Alcohol-Overdose Community Health Assessment & Evaluation Synthesis (Oregon SPF - PFS)~1.pdf

SPF-PFS Community Health Assessment/Evaluation Synthesis – March 2024

Oregon Health Authority (OHA), Public Health Division (PHD) - Center for Prevention & Health Promotion

Health Promotion and Chronic Disease Prevention Section (HPCDP)

Injury & Violence Prevention Section (IVPP)

March 2024

Alcohol/Overdose Community Health Assessment & Evaluation Synthesis/Oregon Strategic Prevention Framework - Partnerships for Success

The following synthesis summaries key findings and recommendations from recent evaluations, reports, studies, and gaps analyses related to alcohol and other drugs, including tobacco, in Oregon (2019-2024). OHA-PHD HPCDP and IVPP or their contractors have developed these materials, along with other key state agency and academic partners.

Findings provide a snapshot of community health needs and gaps at the state, regional and local level in Oregon. This document also serves as OHA-PHD’s state level

Community Health Assessment (CHA) to guide planning and funding allocation for Oregon’s Strategic Prevention Framework-Partnerships for Success grant funded by SAMSHA.

Communications & Health Education Community Engagement

• Oregon’s Rethink the Drink (RTD) messaging campaign has raised public awareness of excessive drinking harms and health impacts.

• Marketing contributes to high alcohol consumption rates.

• Alcohol use is rising among young adults and adults.

• State funded alcohol and overdose prevention messaging campaigns have been successful and well received by communities.

• There are gaps in education/awareness about the benefits of overdose reversal medication.

• Reduce stigma related to drug use and harm reduction.

• More effectively communicate the effectiveness and return on investment of primary/universal prevention.

• Expand culturally and linguistically specific and responsive messaging and programs.

• Conduct needs assessment with priority populations to better understand their unique needs and the impacts of alcohol and other drugs on their communities.

• OHA-PHD staff capacity and grant limitations are barriers to increasing communication and engagement with community organizations.

• OHA built infrastructure to conduct outreach and co-develop prevention initiatives with cultural and linguistic specific communities during the Covid-19 pandemic, but more investment is needed to accelerate progress.

• Local Public Health Authorities’(LPHAS) capacity for overdose surveillance, prevention, and harm reduction vary widely across the state.

• Mobilize communities, policy, and funding to advocate for primary prevention.

• Promote cross sector partnerships to increase collective impact of prevention interventions.

• Coordinate strategies and partnership across the SUD continuum.

Youth & Families Funding & Capacity Building

• Oregon youth report that most have heard about fentanyl from the internet or friends, but listed healthcare providers or OHA as trusted information sources.

• Youth are unfamiliar with fentanyl test strips, carrying overdose reversal medications, recognizing an overdose, and Oregon’s Good Samaritan Law.

• Focus on children, youth and parents, and schools for polysubstance use prevention.

• Listen and collaborate with young people.

• Fund comprehensive, evidence-based substance use curricula and health education

• Develop local, age specific community resource lists.

• Intervene early and engage youth with alcohol prevention outreach and messaging.

• Alcohol is available nearly everywhere. Foster activities and spaces in communities not centered on alcohol.

• Strengthen cross-sector partnerships across local and Tribal prevention programs and schools, including Educational Service Districts and the Oregon Department of Education.

• LPHAs have gaps in funding and capacity to conduct alcohol and overdose prevention and response.

• Costs of overdose reversal medications prohibit wider access and use.

• Compared to treatment investments, Oregon’s prevention system is chronically underfunded.

• Gaps in funding for substance use disorder (SUD) treatment still exist, despite BM110 investments.

• CBOs funded through OHA-PHD’s Health Equity Program report easy access to the funding application process.

- FAQs, informational sessions, budget webinars, onboarding processes were clear and well communicated.

- Non-funded CBOs felt scoring system was unclear, feedback was not provided, review process was inconsistent, and funding favored urban over rural communities.

• Continue to expand funding opportunities, support learning, training and technical assistance, and offer frequent collaboration opportunities.

Treatment and Harm Reduction

Data & Policy

• Most service providers lack capacity to meet current demand for services (translating to a 49% gap in systems capacity in Oregon).

• Among Oregon Health Plan members, rates of SUD diagnoses suggest that less than half have been diagnosed or treated.

• Among surveyed facilities, only 51% dispensed buprenorphine or naltrexone, while less than one in five reported certified Opioid Treatment Programs licensed to dispense methadone.

• Pharmacists prescribe overdose reversing medication less often than providers because of requirements that impact prescribing.

• Some harm reduction and other services have increased since M110, but gaps still exist, especially in prevention.

• Funding availability limits Oregon’s overdose data and surveillance infrastructure.

• Translate data and research for use in community practice.

• Early studies have found no association between M110 and fatal overdoses.

• Legal changes to remove or decrease criminal penalties for drug possession are not associated with the fatal drug overdose rates 1-year post implementation.

• The most substantial contributors to risk of hospitalization for a substance use disorder in all 36 counties in Oregon include violent crime, high alcohol outlet density, and low social association rates

• Consider pricing and tax strategies to raise revenue for treatment and prevention programs.

• Prioritize equity in both pricing strategies and revenue allocation.

• One in five providers offering harm reduction services also provide drug checking or syringe services.

• Almost half of rural opioid users in Oregon were recently incarcerated and more likely to have tried and failed at accessing treatment than their non-incarcerated counterparts.

• Many nonfatal overdoses are being revived by overdose reversal medications outside of the emergency system.

• Prioritize workforce development across the SUD continuum.

• In 2021, 37% of home alcohol deliveries did not comply with ID checking requirements.

