Southern Ohio has been the epicenter of the opioid crisis, with record-breaking rates of overdoses and deaths.
In addition to becoming a family physician for Adena Health, John Gabis, MD, FAAFP, CPE, also served as the coroner for Ross County, Ohio in 2009. After noticing a rise in prescription opiate overdose deaths in 2009 and 2010, he alerted appropriate agencies that he thought could help; however, they were not proactive.
As Adena Health's medical director of community partnerships, Gabis took it upon himself to develop a drug abuse coalition that included law enforcement, judicial service providers, child and family services, and other medical groups. For more than a decade, the group has had different iterations, but is now referred to as the Hope Partnership Project (HPP).
The first iteration of the group began in 2015 with the assistance of a grant from the Ohio Criminal Justice System. The funding from the grant paid for a coordinator to come in and assist with putting their plans into action.
In 2019, the group, now known as HPP, applied for and received a $1 million dollar grant from the Health Resources and Services Administration (HRSA) through its Rural Communities Opioid Response Program (RCORP), to be dispersed over three years.
"That provided us the latitude to build our infrastructure of our community partners who provide services for people [struggling with] substance abuse disorder," Gabis said. Adena Health, he added, is a "convenor, collaborator, and catalyst in our community specifically in substance abuse disorder."
The efforts of Adena Health and HPP were recognized by the American Medical Association as one of three finalists for the Foster G. McGaw award; a feat Gabis believes says a lot about the importance of what their community is doing.
"We were part of the epicenter of the drug epidemic that took over the nation. We had a high rate, and unfortunately, still do, of overdoses and overdose deaths per capita compared to other counties and other regions in Ohio and in the country," he said. "We know that no one agency can attack this and be successful, and we know that we don't have enough services available that will provide all our community's needs. So, the only way to solve this problem, or begin to attack it, is to work with community partners."
Previous community health needs assessments have shown that there's a high rate of poverty and substance abuse, with mental health and substance use disorders considered high priority issues for their region. With the onset of the pandemic, Gabis said these numbers continued to rise, with the region setting records every year for overdose deaths.
"[Isolation] is not good for someone that has substance use disorder and often a cooccurring mental health diagnosis," He explained. "Whenever they're isolated, they tend to medicate their emotions with other substances."
One of HPP's biggest successes has been the implementation of the post-overdose response team. A team consisting of a law enforcement officer, peer recovery supporter, and social worker go to the address of an individual who had an overdose within the last seven days. In addition to providing information on treatment options, the team also distributes a dose of Narcan – a nasal spray used to treat a narcotic overdose.
"Most often, the person who overdosed is not at that address, but that's a chance to talk with families and loved ones about what they can do to help that person," Gabis said.
In the beginning, HPP has struggled with tackling the negative stigmas around substance use disorder and the use of Narcan, which some think enables individuals to continue abusing drugs. Gabis explains that the Narcan is meant to guide the individual to the path of active recovery. Today, the community is more receptive to these efforts.
The peer recovery supporters are individuals who previously struggled with opioid use disorder and have been in active recovery for a substantial amount of time.
"They take their knowledge of how they got addicted, how they found recovery, and how they maintain recovery, and they're able to speak to people in similar situations and ways that carry so much more impact that me talking to them, who doesn't have that experience to draw from," Gabis said.
Other successes include increasing the number of primary care providers who can provide medication assisted treatment at the health system from 8 to 30, and the streamlining of the system's emergency department referral process to get patients suspected to have opioid use disorder into treatment with three days.
For other communities or medical systems wanting to take on substance use, Gabis offers the following suggestions.
- Organize a get-together with your community to assess what resources the community already has
- Implement harm reduction policies, including community distribution of Narcan
- Work with and influence other providers to come into your community to provide further assistance
"Since we were part of the epicenter of this crisis, it would be awesome if we had a world class treatment center that served the region," Gabis said. "My dream is that the health systems of central and southern Ohio band together and work to bring something like that to our region so that our communities have hope."
“We know that no one agency can attack this and be successful, and we know that we don't have enough services available that will provide all our community's needs. So, the only way to solve this problem, or begin to attack it, is to work with community partners.”
John Gabis, MD, FAAFP, CPE, medical director of community partnerships, Adena Health
The health system's partnership with the community, the Hope Partnership Project, has helped them combat substance abuse disorders like opioid addiction in their community.
Appalachian Ohio was the epicenter of the nation's opioid crisis.
Taking steps to disprove negative stigmas associated with substance abuse disorders has made the community more receptive of the Hope Partnership Project's efforts.