After a dramatic rise in heroin overdose deaths in Jefferson County and the greater Birmingham area of Alabama in 2012-2013, the U.S. Attorney for the Northern District of Alabama partnered with the Jefferson County Department of Health, the UAB School of Public Health, the Addiction Prevention Coalition and others to convene community stakeholders for a “Pills to Needles” Heroin Summit in June 2014.
This was the kick-off of a multi-stakeholder community effort to address what was beginning to be called the “Opioid Epidemic,” and it was a recognition that this was an extremely complex problem that no one organization or sector of the community could solve alone. The Heroin Summit was followed by the development of a strategic plan and an informal coalition of partners, known as the Pills to Needles Initiative, which worked together on several strategic priorities.
The group was reconvened in 2018 and is now titled the Addiction and Recovery Alliance.
- To create a healthier Jefferson County for all by:
- Preventing and reducing substance use behaviors and harms among its residents.
- Reducing harms associated with substance use.
- Promoting prevention and recovery and improving quality of life for people affected by substance use.
- To employ a community network model of collaboration in which organizations and individuals work together on common priority areas related to substance use beyond what is achievable when these organizations and individuals work separately.
- To assist or exchange ideas with neighboring Alabama counties in their own collaborative efforts to address substance use, and serve as a model that other communities can replicate.
The Initial Priority Areas of the Alliance will be:
Participants were invited to identify challenges and propose solutions in two areas: Prevention, Education and a Message to Parents and the other Access and Resources to Treatment. Below are the results of those sessions.
Prevention, Education, A Message To Parents
What else needs to be done to further youth-specific preventive measures for opioid and heroin abuse and addiction?
About 60% of the responses to this question focused on building awareness and offering education for youth and families. These included:
- creating a targeted plan for outreach
- educating teachers
- developing age appropriate curricula about addiction
- hiring more prevention educators and counselors in schools
- using media to increase attention to the issue
Specific strategies for building awareness and educating youth included creation of youth advocacy groups within schools and across districts, increasing outreach to elementary school students, mandating drug awareness and education classes for students and parents in schools, promoting programs through the faith community, and leveraging social media and other technology resources.
Additional recommendations addressed prevention; these included
- focusing on those experiencing “adverse childhood events” (ACE)
- mandating drug prevention education for vulnerable populations, such as youth in foster care and the juvenile justice system
- creating tougher drug testing protocols for students and an anonymous reporting system
With regard to treatment, increased access to mental health care and third party coverage of substance abuse treatment was recommended as was street outreach for referral to treatment.
A number of comments referred to the need to reduce stigma about opioid and heroin use to encourage schools, churches, neighborhood associations and other groups to talk about this issue. Creating safe spaces for people to share their stories, leveraging social media, and promoting the face of recovery were strategies identified to address stigma.
Other suggestions included partnering with law enforcement agencies in rural areas to dispose of prescription drugs, pursuing grants through the Drug-Free Communities Support Program, providing free drug testing kits for parents and establishing a central individual and phone contact number for kids and adults to report drug issues and concerns so that they can be acted upon by school and law enforcement.
What metrics do we need to track the impact of these preventive measures?
- number of 30+ day prescriptions
- number of students requiring intervention
- crime statistics for minors
- age of onset of drug use
- number of overdoses and overdose deaths
- quantity of unused medication turned into drop boxes
Resources and Access to Treatment
What else do we need to be doing within our personal communities and the community-at-large to combat opioid and heroin addiction and abuse?
What are we missing?
Approximately 50% of responses to this question focused on educating youth and their families and teachers about opioid abuse and heroin addiction, recommending
- student awareness initiatives
- teacher training
- curriculum development
- increasing availability of social workers in schools
Responses also included recommendations about general community engagement and awareness, such as
- developing community coalitions
- holding public workshops and information sessions
- using PSA’s and drug deactivation kit distribution to raise awareness
With regard to providers, recommendations included educating and empowering physicians and better equipping the non-medical provider community with evidence based resources such as naloxone. Additional suggestions included more stringent use of PDMP and opening additional county health departments to assist with treatment.
Additional comments included the suggestion to research best practices in other communities for addressing the opioid epidemic. Finally, with regard to law enforcement, it was recommended that law enforcement agencies be encouraged as appropriate to divert substance users to treatment instead of the legal system.