MaineGeneral Harm Reduction Program
- Need: To reduce deaths from opioid overdoses in rural Maine.
- Intervention: The MaineGeneral Harm Reduction Program provides community education and training for healthcare staff and first responders in rural Kennebec and Somerset counties.
- Results: During the grant period, MaineGeneral trained 45 deputies and 246 healthcare staff and educated 60 community members.
In 2016, Maine lost 376 lives due to overdoses from illicit or pharmaceutical drugs, compared to 38 lives lost in 1997. MaineGeneral Medical Center primarily serves the rural counties of Kennebec and Somerset, which have seen some of the highest rates of overdose deaths in the state.
MaineGeneral's service area spans nearly 5,000 square miles from central Maine to the Canadian border. First responders report that it can take up to 30 minutes for emergency medical services to arrive on scene, which can be too late in the event of an overdose. Maine law requires people to have a prescription in order to obtain naloxone (a drug that reverses opioid overdoses), which is a barrier for many people who lack primary care. This vast geographic region faces additional challenges, such as healthcare professional shortages and persistent stigma, that impact access to treatment for opioid use disorders.
The MaineGeneral Harm Reduction Program works to reduce these overdoses by educating medical staff, first responders, and the public on accessing and administering naloxone and accessing substance use treatment. The program received funding from the Federal Office of Rural Health Policy (FORHP) Rural Opioid Overdose Reversal Grant Program (ROOR).
The Harm Reduction Program provides:
- Community education in overdose prevention, naloxone access and use, and local treatment options
- Law enforcement trainings in naloxone use
- Training for medical staff in naloxone prescription and distribution in a clinical setting and waiver obtainment for prescribing buprenorphine for medication-assisted treatment
- Referral to treatment
Referring people at the scene of an overdose:
Maine does not require people who survive an overdose to be transferred to a medical facility, so MaineGeneral found that some people would decline further treatment and some even experienced another overdose after the naloxone wore off. To address this problem, MaineGeneral created wallet-sized information cards.
First responders carry these wallet-sized information cards to give to those who have overdosed or are at risk of an overdose. These cards provide phone numbers for the Harm Reduction Program, local substance use treatment programs, and the Maine Alliance for Addiction Recovery (a peer recovery group).
Referring people in a clinical setting:
Healthcare staff training on naloxone included how to screen patients and refer them to treatment. Program coordinators collected data on emergency admissions, drug-related admissions, and overdoses in the service area. These and other data helped healthcare staff determine which patients were at risk of an overdose.
Patients identified as at-risk might receive a naloxone kit, a brief intervention, or a referral to treatment, depending on a patient's risk level. The IT department developed an automatic prompt to alert staff to refer these patients to the Harm Reduction Program for additional education or follow-up.
During the ROOR project:
- 45 deputies at county sheriff's offices trained
- 60 community members and/or community organization staff educated
- 312 Narcan kits distributed to practices
- 81 kits dispensed to patients
- 46 from the emergency department or Mental Health & Substance Abuse Detox
- 35 from primary care
- 6 trainings to 35 emergency department staff
- 13 trainings to 211 primary care staff
- 91 patients referred and/or received a kit or other
- 54 from the emergency department or Mental Health & Substance Abuse Detox
- 35 from primary care
- 2 from sheriffs
- 3 confirmed reversals
- 2 from Kennebec County sheriffs
- 1 from the emergency department
In June 2017, MaineGeneral presented its Harm Reduction Program during the National Organization of State Offices of Rural Health (NOSORH) Reducing Rural Opioid Overdoses: Lessons Learned from the Rural Opioid Overdose Reversal Grant Program webinar.
First responders were unsure when, where, or how to hand out the wallet-sized information cards, so program coordinators developed talking points and scripts to help the responders feel more comfortable having conversations about overdose, treatment, and available resources.
Healthcare staff face many barriers with staffing shortages and existing patient care and quality improvement priorities. Staff needed support in implementing new workflows for screening, referral, and naloxone prescribing. Program coordinators developed naloxone prescribing guidelines to help staff quickly screen for opioid overdose risk, created local resources for accessing naloxone, and worked with the IT department to electronically automate tasks.
Before receiving the FORHP grant, MaineGeneral had done a pilot program distributing emergency opioid overdose kits through the chronic pain clinic. This experience helped the center in applying for and receiving the grant. The pilot program also helped MaineGeneral gain buy-in from stakeholders such as healthcare leaders and law enforcement.
Harm Reduction Program coordinators keep track of local resources such as substance abuse treatment, counseling, and social services available in the region, so people who are ready for intervention or treatment know they have nearby options. Program coordinators also called local pharmacies and kept track of which had naloxone in stock (injector or nasal spray).
MaineGeneral involved champions for its program. MaineGeneral has a staff member who has been providing medication-assisted treatment for a number of years. This staff member offers mentoring and support to the newly trained providers, who received training through the American Academy of Addiction Psychiatry's buprenorphine waiver training program.
Other resources, courtesy of MaineGeneral:
- Resource Binder for Naloxone Distribution in Emergency Department
- Resource Binder for Naloxone Distribution in Primary Care
- Kennebec County Sheriff's Department Opioid Overdose and Naloxone Administration Student Manual
Wallet-sized information cards:
Information about overdose, naloxone, and waiver training:
Malindi Thompson, MPH, Harm Reduction Program Manager
MaineGeneral Prevention & Healthy Living
Emergency medical technicians and paramedics
Health workforce education and training
Illicit drug use
Prescription drug abuse
July 31, 2017
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