Grants Dashboard

The King County Emergency Medical Service Overdose Prevention Project (KCEOPP), is a program of Public Health-Seattle & King County (PHSKC) Emergency Medical Services (EMS) to provide an enhanced response to people who use drugs in King County who access EMS. The program will train first responders in King County, implement a naloxone leave-behind program and start medication tele prescribing with supportive services, care management, and referral. King County, WA has an estimated 2.2 million people residing within the county. It is diverse, with the population spanning high-density urban, suburban, and rural areas, comprised of 60.9% non-Hispanic white, 16.6% Asian, 10.1% Hispanic/Latino, 6.4% Black/African American, 0.8% Native Hawaiian/Pacific Islander, o.6% American Indian/Alaska Native, and 4.6% multi-racial individuals. There are stark disproportionalities in the impact of drug use in King County. Unhoused individuals make up approximately 15% of overdose deaths despite being only 1% of the population. Other marginalized populations are also disproportionately impacted; American Indian/Alaska Native residents have an estimated overdose death rate of more than five times the county average and Black and Latinx individuals also have disproportionately high overdose rates. The year 2021 culminated in the largest yearly increase to date, to which factors related to the pandemic and the influx of fentanyl in the local dug supply have contributed. Fentanyl has been increasingly involved in overdose deaths, from 3 deaths in 2015 to 360 in 2021-a nearly 12,000% increase in just six years. Overdose disproportionately impacts marginalized demographic groups; death rates (in numbers per 100,000) in 2020 were 77.2 for American Indians/Alaskan Natives, 32.7 for Blacks, and 16.5 for Hispanics, compared to 16 for Whites. PHSKC EMS is the applicant organization for t his grant. The Medic One/EMS system is built on partnerships that are rooted in regional, collaborative, and cross jurisdictional coordination between four 9-1-1 dispatch centers, 28 fire agencies, five paramedic agencies, over 20 hospitals, the University of Washington, and the citizens throughout King County that allows the system to excel in pre-hospital emergency care. It is Based on a three-tiered model of Basic Life Support, Advanced Life Support, and Mobile Integrated Health. In 2021, EMS responded to over 4,000 nonfatal overdoses in King County, an increase of 59% since 2018. The three goals of this project are: 1) Increase knowledge among EMS first responders across King County's tiered EMS system on opioid use disorder, reducing addiction stigma, trauma-informed overdose response, secondary trauma, drug safety measures, and related topics. 2) Reduce overdose fatalities among EMS patients with know or suspected overdose, and those at risk of overdose. 3) Increase access to appropriate treatment and recovery support services among EMS patients with opioid use disorder and opioid-related needs. The KCEOPP will provide enhanced overdose prevention services to 10,800 people, provide post overdose follow-up to 5,700 people and train 28 fire departments.

The overall goal of the Rhode Island 2022 FR CARA Project is to reduce overdose deaths and increase warm handoff referrals to treatment and recovery support. Project staff will work with EMS and Law Enforcement to fortify existing partnerships to achieve this target. In addition, we aim to establish Leave-Behind programs, safe station programs, and Mobile Integrated Healthcare / Community Paramedicine (MIH-CP) programs across the state. Finally, the project staff seeks to develop and implement evidence-based training, leverage the First Responder Workgroup, and establish data processes, protocols, and mechanisms that facilitate program surveillance. Accidental drug overdose deaths have affected every community across Rhode Island. The population of focus for this project is first responders in Rhode Island with the intent of equipping them with naloxone, training, and tools to respond to those vulnerable to the opioid overdose epidemic and who have had an instance of overdose. First responders have an active role in addressing the overdose crisis in Rhode Island. In 2021, Emergency Medical Services (EMS) practitioners responded to 1,822 non-fatal opioid overdose-related emergencies, and Law Enforcement Officers (LEOs) responded and administered naloxone on 260 occasions. When LEOs responded, they administered 412 doses of naloxone and saw improvement in 207 (77%) of the cases. EMS and Law Enforcement officers responded to primarily white males between the ages of 25 and 64, with the majority between 35 and 44. However, our surveillance team has seen overdose death rates for Black and Hispanic Rhode Islanders increase over the last few years. From 2018 to 2020, Black Rhode Islanders' overdose death rates increased from 29.9 to 53.9, compared to 18.4 to 27.2 in Hispanic Rhode Islanders and 29.8 to 39.2 in White Rhode Islanders. Unfortunately, despite the best efforts and amidst a pandemic, Rhode Islanders are still dying of overdoses. As of March 10, 2022, 420 individuals died of an accidental drug overdose in Rhode Island in the calendar year 2021. Therefore, we promote enhancing the first responder's role in preventing overdose deaths. We have seen over the years that equipping first responders with naloxone, enhancing their training, and encouraging them to refer patients to recovery and treatment services have resulted in a positive impact. The project has five goals, each addressing a key requirement: access to naloxone, access to training, access to mechanisms for referral, access to an advisory leadership, and access to quality data. The project aims to train 3,000 EMS practitioners and refer approximately 900 suspected overdose patients to recovery and treatment services. In addition, the project aims to establish at least ten MIH-CP programs, ten new Safe Stations, and ten new leave behind programs across the state.

University of Louisiana at Monroe Harm Reduction Education and Referral for Opioid Overdose Reversal (ULM H.E.R.O) Training Program aims to provided first responders and key community organizations evidence-based educational programs on opioid reversal medications to reduce opioid overdose rates and increase referrals to treatment recovery centers in the greater Orleans Parish and Ouachita Parish. Both Parishes have and are surrounded by highly underserved populations that are high in medical need with poor access to healthcare. Our first objective is the creation of an adaptable risk-reduction curriculum tailored to different types of first responders that meet the unique needs of the state of Louisiana. This includes addressing stigma regarding opioid use, review of Louisiana legislation, how to use and teach how to use opioid reversal medications, and test strips, and building a network between first responders and local treatment/recover centers in the area. Our second objective is to educate at least 2,000 first responders by September 30th, 2026. And, our third objective for this goal is to increase our collaborations with local treatment and recovery centers by 80%. Our secondary goal is to implement evidence based educational programs for community first responders (such as people who use drugs or people who may witness and respond to an overdose) with the objective of hosting 50 community events providing risk reduction education directly in underserved communities. And finally, our tertiary goal is to effectively educate and train student first responders in healthcare programs to expand our reach into communities of need. We selected this unique population because students training in healthcare in our state typically stay within our state and come from rural, underserved parishes. Our objective is to provide harm reduction education to at least 800 first responders-in-training by September 30, 2026. Faculty at the ULM College of Pharmacy and Edward Via College of Osteopathic Medicine, Louisiana Campus are highly trained individuals in education who are passionate about the opioid epidemic and are eager to bring awareness to underserved communities. The number of people served will be 500 people the first year, 750 people the second and third years, and 1000 people the fourth year.

The Health and Hospital Corporation of Marion County (HHC), d/b/a Eskenazi Health, is applying for funding to provide support for Indianapolis Emergency Medical Services and Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment) in the Eskenazi Health Emergency Department to combat the epidemic of opioid overdose in Marion County, Indiana. The Eskenazi Health First Responders Naloxone Support Program will help provide naloxone training and naloxone supplies to first responders in Marion County, Indiana. The rate of fatal opioid overdose deaths is higher in Marion County than across Indiana and nationwide. Opioid overdose deaths in Marion County decreased steadily from 2016 to 2018 by 15%, increasing again in 2019 compared to 2018. By the end of 2020 the number of opioid deaths increased sharply by more than 56% compared to 2019. Emergency department visits involving opioid overdoses saw a steady increase from 2016 to 2020. By the end of 2020, they increased by 128% compared to 2016. A study conducted by MCPHD Safe Syringe Access and Support Program (SSAS) with the Indiana Department of Health (IDOH) Laboratories over a three-month period in 2021 showed that syringes retrieved from SSAS and tested at IDOH Labs indicate a large variety of fentanyl and fentanyl analogues in the circulating drug supply. IEMS, EH ED Project POINT, and Eskenazi Health Pharmacy will provide resources to support the availability and use of naloxone devices for emergency reversal of known or suspected opioid overdose to first responders, revived overdose patients, and patients seeking substance use treatment. The primary goal is to decrease the numbers of opioid overdose deaths in Marion County. IEMS will train and provide resources for first responders, ED staff, and members of other key community sectors. Project POINT staff will train revived overdose victims and patients who request assistance with opioid withdrawal on the following to decrease the numbers of opioid overdose deaths in Marion County: -Carrying and administering naloxone -Education and safety measures around fentanyl, carfentanil, and other dangerous licit and illicit drugs. -Establishing policies and procedures for the implementation of evidence-based trauma-informed care practices. IEMS and Project POINT are in the ideal situation to reach the majority of first responders and first-responders-in-training over the four years of the grant. More than 10,000 individuals will receive training and access to naloxone, thereby reducing opioid overdose deaths in the county. Number of Unduplicated Individuals to be Trained with Grant Funds: -Year 1: 3,112 -Year 2: 1,954 -Year 3: 3,112 -Year 4: 1,954 -Total: 10,132

The New Jersey State Police (NJSP) Office of the Drug Monitoring Initiative (ODMA) gathers intelligence on the illicit drug environment through multidisciplinary datasets and can recognize evolving threats, impacts from drug activity, and potentially at-risk persons, populations, and areas. To bring data to action and assist those in need, NJSP developed Operation RISE in 2021, a unique law-enforcement led outreach pilot program under the leadership of the Attorney General of New Jersey. Operation RISE (Recovery, Initiative, Support and Engagement) is a wide-ranging collaborative approach to reducing community drug harm. This proactive initiative employs an evidence-based approach, using data analysis and the science of peer recovery professionals, to conduct strategic and targeted outreach. These efforts will provide linkage to the appropriate level of care for individuals and families impacted by substance use disorder (SUD), reduce recidivism rates of crime associated with drug use, and reduce the stigma associated with the disease of addiction. Operation RISE is currently a proposed pilot program in the southern six counties of New Jersey and NJSP requires grant assistance to expand statewide. Operation RISE utilizes a multifaceted approach. First, it uses Trooper participation. Troopers will be trained on how to identify and be an intervention point for individuals with SUD and how to leverage the resources of Operation RISE to provide outreach. Referrals will be made to NJSP employed RISE advocates. Advocates will assess the current stage of addiction and determine the appropriate level-of-care needed, provide a connection to appropriate care services, and ultimately, establish a conduit of continual support and communication throughout the recovery process. Troopers assigned to the ODMA unit will conduct outreach training programs for law enforcement, other first responder professionals and stakeholder agencies. In addition, ODMA will distribute Naloxone and recovery resources to all barracks, so all troopers have immediate access to this life saving medication while on patrol. Supplies should also allow for distribution to local jurisdictions experiencing financial hardship. Secondly, RISE advocates will proactively engage individuals in need. They will conduct overdose follow-up in a coordinated effort to align with naloxone administrations. Targeted "hot spot" intelligence in urban, suburban, and rural areas allows for specified, coordinated outreach operations for individuals who are most at risk. RISE advocates will also conduct court diversion in jurisdictions with increased levels of drug arrests. Lastly, advocates will provide community outreach in drug demand areas through community education forums. This outreach will provide awareness of the current drug environment, education on treatment options and increase the availability of naloxone to the community. Additionally, Operation RISE will coordinate with already existing law enforcement-led outreach efforts under the Office of the Attorney General to best deploy resources to areas of need. During the grant period, we expect to have the following unduplicated individuals served: Year 1: 208, Year 2: 411, Year 3: 625 and Year 4: 625 (1869 total individuals over 4 years). If successful, we anticipate there will be a reduction of naloxone administrations by first responders, a reduction in drug-related overdose deaths, and an increase in treatment admissions. Reversing increasing negative illicit drug trends is our priority.

The City of Lowell Health Department (LHD) is applying for the FY 2022 First Responders-Comprehensive Addiction and Recovery Support Services Act Grant to support, expand, and enhance existing programs for first responders and recovery support workers to train, carry, and distribute Naloxone, via the Lowell Comprehensive Addiction and Recovery Support Initiative (CARSI). The proposed catchment area for the CARSI is Lowell, Massachusetts. The population of focus is adults 18 years of age and older at risk of substance use, which includes the underserved Hispanic and Black communities in Lowell. The CARSI will 1) increase the number of first responders and members of other key community stakeholder organizations trained in the use of overdose reversal medication, and increase the distribution of such medication; 2) establish processes, protocols, and mechanisms for referral to appropriate treatment and recovery support services, and safety around opioids, including but not limited to fentanyl, carfentanil, and other dangerous licit and illicit drugs; 3) increase access to culturally and linguistically sustaining (CLAS) appropriate materials, services, wound care, and infection treatment for people who use substances; 4) increase knowledge within the substance using community, and their networks about the Good Samaritan Law in order to increase bystander use of naloxone when needed, and reduce stigma therein; 5) utilization of FirstWatch for real-time data of opioid-related 9-1-1 calls; and 6) maintain detailed electronic record-keeping of individuals at risk of substance use to provide time appropriate referrals and recovery support services.

The Roanoke Valley Collective Response, a project of the Roanoke Valley-Alleghany Regional Commission, proposes to build out a first responders peer recovery initiative to assist EMS and law enforcement in the catchment areas with addressing the increase in overdose calls, to prevent repeat calls, and to work to facilitate warm hand off of individuals who have overdosed. The COVID-19 pandemic produced record high overdoses nationally, but Southwest Virginia, which includes almost all of our catchment areas, has been heavily impacted by the addiction epidemic. According to the Virginia Department of Health, from 2019-2020 the region saw a 22% increase in all drug overdoses, and a 25% increase in opioid overdoses. The region saw a 79% increase in heroin overdoses, compared to the state average of a 36% increase. The proposed first responders peer recovery initiative responds to the growing regional need of EMS and law enforcement peers with lived experience to assist in on-sight overdose calls, training and education, outreach, and networking between first responders and the addiction recovery professionals and community. This collaboration will allow for peers to be present on 911 overdose calls so that they can provide additional support to EMS, those experiencing overdose, and family members on the scene of overdose. This initiative is based on the best practices learned from a pilot project with Salem VA EMS and the HOPE Initiative. The HOPE Initiative was started in 2016 to assist individuals with Substance Use Disorders who are seeking addiction treatment and recovery resources. It is a peer-based model, staffed entirely by Certified Peer Recovery Specialists (CPRS) who work with individuals and families by providing information on treatment and recovery resources personalized to meet client needs as well as assisting in the program application process. The HOPE Initiative works closely with many community partner agencies to help bridge gaps to treatment, and educate the community at large about Substance Use Disorder. The proposed first responders peer recovery initiative will utilize best practices from the HOPE Initiative which include live updates of the participant electronic health record, real-time consent forms, reporting procedures for EMS, and peer support during overdose spike hours. The requested peers will work on this project to engage in overdose response calls. Their role will be to facilitate linkage between the participant and treatment and recovery resources. The overarching goals of this initiative are providing live assistance to EMS and law enforcement while seeking to reduce the changes of repeat overdose calls, introducing participants into the spectrum of treatment and recovery, and providing information on resources across the recovery spectrum. The CPRS will act as care coordinators after handoff from EMS and law enforcement, assisting with reducing the barriers to treatment, housing, insurance status, support groups, and other needed services to create a foundation for achieving long term recovery. These services will produce a number of measurable deliverables including: participant counts, treatment resources utilized, counts of co-occurring disorders including mental health, participant demographic information including insurance, employment, and housing status, and other recovery service variables. Alongside the overdose response program, we will provide various trainings including : REVIVE training (overdose reversal and Narcan distribution), Trauma basics, compassion fatigue, and more to all participating EMS and law enforcement that are in need.

The Yurok Tribe proposes to implement the Safety Net Responders project, the overall goal of which is to reduce opioid-related overdose (OD) risks and avoidable deaths, disease, and other negative effects on health and social wellbeing among Yurok tribal community members. With strategic assistance from our project partners (see letters) and guided by the Yurok Tribal Wellness Coalition serving as our project advisory council, we will implement lifesaving activities in our California geographic catchment area of the Yurok Indian Reservation and Humboldt and Del Norte (HM-DN) counties not located in a metropolitan statistical area (MSA). Together these counties span over 5,282 square miles in this mountainous region and are referred to as the "Emerald Triangle," so named because, since the 1960s, it has been the largest cannabis-producing region in the US. Its thick cover of trees, seemingly endless rural terrain, and washed-out single lane dirt roads, often inaccessible in the winter, provide cover for covert activities including underground cannabis cultivation and human, sex, and drug trafficking (including opioids, methamphetamine, and cannabis) (1,2). COVID and other factors have limited opioid-related data collection, reporting and consistency. However, available data over the last few years is nonetheless alarming: 1,356 drug-related OD emergency dept. visits (HM and DN) in 2019 (CA Overdose Dashboard), 33 fentanyl deaths in HM County alone in 2021 (9), and more. Native Americans in HM County have the highest prevalence of opioid-related encounters throughout the state and within Indian Health Programs (10). Our population of focus, the Yurok tribal members who live on the Reservation or in other parts of HM and DN counties, experience many social and health disparities layered upon the existing unhealed historical trauma from generations of oppression and colonial pain they and their ancestors have suffered and are still affected by today. These and other stressors contribute to disproportionately high rates of substance use, including opioid use, suicide, domestic violence, child maltreatment, and more (6,7). Further stress is caused by a severe behavioral health workforce shortage in our target geographic area which makes providing access to care in remote areas extremely challenging (15), especially in terms of relevant treatment, recovery support, harm reduction, and reconnection to tribal culture and traditions for healing. Project activities over the 4-year award period include: creating and implementing culturally specific OD reversal and response training to at least 876 first responders and members of other key community sectors including family members from HM and DN counties; dispensing thousands of Narcan/other approved opioid OD devices and fentanyl test strip kits; improving local data collection; standardization, and reporting, and leveraging, a harm reduction partner's low threshold buprenorphine access. Our project will be housed under the Yurok Tribal Court to enhance tribal wellness services and referrals to outside community assistance such as shelter, housing, and domestic violence and behavioral health services.

Abstract -Expanded First Responders and Community Partners Overdose Prevention Project (EFRCPOPP). The geographic catchment area for this SAMHSA FR-CARA proposal is Lexington-Fayette County, Kentucky The 2020 National Survey on Drug Use and Health estimates that 9.6% of adult Kentuckians used an illicit drug in the past 30 days and that 6.0% met criteria for an illicit drug use disorder in the past year. Direct application of these estimates to Lexington's adult population suggest that 24,525 adults used illicit drugs in the past 30 days and 15,329 met criteria for an illicit drug use disorder in the past year. Lexington, KY has experienced a great deal of loss due to the opioid and other substance use crisis. Although 2018 and 2019 brought significant declines in the number of overdose fatalities in Lexington after experiencing a peak year 2017, when the COVID-19 pandemic began in early 2020, overdose fatalities quickly began to increase. In Lexington, KY in 2020, there were 209 overdose fatalities according to the Fayette County Coroner's Office. This was a staggering increase from 128 overdose fatalities experienced in 2019. The COVID-19 pandemic appeared to particularly devastating to individuals that use drugs and some in early recovery from substance use disorder across the United States and Lexington was no different. Lexington was awarded a FR-CARA grant in 10/2018 and with implementation partners has been able to distribute more than 10,000 naloxone kits and facilitate linkages to recovery residences, treatment programs and other services for individuals that sought assistance to stop using illicit substances. However, the FR-CARA grant is currently slated to end 09/29/2022. The ending of the grant unfortunately coincides with a drastic increase in overdose fatalities in Lexington and across the country that resulted from a pandemic no one could have predicted. LFUCG proposes to expand the scope of its current FR-CARA project to include a Leave Behind Program currently implemented by the Lexington Division of Fire and Emergency Medical Services Community Paramedicine Program that follows-up with individuals that survived an overdose. The program provides naloxone and overdose prevention training and connects the survivor with non-judgmental service providers that want to meet him or her where he or she is, both physically and psychologically. This mobile unit is made up of firefighters, social workers and a police officer whose long-term assignment is the Community Paramedicine Program. The program anticipates assisting 400 individuals per year. Additionally, FR-CARA would begin to provide naloxone for officers joining the Lexington Police Department and provide refills for officers that need one. It is anticipated that up to 150 doses of naloxone would be needed annually to provide this service for the Lexington Police Department. The Leave Behind Program and the program to provide new officers with naloxone would join the well-established Syringe Service Program overdose prevention education and naloxone distribution program as well as the community naloxone program. It is anticipated that these four programs would serve 9,200 unduplicated individuals throughout the grant period. It should be noted that because the local drug supply contains a great deal of fentanyl and its analogs, overdose response trainings in the community and at the SSP already include a component on the dangers of it. Firefighters, paramedics and police officers receive training, as well.

