Using peers and crisis stabilization sites to address opioid overdoses
The three rounds of the State Opioid Response (SOR) grants to Maryland have been used to reducing opioid overdose deaths and increasing access to treatment for opioid use disorders (OUDs). Recently, stimulant use disorders were added to appropriate use of the SOR grants; officials from the state told attendees of a pre-conference session Oct. 31 at the AATOD (American Association for the Treatment of Opioid Dependence) meeting in Baltimore.
The statewide project began with the Maryland Opioid Rapid Response (MORR) before the predecessor to SOR – STR (State Targeted Response to the Opioid Crisis) which was only for treatment and began in 2017. SOR I and II were built on STR, with goals to reduce the number of OUDS, to reduce the unmet treatment need, and to increase the use of buprenorphine, methadone, and naltrexone to treat OUDs.
Part 1: Crisis stabilization in Anne Arundel County
One of the unique features of Maryland is a focus on crisis stabilization centers, which help people find treatment, but mainly help them with up to four days of a place to eat, shower, sleep, talk to peers, and get ready for treatment if that is what they need. These “safe stations” can be embedded in fire and police departments, places which are typically open 24/7 and whose locations are known to everyone.
Unfortunately, many people who need treatment not only can’t figure out how to get admitted, but don’t even know who to call or where to look. The purpose of the Maryland program is to make it easy to find treatment.
Even with the best private insurance, it’s almost impossible to get admitted to treatment at 3:00 pm on a Friday afternoon, said Sandra O’Neill, director of the Department of Behavioral Health in Anne Arundel County. O’Neill runs the crisis stabilization services program there, collaborating with treatment providers who opted for a network. The crisis stabilization services are located in fire houses in the county.
For those who are familiar with the Massachusetts PAARI (Police Assisted Addiction Recovery Initiative) program, Maryland’s crisis stabilization services may sound similar, but actually the state’s system, which is based on SOR, is more similar to New Hampshire’s. One of the benefits of SOR is that the procurement process is less time-consuming and cumbersome than for other funding.
But creating the sites in Anne Arundel county turned out to create its own problem – the demand was huge. With so many people coming in needing help, the county needed to figure out how to send them to the services they needed, if they needed them. The safe stations quickly became inundated. While the crisis centers were open 24/7, the treatment centers weren’t.
After doing a medical evaluation to make sure the patient was able to stay instead of going to the emergency department, the fire house would hold the people and the crisis site, with beds, would pick them up.
The program opened up even more with walk-ins, so that instead of going to fire houses, patients could go directly to the safe house.
Included in what was needed:
- crisis beds
- fire and police as detention centers
- hub and spoke model
- medical patient engagement with nursing homes having access to medications
- adolescent clubhouses
- detention centers across Maryland
- new medication adherence technology, such as an electronic pill dispenser
- residential treatment for pregnant women and children
- minority outreach and technical assistance
- workforce development
Peers are a major aspect of the crisis stabilization centers in Anne Arundel County.
Stay tuned for Parts 2 and 3 from Maryland.