In January 2019, the National Association of County and City Health Officials' (NACCHO's) Opioid Team surveyed almost 200 local health departments (LHDs) across the country about the opioid prevention and response activities they and their partner organizations conduct. Specific areas surveyed include communications, direct and indirect services, partnerships, policies, data collection, and evaluation. This summer, NACCHO released a report, Local Health Department Approaches to Opioid Use Prevention and Response: An Environmental Scan, detailing the survey results and providing examples of innovative and successful programs.1 This issue of “News From NACCHO” covers some of those results, with an emphasis on the close relationships among LHDs and community partners that are crucial to addressing the opioid overdose crisis.
Why focus on partnerships? Because without them, addressing the opioid overdose crisis would be nearly impossible. The scope, scale, and sudden shifts to the particularities of the crisis are simply too great for any one organization to tackle alone. Partners are part of a 2-way relationship to provide and solicit support, input, resources, and knowledge. For LHDs with limited budgets, staff, and time, partnerships amplify their impact by increasing the loci for public health services and by offering services LHDs do not themselves offer. Partners are also, in many cases, not bound by the same regulations that may limit the services LHDs are able to offer. For these reasons, the survey framework was designed to solicit responses that considered the combined efforts of LHDs and their partners.
The opioid overdose crisis represents a quintessential example of how partnerships amplify impacts and ensure proper response to public health issues. To combat the crisis, prevention, harm reduction, and treatment need to be considered. Each one of these areas is vastly complex, and the report's findings illustrate how LHDs and their partners work together to address them.
NACCHO's 2018 Forces of Change survey identified the types of organizations that LHDs generally partner with on this issue, including state or local agencies, health care, schools, and nonprofits. The Forces of Change survey also identified disparities between the robustness of partnerships at health departments of different sizes, with fewer smaller health departments generally reporting partnerships with various entities.
Stories From the Field
One of our lessons learned was that strong partnerships with new and existing partners are instrumental in uncovering pockets of need in zip codes not previously on our radar and targeting demographics affected by the opioid overdose epidemic that may otherwise fall through the cracks. Expanding partnerships with initiatives such as Manatee County's Handle with Care, which launches a response when a substance use-related and/or trauma-related issue affects a child, increased the reach of the campaign. Furthermore, the use of results from the Lakewood Ranch Brain Health Coalition's LWR Brain Health Initiative helped us use data to identify areas and demographics to target with our Rx Awareness Campaign efforts.” (Florida Department of Health, Manatee County)
Environmental Scan Findings
The scan divided up responses on partnerships into 2 large buckets: local government organizations and community organizations serving those with opioid use disorder (OUD). The top-reported partner agencies were divided across both these sections. More than 75% of responding LHDs reported collaborating with local public safety, local emergency medical services (EMS), mental/behavioral health facilities, and community/prevention coalitions. The only local government agency with less than 50% of respondents reporting collaboration was local housing agencies.1 Housing as a recovery or upstream public health intervention is gaining momentum, though, and it is NACCHO's hope that LHD partnerships with housing agencies and other organizations that provide similar services will rise with time.
While partnering with local EMS and public safety was predictably high, at 75% and 86% of respondents respectively, it is encouraging to note that 83% of LHDs surveyed also reported working with mental/behavioral health specialists, as the public understanding of addiction evolves. Given the prevalence of stigma around OUD, greater focus on treating it as a treatable disease is vital. Collaboration with the recovery and active use communities is also important in tackling stigma. However, only 33% of LHDs surveyed reported partnering with the active use community.1 To bring the crisis to heel requires input from the community members themselves. Concentrating opioid overdose prevention and response efforts on at-risk communities can only improve the uptake and outcomes of clinical and programmatic services.
Often, these diverse partners will form local coalitions to share information and coordinate activities. LHDs overwhelmingly indicated that they do take part in these health care coalitions, with almost three-fourths reporting they serve in a convener or leadership role and another one-fifth indicating that they participate. These results demonstrate the type of partners LHDs coordinate with and the roles they play within their partner networks.
When asked about programmatic services provided, LHDs indicated that they and their partners provided services including stigma reduction, naloxone training and distribution, and prescriber education outreach at relatively similar rates. Slightly more LHDs reported offering community education services, while partners more often reported offering linkages to care, medication take-back, and peer navigation. This shows how community partners amplify the availability of services provided by the LHD, while also complementing their work by filling in necessary gaps.
This need for partnerships to fill in gaps is even more apparent when considering clinical services. More LHDs reported offering HIV/STI (sexually transmitted infection) testing than their partner organizations, but many fewer LHDs reported offering recovery support, MAT (buprenorphine, naltrexone, and methadone), crisis hotlines, housing, or detox programs. Less than 15% of LHDs reported offering many of the above-listed clinical services, but more than half indicated that their partners did. In addition, more LHD partner organizations reported offering syringe service programs (SSPs) than LHDs, but the most common result overall was that SSPs were simply not available in the community at all. As health departments have very limited funding, equipment, or staff to offer these direct clinical services, their ability to work with their partners to fulfill the medical needs of the local OUD community is vital.
Together, LHDs and their partners operate an interconnected system of prevention, harm reduction, and treatment services. These partnerships are an integral component of any comprehensive response to the opioid overdose crisis and allow for both more robust availability of traditional services and the potential for more cutting-edge practices that LHDs are unable to offer. NACCHO is pleased that the results of the Environmental Scan demonstrated the breadth and depth of partnerships among LHDs and other organizations working on opioid overdose prevention and response and will continue to support efforts to expand the work they engage in together.
Finally, we recognize that each partnership offers its own unique benefits. Anne Arundel County Department of Health in Maryland said it best when asked about its most successful partnership: “With so many [options], it is challenging to choose one as each partnership is critical in our interventions: public schools, local hospitals, crisis response, police, fire, HIDTA [DOJ's High Intensity Drug Trafficking Areas Program], treatment centers, and the judiciary.”
NACCHO offers a number of opioid use and overdose prevention and response resources on its Opioid Web page.2 To access LHD-developed resources collected through NACCHO's Environmental Scan, visit NACCHO's Opioid Overdose Epidemic Toolkit for Local Health Departments.3 NACCHO's full Environmental Scan Report also contains more data, analysis, and stories from the field.1
NACCHO's document on Strengthening Partnerships recommends a number of methods for involving partners.4
1. Higgins F, Raja K. Local health department approaches to opioid use prevention and response: an Environmental Scan. https://www.naccho.org/uploads/downloadable-resources/Environmental-Scan-V3-July-2019-FINAL-v2.pdf
. Published July 15, 2019. Accessed October 28, 2019.
2. National Association of County and City Health Officials. Opioid Overdose Epidemic. https://www.naccho.org/programs/community-health/injury-and-violence/opioid-epidemic
. Accessed November 25, 2019.
3. National Association of County and City Health Officials. Opioid Overdose Epidemic Toolkit for Local Health Departments. https://www.naccho.org/programs/community-health/injury-and-violence/opioid-epidemic/local-health-departments-and-the-opioid-epidemic-a-toolkit
. Accessed November 25, 2019.
4. National Association of County and City Health Officials. Strengthening Partnerships. https://www.naccho.org/uploads/downloadable-resources/Strengthening-Partnerships.pdf
. Accessed November 25, 2019.