balance between preventing opioid misuse and supporting patient needs for pain medications. Providers should advise patients about the adverse effects of opioids and screen for opioid use disorder. Policies can be enacted related to written instruction, such as the detailed labeling of opioids. One strategy to prevent opioid misuse is to require opioid manufacturers to fund continuing medical education for providers. These programs are voluntary and aim to increase knowledge about opioid use and prevent harm. Another approach is to expand access to treatment for opioid use disorder through the Affordable Care Act and Medicaid expansion. This will help individuals receive the necessary care and support to overcome their addiction (Hoffman, Ponce Terashima, & McCarty, 2019).

The outreach program should consider the limitations and consequences of opioid use and promote effective treatment options. The operational and support issues should be addressed through a comprehensive action plan (Hoffman, Ponce Terashima, & McCarty, 2019). The program should aim to be inclusive and meet each client’s unique needs while also considering the city’s stance on “another free clinic.”

6. Develop a program justification for stakeholders. Include well-defined expectations and value propositions.

The COVID-19 pandemic has had a far-reaching and profound impact on the lives of people who use opioids (PWUOs). The pandemic has added to an increase in overdose rates. It has exacerbated the existing challenges that PWUOs face, such as isolation, decreased access to treatment and harm reduction services, and increased comorbidities (Krawczyk, Fawole, Yang, & Tofighi, 2021).

Given the urgency of the challenges, access to treatment for opioid use disorder (OUD) must be improved. Medications for opioid use disorder (MOUD) and harm reduction services, such as naloxone administration and syringe services programs, have been proven effective in reducing overdose risk and improving health outcomes. MOUD, such as methadone and buprenorphine, can help PWUOs manage their opioid cravings and withdrawal symptoms. In contrast, harm reduction services can help prevent overdoses and the spread of blood-borne diseases (Krawczyk, Fawole, Yang, & Tofighi, 2021).