Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a “hub with many spokes” model

Hannah K. Knudsen; Patricia R. Freeman; Douglas R. Oyler; Carrie B. Oser; Sharon L. Walsh

doi:10.1186/s13722-023-00426-6

Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a “hub with many spokes” model

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Background: Scaling up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, in communities remains a challenge. Novel models and intentional implementation strategies are needed. Drawing upon the EPIS model’s phases of Exploration, Preparation, Implementation, and Sustainment (Aarons et al. in Adm Policy Ment Health 38:4–23, 2011), this paper describes the development of the University of Kentucky’s unique centralized “Naloxone Hub with Many Spokes” approach to implementing OEND as part of the HEALing Communities Study (HCS-KY). Methods: To scale up OEND in eight Kentucky counties, implementation strategies were utilized at two levels: a centralized university-based naloxone dispensing unit (“Naloxone Hub”) and adopting organizations (“Many Spokes”). Implementation strategies varied across the EPIS phases, but heavily emphasized implementation facilitation. The Naloxone Hub provided technical assistance, overdose education resources, and no-cost naloxone to partner organizations. Implementation outcomes across the EPIS phases were measured using data from internal study management trackers and naloxone distribution data submitted by partner organizations. Results: Of 209 organizations identified as potential partners, 84.7% (n = 177) engaged in the Exploration/Preparation phase by participating in an initial meeting with an Implementation Facilitator about the HCS-KY OEND program. Adoption of the HCS-KY OEND program, defined as receipt of at least one shipment of naloxone, was achieved with 69.4% (n = 145) of all organizations contacted. During the Implementation phase, partner organizations distributed 40,822 units of naloxone, with partner organizations distributing a mean of 281.5 units of naloxone (SD = 806.2). The mean number of units distributed per county was 5102.8 (SD = 3653.3; range = 1057 − 11,053) and the mean county level distribution rate was 8396.5 units per 100,000 residents (SD = 8103.1; range = 1709.5–25,296.3). Of the partner organizations that adopted the HCS-KY OEND program, 87.6% (n = 127) attended a sustainability meeting with an Implementation Facilitator and agreed to transition to the state-funded naloxone program. Conclusions: These data demonstrate the feasibility of this “Hub with Many Spokes” model for scaling up OEND in communities highly affected by the opioid epidemic. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .

Original language	English
Article number	72
Journal	Addiction Science and Clinical Practice
Volume	18
Issue number	1
DOIs	https://doi.org/10.1186/s13722-023-00426-6
State	Published - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s).

Funding

We wish to acknowledge the participation of the HEALing Communities Study communities, community coalitions, and organizations who partnered with us on this study. In addition, we wish to express gratitude to the staff of the Naloxone Hub, which included Josie Watson (Naloxone Coordinator), Brent Watts (Naloxone Assistant), and the team of Implementation Facilitators who worked with Wave 1 OEND partner agencies: Kathy Adams, Shaquita Andrews-Higgins, Sandi Back-Haddix, Michael Goetz, Jeanie Hartman, Rachel Hoover, Latasha Jones, Ryan Morris, and Melissa Reedy-Johnson, as well as Courtney Rogers, who provided administrative support to the team. We also acknowledge the contribution of Dr. Michelle Lofwall, the HCS-KY addiction psychiatrist, who signed the OEND standing order agreements with the partner organizations. This research was supported by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration through the NIH HEAL (Helping to End Addiction Long-term) Initiative under award number UM1DA049406. (ClinicalTrials.gov Identifier: NCT04111939). This study protocol (Pro00038088) was approved by Advarra Inc., the HEALing Communities Study single Institutional Review Board. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Substance Abuse and Mental Health Services Administration or the NIH HEAL Initiative. SM SM

Funders	Funder number
Melissa Reedy-Johnson
National Institutes of Health (NIH)	NCT04111939, UM1DA049406
Substance Abuse and Mental Health Services Administration

Keywords

Implementation strategies
Naloxone
Opioid epidemic
Opioid overdose
Overdose education and naloxone distribution

ASJC Scopus subject areas

Clinical Psychology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s13722-023-00426-6

Cite this

@article{7931b87d732941e98ff0493e6476e313,

title = "Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a “hub with many spokes” model",

abstract = "Background: Scaling up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, in communities remains a challenge. Novel models and intentional implementation strategies are needed. Drawing upon the EPIS model{\textquoteright}s phases of Exploration, Preparation, Implementation, and Sustainment (Aarons et al. in Adm Policy Ment Health 38:4–23, 2011), this paper describes the development of the University of Kentucky{\textquoteright}s unique centralized “Naloxone Hub with Many Spokes” approach to implementing OEND as part of the HEALing Communities Study (HCS-KY). Methods: To scale up OEND in eight Kentucky counties, implementation strategies were utilized at two levels: a centralized university-based naloxone dispensing unit (“Naloxone Hub”) and adopting organizations (“Many Spokes”). Implementation strategies varied across the EPIS phases, but heavily emphasized implementation facilitation. The Naloxone Hub provided technical assistance, overdose education resources, and no-cost naloxone to partner organizations. Implementation outcomes across the EPIS phases were measured using data from internal study management trackers and naloxone distribution data submitted by partner organizations. Results: Of 209 organizations identified as potential partners, 84.7\% (n = 177) engaged in the Exploration/Preparation phase by participating in an initial meeting with an Implementation Facilitator about the HCS-KY OEND program. Adoption of the HCS-KY OEND program, defined as receipt of at least one shipment of naloxone, was achieved with 69.4\% (n = 145) of all organizations contacted. During the Implementation phase, partner organizations distributed 40,822 units of naloxone, with partner organizations distributing a mean of 281.5 units of naloxone (SD = 806.2). The mean number of units distributed per county was 5102.8 (SD = 3653.3; range = 1057 − 11,053) and the mean county level distribution rate was 8396.5 units per 100,000 residents (SD = 8103.1; range = 1709.5–25,296.3). Of the partner organizations that adopted the HCS-KY OEND program, 87.6\% (n = 127) attended a sustainability meeting with an Implementation Facilitator and agreed to transition to the state-funded naloxone program. Conclusions: These data demonstrate the feasibility of this “Hub with Many Spokes” model for scaling up OEND in communities highly affected by the opioid epidemic. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .",

