PLYMOUTH —

PLYMOUTH — The Plymouth County Outreach Advisory Board members and Police Chiefs would like to provide the following message relating to the recently-released 2019 Plymouth County Outreach Annual Report.

Click here to view a video presentation of the 2019 Annual Report. 

“2019 has been a momentous and watershed year for Plymouth County Outreach (PCO). Since its inception a scant four years ago as an entity singularly dedicated to finding solutions to the biggest drug crisis of our generation, PCO has organically evolved from a volunteer-based coalition of individual interest groups and police departments across the region.

Eighteen months ago, PCO became a cohesive, grant-funded partnership that now includes three full-time employees and multiple part-time and per diem experts in the form of outreach workers and certified recovery coaches. PCO has been built and continues to evolve on a strong foundation of community stakeholders representing the recovery, public health, education, social service, healthcare, law enforcement, and faith-based communities. 

The level of cooperation and coordination amongst these allies is unprecedented, and exactly what is needed to successfully battle the long term and complex issues associated with opioids and other substance use disorders (SUDs). PCO is living proof of and executes daily on the concept that anthropologist Margaret Meade famously stated, which was “Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it’s the only thing that ever has.”

The important and measurably significant work that PCO has done has not gone unnoticed by other allies in this same war. PCO was publically cited by Governor Baker, Health and Human Services and the Department of Public Health in their 2018 annual overdose report, as they featured that Plymouth County “experienced a notable decrease in (overdose) deaths in 2018 as compared to 2017.”

Further, in 2019, PCO was selected by the federal Bureau of Justice Assistance to become a national mentor for their Law Enforcement/First Responder Diversion Mentor Program. That prestigious honor and the program has already started in 2020, as a group from Maryland has been selected to come and spend two days learning from PCO.

PCO is an outcome-driven organization. Data is the “fuel” that drives these positive outcomes. Using the strong database that it has worked on with its research partner, Kelley Research Associates, PCO leverages its Advisory Board and stakeholders to continually assess what works, what efforts can be further optimized, and where their finite resources can make the biggest impact within the complex rubric of substance use, mental health, and socioeconomic variables. The data will continue to evolve as the battle lines of this war dynamically shifts.

For example, a change in the usage and composition of substances of use in 2019 has sadly resulted in a 19% increase (from 121 in 2018 to 144 in 2019) in fatal events in PCO as compared to 2018, and that reality has required PCO to adapt its strategy. The data in PCO shows that in 2019, 70% of the people who fatally overdosed had no prior interactions with the PCO outreach teams since its inception in 2016. This data point identifies an at-risk population that the PCO model was not initially designed to address. 

PCO was originally built on a model of support after a first and non-fatal overdose occurred by connecting those suffering and their loved ones to the resources that lead to treatment, long term recovery, and happiness. Now, with this valuable information, PCO will work to adapt its data-driven strategy to not only serve those individuals in post overdose outreach situations but work tirelessly to bring more awareness and outreach within our communities before these high-risk incidents occur.  

Conversely, the PCO data does show that when PCO trained responders deliver Naloxone (Narcan) in the field, they are successful 94% (762 of 808) of the time, which is tremendous! We will discuss how parts of our model are changing to adapt to this new reality later.

What exactly has changed in the substance use battle over the past year? In 2019, Plymouth County began to experience locally what the national and state experts are now calling “The Fourth Wave of the Opioid Crisis”, where powerful opioids like fentanyl are being mixed with other substances of use. This is termed polysubstance use and requires different approaches than those used for opioids. Illustrative data from the Department of Public Health report (i.e. current for the calendar year 2019 through November) and which support this new reality includes:

• 93% of people who died of overdoses in Massachusetts are testing positive for fentanyl.
• Fentanyl is 50-100 times more potent than morphine and is made synthetically from chemicals, not the poppy plant.
• Fentanyl is increasingly mixed in other substances of use such as marijuana, cocaine, and benzodiazepines, and the user is often not aware of that fact.
• Cocaine was present in 42% of these fatal overdoses.
• Benzodiazepines (which include Ativan or Valium like drugs) are present in 33% of these fatal overdoses.
• There is an upward trend is the presence of methamphetamine, for which there is no effective medication-assisted treatment (MAT) like there is for opioids (such as Vivitrol, Methadone or Buprenorphine (Suboxone). MAT is now being referred to as Medication to treat Opioid Use Disorder (MOUD)).
• Combining opioids with other drugs increases the risk of overdose and decreases the effectiveness of Naloxone (Narcan).

