developed and disseminated similar guidelines, which were well-received by ER clinicians. We will use the data obtained from the Overdose Fatality Review Process to influence where additional efforts need to be focused. For example, if it is determined that many of the opiate-related deaths are among individuals with chronic pain syndromes, increased focus on case management and/or care coordination services could be implemented. Additionally, the development of education materials for all pain management specialists on the identification and treatment of patients with substance use disorders and training on brief interventions and referral to treatment resources could be impactful. Similarly, if it is determined that many of the opiate-related deaths are among individuals with co-occurring mental health conditions, increased focus on case management and/or care coordination among mental health providers and somatic care providers should be implemented. These interventions will be further discussed after the Overdose Fatality Review has begun to meet and some initial analyses can be conducted to inform these efforts Opiate Use Disorder Treatment Providers Because of the increased risk for respiratory depression in the setting of benzodiazepine and opiate use, benzodiazepine prescribing guidelines for opioid maintenance providers were developed in 2013. guidelines continue to be disseminated among opioid maintenance providers. We will work with DHMH ADAA Prescription Drug Monitoring Program (PMDP) Coordinator to disseminate information about PDMP among opiate use disorder treatment providers. All opiate use disorder treatment providers will be strongly encouraged to routinely check the PDMP to ensure their clients are not receiving controlled substances from outside providers. General Medical Community Efforts to increase implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT) will be further expanded in Baltimore City to the Mercy Hospital Emergency Department. (B) Outreach to High-Risk Individuals and Communities As discussed in Section 1, demographic data needs to be reported for each type of overdose death so that appropriate messaging can be developed. Possible strategies for targeting populations in need of interventions are listed below. Individuals who have not been identified as having substance use disorders: Efforts to increase implementation of Screening, Intervention and Referral to Treatment (SBIRT) will be further expanded in Baltimore City to the Mercy Hospital Emergency Department. Populations not actively engaged in care:
Section 3: Performance Metrics Goal 1: Identify meaningful ways to obtain and analyze data that will allow Baltimore City to develop more targeted interventions by June 2014. Problem Statement Strategies (Identify each strategy you will employ to affect your goal.) Activities ( List each activity implemented to support the strategy) Measurable Outcomes/ Timeline (how much impact by when.) Progress to date Baltimore-City specific data is currently not being reported in one central location (last report completed was for 2009 deaths) Development of an annual Intoxication Deaths report for Baltimore City Baltimore City Health Department (BCHD) and BHS Baltimore epidemiologists will discuss how to collaborate to develop this report BCHD and BHS Baltimore will work with OCME to ensure confidential transfer of relevant overdose death reports BCHD and BHS Baltimore epidemiologists will work together to develop annual report 2012 report will be completed within six months after receiving data and reports from OCME Aruna Chandran from BCHD Epidemiology Department has signed confidentiality waivers. No data has been received Baltimore City does not currently have a way to systematically review individual case reports of overdose deaths Development of a local overdose fatality review team(LOFRT) Identify members of fatality review team Identify process for reviewing all overdose deaths in Baltimore City Work with OCME to make sure that all information needed from reports are available Local Overdose Fatality Review Team will start within two months of receiving the first case reports Team members have been identified Team members have signed confidentiality waivers First cases are expected to be received in late January, and first review meeting will be held February 11, 2014
Goal 2: Increase awareness of overdose risk and overdose prevention strategies among providers who prescribe opioids (methadone, buprenorphine, and prescription opioids). Problem Statement Strategies (Identify each strategy you will employ to affect your goal.) Activities ( List each activity implemented to support the strategy) Measurable Outcomes/ Timeline (how much impact by when.) Progress to Date Opiate prescribing practices are contributing to the use of opiates for non-medical purposes Core REMS Training Attain funding for CO*RE ER/LA Opioid REMS training Schedule CO*RE REMS training in Baltimore City Advertise training event to clinical providers with prescribing privileges, including dentists, primary care, and mental health professionals Hold event How many Baltimore City practitioners participate in training Post-training evaluation on anticipated changes in practice CO*RE REMS training has been scheduled in Baltimore City for March 12, 2014 at the MedChi Office Many health care providers are not aware of the Maryland PMDP system which will allow prescribers to assess whether a patient is receiving opiates or other controlled drugs from other providers PMDP education campaign to healthcare providers BHS Baltimore will collaborate with the DHMH ADAA PDMP Coordinator to ensure that outreach efforts are not duplicated BHS Baltimore will work with the University of Maryland School of Pharmacy on increasing awareness among providers of the PDMP and its uses Number of clinical providers in Baltimore City who receive information on how to sign up for PMDP and how to use it effectively Percentage of new providers participating in PDMP each quarter BHS Baltimore has been in contact with Michael Baier of ADAA to discuss provider access to PDMP BHS Baltimore will discuss PDMP access with BHS Baltimore-funded buprenorphine providers at next BBI meeting, scheduled for March 18, 2014 BHS Baltimore will disseminate information among BHS methadone providers (date tbd)
