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Project Save of Miami Valley provides overdose prevention, education, and overdose reversal medications to first responders in Darke, Montgomery, and Preble Counties in Ohio. This program works by providing naloxone to first responders via Centralized Naloxone Repositories, equipping non-transporting EMS vehicles with naloxone, furnishing naloxone to citizens via EMS agencies, and conducting outreach services to promote linkages to treatment. Montgomery County has the fifth highest overdose death rate in the state while Darke and Preble Counties’ deaths rates have more than doubled over the last three years. The highest risk populations to experience an opioid overdose are mostly white (81%) males (64%) between the ages of 20-59 (100%) who have a comorbid physical illness or disability (66%) and a history of substance abuse (95%). Currently, only 16 out of 40 police departments carry naloxone. Annually, Project Save will serve up to 85 law enforcement officers; 400 EMS personnel; 1,920 overdose victims; 67 friends/families of overdose victims; and 800 community members. Throughout the lifetime of the project, that equates to 340 law enforcement officers; 1,600 EMS personnel; 7,680 overdose victims; 268 friends/families of overdose victims; and 3,200 community members. Project Save utilizes six main key activities: (1) equipping law enforcement agencies with naloxone by training on and implementing Centralized Naloxone Repositories; (2) equipping non-transporting EMS vehicles with naloxone; (3) equipping EMS departments to furnish naloxone to citizens directly at the scene of an overdose as well as at fire/EMS stations; (4) outreach services to link individuals to treatment and recovery services after a non-fatal overdose; (5) prevention and education services that focus on how to have a healthy relationship with prescription medications; and (6) trainings to healthcare providers on overdose dangers and encouraging them to provide resources to overdose victims and their families. The project’s goal is to create healthy, drug-free communities in which opiate addiction, and its dangerous consequences, do not diminish the quality of life for our communities’ residents nor result in premature death. Measurable objectives include: 15% (485) yearly increase of first responders trained to use naloxone; 15% (10) yearly increase of first responder agencies that have established processes and protocols for carrying and administering naloxone; 10% (2,042) yearly increase in overdose reversals by first responders; 20% (67) yearly increase of family/friends who receive overdose prevention education and a naloxone kit directly following an overdose reversal; 800 community members trained to administer naloxone per year; 20% (14) yearly increase in the number of first responder agencies that have established mechanisms for referring and connecting individuals to treatment and recovery services; 557 individuals will receive referrals to treatment or recovery services per year; and a 5% (28) yearly increase in the number of non-fatal overdose victims that engage in treatment services.

Project Name: The Lorain Count’s First Response Applicant Name: Alcohol and Drug Addiction Services Board of Lorain County Target Community: Lorain County, Ohio Adults and families impacted by overdose From opiates, including heroin Lorain County’s First Response (LCFR) is a public/private partnership in Lorain County, Ohio that will save lives due to overdose from opiates, including heroin. The target population is 250 overdose survivors annually, or 1,000 survivors over the four years, and their families who will receive a rapid, community response from police, nurses and treatment and recovery support providers ensuring that these survivors have the best opportunity to continue to live another day. The target population includes overdose survivors and their families who will receive a comprehensive response through a team. This will include rapid response by trained first responders using the life saving device – Naloxone (aka Narcan). Program services that will be offered through LCFR include: training and distribution of the life-saving device for emergency treatment of known or suspected opioid overdose, training of first responders on addiction, including treatment and recovery supports, and an outreach team that will engage overdose survivors and family members to access supports. Finally we will design and provide comprehensive overdose prevention education and information throughout Lorain County. The goals and objectives for LCFR are: Goal 1: Ensure all first responders, including police personnel and other key community sectors are trained and receive Nasal Naloxone; Goal 2: Increase in the number of opioid and heroin overdoses reversed by first responders and community members; Goal 3: Increase the knowledge of first responders about addiction.; Goal 4: Increase the number of overdose survivors who engage in treatment and/or recovery supports. Partners in the LCRC include: Alcohol and Drug Addiction Services Board of Lorain County, Lorain County General Health District, Avon Police Department, Avon Lake Police Department, Let’s Get Real, The LCADA Way, Mercy Parish Nursing. This effort will be accomplished by the implementation of following efforts over the next four years: train and equip all local police departments and first responders to carry Nasal Narcan, train and distribute Nasal Narcan to community key stakeholders; Train first responders on addiction, including treatment and recovery supports, utilize and Outreach Team through the Quick Response team to engage overdose survivors into treatment and recovery support services; and use data mapping to create impacting Overdose Prevention Education campaigns in Lorain County Communities. We believe that this comprehensive approach will ultimately save lives and help us to achieve our goal of reducing deaths due to overdose from opiates, including heroin in Lorain County.

