HAWAIʻI OPIOID INITIATIVE

Evaluation Report

November 5, 2019

Introduction

Public Health and Safety Challenge

The opioid epidemic has become a major public health and safety challenge impacting thousands of people in the State of Hawaiʻi. There were more fatalities from drug overdoses than from car accidents both in Hawaiʻi and in the nation. In the United States, overdose fatalities claim 91 lives every day. In Hawaiʻi, drug poisoning is the leading cause of fatal injuries, with opioids involved in a substantial proportion of these deaths.

Not only do drug poisonings inflict a high toll in human lives, treatment for drug poisonings is a significant burden of resources in the state. Costs for related inpatient and emergency care for 4,275 visits totaled over $107 million (a lower-bound estimate which excludes the costs of prescription drugs and outpatient medical care).

These conditions disproportionately affect men as well as certain socioeconomic groups such as low-income individuals. Federal and state governments bear a large burden of covering these costs.

While the opioid epidemic in Hawaiʻi is not as severe as that in the continental United States, continued and active efforts from the State of Hawaiʻi are needed to further protect the public’s health.

HAWAI'I OPIOID INITIATIVE

The Hawaiʻi Opioid Initiative was established through the joint effort of Governor David Ige and the Hawaiʻi State Department of Health (DOH) in July 2017. This initiative aims to address the opioid epidemic with a coordinated and proactive response that incorporates different stakeholders, approaching the issue from several angles and sectors. The Hawaiʻi Opioid Initiative approaches the epidemic from seven Focus Areas and corresponding Work Groups:

  • Treatment Access
  • Prescriber Education
  • Data-Informed Decision Making
  • Prevention & Public Education
  • Pharmacy-Based Interventions
  • Law Enforcement & First Responders
  • Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Work Groups are organized for each Focus Area and convene members voluntarily from different sectors and agencies with differing expertise and interdisciplinary perspectives to address the opioid epidemic in Hawaiʻi.

Funding for the Hawaiʻi Opioid Initiative relies on a variety of sources including state funds and discretionary grants from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC).

PURPOSE OF THE EVALUATION REPORT

The University of Hawaiʻi at Mānoa (UH) Office of Public Health Studies was invited to serve as the Evaluation Team of the CDC Data-Driven Prevention Initiative (DDPI) which supported the coordination of activities and technical assistance to the Hawaiʻi Opioid Initiative’s Work Groups. As part of the CDC DDPI cooperative agreement requirements, the Alcohol and Drug Abuse Division (ADAD) requested this evaluation report to assess the successes and challenges and to explore recommendations for the Hawaiʻi Opioid Initiative.

Evaluation can help to identify barriers and areas for improvement in establishing an effective public health program. Since the Initiative’s implementation in July 2017, the UH Evaluation Team has monitored the progress and completion of the objectives outlined in the Hawaiʻi Opioid Initiative Action Plan, a living document that is updated and changed each year with the progress of the Initiative. The purpose of this evaluation report is to identify areas of achievement and challenges in implementing the Action Plan.

A complex issue such as opioids requires a complex system that engages various community members and organizations, as noted by the CDC. This evaluation report is a tool of accountability for the many stakeholders involved in this initiative, while allowing Work Group Co-chairs to voice recommendations and articulate the successes and challenges they have faced between July 2017 and May 2019. Furthermore, this evaluation will provide insights on how the Work Groups and focus areas have organically evolved and collaborated across sectors and agencies.

The UH Evaluation Team led by Dr Victoria Fan and a team of students evaluated the Hawaiʻi Opioid Initiative over 2018 and 2019 through documentation review, coordination of the Hawaiʻi Opioid Initiative Work Groups, and confidential interviews of active Work Group Co-chairs of the Hawaiʻi Opioid Initiative Work Groups as well as selected participants and members of the Hawaiʻi Opioid Initiative Executive Steering Committee.

As part of the documentation review for this evaluation report, the UH Evaluation Team requested documentation from ADAD on its activities and contracts as part of the Hawaiʻi Opioid Initiative. The Evaluation Team also obtained epidemiologic presentations from the Emergency Medical Services and Injury Prevention System Branch (EMSIPSB) epidemiologist Dr Daniel Galanis as part of its assessment.

