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N E W H A M P S H I R E

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Final Report

Report Contributors:Christin D’Ovidio, MFA, CCPH

Debbie Love, BS

Frances Marshman, MPH

Martha Bradley, MS

Melissa Schoemmell , MPH

Karyn Madore, M.Ed., CCPH

Lisa Bryson, BA

Rachel Kohn, MSW, MPH

New Hampshire Statewide Opioid Public Awareness Campaign

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Table of Contents

New Hampshire Statewide Opioid Public Awareness Campaign - April 2016

EXECUTIVE SUMMARY.......................................................................................................3FORMATIVE RESEARCH SUMMARY ..................................................................................5Introduction ......................................................................................................................5PHASE I - Implementation ................................................................................................6

Formative Research Findings and Results ..................................................................6Defining the Opioid Epidemic in NH .........................................................................6Review of Naloxone Laws and Policies .....................................................................7New Hampshire Naloxone Laws .................................................................................7HB270 (Requesting Medical Assistance) ....................................................................7HB271 (Prescribing and Dispensing By Professionals or Lay People) ...................... 8Naloxone Laws and Implementation in Other States ..............................................8Review of State Naloxone Campaigns .....................................................................10Scan of New Hampshire Media Messages ................................................................13Focus Groups ................................................................................................................14Key Focus Group Themes ............................................................................................15Campaign Branding and Design ..............................................................................17Mood Boards.................................................................................................................17Media Buy and Campaign Activities .........................................................................17Earned Media and Additional Activities ...................................................................18Engagement of NH Partners ......................................................................................19

PHASE II - Implementation ...............................................................................................24Engagement of NH Partners ......................................................................................24Media Buy and Campaign Activities ........................................................................25Earned Media and Additional Activities ...................................................................25Paid Media ....................................................................................................................25Social Media (Owned Media) ....................................................................................25Conclusion ....................................................................................................................28Material Dissemination Phase I and II: ........................................................................30Attachments: ...............................................................................................................30


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EXECUTIVE SUMMARYNew Hampshire was, and still is, facing unprecedented rates of opioid use which led to a 2015 Declaration of a Public Health Emergency by NH’s Governor, Maggie Hassan. A contract was put in place between the NH Department of Health and Human Services (NHDHHS) and the Community Health Institute (CHI) to: increase the capacity of NH Public Health Regional Networks to assist with the response to the public health emergency regarding the epidemic, and to increase awareness of a) the opioid epidemic in New Hampshire, b) the Governor’s Declaration, c) the Good Samaritan law (RSA 508:12) and, d) how to access Narcan™ (Naloxone) for emergency use (RSA 318-B:18).

NH Bureau of Drug and Alcohol Services (BDAS) contracted with CHI to develop and implement an opioid awareness campaign with a call to action and a connection to resources, that utilized the self-efficacy theory, theory of reasoned action, and exchange theory that worked to 1) reduce the stigma of drug use, 2) eliminate the perceived barrier of arrest, 3) prepare New Hampshire residents for an overdose situation, and 4) increase immediate responses to an overdose in order to reduce overdose deaths.

CHI conducted focus groups with multiple partners across the state gathering knowledge, attitudes and beliefs from those affected by opioid misuse. From this research, the Anyone.Anytime.NH™ campaign was developed, tested and implemented statewide. Additionally, CHI facilitated media events, took part in statewide conferences and awareness events, and facilitated the disbursement of naloxone kits to community health centers and partners as well as developed a paid relationship with 211 to drive opioid inquiries to the treatment locator site: www.nhtreatment.org. The implementation of Anyone.Anytime.NH™ came in two phases: Phase I campaign was implemented 9/28/15 - 1/6/16 and Phase II of the campaign ran 9/1/16 – 2/28/17.

During both phases of the campaign there was significant local and national conversation surrounding the opioid epidemic. The following report highlights the process of creating and implementing the phases of the campaign and provides process evaluation measures and outcomes attributable to campaign activities.

Results of the media campaign and CHI activities were measured after both phases and include: number of focus groups conducted; materials distributed; increased number of earned media articles with mention of Anyone.Anytime.NH™; number of naloxone kits distributed; number of inquiries to 211 on opioids; activity on/traffic to the NH Alcohol and Drug Treatment Locator website; owned media, such as organic social media activity on Facebook and Twitter and Anyone.Anytime.NH™; searches on DrugFreeNH.org; and impressions, reaches and frequencies of the paid media campaign.


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An overview of Phase I and Phase II media activities are highlighted on the following page and a detailed description is provided in the report narrative.

Table 1: Combined Media Buy for Phases I and IIMedia Phase I (9/28/15 -

1/17/2016)Phase II (9/1/16 – 2/28/17)

Television/Cable Reached 50% of NH Adults Age 18-35+ an average of 3 times

Reached 86% of NH Adults Age 18-35+ an average of 4.35 times

Radio 14,904 spots reached 70%-90% of the NH adult population an average of 14.97 times

10,198 spots reached 73.4% of NH Adults age 18-34 an average of 10.3 times

Bus Transit/Shelters 122 bus interior/exterior and shelter ads with a reach of 1,423,521 riders (potentially many more non-riders also saw the ads)

94 bus interior/exterior and shelter ads with a reach of 1,423,521 riders (potentially many more non-riders also saw the ads)

Newspaper 11 papers, 104 ads, population 24,316

HIPPO Paper Special Addiction & Recovery Issue, 20 weeks, 284,965 readers/week

Mall Kiosk Ads 14 ads, population 5,209,773

N/A

Online/mobile (Three sites: DrugFreeNH.org, NHTreatment.org, 211.org )

647,202 impressions, over 1,665,845 visits per month

Separated below

NHTreatment.org Combined above 14,586 sessions by 10,874 users. 188 visitors from anyoneanytimenh.org (after launch). 64 from drugfreenh.org (prior to site transition)

DrugFreeNH.org/ AnyoneAnytimeNH.org 9/1/16 - 10/19/16

N/A 1,587 sessions (prior to the site migration to AnyoneAnytimeNH.org)

AnyoneAnytimeNH.org Launched: 10/19/16

N/A 13,622 sessions by 12,066 users. 1,556 were return users. 1,217 users spent more than a minute on the site

Twitter Since 9/1/16: 348 Profile visits, 27 New followers, seven Mentions, 6,622 Impressions (Impressions are how many times your tweet has been seen). @AnyoneAnytimeNH has 170 total followers

YouTube 111,912 views, 15 shares. (89,195 were in Q4-2016 & Q1 2017)

Facebook/AnyoneAnytimeNH

744 Likes, Reach of over 1K per post

On demand/streaming

N/A 909,000 impressions, 71 sessions on anyoneanytimenh.org

Hearts Web/Mobile Ad Platform

N/A 2,429,547 impressions, 812 ad clicks

Google AdWords N/A Display, search and video (YouTube): 5,944,142 impressions, 116,593 interactions


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FORMATIVE RESEARCH SUMMARYIntroductionIn the summer of 2015, the state of New Hampshire (NH) was in the grips of a public health emergency with record number of residents overdosing and dying of opioid use. According to the National Survey on Drug Use and Health, NH ranks as one of the highest in the country for illicit drug use (other than marijuana) among 18 to 25 year olds. Ninety-one percent (91%) of overdose deaths are opioid related. Fentanyl has been a factor in nearly two-thirds of the opioid deaths in 2015.

In response to this sharp increase in overdose deaths, officials initiated a multi-prong emergency response that included changes to the law for the distribution of the lifesaving drug, Naloxone, and a statewide public awareness campaign to increase awareness of the problem and knowledge about resources and access to the rescue drug for the general public, caregivers and health care professionals. This multi-media campaign was coordinated with a broader public health response that included the:

1. Passage of two new house bills (HB); HB 271 which allows for broad prescribing, dispensing, and distribution of Naloxone (a rescue drug commonly known as NARCAN®) and HB 270 also known as the Good Samaritan Law, which provides protections for individuals administering the drug and protections from drug possession (e.g. heroin) charges;

2. Distribution of emergency kits of Naloxone through NH Department of Public Health Services (DPHS)-funded community health centers to dispense to appropriate patients and other individuals as allowed by HB 271;

3. Training of individuals in the 13 NH public health regions to increase their capacity to safely use Naloxone; and

4. Coordination of film screenings and community events to educate the public about this important public health issue.

In August 2015, the Bureau of Drug and Alcohol Services (BDAS) directed the Community Health Institute (CHI) to develop a public awareness campaign that targeted caregivers, health care providers and those most at risk of overdose and death. Specifically, the objectives of the public awareness campaign were to increase awareness of the:

• Prevalence of opioid use (e.g., heroin) problem in NH;

• Benefits and availability of Naloxone as a rescue drug in the event of overdose;


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● Legal protections covered by the Good Samaritan law; and

● Available treatment and recovery services in NH.

CHI engaged in a “fast tracked” approach (seven-weeks) in which campaign material was conceptualized, designed, audience tested, produced and placed on air, out-of-home, and print during the months of August and September, 2015.

PHASE I - ImplementationThe first step in this rapid cycle of campaign development was to conduct formative research to provide the basis for the development of effective materials and communication strategies to frame a response to this crisis by identifying and understanding the information needs of multiple target audiences to help inform their decisions and actions related to the crisis.

The formative research consisted of the following concurrent activities:

1. Define the opioid epidemic in NH: CHI researched current statistics to inform the development of a fact sheet about NH’s Heroin, Fentanyl & Other Opioid Crisis.

2. Review of Naloxone Laws: The NH Legislature amended two Naloxone-related laws in mid-2015 and this section provides a summary of those changes as well as Naloxone laws implemented in other states across the country.

3. Review of other State Campaigns: CHI conducted an environmental scan of existing national opioid campaigns to study what had been done as a response in other states.

4. Media scan: CHI examined the current NH media coverage on heroin and opioid overdoses and deaths to understand how the story was being portrayed in our state. The scan focused on messages, articles, media that occurred following the June 2, 2015, signing of HB 270. CHI also set up a media alert system to capture current and future messages that could form the basis of measuring the reach of messages and materials developed.

5. Focus Groups: CHI conducted a series of focus groups to ensure the material was relevant and motivating, involving the target audiences in every step of the process where possible.

6. Visual and content elements: CHI developed first drafts of visual and content elements of the campaign.

A summary of the results for each of these activities are described in more detail on the following pages.

Formative Research Findings and ResultsDefining the Opioid Epidemic in NH

Current statistics were gathered to inform the public about NH’s Heroin, Fentanyl & Other Opioid Crisis. These data were used to develop a visual graphic fact sheet.

According to the NH Medical Examiner’s Office, nearly one person dies from a drug overdose every day in New Hampshire. In all of 2014 and the first eight and a half months of 2015, on average, 27 individuals per month died from a drug-related overdose. There were 558 drug-related overdose deaths in NH from January 1, 2014 through September 18, 2015.

The data also spoke to the increase in overdoses related to fentanyl use. In 2014, 70.3% (206) of the 293 opioid overdose deaths were caused by heroin or fentanyl; this has increased to 84.8% (179) of the 211 opioid overdose deaths that occurred in 2015 as of September 18, 2015.

The research found that young adults (18-25 years of age) are using prescription painkillers non-medically at higher rates in NH (10.5%) than the average of other states in the northeast region1 (8.6%) and the rest of the nation (9.5%).

1 Northeast Region includes: CT, MA, ME, NH, NJ, NY, PA, RI and VT


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In addition, young adults are dependent on and abusing illicit drugs at a higher rate in NH (9.4%) than the average of other states in the northeast region (8.0%) and the rest of the nation (7.6%). New Hampshire’s young adults are using non-marijuana illicit drugs at a significantly higher rate (10.0%) than the average of other states in the northeast region (7.0%) and the rest of the nation (6.9%).

It was established, however, that drug-related overdose deaths are not just an issue faced by young adults. All adult age groups are impacted by this crisis. The highest number of overdose deaths occurred in the 30-39 year old age group.

Emergency department heroin and opioid use visits have also increased each year over the past several years.

Review of Naloxone Laws and PoliciesNew Hampshire Naloxone Laws

The NH Legislature amended two Naloxone-related laws in mid-2015 which are summarized below.

HB270 (Requesting Medical Assistance)

This act amends Title XXX: Occupations and Professions, Chapter 318-B, Controlled Drug Act by adding a new section after RSA 318-B:28-a: 318-B:28-b Immunity From Liability. The act permits a witness or victim of a drug overdose to request medical assistance in order to save the life of an overdose victim by protecting the witness or victim from arrest, prosecution, and conviction. It also provides immunity from arrest, prosecution, or conviction for a person who, in good faith and in a timely manner, requests medical assistance for someone who is experiencing a drug overdose or for themselves if they are experiencing a drug overdose.

Specifically, the act provides immunity for arrest, prosecution, or conviction for possessing, or having under his or her control, a controlled drug in violation of RSA 318-B:2, if the evidence for the charge was gained as a proximate result of the request for medical assistance. If the person does not request medical assistance, or does not do so “in good faith and in a timely manner,” he/she may not be immune from prosecution from evidence in connection with the investigation or prosecution of a crime. This act does not limit the lawful seizure of any evidence or contraband and does not provide protection from arrest, prosecution or conviction for any other crimes not protected under this act.

By January 1, 2016, the commissioner of NHDHHS shall develop and make available on the department’s public internet website, information for the public explaining the meaning and applicability of the provisions of this section. Effective date September 6, 2015, this act includes a sunset provision that provides that the law shall cease to have effect after a September 1, 2018, unless further legislative action is taken to extend the law.

“The number of heroin-related emergency department visits during the first eight months of 2015 is 76% greater than during the same eight-

month time period in 2014.”2

2 New Hampshire Drug Monitoring Initiative, August 2015 Report


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HB271 (Prescribing and Dispensing By Professionals or Lay People)

HB 271 was effective on June 2, 2015 and exempts a health care professional or other person who prescribes, dispenses, distributes, or stores an opioid antagonist, or who administers it to an individual suffering from an apparent opioid-related overdose from the provisions of the controlled drug act.

