Project Description Narrative:
In Milwaukee County, the rate of drug deaths has been rising dramatically with nearly an 80% increase from 2018 to 2022, with 674 deaths recorded in 2022. The burden of this increase has been disparate across demographic groups and geographic areas. The rate of drug deaths rose 164% among Black individuals, 214% among Hispanic individuals, and 36% among White individuals, with the rate of drug deaths for Black individuals now exceeding the rate for White individuals. Additionally, the substance combinations in drug deaths are shifting; in 2018 nearly one in four drug deaths in Milwaukee County involved fentanyl and cocaine compared to nearly one in two in 2022. The impact of this fentanyl and cocaine combination is also disparate with a 635% increase among Black individuals, 467% increase among Hispanic individuals, and 117% increase among White individuals from 2018 to 2022.
In 2022, the majority of fatal and nonfatal overdoses across the county occurred in the city of Milwaukee (74% and 86%, respectively). Recent geographic trends indicate that there are disparities in fatal and nonfatal overdoses on the north side of Milwaukee, in predominantly Black communities. Recent survey information also demonstrates that at least in Milwaukee, despite the increasing rate of data of fatal and nonfatal overdose incidents for individuals who are non-Hispanic Black, the likelihood of utilizing treatment or harm reduction services is lower for this group than for individuals who identify as Hispanic or non-Hispanic White.
The Milwaukee Overdose Response Initiative (MORI) is a mobile integrated health (MIH) program serving the city of Milwaukee. The team is comprised of a community paramedic (CP) and a peer support specialist (PSS) that go out into the community to meet with individuals following a nonfatal overdose to provide targeted outreach, support and linkage to treatment and recovery services, as well as referrals to other social services. Community paramedicine involves extending the role of paramedics beyond traditional emergency response to provide preventive care, health education, and chronic disease management within communities. It aims to improve access to healthcare, reduce emergency department visits, and enhance overall health outcomes through proactive, community-based interventions.
As part of this team, PSSs serve as individuals with lived experience who provide guidance, empathy, and understanding to those at risk of or affected by overdose. Through their own experiences, they offer non-judgmental support, education, and resources to help individuals navigate recovery, reduce harm, and prevent future overdoses. Through the integration of social workers onto the MORI team, this project will build capacity, diversify knowledge and expertise, and ultimately expand the team's ability to refer individuals with opioid use disorder to a broader scope of services.
Recognizing the need for a more focused approach and expanded and diverse workforce, this project aims to implement a modified strategy within a concentrated geographic area heavily impacted by overdose incidents.
The primary goals of the project are to develop and implement a targeted community outreach and education program aimed at increasing awareness about MORI while bolstering response capabilities within an identified focus area of Milwaukee through expansion of team capacity.
In the first phase of this program, the researchers we aim to identify a focus area based on the highest concentration of overdose incidents on the north side of Milwaukee, provide educational resources on overdose prevention, harm reduction strategies, and available local resources for both the target population and their support networks, and collaborate with various organizations, businesses, and local entities such as churches and barbershops to facilitate education, outreach, and access to harm reduction materials. The next phase will involve integrating social workers into MORI to address the psychosocial needs of patients, including issues like housing instability, food insecurity, and access to social support networks. Additionally, the initiative plans to train these social workers to provide culturally responsive support within the focus area, centering equity in service delivery, and more directly reflecting the racial composition of the community to facilitate building trust. This program seeks to collaborate with local social service agencies, particularly those in the focus area, to establish a robust network of resources and referrals for patients and their immediate network in need of social support services.
By concentrating efforts in the northern part of Milwaukee, where overdose rates are disproportionately high, particularly for Black residents, this project seeks to evaluate program outcomes and effectiveness compared to MORI's general implementation with a specific focus on advancing health equity. Through education, partnership, and enhanced team composition, this project aims to make a meaningful impact on overdose prevention and support for those impacted by substance use disorders in the community.