The First Responders Addiction and Recovery Support (FRARS) program will provide all first responders in Durham County the ability to carry and administer intranasal naloxone, a drug/device for emergency reversal of known or suspected opioid overdoses. This program expands the availability of this life-saving drug to communities and populations with greater substance use activity but fewer opportunities to obtain treatment and referrals to continued care outside of calling 9-1-1.
In North Carolina and United States, the percentage of opioid overdoses in Whites is higher than those of other races and ethnicities. In Durham County, NC, however, the trend is different with Black or African American individuals comprising 54% of opioid overdoses and Whites only 44%. Most overdoses occur in geographical areas considered highly vulnerable areas exhibited by higher unemployment, significant housing and food insecurities, social vulnerabilities, and greater mental health concerns. Many are uninsured or underinsured making access to health care challenging.
The FRARS program has several goals, all but one to begin in the first year of the grant. One is to increase the number of first responders with access to intranasal naloxone. Each first responder will be trained on the safest way to carry the devices, how to recognize an overdose, and how to administer the drug. They will learn more about substance use, especially opioid use, and how trauma-informed care can play a role in helping persons be more willing to begin treatment and recovery. Each first responder will have access to information about community resources that can help people with substance use disorders start medication assisted treatment (MAT), substance use counseling, and other supports as needed for emotion, psychological, or social determinant concerns.
Another goal is to extend our current community harm reduction outreach by providing intranasal naloxone kits and resource guides to every person who has had or is at risk of experiencing an opioid overdose. Currently, EMS Community Paramedics (CPs) attempt to provide these resources via a post-overdose response but are only able to connect with around 10 percent of all overdose patients for whom 9-1-1 was called. Recently, these kits were added to ambulances so EMS crews can distribute naloxone kits and resource guides at the point of contact thus increasing the number of people impacted. We plan to expand this outreach further by providing additional kits for all first responders and community organizations with the potential to encounter someone who is at risk of an opioid overdose. These responders and community members will also receive training on substance use and trauma-informed care as well as information about community resources that can help a person with treatment and recovery.
Fentanyl use is on the rise in Durham County. We plan to begin distributing Fentanyl test strips along with the intranasal naloxone kits during harm reduction efforts. Substance users can then test their drugs before use to determine if Fentanyl is included with their drugs. They will then be able to take stronger precautions against death by overdose. Everyone receiving these test strips will receive education and information about the risks of Fentanyl along with referrals to community resources for medication, treatment, and recovery.
Finally, in year two of the grant, CPs will begin providing field initiated Suboxone or a generic equivalent. This is intended to help individuals in underserved areas have a greater opportunity to obtain medication and treatment to help them begin recovery. CPs will work with each person to provide the medication while getting them enrolled in a community-based office-based opioid treatment (OBOT) center. Through motivational interviewing and trauma-informed care, CPs will be able to help persons who may otherwise never enter treatment.