This act amends Title XXX: Occupations and Professions, Chapter 318-B, Controlled Drug Act by adding a new paragraph after RSA 318-B:15 III: VI (a)-(d). This act defines the prescription, act of dispensing or distribution, directly or by standing order, of opioid antagonists by an authorized health care professional to a person at risk of overdose, a family member, friend or other person who may assist in the event of an overdose as a legitimate medical purpose. It further states that persons or organizations, who have received the opioid antagonist in this way, may store it, and dispense and distribute it to someone who they believe is suffering from an overdose.

Health care professionals and those to whom they have dispensed the opioid antagonist will not be subject to criminal or civil liability, or any professional disciplinary action for “any outcome” resulting from giving opioid antagonists if they “act in good faith and with reasonable care.”

The act includes the following definition:

In addition to these new laws, NH Police are now offered training for naloxone administration. Until this point, EMTs were the only first responders offered naloxone training. The training for EMTs was 100 hours, but has been reduced to eight hours for police trainings.3

Naloxone Laws and Implementation in Other States

This summary includes some vital resources and a few examples from states. Opioid overdose prevention and treatment is being increasingly addressed in states across the country. The majority of states (37) have passed a naloxone law. Fewer states have addressed the many permutations, including prescribing and administering naloxone, of implementation and enforcement.

The Law Atlas’s Policy Surveillance Portal includes a map4 of the United States on which every state is tracked for eight points relative to naloxone:

1. Jurisdiction has a naloxone law

2. Prescribers immune from criminal liability

3. Prescribers immune from civil liability

4. Third-party prescription authorized

5. Prescription by standing order authorized

6. Lay administrator immune from criminal prosecution

7. Lay administrator immune from civil liability

8. Removes criminal liability for possession of naloxone

“Opioid-related drug overdose” means a condition including, but not limited to, extreme physical illness, decreased level of consciousness, respiratory depression, coma, or death resulting from the consumption or use of an opioid, or

another substance with which an opioid was combined, or that a layperson would reasonably believe to be an opioid-related drug

overdose that requires medical assistance.”

3 WMUR, March 26, 2015. Accessed at http://www.wmur.com/news/officials-to-announce-new-rules-for-administering-narcan/32021742.4 http://lawatlas.org/query?dataset=laws-regulating-administration-of-naloxone


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Thirty-seven states have a naloxone law (#1), but only four – California, New York, Vermont, and Wisconsin – have the seven other provisions of the law in place. Further research into these laws found that New Hampshire’s laws now have all eight, too.

On June 23, 2015, the Senate introduced S.1654 – Overdose Prevention Act, a bill to “prevent deaths occurring from drug overdoses.” It has been read twice and referred to the Committee on Health, Education, Labor, and Pensions for further discussion. This bill amends the Public Health Service Act and has many provisions, including ones about naloxone purchase and distribution, educating the public and health professionals, and reporting overdoses. 5

Washington, D.C.: The Obama Administration announced a new program today to fund public health-public safety partnerships to address the heroin and prescription opioid crisis. The new program would hire 15 drug intelligence officers and 15 health policy analysts to work within High Intensity Drug Trafficking Area (HIDTA) programs. The drug intelligence officers are expected to gather information on trafficking patterns and trends for street-level law enforcement. The health policy analysts are expected to help improve regional overdose surveillance, identify adulterated batches of heroin that could pose a major threat to public health and train first responders on how to recognize and handle overdoses, including the administration of naloxone. The Office of National Drug Control Policy (ONDCP) announced it would fund this new program using HIDTA funding that ONDCP administers. In support of this effort, Bill Piper, director of the Drug Policy Alliance’s office of national affairs stated that “half of what [policy makers are] doing is right – the focus on health and overdose prevention – but the other half, the side that focuses on the failed arrest and incarceration policies of the past is destined to ruin lives and fail.”6

Massachusetts: In March 2014, Governor Patrick of Massachusetts declared a public health emergency that led to regulations permitting first responders to carry naloxone under a medical director’s supervision. In July 2014, a law took effect that permits pharmacists to furnish naloxone rescue kits (NRKs) under a standing prescription order. There are four types of naloxone standing orders in place statewide currently:

1. Statewide order issued as part of the Massachusetts Department of Public Health (MDPH) overdose prevention pilot program, permitting distribution of NRKs by public health workers

2. Statewide protocol adopted by MDPH’s Office of Emergency Medical Services that permits EMTs and first responders to administer naloxone for opioid overdose

3. Prescriber-issued standing order for pharmacists to furnish NRKs without a patient-specific prescription

4. Hospital standing orders that allow a hospital pharmacy to furnish NRKs to patients upon discharge

Training and education, plus these four standing orders, have increased community access to naloxone. As of late 2014, over 30,000 people in the state had been trained to administer naloxone; over 3,500 successful reversals have been reported.7

In response to the overdose epidemic in Massachusetts, a network of family support groups has been providing overdose education and naloxone rescue kits (OEN). At first, harm reduction organizations provided the infrastructure for OEN programs and focused on injection drug users. In response to growing public awareness, access to OEN has expanded to community support groups, emergency first responders, and addiction treatment settings.8 In 2010, the city of Quincy began equipping its 211 officers with naloxone.9

5 https://www.congress.gov/bill/114th-congress/senate-bill/1654/text6 The Drug Policy Alliance has an excellent website: www.drugpolicy.org.7 Davis, CC, Walley, AY, and Bridger, CM. Lessons Learned from the Expansion of Naloxone Access in Massachusetts and North Caroli-na. Public Health Law Conference: Intersection of Law, Policy and Prevention, Spring 2015. 8 Bagley, SM, Peterson, J, Cheng, DM et al. Overdose Education and Naloxone Rescue Kits for Family Members of Individuals Who Use Opioids: Characteristics, Motivations, and Naloxone Use. Substance Abuse, 36: 149-154, 2015.9 Anti-Overdose Drug Becoming an Everyday Part of Police Work. New York Times, June 2, 2014.


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New York: In May 2014, William Bratton, the New York City police commissioner, announced that the entire police force would be equipped with and trained on naloxone administration. A month later, Governor Cuomo committed funds for emergency medical workers to administer naloxone. Roughly 150 police departments in New York State are participating.10

The New York City Department of Public Health worked with the police department to help train officers participating in a pilot program on Staten Island. The expansion, distributing 19,500 NRKs to officers in all precincts, is part of a $5 million program overseen by the state’s attorney general to get naloxone to all police officers. “As in other aspects of police work, officers administering naloxone in places where programs have begun would be indemnified from legal liability,” officials said.11

North Carolina: In 2013, the General Assembly in the state passed a law (nearly unanimously) to increase naloxone access. The law permits prescribers to issue prescriptions for third parties, and it protects both the prescriber and administrator from civil and criminal liability (same as under Massachusetts law.) The law also provides protection from criminal charges for the overdose victim and bystanders who act in good faith when calling emergency responders.

It explicitly permits prescribing naloxone under a standing order, yet at least one county, Orange County, found itself challenging the North Carolina Board of Pharmacy regulation that limited the medications that public health nurses are permitted to dispense under a standing order. The Department of Health petitioned the board which reversed its existing rule and added naloxone to the public health nurse formulary. Out of this decision came a standing order that was developed throughout the state, a standardized web-based training and dispensing of naloxone, and the Department and partners publicizing the NRK program.12 Note: Seems that North Carolina has not established all eight provisions related to naloxone (see I. above). Makes sense given the Orange County story.13

Review of State Naloxone CampaignsA small number of statewide campaigns existed, targeting a mix of professionals and the public. All state-funded campaigns focus on opioids in general, but are inclusive of naloxone. A longstanding campaign in Scotland focuses specifically on naloxone and has shown success in increasing distribution of the drug. Campaigns are administered within varying state agencies: health departments (Maryland, New York, Vermont), attorney general’s office (Indiana, Wisconsin), governor’s office (Massachusetts), and generally have a web presence within a .gov URL. Wisconsin is looking to have a microsite to minimize potential concerns regarding association with government site.

Indiana: Conducted through State Attorney General’s office. Currently it is primarily a website.14 A broader public awareness campaign began airing in Sept 2013. The campaign included online, print, television, videos and radio service announcements.15 In 2014, they partnered with Indianapolis Colts to further reach. Bitter Pill is part of a larger statewide public awareness campaign aimed at prescription drug abuse. Information on naloxone available is in other harm reduction materials.16

Maryland: One flyer (date unknown) was located that appeared to be aimed at the general public. The Department of Health indicates there is more (posters, pamphlets, emergency cards) but materials not available on their website. People are directed to 2-1-1, the statewide health and human services hotline. As of December 2015, there is a new heroin & opioid emergency task force established to address Maryland’s growing heroin and opioid crisis.

10 Around two dozen of the country’s 18,000 police departments have naloxone programs or are setting them up with more cities and counties considering such a move all the time. 11 Ibid. http://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/12 Davis, CC et al. Lessons Learned from the Expansion of Naloxone Access in Massachusetts and North Carolina. 13 http://www.nchrc.org/programs-and-services/overdose-prevention-project/14 http://www.in.gov/bitterpill/15 https://www.youtube.com/playlist?list=PLZUaP_vSFfbZgFbPnPlEt3yRvADe0gCPo16 https://drive.google.com/a/jsi.com/file/d/0ByPYhOgyvwxDYU10WHN0WlhHcTg/view?pli=1


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Table 2: Overview of State Naloxone Campaigns

Location Name of Campaign Dates Primary audience(s) Material samples

Indiana Bitter Pill Launched August 2013

General public Website

Flyer summarizing law on prescribing opioids

Videos

Maryland Dial 211 12/12 - 10/14 General public Provider letters

Flyer

Facebook

Massachusetts Stop Addiction in its Tracks

Launched June 17, 2015. TV PSAs ran through July 31

Family of those facing addiction

Main website

Facebook

Sample transit ad and brochures

New York Combat Heroin

Launched 9/22/14

parents, educators, health care professionals

Main webpage here

Sample videos: personal, family stories, professional perspective.

Rhode Island Naloxone and Overdose Prevention Education Program of Rhode Island (NOPE RI)

Ongoing Opioid users, friends and family of users, health and law professionals

Website

Vermont N/A Ongoing VT DOH opioid addiction and treatment website

Naloxone specific info

Wisconsin The Fly Effect

September 2013 - January 2015

Youth 12-18 Videos

Scotland Take Home Naloxone (THN)

August 2010 through 2013

Opioid users, friends and family of users

THN website

THN posters

Comprehensive Naloxone site

Global I’m the Evidence. Naloxone Works

April 2011 - Present

Opioid users, friends and family of users

Facebook

Videos

http://www.bitterpill.in.gov

https://drive.google.com/open?id=0ByPYhOgyvwxDYU10WHN0WlhHcTg

https://www.youtube.com/playlist?list=PLZUaP_vSFfbZgFbPnPlEt3yRvADe0gCPo

https://drive.google.com/a/jsi.com/folderview?id=0ByPYhOgyvwxDflk2eWhTNWdPUXEyVm03N1FFa3lyeHRvcFlLSGNlbkFqSWpNUjFsQ0thNWM&usp=sharing

https://drive.google.com/open?id=0ByPYhOgyvwxDVV9Od2UwaHJNdm8

https://www.facebook.com/SUDMD

http://www.mass.gov/eohhs/gov/departments/dph/stop-addiction/

https://www.facebook.com/StopAddictionMA

http://combatheroin.ny.gov/

http://combatheroin.ny.gov/real-stories

http://www.noperi.org/users.html

http://healthvermont.gov/adap/treatment/opioids/

http://healthvermont.gov/adap/treatment/naloxone/index.aspx

https://www.youtube.com/playlist?list=PLO-TtfHzKM9SquoNlSuC7zDvPJ_SsNXDg

http://www.sdf.org.uk/drug-related-deaths/take-home-naloxone-thn-overdose-intervention-training/

https://drive.google.com/open?id=0ByPYhOgyvwxDRDZTb3RWdGo0Ylk

http://www.naloxone.org.uk/

https://www.facebook.com/NaloxoneWorks

https://www.facebook.com/NaloxoneWorks/videos


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Massachusetts: The Massachusetts campaign was funded ($800,000) through a Federal Grant, and administered through the Governor’s Office. The website is embedded within state HHS site.17 Materials are available in English and Spanish. Campaign includes storytelling as a primary element - families who lost someone due to overdose and has a strong social media presence.18 TV ads ran through July 31, 2015. There are seven videos ranging from 30 seconds to just over three minutes in length. The ads take the scare tactic route (generally focused on death from overdose). One story features someone living with disabilities as a result of drug use. While the campaign is aimed at the general public, the website is not particularly consumer friendly with too many words, and the use of white text on black background which can be hard to read. Naloxone is not in the materials, but information is available on the website. An RFP was released from the Bureau of Substance Abuse Services (BSAS) on August 14, 2015 to extend this campaign, seeking vendors to create an Anti-Stigma campaign slated to begin in late October 2015.

New York: Maintained and operated by the New York State Office of Alcoholism and Substance Abuse Services, the NY campaign also connects to NY Office of Alcoholism and Substance Abuse Services (NYOASAS) pages on Facebook, Twitter, and YouTube.19 Each of these sites is currently using the Combat Heroin branding.20 An associated package of legislative bills21 was announced June 18, 2014, addressing various angles: public education, informational cards on naloxone, penalties for distribution, and measures to support treatment. Media buys include billboards, posters (mass transit and malls), online ads, social media, commercials which were aired across the state for four weeks starting in late February 2015.

Rhode Island: Funded through RI Disaster Medical Assistance Team and Medical Reserve Corps of RI, they have some handy printed materials (such as wallet sized cards) that can be used by outreach workers or other health professionals.22 Although there is no state campaign, RI HEALTH is developing a communications campaign regarding opioid overdose targeting health care providers, first responders and drug users, and their families and friends.23There was no public evidence of campaign, aside from the flyer shown in the article.