Coordination activities for the Hawaiʻi Opioid Initiative included preparing meeting agendas, meeting minutes, and other logistics convening stakeholders spanning various sectors, disciplines, expertise, and backgrounds of the seven Work Groups, and later, the Operational Work Group. Remarkably, the activities and meetings of the Hawaiʻi Opioid Initiative are not required by statute but rather are organized voluntarily through pertinent agencies.

The UH Evaluation Team met with all Work Group Co-chairs and purposively selected Executive Steering Committee members. Interview guides were prepared for each Work Group Co-chair. The interview guides inquire about personal experiences with the Initiative, Work Group objectives, successes and challenges, and finally, recommendations. See Annex 1 for the list of interviewees and Annex 2 for interview guides. A total of 16 stakeholders were interviewed. Interviews were transcribed, coded for themes, and summarized.

STRUCTURE OF THIS REPORT

Chapter 2, “National Context, State Landscape,” summarizes of the needs assessment previously conducted by Dr Daniel Galanis in an infographic. Chapter 3, “Scorecards 2.0,” presents the Focus Area and Work Group objectives while tracking their progress. Chapter 4 summarizes the achievements of the Focus Areas and Work Groups. Chapter 5 discusses overall successes of the Initiative, based on confidential interviews. Chapter 6 discusses challenges of the Initiative and Chapter 7 makes recommendations for the future of the Initiative.

NATIONAL CONTEXT, STATE LANDSCAPE

CLICK TO ENLARGE

SCORECARDS 2.0

CLICK TO ENLARGE

ACHIEVEMENTS

CLICK TO ENLARGE

OVERALL SUCCESSES

As part of the evaluation methodology, the UH Evaluation Team confidentially interviewed Work Group Co-chairs and other stakeholders of the Hawaiʻi Opioid Initiative. Interviewees were solicited for their views on the successes and challenges of the Initiative as well as recommendations for the Initiative. For Work Group Co-chairs, scorecard objectives were also presented.

Remarkably, the vast majority of the interviews focused not on specific operational achievements or activities but rather the communication, leadership, and administrative functions of the Initiative. The common themes across the interviews are summarized and the number of unique interviewees (of the 16 interviews) linked to these themes are noted.

INCLUSIVE LEADERSHIP

[1] There is wide consensus among Work Group Co-chairs that the ADAD, and later Behavioral Health Administration (BHA) leadership, was effective in creating an inclusive and collaborative mechanism to tackle the opioid epidemic.

[1.1] Specifically, the leadership of the Hawaiʻi Opioid Initiative convenes many stakeholders across different sectors who might not otherwise engage easily or regularly (n=7).

It’s incredible because in my 25 years I’ve never seen public health, public safety, and law enforcement work together like this.

[1.2] Many Work Group Co-chairs observed that the ADAD and BHA leadership of the Hawaiʻi Opioid Initiative has brought stakeholders together voluntarily toward a common goal and has inspired stakeholders to not merely hold meetings. The ADAD and BHA leadership has created an environment in which the Work Group meetings enable and empower members to take initiative and progress toward Work Group objectives voluntarily (n=2).

When I compare it with what’s happening in the other states, I really think ours rises to the top because we’ve broken it down in ways that people can be meaningfully involved and feel like they can be making a contribution, making a difference... There's an ongoing commitment to try and work on these areas and continually improve.

[1.3] A Co-chair noted that there is wide participation from organizations due to the potential availability of resources from the Initiative.

INTERDISCiPLINARY COLLABORATION

[2] The Hawaiʻi Opioid Initiative has brought together people who do not normally or easily communicate with each other due to silos and different disciplines and fields.

[2.1] Some work Group Co-chairs remarked that the Initiative brings together research experts as well as programmatic and operational staff, bridging the divide between best practice guidelines and implementation, and there are valued complementary roles of both research and practice (n=2).

[2.2] A few Work Group Co-chairs observed that the Initiative has brought together individuals from communities that often do not see eye to eye in an environment conducive to communication. They also noted that public perspectives on substance use have shifted slightly from an abstinence-based to a harm reduction outlook, indicating wider understanding and stronger communication between different communities of practice (n=3).

