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A quick profile of the opioid crisis.
Before the medical community fully realized how addictive opioid pain relievers could be, the drugs became a popular prescription starting in the late 1990’s because of their level of effectiveness. Today, an estimated 29% of patients misuse their prescriptions, an estimated 12% develop an addiction, and an estimated 6% slip into more serious drug use. It is an national medical crisis that is responsible for more than 130 deaths a day, and has cost the United States over $78 billion a year.
In the State of Nevada, the National Institute on Drug Abuse’s last annual survey found that there were 412 overdose deaths involving opioids. While that number has been declining since 2010, and it translates to a rate below the national average, it is still a concerning figure since 276 of those deaths (67%) were the result of prescribed opioids.
“States have been receiving funding from Federal agencies to fight this crisis and much of it is Congressionally appropriated, which means they are not ‘forever dollars’ and the funding comes with a huge amount of scrutiny,” said Dr. Woodard. “Purchasing a bulk amount of Naloxone isn’t a great strategy because it has a shelf life of 18 to 24 months. But purchasing small amounts over and over, using one funding stream at a time, is more difficult to monitor, report on and ensure it makes it to those who need it most. We needed a solution that enabled us track results on the business side (funding, distribution operations, and reporting), and the mission side (saving lives).”
Best Practices from the Nevada Department of Health and Human Services
Introducing the Naloxone Virtual Dispensary.
As a solution to track results, Dr. Woodard and her team deployed the Naloxone Virtual Dispensary, an inventory management application developed on the Salesforce Platform. It tracks the state’s funding levels and distribution of Naloxone, giving leadership the kind of data granularity that serves as the first step to solving any complex, larger-than-life problem.
Distribution centers (law enforcement, emergency medical services, community based organizations, etc.) participate in an onboarding process, and are invited to register an account where they can submit requests for Naloxone doses. Centers can specify regular shipments -- much like any standard subscription model, or request large orders for special events, such as an information night, training event, or education fair. Each shipment is logged in the application against its funding source(s), providing information on which dollars are being used where, all across the state.
As the distribution center draws down their inventory, they can note it in the system. “This helps us be proactive; we get trigger notifications when a supply is low, prompting us to contact the distributor and ship more doses before they run out,” said Dr. Woodard.
The team can also pull a report that identifies a distribution center’s inventory as it relates to previous periods in time, compare one center to the next, and glean real-time, data-driven insights.
“If we notice that one center has an abundance of Naloxone, and another is uncharacteristically low, we can coordinate the transfer of doses. This ‘just-in-time’ redistribution keeps Naloxone from expiring on a shelf, and saves us from having to order more at the federal level, which saves taxpayers money,” said Dr. Woodard.
The team sees results on both the business and mission sides of the work.
On the business side, the results are impactful. Collecting timely and accurate data related to the number of Naloxone doses has helped Dr. Woodard and her team show how well the state is using funding while demonstrating responsible stewardship of taxpayer dollars. It has also helped them build a solid case for sustained federal funding, and, when those dollars are no more, support a specific request of the state legislature.
Adoption of the dispensary application was intuitive, as many of the distribution sites administer "hundreds of doses a month, so staff could easily see how this would help them get more Naloxone off the shelves and into the hands that need it." This freed up time and energy for teams to focus on more foundational training – how people developed an addition in the first place and ways to help them overcome the stigmas that often serve as a barrier to getting help.
On the mission side, the results are incredible. While DHHS does not require its customers who are receiving Naloxone to report back, the Department has received valuable information and voluntary accounts of what happened to the first dose should someone ask for a second, third, or even fourth. Those reports, which were previously unrecorded, are now captured in the dispensary application.
“We had 856 spontaneous reports of opioid overdose reversals through this distribution program alone. To date, the team has dispensed a total of 11,861 naloxone kits to its distribution sites, 4,942 naloxone kits to first responder agencies, and moved roughly 150 kits between entities. That’s 856 lives saved,” said Dr. Woodard, “And that doesn’t include law enforcement or EMS uses, which are tracked through channels associated with their job scope.”
“This has been an opportunity to act on an issue of which the public is painfully aware, change the narrative, and address the subject at its core.”