The Texas FR-CARA project will enable the Texas Health and Human Services Commission to implement a comprehensive strategy to decrease opioid overdose mortality in San Antonio, Texas, and the surrounding communities of Bexar County. This project will provide opioid overdose reversal materials and comprehensive overdose prevention training for first responders and will connect overdose survivors to local treatment and recovery support services. Bexar County was chosen for the project based on the historical context of opioid use in the area as well as existing epidemiological data, including prevalence of Opioid Use Disorders, opioid-related poisonings, and opioid-related mortality rates. The Texas Statewide Behavioral Health Strategic Plan (2017-2021) identified access to treatment and increasing recovery support services as essential for behavioral health planning in Texas. This project will address the alarming opioid crisis trends by working in concert with this strategic plan. The goals include: 1) assessing the existing county organizational infrastructure to improve the surveillance of opioid overdose, identify traditional and non-traditional first responders, and identify the readiness of institutions for connecting individuals to appropriate treatment and recovery services; 2) train traditional and non-traditional first responders on comprehensive opioid overdose prevention and care coordination in the targeted communities; 3) disseminate opioid overdose reversal materials to traditional and non-traditional first responders in the targeted communities; 4) implement the Overdose Survivor Outreach Program (OSOP) in emergency departments to connect opioid overdose survivors to appropriate treatment and recovery communities; and 5) develop a statewide protocol and sustainability plan. Project activities will be implemented with collaboration of local and statewide stakeholders through the Bexar County Opioid Task Force and the state-level Texas Opioid Advisory Workgroup. This project will train approximately 6,720 traditional and non-traditional first responders and provide at least 55,400 doses of overdose reversal medication in the targeted communities in Bexar County. Referrals made to treatment and recovery services will be tracked and approximately 300 opioid overdose survivors will receive long-term recovery support over the funding period. Project activities are intended to increase the number of first responders trained in overdose prevention, decrease rates of repeat overdose episodes, increase rates of treatment and recovery support engagement, and increase the amount of overdose reversal medication available to the community, framed by three overarching functions, Train, Disseminate, and Connect.

New Hampshire Department of Safety (NH DOS) seeks this grant to increase the number of first responders capable of responding to an opioid use disorder (OUD) emergency, establishing a statewide first responder facilitated referral process, and first responder follow-up services to at-risk individuals and their support systems. Services will include training on cardiopulmonary resuscitation (CPR), rescue breathing, administration of the opioid reversal medication naloxone, and naloxone kit distribution to at-risk individuals and their support systems. Populations to receive services have been selected due to their high rates of OUD admissions, EMS administration of naloxone, and rate of opioid overdose fatalities. NH anticipates serving approximately 1,400 individuals. NH DOS will work collaboratively with the NH Department of Health and Human Services (NH DHHS), Bureau of Drug and Alcohol Services (NH BDAS), NH DHHS Emergency Services Unit (NH ESU), New Hampshire Governor Christopher P. Sununu’s Office, the thirteen NH Public Health Networks, NH Association of Fire Chiefs, NH Chiefs of Police, and other private and public stakeholders to ensure proper project implementation for the prevention and intervention programs. Unique to this proposal is the strong collaboration between NH DOS and NH DHHS to deliver the services and an emphasis on a first responder’s ability to connect with their communities at a street level. This connection and interaction establishes a unique opportunity to deliver lifesaving skills and supplies to sustain a life while waiting for Emergency Medical Services (EMS) arrival. It also provides a prime opportunity for first responders to facilitate an individual’s entry into treatment and recovery services using supportive communication and information on available services, while reducing the strain on emergency services, costly ambulance transports, and emergency department visits. NH believes mere delivery of a medication without simple additional supportive measures such as cardiopulmonary support, protective devices, and referral to systems of care, fails to provide the most effective treatment or the best chance for survival. NH intends to use this grant to provide naloxone, devices and education to treat opioid overdoses for at-risk individuals and their support systems. In addition, the grant will be used to facilitate a first responder referral process to the NH Crisis and Regional Access Services (NH CARAS) program which will provide a single regional point-of-contact to facilitate entry and follow-up with treatment and recovery programs as of January 1, 2018.

The Alabama Opioid Assistance (AOA) Project will make training available to 20 emergency medical service providers (EMSPs) and volunteer fire departments for the purpose of increasing access and administration of Naloxone (Narcan) and provide treatment referrals and recovery support services to 1,000 overdose victims and their families in Alabama. The AOA will reach target ten counties with the highest administration of Naloxone and ten rural counties with minimal or no cases of administering the drug in 2016. The goals of the AOA Project are to (1) decrease the number of opioid and heroin overdose deaths in the identified counties of Alabama and (2) increase the number of overdose victims and families who request information and are referred to and/or access treatment and recovery support services. These goals will be accomplished by completing the following objectives: (1) To provide training and education sessions to first responders in Alabama regarding response to overdose; (2) To increase the number of reversed opioid and heroin overdoses using Naloxone by EMSPs and volunteer fire departments; and (3) To establish a protocol, including policies and procedures, to provide information and referral services to overdose victims and families. Scheduled activities to be implemented include developing and implementing a marketing campaign; annual trainings on opioid and heroin use, treatment and recovery to first responders; developing online trainings and resources; purchasing Naloxone to first responders; establishing protocols, policies and procedures, providing peer support to overdose victims and families, and developing pocket referrals to distribute to first responders. The AOA Project will be a collaborative effort involving the leading applicant agency, the Alabama Department of Public Health, Division of Emergency Medical Services, Council on Substance Abuse-National Council on Alcohol and Drug Dependence (NCADD), Alabama Department of Mental Health and other community stakeholders working to address the opioid and heroin epidemic in Alabama.

