Between 1999 and 2020, nearly 841,000 people (about half the population of Idaho) died from drug overdoses, with 500,000 of these fatalities attributed to both prescription and illicit opioids. As clinics became inundated with patients seeking opioids for pain management and relief, the country grappled with an escalating crisis of addiction and mounting desperation.
In Minnesota, the opioid crisis continues to be a significant public health issue that requires coordinated efforts by various entities to make progress to reduce opioid-related harm. American Indian and Black Minnesotans experience the greatest burden of drug overdose in the state, reflecting a broader national trend where Indigenous communities face higher rates of substance use disorders (SUDs) and overdose deaths.
In recognition of this intensifying crisis, especially in rural Minnesotan communities, an innovative community-and-clinic based model called Tackling Overdose with Networks (TOWN) was developed by the Minnesota Department of Health (MDH) with an established local nonprofit organization and leader in healthcare quality and safety to help make lives better through collaborative and novel efforts.
The MDH has been providing grants to implement the TOWN program throughout the state. The program’s goal was to assist four to six primary care clinics in Minnesota for four years, targeting the communities hardest hit by the opioid crisis. The state recognized that this program needed to be deeply rooted in equity for it to be successful, and that the support needed to be designed to help clinicians and communities address opioid use disorder (OUD) as a chronic disease through harm reduction, stigma reduction, and culturally relevant whole-person care.
Overall, the success of the program hinged on the inclusion of education, providing open participation access for rural clinicians and their care teams, and being sensitive to the unique needs of rural communities and clinicians helping underserved and hard-to-reach patient populations.
How TOWN Works
The TOWN program provides clinic-level support to prepare healthcare teams to better address the drug use challenges in their communities. The goal of the model is to help lower the incidence of chronic opioid prescriptions, expand access to medication for opioid use disorder (MOUD), and bolster community care coordination and prevention efforts. The model focuses on strategies and tactics that support clinic- and community- level changes to support overdose prevention.
For example, in the TOWN model, a designated nurse coordinator works with clinicians and staff in the clinic and broader community to:
- Monitor chronic opioid use
- Increase access to MOUD among patients with SUD
- Increase care coordination and prevention efforts in the community
- Build and support staff and clinic capacity
Through educational resources, technical assistance to clinic staff, and ensuring timely access to clinical subject matter experts, healthcare teams can monitor chronic opioid use; increase access to MOUD; increase the number of medical professionals with credentials to provide MOUD; integrate MOUD in emergency departments; and more. The strategic engagement includes a range of activities, from team meetings and site visits to one-on-one technical assistance for both individuals and entire sites. Built by experts in conjunction with the care teams, communities, and people with OUD, the customized support ensures a successful approach to building and improving a TOWN model, by working collaboratively with program evaluators to objectively measure success.
American Indian and Alaska Native people commonly experience lower health status when compared with other Americans. They are at high risk of health care inequities due to historical and ongoing structural and social drivers of health such as disproportionately high poverty rates, impacts of cultural and individual trauma, and geographical and environmental challenges.
The Partnership to Advance Tribal Health (PATH), funded by the Centers for Medicare & Medicaid Services, is a strategic alliance of organizations that are committed to improve healthcare for American Indians. Three organizations collaboratively lead this work which is focused on supporting 24 Indian Health Services (IHS) managed hospitals across the country. The goal is to improve healthcare quality and address the unique healthcare issues of the populations IHS hospitals serve by implementing best practices and providing performance improvement training and coaching.
In Minnesota, the group is working with IHS to develop leaders; promote teamwork; provide training to foster a culture of improvement and patient safety; adopt and spread clinical best practices; and obtain and retain hospital accreditation and patient-centered medical home (PCMH) certification. Importantly, work is also underway with the IHS HOPE (Heroin Opioids and Pain Efforts) Committee to implement best practices to promote appropriate and effective pain management, reduce overdose deaths, and improve access to culturally appropriate treatment.
The burden of drug overdose among American Indian Minnesotans is a complex public health issue that requires targeted, culturally sensitive approaches. Addressing this crisis involves not only providing immediate support and treatment but also tackling the broader systemic issues that contribute to SUDs in these communities. Through strategic collaboration, progress can be made to tackle the opioid crisis and support recovery.
Continuing Efforts
National Opioid Awareness Day, observed on September 21 each year, aims to increase awareness about the impact of opioid overdose, reduce the stigma associated with drug-related deaths, and recognize the grief experienced by families and friends. However, for communities everywhere, more must be done to raise awareness about the opioid crisis at a local level, and to increase access to evidence-based and culturally relevant care for OUD, improve opioid prescription practices for pain management, and reduce disparities in care and outcomes.
Sue Severson
Sue Severson is the Vice President of Business Solutions and Health for Stratis Health, a nonprofit organization with a mission to collaborate and innovate to improve health. The organization began addressing the opioid crisis in 2014, with a focus on increasing access to evidence-based and culturally relevant care for opioid use disorder, improving the appropriate prescribing of opioids for pain management, and reducing disparities in care and outcomes. Sue is a national subject-matter expert on health improvement technology (HIT), an essential tool for improving health care quality. She is a Certified Professional in Health Information Technology (CPHIT) and Electronic Health Records (CPEHR), Healthcare Certification. Sue holds a Bachelor of Applied Sciences, Community Health and Wellness Education and has completed two years of post-graduate studies in Healthcare Administration at the University of Minnesota Carlson School of Management. She is currently completing her master’s program in organizational leadership.
Stratis Health, based in Bloomington, Minnesota, is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities. For more information, visit stratishealth.org.