The purpose of the project titled, Reimaging Public Safety with Training, Resources and Prevention to Opioid Overdose and Death, complements the formation of the new Albuquerque Community Safety department, a third branch of the 911 public safety system designed to transform the City's approach to emergency response by connecting residents to treatment and recovery support services that are needed in that moment and for the long term. While protocols are currently in place for all City first responders to carry and administer Naloxone, there is a need to adopt a City policy to facilitate immediate overdose follow-up support across all city emergency responders; expand access to Naloxone and training on how to use the device to community members impacted by overdose; maintain sufficient supply of Naloxone and training to expand access; offer time-limited comprehensive support services through engagement with certified peer recovery support professionals; and, with the recent passage in New Mexico to legalize test strips that can detect the presence of the potent opiate fentanyl and potentially help avoid deadly overdoses, initiate a policy and process for responders to distribute fentanyl test strips and create education on safety measures around use of such drugs. The City of Albuquerque is applying for the SAMHSA FR-CARA grant in the amount of 2 million over a four year time period to accomplish the above stated goals and objectives and to train a minimum of 1600 unduplicated individuals over the life of the grant, with an estimated 200 the first year, 300 year 2, 500 year 3, and an additional 600 individuals in year 4. Albuquerque is the largest city in the State of New Mexico and the target area of this request. The most recent estimated population of Albuquerque is more than 564,000, with the City proper population estimated at 558,000 and metropolitan population estimated at 916,000. Albuquerque is similar to most cities in the U.S. today with substance abuse often the cause of rising rates in crime, homelessness, overdose, emergency response, and death. The problems associated with addiction throughout New Mexico and in Albuquerque are complex, multi-generational and most often driven by underlying social determinants of health issues, including poverty and quality of care. In the past four years, Albuquerque Fire and Rescue responded to 43,820 substance-related intoxication and overdose incidents, at an estimated cost of more than 1.3 million per year. From 2019 through 2021, AFR realized a 42 percent increase in administration of Naloxone for known or suspected opioid related overdose, with 639 incidences recorded in 2019; 737 in 2020; and 903 in 2021. And according to the New Mexico Department of Health, the state's overdose death toll jumped to 721 in 2020 compared with the 574 the year before. The 25 percent increase in New Mexico overdose deaths is reportedly fueled by and increased abuse of opioid fentanyl. ACS is Albuquerque's newest approach to reimagining public safety and is the lead agency to implement the activities outlined in this request. The new department, the nation's first cabinet level department of its kind, began serving the Albuquerque community in September 2021 to relieve pressure on police and fire, allowing officers to focus on addressing violent crime calls, and freeing up EMTs to quickly respond to urgent, life threatening situations. ACS first responders have the training and resources to step in when someone is experiencing a mental health, addiction or housing crisis to get the person connected with the right resources that are needed in that moment and for the long term, to assist Albuquerque residents in maintaining and sustaining recovery and to ultimately reduce opioid-related overdose and death.

Police N Peers is an innovative new program aimed at using the quick response of law enforcement paired with the diversion and social service awareness of a co responding Peer Recovery Support Specialist (PRSS). The PRSS are specially trained in case management and motivational interviewing and can deescalate volatile behavioral health, drug related or domestic situations thus freeing up Law enforcement to focus on the enforcement aspect of the incident. PRSS will be trained in and assist with opioid reversal, gateways into treatment; fentanyl & carfentanil awareness and testing; train and provide resources to first responders and key community sectors; establish policies and procedures for process improvement and participate in advisory committee; educate physician and pharmacist on ethical prescribing and participation on prevention and handle with care programs. PRSS will have direct access to resources and outreach capabilities linking needed members to drug addiction treatment centers, social services and programs such as Sobriety Treatment and Recovery Teams (START), Quick Response Teams (QRT) and DHHR continuum of services such as welfare, housing assistance, and CPS as well as Veterans Assistance (VA) services.

The County of Burlington, New Jersey, will implement the Burlington County FR-CARA Project to provide Narcan cartons and training on Narcan use and related topics to first responders and members of other key community sectors in response to rising opioid use throughout the county. In addition, the project will deploy Peer Recovery Coaches on a 24/7 basis to meet with individuals at the scene of overdose events to facilitate warm-handoffs to treatment and recovery services as well as additional supports. First responders will also participate in training on mental health, substance use, tobacco cessation, stress relief, and safety around fentanyl and other licit and illicit drugs. As part of public education efforts, the project will develop and disseminate information on Good Samaritan laws to reduce the number of opioid deaths that have been rapidly increasing throughout the county. The project will focus on training first responders, including law enforcement, fire, and EMS professionals and volunteers, as well as members of key community sectors including K-12 schools, hospitals, libraries, colleges and universities, government, faith and community-based organizations, and large employers in the county such as Amazon. Services to connect individuals to treatment and recovery services and related supports will also be served throughout Burlington County, particularly those experiencing overdose events and/or seeking help with entering treatment. The population of focus is Burlington County, New Jersey, the largest county by area in New Jersey at 820 square miles. According to the US Census Bureau, the County has 446,301 residents across 40 municipalities. The population is 66.6% White/Non-Hispanic, 16.1% Black/African-American, 8.3% Hispanic/Latino, 5.1% Asian, and 3.9% Other or Two or More Races. The poverty rate is 7.7%, totaling 34,365 people. Based on the most recent NJ Department of Human Services data detailing treatment admissions, the population of people who use substances in Burlington County is estimated to be 72% White/Non-Hispanic, 20% Black/African-American, 6% Hispanic/Latino, and 1% Other. About 68% of admissions are male and 32% are female, with less than 1% identifying as neither male nor female. By age, 9% of admissions are 18-24, 40% are 25-34, 25% are 35-44, 17% are 45-54, and 9% are over 55. About 90% have incomes at or below 133% of the federal poverty level, while 20% are uninsured and 64% have Medicaid insurance coverage. An estimated 23% are unemployed, 8% are homeless, and 14% did not complete high school. The goals of the project are to: increase the capacity of first responders to prevent overdose deaths and connect individuals to resources that support recovery from Substance Use Disorder; increase the capacity of first responders to refer individuals using substances to appropriate treatment and recovery support services; and, increase the capacity of first responders, members of key community sectors, and members of the general public to identify and respond to mental health or substance abuse issues in the community. Throughout the four year project, the County will reach 4,500 first responders and members of other key community sectors with training on Narcan use and related training to increase the county-wide capacity to reduce opioid overdoses and fatalities. Additionally, 2,200 first responders will complete training on tobacco cessation and mental health first aid and more than 4,000 members of the public will participate in training on Good Samaritan laws.

