Title
Opioid Response Planning: Environmental Scan Results
Description
This report provides an update to the Public Safety and Justice Subcommittee on the results of the Opioid Response Planning Environmental Scan as part of the City of Phoenix opioid and substance use response planning.
THIS ITEM IS FOR INFORMATION AND DISCUSSION.
Report
Summary
In August of 2021, the City of Phoenix joined cities, towns, and counties across Arizona in signing the One Arizona Opioid Settlement Memorandum of Understanding (“One Arizona MOU”). The One Arizona MOU outlines the distribution of the estimated $542 million dollars that Arizona will receive over 18 years. Within this spending framework, 56 percent of the total settlement will be disbursed to local governments and the remaining 44 percent will remain with the State (administered by the Attorney General’s Office). The City of Phoenix receives 21.28 percent of the funding received by Maricopa County, dispersed annually.
Under the One Arizona MOU, funds must be used for future opioid abatement strategies that are nationally recognized. Approved uses include evidence-based, evidence-informed strategies addressing:
Treatment of Opioid Use Disorder (OUD)
Support for people in treatment and recovery
Support for people who have or are at risk of developing OUD
Prevention of overdose deaths and other harms
Prevention of opioid misuse
In March of 2023, the Office of Public Health presented to the Community and Cultural Investment (CCI) Subcommittee, outlining activities and actions to be taken as part of the City’s opioid response planning, including:
Scan of existing departmental policies and practices related to substance use.
Development of trainings and professional development opportunities for City employees related to evidence-based opioid prevention, treatment, and harm reduction strategies.
Review and investigate opportunities to expand naloxone (Narcan) access through city departments and outreach opportunities.
Develop a dashboard to improve opioid-related surveillance, including fatal and non fatal overdoses, to inform planning, future actions, and evaluation.
Planning and implementation of community information and feedback forums.
Comprehensive needs assessment, including surveys led by the MCDPH and a community survey led by the City of Phoenix.
Results
To create an opioid response plan for the city that meets the needs of the community, a comprehensive needs assessment was completed in 2023. The assessment process included multiple components: (1) assessment conducted with substance use and mental health care providers; (2) an assessment with people who use drugs (PWUD); and (3) an assessment with City of Phoenix residents. The following provides a brief overview of each assessment and key recommendations:
1. Opioid and Substance Use Needs Assessment: Service/Care Providers
Maricopa County Department of Public health (MCDPH) contracted with LeCroy and Milligan Associates, Inc. (LMA) to conduct an assessment of organizations identified as responding to opioid and substance use, including substance use treatment, prevention, and harm reduction organizations as well as mental health care providers, from January to May 2023 (MCDPH, 2023). The assessment included representatives from over 300 community-based agencies, health care organizations and governmental departments engaged in opioid and substance use response across Maricopa County. The final report was released by MCDPH in July 2023.
In addition to covering the broad landscape of substance use funding, programs and policies in Maricopa County, the assessment highlighted barriers in specific geographical regions. In the City of Phoenix, key barriers to delivering care noted by providers included challenges with housing, insurance, coordination among providers, and lack of knowledge of services available. Providers in Phoenix specifically identified the following concerns and recommendations:
Need for stable housing, and support for transportation.
Need for services for highest-risk populations, including LGBTQ+, BIPOC, women and families, and people leaving incarceration.
Need for improved coordination among providers of interlinked or sequential services (i.e., the “warm handoff” problem).
Need for integration of harm reduction into social services, including expanded street outreach.
Need for consistent resource and referral information.
Need for better access to data to inform interventions and funding applications.
The assessment provided over 30 recommendations organized into four themes: social determinants of health and equity, systems and policies, provider partnerships and capacity, and data and evidence.
Key recommendations for the City of Phoenix to consider include:
Support substance use and overdose surveillance and data sharing to track opioid and other substance use trends.
Empower crisis and post-overdose response teams to immediately connect people in distress to most relevant care services.
Integrate harm reduction education and services into treatment and recovery interventions.
Increase access to primary and secondary prevention in K-12 settings.