Vermont: No evidence was found of a unified statewide public awareness campaign. Rather, the campaign consists of expanded surveillance and criminal prosecutions, a “hub-and-spokes” treatment program to expand drug rehabilitation availability, supplying police officers and EMTs with plentiful doses of naloxone, the opening of more drug courts, and limiting the availability of Zohydro (an opioid pain medication).24Similar to Maryland, the 2-1-1 resource is promoted on the DOH website.25

Wisconsin: The multimedia campaign consists of TV, radio, online ads, and an interactive website. The Department of Justice (DOJ) initially committed $250,000 plus additional funds to cover air time. A number of printed and online-ready graphics were created, all based on the concept of the folk story of the woman who swallowed a fly. The campaign used a mixture of print and video. Videos shared personal stories from individual users as well as families impacted. The materials were striking, but according to the campaign developers, it was deemed ineffective. Anne Schwartz, the head of PR for the Wisconsin Attorney General indicated that it was discontinued as soon as the new Attorney General took office (the AG website indicates he will “continue to enhance the “Fly Effect” advocacy programs”). A new campaign was scheduled to be launched on 9/17/15; anticipating a $2M dollar budget. The primary audience is young people, parents, providers (particularly dentists). Media buys were to be timed around dates when there may be more stress (standardized tests, bar exams, holidays, etc).26 The campaign uses a microsite so it is not associated with the DOJ or other government officials.

17 http://www.mass.gov/eohhs/gov/departments/dph/stop-addiction/18 https://www.facebook.com/StopAddictionMA19 http://combatheroin.ny.gov/real-stories20 http://combatheroin.ny.gov/21 https://www.governor.ny.gov/news/governor-cuomo-and-legislative-leaders-announce-agreement-package-bills-combat-heroin-opioid22 http://www.noperi.org/resources.html23 https://drive.google.com/a/jsi.com/file/d/0ByPYhOgyvwxDXzY5Z3ozTnhpQVU/view?pli=124 http://healthvermont.gov/adap/treatment/naloxone/index.aspx25 http://healthvermont.gov/adap/treatment/opioids/26 https://www.youtube.com/playlist?list=PLO-TtfHzKM9SquoNlSuC7zDvPJ_SsNXDg


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Scotland: This campaign contributed to a 70% increase in distribution of naloxone kits in 2013-2014.27 Drug-related deaths also dropped, but it is unclear what portion was attributable to this campaign.28 According to a World Health Organization article,29 “since 2011, all Scottish prisons have provided naloxone kits to individuals on their release from custody. In 2012 and 2013, the proportion of opioid-related deaths among former inmates dropped by 50% in the four-week period following their release from prison, according to the new report from NHS Scotland.” This campaign appears to be spreading to other areas such as BC, Canada.30 In addition to Take Home Naloxone, there is an ad positioning bystanders as potential heroes for Prenoxad (naxolone injection for take home use).31

Global: A global campaign, sponsored by Harm Reduction Coalition and the Eurasian Harm Reduction Network, uses storytelling for awareness and prevention of overdose, with regional affiliates. Massachusetts is a particularly active member.32 In addition, while not a campaign specifically, there is an animated short film called Nuggets which takes a different approach to show the effects of addiction and is worth viewing.33

Scan of New Hampshire Media MessagesCHI examined the current NH media coverage on heroin and opioid overdoses and deaths to understand how the story was being portrayed in our state. The scan focused on messages, articles, media that occurred following the June 2, 2015 signing of HB 270. CHI also examined the comments section of stories or other posts to gain an understanding the attitudes, beliefs and knowledge about heroin use, overdoses and deaths. CHI also set up a prospective media alert system to capture current and future messages that could form the basis of measuring the reach of messages and materials developed. A total of 27 articles or news reports were identified between June 2 and August 15, 2015: nineteen were written articles and eight were radio or television news reports. Headlines included the following:

• “Hassan Signs Bill Making Overdose-Reversing Drug Narcan Available By Prescription” (http://nhpr.org/post/hassan-signs-bill-making-overdose-reversing-drug-narcan-available-prescription)

• “NH Ends Prohibition of Narcan, the Heroin Overdose-Reversal Drug” (http://freekeene.com/2015/06/02/nh-ends-prohibition-of-narcan-the-heroin-overdose-reversal-drug/)

• “‘Community Is Greater Than Heroin’ film project unveiled” (http://www.seacoastonline.com/article/20150605/NEWS/150609387)

• “Guinta Co-Sponsors Bi-Partisan Opioid, Heroin Abuse Bill” (http://patch.com/new-hampshire/bedford-nh/guinta-co-sponsors-bi-partisan-opioid-heroin-abuse-bill)

• “NH gov signs immunity law for OD situations” (http://www.newburyportnews.com/news/local_news/nh-gov-signs-immunity-law-for-od-situations/article_6b3cbe4c-4192-5f71-b111-a91f30e79921.html)

• “Heroin recommendations call for treatment, education: Drug czar reveals guidelines to Executive Council” (http://www.wmur.com/news/heroin-recommendations-call-for-treatment-education/34301336)

In addition to this media scan, an email request was sent to the Substance Misuse Prevention (SMP) Coordinators asking for information relative to current awareness of opioid misuse as well as public messages and media campaigns in the state in response to the crisis in opioid misuse. SMPs were asked to provide their input so that the campaign could build upon what is already underway. The SMPs were specifically asked to describe the following:

27 http://www.naloxone.org.uk/28 http://www.sdf.org.uk/drug-related-deaths/take-home-naloxone-thn-overdose-intervention-training/29 http://www.who.int/features/2014/naloxone/en/30 http://towardtheheart.com/naloxone/31 https://drive.google.com/a/jsi.com/file/d/0ByPYhOgyvwxDQnJIRnJFSXU0cG8/view?pli=132 https://www.facebook.com/WATEMASS?fref=nf33 https://www.youtube.com/watch?v=HUngLgGRJpo

http://nhpr.org/post/hassan-signs-bill-making-overdose-reversing-drug-narcan-available-prescription

http://nhpr.org/post/hassan-signs-bill-making-overdose-reversing-drug-narcan-available-prescription

http://freekeene.com/2015/06/02/nh-ends-prohibition-of-narcan-the-heroin-overdose-reversal-drug/

http://freekeene.com/2015/06/02/nh-ends-prohibition-of-narcan-the-heroin-overdose-reversal-drug/

http://patch.com/new-hampshire/bedford-nh/guinta-co-sponsors-bi-partisan-opioid-heroin-abuse-bill

http://patch.com/new-hampshire/bedford-nh/guinta-co-sponsors-bi-partisan-opioid-heroin-abuse-bill

http://www.newburyportnews.com/news/local_news/nh-gov-signs-immunity-law-for-od-situations/article_6b3cbe4c-4192-5f71-b111-a91f30e79921.html



http://www.wmur.com/news/heroin-recommendations-call-for-treatment-education/34301336

http://www.wmur.com/news/heroin-recommendations-call-for-treatment-education/34301336


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1. Messages you have used to alert those in your community to the issue, including Naloxone availability.

2. Relevant messages you have seen being used in the region or state.

3. Any assessment as to whether these messages have been effective at raising awareness or knowledge in the community about the prevalence, consequences or resources available for opioid users and their friends/families.

4. What do your public and partner organizations want to know. (This might be based on questions you have heard asked.)

5. Any efforts being made in your region to make people aware of the extent of the issue and resources available.

6. Your ideas on what would make an effective media message: Who would the target audience for messaging about opioid misuse and/or the potential benefits and accessibility of Narcan be in your region? Do you have any ideas for what the key messages should be for these audiences? Who would be the appropriate messengers to get this information to the target audiences?

The SMPs noted that local meetings were being held on the heroin crisis, opioid overdose, the availability of naloxone, prescriber training, and the expanded need for prescription drug take-back programs. Many were sharing resources and information about where and how to obtain naloxone in the community. Many concurred that, in general partners, were asking for support for emergency room personnel and education for the communities around substance misuse; hospitals were looking for programming in their community; police chiefs were looking for drug testing kits to distribute to parents as an aid in identification and intervention, and there was a need for outreach, support and training for pharmacists.

Focus GroupsCHI selected the strategy of focus groups (FG) in order to gather the greatest amount of qualitative data from the intended audience in the shortest time period. Participants were asked to review and rate several campaign concepts for visuals, concepts for messaging and taglines. CHI worked with and through community-based organizations and social media outlets to recruit participants and schedule the groups.

The objectives of this aspect of formative research were to:

• Objective 1: Understand the audience’s need for information

• Objective 2: Understand the audience’s perception, attitudes and beliefs regarding the use of Naloxone

• Objective 3: Gather feedback on sample design elements and concepts of campaign material

Within the focus groups (FGs) CHI explored broad areas with the intended audience to inform the development of a relevant and persuasive NH-based campaign. The broad areas included the assessment of:

1. Participants’ information needs about opioid (e.g., heroin) addiction and resources;

2. Participants’ attitudes and knowledge about the use of Naloxone or Narcan™; and

3. Sample campaign materials.


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Table 3 provides an overview of the seven FGs, their location and date, and number of participants.

Table 3: Overview of Focus Groups

Summary of Focus Groups

Group/Location DATE # of participants

Families in Transition - Manchester, NH 8/24/15 7

Families Sharing without Shame, Concord, NH 8/20/15 8

General Population, CHI - Bow, NH 9/5/15 4

Child and Family Services, FASTER Support Group - Manchester, NH 9/15/15 6

Laconia Police Department - Laconia, NH 9/21/15 10Second Start - Concord, NH 10/8/15 13Pharmacy Association - Concord, NH 10/14/15 10

TOTAL 58

Key Focus Group Themes

Information Needs:Overwhelming, participants’ described resentment about how people struggling with addiction are treated and portrayed in general. They shared a frustration with how the story of addiction was being portrayed in the media. They felt their loved ones’ arrests, deaths and struggles were being exaggerated to sell the story. They disliked seeing the image of needles as the introduction to a story. In particular participants’ shared that they felt the reports on www.Patch.com and WMUR TV were very distasteful. In general, they said their loved ones were not treated with the same compassion extended to other individuals with a chronic condition. In particular, they talked about how their loved ones are treated when they go to the emergency room for care or when emergency services respond to a 911 call. If they were to present for a condition other than addiction, they would be given a team of specialists to help them get better. With heroin use, however, they are sent home without any care coordination or follow-up services.

Caregivers shared they struggled to find services for their loved ones. They were not aware of the NH Treatment Locator. They talked about the shortage of inpatient treatment facilities with a few sharing they feigned residency in Massachusetts in order to get treatment. Among the pharmacists, there was a need for more clarification on where to order supplies. “If pharmacies are on the front line, we need to have something to hand out.”

Participants made the following suggestions:

• They suggested a better angle to persuade people to get help and to convey the prospect of hope and recovery, suggesting that people need to know there is help and support.

• They need to know the recovery is a long process, but it is doable.

• They would also like people to know that anyone can cross the line into addiction. It doesn’t matter your profession, family, background. It is not just a derelict, homeless person who struggles with this problem.

• Do not show needles on material as that is a trigger for the person who is using.

• They also said caregivers need information on the early signs of heroin or other opioid use.

• They said caregivers have critical times in which they seek help i.e., after a person goes to jail,

• after emergency department (ED) visits, problems with work, and after a detox program.


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• They need insurance information – caregivers would like guidance on working with insurance groups to understand how to get services/treatment covered.

• They would like a resource of services, treatment, or programs.

• They would like a number to call to get resources.

• Present addiction as a brain disease or illness vs a character flaw, bad habit or choice.

• They would like pictures of people with personal stories describing help and support.

• Caregivers found good support and information on the closed Facebook page Addict’s Mom.

“Not administering Naloxone is like watching someone drown.” - Participant

Perceptions, Attitudes and Beliefs regarding the use of Naloxone:The focus group participants where in two different camps regarding the use of Naloxone. While the majority felt it was a positive move to allow caregivers and lay people to get and give Naloxone, a small segment felt it was a form of enabling. This topic raised a lot of ethical questions for the participants in both camps. They discussed the consequences of reviving someone who does not want to “come back” or want help. Individuals may be combative or angry because they wanted to continue the “high” or because they wanted to end their life. Those in favor of the broad distribution of the drug said they need training on how to recognize an overdose, how much to dose, and how to respond when the person “comes through”. Caregivers feel desperate to help their loved ones and are willing to prepare ahead of time for an overdose emergency.

“I have more than one friend that has been Narcaned more than one time and thinks it is funny.”

- Participant A smaller, less dominant voice in the discussions was the belief that the use of the drug is a sort of “band aid” on the problem; suggesting those most at risk of overdose might push the envelope more knowing this reversal drug is available.

Both camps recommend sending a very strong message that there are consequences to using Naloxone (e.g., you might not get the drug soon enough and will suffer from a prolonged lack of oxygen). Emergency medical personnel should be trained to provide a brief intervention after Naloxone is used with the patient. Participants were not comfortable with letting the person go after using Naloxone. Some participants even suggested the person be court ordered to counseling.

Regardless of what side the participants took on this issue, they all said that more detoxification and rehabilitation programs need to be available for those who are ready. Many participants shared their personal story or the story of a loved one who suffered through a prolonged wait to get into a program. Both sides suggested that if there were fewer barriers to accessing treatment services, there would be less need for and use of Naloxone. The help needs to be immediate. When a person with an addiction decides to get help, it needs to be available.

Campaign Visuals and Concepts

At the end of each focus group discussion, participants were asked to review and rate a sample display or mood board of campaign materials. A variety of taglines, symbols, fonts, photographs and color schemes were presented to the participants. They were asked what they liked and did not like about each sample. The feedback and suggestions were incorporated into the subsequent version of moods to be presented at the next focus group. The early sample of the material is in the appendix section of this report. The participants emphasized they wanted a central number to call for resources, they liked the images of a variety of people, they liked the Celtic symbol that represented renewal (even though most did not know its meaning), they liked the tagline “Anyone. Anytime”. They wanted to add NH, so people would see it as a NH-specific campaign.


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Campaign Branding and Design Mood Boards

Based on the formative research CHI developed the first drafts of the visual and content elements of the campaign. The visuals and content were compiled into two themes and spread across four mood boards. A mood board is a type of collage consisting of images, text, and samples of objects in a composition. They may be physical or digital, and can be “extremely effective” presentation tools.34 Graphic designers use mood boards to visually illustrate the style they wish to pursue. In short, mood boards are not limited to visual subjects, but serve as a visual tool to quickly inform others of the overall “feel” (or “flow”) of an idea. In creative processes, mood boards can balance coordination and creative freedom.35

As part of the formative research phase, CHI tested the two themes spread across four mood boards. The themes were “Change the story” and “Anyone.Anytime.NH.” and each theme had two mood boards consisting of draft logos, color palettes, social media icons, relevant photos, images, illustrations, typography fonts, taglines, and an example of campaign material if that particular mood board and theme were used for the campaign. After testing the four mood boards it became apparent that the “Anyone.Anytime.NH.” theme, along with specific elements mentioned earlier, was the clear winner. This feedback was incorporated into one mood board (attachments) and vetted one last time. Finally, this vision was presented at a BDAS stakeholder meeting on September 10, 2016, where the campaign elements were approved. Final mood board attached. The resulting campaign is entitled, Anyone.Anytime.NH. The campaign materials were launched at a press event on September 29, 2016 where Governor Margaret Hassan laid out a presentation of the state’s short- and long-term comprehensive approach to combatting this life threatening epidemic.