Partnership platform for action

[3] Through regular engagement of stakeholders, the Initiative established a mechanism to create partnerships and collaborations that can be applied to areas for social action. Establishing partnerships, building relationships, and communicating across different agencies is a challenge, but the inclusive nature of the Initiative created a forum or platform for partnership. This platform has the potential not only for tackling opioids but also for combating other social challenges such as homelessness (n=3).

[3.1] Through the evolution of the Initiative, there has been greater perceived inclusiveness of participation, resulting in greater communication across relevant programs and grants (n=3).

It's the people factor. I think people already had the desire. So none of the stuff that we're doing today in the Opioid Initiative is new or necessarily any kind of earth-shattering approach or anything like that. I think what makes it so successful is that it gives a lot of folks a venue to cooperate and unite around things that people wanted to see happen anyway. So I think it just serves as a catalyst to bring them together and help these people do all of the amazing, great stuff they’re already doing anyway, but doing it in a way that doesn't feel like they're alone or paddling upstream by themselves.

[3.2] The Initiative has strengthened the relationship between members and built the foundation of knowledge needed to be proactive in addressing the opioid crisis (n=2).

[3.3] A stakeholder noted that throughout the evolution of the Initiative, there has been more collegiality among the members of different organizations, allowing the sharing of best practices and clarifications of expectations.

Connecting stakeholders

[4] Due to the large number of stakeholders involved, communication across Work Groups, and between high-level leadership and mid-level Work Groups, was identified as an area for improvement. Subsequently, a stakeholder noted that the creation of the Operational Work Group which brings together the Co-chairs of each Work Group on a monthly basis is helping to enhance communication across focus areas and enhance synergies and collaboration.

[5] Work Group Co-chairs observed that ADAD played a role in Work Group successes and adherence to an established timeline. Without ADAD, some Work Groups would not have met as often, and some tasks would have otherwise stalled within these voluntary Work Groups (n=2).

[6] A stakeholder noted that having a balance between the energy of newer stakeholders mixed with the knowledge and wisdom of experienced stakeholders creates a synergy that helps move the Initiative forward.

[7] A stakeholder noted that DOH personel are subject matter experts, who provide guidelines to improve outcomes of each Work Group and offer tools to address noted community issues.

[8] The CDC DDPI Grant Coordinator in ADAD helped greatly in linking Work Groups with ADAD and coordinating among different Work Groups (n=2).

CHALLENGES

Interviewees noted several challenges facing the Hawaiʻi Opioid Initiative and specific Work Group activities, particularly in terms of administration and finance, documentation, and designation of roles and responsibilities.

[1] The challenge of tracking activities: The UH Evaluation Team acknowledges that there are likely to be other achievements and successes to which the Evaluation Team is not yet aware. Due to the size of the Initiative, voluntary nature of the activities, and large number of stakeholders and participants, tracking of activities poses a major challenge given current staffing levels in ADAD and the Evaluation Team (n=2).

[2] The challenge of the evolving scope of the Work Groups: While recognizing that the Work Group has benefited from a voluntary spirit of the Work Group Co-chairs, there may be a need for clearer communication of the roles and responsibilities of the Work Group as well as individual Work Group Co-chairs and members. The roles and responsibilities of each Work Group in preparing, planning, and implementing detailed work plans could be more clearly defined, even as Work Groups’ roles have evolved over time. There is an implicit change in the Work Groups from planning to implementation; this change in role needs to be recognized more explicitly by ADAD and the Co-chairs (n=2).

[2.1] A stakeholder noted that the Work Groups appear to be provided with a set of objectives which they are implicitly expected to implement rather than explicitly define.

[2.2] While the intention of the Work Group has been to rely on voluntary efforts, rather than formal statutory or regulatory mechanisms, many stakeholders may be unfamiliar or unaccustomed to a dynamic and organic approach to working across agencies and sectors.