Establish centralized care navigators to facilitate integration of and transitions between services.
Support justice system diversion and deflection for drug-related charges that do not pose a threat to others.
Support harm reduction street outreach efforts, particularly in locations where PWUD congregate.
Increase naloxone access, focusing on geographic areas with lower access and high overdose rates.
Improve transportation support for people accessing OUD/SUD services.
Address stigma associated with PWUD.
Improve access to longer-term housing for PWUD, and those in treatment and recovery.
2. Assessment of Service Needs: People Who Use Drugs (PWUD)
Maricopa County Department of Public Health (MCDPH) further contracted with LeCroy and Milligan Associates, Inc. (LMA) to complete an assessment of People Who Use Drugs (PWUD) from April to June of 2023 (MCDPH, 2023). This assessment included a survey for PWUD with 525 respondents, as well as completion of 40 semi-structured qualitative interviews with PWUD who were also experiencing homelessness (PEH). The assessment covered areas such as housing, drug use, substance use treatment, harm reduction, general services and needs, and reproductive health. Phoenix residents accounted for almost half of all responses.
The final report was released by MCDPH in October 2023. Recommendations were extensive, and included the following actions:
Improve housing stability through eviction prevention programs, affordable housing, and removing barriers for PWUD and those with criminal records.
Improve access to shelters for PWUD by removing requirements for sobriety.
Improve awareness and accessibility of cooling centers among PWUD.
Increase awareness and distribution of safer use supplies and naloxone.
Explore the creation of a safe use site to reduce substance use harms and overdose, and to connect PWUD to services.
Increase access to low-barrier treatment and health services.
Reduce and/or supplement costs of treatment.
Reduce stigma among healthcare providers.
3. City of Phoenix Community Opioid and Substance Use Survey
In partnership with the Substance Use and Addiction Translational Research Network (SATRN) at ASU, the Office of Public Health developed and launched a Community Opioid and Substance Use Survey in late August 2023 (available in both English and Spanish). The survey remained open until the last week of October 2023, and was completed by approximately 765 residents. The goal of the survey was to assess substance use-related knowledge, attitudes, needs, and priorities among Phoenix residents. A full report of survey findings is still in development; the following are preliminary results.
The survey sample was representative of the Phoenix community as a whole. Distribution was spread across Phoenix zip codes as well as income level. The majority of respondents were female (69 percent); 53 percent identified as White and 30 percent as Hispanic. Survey participants were asked about their personal experience with opioid use and overdose, their confidence and willingness to intervene if someone was overdosing, and their knowledge of resources for substance use.
Approximately one third of respondents reporting using an opioid in the past five years (prescription or illicit).
Greater than two thirds knew someone addicted to opioids or another substance.
40 percent had encountered one or more people who appeared to have overdosed in the past three years.
Respondents expressed strong willingness to administer naloxone to reverse an opioid overdose, but were less confident in knowing how to do so, and/or were afraid of doing something wrong that would cause the patient harm.
When asked about drug-related problems in their community, respondents rated all issues linked to illegal substance use as areas of strong concern. When asked to rate their level of support for various opioid abatement initiatives in which the City of Phoenix could invest, respondents strongly supported all areas of intervention including substance use disorder treatment and related social support services, primary prevention efforts, and harm reduction.
Next Steps
The Office of Public Health is using the information gathered through these assessments, as well as information collected through the City of Phoenix staff and departmental environmental scan, to develop an opioid and substance use response strategy. The strategy will incorporate data and evidence to develop strategic priorities for further investment and/or investigation by the City of Phoenix using Opioid settlement funds.
Financial Impact
The funding associated with this work will come from the Opioid Settlement dollars as part of the One Arizona Memorandum of Understanding (MOU). To date the City has received $5,479,871.20 as part of its installments of funding from the Distributor settlement, Janssen settlement and Mallinckrodt Bankruptcy covering years 2021 to the present. It is anticipated the City will receive additional settlements; the total amount is unknown at this time.
Department
Responsible Department
This item is submitted by Assistant City Manager Lori Bays and the Office of Public Health.