Denver Regional Opioid Abatement Settlement Funding
The City and County of Denver’s first funding request to the Colorado Opioid Abatement Council for Opioid Settlement Funds was found to be compliant on Sept. 29, 2022, by the Colorado Opioid Abatement Council (COAC). Denver’s request for over $4.7 million encompasses strategies to address opioid use in Denver including prevention, treatment, harm reduction, and innovative approaches to mitigate the harms of opioids in our community..
Denver’s submission follows the sections and categories laid out in the memorandum of understanding between the Colorado Department of Law and all counties, municipalities, towns, and county and city municipal corporations, including the City and County of Denver.
In addition to explicitly stated areas of use outlined by COAC and in the MOU, Denver has also proposed additional strategies to combat opioid use, improve treatment options and outcomes, and support activities or projects that have the potential to impact opioid use in Denver by changing the ways people who use opioids interact with systems and their community networks of treatment and support.
Denver’s additional strategies aligned with the COAC approved use categories are here(XLSX, 28KB) and outlined below.
Round One Funded Projects*
*These are the intended recipients of 2023 funding, as voted on by the Denver Opioid Abatement Council. Details are subject to change until contracts are executed.
The Denver Opioid Abatement Council (DOAC) posted a request for proposal (RFP) from April – June 2023. The DOAC received 36 completed applications from organizations supporting opioid abatement efforts throughout the city and county of Denver. In August 2023, the DOAC voted to fund the follow fifteen projects for one year. The contracting process is currently underway.
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5280 Recovery Expansion for Adolescents
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Culturally Responsive Peer Recovery Support Expansion
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Fentanyl Wastewater Intelligence
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Community-wide Stigma Reduction Campaign
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Colorado Health Network #1
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Increasing Accessibility to Care and Treatment for People Who Use Drugs
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Colorado Health Network #2
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Denver Health and Hospital Authority #1
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Engaging Youth for Opioid Abatement
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Denver Health and Hospital Authority #2
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Opioid Stewardship Clinical Pharmacist Specialist Program
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Denver Health and Hospital Authority #3
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Substance Use Prevention Float Program
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Harm Reduction Action Center
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Permanent harm reduction facility
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Public Education Campaign—Opioid Use and Overdose Prevention
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Colorado Prehospital Addiction Care Consortium: Denver County First Responder Naloxone Distribution and Harm Reduction program Pilot
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Transportation for Tribe Recovery Homes
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Peer Recovery Support & Harm Reduction for Denver Youth and Young Adults
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Denver Regional Opioid Abatement Plan - Sept. 2022
Prevention
Proposed Budget: $1,575,046
Prevention activities work to educate and support individuals and communities to prevent the use and misuse of drugs and the development of substance use disorders. Prevention efforts should address multiple levels of the socio-ecological model to be most effective. Therefore, there are a wide variety of activities that can help to prevent substance use, such as educating providers on prescribing practices, educating youth and families on substance use, and promoting systems that result in the creation of strong protective factors. Both literature and feedback from focus groups and interviews indicate that people want information that supports their families, friends, extended networks, and themselves. This could be in the form of formal education in schools, community-based facilitated conversations, or easily accessible and trustworthy online resources. Since substance use is often co-occurring with other issues, it’s important to dedicate a significant number of resources to alter structures that have a negative impact on health, such as housing, finances, support networks, etc. MOU compliant uses for funding include:
Prescribing Practices
- Fund development of a multistate/national prescription drug monitoring program (PDMP) that permits information sharing while providing appropriate safeguards on sharing of private information
- Enhance usability of PDMP amongst providers
- Educating pharmacy dispensers on appropriate opioid dispensing
- Training for health care providers regarding safe and responsible opioid prescribing, dosing, and tapering patients off opioids
- Implement peer-led interventions in the emergency departments
- Support for non-opioid pain treatment alternatives, including training providers to offer or refer to multi-modal, evidence-informed treatment of pain
Misuse of Opioids
- Public education related to drug disposal
- School and community education programs related to opioid misuse
Overdose Deaths and Other Harms
- Increasing availability and distribution of naloxone and other drugs that treat overdoses to first responders, overdose patients, opioid users, families and friends of opioid users, schools, community navigators and outreach workers, drug offenders upon release from jail/prison, and other members of the general public
- Increase naloxone distribution in partnership with Community organizations
- Training and education regarding naloxone and other drugs that treat overdoses for first responders, overdose patients, patients taking opioids, families, schools, and other members of the general public
- Expand the current City and County of Denver Anti-Stigma campaign with messaging geared directly towards opioid/substance use/alcohol use, and continue current messaging for future years
- Make naloxone free and easily accessible
- Increase naloxone distribution in partnership with Community organizations
- Syringe service programs, including supplies, staffing, space, peer support services, and the full range of harm reduction and treatment services provided by these programs
Treatment
Proposed Budget: $1,895,040
Decades of needs assessments and environmental scans in Colorado have demonstrated the need to increase the availability of treatment services for behavioral health conditions (mental health and substance use) statewide. With increasing rates of fatal and non-fatal overdoses, and widespread negative mental health outcomes driven by the COVID-19 pandemic, this is more important than ever.
An ongoing assessment has indicated the need for not only prompt access to behavioral health services, but for more culturally representative providers. As it stands, there are limited opportunities for people whose first language is not English to access inpatient options in our community.
For those currently in the behavioral health workforce, additional training is needed as well as pay increases to maintain staff. Those considering entering the workforce should be incentivized through programs that finance their education, and emphasized with specific strategies on increasing the racial, ethnic, and cultural diversity of the workforce.
In addition to workforce capacity, certain types of interventions and treatment are currently unavailable or essentially inaccessible in Denver. Funding should be used to create the systems necessary to support a full continuum of care, including covering the costs of services when personal finances and insurance do not meet the individuals’ needs. MOU compliant uses for funding include:
People in Treatment and Recovery
- The full continuum of care of recovery services for Opioid Use Disorder (OUD) and any co-occurring substance use or mental health issues, including supportive housing, residential treatment, medical detox services, peer support services and counseling, community navigators, case management, and connections to community-based services
- Market and promote utilization of harm reduction, overdose prevention and mental health services
- Expand naloxone distribution using a data-informed approach (ensure overdose prevention kits are getting to those that need them the most)
- Expand substance use and overdose education, naloxone, and drug testing resources using ideal modes of communication to reach target populations (i.e. more than just a press release)
- Provide sustainable funding to Syringe Service Programs and other community organizations to expand access to physical space for people who use drugs and their support networks to engage, ride out a high, or use under supervision where applicable law allows
- Community-wide stigma reduction regarding treatment and support for persons with OUD, including reducing the stigma on effective treatment
Treatment of Opioid Use Disorder and its Effects
- Expand availability of treatment, including Medication-Assisted Treatment (MAT), for OUD and any co-occurring substance use or mental health issues.