Note: This supplementary material is provided for informational context and is not part of the Hawaiʻi Opioid Initiative Evaluation Report.  The views, information, or opinions expressed during this video are solely those of the individuals involved and do not necessarily represent those of this report’s authors, partners, and agencies. The authors, partners, and agencies involved do not accept any liability for the accuracy, reliability, or completeness of the information in this video.

[3] The challenge of voluntary roles: Several interviewees noted that Work Group members voluntarily participate in meetings outside the direct scope of their primary responsibilities. As such, the participation of Work Group members varies considerably. There is also a need for technical assistance and full-time dedicated staffing to support the Work Groups in defining and implementing work plans (n=4).

[4] The challenge of state procurement and administrative processing: The State’s contract and procurement systems pose challenges in implementation in a timely manner, and different stakeholders have different levels of familiarity in navigating these bureaucratic and administrative environments (n=3).

[5] The challenge of sustainability: Federally driven initiatives can result in plans which are not well implemented and not well sustained after federal resources end. Ensuring implementation and sustainability of the Hawaiʻi Opioid Initiative’s plan is crucial for long-run success. There are concerns about initiatives developed with federal funding that may not have strong enough local support for long-run sustainability. At the same time, there is a risk that state agencies are reactive to federal government funding rather than proactive toward emerging local issues. For example, it was raised by a few Co-chairs that other emerging public health issues (e.g., suicide and methamphetamine abuse) are significant and should not be neglected amidst sustained attention on the opioid crisis (n=2).

I’d say one of the challenges in this is going to be looking past the planning period, [past] creating the plan and the conversations — but actually how do we envision this rolling out and actually happening on the ground. What are the players at the table going to commit to doing in their own little sections of the world? Because I think we can all come to meetings, we can all give our expert adviser thoughts, but if we're not going to actually see our involvement and our commitment to get buy-in in our corner of the world, it's not going to get beyond that.

[6] The challenge of including community voices: It was noted by a stakeholder that the Initiative is “one size fits all.” The Work Group objectives are generally statewide (such as statewide legislative and regulatory reforms) rather than community-specific. Inclusion of voices from highly affected communities, particularly rural areas and high-impacted vulnerable populations, could be captured more effectively.

[7] The challenge of new models of care: There have been difficulties for providers to adjust to the harm reduction model of healthcare delivery, primarily due to the unfamiliarity of this approach and the longstanding abstinence-based approach to substance abuse treatment. Expansion of outreach and education to physicians and other providers may help bridge this gap (n=2).

[8] The challenge of knowing and aligning to best clinical practices: Although Suboxone is available to be administered, a stakeholder noted that not all physicians with substance abuse patients are utilizing it due to the unfamiliarity with the prescribing protocols. Due to the highly patient-specific focus of Suboxone treatment, physicians typically require at least five years of utilization before becoming experienced with prescribing protocols.

[9] The challenge of disproportionate participation: Disproportionate participation in the establishment of take-back sites across the different counties has resulted in only 1 take-back location for all of Oʻahu, whereas Maui has 6 such sites — but Oʻahu has a significantly larger population as a whole and higher numbers of cases with opioid use disorder (n=3).

[10] The challenge of insurance billing and reimbursement: Work Group 5 has sought to increase availability of naloxone, but financial access still remains a challenge. It remains to be seen if insurance plans will reimburse naloxone, as a covered health benefit, for caregivers presenting at the pharmacy (n=2).

RECOMMENDATIONS

This chapter summarizes areas of recommendations for Alcohol and Drug Abuse Division (ADAD) to shape the future of the Initiative.

[1] Communicate roles clearly: ADAD and the UH Evaluation Team should continue to brief and remind Work Group Co-chairs of their roles and responsibilities, both implicitly and explicitly in meetings and events.

[2] Get more hands on deck: Additional staffing from ADAD to support the Work Group and Co-chairs may allow for the support needed to implement the objectives and plans formed in the Work Groups (n=2).

[3] Communicate across Work Groups: A stakeholder noted that improved communication among Work Groups will ensure that each sector is working toward the same goal. There is a need for identifying the best communication modality to keep relevant stakeholders informed of activities.

[3.1] A summary of the tasks being undertaken by each Work Group presented at the Operational Work Group Meeting will enhance linkages between stakeholders.