The age-adjusted death rate for poisonings involving opioid analgesics in Oklahoma is significantly higher than the national rate. At present, more Oklahoman adults age 25-64 die of unintentional poisonings than of motor vehicle crashes or suicide. Two counties within the Choctaw Nation of Oklahoma (CNO) service area are designated as the “Top 5 Counties” in the state of Oklahoma for unintentional poisoning deaths involving at least one prescription opioid. Such tremendous need to address opioid overdose deaths in Southeast Oklahoma spurred the Choctaw Nation, through its Choctaw Nation Health Services Authority (CNHSA), to develop a small program that began supplying and training tribal employee First Responders in the administration of an FDA approved NARCAN® (naloxone HCl) 4mg nasal spray. LT Morgan Greutman, Pharm.D., who implemented this pilot-level naloxone distribution program as a pharmacy resident, is now applying for SAMHSA’s FR-CARA grant opportunity to fund an expanded First Responder naloxone training and distribution program reaching out to rural community-based First Responder organizations. This program entitled, “Addressing Opioid Overdose Deaths (AOOD)” would have a catchment area that includes: Atoka, Bryan, Choctaw, Coal, Haskell, Latimer, McCurtain, Pittsburg, Pushmataha, and part of Hughes County. If funded, the AOOD team will consist of a pharmacist as Project Director, the Lead Evaluation team of Council Oak Training and Evaluation, Inc. (COTE), and a registered nurse to be hired as the Project Coordinator. By providing naloxone and training on its use to the rural, high-risk counties of Southeastern Oklahoma, the AOOD program is expected to decrease the opioid overdose death rate by 10% over the 4-year grant period. Partnerships with the Oklahoma Department of Mental Health and Substance Abuse services (ODMHSAS) Prevention and Tribal Liaison departments will provide technical and data assistance needed to monitor progress toward grant goals. The CNHSA is well positioned to implement the AOOD program, due to its network of health clinics (1 hospital and 8 clinic locations) and access to tribal community centers (17) positioned throughout the catchment area, along with having already begun a project that trained 34 tribal employee First Responders. Servant Leadership is an important concept to Choctaw Nation and the AOOD project aligns with continuing efforts of the tribe to serve where needed, and to put into practice the philosophy that “a rising tide lifts all boats”. The long-term impact of the AOOD program is expected to be a complete transformation in the way opioid overdoses are addressed in the rural counties of the CNO service area, boosted by a strong state and tribal partnership. The proposed program is expected to offset costs to rural First Responder Southeastern Oklahoma agencies and to build the capacity of these rural police forces, volunteer fire departments, and tribal First Responders to save the lives of opioid overdose victims.

On June 5, 2017, Arizona Governor Douglas Ducey signed a declaration of emergency and notification of enhanced surveillance advisory in response to the significant deleterious impact the opioid epidemic has had in Arizona. From 2012 to 2016, the number of opioid deaths in Arizona increased by 74%. In 2016, the Arizona Department of Health Services confirmed 790 opioid-related deaths, averaging more than two per day; and during the same year, Arizona’s Emergency Medical Services (EMS) agencies responded to over 64,000 substance-abuse-related 911 calls, (175 calls per day). Governor Ducey’s declaration included a requirement of the ADHS Director to “develop and provide training to local law enforcement agencies on proper protocols for carrying, handling, and administering naloxone in overdose situations.” To meet this requirement, the ADHS Bureau of Emergency Medical Services and Trauma System are seeking support from the Substance Abuse and Mental Health Administration First Responders – Comprehensive Addiction and Recovery Act Funding Opportunity Announcement No. SP-17-005 to develop, implement, and assess the following initiatives:  A statewide naloxone delivery system to provide access to naloxone for first responders  A statewide acute opioid-overdose recognition and naloxone administration training program for first responders  A targeted first responder Opioid Screening, Brief Intervention, and Referral to Treatment curriculum to instruct first responders how to recognize actual opioid-related substance abuse or the potential thereof, and to provide appropriate interventions and referrals to care To carry out these initiatives, the Bureau will partner with the University of Arizona Center for Population Science and Discovery, the University of Arizona Center for Rural Health, the Arizona Peace Officer Standards and Training Board, and other key stakeholders. Success will be measured by determining the extent to which the three initiatives contribute to lowering of the number of opioid overdose deaths in Arizona over the course of the 4-year project period. Particular focus will be placed on comparing and contrasting changes in overdose deaths among rural and urban areas disproportionately impacted by the epidemic. Secondary success will be determined by assessing the number of first responders trained to administer naloxone and the number of naloxone kits distributed and employed during the project period. Tertiary success will be measured by successfully piloting the first responder Opioid Screening, Brief Intervention, and Referral to Treatment (SBIRT-EMS) curriculum to train first responders in at least two rural and two non-rural areas of Arizona.

