Public Health and Public Safety Partnerships: Addressing the Overdose Crisis in Maine
Innovative public health and public safety collaborations in Maine link people who use drugs (PWUD), their friends and families to essential resources on the journey from active use to recovery.
The Janet Mills Administration launched the Overdose Prevention Through Intensive Outreach, Naloxone and Safety Initiative (OPTIONS) in Maine during October of 2020. This innovative program embeds behavioral health liaisons into law enforcement agencies (LEAs) throughout Maine’s 16 counties. Liaisons closely collaborate with Law Enforcement Officers (LEOs) to identify individuals at high risk of experiencing an opioid overdose. They also build relationships in the community and conduct proactive outreach, overdose education trainings, and anti-stigma trainings. Liaisons meet PWUD and affected others where they are at on their journey from active use to recovery and provide referrals to harm reduction, treatment, recovery, and social services based on personalized needs and desires.
In collaboration, the Maine Department of Public Safety and the Office of Behavioral Health developed the OPTIONS initiative to address the burgeoning fatal overdose crisis in the state which increased 33% from 2019 to 2020 and 23% from 2020 to 2021. During 2021, LEOs responded to most (77%) of these overdose events. By embedding behavioral health professionals within public safety departments, a preponderance of individuals impacted by overdose events can quickly be referred to services through correspondence and post-overdose follow up alongside LEOs. To date (August 2022), of the more than 3,200 clients linked to services by liaisons, approximately 73% were referred by law enforcement personnel.
This public health and public safety partnership has been a tremendous success because OPTIONS liaisons conduct their proactive outreach and post-overdose work using the harm reduction principle of meeting individuals where they are at and referring them to services which are best fit. This allows liaisons to build trusting relationships with individuals, so they have an ally to turn to as they move forward along their path to recovery. Liaisons support PWUD by distributing naloxone, making connections to sterile syringe services, de-escalating behavioral health crises, providing short-term counseling interventions, referring individuals to community-based treatment options, and finding local recovery resources.
OPTIONS Liaisons also serve as navigators to the often-complex world of social services. Liaisons assist individuals in need with Medicaid applications, refer them to perinatal services, and provide linkages to subsistence and housing programs. Liaisons also leverage vital State-based efforts to mitigate the overdose crisis including:
- Maine Naloxone Distribution Initiative (getmainenaloxone.org)
- Maine CDC needle exchange programs
- Integrated care teams for perinatal persons struggling with opioid use (MaineMOM)
- Rapid induction of medication for opioid use disorder at emergency departments
- ODMAP to identify LEO overdose responses for post-overdose follow-up response
- Department of Public Safety Law Enforcement Assisted Diversion Programs assisting PWID in transitioning from the criminal justice pathway to the pathway of recovery
Programmatic Outputs and Outcomes
Each month, liaisons report output and outcome data providing the State with programmatic successes, challenges, and barriers. As of August 2022:
- Liaisons distributed 8,388 doses of Narcan® and educated 3,903 community members in anti-stigma and overdose response. As an integral part of Maine’s naloxone distribution program which places naloxone into the hands of individuals at high risk of witnessing an opioid overdose, liaisons have contributed to the successful reported reversals of 5,594 opioid overdoses from the Maine Naloxone Distribution Initiative.
- Liaisons made 1,130 referrals to community-based treatment programs and 1,221 referrals to community-based recovery support programs. By meeting people where they are at on their journey with problematic substance use, OPTIONS liaisons have achieved great success in referring clients to appropriate services. This is evidenced by 84% of clients referred to treatment attending their first appointment with providers. Liaisons also have been effective at reaching marginalized individuals with 28% of clients being unstably housed and 32% of clients being homeless.
- Liaisons report barriers for PWUD to access services. By reporting on challenges linking clients to services, liaisons provide State policymakers with feedback loops for potential intervention and education for providers, law enforcement agencies, and State program directors.
As the OPTIONS initiative enters its third year, we are leveraging the enthusiasm from law enforcement leaders in the success of the program. These individuals will champion the program in consulting roles assisting in communicating with LEOs regarding questions, policies, and programmatic updates. We also have applied for additional funding to support an OPTIONS Project ECHO (Extension for Community Healthcare Outcomes) an evidenced-based model for offering distance education utilizing case-based learning. Finally, we are using business analytics software to conduct geospatial and temporal analysis of output and outcome data to find areas of programmatic and workflow improvement.
Want to learn more about the creation and implementation of the OPTIONS initiative? Read our paper in the Journal of Public Health Management and Practice here:
- The OPTIONS Initiative Website: www.knowyouroptions.me
- The OPTIONS project-to-date data report for August 2022: https://mainedrugdata.org/wp-content/uploads/2022/09/2022-08-OPTIONS-Monthly-report-final.pdf
- Barbieri D, Taxman P. (2019). Diversion and alternatives to arrest: A qualitative understanding of police and substance users’ perspective. J Drug Issues. 49(4):03-17
- Formica, S. W., Apsler, R., Wilkins, L., Ruiz, S., Reilly, B., & Walley, A. Y. (2018). Post opioid overdose outreach by public health and public safety agencies: Exploration of emerging programs in Massachusetts. International Journal of Drug Policy. 54: 43–50.
- Reichert, J., Gleicher, L., Mock, L., Adams, S., & Lopez, K. (2017). Police-led referrals to treatment for substance use disorders in rural Illinois: An examination of the Safe Passage Initiative. Illinois Criminal Justice Information Authority.
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- The Massachusetts Department of Public Health Post Overdose Support Team Initiative: A Public Health-Centered Co-Response Model for Post-Overdose Outreach
- First Responder Deflection Programs: Partnerships Across Disciplines
- Public Health and Public Safety Partnerships: Addressing the Overdose Crisis in Maine
Amy Carter, BSHA-M, is Director of the Maine Medical Association Center for Quality Improvement (MMA-CQI). Her focus is to improve health and healthcare for all Mainers. Manages multiple quality improvement projects with healthcare providers throughout Northern New England.
Daniel S. Soucier, PhD, is a research associate at the Margaret Chase Smith Policy Center and the Interim Graduate Director for the Maine Studies program at the University of Maine. He is also the project director of the Maine Drug Data Hub: www.mainedrugdata.org.