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Project Name: Rural Communities Opioid Response Program-Overdose Response (G39)
Applicant Title: EAST CAROLINA UNIVERSITY
Abstract Text: Summary: The overall goal of this project is to reduce morbidity and mortality of individuals who use opioids within high-risk rural communities in North Carolina (NC). We propose to work with five high-risk rural counties in NC to expand or enhance their current overdose prevention infrastructure. Specifically, we will expand access to the opioid overdose antidote naloxone by working with these five communities to implement public health vending machines (PHVMs) that dispense naloxone. We will work with key stakeholders, including decision makers and people with lived experiences of opioid use, in the five counties to obtain community support and buy-in to implement public health vending machines. Target population: For this project, we will partner with overdose prevention providers located in and serving five HRSA-designated rural counties in NC - Carteret, Jackson, Stanly, Surry, and Swain - that have been impacted by the opioid crisis. The five counties are modest in size, represent different regions of NC, and have structural inequities. Needs to be addressed: For more than a decade in NC, rural populations have experienced higher mortality rates than residents of metropolitan areas. Rural communities of NC have higher rates of drug and alcohol use, suicide, years in productive life lost, injury, uninsured patients, and preventable hospitalizations. Residents of rural areas in NC face a shortage of all types of medical providers. The five counties that we will be working with are defined as high-risk in that they have high rates of: (1) drug overdose deaths, (2) illicit opioid-involved overdose deaths, (3) drug overdose emergency department (ED) visits, and (3) residents receiving an opioid prescription. Further, all five counties have documented drug overdose disparities based on the race and ethnicity of the residents with higher rates than the state of overdoses among American Indian/Alaskan Native or Black Non-Hispanic residents. In NC, naloxone is distributed to laypersons by syringe service programs (SSPs) and medical providers, such as pharmacies. There are currently 35 registered SSPs that serve residents of NC. Only two of our five counties are served by a SSP, and the fixed location of the SSPs that serve the two counties are not located in the counties. Collectively, this data indicates that there is a need to purchase and distribute naloxone by establishing new fixed care delivery sites within these five counties. Proposed services: To achieve this goal, we will implement two of the allowable activities: (1) establish PHVMs as a care delivery site to improve access to naloxone within the target rural service area (allowable activity 2) and (2) purchase and distribute naloxone within the target rural service area (allowable activity 1). To establish PHVMs as a care delivery site to improve access to naloxone within the five counties we will (1) work with Community Health Workers (CHWs) to determine the preferred placement of PHVMs, (2) purchase and install PHVMs, and (3) distribute a harm reduction flyer on the outside of the PHVMs. To purchase and distribute naloxone in the five counties, we will (1) purchase naloxone and stock PHVMs, (2) publicize the PHVMs, (3) track use of public PHVMs and restock with naloxone as needed, and (4) develop a county specific sustainability plan to maintain the PHVMs. Anticipated impact: The proposed project aims to implement PHVMs to expand access to naloxone in five high-risk rural counties in NC. The activities outlined in this project will increase the number of community members who have the ability to prevent opioid overdose deaths in their communities.