Through key community partnerships with organizations that reach the most vulnerable and underserved, the TRAIN (Training Responders to Assess, Initiate, & Navigate) project will train and support responders and community partners to efficiently provide FDA approved overdose reversal drugs, assess appropriateness of and initiate low-barrier MAT, and assist individuals in navigating the pathways between harm reduction, treatment, and supportive services. TRAIN will close the deadly gaps in the continuum of care through coordinated training on SUD, trauma, and evidence-based practices; outreach and navigation staff with shared lived experience; and data sharing to ensure efficiency and effectiveness. The City of Huntington in Cabell County, West Virginia has been disproportionately impacted by the substance use epidemic. The 2020 census demonstrated the continued downward trend in population seen over the past six decades, during which Huntington has lost almost half its population. Eighty-five percent of the population identifies as White and 8% identify as Black. Most of the population speaks English with just less than 4% speaking a language other than English at home. Approximately 850 persons experience homelessness annually in the Cabell-Huntington-Wayne Continuum of Care alone. In Cabell County, 49.7 per 1,000 persons have a SUD (WV DHHR, BMS 2020). Although a large number of overdoses go unreported to 911, Cabell Emergency Medical Services responded to over 1,000 suspected overdoses in 2021. A report by Allen et al. (2019), estimated that there were 1857 people who inject drugs (PWID) in Cabell County. It is critical to establish the processes for these disproportionally impacted individuals to navigate treatment and recovery support services. This unique project, TRAIN, will serve the residents of Cabell County, the City of Huntington, those who are unsheltered or unstably housed, those who overdose, those who seek treatment and fall out of care, and those who receive harm reduction services in the region. This grant will also serve first responders and key community partners who work with individuals struggling with SUD. In the first year of funding, TRAIN will provide trainings to 100 responders and community partners on the topics surrounding the development, advancement, and treatment of SUD; trauma-informed EBPs including SBIRT and motivational interviewing; and trainings to improve access to and the use of overdose reversal drugs in Cabell County. By the completion of the project over 550 individuals will have been trained. TRAIN staff will initially work with two community partners, PROACT and the QRT, to develop the processes to increase low barriers access to Buprenorphine at PROACT in the first year with expansion to other community groups, such as the Health Department and Harmony House. By developing a HIPPA compliant referral and consent tool, the TRAIN Case Navigator will be able to decrease gaps in the continuum of care, increase compliance with treatment and recovery services, and provide person-centered care using the outreach support of existing and new Peer Recovery Support Specialists (PRSS). The navigation system in TRAIN, the data sharing, and the necessary community partners will be supported and overseen by an Advisory Board to include state and city leaders, first responders, peers with lived experience in SUD and homelessness, harm reduction, prevention, treatment and recovery support experts with signed MOUs. These partners have already committed with Letters of Commitment. The City of Huntington along with their committed partners is equipped to implement this life saving training, medication and service initiation, and navigation network with the support from the First Responders-Comprehensive Addiction and Recovery Support Services Act Grant.

The First Responders Addiction and Recovery Support (FRARS) program will provide all first responders in Durham County the ability to carry and administer intranasal naloxone, a drug/device for emergency reversal of known or suspected opioid overdoses. This program expands the availability of this life-saving drug to communities and populations with greater substance use activity but fewer opportunities to obtain treatment and referrals to continued care outside of calling 9-1-1. In North Carolina and United States, the percentage of opioid overdoses in Whites is higher than those of other races and ethnicities. In Durham County, NC, however, the trend is different with Black or African American individuals comprising 54% of opioid overdoses and Whites only 44%. Most overdoses occur in geographical areas considered highly vulnerable areas exhibited by higher unemployment, significant housing and food insecurities, social vulnerabilities, and greater mental health concerns. Many are uninsured or underinsured making access to health care challenging. The FRARS program has several goals, all but one to begin in the first year of the grant. One is to increase the number of first responders with access to intranasal naloxone. Each first responder will be trained on the safest way to carry the devices, how to recognize an overdose, and how to administer the drug. They will learn more about substance use, especially opioid use, and how trauma-informed care can play a role in helping persons be more willing to begin treatment and recovery. Each first responder will have access to information about community resources that can help people with substance use disorders start medication assisted treatment (MAT), substance use counseling, and other supports as needed for emotion, psychological, or social determinant concerns. Another goal is to extend our current community harm reduction outreach by providing intranasal naloxone kits and resource guides to every person who has had or is at risk of experiencing an opioid overdose. Currently, EMS Community Paramedics (CPs) attempt to provide these resources via a post-overdose response but are only able to connect with around 10 percent of all overdose patients for whom 9-1-1 was called. Recently, these kits were added to ambulances so EMS crews can distribute naloxone kits and resource guides at the point of contact thus increasing the number of people impacted. We plan to expand this outreach further by providing additional kits for all first responders and community organizations with the potential to encounter someone who is at risk of an opioid overdose. These responders and community members will also receive training on substance use and trauma-informed care as well as information about community resources that can help a person with treatment and recovery. Fentanyl use is on the rise in Durham County. We plan to begin distributing Fentanyl test strips along with the intranasal naloxone kits during harm reduction efforts. Substance users can then test their drugs before use to determine if Fentanyl is included with their drugs. They will then be able to take stronger precautions against death by overdose. Everyone receiving these test strips will receive education and information about the risks of Fentanyl along with referrals to community resources for medication, treatment, and recovery. Finally, in year two of the grant, CPs will begin providing field initiated Suboxone or a generic equivalent. This is intended to help individuals in underserved areas have a greater opportunity to obtain medication and treatment to help them begin recovery. CPs will work with each person to provide the medication while getting them enrolled in a community-based office-based opioid treatment (OBOT) center. Through motivational interviewing and trauma-informed care, CPs will be able to help persons who may otherwise never enter treatment.