- Appropriate triage of clients to ensure individuals are receiving timely and clinically appropriate care
- Cover the costs of mental health services for people unable to access them otherwise
- Supportive housing, all forms of FDA-approved MAT, counseling, peer-support, recovery case management and residential treatment with access to medications for those who need it
- In collaboration with the State of Colorado, further expand supportive housing options (utilizing all forms of FDA-approved MAT) via use of a HMIS system for all applicable city employees
- Expand telehealth to increase access to OUD treatment, including MAT, as well as counseling, psychiatric support, and other treatment and recovery support services
- Reduce wait time for appointments to increase network capacity
- Fellowships for addiction medicine specialists for direct patient care, instructors, and clinical research for treatments
- Increase the training for providers in their ability to address ethnic, cultural, and gender issues in treating substance use
- Scholarships for certified addiction counselors
- Implement incentive-based programs, such as scholarships, to expand training for health care providers, students, and other supporting professionals regarding MAT and harm reduction
- Clinicians to obtain training and a waiver under the federal Drug Addiction Treatment Act to prescribe MAT for OUD
- Training for health care providers, students, and other supporting professionals, such as peer recovery coaches/recovery outreach specialists, including but not limited to training relating to MAT and harm reduction
- Dissemination of accredited web-based training curricula, such as the American Academy of Addiction Psychiatry's Provider Clinical Support Service-Opioids web-based training curriculum and motivational interviewing
- Train front line staff on culturally appropriate motivational interviewing skills to assess readiness for change
- Development and dissemination of new accredited curricula, such as the American Academy of Addiction Psychiatry's Provider Clinical Support Service Medication-Assisted Treatment
- Support and reimburse services that include the full American Society of Addiction Medicine (ASAM) continuum of care for OUD
- Strategies recommended by Denver and approved for use
- Purchase and support staffing for the use of advanced technology to test drugs submitted by community members
- Create and support recovery-oriented spaces such as sober sections at music and sports events
Intervention
- Ensure that health care providers are screening for OUD and other risk factors and know how to appropriately counsel and treat (or refer, if necessary) a patient for OUD treatment
- Fund Screening, Brief Intervention and Referral to Treatment (SBIRT) programs to reduce the transition from use to disorder
- Utilize “Implementing Technology and Medication Assisted Treatment Team Training and Resources” (ITMATTTRs) framework for team-based care initiatives where alternatives to opioids are utilized
- Training and long-term implementation of SBIRT in key systems (health, schools, colleges, criminal justice, and probation), with a focus on the late adolescence and young adulthood when transition from misuse to opioid disorder is most common
- Training for emergency room personnel treating opioid overdose patients on post discharge planning, including community referrals for MAT, recovery case management and/or support services
- Address systemic issues to make services more affordable and work with the community to identify ways to minimize cost as a barrier to receiving services
- Support work of Emergency Medical Systems, including peer support specialists, to connect individuals to treatment or other appropriate services following an opioid overdose or other opioid-related adverse event
- Ensure people understand prevention and early intervention services covered by insurance or available for free
- Reduce cost of services (including substance use/mental health services and other services that impact social determinants of health)
- Develop best practices on addressing OUD in the workplace
- Reduce cost of services (including substance use/mental health services and other services that impact social determinants of health) provided by employers
Criminal-Justice – Involved Persons
- Address the needs of persons involved in the criminal justice system who have OUD and any co-occurring substance use disorders or mental health (SUD/MH) issues
- Expand treatment of opioid use disorder in the jails to include but not limited to MAT, education, and evidenced-based therapies
- Support pre-arrest diversion and deflection strategies for persons with OUD and any co-occurring SUD/MH issues
- Offer specific treatment pods for persons experiencing substance use disorders that need, and are willingly engaged in treatment
- Support treatment and recovery courts for persons with OUD and any co-occurring SUD/MH issues, but only if they provide referrals to evidence-informed treatment, including MAT
- Support and ensure a warm handoff is made upon release from incarceration for individuals to continue MAT and/or substance use treatment
- Provide evidence-informed treatment, including MAT, recovery support, harm reduction, or other appropriate services to individuals with OUD and any co-occurring SUD/MH issues who are incarcerated, on probation, or on parole
- Provide evidence-informed treatment, including MAT, recovery support, harm reduction, or other appropriate re-entry services to individuals with OUD and any co-occurring SUD/MH issues who are leaving jail or prison or who have recently left jail or prison