Media Buy and Campaign Activities

The Anyone. Anytime. NH Opioid awareness media campaign was developed, tested and implemented statewide. Additionally, the CHI facilitated media events, took part in statewide conferences and awareness events, and facilitated the disbursement of naloxone kits to community health centers and partners as well as developed a paid relationship with 211 to drive opioid inquiries to the treatment locator site: www.nhtreatment.org. During the campaign, there was significant local and national conversation surrounding the opioid epidemic, the evaluation below measures process and outcome for measures attributable to campaign activities.

Results of the media campaign and CHI activities were measured after the three-month period by:

• number of focus groups conducted;

• materials distributed;

• increased number of earned media articles with mention of the Anyone.Anytime.NH campaign;

• number of inquiries to 211 on opioids;

• activity on and traffic to the NH Alcohol and Drug Treatment Locator website;

• owned media, such as organic social media activity on Facebook and Twitter and Anyone.Anytime.NH.org,

• searches on DrugFreeNH.org; and

• impressions, reach and frequency of the paid media campaign.

34 Wyatt, Paul (27 January 2014). "How to create mood boards: 40 pro tips and tools". Creative Bloq.35 Endrissat, N., Islam, G., & Noppeney, C. (2015). Visual organizing: Balancing coordination and creative freedom via mood boards. Journal of Business Research.http://doi.org/10.1016/j.jbusres.2015.10.004


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Impressions are the number of times your audience sees your advertising message. Reach refers to the number of individuals within your target market that are exposed to a specific ad over a specific period of time. This number is expressed as a percentage of your total market (a typical goal is 70% of your target audience market). Frequency refers to the number of exposures those individuals got to your specific ad over the same specific period of time (a typical goal is three times).

Earned Media and Additional Activities

After the Anyone.Anytime.NH campaign was launched, there were three online news stories that covered the campaign. On September 29, 2015, CHI coordinated a press conference, press kit, and posters; for the event, 558 Purple Flags were displayed on the NH Statehouse lawn representing the number of people who had died of an overdose from January 1st, 2014 to September 28, 2015, and two media stories were run on the purple flag event held on the capitol lawn. NH1 News presented an hour-long special, “Killer High: Crisis in the Granite State” detailing the Heroin Epidemic in New Hampshire on Wednesday, November 4, 2015 from 9pm-10pm with a re-broadcast November 8, 2015 from 7pm-8p. Killer High was sponsored by this campaign via paid TV advertising. In addition, there were a variety of TV and radio interviews including but not limited to round table discussion with NH’s former Drug Czar, John Wozmak, J.D., exclusive interviews with Governor Maggie Hassan, members of various Police Departments & more.

CHI created the promotional materials (pull-up banners announcing free naloxone), and created educational information on how to administer naloxone as part of the planning committee.

List of NH Community Health Centers who received Free Naloxone Banners

1. White Mountain Community Health Center

2. New London Hospital Association

3. Tim Soucy – Manchester (?)Health Department

4. Manchester Community Health Office

5. Lamprey Healthcare

6. Indian Stream Healthcare

7. Harbor Homes Inc.

8. Goodwin Community Healthcare

9. Families First of Greater Seacoast

10. Coos County Family Health Services

11. Concord Hospital Family Health Care

12. Ammonoosuc Community Health Services

• 1,820 kits naloxone kits distributed by NH community health centers and other NH human service agencies.

• 48,954 Materials distributed to NH communities (Pull-Up Banners, Posters, and Rack Cards)

• 2,711 naloxone kits – state purchased

CHI created materials and promoted the events online through www.anyoneanytimenh.org and Facebook. CHI staff created educational information on how to administer naloxone as part of the planning committee. CHI staff remained on this committee through March 2017.


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Engagement of NH Partners

At the request of the NH DHHS BDAS, CHI, the state contractor for the NH Center for Excellence, coordinated the distribution of funds through subcontracts to engage partners around the state in the ongoing statewide opioid awareness efforts.

Granite State United Way – 211 – Subcontract as a resource contact for people experiencing addiction and their friends and family

CHI contracted with Granite State United Way – 211 (GSUW), for $50,000, to provide a telephone and online resource contact for NH residents experiencing addiction; parents, family and friends of those experiencing addiction; health care, safety, and other system staff working with people who may be experiencing addiction; and those most at risk of overdose and death. Under this agreement, CHI staff provided specific training to 211’s information and referral specialists on the nature of addiction, the types of information and support often sought by those experiencing addiction and their families; and on resources available. GSUW was responsible for increasing staff coverage of the 211 line for the anticipated increase in calls related to the opioid crisis; tracking after-hour calls handled by the NH211 answering service and collecting and reporting on substance misuse-related calls relative to call volume, change in volume (week and month comparisons), and demographics of callers and nature of calls. NH211 reported that they received 76 telephone calls related to the NH Opioid crisis from September 2015– January 2016.

New Hampshire Public Health Association (NHPHA)

CHI coordinated a community awareness and engagement opportunity across the state. CHI worked through a $15,000 subcontract agreement with NHPHA to promote a film screening and community event among regional public health networks (RPHNs). CHI purchased the royalty rights to show several thought-provoking films that addressed the complex issue of opioid addiction to the RPHNs who were encouraged to host the film screening along with a panel discussion of local experts or naloxone distribution event.

CHI created a simple application and fact sheet to recruit RPHNs to participate in this opportunity. The RPHNs received a small stipend to cover event-related expenses. Community groups showed the following films:

• The Anonymous People

• Hungry Heart

• Killer High: Crisis in the Granite State, NH1 special investigative report

• The Opiate Effect

Below is a list of the nine organizations that received funding from NHPHA to host a film screening and community event. The events ran through April 30, 2016.

New Hampshire RPHNs:

1. ALL Together - DHMC- Upper Valley RPHN

2. North Country Health Consortium – North Country RPHN

3. Sullivan County Public Health Network – Sullivan County RPHN

4. Partnership for Public Health – Winnipesauke RPHN

5. Makin’ It Happen Coalition for Resilient Youth – Greater Manchester RPHN

6. Communities for Alcohol and Drug Free Youth – Central NH RPHN

7. Greater Monadnock RPHN

8. Seacoast RPHN

9. Bow/Dunbarton Community Wellness Coalition – Capital Area RPHN

CHI created the following forms to organize and promote these events:


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• Application for Funding

• Event Fact Sheet

• Press Release

• Community Announcement

• Event Guide with tips on hosting a successful event

• Sign-in Sheet

• Event Agenda

• Event Evaluation

• ▪ Event Tickets

NH Governor’s Office - coordinated with Governor Maggie Hassan’s Office for 9/28/16 Press Conference. Materials are in attachments

Geovision – CHI subcontracted with Geovision for web support to provide technical website support for www.anyoneanytimenh.org

Table 4: Media Buy for Phase I 9/28/15 - 1/6/16 (some media extended to 1/17/2016)

Media Phase I (9/28/15 - 1/17/2016)





Mall Kiosk Ads 14 ads, population 5,209,773

Online/mobile (3 sites: DrugFreeNH.org, NHTreatment.org, 211.org )


NHTreatment.org Combined above

DrugFreeNH.org/anyoneanytime 9/1/16 - 10/19/16

N/A

AnyoneAnytimeNH.org Launched: 10/19/16

N/A

Twitter Since 9/1/16: 348 Profile visits, 27 New followers, 7 Mentions, 6,622 Impressions (Impressions are how many times your tweet has been seen). @AnyoneAnytimeNH has 170 total followers



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Television - Statewide local and cable television ads were purchased on WMUR/MeTV, Comcast and Binnie-TV for $103,592; this purchased 6,344 ads targeting New Hampshire residents 18-35 years of age. About 50% of this population was reached more than three times; additionally, those in the viewing audience beyond the target age range (18-35) were also reached. This population would include: all other NH adults, emergency personnel, school and public health partners and so actual reach is much higher.

Transit - Transit ads were run in all major NH markets, $53,319 was spent on transit advertising in via ATA Transit in the cities of: Concord, Laconia, Portsmouth, Dover, Rochester, Somersworth, Newington, Greenland, Stratham, Exeter, Manchester, Bedford, service to the Manchester-Boston Regional Airport, and the Greater Nashua area, including Hudson, Merrimack, Amherst, and Milford. This advertising included internal bus advertising, and curbside, street side, shelter and station advertising (122 ads total). A population of 498,000 people who are possibly daily riders and 76,000 city residents were reached with this transit and out-of-home media buy.

Radio - A total of 19 radio stations were used to reach the target audience of residents aged 18-34 or 18-54 (some stations inherently have a broader listening audience), statewide; $152,720 was spent on 14,904 radio advertisements (this budget includes radio web advertising and online streaming for some stations, this will be detailed in the following paragraph). Because of the prohibitive costs associated with membership to Nielsen and their rating system, a number of New Hampshire radio stations do not subscribe and are, therefore, unable to give reach and frequency. However, with frequently small broadcast areas with niche markets, these stations are of value to reach these markets.

Online/Mobile - The cost of online/mobile advertising and streaming with both television & radio stations is included in the radio and television budgets above. In additional to web advertising and online streaming for some stations, media package buys included: , E-blasts, blog posts, on-site promotion, feature sponsorship, and interviews on multiple stations for increased visibility and reach which is not quantified here. Online/mobile advertising was placed with NH1.com, WMUR.com, and Xfinity.com; average monthly visits for all three sites combined are < 1,665,845.

Newspaper - Multiple statewide, daily and weekly newspapers were used to carry the Anyone.Anytime.NH campaign, a total of $23,147 was spent on 104 ads reaching 24,316 people. Ads ran for 16 weeks in the: Newfound Landing, Winnisquam Echo, Baysider, and the Berlin Reporter and the Gilford Steamer, 16 weeks in the Union Leader, 16 weeks in the Concord Insider, 20 weeks in the Hippo Press, four weeks in the Seacoast Scene, 16 weeks in the Kearsarge Shopper and 16 weeks in the Suncook Valley.

Mall Kiosk – Fourteen backlit display panels of Anyone.Anytime.NH ads were placed at: the Mall of New Hampshire, the Pheasant Lane Mall, and the Mall at Rockingham Park for eight weeks. The average monthly visits to these NH shopping malls are 5,209,773; total ad cost for malls was $37,800.

The primary social media tools used within this campaign were Facebook and Twitter. The Facebook page can be found at https://www.facebook.com/AnyoneAnytimeNH; the Twitter account can be found at https://twitter.com/anyoneanytimenh.

CHI utilized both new and traditional communication channels to educate the public on laws regarding the use of naloxone as well as expanding the reach of information and resources. We also used these channels to listen, learn from, and engage with our audiences. By doing so, we stay abreast of the conversation, enabling us to respond, as needed, with a tweet, comment, or timely blog post that addresses the concerns and information needs of our audiences. Listening allows us to have a better understanding of our audiences and what they are saying, and informs us of relevant and timely content for our communications. Goals set for social media were:

• Facebook: Post at least twice daily, Monday through Friday,

• Twitter: Post at least once daily, Monday through Friday,


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• Share posts from other relevant pages and individuals on the Anyone.Anytime.NH Facebook page on an as-discovered basis,

• Retweet posts from other relevant organizations and individuals on the Anyone.Anytime.NH Twitter feed,

• Upload video content on YouTube as needed and promote via social media,

• Monitor all live posts for content and comments and respond as appropriate, and,

• Address any negative comments and/or hide/remove posts that violate the policy.

Facebook & Twitter - Result of the Anyone.Anytime.NH Facebook activities were an average daily reach of 3,318 people, average weekly reach of 15,971 people, 13.5 average shares/month (organic, not paid), and 533 likes generated during campaign (currently there are 613). The Anyone.Anytime.NH Facebook page demographics were 78% Female/22% Male. For Twitter, there were 90 followers during campaign (currently there are 118), 51 link clicks, 77 retweets, and 30 likes. The conversation around the opioid crisis was an active online conversation. It allowed for engaging organic social media activities and, therefore, we did not need to purchase social ads.

In addition to websites we currently review for news and content, CHI actively sought out organizations on Facebook aligned with our mission, monitoring their content for information relevant for our campaign. When appropriate, we interacted with their pages via likes, sharing their content, and commenting. By engaging with their pages we hoped to let them know we are actively listening, and actively available for partnership and other opportunities to address the opioid crisis in New Hampshire.

CHI developed content that was easily sharable and include a “call to action.” Although content is meant for the general public, messages may be relevant to a specific segment of the target audience (e.g., addicts, friends/family of addicts, those in recovery, providers). Whenever possible, current events and national health observances are integrated into our posts. CHI still maintains the Anyone.Anytime.NH Facebook and Twitter accounts in order to continue the momentum and conversation.

Phase I: Most popular Facebook Post 10.9.15

Most popular Facebook post from 10.9.15 reached 5,513 people, had 342 likes, comments and shares, and 555 clicks.


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DrugFreeNH.org - (Aug 1, 2015 Jan 31, 2016) The NH Department of Health and Human Services (NHDHHS) operated the site, drugfreenh.org., which housed the Anyone.Anytime.NH landing page. The web address promoted in the Anyone.Anytime.NH campaign, anyoneanytimenh.org, brought visitors to a page on this site: http://drugfreenh.org/anyoneanytime. During the campaign, there were 11,918 visitors to the site, 74% of which were new visitors, the majority of visitors (6,002) were from NH and then Massachusetts (1,279). People visited the site most from the following cities: Concord (1,395), Manchester (695), and Nashua (315), and average time on the site per session was high, ranging from two to over three minutes. Top pages viewed are listed below in the figure 1, which indicates the home page of the site). Visitors entered the site (the page they were driven to) on Anyone.Anytime.NH content about 33% (3,844 visitors) of the time.