Title: Erie County NY First Responder Opioid Epidemic Task Force Support Program. The Erie County, NY Department of Health, on behalf of the Erie County Opioid Epidemic Task Force, will enhance and expand a countywide first responder support services program to equip and train over 3,000 first responders from all 131 units (police and fire) in the county. The 2021 Erie County opioid overdose rate exceeded the national rate by over 55%. This proposal targets first responder training/supply gaps and treatment initiation barriers to address this crisis. Since the start of the COVID pandemic, Erie County has experienced a precipitous increase in opioid overdose deaths, largely driven by fentanyl. At the same time, local harm reduction efforts by first responders were superseded by the COVID surge – creating a perfect storm of overdose. The County has established a First Responder Support Services Leadership Team to lead and sustain this initiative in response to growing needs. They will deploy a harm reduction service delivery model using evidence-based interventions to achieve three goals: Goal 1) Train / Retrain First Responders in Overdose Rescue Procedures: Obj. 1.1) Trainings on use of Naloxone with trauma informed approach; & Obj. 1.2) Trainings around fentanyl exposure safety. Goal 2) Distribute Naloxone & Other Harm Reduction Supplies to First Responders & Community Settings: Obj. 2.1) Rescue supplies distributed to First Responders; & Obj. 2.2) Wall Boxes distributed to community locations. Goal 3) Test Peer-Mediated Telemedicine Low-Threshold Buprenorphine Pilot: Obj. 3.1) Peer linkage of OD survivor to MAT providers; & Obj. 3.2) Virtual Field-Initiation of MAT with Peer Connection to after-hour Call Center (UB Addiction Medicine) with initial treatment follow-up linkage via the New York State MATTERS app. Evidence-based interventions will include harm reduction education and overdose prevention training, naloxone distribution, and Peer support services, linking survivors to MAT. The Leadership Team includes consumer representatives (advocates and those in recovery), first responder leaders, treatment provider representatives, the Public Health Commissioner, the Director of the Erie County Opiate Epidemic Task Force (Project Director), the Commissioner of Mental Health, and the University at Buffalo Evaluation Partner. By equipping and training all first responders and targeted community areas over the 4-year project period, we expect that: (1) overdose deaths will drop 10% annually (from 310 to 225); (2) first responder rescues will decrease 10% annually (from 1,000 to 730); (3) a pilot program that is peer-mediated with responders will assist over 220 overdose survivors; (4) 50% of responder rescues will be referred to support services; and (5) 80% of referrals will be linked to treatment and support.

The Arizona Department of Health Services Bureau of EMS & Trauma System (Bureau) is seeking funding from the Substance Abuse and Mental Health Services Administration FY 2022 First Responders-Comprehensive Addiction and Recovery Support Services Act (FR-CARA) Grant to continue work to increase the capacity of Arizona first responders to respond to and prevent known and suspected overdoses statewide. From 2017 to 2021, the number of opioid-related deaths in Arizona increased by 112%. As a result, EMS and law enforcement response to suspected opioid overdoses in Arizona increases year after year. In response, the Arizona FY 2022 FR-CARA project will develop, implement, and assess strategies to engage first responder agencies in responding to suspected opioid overdoses, increase the capacity of first responder agencies to respond to and prevent suspected opioid overdoses, and increase the capacity of first responders to refer suspected non fatal opioid overdoses to treatment. The Bureau proposes the following objectives: ? Over the four year grant period, purchase and distribute 12,200 naloxone kits free of charge to (1) to first responder agencies for the purposes of responding to suspected opioid overdoses and (2) to EMS agencies participating in the Naloxone Leave Behind Program. -Provide naloxone administration training to 2,000 first responders statewide over the four year grant period through the promotion of the developed virtual first responder naloxone training platform -Expand the virtual first responder naloxone training platform to include a training on Naloxone Leave Behind -Conduct individualized outreach to 100 fire and EMS agencies across Arizona promoting participation in Naloxone Leave Behind and the existing PHELE program -Conduct individualized outreach and training to 50 agencies based on monthly EMS Naloxone & Opioid Reports -Facilitate the development of educational pamphlets with referral resources specific to the jurisdiction implementing Naloxone Leave Behind Programs -Engage existing opioid advisory councils (ADHS Opioid Action Plan, Drug Overdose Fatality Review Team) to expand the capacity of grant programming (BEMSTS) To carry out these initiatives, the Bureau will partner with the University of Arizona Emergency Medicine Research Center, the University of Arizona Center for Rural Health, the ADHS Opioid Action Team, the Drug Overdose Fatality Review Team, and other key stakeholders.

The First Responders-Comprehensive Addiction and Recovery Act (FR-CARA) project will serve tribal citizens across seven rural counties in Cherokee Nation. Administered under Cherokee Nation's Restoring Lives Network (RLN), the grant will help grow regional partnerships to provide increased access to community-based resources for substance use disorders and overdose prevention education. Regionally, there has been an increase in substance misuse coupled with low treatment rates which highlights the need for adult residential treatment options. The purpose of the project is to educate and equip the community and healthcare practitioners to best respond to substance misuse by increasing regional access to treatment, raising awareness of existing resources, and encouraging sustainable, trauma-informed recovery networks and referral processes. Implementation strategies will be informed by the RLN Advisory Council comprised of key stakeholders from the served communities which will ensure representation in the development of policies, outreach, and partnerships. Under this grant, staff will utilize evidence-based overdose response methods, provide targeted Naloxone trainings, establish robust referral processes, and educate community members to reduce stigma, and build culturally appropriate recovery networks. Over the course of four years, this project will train 500 unduplicated individuals and will aim to decrease regional overdose rates. The proposed multi-year program will be heavily informed by strategic partnerships and engagement with first responders which will be imperative to its success and sustainability. For the duration of the grant, staff will work closely with the evaluation team to gather data, evaluate efficacy of trainings, and provide reports to illustrate impact and utilize the Process Improvement Model to ensure metrics are being met.

KDADS will address the growing increase of drug overdose deaths by implementing a program that will provide resources to first responders and members of other key community sectors at the local level in four rural regions of the state: Northwest, Southwest, North Central and Southeast. This will encompass slightly more than half (53) of the state's 105 counties.

