A network of health centers in New York state is using safety planning – which has most often been associated with reducing risk of suicide – in an attempt to reduce opioid overdoses.
The Institute for Family Health, which has community health centers throughout New York City and in the Mid-Hudson region, has designed and begun to use two-page, personalized Harm Reduction and Early Recovery Safety Plans, which take into account the different ways in which a person might be at risk of an opioid overdose.
“One group of people at risk of an opioid overdose are those who are actively using opioids, who may not be ready to stop,” says Thomas McCarry, LMHC, Director of Substance Abuse Prevention at The Institute. “These people need a harm reduction approach, which acknowledges that not everyone wants to be free of substances, and even those who do may have a difficult time getting there. We tell them there are things they can do to take care of themselves and reduce possible health and other risks associated with using illicit drugs.”
A second group of people have stopped using drugs. Some are intentionally working on recovery after treatment, while others may have stopped because they were incarcerated or are pregnant. They are still at increased risk of an overdose if they use opioids again, because they now have a lower tolerance than they did while they were still actively using drugs, McCarry says. These people need an early recovery safety plan focused on maintaining sobriety.
McCarry spoke about his organization’s experience with implementing the new safety plans at the recent American Public Health Association annual meeting. The new safety plans are being used in all 26 health centers associated with The Institute, which are federally qualified health centers that are focused on serving underinsured patients. Once completed, the plans are stored in patients’ electronic health records. They are available in English and Spanish.
“It is a tool for providers who may be less comfortable talking with patients about the risk of an overdose,” McCarry says. “This is designed so that providers, regardless of their experience, can feel confident about having this conversation.”
The harm reduction safety plan begins, “Though, we as your care team remain committed in the belief that everyone can recover, we also understand that not everyone chooses abstinence; even those who have sobriety as a goal often struggle to get there. And for some people, the current medications they are prescribed put them at increased risk of overdose.”
The plan lists overdose prevention tips, including:
- Use less after any period of abstinence!
- Do not mix drugs, prescriptions, and/or alcohol.
- Use a less risky method (i.e. snort instead of smoke or inject)
- Test the strength of the drug before you do the whole amount.
- Do not use alone.
- Do not share or reuse needles.
- Develop an overdose plan with your friends or partner.
- Do not use when having thoughts of suicide.
- Keep a Naloxone “Narcan” Kit with you and learn how to use it.
- Seek medical attention after an overdose, even if you were given Narcan.
The plan leaves spaces for the patient to add ways they plan to reduce the risks associated with their drug use. At the end, it includes information about naloxone, and lists resources for getting help. It concludes, “Should abstinence or sobriety become your goal, please reach out for help and anyone on your care team can help you wherever you are on your path.”
The personal recovery safety plan provides space for the patient to list their top reasons why they choose to be sober, and things they do regularly to stay sober. They also list actions they can take if and when they have cravings (such as call a support person, eating if hungry, going to a meeting, reading recovery material, reminding themselves that cravings can be intense but pass, or thinking of the consequences of using). They list places they can go that provide positive distraction (like 12-step meetings, a coffee shop, the library, or specific family or friends), their triggers or early warning signs (such as cravings, changes in attitude toward recovery, or behaviors), and space to list a few people they can call who support their recovery.
As with the harm reduction plan, it lists overdose prevention tips, recovery resources and information about naloxone. It concludes, “If you do have a slip, don’t give up! Many people have had slips, so reach out for help and get back up. Good luck as your recovery journey continues!”
McCarry said he hopes the next step will be to research the effectiveness of these safety plans in reducing overdoses and deaths. “The two plans together show recovery is a circle, and not a straight line. Addiction is a chronic illness and relapse is something many people experience. We hope these tools will provide an integrated approach that addresses an individual’s needs across all of their medical services, similar to those we use with other complex medical issues.”