STRATEGIC PREVENTION FRAMEWORK FOR PRESCRIPTION DRUGS – SPF-RX GRANT (SAMHSA)
The SPF Rx grant program, awarded in September of 2016, is an opportunity to target the priority issue of prescription drug misuse. The Southern Plains Tribal Health Board Oklahoma Tribal Epidemiology Center and four of its Tribal Partners have prioritized and successfully implemented strategies to reduce the non-medical use of prescription drugs in Indian Country.
The program is designed to raise awareness about the dangers of sharing medications and work with pharmaceutical and medical communities on the risks of overprescribing to young adults. SPF Rx will also raise community awareness and bring prescription drug abuse prevention activities and education to schools, communities, parents, prescribers, and their patients. In addition, SAMHSA will track reductions in opioid overdoses and the incorporation of Prescription Drug Monitoring Program (PDMP) data into needs assessments and strategic plans as indicators of program success.
The program directly supports the goals of SAMHSA’s Strategic Initiative: Prevention of Substance Abuse and Mental Illness. Prescription opioid-related overdose deaths now outnumber overdose deaths involving all other illicit drugs, including heroin and cocaine. Due to the alarming trends related to prescription drug misuse and opioid overdoses, SAMHSA is prioritizing efforts to address prescription drug misuse.
Goals of the Project:
- Reduce Native prescription drug disparities,
- Increase Natives perception of the risk from prescription drug use,
- Obtain PMP data for planning,
- Implement CDC and SAMHSA best practices and
- implement a statewide Tribal prescription drug awareness campaign.
- Work with the PMP Data Improvement Workgroup in our first year to expand membership and develop a channel to communicate the needs of Native health organizations.
- Implement a Native specific evidence based statewide awareness campaign to increase Natives perceptions of the risks and consequences of prescription drug use.
Warner M, Chen LH, Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980– 2008. NCHS data brief, no 81. Hyattsville, MD: National Center for Health Statistics. 2011.
The Southern Plains Tribal Health Board continues to implement the Strategic Action Plan and the Prescription Drug Education Plan approved by the Substance Abuse and Mental Health Services Administration during the first year of the grant. By working with our three sub-awardees we have gained valuable insight about what can be done at the Tribal level to work with our youth and our elders both of whom are at risk for prescription drug misuse.
Because our grant focuses on Natives we have endeavored to provide culturally appropriate training and technical support while simultaneously adapting evidence based practices in our work. In this our third year, the grant sponsored a four day Gathering Of Native Americans (GONA) attended by over sixty Tribal members and all three sub-awardees. Each GONA empowers Natives by working through the following themes over a four day period:
GONA participants learn about how historical trauma impacts their daily lives, how Native people are interconnected, and how they can plan and conduct future actions with pride in their Native identify. Each GONA concludes with gift giving symbolizing each participant’s larger gift to their Tribal communities. One of our sub-awardee Tribal Partners, Seminole Nation of Oklahoma attended the GONA and later held a youth GONA attended by 35 Native youth.
Also in this third year we completed a Native Specific, Substance Abuse Prevention Skills Training (SAPST). The Native American SAPST is essential in translating SAMHSA’s evidence based practices to Indian Country. The SAPST is a four day intensive review of how substance abuse prevention works from assessment to evaluation, but more specifically how each of the five steps (assessment, capacity building, planning, implementation and evaluation) is related to the everyday life of Native people. The training is replete with Native examples; it is taught by Natives and each participant receives a well organized notebook as a reference for their future prevention work.
Our sub-awardees have each developed prevention programs suited to their needs and abilities. All practice education of youth and elders in safe storage and disposal of prescription drugs and all provide incentives (lock boxes, deterra bags) to assist Tribal members in preventing diversion of narcotic drugs. Most significantly, the SPTHB has developed public service announcements using Native actors that will be shown in doctors offices and clinics throughout the state via Good Health and Wellness TV.
Unfortunately our PMP, like many throughout the Nation, does not collect race data that could be used to create a profile of Native prescription drug use patterns although our grant requires we use Oklahoma Prescription Monitoring Program (PMP) data. We are pleased to report that in our third year we have achieved a major breakthrough in data sharing that will greatly improve our planning and assessment capacity for American Indians. Working with the Indian Health Service (IHS), the Oklahoma Bureau of Narcotics and Dangerous Drugs, and several Native and Non Native subject matter experts, we have obtained permission from the IHS to use de-identified aggregate Native collected from their clinics which will allow us to identify areas of high need and provide an accurate picture of a large sample of Natives who use the IHS.
Our grant has had significant impacts. Within the Southern Plains Tribal Health Board SPF Rx has provided leadership in bringing together several other more recent prescription drug grants to share goals and strategies. At the state level, the SPF Rx Project Director, Melanie Johnson has been an active participant and advocate for Native issues at the State and Tribal Epidemiological Outcomes Workgroup (STEOW) and encouraged Tribal STEOW members to create a committee devoted to Native issues which is actively pursuing issues such as sustainability, data utilization and Tribal best practices.
Statewide our use of grant funds to create and purchase public service announcements is attracting attention. By creating high quality, carefully edited, Native specific PSA’s our Native disparities are brought to light to the general population waiting in Doctor’s offices. Not only is the general population impacted but the need for prevention of Rx misuse is brought home to the doctors and other clinicians working in these medical settings. Already other Tribes have reached out to SPTHB about creating additional videos for Good Health And Wellness TV.
Perhaps one of our greatest impacts has been the ability of the SPF Rx grant to draw attention to the fact that although Native people suffer the greatest overdose mortality of any race, we lack the data (PMP data) to track the prescription use patterns of our Natives. Grant staff have worked tirelessly for over three years to draw attention to this program and finally to identify a useful workaround by achieving a data sharing agreement with the Indian Health Service. Our agreement with IHS maintains the confidentiality required by HIPAA yet it allows us to identify drug use “hot spots” and gives us the information needed to convince doctors and other prescribers with the need to review client records. We hope to share our methods with other Tribes throughout the nation who are currently lacking the data needed to implement effective opioid reduction programs.
In addition to the creation of our two major planning documents the SPF Rx Strategic Action Plan and the SPF Rx Education Plan we have developed and implemented programmatic tools such as data driven monthly reporting and performance-based contracts with our sub-awardees that bring accountability and improve results.
Through SPF Rx many Tribal members have been given the information and the physical means to keep their medications safe and prevent opioid from being diverted to drug users or used in suicide. This year we are beginning to distribute Narcan (the opioid overdose reversal drug) free to high risk Tribal members. Narcan is available without a prescription in Oklahoma but the cost at $80/dose sometimes prevents purchase These are significant real-world accomplishments.
The creation of video PSA’s with Native actors and with Native themes has brought prevention messaging to many Tribal members as well as the clinical community and will continue to do for a relatively small expenditure of grant funds.
Perhaps our most significant accomplishment has been the ability to forge partnerships both within and outside of Indian country. If other Tribes follow our example, they too can reach collaborative agreements with their local Indian Health Service agency as well as State PMP’s to obtain high quality planning data. Without a doubt, much remains to be done however, we are pleased with the progress of SPF Rx to date.
The Oklahoma Inter-Tribal Consortium Strategic Prevention Framework Partnership for Success (SPF-Rx) grant was awarded in 2016 from the Substance Abuse Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP).