Education on Prescription Opioid Abuse in Bronx, NY
PA Seminar- Public Health Awareness Project:
Mercy College Mobile Health Vehicle Initiative
July 15th, 2015
Last year approximately 1,300 people died of a drug overdose in New York alone, 80% of which involved opioids. This was the leading cause of unintentional injury-related deaths in New York City in 2016; claiming more lives than car accidents and homicides combined. According to the CDC, each day more than 1,000 people are treated in emergency departments for not using prescription opioids as directed (Centers for Disease Control and Prevention, 2017). With the death rate from prescription opioid overdose having nearly doubled since 2002 and steadily climbing, it is imperative that prescription drug abuse intervention plans be implemented (Volkow, 2017). In 2009, Drug and Alcohol Dependence published a study showing that their substance abuse intervention program focusing on patient education and awareness of substance abuse, was able to reduce illicit drug use at their targeted sites by 67.7% in a six-month period (Madras et al., 2009). A study published by the British Medical Journal which focused on opioid overdose rates, showed that the implementation of an overdose education and nasal naloxone distribution intervention program in Massachusetts resulted in significant reduction of opioid overdose death rates when compared to communities that did not have the intervention implemented (Walley et al., 2013).
With regard specifically to New York City, the Department of Health and Mental Hygiene published data showing the number of unintentional overdoses in the five New York boroughs from 2000 to 2015. Nearly double the number of overdoses were seen in the Bronx than any other area; including Brooklyn, Manhattan, Queens, and Staten Island. It is important to be aware that this issue is not restricted to a specific age group, race, ethnicity, class, or neighborhood. As State Comptroller Thomas DiNapoli mentions, New York’s opioid overdose death rate has equaled or exceeded the national rate every year since 2006 (DiNapoli, 2016). According to a study on drug induced overdoses published by the Bureau of Vital Statistics/Office of the Chief Medical Examiner of New York City, 3 of the top 5 neighborhoods with an overdose problem in New York City are in the Bronx including Hunts Point, High Bridge, and Crotona-Tremont (New York City Office of the Mayor, 2017). Furthermore, the same study shows that the Bronx has the highest number and percentage of unintentional drug poisoning (overdose) deaths involving heroin at 30%, with Hunts Point specifically leading that category (New York City Office of the Mayor, 2017).
Our program will aim to reduce overdose death due to prescription opioid abuse by bringing vital information and resources on how to prevent substance misuse to the communities most in need. In addition, our program will be educating the public on the potential drawbacks of overreliance on Narcan as well as how and when to appropriately administer Narcan. Narcan is a pharmaceutical drug, that can be administered intramuscularly or nasally, which functions to block the effect of opioids and reverse an overdose by blocking opioid receptors in the brain. It gives individuals the opportunity to save victims of opioid overdose from possible brain damage prior to treatment by medically trained professionals. This substances is effective regardless of the mechanism in which the individual used an opioid drug. While Narcan is a great life-saving treatment it can also be abused and therefore exacerbate the issue at hand. Many drug abusers now feel safer using increasing quantities of illicit drugs because they will most likely be able to receive Narcan from first responders or a nearby individual.
In addition, our program aims to build partnerships with community-based organizations, such as hospitals, churches, and drug counseling centers to best spread the education. The fair will be open to both the general public and health-care professionals alike. Our primary focus will be to educate the general population on the dangers of opioid use although prescribed by a healthcare professional. These dangers include respiratory depression, changes in heart rate, hypertension, nausea and vomiting, as well as addiction and subsequent use of heroin (Schug et al., 1992). Our hope is that by providing individuals with this information they will be less likely to fill opioid prescriptions and instead request alternative pain management medications. In the instances where an individual requires opioids our goal is to educate them on using them responsibly. However, by educating healthcare professionals as well there is even more potential to greatly reduce the number of opioid induced overdose deaths in the city. Prior to the fair we will provide various locations and aforementioned community-based organizations with flyers to advertise our event, hopefully increasing participation and optimizing our success. The advertisement will mention that all participants will receive a free T-shirt for attending to increase incentive.
Due to its central location in the Bronx, we intend to host an educational health fair at St. Barnabas Hospital in Fordham. We feel as if this will lead to the greatest benefit as we will be able to optimize attendance of members from our target communities because there is ample public transportation to the area. During the event we will use a projector presentation to relay our information, for the purpose of educating attendees of the different perils of opioid addiction. This strategy is efficient in providing an opportunity for many people in the area to access the resource even after the education program is over (Chinazo et al., 2013).
In order to assess the efficacy of our program, data sourced from outreach to local police precincts, fire departments, pharmacies, and medical facilities regarding the number of opioid prescriptions filled and overdoses secondary to opioid use in our target areas shall be collected to serve as pre-intervention reference values. Noted in the study published by the New York City Department of Health and Mental Hygiene, the city is pushing towards establishing metrics to track prescribing patterns regarding dosage and supply through a system-wide NYC Health+Hospitals Opioid Use and Treatment Dashboard. Data values from the city implemented dashboard shall be requested for the time period after implementation of our program, allowing us to evaluate the efficacy of our intervention.We anticipate to see a decrease in people abusing opioids and therefore a decline in the number of prescriptions filled, opioid overdoses, and violence due to drug deals gone wrong. In addition, we anticipate this will decrease the need for Narcan as well as improper use.
From a public health standpoint community based education is one of the best ways to decrease incidence. The location of St.Barnabas Hospital is easy to access allowing all members of the community to come out and learn about the dangers of opioid use, even when prescribed by a provider. By reaching out to other local facilities, such as police departments, churches, and other surrounding hospitals will ensure that not only the Fordham area will be benefiting from the event. During the event presentations with visual aides will be shown to help reinforce our main goal. This will allow complicated information to be converted into something that is basic and all members of the community are able understand. Along with presentations the overall event will give community members and healthcare professionals a place to openly talk about some reasons why people become addicted, how community members can work together to stop addiction, and what to do if someone does overdose. To follow up and determine the benefits of community based events in relation to opioid use we plan to collect data from local hospitals and police departments three to six months after the event to see if the rates of opioid overdose decreased since the time of the event. Another way to see the benefits of the event would be to interview individuals who attended the event and identify how much they learned and if they would help educate other members of the community.