[4] Continue to invite the community: The Initiative has been an inclusive and participatory mechanism to create meaningful change in public health issues. To further maintain and ensure inclusive efforts produced from previous stakeholders, it was noted that invitations to community members should be continued on a scheduled basis and be a part of Work Group meeting agendas. Work Group Co-chairs and ADAD can work to develop a flexible, organic mechanism for inviting new members and allowing old members to step down as needed. Involving stakeholders and members from outside Honolulu remains a challenge and the use of technology through Zoom has helped to ensure wider participation.

[5] Reach out to physicians: A stakeholder noted that further focus should be put on increasing physician awareness to substance abuse treatment options to complement prescribing protocols, including alternatives to pain management.

[6] Reconvene and re-energize: A continual reconvening is recommended to review what the Initiative has completed, how the plans can be operationalized, and what steps can be taken so that a difference can be made in the community (n=5). A stakeholder noted that after the first or second year of being part of the Initiative, the energy that invigorated the many stakeholders has diminished. The idea was posed to onboard new stakeholders to carry out the plan as they will have the excitement of working on a new project.

[7] Enhance administrative efficiency of the state: Communicate with leaders across state agencies to develop a strategy to enhance the efficiency and timely execution of statewide administrative and financial processing of contracts. As procurement is governed by statute and dictates rules and regulations of all contracts in DOH and the state, high-level political leadership and advocacy to address procurement delays while ensuring ethical conduct is needed.

In addition, Work Group Co-chairs made specific recommendations to objectives as follows:

  1. Work Group 2: Objective 2.6 is viewed as outside of the scope of the Work Group.
  2. Work Group 2: Objective 2.1 (2.0) and 2.3 (2.0) can be merged.
  3. Work Group 3: Objective 3.5 (2.0) can be subsumed under 3.4A.

ANNEX

1: LIST OF INTERVIEWS

Work Group Co-chairs

  • Julianna Moefu-Kaleopa (WG 1)
  • Alan Johnson (WG 1)
  • Roy Goo (WG 2)
  • Melinda Ashton (WG 2)
  • Daniel Galanis (WG 3) *
  • Amy Curtis (WG 3)
  • Jared Redulla (WG 3) *
  • Thaddeus Pham (WG 4)
  • Heather Lusk (WG 4)
  • Aryn You (WG 5)
  • Patrick Uyemoto (WG 5)
  • Valerie Matsunaga (WG 6)
  • Tivoli Faaumu (WG 6)
  • Merry Prince (WG 6)

Executive Steering Committee Members

  • Michael Chang *
  • Robert Hirokawa *
  • Josh Green
  • Rosalyn Baker
  • Sheri Daniels
  • Valerie Mariano

 * Unable to interview

2: SAMPLE INTERVIEW GUIDE

  1. Could you please tell me your employer and job title?
  2. Could you please describe when you got involved with the Hawaiʻi Opioid Initiative and how did you get involved?
  3. What do you view as the purpose of your Work Group?
  4. To what extent did your Work Group achieve these objectives? Note: Objectives provided via email.
  5. What successes did your Work Group achieve?
  6. What challenges and barriers did your Work Group face over this period?
  7. What recommendations do you have to improve your Work Group and to achieve your Work Group goals?