The Indiana First Responder - Comprehensive Addiction and Recovery Program will: 1) provide resources through the Indiana Naloxone Kit Distribution Program for First Responders for emergency treatment of known or suspected opioid overdoses in rural communities; 2) train first responders on carrying and administering naloxone; and 3) expand the Indiana Recovery and Peer Support Initiative for referral to appropriate treatment and recovery communities. The Indiana State Department of Health (ISDH) and partners will target rural communities, including 49 rural counties that represent 1.47 million Indiana residents (22.3% of the total population). These counties have high rates of non-fatal emergency department visits due to opioid overdose, high average daily morphine milligram equivalents of opioids prescribed per capita, a greater percentage of non-Hispanic white residents, and have lower reported use of naloxone by first responders. This Program will partner with the Indiana Commission to Combat Drug Abuse for support in meeting requirements of the grant. Activity 1: The Indiana Naloxone Kit Distribution Program for First Responders aims to expand capacity by distributing naloxone in rural areas to first responders through a grants process. Applicants will be required to report data on a quarterly basis through the ISDH and Emergency Medical Services (EMS) registry. ISDH will partner with Indiana University to include a postcard survey evaluation in the kits that are given to first responders to learn more about the uptake of and barriers to naloxone administration. The measureable objectives include: expand naloxone distribution and use by first responders in rural populations; decrease number of fatal overdose incidents; and improve overdose reversal reporting. Activity 2: Overdose Lifeline will train first responder agencies receiving naloxone reversal kits to use in 49 rural counties to maximize the number of first responders equipped to use the kits. The measureable objectives include: expand naloxone training to first responders in rural populations; increase appropriate use of naloxone to reverse opioid overdose; and reduce the stigma of drug addiction. Activity 3: The Indiana Recovery and Peer Support Initiative (IRPSI) will focus on referral to appropriate treatment and recovery communities in rural communities through a wrap-around program for individuals who arrive in an emergency department after experiencing an opioid overdose. Participants are paired with Recovery Coaches to complete IRPSI steps: 1) screening and assessment; 2) immediate counseling and intervention; 3) referral to treatment; 4) and post-treatment care coordination. A request for proposals will be released for rural hospitals to establish processes, protocols and mechanisms for referral to appropriate treatment and recovery communities. The goal is to increase participants receiving integrated treatment and recovery services. The measureable objectives include: increase the number of individuals who receive recovery services in rural areas and decrease the number of repeat non-fatal overdoses.

The Orange County First Responders CARA grant funding will serve the citizens of Orange County, Florida. The purpose of the grant is to work with local law enforcement agencies, EMS and key community sectors and provide naloxone and training on the reversal medication for a suspected opioid/heroin overdose. We will work with non-profit hospitals busiest emergency departments to establish processes and protocols to provide appropriate referral to treatment for opioid/heroin dependence or addiction. Orange County includes 13 municipalities and will work with law enforcement agencies serving unincorporated Orange County, city police departments and the university police department on the purchase of naloxone, the reversal medication for a suspected opioid/heroin overdose. We will also work in partnership with Orange County Fire Rescue to equip Asst./Deputy Chiefs with naloxone when needed. The first responder agencies will receive training from the Medical Director of Orange County Emergency Medical Services on the administration of naloxone and the latest information on opioids, heroin and illicit fentanyl sold on our streets and the safety precautions necessary for first responders. We will also work with key community sectors to include our federally qualified health centers and hospitals on the purchase of naloxone kits for their agencies and training for staff. In addition, we will provide local substance abuse treatment providers, healthcare providers, county jail and public school system with naloxone training materials for staff and dissemination of treatment resource packets to the public. The goal of the project is to increase the number of first responders/key community sectors equipped and trained to carry naloxone and increase the number of referrals for substance abuse treatment services for opioid/heroin dependence and addiction. The population focus will be individuals who have received naloxone to reverse an opioid overdose by first responders and key community sectors admitted to Orlando Health and Florida Hospital busiest emergency departments for suspected opioid/heroin overdose. The estimated population to be served by the project is 350-400 patients annually based on current data sources and 1400-1600 during the life of the grant. Project data will be collected by the epidemiologist/evaluator and the measurable outcomes will include the number of first responders and key community sectors equipped with naloxone, number of suspected opioid/heroin overdoses reversed by first responders/key community sectors, number of first responders/key community sectors who received training on naloxone administration, the number of responses to requests for services to opioid and heroin overdoses and the number of overdose victims and families that have received treatment referral services and resources and available data on treatment admissions. Orange County is an urban county with a population estimate of 1.3 million people. Approximately 22% of the population is under 18 years, 66% between 18 and 64 years, and 11% are 65 years and older. 51% of the population is female and 49% male. 68% of the population is White, 22% Black or African-American 30% is Hispanic is Latino and 6% Asian and 3% other.

