COPE Project at a Glance
A Quick Refresher on the Opioid Epidemic
Opioids: A Potent Killer
More than 750,000 people have died since 1999 from a drug overdose. Two out of three drug overdose deaths in 2018 involved an opioid. Opioids are substances that work in the nervous system of the body or in specific receptors in the brain to reduce the intensity of pain. Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl), have increased almost six times since 1999. Overdoses involving opioids killed nearly 47,000 people in 2018, and 32% of those deaths involved prescription opioids.
The opioid crisis continues to remain a significant public health concern. In recent years, opioid-involved overdoses have killed more people annually than car collisions, gun incidents, or breast cancer. In fact, the opioid epidemic has reduced American life expectancy by 2 years. This is the first drop the United States has seen in life expectancy since President John F. Kennedy was in office.
The Three Waves of the Opioid Crisis
Opioid Use Disorder and the Number of Overdose Deaths Continue to Grow
The recent wave of potent synthetic opioids taking hold across the United States has dramatically increased the number of opioid-related overdoses and deaths. Additionally, the COVID-19 pandemic is exacerbating the opioid crisis as addiction treatment systems are disrupted, healthcare access is diminished, and opioid users are more isolated than ever.
EMS-Driven Public Health Initiatives for the Opioid Epidemic
Public health organizations and EMS providers are actively addressing the ongoing opioid epidemic in California. California's public health organizations work proactively through broad, population-based approaches to prevent opioid addiction and overdose before they occur. In contrast, California EMS agencies provide reactive care to opioid users in a one-on-one manner after overdose events or for other health issues stemming from addiction. Despite these different approaches to community health, collaborations between public health and EMS would likely accelerate the work of both groups.
The Risk Assessment and Programming (RAP) Toolkit
The California Paramedic Foundation has created the Risk Assessment and Programming (RAP) Toolkit to support collaboration between public health and EMS on numerous issues including the opioid crisis. Each tool in the toolkit identifies an area for collaborative work on an issue affecting community health, and uses a light-weight, simple structure to help answer the following questions:
1. Is a given public health problem valid for EMS collaboration?
2. How can EMS evaluate their own community's level of risk for a given public health issue?
3. What public health initiatives should EMS deliver given their community's identified public health risk?
The suggested public health initiatives in each RAP Tool are built around three intuitive interfaces with traditional 9-1-1 operations—education initiatives, integrated initiatives, and expanded initiatives. Follow the link to learn more about the RAP Toolkit methodology and browse current RAP Tools.
California's Opioid Crisis by County
Which California communities face the greatest risk from opioid overdose and death? California has a large and diverse population, and the opioid epidemic has not affected every community the same. The COPE Project has identified counties at high, moderate, and low risk of opioid through overdose data available from the California Opioid Task Force and Centers for Disease Control and Prevention.
California Counties Identified at Low-Risk of Opioid Use Disorder
The COPE Project considers these California counties to be at low-risk for opioid use disorder because their county-wide opioid overdose death rate is near pre-epidemic rates of occurrence (3 overdose deaths per 100,000 individuals).
It is important to note that even low-risk counties may contain regions, cities, or neighborhoods that face elevated opioid-use risk. Thus, it is important for sub-county jurisdictions to weigh the need for their own EMS public health programs. The COPE Project team hopes to identify and support this more granular programming in later stages of development.
(source: CA Opioid Surveillance Dashboard)
Public Health Initiatives for Low-Risk Counties
The COPE Project encourages low-risk counties to consider the delivery of Educational EMS Public Health Initiatives. These initiatives inform the practice of EMTs and Paramedics and support intelligent provider-patient interactions on 9-1-1 incidents. This education should include important topics such as opioid cultural competence, local resources for opioid use disorder (OUD), current local public health programming on opioid use, and opioid epidemic updates.
The California Paramedic Foundation has built a new online course for EMTs and Paramedics that provides information on many of these opioid topics. The course is free to take and offers continuing education hours to participants. Starting a new opioid educational PHI is as simple as directing an agency's workforce to this free, high-quality course.
California Counties Identified at Moderate-Risk of Opioid Use Disorder
The COPE Project considers these 13 California counties to be at moderate-risk because their regional opioid overdose death rate is currently more than two times (2x) the national, pre-epidemic overdose death rate of 3 overdose deaths per 100,000.
(source: CA Opioid Surveillance Dashboard)
Public Health Initiatives for Moderate-Risk Counties
The COPE Project encourages moderate-risk counties to consider the delivery of Integrated EMS Public Health Initiatives in addition to the educational initiatives of low-risk counties.
Integrated EMS Public Health Initiatives deliver public health prevention resources or capture actionable public health data from the standard, everyday 9-1-1 operations of EMS. These initiatives assume that the reactive EMS system will bring EMS providers into contact with a specific population—in the case of the COPE Project, this is opioid users. This interaction provides an opportunity to provide important resources—addiction services information, referral services, naloxone distribution—and also capture meaningful, real-time data to inform ongoing public health programming.
These lightweight programs have a relatively low threshold of implementation because they demand only lightweight training and reach at-risk individuals in a passive manner.
California Counties Identified at High-Risk of Opioid Use Disorder
The COPE Project considers these 10 California counties to be at high-risk because their regional opioid overdose death rate is currently more than three times (3x) the national, pre-epidemic overdose death rate of 3 overdose deaths per 100,000.
(source: CA Opioid Surveillance Dashboard)
Public Health Initiatives for High-Risk Counties
The COPE Project encourages high-risk counties to consider the delivery of Expanded EMS Public Health Initiatives in addition to the educational and integrated initiatives of moderate- and low-risk counties.
Expanded EMS Public Health Initiatives (or PHIs) go above and beyond the normal practices of EMTs and paramedics. Expanded initiatives are anchored in the EMS system but use EMTs and Paramedics in roles outside of traditional 9-1-1 calls.
One example of expanded programming is community paramedic initialized or supported, medication-assisted treatment (MAT) with buprenorphine. Another example is EMTs and paramedics taking part in multi-disciplinary teams that seek out overdose victims for a referral to addiction services.
Expanded PHIs are more resource-intensive but are often the most effective of EMS-driven programs. Because they are resource-intensive, expanded PHIs are often used in communities that face the highest risks of opioid use disorder, overdose, and death.
The California Opioid Learning and Action Network (LAN)
The COPE Project will be forming a statewide California EMS Opioid Learning and Action Network (California OpioidLAN) with the goal of promoting opioid initiative implementations and EMS public health partnerships. The OpioidLAN will convene in the Fall of 2020 and last for a minimum of two years. The network will consist of public health and EMS leaders from each California LEMSA who have an interest in:
1) Finding an initial consensus on the opioid risk assessment contained within the Opioid RAP Tool that will drive implementations statewide.
2) Meeting regularly to accelerate their own local EMS opioid prevention initiatives and help other regions and localities with similar implementations.
The COPE Project Schedule
The COPE Project will soon announce a meeting schedule through the Summer and Fall. Please sign up for our newsletter below to receive project updates!