keywords = "Implementation strategies, Naloxone, Opioid epidemic, Opioid overdose, Overdose education and naloxone distribution",

author = "Knudsen, \{Hannah K.\} and Freeman, \{Patricia R.\} and Oyler, \{Douglas R.\} and Oser, \{Carrie B.\} and Walsh, \{Sharon L.\}",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = dec,

doi = "10.1186/s13722-023-00426-6",

language = "English",

volume = "18",

number = "1",

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T1 - Scaling up overdose education and naloxone distribution in Kentucky

T2 - adoption and reach achieved through a “hub with many spokes” model

AU - Knudsen, Hannah K.

AU - Freeman, Patricia R.

AU - Oyler, Douglas R.

AU - Oser, Carrie B.

AU - Walsh, Sharon L.

PY - 2023/12

Y1 - 2023/12

N2 - Background: Scaling up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, in communities remains a challenge. Novel models and intentional implementation strategies are needed. Drawing upon the EPIS model’s phases of Exploration, Preparation, Implementation, and Sustainment (Aarons et al. in Adm Policy Ment Health 38:4–23, 2011), this paper describes the development of the University of Kentucky’s unique centralized “Naloxone Hub with Many Spokes” approach to implementing OEND as part of the HEALing Communities Study (HCS-KY). Methods: To scale up OEND in eight Kentucky counties, implementation strategies were utilized at two levels: a centralized university-based naloxone dispensing unit (“Naloxone Hub”) and adopting organizations (“Many Spokes”). Implementation strategies varied across the EPIS phases, but heavily emphasized implementation facilitation. The Naloxone Hub provided technical assistance, overdose education resources, and no-cost naloxone to partner organizations. Implementation outcomes across the EPIS phases were measured using data from internal study management trackers and naloxone distribution data submitted by partner organizations. Results: Of 209 organizations identified as potential partners, 84.7% (n = 177) engaged in the Exploration/Preparation phase by participating in an initial meeting with an Implementation Facilitator about the HCS-KY OEND program. Adoption of the HCS-KY OEND program, defined as receipt of at least one shipment of naloxone, was achieved with 69.4% (n = 145) of all organizations contacted. During the Implementation phase, partner organizations distributed 40,822 units of naloxone, with partner organizations distributing a mean of 281.5 units of naloxone (SD = 806.2). The mean number of units distributed per county was 5102.8 (SD = 3653.3; range = 1057 − 11,053) and the mean county level distribution rate was 8396.5 units per 100,000 residents (SD = 8103.1; range = 1709.5–25,296.3). Of the partner organizations that adopted the HCS-KY OEND program, 87.6% (n = 127) attended a sustainability meeting with an Implementation Facilitator and agreed to transition to the state-funded naloxone program. Conclusions: These data demonstrate the feasibility of this “Hub with Many Spokes” model for scaling up OEND in communities highly affected by the opioid epidemic. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .

AB - Background: Scaling up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, in communities remains a challenge. Novel models and intentional implementation strategies are needed. Drawing upon the EPIS model’s phases of Exploration, Preparation, Implementation, and Sustainment (Aarons et al. in Adm Policy Ment Health 38:4–23, 2011), this paper describes the development of the University of Kentucky’s unique centralized “Naloxone Hub with Many Spokes” approach to implementing OEND as part of the HEALing Communities Study (HCS-KY). Methods: To scale up OEND in eight Kentucky counties, implementation strategies were utilized at two levels: a centralized university-based naloxone dispensing unit (“Naloxone Hub”) and adopting organizations (“Many Spokes”). Implementation strategies varied across the EPIS phases, but heavily emphasized implementation facilitation. The Naloxone Hub provided technical assistance, overdose education resources, and no-cost naloxone to partner organizations. Implementation outcomes across the EPIS phases were measured using data from internal study management trackers and naloxone distribution data submitted by partner organizations. Results: Of 209 organizations identified as potential partners, 84.7% (n = 177) engaged in the Exploration/Preparation phase by participating in an initial meeting with an Implementation Facilitator about the HCS-KY OEND program. Adoption of the HCS-KY OEND program, defined as receipt of at least one shipment of naloxone, was achieved with 69.4% (n = 145) of all organizations contacted. During the Implementation phase, partner organizations distributed 40,822 units of naloxone, with partner organizations distributing a mean of 281.5 units of naloxone (SD = 806.2). The mean number of units distributed per county was 5102.8 (SD = 3653.3; range = 1057 − 11,053) and the mean county level distribution rate was 8396.5 units per 100,000 residents (SD = 8103.1; range = 1709.5–25,296.3). Of the partner organizations that adopted the HCS-KY OEND program, 87.6% (n = 127) attended a sustainability meeting with an Implementation Facilitator and agreed to transition to the state-funded naloxone program. Conclusions: These data demonstrate the feasibility of this “Hub with Many Spokes” model for scaling up OEND in communities highly affected by the opioid epidemic. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .

KW - Implementation strategies

KW - Naloxone

KW - Opioid epidemic

KW - Opioid overdose

KW - Overdose education and naloxone distribution

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Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a “hub with many spokes” model

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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