Project Abstract White Earth Band of Chippewa, White Earth Public Health Department ATTN: Cyndy Rastedt, RN, PHN, White Earth Public Health Services Coordinator PO Box 418 White Earth, MN 56591 218-983-3286 ext. 1356 Fax 218-983-3641 Cyndy.rastedt@whiteearth-nsn.gov https://whiteearth.com The project will build on the foundation developed by the creation of the Overdose Response Committee and its commitment to reducing and eliminating the number of overdose related incidents or deaths on the White Earth Reservation. The epidemic of opioid use and abuse is well documented, as it the fact that it has impacted rural and tribal communities particularly hard. White Earth Reservation is located in rural northwestern Minnesota and covers over 1300 square miles. The Tribe has instituted a number of innovative new programs to address the epidemic, even receiving awards from the state of Minnesota. We have also been recognized as part of a documentary by SAMHSA that includes us as a promising practice for our MOMS (Maternal Outreach Mitigation Services) Program. Our specific goals for this grant include: Goal 1: Make a drug or device approved or cleared under the Federal Food, Drug and Cosmetic Act for emergency treatment of known or suspected opioid overdose available to be carried and administered by first responders and members of other key community sectors. Goal 2: Train and provide resources for first responders and members of other key community sectors on carrying and administering a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose. Goal 3: Establish processes, protocols, and mechanisms for referral to appropriate treatment and recovery communities, which may include an outreach coordinator or team to connect individuals receiving opioid overdose reversal drugs to follow-up services. Goal 4: Comply with all grant requirements and deadlines in a timely and complete manner. Goal 5: Comply with all data collection, evaluation and local performance measurement requirements of the grant project. White Earth Nation is skilled at data collection, compliance with grant requirements, and working in collaboration with local, state and federal partners.

Hampshire County, located in Western Massachusetts, has been hard hit by the opioid crisis sweeping the nation. Since 2011, there has been a 240% spike in the number of opioid overdose (OD) fatalities. In response, the City of Northampton will take a county-wide two-pronged approach to reduce the overdose death rate. First, this project will increase the capacity to reverse opioid overdoses by ensuring all first responders are equipped with Naloxone. Secondly, the project will implement a comprehensive overdose response team consisting of first responders, emergency departments, recovery coaches, and addiction treatment centers. This proposed project will leverage relationships and build off the progress made to date by Hampshire HOPE, a multi-sector coalition addressing the rise in prescription opioid misuse, heroin use, addiction, and overdose death in Hampshire County. This project will engage at least 300 residents per year by administering Naloxone to overdose victims and by engaging victims of overdose and their family members through an overdose response team. Measureable objectives will include the number of: First responders and other key community members equipped to carry Naloxone; Opioid overdoses reversed by first responders or other key community members; Fatal opioid overdose; Overdose victims who are screened for program eligibility and sign waiver to participate; Participants engaged in an intervention by the overdose response team. This comprehensive overdose response team will bridge gaps in our current systems of emergency response, intervention, and treatment in order to improve the outcomes for people struggling with opioid addiction.

This proposed grant, entitled “Empowering and Equipping Law Enforcement and Communities in Rural Illinois to Reduce Opioid Overdose,” targets 18 high-need rural counties in Illinois and will address five goals in this geographical area: (1) equip more law enforcement officers with naloxone, (2) train more law enforcement officers to carry and administer naloxone, (3) establish robust follow-up, referral, and care coordination mechanisms for individuals who experience opioid overdose, (4) increase public awareness of Illinois’ “Good Samaritan” law, and (5) ensure that implementation activities of the proposed project are effective and data-driven. IDPH will be partnering with five agencies/organizations to implement this proposed project: the Illinois Law Enforcement Alarm System (ILEAS), Heartland Human Services (HHS), Bethany Place (BP), the Illinois Broadcaster's Association (IBA), and the Illinois Department of Human Services - Divisions of Alcohol and Substance Abuse (IDHS/DASA). ILEAS will be responsible for naloxone distribution and training activities for law enforcement. HHS and BP will be responsible for developing referral networks and providing care coordination services for individuals who experience opioid overdose in the chosen area. IDPH will also collaborate with IBA to develop and broadcast a radio and TV public awareness campaign regarding the Good Samaritan Law to the chosen area. IDHS/DASA will provide (in-kind) data regarding overdose reversals in the chosen area and collaborate with IDPH to perform resource-mapping activities for developing a referral network. The population served consists of 387,000 individuals residing in 18 poorly-resourced and high-need rural counties that are collectively in the 85th percentile for fatal overdose and 80th percentile for non-fatal overdose among all potential 18-county rural areas that could have been selected. The opioid overdose death rate in the chosen area has increased over 50% in the past two years, outpacing the average increase in all rural Illinois counties of 30% over the same period of time. These rural counties are particularly sparsely resourced in terms of emergency medical system services, and law enforcement are often first to arrive at the scene of an overdose. Thus, in order to address overdose deaths in these areas, it is critical that we focus on efforts to increase the capacity of law enforcement to prevent and respond to opioid overdoses. Among the objectives of this project is to equip and (re-supply as needed) every police and sheriff department squad car in the chosen area (513 squad cars) as well as provide training on overdose prevention and naloxone use to every law enforcement officer in the area (783 officers). The Illinois Department of Public Health (IDPH) submits this application in response to Funding Opportunity Announcement (FOA) #SP-17-005, First Responders – Comprehensive Addiction and Recovery Act (FR-CARA).