Similar corroborating but lagging (2018 data is the most recent available) data is published by the federal Center for Disease Control (CDC), a summary of which is the following:

• In 2018, there were 67,367 drug overdose deaths in the United States, a 4.1% decline from 2017 (70,237 deaths).
• The age-adjusted rate of drug overdose deaths in 2018 (20.7 per 100,000) was 4.6% lower than in 2017 (21.7).
• For 14 states and the District of Columbia, the drug overdose death rate was lower in 2018 than in 2017.
• The rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) increased by 10%, from 9 in 2017 to 9.9 in 2018.
• From 2012 through 2018, the rate of drug overdose deaths involving cocaine more than tripled (from 1.4 to 4.5).
• The rate for deaths involving psychostimulants with abuse potential (drugs such as methamphetamine) increased nearly 5-fold (from 0.8 to 3.9).
• Polysubstance use amongst adolescents is rising rapidly, and that upward trend is highest in the non-Black and non-Hispanic demographics.
• One in five overdose deaths across the U.S. in 2017 involved cocaine. 

Narcan distribution and early identification of those suffering from SUDs across Plymouth County have been key strategies that PCO has deployed with some success, as noted by the reduced number of individuals who died of overdoses in 2018.

Our developing data tells us that we need to continue to revise and advance our strategy, keeping what has worked while designing and executing new strategies to meet the evolving threat of polysubstance use and intervening before the first usage to save lives. As General Sun Tzu wrote in the Art of War, “Therefore, just as water retains no constant shape, so in warfare, there are no constant conditions.”

PCO was designed to adapt quickly and excel in keeping our focus on the needs of those Plymouth County residents suffering from substance use disorders. PCO is already using as our strategic framework what the CDC’s advice (listed below) has suggested:  

“There is an urgent need to implement a multifaceted, collaborative public health and public safety approach. Building on existing resources, more rapidly available and comprehensive surveillance data are needed to track emerging drug threats to guide public action to prevent and respond to the epidemic through increased naloxone availability, harm reduction services, linkage into treatment (including medication-assisted treatment), safe prescribing practices, and supporting law enforcement strategies to reduce the illicit drug supply.” – Center of Disease Control, March 2018

2020 PCO Focus Action Items include:

1. Initiate a Public Service Announcement (PSA) featuring our Recovery Community team members. We need to continue to get involved early and often to connect to SUDs persons before it negatively impacts their lives while continuing to partner with all local substance use coalitions, like PCO HOPE.
2. Publically speak to continue changing the perception around SUDs at every opportunity, including community events such as Coffee with Cops.  
3. Continue to increase access to Naloxone through our outreach teams and publicly available Naloxone access stations.
4. Use the data to drive targeted interventions in the areas hardest impacted by overdose deaths in 2019 including Brockton, Plymouth, Middleboro, Hull, Abington and Wareham. Further detailed overlay analysis is ongoing and will further refine these strategies by age, demographics, and transportation availability and incident locations.
5. Expanding the reach of PCO by partnering with Plymouth County clinicians from across the healthcare continuum who have expertise in the often co-occurring needs of social work and SUDs. Again, PCO is working to identify problems and intervene early, but recognizes that the underlying issues are complex and SUDs are often a lagging and sometimes deadly indicator of unaddressed suffering.  
6. Through our PCO COAP (Comprehensive Opioid site-based Abuse Program) grant team, partner closely with Brockton’s new federally-funded COAP grant team to identify individuals who are at elevated risk, sharing vital information, experience and resources with our Brockton partners.
7. The 2020, launch of the new PCO Hub Model, which aims to increase access to mental health services and mitigate the social determinant needs for those at elevated behavioral health risks. This innovative collaborative is based on and adapted from successful well studied models in Canada and is driven by PCO and PARRI with grant funding from the South Shore Health Community Benefits pool. 

In summary, Plymouth County Outreach remains fully committed to the collaborative work of saving lives impacted by Substance Use Disorders across the spectrum of behavioral health issues. We look forward to working with all of you in the complex and meaningful work ahead, as our motto clearly states: “PCO, a Community Solution to a Community Challenge”.”

More information on PCO can be found at www.plymouthcountyoutreach.org.

About Plymouth County Outreach: Plymouth County Outreach is a collaborative of police departments throughout Plymouth County led by the following chiefs: Abington Chief David Majenski, Bridgewater Chief Christopher Delmonte, Bridgewater State University Chief David Tillinghast, Brockton Chief Emanuel Gomes, Sgt. William Schlieman of the Brockton Police Department, Carver Chief Marc Duphily, Duxbury Chief Stephen R. McDonald, East Bridgewater Chief Paul O’Brien, Halifax Chief Joao Chaves, Hanover Chief Walter Sweeney, Hanson Chief Michael Miksch, Hingham Chief Glenn Olsson, Hull Chief John Dunn, Kingston Chief Maurice Splaine, Lakeville Chief Matthew J. Perkins, Marion Chief John Garcia, Marshfield Chief Phillip Tavares, Mattapoisett Chief Mary Lyons, Middleboro Chief Joseph Perkins, Norwell Chief Ted Ross, Pembroke Chief Richard Wall, Plymouth Chief Michael Botieri, Plympton Chief Matthew Clancy, Rochester Chief Robert Small, Rockland Chief John Llewellyn, Scituate Chief Michael Stewart, Wareham Chief John Walcek, West Bridgewater Chief Victor Flaherty and Whitman Chief Timothy Hanlon.

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