Figure 1

www.nhtreatment.org - The NH Alcohol and Drug Treatment Locator was officially launched on January 5, 2015. A press release was issued. Task forces, various organizations, groups, and associations were made aware of this website through dissemination of promotional materials, announcements and other forms of communication to inform people of this resource. Additionally, the Anyone.Anytime.NH campaign referenced this directory as a resource from September 2015 through December 2015. At the end of Phase I, there were 8,483 unique visits (new visitors) and 10,720 total sessions on the website. The figure that follows shows visits by the referring source and what percent of new visitors each represented for the time period of Sep 1, 2015-Jan 17, 2016.

Figure 2


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PHASE II - ImplementationIn response to the steady continuation of overdose deaths from opioids, the State of New Hampshire (NH), Bureau of Drug and Alcohol Services (BDAS), funded Phase II of their statewide public awareness campaign, Anyone.Anytime.NH™ (AOAT), for the general public, caregivers and health care professionals. Concurrently, CHI trademarked the term Anyone.Anytime.NH™. Specifically, the trademark language describes the trademark as: “The words ANYONE ANYTIME (Quad celtic symbol in black). The upper letters ANYONE in turquoise Billiebarred font. ANYTIME New Hampshire = Century Gothic font. This mark applied to flyers, websites, print materials, media materials, bus ads, billboards, TV ads.”

At the onset of the Phase II AOAT campaign, BDAS requested that CHI reach out to the four original campaign participants to initiate a discussion about continued campaign representation. CHI received permission from all four participants to continue to use their likeness in campaign materials (printed and on-air) and one participant requested that they not be used on out-of-home materials (like bus shelters). For Phase II, CHI created additional images for materials using focus-group-tested images

The evaluation of the AOAT campaign was focused on process and short-term outcome measures. One limitation of the evaluation was that the funds for the campaign were focused on getting the key messages to the target audiences in a timely manner and not for the evaluation of resident’s knowledge, attitudes and beliefs around opioids/addiction/campaign messages or ad recall for the Anyone.Anytime. NH™ campaign.

Engagement of NH Partners

CHI promoted the services of the NH Statewide Addiction Crisis Line (Crisis Line), which is funded by NHDHHS with the strategic goal of providing streamlined coordination between Regional Access Point Services (RAPS) Providers, 211-NH, and the Crisis Line. The 24 hours a day, seven days a week Crisis Line began taking calls on May 10th, 2016. The Crisis Line provides information on services to callers from a wide range of treatment options throughout NH. These options include private- and state-funded treatment options, as well as peer support and other services. These resources are updated constantly by Crisis Line staff.

The Crisis Line is staffed 24/7 by Certified Recovery Support Workers (CRSWs), and all calls are answered by a live person. The Crisis Line assists callers who are experiencing an addiction-related crisis. CRSWs assist callers in determining what level of treatment would be appropriate for them, discuss different types of treatment options that are available, provide options specific to their location, provide options for interim services, explain the process of different treatment paths, and provide support and advice to callers. In addition to providing appropriate referrals based on callers’ substance-use related crises, CRSWs also assess psychological stability and risk of harm to self or others.

Recently the Crisis Line began receiving calls directly from 211 NH’s voice menu system, enabling individuals experiencing a substance-use related crisis to be directly transferred to the Crisis Line seamlessly.

In the event of an emergency, a Licensed Alcohol Drug Counselor (LADC) is available on site or on-call 24/7. This counselor works closely with the CRSW to provide assistance in all areas of the state. The Crisis Line assists any person experiencing an addiction-related crisis. This incudes, but is not limited to, the person directly seeking treatment and support, parents and other loved ones who


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know someone suffering from a substance-use disorder, and health care providers reaching out on behalf of their patients. During Phase II of Anyone.Anytime.NH™ (9/1/2016 to 2/28/2017) the Crisis Line received a total of 1,798 calls.

Media Buy and Campaign Activities

Results of the Phase II media campaign and CHI activities were measured after the five-month period by:

• materials distributed;

• activity on and traffic to the NH Alcohol and Drug Treatment Locator site (nhtreatment.org) and new website www.AnyoneAnytimeNH.org;

• owned media, such as organic social media activity on Facebook and Twitter and Anyone.Anytime.NH™ searches on www.DrugFreeNH.org; and

• Impressions, reach and frequency of the paid media campaign.

Earned Media and Additional Activities

CHI created materials and promoted the events online through www.anyoneanytimenh.org and Facebook. CHI created educational information on how to administer naloxone which was included in kits and is online, as well as remained as part of the planning committee through March 2017.

During Phase II a total of 20,653campaign materials were distributed to NH communities, bringing the total number of campaign materials distributed for both phases to 69,607.

Paid Media

Television and Radio – Paid television, cable and radio ads reached adults 18-34+ over four times for each person and reached over 70% of the target population as detailed in Table 1. Creative materials/ visuals from the first AOAT campaign appeared or was heard over 10,818 times.

Online/Mobile – Paid online ads appeared via Google AdWords (including search, display and YouTube advertising) and the Hearts web and mobile ad platforms with a total of 8,373,659 impressions and 117,405 interactions (clicks). The cost of streaming with both television & radio stations is included in the radio and television budgets. In additional to web advertising and online streaming for some stations, media package buys included: E-blasts, blog posts, on-site promotion, feature sponsorship, and interviews on multiple stations for increased visibility and reach which is not quantified here. All new creative/visuals were made for the online/web/mobile platforms. Paid advertising was placed on Xfinity (including on-demand, the Xfinity app and streaming) which resulted in 909,000 impressions and 71 sessions on www.anyoneanytimenh.org

Newspaper – An ad was place in the Hippo newspaper which reaches 284,965 people weekly in southern New Hampshire, the first ad ran in a special edition on addiction and recovery and ran for 20 weeks.

Social Media (Owned Media)

Facebook, YouTube & Twitter - Results of the Facebook: https://www.facebook.com/AnyoneAnytimeNH/ activities were a total of 744 likes and a reach of over 1K per post. The AOAT Facebook page demographics are 78% female/22% male, and are from NH. On Twitter, @AnyoneAnytimeNH has 170 total followers. As in Phase I, the conversation around the opioid crisis was still an active online conversation. It allowed for engaging organic social media activities, therefore, we did not need to purchase social ads.

In addition to websites we currently review for news and content, CHI actively sought out organizations on Facebook aligned with our mission, monitoring their content for information relevant for our campaign. When appropriate, we interacted with their pages via likes, sharing their content, and commenting. By engaging with their pages we hoped to let them know we are


26

actively listening, and actively available for partnership and other opportunities to address the opioid crisis in New Hampshire.

CHI developed content that was easily sharable and include a “call to action.” Although content is meant for the general public, messages may be relevant to a specific segment of the target audience (e.g., addicts, friends/family of addicts, those in recovery, providers). Whenever possible, current events and national health observances are integrated into our posts.

Phase II: Most popular Facebook Post 9.21.16 & 1.3.17

743 people were reached with this post on 1.3.17 and it got the most engagement (66 clicks and 25 reactions).

Widget – CHI created a shareable widget for partner sites to embed on their websites.

AnyoneAnytimeNH.org - (launched October 19, 2016) CHI created a new AnyoneAnytimeNH.org site for the NHDHHS in order to create a web environment with the look and feel of the AOAT campaign. As of February 25, 2017 there were 13,622 sessions by 12,066 users and 1,556 were return users. Over 1,217 users spent more than a minute on the site.

www.nhtreatment.org – (9/1/16-2/25/17) The NH Alcohol and Drug Treatment Locator had 14,586 sessions by 10,874 users, and 188 visitors from anyoneanytimenh.org (after launch of the new site). There were 64 visitors from drugfreenh.org (prior to the site transition).

Bus Transit/Shelters – New ad creative was placed in 94 bus interiors, exteriors and shelters with a reach of a minimum of 1,423,521 riders (potentially many more non-riders also saw the ads).


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Table 5. Media Measurement for Anyone.Anytime.NH™ September 1, 2016 – February 28, 2017

Media Phase II

Television/Cable Reached 86% of NH Adults Age 18-35+ an average of 4.35 times

Radio 10,198 spots reached 73.4% of NH Adults age 18-34 an average of 10.3 times

Bus Transit/Shelters 94 bus interior/exterior and shelter ads with a reach of 517,840 riders (potentially many more non-riders also saw the ads)

Newspaper HIPPO Paper Special Addiction & Recovery Issue, 20 weeks, 284,965 readers/week

Mall Kiosk Ads N/A


Separated below

NHTreatment.org 14,586 sessions by 10,874 users. 188 visitors from anyoneanytimenh.org (after launch). 64 from drugfreenh.org (prior to site transition)

DrugFreeNH.org/anyoneanytimeNH.org 9/1/16 - 10/19/16

1,587 sessions (prior to the site migration to AnyoneAnytimeNH.org)

AnyoneAnytimeNH.org Launched:

10/19/16

13,622 sessions by 12,066 users. 1,556 were return users. 1217 users spent more than a minute on the site



Facebook/AnyoneAnytimeNH.org 744 Likes, Reach of over 1K per post

On demand/streaming 909,000 impressions, 71 sessions on anyoneanytimenh.org

Hearts Web/Mobile Ad Platform 2,429,547 impressions, 812 ad clicks

Google AdWords Display, search and video (YouTube): 5,944,142 impressions, 116,593 interactions


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ConclusionAnyone.Anytime.NH™ was recognized in the 2016 U.S. Surgeon General’ Report, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health” and should be considered a successful campaign. In June 2017,“Anyone.Anytime. NH™” was recognized as an example of excellence in health communication by the National Public Health Information Coalition (NPHIC), will be promoted on www.nphic.org and will be highlighted at the NPHIC Advance Knowledge Track (AKT) session on August 14, 2017 in Atlanta, GA.In addition, the states of Alaska, Connecticut, and a County in New York have expressed interest in replicating the Anyone.Anytime.NH™ campaign in their states. While no formal evaluation has been conducted, the campaign has significant brand recognition amongst the prevention, treatment & recovery, medical, and law enforcement communities. The Anyone.Anytime.NH™ campaign could easily be reinvigorated again, repurposed, and tested for a new audience. Future iterations could be adapted and applied to other states, other substances, stigma prevention, a young adult population, or potentially targeted to a specific ethnic or social demographic. The engagement of statewide partners (Mid-Stream Audience) as a communication channel is a common strategy to reach our (Down Stream Audiences), which are our target audiences. Based on the process measures for both phases of Anyone.Anytime.NH™ it can easily be stated that this campaign reached a significant number of NH residents and engaged statewide partners. Table 1 as presented in the executive summary and below provides an overview of the paid and earned media for both Phases I and II. Table 6 provides an overview of the number of materials distributed throughout NH via statewide partners.

Table 6: Combined Media Buy for Phases I and II

Media Phase I (9/28/15 - 1/17/2016) Phase II


Reached 86% of NH Adults Age 18-35+ an average of 4.35 times


10,198 spots reached 73.4% of NH Adults age 18-34 an average of 10.3 times


94 bus interior/exterior and shelter ads with a reach of 1,423,521 riders (potentially many more non-riders also saw the ads)


HIPPO Paper Special Addiction & Recovery Issue, 20 weeks, 284,965 readers/week

Mall Kiosk Ads 14 ads, population 5,209,773 N/A



Separated below

NHTreatment.org Combined above 14,586 sessions by 10,874 users. 188 visitors from anyoneanytimenh.org (after launch). 64 from drugfreenh.org (prior to site transition)


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DrugFreeNH.org/anyoneanytime 9/1/16 - 10/19/16

N/A 1,587 sessions (prior to the site migration to AnyoneAnytimeNH.org)

AnyoneAnytimeNH.org Launched:

10/19/16

N/A 13,622 sessions by 12,066 users. 1,556 were return users. 1217 users spent more than a minute on the site



Facebook/AnyoneAnytimeNH

744 Likes, Reach of over 1K per post

On demand/streaming N/A 909,000 impressions, 71 sessions on anyoneanytimenh.org

Hearts Web/Mobile Ad Platform

N/A 2,429,547 impressions, 812 ad clicks

Google AdWords N/A Display, search and video (YouTube): 5,944,142 impressions, 116,593 interactions

Table 7: Combined Media Buy for Phases I and II

Materials Distributed AOAT Pens

Phase I 48,954 0

Phase II 20,653 5,400

Total 69,607 5,400

Phase I

General Requests 48,954

Phase II

General Requests 321 600

BDAS 424 900

RPHN and BDAS 17,099 3,900

NADACHA Training Institute 2,809

Total Phase II 20,332 5,400

Total Phases I AND II


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Material Dissemination Phase I and II:

In phase I, a total of 48,954 campaign materials were distributed to NH communities, including Pull-Up Banners, Posters, and Rack CardsIn phase II, a total of 20,332 campaign materials were distributed to NH communities, BDAS, RPHN’s, and NHADACA Training Institute. In total, 69,607 campaign materials were distributed to communities, statewide partners and BDAS.

Attachments:

Phase I1. FACT SHEET: The Facts About New Hampshire’s Heroin, Fentanyl and Other Opioid Crisis

2. Governor’s Statewide Letter to NH Providers

3. AnyoneAnytimeNHTM Campaign Products

4. Final moodboard

5. Press Kit – including visual of state’s response to Opioid Epidemic

Phase II1. Executive Summary of New Hampshire Statewide Naloxone and Distribution Training

Initiative

2. Transit Advertisements and Posters

3. Newspaper Advertisement

4. Hypertherm Foundation cards

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TM

Phase I Attachments

32

Fact Sheet

Emergency department heroin use visits have increased each year over the past several years.

“The number of heroin-related

emergency department visits during the first eight

months of 2015 is 76% greater than during the

same 8-month time period in 2014.” 4

more Facts about New Hampshire’s Heroin, Fentanyl & Other Opioid Crisis

Sources: 1 New Hampshire Medical Examiner’s Office2 National Survey on Drug Use and Health (2012-2013)3. New Hampshire Department of Health & Human Services4 New Hampshire Drug Monitoring Initiative, August 2015 Report5 Bureau of Emergency Medical Services

Anyone. Anytime. is a statewide public awareness campaign designed to educate the public about the heroin epidemic impacting NH and inform caregivers, healthcare providers and those seeking help for their addiction about treatment and recovery resources.