- Strive to reduce disparities across the spectrum of substance use referral to harm reduction, treatment services
- Build up and support diversion opportunities for individuals who have substance use disorders
- Strategies recommended by Denver and approved for use
- Implement early intervention with adolescents who are engaged with the criminal justice system. Early intervention and referral system on 1st charge to avoid recidivism
- Offer counseling and psychopharmacology in jail settings
- Support individuals in Medicaid application and enrollment pre-release so the individual is covered upon release from incarceration
- Support individuals connecting to DHS Navigators out of custody in the courthouses, Probation, pre-trial, and in-custody
- Purchase and support staffing for the use of advanced technology to test drugs submitted by community members
- Create and support recovery-oriented spaces such as sober sections at music and sports events
Women Who Are or May Become Pregnant
- Evidence-informed treatment, including MAT, recovery, and prevention services for pregnant women or women who could become pregnant and have OUD
- Specialized treatment for pregnant women who experience substance use disorder(s)
- Training for obstetricians and other healthcare personnel that work with pregnant women and their families regarding OUD treatment
- “Train the trainer” collaboratives for subject matter experts in addiction treatment providing training to other providers/clinicians who may encounter a pregnant person who uses drugs
- Child and family supports for parenting women with OUD
- Increase interventions among front-line essential workers and their children and increase awareness among providers to target this at-risk population, such as burnout/compassion fatigue/secondary trauma prevention
- Enhanced family supports and childcare services for parents receiving treatment for OUD
Additional Areas
Proposed Budget: $1,240,065.04
This category focuses on activities or projects that have the potential to impact opioid use in Denver by changing the ways people who use opioids interact with systems and their community networks to receive treatment and support.
Many of the strategies proposed here were not explicitly outlined in the MOU but have been deemed compliant to use by COAC.
Services for Children
- Support for children's services: Fund additional positions and services, including supportive housing and other residential services, relating to children being removed from the home and/or placed in foster care due to custodial opioid use
- Provide accurate information about drugs and alcohol in schools (Pilot Drug Policy Alliance Curriculum)
- Expand Anti-Stigma campaign with messaging geared directly towards opioid/substance use/alcohol use by youth, and continue current messaging for future years
- Implement peers in Denver schools and explore integration of substance use disorder-specific prevention into the model
- Strategies recommended by Denver and approved for use
- Increase capacity for resiliency and positive coping strategies by facilitating opportunities for adolescents (and/or all age groups) to communicate with peers about drug/alcohol use
- Ensuring continuum of care for youth
First Responders
As defined, a first responder consists of those who respond first when there is an emergency and/or crisis. This would include traditional first responders, such as law enforcement and/or fire personnel, but also extends to those who are responding to a mental health emergency or crisis de-escalation opportunity:
- Strategies recommended by Denver and approved for use
- Partner with community to establish MAT clinics utilizing ITMATTRS Frameworks for mobile MAT and inductions
- Educating first responders regarding appropriate practices and precautions when dealing with fentanyl or other drugs
- Utilize Peer Support Specialists to reinforce connection to more supportive long-term efforts, and ensure that individuals served and supported by those with lived experiences
- Expand current mobile treatment efforts
Community Leadership
A fundamental framework of this plan is system level interventions. DDPHE plans to partner with Statewide organizations, such as Health Care Policy and Financing, insurance payers like Medicaid and Medicare, Regional Accountable Entities (RAEs), etc. to ensure the process for credentialing and validating with payors is more accessible to smaller treatment providers.
- Strategies recommended by Denver and approved for use
- System level interventions at a variety of entities to ensure the process for credentialing and validating with payors is more accessible to smaller treatment providers
Staffing and Training
Due to the impacts of COVID-19, many individuals are feeling burned out and have resigned from health care, including mental health.
- Funding for programs and services regarding staff training and networking to improve staff capability to abate the opioid crisis
- Strategies recommended by Denver and approved for use
- Compensation and retention for front-line staff, specialists, etc.
- Increase the number and diversity of providers in the work force, especially providers of color who are representative of those communities’ needing services
- Intake form that can be used across organizations so that clients do not need to repeat the process
Research
- Funding opioid abatement research
- Research improved service delivery for modalities such as SBIRT that demonstrate promising but mixed results in populations vulnerable to OUD
- Support research for novel harm reduction and prevention efforts such as the provision of fentanyl test strips
Other
- Administrative costs for any of the approved purposes on this list