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Clarity Healthcare, a division of Preferred Family Healthcare, Inc. (PFH) Overdose Prevention Strategies (OPS) project will establish an expanded system of integrated and coordinated educational, prevention, early intervention, and treatment resources for opioid use disorder (OUD) and overdose (OD) for various numbers of community members, businesses, and provider-entities (100-education/prevention; 75 Naloxone administration training; 600 average Naloxone HCL intranasal cannulas distributed per year) in the Missouri Counties of: Pike, Marion, Monroe and Ralls; and Illinois Counties of: Adams and Pike. Strategies/interventions include three (3) goals and corresponding objectives have been established to measure education, training, improved access to services, improved care coordination, and increased community resource connection project goals and measurable objectives, including: 1.) Provision of education and training on OUD and OD to community entities and members, throughout 6 Missouri and Illinois counties: Obj. 1.OPS staff will provide education on OUD to project partners, reaching 100 individuals annually and a total of 30 organizations and 500 individuals over 5 years; Obj. 1.2 OPS staff will train 75 individuals from referenced entities annually on administration of overdose reversal drugs, for a total of 375 in 5 years. (e.g., Train the Trainer); Obj. 1.3 OPS staff will distribute 300 intranasal Naloxone kits (2 units per kit) to community members and first responder entities annually, for a total of 1,500 kits distributed over 5 years 2.) Increase of behavioral health treatment referral and care coordination for those with SUD/OUD experiencing OD-50 participants with known or suspected OD history will be assisted with co-payments and prescription costs for OD reversal drugs by the end of each year of the project: Obj. 2.1 50 participants with known or suspected OD history will be assisted with co-payments and prescription costs for OD reversal drugs by the end of each year of the project; Obj. 2.2 90% of participants that have experienced OD and are referred/connected to behavioral health treatment will engage in available services within 10 business days; Obj. 2.3 Participants engaged in treatment who have experienced OD & accessed ER/ hospital treatment will reduce emergency medical treatment episodes by 25% within 6 months.; Obj. 2.4 Patients referred by MDs for overdose risk on prescription medications will complete at least 2 sessions with Care Coordinator, MAT Nurse, or Therapist. 3.) Provision of wraparound community resource connection and wellness support for those impacted by OD: Obj. 3.1 90% participants will access community resources (e.g. food bank or dental care) through OPS Obj. 3.2 90% treatment-engaged participants who use tobacco will receive tobacco cessation education, resources, and treatment: Obj. 3.3 75% of participants will experience an increase in global functioning, as indicated by DLA-20 (MO) or ASAM (IL), within 6 months.

The Institute for Family Health, a federally qualified health center (FQHC) network, will increase community access to FDA-approved overdose reversal drugs in partnership with community-based organizations and prescribers, resulting in a decrease in community risk for opioid overdose fatalities in two regions of New York State. PROJECT NAME: Improving Access to Overdose Treatment Program POPULATION(S) TO BE SERVED: The Institute will implement this project in two distinct regions of New York State – the Mid-Hudson Valley and New York City – both of which experience a disproportionate share of opioid dependence and associated overdoses related to prescription drug abuse, heroin use, and/or fentanyl ingestion. The Mid-Hudson Valley comprises New York’s largely rural and semi-rural counties of Ulster and Dutchess, and is affected by limited access to health care, transportation, and job opportunities. In New York City, a majority of overdose deaths occur in high-poverty neighborhoods, where the Institute and its partners are located. In both areas, men and younger people are most affected by the opioid crisis. STRATEGIES/INTERVENTIONS: To address this need, we will expand screening for overdose risk and distribution of opioid reversal drugs in our network of 32 community health centers; develop and launch a multi-pronged overdose prevention training program for community members and agencies; and provide linkage to treatment for patients who have experienced an overdose, or are at increased risk for overdose. PROJECT GOALS/MEASURABLE OBJECTIVES/NUMBER OF PEOPLE TO BE SERVED: The goal of this program is to increase community access to FDA-approved overdose reversal drugs, in partnership with community-based organizations and prescribers, resulting in a decrease in community risk for opioid overdose fatalities in two regions of New York State. Our program objectives are 1) By April 2020, expand screening for overdose risk and expand distribution and tracking of opioid reversal drugs in our network of 32 community health centers; 2) Beginning in 2019, develop and launch a multi-pronged overdose prevention training program, such that 300-500 individuals, 10-20 prescribers, 6-12 community organizations and/or pharmacies, and staff at 1-2 new overdose reversal drug distribution sites are trained or re-trained annually; and 3) Throughout the five-year project period, provide linkage to treatment for patients who have experienced an overdose or are at increased risk for overdose, such that an estimated 20-40 additional individuals access care for substance dependence annually.

