Excerpt from feature in the Winter 2018 issue of Philanthropy magazine
By Caitrin Keiper
Incrementalism in Indiana
So you’ve been brought back from the dead with naloxone. Now what? At this vulnerable moment, you might be receptive to drastic help. But most hospital emergency rooms, where you are likely to be taken, are not equipped in any way to tackle addiction.
“You can’t just sprinkle naloxone on everyone and think this will get better,” emergency physician Krista Brucker told AHA News. That’s why Dr. Brucker and her colleagues at Eskenazi Health in Indianapolis created Project Point, which connects overdose patients to more lasting help. It assigns “recovery coaches”—former users stably living in sobriety—to come in and do an intervention, point the patients to community treatment resources, and be their support system going forward. Especially when there’s a gap between the E.R. visit and the next available opening in treatment, as there usually is, recovery coaches help participants stay on track in the interim. Participants also receive hepatitis C testing and take-home naloxone kits.
Funded by the Richard M. Fairbanks Foundation, Project Point has already begun to change the way that doctors and patients interact. E.R. personnel used to seeing the same drug users on an endless loop express relief that “I can actually do something for them now.” Patients are surprised and grateful that someone at the hospital is “taking the time to care.”
Project Point is just a small piece of the Fairbanks Foundation’s big push on opioids. Founded by broadcasting magnate Dick Fairbanks, the group focuses on health and education within greater Indianapolis. (The nearby Fairbanks drug and alcohol treatment center, though not a product of the foundation, is named for Dick’s grandmother, Cornelia.) It gave Indiana University $20 million in 2009 to establish the state’s first school of public health, which is now central to its strategy on the opioid crisis: Research. Prevention. Harm reduction. Treatment. All of this carefully evidence-based.
The foundation’s president is Claire Fiddian-Green—previously an education policy adviser to then-governor Mike Pence. As the foundation was freshening its vision in 2015, the whole state was taking in a strange emergency: a sudden spike of 200 cases of HIV and hepatitis C in one rural county (up from one or two a year at most), caused by drug users sharing needles. Governor Pence went against his previous stance to allow for an emergency needle exchange, which brought the outbreak in Scott County to a halt, but in the ensuing investigation into causes it turned out there was almost no drug treatment available in the area—a prime opportunity for philanthropy to step in.
In her new Fairbanks Foundation perch, Fiddian-Green surveyed her region and heard the same thing over and again. One sheriff estimated that 80 percent of the people he locks up have drug or psychological issues. “When I got into this business I thought I was in the law-enforcement business. It turns out I am in the addiction and mental-health business.” In response, the foundation helped create a Mobile Crisis Assessment Team to accompany police on 911 calls that involve drugs or mental disturbance. If the individual is dangerous he proceeds to jail, but if justice would be better served by diverting him into treatment, the crisis team is there to make that happen.
The foundation’s other efforts include a program called Ascend Indiana that encourages workforce development, both by training new social workers specializing in substance issues, and thereby providing support to other workers dealing with addiction so they can remain gainfully employed. Another Fairbanks grant contributes to quadrupling the capacity of a residential treatment program in the state for pregnant women and young mothers. It is also funding news coverage of the opioid epidemic, and sponsoring research aimed at producing statewide recommendations. Fairbanks has taken the lead in convening groups from the philanthropic, private, and public sectors to coordinate efforts.
The foundation’s Ellen Quigley notes that there is strong interest in the opioid problem, “but not a lot of direction, not a lot of clarity around what needs to be done.” Physician and economist Anupam Jena recently compared the opioid crisis to car safety, noting that there are now more fatalities each year from opioids (53,000) than from automobiles (37,000), and noting how many incremental efforts were required to cut the auto fatality rate in half in recent decades. “Think of all the things that we do to make sure people don’t die from motor-vehicle accidents,” he wrote in The New Yorker. “We have air bags, speed limits, cops giving out tickets for speed violations,” many modifications in car design, and so on.
The opioid epidemic similarly calls for many, various interventions. It’s bigger than the mechanical question of car safety, and more difficult than the other diseases to which it’s often compared, as both the symptoms and solutions are directly related to behavior. All the more reason to cast a wide eye for opportunities to intervene, from the individual to the cultural.
“This issue hits education. It hits economic development and job training. There are medical aspects,” says Fiddian-Green. “So there is a role for every kind of funder, regardless of focus area.”
Read the entire Philanthropy Roundtable article here.