The Lac du Flambeau Opioid Overdose Prevention and Education Project is designed to enhance the Tribe's local efforts at reducing fatal overdoses through a combination of local training for first responders, members of key community sectors and community members. This project will also enhance efforts by providing a consistent supply of Naloxone for programs and individuals completing Naloxone administration training, which will be accomplished through the following activities: 1. Participation in training to learn how to administer overdose reversing 2. Collaboration to develop processes, protocols, mechanisms for referral to appropriate treatment and recovery communities 3. Participation in an advisory council made up of agencies engaged in efforts to prevent prescription drug/opioid overdose-related deaths 4. Collaborate with other partners to provide public education on Wisconsin “Good Samaritan” laws that permit bystanders to alert emergency responders to an overdose or to administer FDA-Approved overdose reversal drugs without fear of civil or criminal penalties 5. Participation in data and performance measurement on the number of first responders and key community sectors equipped with opioid overdose reversal drugs, the number of opioid and heroin overdoses reversed and the extent to which victims and families receive information about treatment services and admissions

Nevada consistently demonstrates some of the highest rates of drug overdose mortality in the country. The Centers for Disease Control and Prevention’s (CDC) has reported Nevada has one of the highest rates of prescription painkillers sold and drug overdose deaths per capita. Inpatient hospitalizations and emergency room visits have increased from a combined 10,264 episodes in 2014, to 15,266 episodes in 2015. Heroin deaths increased 22% in the same time period. The City of Las Vegas recorded a 43 percent increase in the number of times paramedics administered Narcan last year compared with 2015. They administered the medication 596 times in 2015 and 853 times in 2016. In unincorporated parts of Clark County, paramedics administered Narcan 591 times last year. In response to the opioid crisis, the Southern Nevada Health District's (SNHD) Office of Emergency Medical Services & Trauma System will train at least 4,150 first responders in Clark County, Nevada and provide them with 6,225 doses of intranasal naloxone. Projected outcomes of the project will include: 1. By the end of the project period, the opioid overdose death rate in Clark County will be reduced by a statistically significant percentage. 2. The percentage of victims receiving intranasal Narcan who receive treatment services will increase by a statistically significant percentage by year four of the project compared to a baseline to be identified in project years one and two. The Southern Nevada Health District (SNHD) is one of the ten largest health districts in the United States. SNHD was established in 1962, following statutory authorization from the Nevada State Legislature. SNHD serves Clark County, Nevada’s largest urban county. The county comprises five metropolitan jurisdictions (the cities of Las Vegas, North Las Vegas, Henderson, Boulder City, and Mesquite), census-designated places, and unincorporated communities. SNHD also considers the public health needs of the surrounding rural and frontier counties, as many residents of those areas rely on healthcare services provided in Clark County. The 2015 U.S. Census Bureau estimated population for Clark County was over 2 million residents comprising over 70% of Nevada’s total population. Clark County also has an average of 40 million visitors annually. The County is highly racially and ethnically diverse. As of 2015, over 28% of residents were non-White, and included African Americans/Blacks, Asians, Native American/Alaska Natives, Native Hawaiians/Pacific Islanders, Hispanic/Latino and mixed groups. SNHD's Office of Emergency Medical Services & Trauma System (EMS) will manage this project. EMS provides medical direction and protocols for the county's emergency response system. The EMS department approves the training for more than 3,000 certified emergency medical personnel at all levels: basics, intermediates, paramedics and pre-hospital nurses. EMS oversees certification and licensure testing for EMS personnel and permits all emergency medical service agencies within the county. Emergency Medical Services & Trauma System Regulations are approved by the Southern Nevada District Board of Health.

