MaineGeneral Harm Reduction Program

Description

In 2019, Maine lost 380 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 primary 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. While Maine law no longer requires people to have a prescription in order to obtain naloxone (a drug that reverses opioid overdoses), the rural nature of the state 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 overdoses by educating medical staff, first responders, and the public on accessing, distributing, and administering naloxone and accessing substance use treatment. The program has received grant funding from the Federal Office of Rural Health Policy (FORHP) Rural Opioid Overdose Reversal Grant Program (ROOR), the Rural Health Opioid Program (RHOP), and the Rural Communities Opioid Response Program to continue and expand this work.

Services offered

The Harm Reduction Program provides:

• Community education in overdose prevention, naloxone access and use, and local treatment options
• Training for medical staff in naloxone prescription and distribution in a clinical setting and waiver obtainment for prescribing buprenorphine for medication-assisted treatment
• Training for staff of community agencies on community distribution of naloxone
• Distribution of naloxone to high-risk individuals, family members, and friends of high-risk individuals
• Referrals to substance use treatment and other recovery services
• Education on Maine's Good Samaritan Law, which protects individuals experiencing an overdose as well as those seeking medical assistance for those individuals
• Education and referrals for Peer Recovery Coach services provided by local partner organizations

State Narcan distribution:

MaineGeneral was selected by the state of Maine to distribute state-purchased Narcan kits to community-based organizations and other healthcare providers throughout 9 of the 16 counties in Maine. MaineGeneral conducts the initial trainings on distribution requirements, data tracking requirements, and resupplies organizations submitting refill requests. Staff collect all distribution data and submit to the state on a monthly basis.

Narcan distribution at the needle exchange locations:

The Chief Medical Officer for MaineGeneral signed a standing order for the distribution of Narcan at both of the needle exchange locations. This allows staff to provide Narcan and trainings directly to the highest-risk populations. Staff track distribution and refills of Narcan. When individuals refill their kits, staff also collect overdose reversal information.

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.

Results

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 Behavioral Health 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 services
  • 54 from the emergency department or Behavioral Health Detox
  • 35 from primary care
  • 2 from sheriffs
• 3 confirmed overdose reversals
  • 2 from Kennebec County sheriffs
  • 1 from the emergency department

During the RHOP Project:

Stigma assessments:

• 10 focus groups with approximately 60 individuals in different stages of recovery
• 103 surveys with individuals in recovery or actively using
• 147 surveys with community members
• 152 with frontline staff (nurses, medical assistants, patient service representatives)
• 71 healthcare providers

The program received valuable feedback from these groups around their experiences with stigma and the impact it has on them. The University of Southern Maine analyzed the survey and focus group data.

Trainings:

• 48 providers were trained on Harm Reduction services
• 45 providers were trained in Screening, Brief Intervention, Referral to Treatment (SBIRT)
• 10 providers were trained to prescribe buprenorphine

All inpatient units at MaineGeneral have Narcan available in their medication dispensing systems to distribute to patients upon discharge. MaineGeneral's Harm Reduction staff provide trainings on distribution, data tracking, and refills:

• 3 primary care practices trained, with 13 prescribers and 35 paraprofessionals
• 16 inpatient units trained, with 2 prescribers and 81 paraprofessionals
• 110 Narcan kits distributed through the emergency department
• 16 Narcan kits distributed through inpatient units

State Naloxone trainings:

• 64 Naloxone trainings conducted throughout 9 of 16 counties in Maine
  • 47 clinical organizations with 502 staff trained
  • 17 community organizations with 193 staff trained
• 695 total staff trained
• 3,803 Narcan kits distributed to community agencies
• 21 reported overdose reversals

There were 146 referrals to harm reduction from the emergency department, and 715 Narcan kits were distributed to exchange members, 60 of which reported overdoses.

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.

Challenges

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 automate referrals to the Harm Reduction program when a Naloxone kit is distributed.

Stigma associated with substance use also remains a major barrier for first responders, law enforcement, healthcare staff, people who use drugs, and the larger community.

Replication

Before receiving the FORHP grant, MaineGeneral developed 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.

MaineGeneral involved champions from all corners of the organization including treatment, behavioral health, senior leadership, legal, and compliance. These champions remain engaged as the legal landscape around substance use changes in Maine. This support allowed for considerable expansion of MaineGeneral's services over the past year.

Harm Reduction Program coordinators keep track of local resources such as substance use treatment, counseling, and social services available in the region. When people are ready for intervention or treatment, staff know the available options. Program coordinators also called local pharmacies and kept track of which had naloxone in stock (injector or nasal spray).

Other resources, courtesy of MaineGeneral:

Wallet-sized information cards:

• First Responder Overdose Wallet Card
• Next Step Wallet Card

Information about overdose, naloxone, and waiver training:

• Accidental Overdose Brochure
• "Save a Life" Magnet
• Narcan Quick Start Instructions

Contact Information

Shane Gallagher, Harm Reduction Manager
MaineGeneral Harm Reduction Program
Shane.Gallagher@MaineGeneral.org