Greetings, public health enthusiasts! We are Alan Dellapenna from North Carolina and Lisa Millet from Oregon. One of the most fundamental paradoxes of public health is the need for quick, impactful intervention systems that account for (and allow) flexibility, nuance, and individuality. It’s a continuous struggle to implement prevention tactics that are enhanced by and mindful of a state’s pre-existing public health infrastructure. North Carolina and Oregon implemented prevention strategies that leveraged existing infrastructure through CDC’s Core Violence and Injury Prevention Program (Core VIPP).

CDC funded 20 states through the Core VIPP Cooperative Agreement from 2011-2016. These states used the funding to enhance existing injury prevention programs with specific emphasis on support for key infrastructure components like surveillance, evaluation, program and policy interventions, and partnerships. Core VIPP-funded states used this infrastructure to be at the forefront of the opioid epidemic. They were able to identify and efficiently respond to the epidemic before other public health funding was available.

What was happening: Core VIPP enabled us to maximize the existing infrastructures within our states and engage injury prevention systems. These common themes emerged even though our states took different approaches based on local circumstances:

1. Utilizing existing infrastructures and partnerships allowed quick mobilization.
2. Sharing information and developing plans with key partners and using existing partnerships as a model to bring on new partners helped us maximize resources.
3. Tracking, analyzing, and disseminating surveillance data allowed us to inform meaningful policy interventions.

What we learned:  The Core program funded crosscutting infrastructure support rather than siloed, single-topic interventions. This approach provided the combination of structure and flexibility required to respond to the emerging opioid overdose epidemic.

Core VIPP partners were nimble, flexible, and cutting-edge in their responses to this public health problem.

Alan: The Core VIPP Injury model was a good match for the challenges posed by the opioid overdose epidemic in North Carolina. Core VIPP enabled us to conduct surveillance, identify opioids as driving the rise in poisoning deaths, and convene partners for addressing this crisis. Many disciplines and groups see opioid overdose deaths through the lens of their discipline – prescribers, dispensers, law enforcement, etc. Working to confront the opioid overdose epidemic through the Core VIPP Injury model allowed us to cut across disciplines and integrate diverse partners. The resulting surveillance data identified that rising deaths mirrored the increase in prescribing, revealing increased opioid prescribing as a key factor in the epidemic. We used these data to educate our policy makers and inform an evidence-based prevention policy agenda. Our Core VIPP-supported work, including our Injury Community Planning Group, built a foundation that enabled us to convene the legislatively mandated Opioid and Prescription Drug Abuse Advisory Committee (https://sites.google.com/view/ncpdaac), the NC Opioid Action Plan (www.ncdhhs.gov/opioids), and inform laws passed by the state to expand naloxone access and ensure appropriate opioid prescribing.

Lisa: Oregon leveraged the Core VIPP Injury program to convene a multidisciplinary workgroup in 2010. This group brought together subject matter experts in the areas of Medicaid pharmacy, Medicaid benefits, Substance Abuse Prevention and Treatment, and public health professionals to look at surveillance data and begin an agency-wide prevention, intervention, and treatment process. Reducing harms associated with substance use was identified as one of the State Health Improvement Plan’s seven priorities because of this workgroup’s recommendations. The Medicaid program established a Performance Improvement Project that set a threshold for prescribing opioids to patients. The Health Evidence Review Committee developed a back pain guideline that included non-pharmacological care for lower back pain and required dosage tapering for patients on high doses of opioid prescriptions for lower back pain. Core VIPP provided the resources to gather data to inform discussions with state leadership and other decision makers on these topics. Data gathered through this funding was able to provide evidence to support efforts, including creating the Oregon Prescription Drug Monitoring Program, distributing naloxone through community-based programs, and positioning our state with a comprehensive strategy that led to the development of several successful grants and cooperative agreements to fund future opioid prevention work.

What action can be taken: Encourage integrated infrastructures, silo-breaking partnerships, and actionable data to identify emerging issues and develop plans for cultivating quick responses to emerging crises.

Check out our article “State Injury Programs’ Response to the Opioid Epidemic: The Role of CDC’s Core Violence and Injury Prevention Program” to learn more about how other states relied upon their injury programs to understand the opioid overdose epidemic and specific actions they took. be helpful to you and your partners, and you can reach us through the contact address in our article.

Read the full issue of our special supplement Catalyzing State Public Health Agency Actions to Prevent Injury and Violence.

 

---

Alan Dellapenna leads the NC Division of Public Health’s Injury and Violence Prevention Branch (IVPB). IVPB includes the Rape Prevention & Education, Youth Suicide Prevention and Prescription Drug Overdose Prevention for States programs, and the Epidemiology Unit that houses the North Carolina Violent Death Reporting System. Dellapenna joined IVPB in 2010 following a 27 year career as a Commissioned Officer in the US Public Health Service assigned to the Indian Health Service (IHS).