Overdose Review Commission releases annual report

Recommendations include expanded residential treatment, public education, and naloxone access

The Delaware Drug Overdose Fatality Review Commission (DOFRC) has released its first annual report to Governor John Carney and the General Assembly with recommendations aimed at reducing overdose deaths in Delaware based on review of the circumstances of deaths over the past year.

The 23-page report details nine evidence-based recommendations based on the review of 56 overdose fatalities that occurred between July and December 2018.

“Delaware grapples with addiction every day in hospitals, in courtrooms, and at home,” said Attorney General Kathy Jennings. “We see the cost of addiction on a daily basis in the Department of Justice, not only because of the epidemic’s impact on the criminal justice system but because it is a public health crisis that, on average, claims another life each day. As prosecutors, and as neighbors of the families and individuals devastated by this disease, we are committed to fighting the epidemic and to helping its victims find help.”

Key findings from the report on overdose deaths include:

  • 93% of incidents occurred where naloxone was not available
  • 50% of the cases reviewed had a history of a prior non-fatal overdose
  • 30% had previously been detained with the Department of Correction; of those whose release dates could be confirmed, 50% suffered a fatal overdose within 3 months of release and 75% suffered a fatal overdose within 1 year of release.
  • 52% had been seen at an emergency department in the three months prior to their overdose
  • 25% of cases reviewed had a documented history of mental health crisis intervention

“Addiction affects many families in Delaware, and as a result, many people – from public health officials, health care providers and advocates to law enforcement and prosecutors – work each day to help reduce the devastation that this epidemic causes across the state,” said Dr. Rebecca Walker, who chairs DOFRC. “The Overdose Fatality Review Commission’s work gives us an opportunity to support the fight against the opioid epidemic with evidence-based, data-driven recommendations. The findings of our investigations represent real opportunities for Delaware to educate the public and to prevent further tragedies through early intervention and a stronger continuum of treatment and care. I’m grateful to my colleagues for their contributions to this report, and I look forward to continuing the Commission’s critical role moving forward.”

“The report emphasizes the tragedy of addiction and the devastation on families,” said Lt. Governor Bethany Hall-Long, who as a state senator working with then-AG Matt Denn sponsored legislation to create DOFRC. “The loss of nearly a Delawarean per day is unacceptable. The Behavioral Health Consortium continues to work with all state agencies and the community. We need boots on the ground to expand access and treatment to curb the mortality of fatal overdoses. Working together, we can save lives.”

Among other harm-reduction strategies, many of the report’s recommendations center on expanding the availability of the overdose-reversing medication naloxone. Based on its findings, the Commission recommends making naloxone available to at-risk individuals through a variety of channels, including primary care settings, emergency departments, first responders, medically-assisted treatment programs, and Department of Correction facilities. Studies of similar initiatives in other jurisdictions have shown substantial reductions in overdose fatalities and opioid-related emergency room visits.

Other key recommendations include:

  • Free replacement of naloxone for those who follow up with the Division of Public Health
  • Expansion of long-term residential treatment – particularly dual-diagnosis facilities that are also prepared to support other mental health needs – and sober living facilities
  • Public service announcements targeted to opioid users, their families, and friends, including campaigns aimed at harm reduction
  • Expanded availability of Naltrexone, a non-addictive drug that blocks opioid receptors and is reported to reduce opioid cravings, for DOC inmates
  • Training on addiction services and treatment for medical staff, as well as promotion of peer engagement services
  • Support for emergency department programs that encourage individuals to enter treatment, offer counseling and support services, and/or provide medication assistance. Research from other jurisdictions has shown a 50% reduction in fatalities for those engaged with a medical provider and placed on Methadone and Suboxone
  • Expansion of Law Enforcement Assisted Diversion (LEAD) programs, such as Hero Help, in which individuals who commit low-level offenses due to unmet behavioral health are diverted away from prosecution and instead referred by law enforcement to trauma-informed intensive case management programs. LEAD participants in a Seattle study were 58% less likely to be arrested after enrollment in the program, compared to a control group that did not go through diversion

The full report is available here.

The DOFRC was established to examine the facts and circumstances of deaths resulting from prescription opioid, fentanyl, and heroin overdoses and make evidence-based recommendations on to how to prevent future overdose deaths. The Commission is staffed by the Department of Justice.