The goal of the King County Opioid Treatment Access Program (KCOTAP) is to decrease opioid overdose-related deaths in King County by expanding access to naloxone and outreaching to individuals who have experienced an overdose. KCOTAP will provide training on naloxone prescribing best practices to providers at the Seattle King County Department of Public Health’s (SKCDPH’s) 9 clinic sites plus the 57 clinic sites of our five partner FQHCs. The project will serve King County FQHC patients with opioid use disorder, whom we estimate to number 34,300 individuals (14% of all patients served annually). KCOTAP will also connect SKCDPH patients who have experienced a drug overdose with appropriate treatment, including MAT, counseling and behavioral therapies via a phone-based post-overdose intervention. We estimate 693 patients per year will be eligible for this intervention. The current rate of opioid-caused deaths in King County is 5.5 times greater among American Indian/Alaskan Natives and 1.3 times greater among Black/African Americans than for (non-Hispanic) whites, so these will be additional populations of focus in order to address disparities. The measurable objectives of the program are as follows: • O1: By May 1 2019, 90% of SKCDPH pharmacists will have received training on naloxone prescribing procedures and formulary. • O2: By December 1, 2019, 90% of SKCDPH prescribing providers will have received training on naloxone prescription and patient counseling. • O3: By Sept 1, 2020, 70% of prescribing providers and pharmacists at 5 King County FQHCs will have received training on naloxone prescription and patient counseling. • O4: By Aug 30, 2020, SKCDPH prescribing providers have dispensed naloxone to 80% of patients diagnosed with opioid use disorder. • O5: By Aug 30, 2024, a social worker will attempt to contact 100% of SKCDPH patients who received emergency medical services for opioid overdose to provide outreach regarding appropriate treatment, including MAT, appropriate counseling, and behavioral therapies. • O6: By Aug 30, 2024, 15% of SKCDPH patients who experienced a drug overdose are connected with appropriate treatment and initiate treatment, including MAT, appropriate counseling and behavioral therapies. • O7: By August 30, 2024, the number of annual opioid-related deaths among SKCDPH patients has decreased by 15% from baseline.

Tarzana Treatment Centers, Inc. (TTC) will increase access to opioid overdose emergency treatment in Los Angeles County (LAC) by providing technical assistance to prescribers, emergency department (ED) personnel, and pharmacists to improve their capacity to respond to LAC’s growing opioid epidemic. TTC’s Opioid Overdose Treatment Access Technical Assistance (OD-TA) Program will address identified service gaps to expand community access to naloxone for emergency opioid overdose treatment. The OD-TA Program will provide training and technical assistance to LAC prescribers and EDs in the establishment or revamping of opioid overdose education and naloxone distribution programs as well as public health detailing at local pharmacies that carry naloxone to share best practices for opioid overdose prevention. TTC will leverage four (4) decades of experience as a substance use disorder (SUD) treatment provider, including the last twenty (20) years with an opioid treatment program, as well as its current countywide Hub & Spoke medication-assisted treatment (MAT) program and participation in LAC’s opioid safety coalition Safe Med LA to engage key community sectors. The specific goals of the OD-TA Program are to: 1) Increase the capacity of local prescribers to establish a program to prescribe/co-prescribe naloxone; 2) Increase the capacity of local EDs to prescribe/co-prescribe naloxone and screen and refer opioid overdose patients to SUD treatment, including MAT; and 3) Increase the capacity of local pharmacies to respond to the increased demand for naloxone. Specific activities and measurable process objectives include the following: 1) Compile existing resources at the local, state and national levels, including SAMHSA’s Opioid Overdose Prevention Toolkit, to develop two (2) Opioid Overdose Prevention Best Practices Toolkits, one (1) targeting prescribers and one (1) targeting ED personnel; 2) Develop training modules based on the Toolkits and deliver training to a minimum of 450 prescribers and 270 ED providers during the lifetime of the project; 3) Develop a Naloxone Action Kit for Pharmacies and conduct a minimum of 225 pharmacy visits during the lifetime of the project; 4) Purchase a minimum of 500 nasal naloxone (NARCAN®) kits or cartons with two (2) 4mg doses each and distribute them free of charge to patients at highest risk for opioid overdose who are ineligible to be prescribed naloxone; 5) Provide ongoing technical assistance to participating EDs in the establishment of protocols for connecting overdose patients with SUD treatment, including MAT; and 6) Provide comprehensive treatment and individualized treatment, including MAT, to referred patients. Additional outcome measures include a reduction in the rate of ED visits and hospitalizations due to opioid overdose, an increase in Naloxone prescriptions among participating prescribers, an increase in referrals to OUD treatment from participating EDs, and an increased awareness among pharmacy staff of opioid overdose prevention best practices at follow-up.

