To tamp down on the growing number of opioid overdose deaths, Indiana stakeholders hope to explore ways to intervene earlier by analyzing “touchpoints” between Hoosiers and healthcare or criminal justice systems.
For the second year in a row, Indiana hit a record high for the number of overdose deaths, with 2,755 Hoosiers dying in 2021 — an increase of 483 deaths from the year before, which was a record itself. Prior to the COVID-19 pandemic lockdowns, overdose deaths had been decreasing slightly.
Finding where overdose deaths could be prevented
Previous research shows that just over 1 in 5 Hoosiers who died from an accidental overdose were recently incarcerated — and frequently released without any support or referrals to treatment programs.
Brad Ray, a researcher with RTI International, was part of the team that released the above numbers following a study in Marion County. He presented updated findings, including data that spanned the entire state, to the Indiana Commission to Combat Substance Use Disorder earlier this month.
Between Jan. 1, 2015 and Aug. 26, 2022, Ray reported that more than 13,000 Hoosiers had died from an overdose — with 2021’s death toll more than twice the number of deaths in 2015.
“That is a lot of people to have died of an overdose in a seven-year period,” Ray said. “That is a lot of grief and trauma for those left behind.”
His analysis sought to identify ways Hoosiers had interacted with various systems in the state — whether healthcare, penal or emergency services — in the time prior to death to find areas where intervention could have helped.
Statewide, 26% of Hoosiers who died of a drug overdose were booked in a county jail within the last year. On average, Hoosiers had five months between leaving jail and dying of an overdose.
But while far more people end up in county jails than prison, 690,528 bookings compared to 11,658 prison releases, former detainees leaving prison were at a higher risk of an overdose than their jail counterparts.
Another potential area to intervene: emergency departments and ambulances. Nearly two-thirds, 65%, of Hoosiers who died had visited an emergency room in the year before their death. Over one-third, 37%, had used another emergency medical service.
Ray said his team had received funding for a five-year “FORTRESS” study, which would try to bring a more localized version of this data to county overdose fatality review teams.
The Fatal Overdose Review Teams Research to Enhance Surveillance Systems, would help those multi-disciplinary groups identify patterns and find opportunities to implement local changes, Ray said.
He said the study chose Indiana because its overdose review teams coordinate with the Indiana Department of Health and Indiana’s Management Performance Hub enables it to create “near real-time dashboards” of overdose deaths compared to touchpoints with the analyzed areas.
Intervening in Emergency Departments, jails
Thomas Gutwein, the emergency department medical director of Parkview Health in Fort Wayne, described the introduction of a program to help those seeking emergency services access medication-assisted treatment.
“We see different people who have this problem and we need to do what we can to break the cycle,” Gutwein said.
Rather than releasing a patient with a referral to treatment, now the person leaves with a small supply of medication to treat their withdrawal symptoms and help them quit whatever addictive substance they use. Patients also leave with an appointment scheduled to follow-up in just a few days.
“This is our window of opportunity when they want help so we have to get them that help right now,” Gutwein said. “Two to three weeks (for an appointment) is too late.”
The program has limitations — for example, pregnant women require more specialized care and would not be eligible — but also refers someone to peer counseling. Though Gutwein acknowledged that the shortage of mental health practitioners hinders that effort.
Doug Huntsinger, the state’s executive director for Drug Prevention, Treatment and Enforcement, said 68% of those who died of a drug overdose had visited an emergency room shortly before their deaths – on average, 96 days prior to dying.
“This emphasizes the critical need for opioid use disorder (treatments) and supports in our emergency rooms,” Huntsinger said.
Huntsinger also highlighted another state effort to intervene and reduce overdose deaths: the Integrated Reentry and Correctional Support program. The pilot program launched over the summer and Huntsinger said 1,400 Hoosiers in Blackford, Daviess, Dearborn, Delaware and Scott counties had been served — all people spending time in the local jail.
Dearborn County Sheriff Shane McHenry shared his institution had partnered with 1 Voice, a local nonprofit, to bring peer recovery coaches into the facility to help those incarcerated — many of whom lived in families who introduced them to their addictions.
“I’ve spent most of my career as a detective… arresting as many people as we can with narcotics… I’ve arrested grandpa, I’ve arrested dad, and I’ve arrested his son,” McHenry said. “We’re doing the same thing over and over, they’re getting arrested for the same things in the same family… Unless we do something, how do we ever expect something will change? A revolving door isn’t going to change things.”
McHenry said the peer coaches help those accused of crimes get a photo ID, some for the first time ever, find a job or a place to live and schedule recovery appointments before they even leave the jail. Without that intervention, McHenry said someone living with a substance abuse disorder could be back in jail in as little as two months.
“When we provide folks with these things, it’s going to increase their chance for success and not coming back to jail,” McHenry said.
Though too early to analyze, he said he’s seen success not only in reducing recidivism but also helping the jail staff by giving those incarcerated someone to talk to about their court dates or any other concerns. Otherwise, staff would be answering requests for public defenders — most of whom are overworked and have too many clients.
Aaron Spaulding, who has been sober since 2015, is the project coordinator for 1 Voice and oversees the five-person team of recovery coaches who have their own experiences with incarceration. For many, he and his team are the only models of what recovery can look like, he said.
With 253 participants since July 6, he said 30 have been diverted to long-term treatment while the team coordinates reentry support services for the rest. This includes relapse prevention skills, weekly check-in meetings and even transportation to probation meetings.
“We’re able to be there the moment they’re released. That’s the beauty of the program… and be that extra support as they’re developing their long-term support,” Spaulding said. “I remember how overwhelming this all can be. It was really overwhelming when I had to do it all on my own… The goal of this program is that every individual that is being released has immediate and ongoing support to where they never have to do this alone again.”
Huntsinger said that none of the five programs looked alike and had to be individualized for the community they served. Still, he said that numerous sheriffs had reached out to him asking for assistance in bringing the program into their facilities.
For someone like Spaulding, before his journey to recovery, it would have been life changing.
“Every Hoosier deserves the opportunity this program offers and no Hoosier should ever feel alone,” Spaulding said.