Unfortunate hotspot: Dover to fight opioid epidemic with Community Response Teams

DOVER — The city of Dover has been identified — unfortunately — as a hotspot for opioid overdose deaths in Delaware.

That was the main reason why Kristan McIntosh met with Dover’s Parks, Recreation and Community Enhancement Committee earlier this month at City Hall as she introduced its members to the concept of forming a Community Response Team to fight the opioid epidemic in the capital city.

Ms. McIntosh is a senior consultant with New York-based Health Management Associates, which is engaged with the Division of Public Health to find strategies to lessen the impact that opioid abuse is having on individuals and families throughout the state.

“The reason I’m here talking to you is because Dover has been identified as a hotspot for opioid overdose death,” Ms. McIntosh said. “Across the state, the number of opioid overdose deaths is rising, and Dover is no exception to that rule.

“These numbers are shocking every time I see them but the number of opioid-related overdose deaths in Delaware is rising exponentially. It’s actually rising more, significantly faster, than it is in the rest of the United States. The 2018 number continues to rise in the wrong direction.”

In 2017, there were more than 70,200 drug overdose deaths in the U.S. — an age-adjusted rate of 21.7 per 100,000 persons. Among those, 47,600 involved opioids. The sharpest increase occurred among deaths involving fentanyl and fentanyl analogs (other synthetic narcotics) with more than 28,400 overdose deaths in 2017.

The age-adjusted rate of drug overdose deaths increased significantly in Delaware by 20.2 percent from 2016 (30.8 per 100,000) to 2017 (37.0 per 100,000). There was a total of 250 opioid-related deaths in Delaware in 2017.

CRT’s could lower death rates

Ms. McIntosh believes that if she can get these Community Response Teams (CRT) together that those opioid-related death rates might finally start to decline.

“We’re trying to gather hyper-local community advocates and community-oriented folks who are concerned about what’s going on in Kent County and in Dover, specifically, who can come together to essentially activate their resources in real-time during an opioid overdose crisis,” she said. “A crisis is defined as any event or situation that is essentially a disruption in the supply of opioids in the community.

“That can be anything from the shutdown of a prescriber who is over-prescribing opioids, to the presence of a contaminated batch like a batch that contains fentanyl in the community. These types of opioid crisis events have been shown to be correlated with an increase in the number of overdose deaths in the community.”

The qualifications to be on a CRT are not that difficult. Team members should live or work in, or adjacent to, the local CRT boundaries; be able to commit 8 to 12 hours of volunteer work annually; be oriented or willing to be trained on the status of opioid overdoses in the community; be a community ambassador for CRT efforts and attend virtual and in-person trainings and meetings as needed.

The local CRT boundaries in the city of Dover are broken into four segments: north of W. North Street, south of Division Street, east of Saulsbury Road and west of State Street.

Ms. McIntosh is currently in the process of the recruitment and start-up phase for the Kent County and Dover Community Response Teams.

“What we would do is we would bring together community advocates, so that the Division of Public Health would have community stakeholders who can hear that these (opioid) events are occurring and who can essentially activate their resources during a crisis,” she said.

Ms. McIntosh added the CRTs could increase the number of community resources that exist in a community prior to a crisis, which may include increased training for individuals to be able to administer Naloxone, the life-saving drug that be administered to save a life during an overdose.

They could also just help to share information about the availability of treatment resources that exist in the community and helping people access services and supports like peer support services to help them connect to treatment.

“During a crisis, the CRT members essentially receive an alert to come together to respond to this type of situation, potentially forming Naloxone-training pods and/or just alerting their community networks that this type of event is going on so that folks can be more aware and informed and hopefully avoid opioid overdose death,” said Ms. McIntosh.

“After a crisis there’s a role in sort of the quality/improvement type of process in accessing the response and improving it and then also just redistributing resources in the community such as Naloxone so that the community is prepared for another event that might occur.”

The Division of Public Health has the ultimate accountability for the CRTs while Delaware Medical Reserve Corps offer support and community to response teams.

Still in ‘start-up phase’

Brother Peter Joseph Avitabile, who attended the meeting regarding the CRTs, said that he is very invested in the topic because he has seen “a great deal of hardship, loss and grief.”

He noted that he saw the word “volunteer” and asked if there would be funding coming into the community to help manage the project once it is brought to fruition.

“I think faith-based organizations are the way to go because people feel more comfortable coming inside a safe environment that doesn’t say ‘mental health services’ or ‘hospitals,’ and there are lots of things that they can do at that first stage when individuals are seeking help,” Mr. Avitabile said.

Dover Mayor Robin Christiansen also had strong feelings regarding the subject of opioids.

“I want to thank you for your presentation and for your efforts in your organization and I would be remiss if I didn’t recognize the efforts of Lt. Gov. Bethany Hall-Long, who took a whole bunch of criticism for her efforts along with Councilman Tanner Polce and myself and others, who went out on the street with the initial distribution of Narcan,” he said. “As a firefighter I responded to a number of calls (involving) heroin overdoses, so I’ve seen it up close and personal.

“But I have to say what I think and feel. I cannot believe the state is undertaking a program to address a health crisis as well as a public safety crisis in regard to the opioid crisis and yet they were on the verge and probably will do it in the next session of the legislature – authorize a gateway drug, and I find that very, very unconscionable because it will unravel all the good works that you (Ms. McIntosh) and other folks are trying to do.

“I think it is unconscionable to put you and other people out on the streets to do what needs to be done at this point in time, and then offer another crisis coming over the hill.”

As of now, Ms. McIntosh said she is just concentrating on getting the first phases of the Kent County and Dover CRT teams organized.
“We’re focused on locating stakeholders who are already located in, living in or are supporting this particular community, to participate on the Community Response Team,” she said. “We are looking for this to be a really inclusive effort.

“We are seeking folks who are compassionate and community-minded in Kent County and Dover — more specifically — to come to the table.”

Anyone interested in joining a CRT in Kent County or Dover is asked to contact Ms. McIntosh, who is the Kent County Lead for the CRTs, at (646) 590-0238 or email her at kmcintosh@healthmanagement.com.

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