Project Abstract Project Title: New Jersey Collaborative to Improve Access to Overdose Treatment Applicant Name: Rowan University School of Osteopathic Medicine Address: 42 East Laurel Road, Stratford NJ 08084 Project Director: Richard Jermyn, DO Phone and Email: 856-566-7010; jermynrt@rowan.edu. Eligibility: SAMHSA waiver to prescribe buprenorphine The NeuroMusculoskeletal Institute at Rowan University School of Osteopathic Medicine proposes a New Jersey Collaborative to Improve Access to Overdose Treatment. The project will form a statewide Overdose Treatment Access Collaborative that will develop a Best Practices for Co-Prescribing Naloxone Toolkit, train 2,500 physicians and pharmacists, and implement the toolkit with 2,500 patients at risk for overdose over five years including co-prescribing naloxone. In 2016, opioid overdoses killed more than 42,000 individuals nationwide. Between 2015 and 2016, the opioid overdose death rate in New Jersey increased 42.3%?the fifth largest in the nation?primarily due to heroin and fentanyl. The geographic catchment area for the project will be five counties in New Jersey with the highest opiate overdose death rates. These counties include Camden, Atlantic, Ocean, Essex, and Middlesex counties. In 2016, these five counties accounted for 48.5% of all overdose deaths in New Jersey including 50% of all heroin overdoses and 48.7% of all fentanyl overdoses. Reports indicate that the epidemic is worsening in New Jersey with 1,204 overdose deaths so far in 2018 which could increase to 3,000 by years end. The US Surgeon General recently called for an increase in naloxone possession and use among patients prescribed opiates for pain and individuals with opiate use disorders. How these populations are to utilize naloxone was not specified. Three different naloxone utilization scenarios can be envisioned. While only one report has appeared on self-administration of naloxone during an overdose (scenario 1), the majority of take home naloxone programs have focused on training individuals to take home and administer naloxone when they witness an overdose (scenario 2). However, there has been no discussion of training patients taking opiates to train peers how to administer naloxone to them in the event of their own overdose (scenario 3). Because the ultimate goal of prescribing naloxone to patients taking opiates should be to save their own life, there is an urgent need to develop unified best practices across all healthcare disciplines for co-prescribing naloxone that includes focused training procedures. The goals of this project are designed to align with the required activities listed in the funding opportunity announcement including 1) expanding access to naloxone for the treatment of overdose in patients taking opiates by formation of a New Jersey Overdose Treatment Access Collaborative to develop a Best Practices for Co-Prescribing Naloxone Toolkit, 2) increasing knowledge of best practices by providing training and resources to at least 2,500 physicians, pharmacists, and other practitioners over five years, and 3) increasing the number of patients co-prescribed naloxone by implementing best practices with 2,500 patients over five years at risk for overdose within the NeuroMusculoskeletal Institute. The project has formed a very large collaborative partnership with the State of New Jersey, FQHCs in high overdose areas, pharmacy schools, the Department of Veteran’s Affairs, the New Jersey Hospital Association and other organizations. The project will be evaluated by the Rutgers Center for Prevention Science.