Government agencies at all levels have taken varied approaches to combat the opioid epidemic, relying on modern tools like detection tech and data and mapping. The state of New Jersey has been a leader in this work through information sharing efforts, but the problem persists.
As Paterson Chief Innovation Officer Edward Boze explained, there are almost five overdoses a day in the city, which has a population of almost 160,000 people.
The solution — a computer-managed dispatch system for the process of prescribing Suboxone — originated as a concept submitted to the Bloomberg Philanthropies’ 2021-2022 Global Mayors Challenge. In January 2021, the city was selected as one of 15 winning cities in this challenge. Each city will receive a $1 million grant and technical assistance as they enter a three-year period to implement the solutions.
Boze said that the first portion of that grant funding is expected this month. The city is also exploring other grant opportunities, as ultimately, the goal is to take the solution statewide, and possibly beyond.
The pilot, which was completed in several months to apply for the grant, proved that a 90-minute response was viable. But, as Boze explained, the long-term behavioral health impact of this solution will be measured with partner Rutgers New Jersey Medical School in a more longitudinal study.
The city partnered with Quickbase, a company whose no-code software is particularly helpful for what its CEO Ed Jennings describes as “big, messy projects.” And with all the moving pieces, Paterson’s solution required technology that could help manage a multifaceted issue smoothly.
“The key of the approach is basically that we needed to make addiction treatment available on demand,” said Boze, underlining the value of Suboxone in not only counteracting withdrawal symptoms but also protecting individuals from overdose.
As Boze explained, the root of the problem is that once people use opioids, they are returning to them to avoid withdrawal symptoms. The 90-minute mark is essential to give individuals an alternative to opioids before they hit that withdrawal.
Essentially, a person dealing with opioid use disorder will call the RealFix hotline and connect with the call center — the operator of which is the only city government employee involved in the process. The call center will collect information which will be passed to a doctor for a telehealth appointment. Following that, the doctor will present the information to the pharmacy for a medication prescription. Finally, a delivery person will go to pick up the medication to deliver it to the individual who needs it.
“Everything has to be working like clockwork for us to meet this 90-minute target,” Boze said.
Another piece of the puzzle is how RealFix will work for individuals experiencing homelessness in the city.
As Boze explained, those experiencing homelessness may not be amenable to taking a telehealth visit over the phone depending on their location. Additionally, those that have a phone may not have the time needed to make a call.
To combat these challenges, the solution has a flexible option. Rather than call the RealFix hotline, individuals can call 911, which has two primary benefits. First, even individuals whose phones do not have minutes can still make a 911 call. Second, it permits GPS tracking of the caller, which helps enable medical transportation for the caller.
The transportation provider, which is not an ambulance but rather what Boze calls a non-emergency transportation provider, will take the person to the emergency room. At the same time, a peer recovery counselor will be contacted to meet the caller at the hospital to reduce the chances of the person seeking illicit opioids before getting treatment.
At each step, the information is tracked in Quickbase so that these moving pieces come together in an efficient, coordinated way.
Jennings explained that the requirements for this solution are unique and complex, but the software helps to connect multiple systems in a way that gets people the help they need in the time they need it.
“So much of what state, local, and even federal government deals with, there’s not a point solution that solves that problem,” Jennings said.
And because the players in the RealFix solution are accessing Quickbase, the call center operator can provide a nudge through the system to ensure things move along at the targeted pace in the case of a delay.
Jennings said that what the software really provides is a foundation, allowing those closest to the problem to determine what needs to be built. Giving those involved the tools to create their own solution, he said, empowers them to solve the problem quickly in a way that is customized for their needs. This is one reason he believes there is a current uptick in the use of low-code and no-code solutions in the public sector.