In an effort to address Cuyahoga County Ohio's growing opioid overdose crisis, MetroHealth hospital will establish the MetroHealth First Responders Project, which will provide naloxone allocations and overdose response training to county police departments and community lay responders. As a part of the project, MetroHealth will also launch the Hope after Overdose Outreach Project (HOOP), a quick response team, which will directly connect with opioid overdose survivors in order to provide pathways to substance use disorder treatment as well as take-home naloxone. The purpose of this project is to allocate naloxone to law enforcement (LE) agencies and lay responders in Cuyahoga County; to provide accessible overdose response training to LE and lay responders including high risk populations; and to establish a quick response team that helps to connect overdose survivors with treatment options and naloxone. The measurable goals for the project include: achieve 95% LE naloxone availability for Cuyahoga County residents by January 2019; offer web-based and in-person training to 100% of Cuyahoga County LE agencies every 12 months; provide 1,000 additional naloxone kits to lay responders through Cuyahoga County's naloxone distribution program; provide 600 naloxone kits to opioid overdose survivors and family members through quick response teams; 100% of eligible overdose survivors will be contacted by the quick response teams in HOOP cities within 7 days of documented overdose incidents; 90% of LE agencies will carry treatment and overdose prevention and response resource guides for community members; and a significant reduction in comparison of rates of individuals with repeat overdose will be achieved as measured by a comparison of rates of individual overdose for a given law enforcement catchment area retrospectively assessed from LE records. The populations served by the MetroHealth First Responder Project will be individuals at risk of opioid overdose or individuals who know someone at risk of opioid overdose in Cuyahoga County Ohio as well as overdose survivors in the cities of Bay Village, Fairview Park, North Olmsted, Parma, Rocky River and Westlake, Ohio. Annual allocations of 1,000 naloxone kits will be provided to county LE agencies, as well as 1,000 naloxone kits to MetroHealth Project DAWN; and 600 naloxone kits to opioid overdose survivors through the HOOP quick response teams. Through the lifetime of the project, 10,400 naloxone kits will be provided to LE and lay responders throughout Cuyahoga County.

Our purpose is to create a Restoring Life Network that will train, equip, educate, and intervene in opioid crisis situations. Through the Restoring Life Network, we will 1) provide training on naloxone use; 2) educate on the benefits of naloxone use; 3) provide naloxone kits to our first responder partners; and 4) promote policy changes that are evidenced based at the local, tribal, and state levels that increase the ability of our communities to not only utilize FDA-approved overdose reversal drugs but to build a crisis intervention protocol that ensures higher referral to treatment.

The proposed Missouri Overdose Rescue and Education (MORE) project will reduce opioid-involved deaths in Missouri through training, education, and distribution of naloxone to qualified individuals. The State of Missouri Department of Health and Senior Services (DHSS) will lead the project partnering with Missouri Heroin Overdose Prevention and Education (MO-HOPE) project, Missouri Institute of Mental Health (MIMH), and the State of Missouri Department of Mental Health (DMH). From 2015 to 2016, opioid related deaths rose 35% in the state of Missouri. Data shows an increasing need for the proposed activities in rural counties within the state, as well as an unmet need in some metropolitan areas. MORE will leverage the existing programs and partnerships developed by MO-HOPE to improve and rapidly implement the activities for the overdose reversal program to reduce overdose deaths in Missouri.

Project Name: First Responders – Comprehensive Addiction and Recovery Act (SP-17-005) Applicant Organization Name: Health and Hospital Corporation of Marion County List of all grant program funds requested in application: $1,594,378 Number of People Served Annually: 5,800; Total: 23,200 Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment) is a comprehensive response to the opioid overdose epidemic in Marion County, Indiana, operated by the Health and Hospital Corporation (HHC) of Marion County, d/b/a Indianapolis Emergency Medical Services (IEMS). The goal is to decrease fatal opioid overdoses by increasing access to naloxone and connecting high-risk, opioid-misusing Emergency Department (ED) patients to ongoing substance misuse and other treatment. In this application, Project POINT has five over-arching goals: (1) provide a continuous supply of naloxone to first responders of the IEMS, Indianapolis Metropolitan Police Department, and Marion County Sheriff’s Office, (3,000 naloxone kits/year for the next four years); (2) supply and train lay responders, including opioid misusers, with naloxone through the Eskenazi Hospital ED, Midtown Community Mental Health, Marion County Public Health Department Substance Use Outreach Service, and Overdose Lifeline, (2,800 naloxone kits/year for the next four years); (3) hire two Care Coordinators and a Financial Eligibility Specialist to engage patients in follow-up treatment and services; (4) evaluate the program to assess its replicability in other counties in Indiana and throughout the country; and (5) establish an Advisory Council, initially with the eight collaborating partners, to provide ongoing guidance to the grant project, and to monitor progress and ensure that the goals of the project are being met. The opioid overdose epidemic has affected the City of Indianapolis and Marion County, Indiana, as harshly as any area in the country. According to the most recently available Big Cities Health Indicators report, Marion County’s overdose mortality rate for 2014 is higher than that of New York, Los Angeles, Miami, Washington D.C., and 14 other cities listed on the data platform for Big Cities Health Indicators. IEMS first responders have effectively trained county-wide personnel in the use of naloxone as treatment for opioid overdose, and are in need of a continuous supply. Marion County is also the home of Overdose Lifeline, which has encouraged Indiana to pass Aaron’s Law (Indiana Code 16-42-27). This increases access to naloxone for individuals, who now can obtain naloxone legally without a prescription. This law has led to the creation of lay responders, who are non-medical personnel seeking to prevent opioid overdose deaths among their family or friends who misuse opioids. This proposed project will enable a comprehensive, multi-faceted, effective response to the opioid overdose epidemic in Marion County.

