Responding to the Opioid Epidemic in North CountryIn 2016, NYHealth awarded Essex County Public Health a grant to implement an evidence-based approach to combatting substance use disorders in Essex County.
Essex County Public Health
Special Projects Fund
May 2016- April 2018
The opioid epidemic has been called the worst drug crisis in American history; death rates rival those of AIDS during the 1990s, and overdoses from heroin and other opioids kill more than 27,000 people a year in the United States.
New York has not been spared—in 12 upstate New York counties alone, the number of heroin overdoses jumped 417% between 2009 and 2013. In response, the Essex County Public Health Department (ECPHD) established the Essex County Heroin and Opioid (ECHO) Prevention Coalition, a multiagency collaboration to prevent and reduce heroin and opiate use and addiction. A top priority for the coalition was to launch a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program in Essex County. SBIRT has been proven to reduce health care costs, decrease severity of drug and alcohol use, and reduce risk of trauma.
Outcomes and Lessons Learned
- Launched SBIRT at Elizabethtown Community Hospital and the Essex County Health Department Maternal Child Health Program.
- Launched a campaign to raise awareness of opioid use in Essex County, establishing a social media presence, website materials, and community forums.
- Hired a coordinator to aid in implementing SBIRT and increase awareness and education of opioid and heroin use. The coordinator worked closely with the ECHO Prevention Coalition in creating a referral resource list that connected emergency departments, safety-net providers, and public health centers using SBIRT with comprehensive treatment options for high-risk patients.
ECPHD was largely successful in increasing the number of provider organizations adopting SBIRT programs. It was unable to enlist one of its target systems, Hudson Headwaters Health Network (HHHN). The main reason for this was the size of the organization—HHHN is one of the largest providers in the region, with 21 community health centers providing primary care to residents living in the 7,200 square miles of the Adirondack North Country and Glens Falls region. The adoption of an SBIRT program would have required buy-in from, as well as training for, each of these sites. ECPHD underestimated the amount of time and resources needed to recruit HHHN by the end of the grant. With this experience in mind, NYHealth will work more closely with grantees to take stock of the major barriers to scaling this type of program and setting appropriate goals.
To complement SBIRT implementation, ECPHD worked with Albany’s chief of police to explore the possibility of piloting a Law Enforcement Assisted Diversion (LEAD) program in the North Country. That partnership proved fruitful and LEAD is currently being developed and piloted by the Sheriff’s office in Essex County.
NYHealth is a longtime supporter of the region and its efforts to strengthen its health care capacity. However, like many of New York State’s rural regions, the North Country’s infrastructure and limited resources continue to pose barriers to health and public health services. The COVID-19 pandemic has only exacerbated these challenges.
Essex County is entirely within the Adirondack Park, making it one of the most rural and underserved regions in the State. The county and surrounding environs have long been designated as a Health Professional Shortage Area. With only 25 beds, Elizabethtown Community Hospital was designated as a critical care access hospital. The county public health department, with its staff of eight, was responsible for coordinating all health services, emergency responses, crisis management and trainings for the region.
Although an SBIRT work plan, policy and training outline were established, the shortage of health care professionals made it difficult to recruit staff for the program. A social worker was eventually placed within the hospital’s emergency department to conduct SBIRT; however, given the enormity of the opioid epidemic, the hiring of one person was not sufficient to address the problem. Consequently, urgent overdose cases were transferred out of Elizabethtown Community Hospital to one of the University of Vermont (UVM) Health Network hospitals, making the collection of data nearly impossible (Elizabethtown was unaffiliated with UVM Health Network at the time). Additionally, it was overly ambitious to train and administer SBIRT within the maternal and child program of such a small county public health department with limited resources.
In recognition of the grantee’s limitations, and to better secure the program’s sustainability, the county public health staff and the ECHO Prevention Coalition agreed to relocate the SBIRT training program to St. Joseph’s Treatment Center, a regional health provider specializing in substance use disorder. As a coalition member and disorder specialist, St. Joseph was familiar with the lessons learned from this grant and was better positioned to continue this work.
Co-Funding and Additional Funds Leveraged: None