• In 2022, 25% of retailors inspected through Oregon’s Tobacco Retail Licensing Program sold tobacco products to persons under 21 years of age.

• People who use drugs are still heavily policed post M110 implementation.

Mental Health Resources Access to Other Resources

• Co-occurring mental illness and substance use disorders are common.

• Advance more holistic, integrated co-occurring disorder prevention and treatment approaches across the service continuum.

• Clinicians need to consistently evaluate patients for a broad range of co-occurring disorders before determining appropriate treatment.

• Assess for co-occurring psychiatric disorders to increase treatment effectiveness.

• Increase workforce strategies that bring people of color into mental health professions to increase workforce from communities experiencing mental health access inequities.

• Replicate peer learning such as Oregon Peerpocalypse which provides peer networking/learning opportunities and raises awareness of mental health and peer support resources, advocacy, and leadership opportunities.

• Unstable housing, and transportation barriers, have a significant impact on overdose, especially for people with substance use disorders who may also experience stigma when accessing community resources.

• Transportation and technology barriers limit access to SUD services and treatment, especially in rural areas.

• There is insufficient availability of cultural and linguistically relevant services and health education.

• Language interpretation and translation services are insufficient to meet current and anticipated future needs given Oregon’s demographic changes.

• Oregon’s workforce does not represent the demographic diversity of the state.

Resources Consulted

• Rethink the Drink, First Campaign Evaluation Findings (April 2023). RMS Research / Oregon Health Authority, Public Health Division, Health Promotion and Chronic Disease

Prevention Section

• Sharing Their Stories: People in Oregon Discuss Alcohol (August 2023). RMS Research / Oregon Health Authority, Public Health Division, Health Promotion and Chronic

Disease Prevention Section

• Oregon Alcohol Outlet Retail Density Maps (funded by CDC Alcohol Epidemiology Grant (2021-current)

• Eyes On Oregon: An Observational Study of Home Alcohol Delivery Compliance. Oregon Liquor and Cannabis Commission (October 2022)

• Addressing Unhealthy Alcohol Use in Oregon. Oregon Rural Practice-Based Research Network, SBIRT Oregon, and Oregon Heath Authority (2019-2022)

• Economic Analysis of Excessive Alcohol Consumption in Oregon. ECONorthwest and Oregon Health Authority, Public Health Division, Health Promotion and Chronic Disease

Prevention Section (2021)

• Alcohol Formative Audience Assessment. PRR Inc. and Oregon Health Authority, Public Health Division, Health Promotion and Chronic Disease Prevention Section Assessment

(April 2021)

• Alcohol Retail Marketing and Product Availability in Oregon. Oregon Health Authority, Public Health Division, Health Promotion and Chronic Disease Prevention Section

(2020)

• 2020-25 Health Promotion and Chronic Disease Prevention Section and 2023 Injury and Violence Prevention Equity Strategic Plans

• Oregon Local Public Health Authority (LPHA) Overdose Rapid Assessment Findings of Unfunded Counties. Oregon Health Authority, Public Division, Injury and Violence

Prevention Section (March 2024)

• Oregon Youth & Young Adult Fentanyl Survey - Descriptive Results. Comagine Health and Oregon Health Authority, Public Division, Injury and Violence Prevention Section

(November 2023)

• Naloxone Access in Pharmacies Assessment. Washington County, Oregon (September 2023)

• Local Public Health Authority - Fentanyl Media Campaigns Scan Final Report (November 2023)

• Oregon Public Health Modernization Huddle - Overdose/Polysubstance Use Listening Session with CBOs and LPHAs (November 2023)

• Oregon State Opioid Response (SOR 3) Grant Year 1 Needs Assessment and Performance Progress Report). Comagine Health and Oregon Health Authority, Division of Behavioral Health (2023)

• Oregon Overdose Prevention Coordination in Funded Regions – Annual Report (September 2022-August 2023). Comagine Health and Oregon Health Authority, Public

Division, Injury and Violence Prevention Section (December 2023)

• “Recent Incarceration, Substance Use, Overdose, and Service use among People who use Drugs in Rural Communities: One Year Association of Drug Possession Law Change with Fatal Drug Overdose in Oregon and Washington”(2023)

• Summary Report of Fall 2023 Overdose/Polysubstance Use Regional Listening Sessions (February 2024). Oregon Health Authority, Behavioral Health and Public Health Divisions.

• 2022 Opioids and the Ongoing Drug Overdose Crisis in Oregon, Annual Report to the Oregon State Legislature (ORS 432.141)

• 2023 Peerpocalypse Conference Evaluation Report (Comagine Health and Mental Health & Addiction Association of Oregon)

• Oregon M110 Research Symposium – Key Takeaways. RTI and Portland State University (January 2024).

• Oregon Secretary of State Audit of Measure 110. Oregon Health Authority and Oversight and Accountability Council (December 2023)

• Oregon Inventory of Services for Co-occurring Substance Use and Mental Health Disorders. Oregon Health and Sciences University and Portland State University, and Oregon Health Authority (December 2023)

• Oregon Substance Use Disorder Services Inventory and Gaps Analysis. OHSU-PSU School of Public Health, Alcohol and Drug Policy Commission, and OHA (2022)

• Oregon’s Ballot Measure 108 Tobacco Tax: Reflections and Learning from a Community Led Process. Metropolitan Group and Oregon Health Authority, Public Health Division, Health Promotion & Chronic Disease Prevention Section (June 2023)

• CBO Public Health Funding Process Evaluation Findings. RMC Research and Oregon Public Health Division (2022)

• Executive Summary from 2022 Prevention Symposium and 2023 Prevention Workshop, Alcohol and Drug Policy Commission and Oregon Health Authority, Center for Prevention and Health Promotion