LCOTF

The United States is in the midst of a growing overdose crisis. More than 100,000 Americans died of drug overdoses during the first year of the COVID-19 pandemic, an almost 30% increase from the year prior.1 Between 2019 and 2020, all Connecticut counties saw an increase in overdose mortality rates, except for Litchfield County, which dropped from 41.8 fatal overdoses per 100,000 people to 39.7.

In response to increased rates of opioid-related overdoses in Litchfield County, The Litchfield County Opiate Task Force (LCOTF) was formed in 2013. The LCOTF is an inter-community team that brings together representatives from public health services, local government, law enforcement, individuals with lived experience, and their loved ones. Having previously had the highest mortality rates in the state, The LCOTF believes the decrease in Litchfield County is notable, and a testament to the county’s existing substance use support systems. Together with The LCOTF, we aimed to assess community needs around current harm reduction services in Litchfield County with a focus on the voices and recommendations of people who use drugs (PWUD).

1. Evaluate how current harm reduction services can better meet the needs of PWUD
2. Explore local stakeholders’ understandings of and attitudes toward harm reduction services
3. Identify existing strengths, barriers to accessing services, and directions for future servicesMETHODS

Surveys

• 75 anonymous, electronic surveys were completed by LCOTF-affiliated community members
  o Likert-scale-based and open-ended questions explored individuals’ experiences with drug use in the community, attitudes toward harm reduction, and recommendations for the future
• Quantitative data was analyzed using descriptive statistics provided by Yale Qualtrics and comparative analysis across three geographic categories1 conducted in Excel.

Interviews

• 7 semi-structured interviews were conducted with PWUD at mobile harm reduction locations (The Rover) in Torrington, Winsted, and Waterbury
  • Interviews explored individuals’ experiences accessing harm reduction services, unmet needs, and recommendations for future services
• 5 semi-structured interviews were conducted with community members affiliated with the LCOTF
  • Interviews explored individuals’ understandings of and attitudes toward harm reduction services
• Qualitative data was analyzed in-line with rapid analysis techniques, utilizing RAP sheets and matrix analyses. Emerging codes and themes were discussed at team meetings as analysis occurred.

Survey

• LCOTF-affiliates were highly aware of existing services and reported high support for a range of additional harm reduction services
  • Awareness varied slightly by geography with all respondents reporting being somewhat aware of The LCOTF and all participants from Torrington reporting ‘Yes’ they were aware of the Task Force
• Awareness of harm reduction services in their area also varied by geography
  • 25% of respondents in Litchfield County outside of Torrington reported not being aware of harm reduction services in their area
  • 100% of respondents in Torrington and Non-Litchfield County respondents were at least somewhat aware of local harm reduction services
• 84% of respondents identified local barriers to the implementation of harm reduction services

Interviews

• PWUD identified many existing strengths in Litchfield County: The Rover’s convenience and low-threshold entry, The Rover’s trustworthy and non-judgmental environment, and existing support systems among PWUD. Shared at right (or below) are some highlights reflecting these themes.

Cross-cutting results from survey and interviews

• Service users and LCOTF-affiliated community members identified similar barriers facing harm reduction services in Litchfield County such as lack of transportation, stigma toward PWUD, and lack of political will.
• Service users and LCOTF-affiliated community members also identified similar opportunities for improvement such as the establishment of overdose prevention sites, increased awareness of current services, and expanded community education.

• We had hoped to conduct more interviews with PWUD; however, time constraints and logistical challenges prevented us from reaching our recruitment goal.
• Because the survey was distributed through LCOTF-affiliated listservs, respondents are likely more familiar with and supportive of harm reduction services than the general community.
• Survey results may also be influenced by non-response bias in that individual who were most likely to respond likely felt the most strongly about the survey’s content.

Service users and LCOTF-affiliated community members identified similar barriers to access and opportunities for improvement among harm reduction services in Litchfield County. Our five broad recommendations for The LCOTF’s future work are as follows, with specific short-term and long-term strategies for implementation:

1. Creating a long-term means of amplifying the voices of active drug users

• Inviting service users to monthly Task Force meetings
• Creating a Consumer Advisory Board made up of active drug users
• Creating staff positions for active drug users and conducting community-driven research

2. Supporting and utilizing the support systems that exist among PWUD

• Offering to distribute extra supplies to Rover users for their social network
• Compensating Rover users for getting the word out (providing stipends to distribute flyers, make referrals, etc.)
• Offering formal peer support services as part of The LCOTF’s initiatives

3. Delivering harm reduction services in non-traditional settings

• Offering more mobile services
• Providing services in high-risk, highly-frequented locations beyond the traditional medical setting
• Providing transportation services to and from brick-and-mortar service providers

4. Providing community education

• Targeting local politicians and law enforcement with educational efforts delivered by LCOTF-affiliated community members in these professions
• Offering Mental Health First Aid trainings to the community

5. Centralizing services

• Continue to bring together service providers as part of The LCOTF
• Prioritize the centralization of services when new services are created

Acknowledgements

Our project would not have been possible without the mentorship and support of our teaching fellow Shannon Carter, our preceptor Lauren Pristo, and our professors Natasha Ray and Dr. Debbie Humphries. We’re very grateful to have been able to learn from The LCOTF members and Rover volunteers. Special thanks to the service users we met at The Rover whose generosity and expertise guided our project.

References

1. Products - Vital Statistics Rapid Release - Provisional Drug Overdose Data. (2022, February 9). https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
2. Opioids and Prescription Drug Overdose Prevention Program. (n.d.). CT.Gov - Connecticut’s Official State Website. Retrieved April 21, 2022, from https://portal.ct.gov/dph/Health-Education-Management--Surveillance/The-Office-of-Injury-Prevention/Opioids-and-Prescription-Drug-Overdose-Prevention-Program
3. Drug Overdose Deaths in Connecticut Data Dashboard, 2015 to 2022. (2022, May 13) Tableau. Retrieved May 19, 2022, from https://public.tableau.com/app/profile/heather.clinton/viz/SUDORS_Dashboard_final2/OverdoseDashboard
4. “Litchfield County Opioid Task Force.” McCall Center, https://www.mccallcen. (n.d.).