Reducing Overdoses and Increasing Access to Treatment in Rural Underserved Communities: Lessons from Connecticut and New York

The CT River Valley Comprehensive Overdose Engagement (COE) targets a rural area that was identified as a service desert for persons with a substance use disorder (SUD). The COE project introduces the first substance use prevention, harm reduction, and access-to-treatment services for adults and their families in this area, through partnerships with Connecticut State Police, Office of Probation Services, Connecticut Harm Reduction Alliance, and a network of Drug Free Communities local prevention councils. This project provides: 1) post-overdose outreach, connection to services, and follow-up to overdose survivors and their families through home visits by an outreach coordinator/state trooper team, including trauma informed services for traumatized children under the Handle with Care model and grief support for families after fatal overdoses; 2) mobile harm reduction services; and 3) community support and organizational infrastructure to enhance substance use disorder support resources in the area. To create community equity and sustainability, the COE established an Overdose Response Taskforce using the Public Health and Public Safety Team (PHAST) toolkit framework.

In 2019, Ellenville Regional Hospital (ERH), a Critical Access Hospital in rural Ulster County, New York, launched Project RESCUE ― a multi-tiered project wherein patients presenting to the emergency department post-overdose or in active withdrawal were offered buprenorphine with a warm handoff to a Certified Recovery Peer Advocate. After seeing great success, ERH looked to reduce the number of overdoses in the community by creating a better coordinated system of care. Partnering with the Ulster County Sheriff’s Office and their Opioid Response as County Law Enforcement (ORACLE) team, a newly developed High-Risk Mitigation Team helps individuals at high risk of overdose or relapse through treatment and recovery, offering temporary housing, assistance with transportation, and expert guidance on navigating the treatment landscape. The next step is to utilize a shared system of data tracking to recognize life-events that indicate an increased risk for overdose. ERH has partnered with New York’s leading health information exchange, HIXNY, to produce an algorithm using data from health care, law enforcement, and social services to predict if an individual has an increased risk of overdosing.