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Rapid Opioid Alert & Response - (ROAR), a New Tool to Address the Opioid Epidemic in Local Communities

'HHS Ignite Team continues their work after the program and scales up ROAR to save lives'

'HHS Ignite Team continues their work after the program and scales up ROAR to save lives'

Mitra Ahadpour, MD, DABAM woke up on October 2, 2015 to a headline in The Chicago Tribune that shook her up.

'74 overdoses in 72 hours: Laced heroin may be to blame'

Ahadpour, a medical officer at the time, now the director of the Division of Pharmacologic Therapies at the Substance Abuse and Mental Health Services Administration (SAMHSA), thought about what she could do to help curb the opioid epidemic that has been sweeping the country.

Ahadpour, along with Gus Lodato, Chandler McClellan and Kaitlin White, also from SAMHSA, applied to the HHS Office of the Chief Technology Officer's Ignite Accelerator program, which provides selected teams with methodological coaching and technical guidance within a fast-paced, entrepreneurial framework, but first Ahadpour's team needed an idea to test and iterate within the HHS Ignite program.

It all started with a box of donuts and a chat with a former heroin dealer. Ahadpour knew about an outreach program for heroin and opioid injection drug users that the Baltimore City Health Department was running in December 2015 in West Baltimore. Ahadpour called the Baltimore City Health Department contact she knew and asked if she could come to the outreach program to hang out and listen.

On a cold December day, Ahadpour set out for Lexington Market in West Baltimore to test out her ideas for the HHS Ignite Accelerator Program with injection drug users.

She was a little apprehensive.

"They warned me. They said 'They may not talk with you. You're a newbie.' I brought a box of donuts. I placed the box and stood on the side. They were talking with people, handing out the naloxone kits. One of them came to me and he was a former drug dealer. He said 'I looked at you and said: Who is this person coming into our territory?' But then he said, 'I saw the donuts.' He eventually gave me his seal of approval," Ahadpour explained.

The meeting in Lexington Market spurred numerous follow-up conversations, during which she bounced ideas off of the injection drug users, health department staff and first responders from Baltimore. Would they want to know if there was really potent or laced heroin on the street? She asked.

"They said, 'We care...we don't want to die,'" she explained.

Ahadpour envisioned a system that would allow SAMHSA to communicate with local health organizations that work with drug users and alert them when there is a spike in overdoses in the area. This spike in overdoses can mean that there is especially potent heroin or that the drugs are being cut with high levels of Fentanyl, which is deadly in high doses. Ahadpour contacted users in the community to find out what they thought about her ideas.

Ahadpour and her team kept plugging away on their ideas and started looking for repositories of real-time data about overdoses in the community. Finally, Ahadpour applied to the HHS Ignite Accelerator boot camp in the spring of 2016 to sharpen the focus.

During the boot camp, she and her team from SAMHSA came up with a prototype. Using drug overdose data from 911 calls and a poison hotline, she worked with SAMHSA staff to set up a program on her laptop that would identify spikes in heroin overdoses in certain areas, which can help public health officials identify tainted heroin in a community.

During the HHS Ignite Accelerator program boot camp, Ahadpour's team was coached and mentored in human-centered design and entrepreneurial methods. The HHS Ignite Accelerator program helped Ahadpour's team to use the feedback from the injection drug users, health department staff and first responders in West Baltimore to develop a solution that would meet their needs.

As a result of the HHS Ignite Accelerator program, Ahadpour and her team developed ROAR, Rapid Opioid Alert & Response, an overdose electronic monitoring system that is based on 911 data. Local health departments, after they get an email alert about an overdose spike, can use this information to quickly respond to overdoses in the communities. ROAR also provides the health departments with information for the injection drug user community about addiction resources, including where to get Naloxone, a drug that can help save heroin overdose victims in most cases if administered quickly.

After the HHS Ignite Accelerator Program

The leadership of the Washington-Baltimore High Intensity Drug Trafficking Area (WB HIDTA) got wind of Ahadpour's project and they liked what they heard.

"It's really about the data. How can we share data to protect, support and save lives? Our mission is to help local law enforcement. It's about how we can support them through intelligence. But we're also the only one [HIDTA] that receives funding for drug treatment, so we find ourselves as a bridge between public health and law enforcement," said Jeff Beeson, the deputy director at WB HIDTA.

Beeson said that the director of the HIDTA, was interested in the SAMHSA team's work on ROAR and brought them in to discuss. The WB HIDTA was already in the process of geomapping opioid-related overdoses through their Overdose Detection Mapping Application Program (ODMAP).

The WB HIDTA team had the data and the SAMHSA team had an alert system, so they joined forces to scale up ROAR. As a result of the partnership between the WB HIDTA and the SAMHSA's team, the ROAR platform is now available on mobile devices through an app. First responders can use the app to report whenever Naloxone is administered. This real time reporting by first responders into the app allows for the public health departments that work with injection drug users to quickly alert their communities that there is tainted heroin in the area. The teams piloted the system for about six weeks earlier this year in Baltimore City, Anne Arundel County, Maryland and two counties in West Virginia. They are now expanding into counties in South Carolina and in Florida, which just passed a bill (HB 249) that authorizes the data collection and specifically mentions ODMAP.

What Beeson and his colleagues have found is that by analyzing the overdose data, patterns emerge.

"We are drawing correlations. If this county has a spike, then we know that this other county is going to have a spike," Beeson said, adding that Fire and EMS departments are using the data to plan ahead and becoming more proactive in responding to drug overdoses.

Opioid overdoses across the country remain at epidemic proportions, but Ahadpour is hopeful that ROAR, as it is scaled up and modified, can be a helpful tool for patients and providers. Beeson has traveled across the country to discuss ODMAP and ROAR and has more than 200 presentations under his belt, most recently in Ohio and Kentucky. Beeson has 60 teaming agreements signed with counties and municipalities to use ODMAP and ROAR and expects to have the app up and running in an additional 40 counties within six months.

Editor's Note: The ODMAP is available for free to States. For more information contact Jeff Beeson at [email protected]. For more information on ROAR, please contact [email protected].

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