AnyoneAnytimeNH is an initiative of the New Hampshire Department of Health and Human Services

There was a 70% increase in heroin-related emergency room visits from 2013 to 2014.3

1,115Emergency Room Visits

2013 2014

654Emergency Room Visits

The number of indicences of naloxone administration by EMS increased by 83% from 2013 to 2014.5

1,921Naloxone

Administered by EMS

2013 2014

1,050Naloxone

Administered by EMS

Drug-related overdose deaths are not just an issue faced by young adults. All adult age groups are impacted by this crisis.

20-2

9

77

30-3

9

79

40-4

9

66

50-5

9

77

60+

19

Drug Overdose Deaths by Age Group* (2014)1

*These data do not include deaths for those under 20 or from out of state

The Facts about New Hampshire’s Heroin, Fentanyl & Other Opioid Crisis

US9.5% NE

8.6%

NH10.5%

Past Year Non-Medical Use of Rx Pain Relievers (2014)2

Past year Dependence & Abuse of Illicit Drugs (2014)2

US6.9%

NE7.0%

NH10.0%

Past month Non-Marijuana Illicit Drug Use (2014)2

IllICIT DrUg USE AmONg YOUNg ADUlTS

Young adults (18-25 years of age) are using prescription painkillers non-medically at higher rates in NH (10.5%) than the average of other states in the northeast region* (8.6%) and the rest of the nation (9.5%).

Young adults are dependent on and abusing illicit drugs at a higher rate in NH (9.4%) than the average of other states in the northeast region* (8.0%) and the rest of the nation (7.6%).

Young adults are using non-marijuana illicit drugs at a significantly higher rate in NH (10.0%) than the average of other states in the northeast region* (7.0%) and the rest of the nation (6.9%).

US7.6%

NE8.0%

NH9.4%


According to the National Survey on Drug Use and Health, NH ranks as one of the highest in the country for illicit drug use (other than marijuana) among 18 to 25 year olds.

Ninety-one percent (91%) of overdose deaths are opioid related. Fentanyl has been a factor in nearly two-thirds (130) of this year’s 211 opioid deaths to date.

There have been 558 drug-related overdose deaths in NH from January 1, 2014 through September 18, 2015.1

As of September 18, 2015, on average, nearly one person a day (27 per month) has died from a drug related overdose in 2014 and 2015.1

Drug overdose deaths in NH since Jan. 20141558

NEArlYONE pErSON DIES

FrOm A DrUg OvErDOSE

EvErY DAY IN NEw HAmpSHIrE1

*Northeast Region includes: CT, MA, ME, NH, NJ, NY, PA, RI and VT.

84.8%Overdose

Deaths due to Heroin orFentanyl

In 2014, 70.3% (206) of the 293 opioid overdose deaths were caused by heroin or fentanyl; this has increased to 84.8% (179) of the 211 opioid overdose deaths in 2015 so far.1

70.3%Overdose

Deaths due to Heroin orFentanyl

2014 2015

33

Governor’s Statewide Letter to NH Providers

34

Do you know someone at risk for a Drug overDose?

Talk to the staff about free naloxone* kits to take home. Naloxone can be used by anyone at anytime in an overdose situation. Always call 9-1-1 first and perform rescue breathing.

N E W H A M P S H I R E*Naloxone is a special medication

that temporarily reverses the effects of opioid overdose.

NH DEPT. OF HEALTH AND HUMAN SERVICES


www.drugfreenh.org www.nhtreatment.org

Can experience addiction • Can ask for help • Can recover

Can save a life

free naloxone kits are available here

Clinic Rack Card and Poster

Talk to the staff about free naloxone* kits to take home. Naloxone can be used by anyone at anytime in an overdose

rescue breathing.

Do you know someone at risk for a Drug overDose?

free naloxone kits are available

here

35

I thought I was above heroin addiction. I had a college degree, a loving family, dreams and abilities. every

actions. At the end, I couldn’t lie to myself anymore. I was addicted, defeated and waiting to die. I fINALLY ASKeD fOr HeLP and slowly got my life back.

anyone, anytime Can reCover.

fOr HeLP: NH Alcohol and DrugT R E A T M E N T L O C A T O R

www.nhtreatment.org



As the parent of a son with a substance use disorder, I know how important it is to GeT eDUCATeD about addiction, enabling, codependency and recovery.

More importantly, if your family is impacted by this disease please fIND SUPPOrT for yourself and loved ones.

Also, ask your doctor for a prescription for NALOXONe. It can save the life of someone experiencing an opioid overdose from heroin or prescription medications.

Anyone Anytime should have access to this lifesaving medication.

anyone, anytime Can ask for HeLP.


www.nhtreatment.org



We’re working directly with people and their families who are suffering from substance misuse by bridging the gap between law enforcement, treatment and recovery. Under the new GOOD SAMArITAN LAW, there will be no arrest for possession or use of a controlled substance if you are helping someone in an overdose situation.

anyone, anytime Can save a Life.


www.nhtreatment.org



A NH law passed in June allows NH healthcare providers to write prescriptions for naloxone for anyone at risk for an opioid overdose or for a friend or family member. NALOXONe CAN Be A LIfe-SAVING MeDICATION in the event of an overdose of heroin, fentanyl or prescription pain relievers after calling 911 and rescue breathing.Please talk with your primary care clinic today about a naloxone prescription for yourself or a loved one. Anyone Anytime can have access to this lifesaving medication.

anyone, anytime Can aCCess naLoXone.


www.nhtreatment.org



AnyoneAnytimeNHTM Campaign Products

36

ANYONE, ANYTIME CAN ASK FOR

NH Alcohol and DrugT R E A T M E N T L O C A T O R

www.nhtreatment.org

FOR HELP:

AnyoneAnytimeNH is an initiative of the New Hampshire Department of Health and Human Services.


TM

Can experience addiction • Can ask for help Can recover • Can save a life

For anyone looking for help with addiction, recovery is real, it’s great, it’s available...TODAY.

www.anyoneanytimenh.org

37

It can take many tries to find the right help at the right time. Don’t stop

trying. Help is out there.

ANYONE, ANYTIME CAN EXPERIENCE ADDICTION.

FOR HELP:



www.nhtreatment.org

N E W H A M P S H I R ECan experience addiction • Can ask for help

Can recover • Can save a life


38

For help:



www.nhtreatment.org



Anyone, Anytime cAn sAve A life.

A new law in New hampshire allows any family member or friend of someone at risk of an opioid overdose to be prescribed naloxone, a medication to use after calling 911 and starting rescue breathing to help prevent an overdose death. Ask your doctor today about naloxone for yourself or a loved one. You can also visit anyoneanytimenh.org to find a list of settings providing community access to naloxone kits.


39

NH’s new Good Samaritan law protects from arrest or prosecution anyone trying to get medical help for themselves

or another person experiencing a drug overdose.Please always call 911 for emergency services if you

think someone is experiencing a drug-related overdose.

For HelP: NH Alcohol and DrugT R E A T M E N T L O C A T O R

www.nhtreatment.org


Anyone, Anytime cAn SAve A life.




40

ANYONE, ANYTIME CAN RECOVER

NH Alcohol and DrugT R E A T M E N T L O C A T O Rwww.nhtreatment.org

FOR HELP:

An initiative of the New Hampshire Department of Health and Human Services.




Can experience addictionCan ask for helpCan recoverCan save a life

41

Transit Advertisements

42

IF YOU USE HEROIN OR OTHER STREET DRUGS, PLEASE CONSIDER THESE FACTS;• Fentanyl’spotencyvariessomuchthatnoamountissafe.• SnortingFentanylisjustaspotentiallydeadlyasshootingit.• Fentanyl is being sold as or cut with heroin, leading to the majority of

overdose deaths in the state.• Fentanylisbeingpressedintopillformandsoldasoxy,again,witha

widerangeofpotency.• Drugusewithneedlesposessignificanthealthandinfectiousdisease

risks,suchasHIVandotherinfectionsthatoftenrequirespecialmedicalattention.

• Naloxoneisavailablethroughyourdoctorandthroughcommunityhealthclinicsinthestate–visitanyoneanytimenh.org

• Rememberthatrecovery is always possible for anyone, anytime.


www.nhtreatment.org www.anyoneanytimenh.org


Please call 211 or visit nhtreatment.org to find help near you.

FENTANYL...NEW HAMPSHIRE’ DEADLIEST STREET DRUG

w


Overdose reversal medication (naloxone/Narcan) is available by prescription for ANYONE concerned about someone's overdose risk. Ask your doctor or pharmacist about a prescription or visit anyoneanytimenh.org for a list of community health centers with free naloxone for patients and loved ones.

Recovery is possible. Talk to your doctor, visit nhtreatment.org, or call 211 to find an outpatient counselor for an assessment.

Community and family support groups are also available at nhtreatment.org under the Resources tab.


Can experience addictionCan ask for help Can recover Can save a life

Addiction treAtment And recovery resources

Mental Health Hotline: 1.800.273.TALK

Emergency: 911

www.nhtreatment.org


For resources and services, visit nhtreatment.org or call 211


w




www.nhtreatment.org



Emergency Services Business Card

Informational/ Educational Cards

43

INTRA

NA

SAL N

aloxone

What to do if you suspect an opioid drug overdose:

1. Call 911

All you have to say: “Someone is not responsive and I can't seem to wake them.” Give clear address and location.

2. Rescue Breathing

Make sure the airway is clear and nothing is inside the person’s mouth. Using a barrier protection for your mouth, tilt head back, seal your mouth over the person's mouth, pinch nose, and breathe, making chest rise. If you do not use a barrier for your mouth, follow up with a medical professional to address possible risk exposure.

4. Continue Rescue BreathingContinue 1 rescue breath every 5-6 seconds until the person awakens or first responders arrive.

3. Give Naloxone

Get naloxone and prepare it quickly so the person won’t go for too long without your breathing assistance. A second dose may be needed.

How to give Nasal Naloxone

Insert white cone into nostril; give a short, vigorous push on end of cap-sule to spray one half of the capsule of naloxone into each nostril.

Push to spray.

5

If no reaction in 3-5 minutes, give the second dose.6

Pull or pry off yellow caps1PLASTIC TUBE

Pry off red cap2

NALOXONE

4 Gently screw capsule of naloxone into barrel of tube.

3 Grip clear plastic wings. Gently screw to connect.

Call 211 for more information and referral resources or go to 211nh.org

Find information on alcohol and drug treatment and recovery support services at nhtreatment.org

RT R E A T M E N T L O C A T ONH Alcohol and Drug

Signs of an overdose:• Not responsive/can’t wake up• Body is limp• Blue/dark purple fingernails and lips• Breathing is slow or stopped• Pulse is slow or stopped• Snore-like gurgling noise• Awake, but unable to talk

Can experience addiction ● Can ask for help ● Can RecoverCAN SAVE A LIFE

If a hypersensitivity to naloxone is or becomes evident, cease naloxone administration and continue rescue breathing until first responders arrive.

Naloxone Instructions

44

FREQUENTLY ASKED QUESTIONS (FAQS) ABOUT NH NALOXONE ACCESS LAWS

The following questions and answers have been prepared and reviewed by several work groups associated with the Opioid Task Force of the NH Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery. Members of these work groups have included senior staff of the NH Medical Society, the NH Board of Medicine, the NH Board of Pharmacy, and the Attorney General’s Office.

LEGAL AND REGULATORY FAQSQ1. Do these laws mean anyone can come to a pharmacy

to fill a prescription for a medication even though they intend to administer the medication to someone else?

A. Yes. People are permitted to access naloxone to have on hand for a friend, family member, or anyone that may be at risk of an overdose.

Q2. Can a doctor write multiple prescriptions for the same person?

A. Yes. The law does not limit the number of naloxone kits that a person can be prescribed, and pharmacies should dispense that number unless limited by supply but fill as soon as adequate supply is available.

Q3. Is the NH Board of Pharmacy aware of and supportive of this legislation?

A. Yes. The NH Board of Pharmacy has been actively involved in review and interpretation of these laws and encourages all pharmacists and pharmacies to support naloxone access as stipulated by law.

Q4. Is there more that pharmacies can do to be prepared for an increase in people filling prescriptions for naloxone?

A. Yes. One important thing that pharmacies can do is to consider partnering with a prescriber to establish a standing order so that people can request naloxone directly from the pharmacy to maximize timely access.

Q5. Am I protected from liability if the naloxone I’ve dispensed-prescribed ends up being used in a way other than prescribed or explained or in a way that causes harm?

A. Yes. The laws were designed to protect prescribers and dispensers while allowing the widest access possible for the general public.

ClINICAL FAQS Q6. Are there different forms/concentrations of naloxone that

are available for dispensing and use? A. Yes, naloxone is available in three forms: 1) intranasal via

atomizer using prefilled syringes; 2) intramuscular using a syringe and needle; and 3) an IM autoinjector with audio instructions.

Intranasal form (2mg/2ml) requires the dispensing of the medication AND the dispensing of the mucosal atomizer device.

Injectable form (0.4mg/ml) requires the dispensing of the medication AND a syringe with a 23 g 1-1.5 in needle to administer.

Auto-injector forms are pre-loaded (1ml dose dispensed as a single use or multi-dose vial).

Q7: For whom is a prescription for naloxone indicated? A: Anyone at risk of an opioid overdose or concerned

about someone at risk for overdose due to opioid misuse or taking an opioid for pain management.

Q8. What are the risks of naloxone? A. Naloxone is not a controlled drug and carries very

minimal risk, even if administered to someone who is not experiencing an opioid overdose.

FAQ for PHARMACISTS Relative to HB 270 & 271



w w w . n h t r e a t m e n t . o r g


45

FREQUENTLY ASKED QUESTIONS (FAQS) ABOUT NH NALOXONE ACCESS LAWS

The following questions and answers have been prepared and reviewed by several work groups associated with the Opioid Task Force of the NH Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery. Members of these work groups have included senior staff of the NH Medical Society, the NH Board of Medicine, the NH Board of Pharmacy, and the Attorney General’s Office.

LEGAL AND REGULATORY FAQS Q1. May I prescribe naloxone to anyone, regardless of whether

or not they are a patient of mine? A. Yes. There is no requirement that there be a prescriber-

patient relationship. The Board of Medicine has issued a statement on naloxone prescribing. (See policies at http://www.nh.gov/medicine/documents/naloxonestatement.pdf)

Q2. Can I write a prescription for naloxone to someone regardless of whether or not the person intends to use it for him/herself or for someone else?

A. Yes. The law is intended to provide access to anyone who may be in a position to help someone experiencing an opioid-related overdose.

Q3. Can I write more than one prescription to one person? A. Yes. Friends, family and community leaders may be

interested in distributing naloxone to other family members or friends. This is allowed under the law. The prescription is written to the individual requesting the medication.

Q4. Am I protected from liability if the naloxone I’ve prescribed ends up being used in a way other than prescribed or explained or in a way that causes harm?

A. Yes. The law provides protection from civil, criminal and professional liability to the prescriber, dispenser and administrator of naloxone in the interest of allowing the widest access possible for the general public.

Q5. What does a ‘standing order’ mean in reference to these laws?

A. The Attorney General has indicated that the law allows for standing orders, which means that a licensed medical provider can have a prescription on file at any pharmacy that will allow pharmacists to dispense naloxone to ANYONE requesting it. This will facilitate the widest possible access to naloxone for the general public. The Board of Medicine is approving and posting a standing order template that will be available under “Announcements and Notices” at www.nh.gov/medicine.

Q6. What are my responsibilities for education of persons receiving a prescription for naloxone?

A. Along with the prescription, prescribers must provide brief instructions that include recognition of opioid overdose, the need to call 911 and to provide rescue breathing, and the administration of naloxone. A standardized instruction sheet is forthcoming and will be available for downloading at the NH Board of Medicine. Dispensers/pharmacists are responsible for in-person education and consultation regarding use.

CLINICAL FAQSQ7. What do I need to know about the different

available forms of naloxone? A. Naloxone is available in three forms: 1) intranasal via

atomizer using prefilled syringes; 2) intramuscular using a syringe and needle; and 3) an IM autoinjector with audio instructions.

Intranasal form (2mg/2ml) requires the dispensing of the medication AND the dispensing of the mucosal atomizer device.

Injectable form (0.4mg/ml) requires the dispensing of the medication AND a syringe with a 23 g 1-1.5 in needle to administer.

Auto-injector forms are pre-loaded (1ml dose dispensed as a single use or multi dose vial).

Q8: For whom is a prescription for naloxone indicated? A: Anyone at risk of an opioid overdose or concerned about

someone at risk for overdose due to opioid misuse or taking an opioid for pain management.

Q9. What are the risks of naloxone? A. Naloxone is not a controlled drug and carries very

minimal risk, even if administered to someone who is not experiencing an opioid overdose.

Q10. How should prescriptions for naloxone be documented? A. If the prescriber has an established clinical relationship with

the recipient of a naloxone prescription, documentation should be made in the medical record. If there is not an established prescriber/patient relationship, the Board of Medicine will have forthcoming recommendations regarding documentation.

FAQ for PRESCRIBERS Relative to HB 270 & 271





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Campaign Title

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Anyone. Anytime. Color Palette

Anyone. Anytime. Inspiration Visuals

Anyone. Anytime. Typography Anyone. Anytime. Taglines Anyone. Anytime. TaglinesTV Advertisement Ending Screen

Can experience addiction • Can ask for help • Can recover

CAN SAVE A LIFEwww.anyoneanytimenh.org

Audience:

General Public

Concept/social media

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o Can experience addiction

o Can ask for help

o Can recover

o Can save a life

Header SampleTanuki

Sub HeadingCentury Gothic Bold

Body TextCentury GothicBody Text Sample: Lorem ipsum dolor sit amet, con-sectetura dipisicing elit, sed do eiusmod tempor inci-didunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nos modo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Ex cepteur sint occaecat cupidatat.


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To: OPIOID AWARENESS RESPONSE PRESS CONFERENCE PARTICIPANTS

From: NH Center for Excellence

Date: September 29, 2015, 11:30 am, State House

Re: ACTION REQUESTED relative to Naloxone Access and Availability and House Bill 270 , an act relative to possession and administration of an opioid antagonist for opioid-related overdoses.

The purpose of this memo is to provide information to participants in the Opioid Awareness and Response Campaign Press Release to support a common understanding of the goals of the conference, the role of each participants, and the materials and resources that will be available and/or referenced during the press conference.

I. GOALS OF THE PRESS CONFERENCE1. To provide a clear message of the state’s comprehensive efforts to address the opioid and overdose

crisis in the state; and

2. To highlight for the media and the general public three important components of the state’s comprehensive efforts:• Two new laws to support access to overdose prevention• Access to overdose reversal medication, naloxone, through health centers and community events

this fall• The new state-wide public awareness and education campaign, Anyone.Anytime.

II. AGENDA OF SPEAKERS AND TALKING POINTSThe following is a list of anticipated speakers, their allotted time, and a broad overview of their topic area. More detailed talking points are provided on subsequent pages if speakers care to use them.

SPEAKERS NOTE: THIS IS AN EXTREMELY TIGHT TIMEFRAMECommissioner Nicholas Toumpas (3-5 min) – Welcome and Introductions (5 min) Governor Maggie Hassan (8 min)– Overview of state crisis and response (10min) Marcella Bobinski (5 min)- Overview of the state Naloxone Distribution and Training ProgramNick Mercuri (3 min) –Trainings available for those distiributing kits to patients or the publicChief Bob Cormier (2 min) –Role of law enforcement in opioid overdose crisisDonna Marston (2 min)–Important of naloxone access to parents, friends and familyDean LeMire (2 min) –Importance of promoting recovery to anyone anytimeJake Leon (3 min) - Overview of the public awareness campaign Jake Leon moderates questions from the press and answers from key stakeholders (15-20 minutes)distribution of these kits are to community health centers in the state who will be distributing kits for their high risk patients.

III. QUESTION & ANSWER PERIOD: Key stakeholders and state leaders present to answer questions





AGENDA

Press Kit

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New Hampshire’s Comprehensive Response to the Opioid Overdose Crisis

New Naloxone Access Laws House Bill 270 - Good Samaritan Law House Bill 271 - Friends & Family Access to Naloxone

Expanding Treatment and Recovery Support Services NH Health Protection Program Substance Use Disorder Benefit Drug Courts Core competencies for behavioral health professionals to treat addiction Initial expansion of Medication Assisted Treatment in a variety of settings for opioid use disorders New federal Youth Treatment Grant ($248,564) New federal Drug Court Grant ($324,997 for Hillsborough South) DHHS funding to 15 Community Health Centers to conduct SBIRT DHHS federal Grant for NH (Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS))

Alcohol & Drug Treatment Locator www.nhtreatment.org

Public Awareness & Education www.drugfreenh.org Partnership for a Drug Free NH and Check the Stats

Expanding Prevention & Early Identification Regional Public Health Network coordination of Substance Misuse Prevention Screening, Brief Intervention & Referral to Treatment (SBIRT) in Community Health Centers & Primary Care Student Assistance Programs in schools & colleges Referral Education Assistance & Prevention (REAP) for older adults New federal Prevention Grant ($2.5 M per year for Partnership for Success Grant targeting prevention services for youth & young adults)

Prescription Drug Monitoring Program

Expanded & Active Governor's Commission on Alcohol & Drug Abuse Prevention, Treatment & Recovery

Accomplishments In Process Future


Expanded Public Access to Naloxone Expanded distribution of naloxone kits through community events and settings Increased prescribing and dispensing through patient-prescriber relationships Expanded Dispensing through Standing Orders

Continued Expansion Medication Assisted Treatment SBIRT in emergency rooms and other settings

Third party Insurers fully covering naloxone access and a robust array of prevention, treatment and recovery support services without eligibility barriers and at or above parity with other chronic diseases

Continuing AnyoneAnytimeNH Public Awareness and Education Campaign

Promotion and Distribution of Intranasal Naloxone Kits to Friends and Family Community Health Centers Local law enforcement

AnyoneAnytimeNH Public Awareness and Education Campaign www.anyoneanytimenh.org TV, radio, print, mass transit, and social media Community Awareness and Engagement promotional material kits

Continued Treatment and Recovery Support Service Expansion Medication Assisted Treatment Recovery Community Organization Capacity Development Expanding public and private treatment programs DHHS awaiting approval for CMS 1115 Transformation Grant that has been earmarked for supporting expanded treatment and recovery support services DHHS released funding to the state’s Public Health Network to expand community capacity across the continuum of care for substance use disorder prevention, intervention, treatment and recovery support services

Expanding state partnerships Department of Safety Bureau of EMS and Drug Monitoring Initiative 211 enhancements for treatment information and referral calls

AnyoneAnytimeNH is an initiative of the New Hampshire Department of Health

and Human Services

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The campaign involves planned elements in the four areas:


NH Alcohol and DrugT R E A T M E N T L O C A T O Rw w w . n h t r e a t m e n t . o r gAnyoneAnytimeNH is an initiative of the New Hampshire Department of Health and Human Services

NH OpiOid Crisis AwAreNess & respONse CAmpAigN

Paid Media Public Relations Community Outreach Social Media

TV CommercialsRadio and Print AdvertisementsMall KiosksMass Transit

Press EventPress Release

Human Interest Stories

HAN Alert211

Community presentations & forumsCommunity postersOutreach Materials & factsheets for health fairs, conferences, community locations, healthcare facilitiesTalking points for key leadersCommunity Outreach Guide

www.Anyoneanytimenh.org www.nhtreatment.org Facebook, Twitter messaging and postsFacebook:https://www.facebook.com/AnyoneAnytimeNH Twitter: https://twitter.com/anyoneanytimenh Media sharing on YouTubeAudience Extension

EVALUATION

Campaign DescriptionAnyone.AnytimeNH is a statewide public awareness campaign designed to educate the public about the opioid overdose crisis impacting NH and inform caregivers, healthcare providers and those seeking help for their addiction about treatment and recovery resources, and inform them about the benefits of the timely administering Naloxone during an opioid overdose. Anyone.AnytimeNH is part of a coordinated statewide public health response which includes the (1) statewide public awareness and media campaign, and (2) passage of two new house bills; HB 271 which allows for a broad prescribing, dispensing, and distribution of Naloxone (a rescue drug commonly known as Narcan) and HB 270 also known as the Good Samaritan which provides protections for individuals administering the drug and protections from drug possession (e.g. heroin) charges (3) distribution of emergency kits of Naloxone through DPHS-funded Community Health Centers to dispense appropriate patients and other individuals as allowed by HB 271 (4) training of individuals in the 13 public health regions to increase their capacity to safety use Naloxone.

Campaign AimThe campaign is a statewide, multi-prong effort aimed at reducing the rates of opioid abuse including heroin and prescription opioids thereby reducing the number of deaths caused by overdose.

Campaign AudienceThe intended audience for the campaign includes:

• General public • Addicted individuals• Caregivers supporting family and friends dealing with an opioid addiction• Healthcare providers (i.e., primary care providers, pharmacists, Nurse practitioners, behavioral health

professionals) treating family members and persons addicted to opioids

Campaign ObjectivesThe objectives of the campaign are:

• Increase awareness about the prevalence of heroin use problem in NH.• Increase knowledge among the general public and the healthcare community about the benefits and

availability of Naloxone as a rescue drug in the event of overdose.• Increase awareness about the legal protections covered by the Good Samaritan law.• Increase awareness of treatment and recovery services available in NH.

Campaign Call To Action (CTA)The primary CTA is for the intended audience to call NH 211 or visit the websites www.nhtreatment.org or www.anyoneanytimenh.org for more detailed information on the early warning signs of addiction, resources on detoxification, treatment and recovery (treatment locator) and the availability of Naloxone. Secondary CTA implores caregivers and consumers to get an emergency kit on Naloxone to have on hand in the event of an overdose.





NH OpiOid Crisis AwAreNess & respONse CAmpAigNANyONe.ANytimeNH

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Key InformatIon about comprehensIve actIons to address the opIoId overdose crIsIs

7. House Bill 2703, also known as the “Good Samaritan Law,” was signed and became effective on June 2, 2015. This law protects anyone who acts in good faith to help in an opioid overdose situation from arrest or prosecution for possession or use of illegal drugs.

8. The increase in the misuse of opioids increases risk of infectious diseases such as HIV and Hepatitis. All health professionals and systems are asked to underscore these risks with patients and to provide adequate prevention, screening, testing and treatment for infectious diseases associated with needle-injecting drug use. More information and resources are available at http://www.cdc.gov/hiv/riskbehaviors/idu.html and from other federal partners.

9. Relevant resources, practice rules, and other protocols being amended or adopted by the NH Boards of Pharmacy and Medicine to support the naloxone access are available on-line:

• NH Board of Medicine statement allowing prescribers to prescribe naloxone to non-patients4

• NH Board of Pharmacy information and resources to support naloxone access5 .

10. The Department of Safety’s Bureau of Emergency Medical Services has provided training for medical credentialed staff to educate patients or clients on naloxone administration.

11. The NH 211 Information and Referral Line is an active state partner and is providing information and referral services to the public for those seeking treatment and recovery support services.

12. NH’s Health Protection Program (NH HPP) is currently providing health coverage with a broad array of treatment and recovery support services in its benefit package for low income adults. For information on eligibility or registration, visit http://www.dhhs.nh.gov/ombp/nhhpp/.

13. The NH Bureau of Drug and Alcohol Services has funded the state’s Regional Public Health Network and Community Health Center systems for expanded prevention services, universal alcohol and drug screening among all patients, and is rolling out strategies this fall for expanded Medication Assisted Treatment and Recovery Support Services.

14. The Departments of Health and Human Services, Safety, and other state agencies are aggressively seeking federal support to expand prevention, treatment and recovery support services. This year alone, the state and communities have been awarded $2.5M in federal funding for school- and college-based prevention services. $324,997 in new Drug Court funding, $248,564 in youth treatment planning funds, $500,000 in Drug Free Community prevention coalition funding, and $75,000 in peer recovery support capacity development.

15. AnyoneAnytimeNH is a public awareness and education initiative of the New Hampshire Department of Health and Human Services. Media and promotional materials for public education and awareness associated with naloxone access, prevention messages, and treatment and recovery resources are available at www.anyoneanytimenh.org. Materials will be expanding and continually updated on this site as the campaign continues.





3 http://www.gencourt.state.nh.us/legislation/2015/HB0270.html4 http://www.nh.gov/medicine/documents/naloxonestatement.pdf5 http://www.opioidoverdosepreventionforpharmacists.com/

Key InformatIon about comprehensIve actIons to address the opIoId overdose crIsIs

The following information developed by key stakeholders provides context for health care and community service providers and their staff relative to the state’s comprehensive effort to address the opioid and overdose crisis. Materials associated with these efforts are available at anyoneanytimenh.org

1. More people died in New Hampshire from a drug-related overdose in 2014 than ever before, and the majority of deaths were caused by opioid overdose (e.g. prescription pain relievers, heroin, street fentanyl, etc.). Drug overdose deaths totaled 326 in 2014, and 232 have been confirmed for 2015 as of September 18, 2015.1

2. To help prevention overdose deaths, the opioid antagonist NALOXONE can now be prescribed by any prescriber to any person or patient who may be at risk of an opioid overdose or who knows someone who may be at risk of an overdose. House Bill 2712 was signed into law and became effective July 2, 2015. The law stipulates:

A health care professional authorized to prescribe an opioid antagonist may prescribe, dispense, or distribute, directly or by standing order, an opioid antagonist to a person at risk of experiencing an opioid-related overdose or a family member, friend, or other person in a position to assist a person at risk of experiencing an opioid-related overdose; andNo health care professional who, acting in good faith and with reasonable care, prescribes, dispenses, or distributes an opioid antagonist directly or by standing order and no person who, acting in good faith and with reasonable care, stores, dispenses, or distributes an opioid antagonist or administers an opioid antagonist to another person who the person believes is suffering an opioid-related drug overdose shall be subject to any criminal or civil liability, or any professional disciplinary action, for any action authorized by [the law] or any outcome resulting from an action authorized by [the law].

3. Pharmacies should be prepared to fill prescriptions for naloxone that may be filled by friends and family. Family and friends are often experiencing significant emotions associated with their loved one’s opioid dependence and are likely to have questions about how to use the naloxone, when to call 911, what signs they should be looking for, and so forth. A helpful set of instructions is included with this letter. Please use this or other materials as a reference. Compassionate and informational responses are often helpful to loved ones who are learning about how to use naloxone in a life-threatening situation.

4. The Department of Health and Human Services has purchased intranasal naloxone kits and is distributing them to community health centers and other public health partners for free distribution and patient/public education in the administration of naloxone. Participating community health centers are listed at anyoneanytimenh.org.

5. Hospital Emergency Departments in New Hampshire may consider providing intranasal naloxone to someone who is being treated in the emergency room for an opioid overdose. As described above, medical staff can prescribe the take-home naloxone kits to the individual patient or to friends or family of the patient who may be with them in the ER.

6. Health Insurers should consider the implication of NH’s new naloxone access law in terms of coverage for naloxone prescriptions that may be for a friend of family member. Allowing coverage of the low-cost intranasal form of naloxone to the insured as well as to friends and family of the insured will support the legislation and its intent – to help save lives and provide hope for treatment and recovery.





1 New Hampshire Medical Examiner’s Office 2 http://www.gencourt.state.nh.us/legislation/2015/HB0271.html

51

FREQUENTLY ASKED QUESTIONS ABOUT OPIOID ADDICTION

What are opioids?

Opioids are drugs that work in the brain to relieve pain. They can produce a high and can make a person feel drowsy and nauseous. Opioids include medicine made from the poppy plant (opium, morphine, and codeine) and those made synthetically (artificially) such as oxycodone, methadone, fentanyl, and hydrocodone. Some people are given opioids by their doctor to address painful conditions or injuries, but opioids are also sold and used illegally, including heroin, “street” fentanyl, oxycodone, methadone, and morphine.

How do people become addicted?

Addiction can happen to anyone from any walk of life. The use of opioid drugs fires up the reward center of the brain. Over time the brain needs more or craves the drug to get the same high. This can start a cycle of brain changes that leads to dependence and addiction. Some people are more at risk of addiction if they have family members with addiction or are dealing with other mental health issues.

How do people get better?

Individuals who have become physically dependent and addicted to an opioid begin getting better by stopping use of the drug. When individuals stop using the drug, they get really sick and will have withdrawal symptoms. A doctor can help manage these symptoms. Treatment can include counseling, medication assistance, and recovery support. Long-term treatment and recovery can take time. Some people may relapse or use while working to achieve recovery.

Where can I find out more about treatment options?

Treatment and recovery supports are available and it is important to know that recovery is possible for anyone at any time. Asking for help is the first step. Your doctor can help you find options. In addition, visit the NH Alcohol and Drug Treatment Locator (www.nhtreatment.org) or call 2-1-1 for help finding treatment and recovery support options in your area.


What is naloxone?

Naloxone (or Narcan) is a drug used during an opioid overdose after first calling 911. This drug is safe and, when used with rescue breathing, can save a person’s life by helping them to start breathing. Naloxone comes in many forms, including an intranasal spray (spray you squirt into the nose) or by a shot into a large muscle.

If I use illegal drugs, will I get in trouble if I call 911 for help for an overdose?

No. A law passed in June 2015 protects anyone who calls for emergency help for an overdose from arrest or prosecution for drug possession.

Who should have naloxone?

If you use opioids or you have friends and family who use, you should consider having naloxone.

How can I get naloxone for myself or a loved one?

Talk with your doctors about getting a prescription for naloxone for yourself or a loved one. Naloxone is also available at no cost at some community health centers and public events in your community. Visit www.anyoneanytimenh.org to find out about free naloxone.






FREQUENTLY ASKED QUESTIONS ABOUT

NALOXONE


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Phase II Attachments

53AnyoneAnytimeNHTM is an initiative of the New Hampshire Department of Health and Human Services 2

The majority of the survey respondents indicated that a family member or friend used naloxone provided by the state to reverse an overdose therefore saving a life.

“[The] mother administered Narcan to [her] daughter (who was at home awaiting admission to inpatient treatment) after hearing [her] daughter collapse in the shower.” This daughter was able to recover and was then fast tracked to a treatment facility.

—Naloxone Survey Respondent

One parent was told by EMS if she hadn’t administered naloxone, EMS personnel would have been too late to save her daughter. Five family members administered naloxone in the sample, with an additional eight described as being “peers.” The majority of statewide partners said that there is a need to continue to provide free kits for distribution. Many felt that the state-supplied kits saved lives and generated interest from the community regarding distribution.

“There is a definite need for this continued service. The service is needed until there are adequate treatment resources to support the current epidemic.”


Increasing availability of naloxone kits has resulted in an increase in naloxone administrations by non-ems individuals including family and friends. In 2015 from January to May, 85 of the 1,641 naloxone administrations in the state (5%) were administered prior to EMS arrival. In the same time period of 2016, that number increased to 11% of naloxone administrations that were done prior to EMS arrival. This data indicates that naloxone administrations done by family or bystanders, and non-EMS

health care providers has increased over this period. Additionally, as of September 2016, 112 police officers and 14 New Hampshire law enforcement agencies are currently trained and licensed to administer naloxone. The various avenues to access naloxone in the state include: healthcare providers, pharmacies, and community health centers. (Table 2).

Table 2: Avenues of Accessing Naloxone

Avenues of Accessing Naloxone

Healthcare Providers (Doctor’s Offices) with a prescription

Pharmacies - May not need a prescription

Community Health Centers

All statewide partners surveyed were aware of the statewide naloxone distribution initiative and received free naloxone kits. The results from this brief survey support the continuation of the statewide distribution of naloxone.

“We know this isn’t the entire solution but it is a key piece that brings people together and continues the conversation. This is a critical element to saving someone’s life and providing them with another opportunity for recovery.”


AddressingAlcohol & Drug Misuse in NH

If you or someone you know is experiencing a substance use or an addiction-related crisis

1.844.711.HELP (4357)

NH STATEWIDE ADDICTION CRISIS LINE

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Executive Summary of New Hampshire Statewide Naloxone and Distribution Training Initiative OCTOBER 2016

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Following the passage of House Bill 271 in June, 2015, The New Hampshire Department of Health and Human Services (NH DHHS) began a Naloxone Kit distribution campaign. (Naloxone is an opioid antagonist that acts as an overdose reversal drug and can be administered both intravenously and as a nasal spray.) The campaign’s goal was to increase access to life-saving medication for individuals at risk for an opioid overdose, their families and friends, while standing orders were established throughout the state’s pharmacies. In 2015, 439 people in New Hampshire died due to a drug overdose; as of September 6, 2016, 241 residents have died from an overdose, with 200 of those deaths (83%) being caused by opiates/opioids.The State ordered 6,000 kits, to be provided free of charge to anyone without the means to pay for naloxone, including those at risk for an overdose, or the family and friends of those at risk. Kits were distributed through the state’s 10 community health centers, three additional clinics, and regional community events coordinated by the state’s regional public health networks. “Train-the-trainer” courses were held statewide to ensure that distribution personnel were knowledgeable about the kits, which included instructions on using the nasal spray, and steps to help victims survive until Emergency Medical Services (EMS) responders could arrive.As of September 2016, a total of 5,310 of the 6,000 naloxone kits were distributed. Due to the continued need, NH DHHS purchased an additional 5,600 kits September 2016 to ensure continued access to naloxone across the state. Standing orders for naloxone kits that have been established at New Hampshire’s pharmacies are currently available at CVS, Rite Aid, and Walgreens stores. Recently, other chain pharmacies have also expressed interest in ordering naloxone kits for their pharmacies.In June 2015 DHHS launched a survey of 60 partners who received the kits. The survey was designed to better understand the experience

of statewide partners involved in the distribution of naloxone since September 2015. Fifty-five percent of the partners responded to the survey. Table 1 provides a breakdown of the types of organizations that responded to the survey, with the percentage of total survey respondents for each sector represented.

TABLE 1: Survey Respondents by Organization Type

Organization Type(N=33)

% ofRespondents

Regional Public Health Network

36%

Community Health Center 18%Pharmacy 15%Nursing 9%Behavioral Healthcare Provider

9%

EMS 6%Social Service Provider 3%Criminal Justice 3%

Key findings of the survey indicated that on average each organization distributed 86 kits with responses ranging from 2 to 412 kits. Thirty-four percent of survey respondents said they knew the naloxone kits they had distributed were used to save a life. In addition, 11 partners recounted unique stories of how naloxone prevented an overdose death.

“I believe free distribution of kits is needed as part of the statewide strategy to stem the tide of Opiate Overdose Deaths.”


AddressingAlcohol & Drug Misuse in NH


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Executive Summary of New Hampshire Statewide Naloxone and Distribution Training Initiative

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It can take many tries to find the right help at the right time. Don’t stop trying. Help is out there.

AnyoneAnytimeNHTM is an initiative of the New Hampshire Department of Health and Human Services

ANYONE, ANYTIME CAN EXPERIENCE ADDICTION.


www.nhtreatment.org

FOR INFORMATION VISIT: If you or someone you know is experiencing a

substance use or an addiction-related crisis

1.844.711.HELP (4357)

NH STATEWIDE ADDICTION CRISIS LINE FOR INFORMATION CALL:


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Can experience addictionCan ask for helpCan recoverCan save a life www.anyoneanytimenh.org


www.nhtreatment.org



1.844.711.HELP (4357)




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ANYONE, ANYTIME CAN SAVE A LIFE. NH’s new Good Samaritan law protects from arrest or prosecution anyone trying to get medical help for themselves or another person experiencing a drug overdose.

Please always call 911 for emergency services if you think someone is experiencing a drug-related overdose.

Transit Advertisements and Posters

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ANYONE, ANYTIME CAN RECOVER.


www.nhtreatment.org



1.844.711.HELP (4357)



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Can experience addictionCan ask for helpCan recoverCan save a life www.anyoneanytimenh.org

My family couldn’t believe how many times I kept picking up. They didn’t know how hard it was and how hard I was trying to stop. I never want to go back to using, but we know better now how it works. And I keep my reasons for not using right in front of me.

ANYONE, ANYTIME CAN ASK FOR



www.nhtreatment.org



1.844.711.HELP (4357)




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My family couldn’t believe how many times I kept picking up.

They didn’t know how hard it was and how hard I was trying to stop. I never want to go back to using,

but we know better now how it works. And I keep my reasons for

not using right in front of me.

ANYONE, ANYTIME CAN RECOVER


www.nhtreatment.org



1.844.711.HELP (4357)




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www.nhtreatment.org



1.844.711.HELP (4357)




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ANYONE, ANYTIME CAN RECOVER.

That girl you saw in the headlines a couple summers

ago–she was caught stealing and argued

when her car was searched. You read

the comments online and shook your head,

but didn’t disagree.

Look again. She’s studying for her

nursing exam. She looks nothing like that

booking photo. She seems 10 years

younger now.

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ANYONE, ANYTIME CAN ASK FOR HELP


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1.844.711.HELP (4357)NH Alcohol and DrugT R E A T M E N T L O C A T O R

www.nhtreatment.org


FOR INFORMATION VISIT: FOR INFORMATION CALL: NH STATEWIDE ADDICTION CRISIS LINE


Newspaper Advertisement

58

w



www.nhtreatment.org

for heLp:

Kids are now starting to experiment with drugs and alcohol as early as 4th grade.1 Talk to your kids about drug use!

In 2015, drug overdoses

lead to

428 deaths in New

Hampshire.2

1 in 4of those who use heroin become addicted.3 Addiction is a disease in which a person’s brain chemistry is changed so that they need to use drugs to feel normal.4

Narcan reverses the affects of an opioid overdose. If you or someone you love is at risk for an overdose, ask your primary care physician for a prescription or contact [email protected] to attend a training to receive a free Narcan kit.

save a Life

• www.anyoneanytimenh.org

• www.drugfreenh.org

• www.twinstatesafemeds.org

• www.operationparent.org

educaTion resources

• NH Statewide Addiction Crisis Line: Dial 1-844-711-HELP (4357) [email protected].

• Headrest 24-hour crisis hotline: 800-273-TALK• VT/NH Statewide information/referral: Dial 211



The facTs

Parent HANDBOOK 6th edition [1]NH Medical Examiner’s Office, 2016 [2]

National Institute on Drug Abuse, 2014 [3,4]

Anyone, Anytime cAn ASK FoR



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Documents

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