Project Abstract Erie County Health Department (ECHD) is the lead applicant for the Saving Lives: Erie, Huron, an Ottawa Counties project. Utilizing existing partnerships with First Responder agencies and developing partnerships with educational/career training institutions, we will train and equip First Responders and those entering medical and first responder fields to administer Naloxone to suspected drug overdose victims. ECHD has identified four primary goals for this project: First, to preserve life after an individual experiences overdose; Second, to connect overdose survivors to immediate treatment at ECHD's medically-supervised detoxification center and to link survivors and their family members to appropriate follow-up care; Third, to expand Naloxone trainings into community sectors and career technical programs at area vocational institutions and schools; Fourth, to expand education efforts surrounding addiction, overdose, and Ohio's Good Samaritan laws to community members and business owners as well as physicians and pharmacists. Since 2016 ECHD has equipped 1,131 First Responders and 4,715 community members with Naloxone training. Combined, 613 lives have been saved because of a Naloxone intervention, however, the overdose epidemic continues to take a toll on community resources and members. In 2020, 323 individuals from Erie County visited an Emergency Room because of overdose; that is a 76% increase in cases compared to 2019. Through September of 2021, 213 (284 annualized) individuals have presented to an ER because of suspected overdose. A similar story is found in both Huron and Ottawa counties, where year over year increases were 44% and 57% respectively. Many experts attribute this dramatic rise to the COVID-19 pandemic which cut many individuals off from needed support systems. The service area of Erie, Ottawa, and Huron counties in Ohio is home to about 172,000 people with an average median household income of $50,373; this is lower than both the national and Ohio median income rates. Nearly one-third (31%) of this population is considered low-income, and nearly 10% are living below the poverty level. The city of Sandusky in Erie County has the highest population concentration within the service area at nearly 25,000 people. The city has a significantly higher poverty rate (21.3%) than the surrounding counties and the state, putting residents here at greater risk for experiencing health disparities including addiction and substance abuse issues. Economic instability feeds directly into addiction rates as those who struggle to find and keep stable employment and housing are also at higher risk of substance abuse according to the National Institutes of Health. The three counties in our service area are HRSA-designated rural areas and are designated as both Health Professional Shortage Area (HPSA) and Medically Underserved Community/Populations (MUC/MUP). Most individuals live in small villages or townships, further removing them from easy access to health care, emergency services, social supports, and other social services. Many have multiple health equity factors be they social, financial, educational or other putting them at great risk for experiencing health disparities. ECHD operates a fully-funded Federally Qualified Health Center (FQHC), a medically supervised detoxification unit, and supervises a female-only residential recovery housing unit on its main campus in Sandusky, Ohio. The FQHC serves over 4,100 unduplicated patients per year. The FQHC provides a broad range of primary, dental, and behavioral health care services. Because ECHD operates an FQHC, we have the ability to integrate primary, dental, and behavioral/mental health care into the drug overdose survivor's treatment regimens. This project will save hundreds of lives and improve quality of life through virtually every sector of the community.

Project and Population to be Served: The Lancaster County Drug and Alcohol Commission recognizes the devastating impact of opioid use disorder has on our community. The LCDAC will focus its efforts on First Responder (FR) trauma-informed education and training and creating clear pathways to treatment and resources for overdose survivors and their family members, including children. Between 1.2020 and 9.2021, Lancaster County FR responded to 1,129 dispatches involving Naloxone or overdose response. In Lancaster County, the opioid crisis got worse with the onset of the pandemic and overdoses increased by 44%. At least 25% of the US population belongs to a family affected by an addiction disorder in a first degree relative. The LCDAC will partner again with Lancaster General Hospital (LGH) as its implementation partner to build on the work of its current SAMHSA FR CARA award and address the impact of trauma on the populations of focus. The populations of focus for this project are: (1) people at risk for overdose in Lancaster County, Pennsylvania, particularly the most vulnerable populations (males ages 25-44 and Black and Hispanic/Latino individuals); (2) Adult loved ones and children of an individual affected by addiction are a population of focus; and (3) Lancaster County First Responders (FR) who will be trained on the role of Trauma Informed (TI) care during health emergencies with a goal to increase FR awareness of trauma's impact in the communities where they work. Each of these populations of focus have experienced or are experiencing trauma. TI care training provides FR with tools to understand where people's behavior comes from, communicate effectively with patients and bystanders (family/ children), build trust, and do the job to the best of their ability. Strategies: Over the 4-year award period, the LCDAC will train 1000 Lancaster County first responders on carrying and administering Naloxone; safety measures around fentanyl, carfentanil, and other dangerous drugs; and establishing policies and procedures for implementation of evidence-based TI care practices. The LCDAC will also establish processes, protocols, and mechanisms for referral to appropriate treatment and resources for people at risk for overdose and their families. The project will engage the services of a certified recovery specialist and a certified family recovery specialist to provide support to the overdose survivors and any family, loved ones or children on scene at an overdose incident. Goals and Measurement Objectives: By the end of the project, the project team will (1) identify and formalize pathways to treatment and resources for overdose survivors, individuals seeking access to buprenorphine, family members, children and vulnerable populations (i.e. LGBTQ+, veterans, non-English speakers).; (2) reduce barriers to treatment for 25% of overdose survivors seeking treatment; (3) increased self-rated hope as measured by the Adult/ Child Hope Scale; (4) educate 400 community members on the Good Samaritan law; and (5) trauma-informed overdose training will be embedded in 100% of EMS and Law Enforcement's onboarding policies and/ or annual training requirements. Number to be Served Annually/ Total: The project will serve 900 FR (Year 1- 150, Year 2-200, Year 3-250, Year 4-300), at least 100 referred overdose survivors with 24-72 hours after overdose; and 400 community members with Good Samaritan Education.

The Department of Behavioral Health and Developmental Services (DBHDS) is applying for the First Responder grant in the hopes of continuing to partner with the Virginia Association of Chiefs of Police (VACP) to ensure proper training and Naloxone to all public safety individuals statewide. This grant award will allow DBHDS to expand our goals to include: Goal 1- To train 3,000 First Responders in Virginia's REVIVE! Program for the use of Naloxone and provide resources for them and members of other key community sectors to carry and administer naloxone for emergency treatment of known of, or suspected opioid overdose. Goal 2- To equip no less than 70% of first responders and community sectors with naloxone for emergency treatment of known of, or suspected opioid overdose. Goal 3- Provide fentanyl test strips for campus and university police and security officers. This final goal is the next step in combating the rising overdose rate in Virginia by working with our statewide university and private colleges to ensure that test strips are available for those in need and provide linkages to harm reduction supports in local areas. Additionally, the purchase of carrying cases for those in need to ensure that the Naloxone is kept protected and secure throughout the shift of public safety members.

Project Name: SNHD FR-CARA Populations to be Served: naloxone trainings will be targeted toward first responders and members of other key community sectors that serve individuals who are vulnerable to overdose, especially among underserved populations. This specifically includes individuals who were recently incarcerated, who recently overdosed, and/ or who are experiencing homelessness. Strategies/Interventions: 1. SNHD will make intranasal naloxone available to be carried and administered by first responders and members of other key community sectors. 2. SNHD will train and provide resources for first responders and members of other key community sectors on carrying and administering intranasal naloxone for emergency treatment of known or suspected opioid overdose. 3. SNHD will establish processes, protocols, and mechanisms for referral to appropriate treatment and recovery communities, which may include an outreach team to connect individuals receiving opioid overdose reversal drugs to follow-up services. 4. Goal: To prevent loss of life related to opioid overdose in Clark County, Nevada by preparing first responders to administer intranasal naloxone through trainings conducted by SNHD. Process objectives: 1. By the end of the project period, SNHD will train at least 4,965 first responders in Clark County, NV and provide them with 26,740 doses of intranasal naloxone. 2. By the end of the project period, SNHD projects at least 50 percent of the doses of intranasal naloxone will be administered to known or suspected opioid overdose victims. 3. The percentage of individuals receiving intranasal naloxone who receive treatment services will increase by at least 25% percent by year four of the project compared to a baseline. 4. Within six months of grant award, SNHD will form an advisory council that meets the requirements of the grant. 5. SNHD will collect and report data quarterly Number of People to be Served Annually: Year 1, 925; Year 2, 1,110; Year 3, 1,332; Year 4, 1,598; Total, 4,965

This grant proposal targets 18 counties across Missouri with high rates of opioid-involved overdose deaths. We will be offering the training Overdose Response: Brains, Bias, and Best Practices developed by the Mid-America Addition Technology Transfer Center (ATTC) to first responders, which includes overdose education and naloxone distribution training. We will also be doing naloxone distribution with local health departments and first responder agencies, as well as supporting the development and/or expansion of opioid-focused community coalitions. Our goal is to provide increased training, naloxone, and community infrastructure development and support to high-need communities across Missouri to help reduce the incidence of fatal opioid overdoses.

The Clay County Board of County Commissioners (BCC) seeks $337,440 in funding to provide additional personnel and naloxone to combat the opioid epidemic in Clay County, Florida. Clay County's Overdose Prevention and Education Program (OPEP) will expand the existing Overdose to Action (OD2A) program, established in January, 2021 and overseen by the Florida Department of Health (DOH), through which CCFR Community Paramedicine Program (CPP) personnel administer low-threshold buprenorphine to persons suffering OUD until they can be transitioned to a community care resource. OPEP will provide for the training and distribution of naloxone in Clay County, Florida and provide a warm handoff of consenting individuals to an engaged program partner for community substance abuse treatment within seven days of an opioid overdose event or request for help with Opioid Use Disorder (OUD). The program will increase community access to naloxone for the prevention of opioid-related deaths and provide community education on the dangers of opioid abuse and the safe handling of fentanyl, carfentanil, and other licit and illicit drugs. OPEP expands OD2A by providing increased institutional capacity to serve persons suffering OUD and their loved ones. The BCC will hire additional staff to plan and schedule opioid and naloxone training throughout the County, maintain training calendars, provide customer service to those seeking assistance, and maintain program data and provide reports to measure efficacy. The program will also allow the BCC to hire one Certified Recovery Peer Specialist to oversee the warm handoff of individuals seeking help to a community care resource and to provide follow-up to clients for one year to measure program success. The program will serve adults in Clay County, Florida where opioid-overdose deaths have increased by 75% from 36 in 2015 to 63 in 2020 according to the Florida Department of Health. Additionally, non-fatal opioid-involved overdoses increased by 1,631.8% in the same period from 22 in 2015 to 381 in 2020, and naloxone administrations increased by 796% from 49 instances in 2015 to 439 instances in 2020. DOH data indicates that 56.6% of opioid-related deaths occurred among males and 43.4% among females in 2020. The average age of overdose was 42.4. The average age of overdoses has increased in Clay County from 37.6 in 2019 to 42.7 in 2021 based on provisional DOH data. OPEP aims to reduce the number of opioid-related deaths and injuries. Objectives to support this goal include increasing the availability of overdose reversal treatment resources by distributing 2,000 naloxone kits by 2026, providing naloxone administration and OUD training to 100% of EMS staff within the County within two years, and providing naloxone administration and OUD training to 800 non-EMT County personnel, business leaders, and community members by 2026. OPEP also seeks to connect overdose victims to effective treatment by establishing meaningful connections with 75% of consenting overdose adults and/or family members within 72 hours of a response event. The project will train 250 individuals in year one and 300 individuals each year in years two through four totaling 1,150 unduplicated individuals trained on OUD, safe handling of opioids, including fentanyl, carfentanil and other licit and illicit substances, and the safe handling and administration of naloxone. The project is estimated to serve 400 individuals suffering OUD disorder over the four-year grant period. If funded through the FR-CARA program, OPEP will provide a model for both large and small counties to reduce opioid overdose and death via a data-driven, systematic, relational model of care.

The name of the project is Rural Mobile Integrated Healthcare for SUD/OUD and BHS and will be implemented in Washington County, Missouri. Washington County has a population of 24,860. The population of focus is individuals under 200% of the federal poverty level, which comprises more than 47.77% of the total population (compared to MO at 32.14% and the US at 30.86%).The project will provide treatment and recovery supports to 400 high-risk individuals with SUD/OUD and will provide training and education to a total of 880 individuals including first responders, school personnel, healthcare providers and other community sectors over the 4-year period. The county's demographic make-up is primarily White, with 51.4% of the population being males. The racial and ethnic make-up is fairly homogenous, with 95.26% of the population White, 2.13% Black and 1.85% multiple races. Only 1.39% of the population report as being Hispanic. Poverty and health literacy are significant contributors to substance use, with many families now in third- and fourth-generation substance use. Washington County is economically challenged and geographically isolated there are few opportunities for vulnerable individuals to connect to meaningful care outside the services provided by Network partners. According to County Health Rankings, Washington County was among the least healthy for outcome measures in 2020. According to the Missouri Department of Health and Senior Services, drug overdose deaths increased about 21% in the first three quarters of 2020 compared to 2019. Overdose deaths involving a combination of opioids and stimulants increased by approximately 82% statewide between 2019 and 2020. Statewide, 2020 increases in opioid-involved and stimulant-involved drug overdose deaths were similar, both about 30% higher than 2019. Opioid-involved drug overdose deaths represent the majority of total drug overdose deaths in Missouri (about 75% of deaths involve opioids). Rates are highest in the Southeast Region which encompasses Washington County. The Southeast Region had the 2nd highest rate percent change in Opioid and Stimulant-Involved deaths from 2019 to 2020 in Missouri. For the period January 2017-June 2018, statewide, many who fatally overdosed had some history of substance abuse (74%) and 14% had overdosed previously. Fatal overdoses frequently happen alone with no bystander present (38%), though Emergency Medical Services (EMS) is nearly always present post-event (92%). Many overdoses indicate polysubstance abuse, including use of benzodiazepines (31%). Unfortunately, substance use treatment is indicated in less than 2 people out of 10 who fatally overdose. The goals of the project are to improve referrals to appropriate treatment and recovery supports for 400 high-risk individuals at or below 200% of the federal poverty level, increase local workforce capacity to engage, treat and support recovery of individuals with SUD/OUD and/or behavioral health needs, develop a replicable and sustainable MIH payment model supported by Medicaid and other payers, and meet all FR-CARA grant deliverables on time and on budget. The primary intervention is provision of mobile integrated health care (aka community paramedicine) through a team-based model that involves hospital emergency department providers and personnel for inpatient services and access to MAT treatment through providers at the federally qualified health center. MIH clinicians trained and employed by Washington County Ambulance District will be dispatched to the location for field initiation of low-threshold buprenorphine and/or suboxone. Community Health Worker and Peer Support will also be leveraged and provided to individuals enrolled in the program. The program will utilize the Guiding Principles to a Trauma-Informed Approach and will standardize treatment protocols cross-organizationally through the MIH Advisory Committee, comprised of executive leadership of each participating organization.