DuPage County Health Department (DCHD) is requesting $1,565,795 for the four year project to deliver the DuPage Narcan Program under the First Responders – Comprehensive Addiction and Recovery Act Cooperative Agreement. Funds will be used to expand and promote the DuPage Narcan Program (DNP), which equips law enforcement officers and other first responders in DuPage County and the surrounding areas with naloxone, an opioid overdose reversal agent. The DNP serves any individual, encountered by a DNP first responder, who is exhibiting signs of an opioid overdose. The DNP trains first responders to recognize signs of an opioid overdose and administer life-saving naloxone. In addition, this project supports a pilot to equip local police department social workers with resources to offer follow-up and referrals to substance abuse treatment to opioid overdose survivors. The project goals are to 1) increase the number of first responders equipped with and trained in the use of naloxone, 2) develop and implement a program with DNP police department social workers to provide information on wrap-around services to opioid overdose survivors, 3) increase public access to the drug disposal program RxBOX, 4) increase public awareness of opioid overdose prevention resources including: Good Samaritan 911 law, signs of overdose, RxBOX, and DNP, and 5) improve evaluation of DNP impact on opioid crisis in DuPage County.

The Oklahoma First Responder- Comprehensive Addiction and Recovery Act (FR) initiative aims to prevent opioid overdose-related death and adverse events through a comprehensive and sustainable approach including overdose prevention education and naloxone distribution (OEND) and referral to treatment for people with opioid use disorders. This will be accomplished through a strategic collaboration with law enforcement and additional first responders to provide OEND services for overdose survivors and bystanders, screening and referral to appropriate treatment and recovery services, and education and policy development around Good Samaritan laws that will sustain program outcomes long-term. The Oklahoma FR project will serve approximately 2000 people per year with OEND services in two metropolitan areas, Tulsa and Oklahoma City, identified as ranking high for opioid overdose risk. An additional 800 overdose survivors and bystanders at risk of overdose will receive screening and referral services per year. Oklahoma will approach the FR project with the following guiding values: (1) overdose is preventable; (2) law enforcement, laypersons, professionals, and people with substance use disorder are capable community responders; (3) all are deserving of intervention; and (4) sustainability is critical.

In an urban county in which opiate overdoses have more than doubled in five years, the Tarrant Opiate Reduction and Recovery Initiative (TORRI) will link 450 overdose survivors to treatment, provide targeted training to 400 first-responders, 2800 individuals who have completed recovery and their families, 210 community members, and partner with 6 agencies who provide law enforcement services to 80% of the County’s 1.9 million residents. TORRI provides a preventive framework for an urban community in which the number of opiate-related overdose calls to the County’s largest emergency medical services provider tripled between 2015 and 2016 with call volume in 2017 expected to exceed previous call volume. With opiate prescribing rate and its prescriber base increasing, opiate-related substance use disorders have emerged as been the leading diagnosis for those admitted into the County’s state-funded substance use services in the last 2 years. Operating in a complex local environment comprised of 41 cities, 28 law enforcement agencies, and 9 emergency responders who serve 1.9 million residents in a 902-square mile urban county, the County is without a collaborative initiative that will develop and deploy a targeted prevention response to the growing number of opiate-related overdoses and subsequent missed linkages to treatment. Through the Tarrant Opiate Reduction and Recovery Network, an Advisory Committee comprised of elected officials, law enforcement, substance use providers, and harm reduction organizations, the County will have both the collaborative partners and a venue through which to provide training and approved opiate reversal drugs to 400 first-responders and to develop protocols that facilitate the rapid referrals by first responders of 450 individuals who experience an overdose to three TORRI Outreach Coordinators. Each a licensed substance use disorder professional, the Coordinators will actively work with each survivor and his/her family within 48 hours of notice of an overdose to linking each to treatment for which he/she is eligible. TORRI will equip 1400 individuals who have completed opiate-related detox treatment and their family members with targeted training and approved opiate reversal drugs prior to their discharge, as well as equipping 210 community members who work with individuals who use and/or may witness an overdose over 4 will support recovery and reduce opiate-related deaths. Recognizing multiple opportunities and audiences through which to prevent fatal opiate-related overdose, TORRI integrates first responder training and education, enhanced access to naloxone and linkages to treatment, and coalition building to save lives, reduce opiate dependence, support recovery, and respond to behavioral health disparities.