According to the Centers for Disease Control and Prevention, there were over 100,000 overdose deaths in the United States during a 12-month period ending in April 2021, an increase of 28.5% from the same timeframe the year before. Across the New England (NE) region, overdose deaths are above average for the nation, ranging from 30.3 to 39.7 deaths per 100,000 population in all six NE states. Additionally, while prescription opioid misuse is still prevalent, most overdose deaths in NE involve illicitly manufactured fentanyl, which is now ubiquitously found in unregulated substances including cocaine, heroin, counterfeit pills, crack cocaine, and methamphetamine. People who use unregulated substances recreationally, particularly stimulants, are frequently unaware that the highly potent opioid fentanyl, or one of its analogues, could be laced in the substance they are ingesting.
Rural communities in NE are seeing some of the largest increases in overdose deaths since the start of the pandemic. There are four potential key factors to increased opioid misuse in rural areas: 1. increased sales of opioids, which leads to greater availability, 2. out-migration of young adults from rural areas which leaves an aggregation of young adults at high risk for drug use, 3. social networks that allow faster diffusion of opioids, 4. increasing economic deprivation and unemployment (Keys et all 2014). Lack of public transportation is also a contributing factor, as most of NE lacks a robust system that supports rural areas in each state, which limits an individual's access to support services for opioid misuse. In addition to geographic considerations, stigma represents a significant barrier to individuals seeking support for opioid misuse, which can contribute to poor mental and physical health, non-completion of treatment programs, delayed recovery, and increased involvement in risky behaviors (Livingston et al 2011).
To address the growing overdose epidemic in Rhode Island, particularly in rural communities, the University of Rhode Island, through its Cooperative Extension program and Academic Health Collaborative, established the Community First Responder Program (CFRP) in October 2019. The goals of the CFRP are to: 1. educate rural communities about substance use disorder and opioid misuse, and 2. provide resources to these communities to help address opioid misuse. To further address the growing overdose epidemic in the region, the CFRP now seeks to expand its services to rural regions in the other five NE states.
Working closely with proposed sub award partner institutions: the University of New Hampshire Cooperative Extension, Husson University School of Pharmacy, Western New England University College of Pharmacy, University of Vermont Cooperative Extension, and University of Maine Cooperative Extension, the CFRP will provide training seminars for partnering institutions' faculty, staff, students, and volunteers in a train-the-trainer model to facilitate each partners' development of a regional rural overdose education, awareness, and outreach plan. The CFRP will provide each partner institution with interactive educational modules for the public and accredited programs for healthcare professionals that will each be redesigned to meet the individual needs of our partner institutions and the rural region(s) they serve. The CFRP will also offer the option to mail no-cost intranasal naloxone to participants living in designated rural catchment areas of Maine, Vermont, New Hampshire, Connecticut and Massachusetts. This collaboration will increase the capacity of NE to distribute naloxone to rural areas, provide continuing education to healthcare professionals related to substance misuse and treatment, and share science-based information with the public about opioid misuse, illicitly manufactured fentanyl, and overdose response.