Community Overdose Engagement Project Targets Overdose Prevention Where it is Needed Most
If it seems like rates of drug overdoses and deaths resulting from them have been getting worse in Providence over the past few years, it’s because they have. Over the past decade, the number of overdose-related deaths in Rhode Island have ranked among the highest in the country, and when COVID-19 struck, the already crisis-level rates of overdose related deaths only increased, increasing by about 25% in Rhode Island in 2020.
In response to this growing overdose crisis a few years prior, the Rhode Island Department of Health (RI DOH) created the Community Overdose Engagement Project (CODE) as a part of the state’s larger Health Equity Zone (HEZ) program. HEZs seek to address health outcome inequities by responding to the specific social determinants of health that adversely impact people’s health in under-resourced zip codes. CODE aims to improve local responses to overdose by collecting and analyzing data specific to these spaces and implementing responses based on community needs identified through community engagement processes. Data from a variety of public sources is compiled by the RI DOH to create localized reports of overdose EMS and fatality data. This data is synthesized to identify ‘hotspots’ where efforts can be targeted based on the disproportionate likelihood of overdoses occurring there again.
Systems Change Strategies was part of the cross-sector partnership of organizations who collaboratively implemented the CODE project in the 02907 HEZ area, which includes the West End, South Providence, Elmwood, Reservoir, and a small area of Cranston (that’s not included in the project’s work). West Elmwood Housing Development Corporation leads the 02907 HEZ as the backbone agency. For this project, Amos House and Project Weber/RENEW (PWR) provided programmatic partnership on the project as well, both are 02907-located direct service nonprofits with well-established histories of providing harm reduction and addiction recovery support (among many other services) to people in the nearby community. Together the team has responded to overdose prevention in Providence using a public health lens and a focus on gathering and operationalizing information garnered directly from the people most affected.
It is, of course, impossible to speak about the state’s response to this crisis without recognizing how divergent the government’s current reaction has been in contrast to the crack epidemic of the 80s. When lives being lost to drugs were relegated to Black and Brown communities, the response was one of previously unseen levels of criminalization and punitiveness, while today the issue of drug-related deaths is being treated as a public health crisis, not a criminal or moral one. The extraordinary step we’ve just seen taken by the state government in passing legislation to create a pilot program for safe injections sites, along with things like the CODE program and the state’s Overdose Task Force, are just a few recent examples of how far the pendulum has swung.
While we can never truly make whole the lives of those who we abandoned during that time, our mission now is to do our best to prevent further suffering and preventable loss of life due to ineffective or harmful policies around drugs and people who use them. And watching the opioid crisis become increasingly worse every year, it’s clear that the decades long ‘war on drugs’ has failed and that there is no time to waste finding a new approach.
There had never been a comprehensive, community-led needs assessment done in Providence to determine the impact of substance use and overdose, so the first step for SCS was executing this formidable task at the height of lockdown during the COVID-19 pandemic in May - July 2020. We began the process by first analyzing existing data about the area, including demographics, the impact of social determinants of health on the levels of drug use and misuse, and reports from the state’s overdose taskforce.
Next came the arguably far more important step of asking for input directly from current or former drug users in order to assess their felt needs around overdose and substance abuse. We solicited our partners' input to create an exhaustive 9-page survey, covering everything from experiences with overdose to housing status and other social determinants of health. The survey was then distributed and collected by outreach workers from Amos House and PWR. The teams ended up collecting surveys from 100 people with lived experience in 02907 which provided information about respondents’ demographics, their familiarity with naloxone administration, and the effect of COVID-19 on local drug use, as well as what resources they identified the greatest need for.
These survey results were then supplemented by insights gathered from key informant interviews with community leaders and heads of organizations who work within the various social, health, and public intersections of overdose prevention. The results were assembled in a comprehensive report that gave a thorough overview of the demographics of the respondents and highlighted the most common responses to questions about community needs. These were adapted into recommendations for further action, which included a desire for greater access to affordable housing, better coordination between social service agencies in Providence, more transparency about available data relating to overdoses, and an appeal for overdose prevention sites.
In year 2 of the project, SCS and the partner organizations got to work fulfilling these recommendations, starting with piloting programs that offered participants access to recovery housing. This resulted in 21 housing grants being awarded through Amos House and PWR to people seeking housing in the community. Quarterly community meetings were held to report the year findings and then quarterly data updates, in addition to offering a space for community members to learn about these efforts, and get involved to support. This includes offer naloxone training to over 50 visual participants on the Q2 2021 meeting. Over 40 local organizations and 6 Providence neighborhoods have represented in attendance at these meetings, and attendees have on multiple occasions reached out to the organizers to hold training sessions for people and organizations in their networks.
Because overdose has a profound effect on not just the person experiencing it, but on the entire community, a key element of Phase Two focused on the inclusion of businesses located in or near the overdose hotspots to bring them into the work of recognizing and preventing overdose. Outreach teams from Amos House and PWR visited these establishments to inform the employees about harm reduction services available in the area, how to obtain and use naloxone to reverse an overdose, and where their neighbors struggling with substance use disorder can find help with housing.
This public education campaign also included the installation in local bus shelters of eye-catching, multilingual posters containing information about how naloxone can stop an overdose, as well as an operation that distributed paper bags with information about harm reduction and overdose prevention in English and Spanish to local shops to use in their check-outs. Additionally the virtual community meetings were held online via Zoom meeting, and promoted on social media platforms via geographically targeted paid advertisements. In this way SCS and the CODE team were able to spread awareness to the entire neighborhood, not just to the people who directly interacted with program staff. Impact measurements for these efforts are still on-going, but we estimate these ads reached over 25,000 community members through year 2, with hundreds of thousands of impressions over the course of the 4 month campaign.
The 02907 CODE project is currently entering it’s 3rd year, and we hope to continue to build on our successes and learn from the challenges we faced, which, in 2020, were numerous. Only a few months into year 1 of the project COVID-19 shut down RI and the world. This meant that not only the community engagement strategy for the project had to be almost entirely reworked to adhere to COVID protocol, but also that the need for overdose response became only more urgent due to a sudden rapid increase in overdose related deaths that concurred with COVID-19 pandemic. In 2021, the passage of landmark legislation to pilot an overdose prevention site, as well as laws to decriminalize buprenorphine and defelonize many drug charges, in addition to the continued investments in projects like CODE indicate that Rhode Island is moving in the right direction, and we at SCS are proud to play a small part in helping our fellow Providencians see an end to preventable deaths caused by overdose, and reduce the risk of harm for people who use drugs.