Washtenaw County's Opioid Response | Brandeis Opioid Resource Connector

Naloxone training and referral to treatment by law enforcement, community education and collaboration, and a post-overdose response team to respond to the opioid crisis in a Michigan county

In response to an increase in overdose deaths, Washtenaw County, which contains the city of Ann Arbor, Michigan, launched a comprehensive response. To address the opioid crisis, the county has led several initiatives:

Training of law enforcement to administer naloxone and refer individuals who have experienced a nonfatal overdose to treatment and other services
Recovery Opioid Overdose Team (ROOT), which is a post-overdose response team that uses a peer navigator to engage individuals in the early recovery process
Washtenaw Health Initiative (WHI) Opioid Project, which is a broad-based community coalition that uses work groups to address the opioid crisis
Holding an annual opioid summit in the county
Providing frequent reports on the status of the opioid crisis and progress made in the county
A community initiative, It is POSSIBLE Opioid Education Campaign, to increase education and reduce stigma among the general public
A leave-behind naloxone program where EMS can distribute naloxone to high-risk individuals

More information on the county-wide response can be found in the presentation here and the news article here.

Nearly 20% of those who experienced a nonfatal overdose and were referred to treatment through the law enforcement initiative sought treatment services.

Continuum of Care

Treatment

Recovery

Harm Reduction

Type of Evidence

Peer-reviewed

Response Approach

Educational

Overdose prevention

Post-overdose response

Recovery coaching

Peer-reviewed Article

Beyond Rescue: Implementation and Evaluation of Revised Naloxone Training for Law Enforcement Officers

Recovery opioid overdose team (ROOT) pilot program evaluation: A community-wide post-overdose response strategy

Assessing Community Needs to Combat the Opioid Epidemic in Washtenaw County, Michigan

Using RE-AIM Framework to Evaluate Recovery Opioid Overdose Team Plus: A Peer-Led Post-overdose Quick Response Team

Implementation of an EMS-based naloxone distribution program: A qualitative evaluation

Evidence of Program Effectiveness

In regard to the initiative to train law enforcement on naloxone and referral to treatment:

"Pre- and post- test scores for all knowledge outcome measures were statistically significant (p <.001) with favorable comments pertaining to the recovery testimony. Out of 31 individuals who received naloxone, 6 individuals (19.4%) continue to be in treatment or received some treatment services." (Dahlem et al., 2017)

"The ROOT program is composed of a peer recovery coach who is in long-term recovery, and a case management navigator who specializes in mental health care and provides guidance for accessing community services. After an overdose reversal, law enforcement contacts a county 24/7 Crisis Team, who then notifies ROOT. The peer recovery coach engages with the survivor in the ED, and then follow up continues with the case management navigator and the peer recovery coach for up to 90 days post-ED discharge...Of the 122 referrals, 77.0% (n = 94) of the survivors initially engaged with ROOT in the ED or in the community...From the 122 referrals, 33.6% (n = 41) received ongoing treatment services (n = 20 outpatient, n = 17 residential, n = 2 detoxification facility, n = 1 recovery housing, n = 1 medication treatment for opioid use disorder), 2.5% (n = 3) were incarcerated, 2.5% (n = 3) died, and 61.5% (n = 75) declined services...he ROOT, a community-wide coordinated program in the EDs, shows promise in linking overdose survivors to recovery support and treatment services post-overdose." (Dahlem et al., 2020)

"Reach: Over 27 months, ROOT + responded to 83% of suspected overdose referrals (n = 607) and engaged with 41% of survivors (n = 217) and 7% of survivors' family/friends (n = 38). Effectiveness: Among those initially engaged with ROOT +, 36% of survivors remained engaged, entered treatment, or were in recovery at 90 days post-overdose (n = 77). Adoption: First responders completed 77% of ROOT + referrals (n = 468). Implementation: Barriers included lack of awareness of ROOT + , working phones, and access to treatment from community partner interviews (n = 15). Maintenance: Adaptations to ROOT + were made to facilitate implementation. Peer-led teams are promising models to engage with overdose survivors." (Dahlem et al., 2024)