The Hawai‘i Opioid Initiative action plan contains seven key focus areas, and workgroups meet regularly to advance progress in each of these areas. See below to learn more about each work group’s objectives and accomplishments.

TREATMENT ACCESS

Improve and modernize healthcare strategies and access for opioid and other substance misuse treatment and recovery services.

Objective: Establish a pilot coordinated entry system to process and coordinate substance use disorder (SUD) treatment referrals.

A coordinated entry system for SUD provides a single point of contact for any community based substance misuse referral. This means that medical providers, law enforcement, community organizations and others will be able to make referrals through one entry point utilizing universal procedures. A coordinated entry system is a unified and universal referral system for the community and helps to integrate primary and behavioral healthcare systems by providing a more streamlined access point for referrals by primary care providers. It also enhances a balanced public health/public safety approach by providing opportunities for entities from both fields to work together toward overlapping objectives.

PRESCRIBER EDUCATION

Objective: Increase primary care provider pain management practice (PMP) registration rates by 25% by providing training to prescribers; increase PMP utilization rates by 10%.

The use of a PMP is nationally and universally recognized as a cornerstone activity for reducing over-prescribing of opioid pain medications, as well as for decreasing diversion and “script shopping”. Universal use of the PMP in other states have been attributed to reduction of duplicated opioid prescriptions as well as increased awareness of medications patients are prescribed by various providers.

Objective: Assure universal screening for substance misuse in hospital and primary care settings Statewide.

One of the primary barriers to effectively intervening with persons at risk for OUD and other SUDs is the lack of universal screening. Often, the emergence of opioid or other substance use problems are a result of critical and acute symptomology such as involvement with law enforcement. Interventions at this point in the progression of the disease, while necessary, requires more resources than if the risk had been identified early on.

DATA INFORMED DECISION MAKING

Implement system-wide routine data collection, sharing and dissemination to increase knowledge and inform practice.

Objective: Amend HRS 329-104 to allow limited release of data by the NED to the DOH for purposes of public health surveillance.

The statute in its current form limits NED’s statutory authority to allow access to PMP data. A change in the language to provide extended authority of NED to provide data for select public health use would significantly support advancement in this area.

Objective: Develop a standardized framework for the collection, synthesis, and dissemination of data.

To assure that opioid prevention and treatment efforts are data driven and measurable, DOH, Emergency Medical Services, Injury Prevention Services Branch (EMS/IPSB) will develop a data framework to analyze and report existing data and identify unmet data needs of the workgroups. A data framework supports and informs system level coordination and policy making by providing clear information on where resources and efforts are most effective. It can be leveraged by both public health and public safety entities to assist with informed decision making that considers the objective of both and promotes balanced policy. A data plan is a framework that not only collects data but collectively processes it in a way that programs can utilize to focus limited resources is self-explanatory.

PREVENTION AND PUBLIC EDUCATION

Objective: Implement year-round drop off/”take back” sites at a minimum of 2 county police stations within the State to include protocols for disposal of unused medications in a safe and secured manner.

Implementation of standing take back sites requires coordination on the federal state, county and community level. Take back initiatives provide the opportunity for law enforcement entities in Hawaii to assist with prevention efforts and to increase community partnerships. Standing take back sites also provide an important opportunity to collect data related to the volume of medications disposed in comparison with those dispensed.

Objective: Develop and disseminate an evidence-based training module on opioid use, misuse, overdose and related harms for non-prescribers.

To reduce opioid misuse and related harms, DOH and community partners will develop and implement a training module to be integrated into existing trainings for Certified Substance Abuse Counselors, Certified Prevention Specialists, adolescents and school-age youth, teachers, home healthcare providers and others who work with populations at-risk for opioid misuse and related harms. There will also be a module for training of trainers to maximize existing training infrastructure and enhance dissemination. Not only will this increase awareness and capacity but will also provide additional opportunities for community engagement around these issues.

PHARMACY-BASED INTERVENTIONS

Increase consumer education and prescription harm management through pharmacy-based strategies.

Objective: Establish a standing order through the DOH to allow pharmacists to dispense Naloxone to patients and community members to increase access to life-saving medication; modify Hawaii Revised Statutes to allow pharmacists prescriptive authority to prescribe Naloxone to patients and community members to increase access to life-saving medication.

Access to Naloxone is a nationally and universally recommended cornerstone practice and has been shown to reduce the incidence of opioid deaths due to overdose. Many states have instituted a standing order that allows pharmacists to dispense the life-saving medication. This objective is specifically targeted for patients who are filling an opioid prescription.

Objective: Provide continuing education presentation on pharmacist role in screening for risk for patients with opioid prescriptions.

Pharmacists play an important role in the strategy to address opioid issues in the State. As a primary point of contact for persons with opioid and other narcotic prescriptions, they represent a significant component for moving the State toward improved integration of healthcare. Pharmacists can provide key screening and education for patients while filling prescriptions and are well positioned to support public awareness efforts.

Objective: Develop Naloxone training program for pharmacists.

Pharmacists play an important role in the strategy to address opioid issues in the State. As a primary point of contact for persons with opioid and other narcotic prescriptions, they represent a significant component for moving the State toward improved integration of healthcare. Pharmacists can provide key screening and education for patients while filling prescriptions and are well positioned to support public awareness efforts.

SUPPORT FOR LAW ENFORCEMENT AND FIRST RESPONDERS

Coordinate operations and services, support specialized training for first responders and assure effective laws and policies.

Objective: Develop a recommended course of action to be taken by first responders when encountering opioid overdose victims using a clearly defined recommended protocol; train 30% of law enforcement/first responders in all four counties on the training program that is developed by this group.

The intent of this goal is to research national evidence-based multi-disciplinary approaches for law enforcement/first responders and develop a training curriculum that meets the needs of Hawaii’s law enforcement/first responders. The intended result is a better understanding by first responders (to include Emergency Medical System (EMS), Fire, and Police) of drug trends, protection and exposure protocols to ensure the safety for themselves and the community.

Objective: Develop and recommend standard procedures for first responders on treatment referral at initial contact by law enforcement/first responders; coordinate with other working groups and stakeholders to create a list of diversion programs for law enforcement/first responders to use as a reference when referring overdose victims.

Diversion efforts such as Law Enforcement Assisted Diversion (LEAD) and Help Honolulu are currently in development in Hawai‘i. These efforts are based on successful and evidence-based programs implemented in other parts of the country. The common theme of these programs is the beneficial partnership between first responders and public health personnel.

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