The HUH Screening, Brief Intervention and Referral to Treatment (SBIRT) Community Expansion Initiative expands on the Howard University’s SBIRT Medical Residency and Medical Professional Programs which trained health care professionals and health care, professional students, to:
Know the R.I.S.K.
- Raise the issue of substance use
- Inform the patient about healthy behaviors
- Screen for substance use problems
- Know how to offer brief intervention
Goal – The HUH SBIRT Community Expansion Initiative will promote the use of an evidence-based SBIRT to reduce substance misuse, related injuries and the associated social, medical, and economic costs. This model fits the collaborative, multidisciplinary approach to prevention and treatment to instill lasting change in attitudes, norms, and practices, which can complement positive health outcomes among individuals with larger societal changes.
Geographic Catchment Area and Population of Focus - The population served mainly lives in Washington, D.C Wards 7 and 8 (and in parts of Wards 1, 5, and 6) in areas with high crime, illegal drug markets and a high density of tobacco and alcohol retail outlets. The population of Wards 7 and 8 are overwhelmingly African American (>90%); 37% of Ward 8 residents and 27% of Ward 7 residents live below the poverty line; 88% of food deserts in Washington, D.C., are in Wards 7 and 8; and Wards 7 and 8 have the highest number of drug overdoses in the city. Wards 7 and 8 are also classified as mental health resource shortage areas.
Extent of the Problem - Persons 12 years of age and older in Washington, DC exceeded the national average for alcohol use disorder (. 8.2 vs 6.1) (SAMHSA, NSDUH 2016). Heroin use rates in DC were slightly higher than the national average years 2013-2014 (.51 vs .30.). Intoxication and cardiovascular disease are the leading cause of death in Wards 7 and 8, and homicide deaths follow closely behind. While cigarette smoking rates have declined substantially throughout most of the nation and most parts of D.C., the prevalence of cigarette smoking remains high in Wards 7 and 8: 41% of Ward 8 residents smoke cigarettes (compared to a citywide average of 18.8%). Populations in the targeted catchment area disproportionately suffer from a range of health problems, including but not limited to heart disease, diabetes, chronic liver failure, high blood pressure, psychiatric illness, HIV/AIDS, environmental-related trauma injuries, and conditions related to substance use disorders. Access to healthcare is also limited in Wards 7 and 8, which, despite Medicaid expansion, have the highest rates of uninsured (>15% in Ward 7). Limited public transportation options, the closure of D.C. General Hospital, and the deteriorating condition of the area’s only other public hospital are additional barriers to access. Many patients continue to use HUH’s ED as their primary source of health care, as evidenced by astonishingly high rates of ED visits (averaging approximately 600 per 1000 population annually in Wards 7 and 8).
The DEA (Drug Enforcement Administration) reported on November 13, 2019, as Western Maryland battles the opioid crisis meth is surging. The CDC estimates that almost 10,500 people died of meth-related drug overdoses in 2017. According to the Maryland Department of Health, the number of meth-related deaths occurring in Maryland rose by over 114% from 2017 to 2018 and has increased over 10-fold since 2014. During that same time, the number of prescription opioid-related deaths increased by 220% from 2014 to 2017, then decreased by about 8% from 2017 to 2018, according to data from the Maryland Department of Health.
The Fentanyl Epidemic:
Synthetics are the next chapter in the D.C. region’s drug crisis, according to D.C. Policy Center. They are easily manufactured and inexpensive. Preliminary estimates based on April 5, 2020 data analysis from the CDC reflects a rise of 10.2% in drug overdose deaths for Washington, D.C. Fentanyl and synthetic cannabinoids represent widespread exposure and deadly consequences both in D.C. and nationwide. Fentanyl and its derivatives are the most prominent of synthetic drugs in fatalities accounting for about half of all U.S. opioid deaths in 2017. The District, along with other cities of the East Coast and Midwest, has been on the leading edge of this increasingly fatal turn. As the D.C. Policy Center previously reported, fentanyl first began to make a substantive impact on local overdose rates in 2015 and drove a dramatic spike in 2016. Local health agencies estimate that fentanyl is now responsible for 90 percent of all fatal opioid overdoses in the District, along with 94 percent in Baltimore and 85 percent in all of Maryland.