BHS Baltimore will work with all BHS Baltimore-funded buprenorphine and methadone providers to ensure that they are aware of the PMDP and are using it appropriately. BHS Baltimore will outreach to mental health providers in Baltimore City to ensure their awareness of the PMDP Emergency room physicians often feel they need to prescribe opiates to patients who come in complaining of pain Development and dissemination of opiate prescribing clinical practice guideline recommendations for emergency room clinicians (this effort has been initiated by Maryland ACEP) ACEP to develop clinical practice guideline recommendations for ER clinicians in Baltimore City Collaboration between BCHD and the Mayor’s office to get political backing for these recommendations Work with local hospitals to ensure dissemination of recommendations Public dissemination of Recommendations for Opiate Prescribing Clinical Practice Guidelines for ER clinicians in Baltimore City by June 2014 BHS Baltimore has partnered with Maryland ACEP representative, Dr. Suzanne Doyon to assist with dissemination of clinical practice guidelines when they become available Opioid maintenance providers are often not aware of potentially harmful interactions between benzodiazepines and opiates Educate opioid maintenance providers on risks of benzodiazepine use with opiates Development and dissemination of benzodiazepine prescribing guidelines for opioid maintenance providers BHS Baltimore-sponsored dinner to review guidelines with opioid maintenance providers Number of providers who receive the guidelines Number of providers who attend the BHS Baltimore-sponsored dinner BHS Baltimore distributed the guidelines to approximately 50 treatment centers and approximately 50 buprenorphine continuing care physicians. A copy is available on the BHSB website at
Three peer recovery coaches will be hired and will undergo a three month training program provided by Mosaic Group Data collection to track outcomes of program Number of positive screens Number of brief interventions by coaches Number of referrals to treatment Number of linkages to treatment Referred 173 patients to treatment. Successfully linked 73 patients to SUD treatment. Mosaic is continuing to work with the leadership of Mercy Hospital to develop a protocol for the implementation of SBIRT. Approximately 50% of individuals who call the BHS Baltimore intake and referral phone line never show up for their intake visit at a treatment center. Develop systems that will allow better outreach to individuals who call the intake and referral line but do not present for their treatment intake Convene a meeting with BHS Baltimore and HCAM to discuss strategies to increase show rates for individuals that call the I and R line. Identify resources to increase incentives for individuals who do show at first appointment Work closely with the University of of Public Health Horowitz Center for Health Literacy to investigate the feasibility of using text messaging systems as appointment reminders. Number of individuals who attended first intake appointment Number of individuals who were a no-show for appointment and were rescheduled and successfully attended visit Scheduled meeting with HCAM and Horowitz Center for Health Literacy in January HCAM Identifying baseline data from FY 2013
Goal 4: Increase educational efforts and general overdose risk awareness to high risk groups. Problem Statement Strategies (Identify each strategy you will employ to affect your goal.) Activities ( List each activity implemented to support the strategy) Measurable Outcomes/ Timeline (how much impact by when.) Progress to Date General population awareness surrounding of opioid overdose is low Creation of a Baltimore City Overdose Awareness Day Conduct overdose prevention and education trainings throughout the day Hold a candlelight vigil in front of City Hall to honor those who have passed away from drug overdose Host an informational session for the community prior to the candlelight vigil and invite community agencies Number of individuals in attendance at the Overdose Awareness Day event on August 21, 2013 Number of individuals trained on overdose prevention on August 21, 2013 BCHD Community Risk Reduction Services (CRRS) hosted the City Overdose Awareness Day on August 21, 2013 Approximately 100 individuals attended 22 individuals received opioid overdose education training and received naloxone Upon release, incarcerated individuals are at higher risk for overdose than the general public Provide overdose prevention education to jail inmates BCHD CRRS will continue to provide weekly overdose prevention education to individuals in ACT/SAP jail program Work with jail administrators and clinicians to identify a way to ensure that all inmates who complete training are a naloxone kit at the time of release from jail. Number of individuals who receive training through the ACT/SAP program Number of individuals who receive naloxone either at the time of release shortly after release BCHD CRRS is currently providing overdose prevention education on a weekly basis to inmates in the ACT/SAP program 163 inmates in the ACT-SAP program received training in 2013 and 4 received naloxone upon release
SB 610 allows family and friends of opioid users to be trained to use naloxone, a potentially life-saving medication in the case of opioid overdose, however trainings are not yet available. BHS Baltimore, in collaboration with BCHD CRRS, will provide naloxone trainings for friends and family of opioid users Apply for grant funding Apply for State-based Entity Authorization Identify sites for 4 trainings Purchase naloxone kits and all other training supplies Prepare all training materials and ensure compliance with State regulations Conduct trainings, prescribe naloxone, track Number of trainings conducted by June 2014 Number of individuals trained by June 2014 Number of naloxone kits distributed by June 2014 BHS Baltimore submitted a grant application to receive funds to host 4 trainings in Baltimore City Awards have not yet been announced