3: TRAININGS, CONFERENCES, AND WORKSHOPS

3: TRAININGS, CONFERENCES, AND WORKSHOPS

5: LIST OF ABBREVIATIONS

Abbreviations Definition
ACEP American College of Emergency Physicians
ADAD Alcohol and Drug Abuse Division, Hawaiʻi State Department of Health
AG Attorney General
AMHD Adult Mental Health Division
ASAM American Society of Addiction Medicine
ASTHO Association of State and Territorial Health Officials
ATS Addiction Treatment Services
BHA Behavioral Health Administration
CAMHD Child and Adolescent Mental Health Division
CARES Community Addiction Resource Entry System
CDC Centers for Disease Control and Prevention
CHOW Project Community Health Outreach Work to Prevent AIDS Project
CSAC Certified Substance Abuse Conselor
DDPI Data-Driven Prevention Initiative
DEA Drug Enforcement Administration
DHS Department of Human Services
DOH Department of Health
East HIPA East Hawaiʻi Independent Physician Association
ECHO Extension for Community Healthcare Outcomes
EHR Electronic Health Record
EMSIPSB Emergency Medical Services and Injury Prevention System Branch
FACEP Fellow of the American College of Emergency Physicians
FTS The Salvation Army Family Treatment Services
HACDAC Hawaiʻi Advisory Commission on Drug Abuse and Controlled Substances
HANO Hawaiʻi Alliance of Nonprofit Organizations
HHHRC Hawaiʻi Health and Harm Reduction Center
HIDTA High Intensity Drug Trafficking Areas
HMIHC Hawaiʻi Maternal and Infant Health Collaborative
HMSA Hawaiʻi Medical Service Association
HOI Hawaiʻi Opioid Initiative
HPC Hawaiʻi Poison Center
HSAC Hawaiʻi State Association of Counties
HSAC Hawaiʻi Substance Abuse Coalition
IPA Independent Physicians Association
JABSOM John A. Burns School of Medicine
LEAD Law Enforcement Assisted Division
MAT Medication Assisted Treatment
MBTSSW Myron B. Thompson School of Social Work
MPD Maui Police Department
NED Narcotics Enforcement Division
NGA National Governors Association
OBOT Office-Based Opioid Treatment
OD Map Overdose Map
OD2A Overdose to Action
OPHS Office of Public Health Studies
OTP Opioid Treatment Program
OUD Opioid Use Disorder
PATH Perinatal Addiction Treatment of Hawaiʻi
PD Police Department
PDMP Prescription Drug Monitoring Program
PMAG Pacific Medical Admin Group, Inc.
PMP Prescription Drug Monitoring Program (see PDMP)
PSD Public Safety Department
PSD NED Public Safety Department Narcotics Enforcement Division
QCIPN Queens Clinically Integrated Physician Network
SAMSHA US Substance Abuse and Mental Health Administration
SBIRT Screening, Brief Intervention, and Referall to Treatment
SOR State Opioid Response
STR State Targeted Response
SUD Substance Use Disorder
UH University of Hawaiʻi
USIS Universal Standardized Intake and Screening
WITS Web Infrastructure for Treatment Services
Abbreviations Definition
buprenophrine Used in medication-assisted treatment (MAT) to help people reduce or quit heroin or other opiates use.
Drop box The Hawaiʻi Medication Drop box Program is a collaborative partnership between state and federal departments to supplement national drug take-back events that take place every year.
Eval Team The UH Eval Team provides logistical and technical support among all Work Groups of the Initiative and leads the evaluation report for the Hawaiʻi Opioid Initiative 2.0.
Mocha Minutes An online education library for prescribing opioids.
naloxone A medication called an “opioid antagonist” used to counter the effects of opioid overdose (e.g., morphine and heroin overdose).
Narcan The brand name of the generic drug naloxone.
National Take-Back Day The National Prescription Drug Take-Back Day provides an opportunity for the public to surrender expired, unwanted, or unused pharmaceutical controlled substances and other medications for destruction.
Suboxone Used to treat adults who are dependent on prescription or illegal opioids.

6: WORK GROUP MEETING INDEX

Date Event
2017-07-12 Launching of The Executive Substance Use Policy Steering Committee & Strategic Planning Committee (SPC) with Governor David Ige
2017-08-01 Strategic Planning Committee (SPC)
2017-08-28 The Executive Substance Use Policy Steering Committee
2017-09-06 Strategic Planning Committee (SPC)
2017-09-29 Working Group Meeting Focus Area 4: Prevention & Public Education
2017-10-01 Working Group Meeting Focus Area 1: Treatment Access
2017-10-03 Working Group Meeting Focus Area 6: Law Enforcement and First Responders
2017-10-04 Operational Working Group
2017-10-09 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2017-10-25 Working Group Meeting Focus Area 4: Prevention & Public Education
2017-11-07 Working Group Meeting Focus Area 3: Data-Informed Decision Making & Evaluation
2017-11-08 Working Group Meeting Focus Area 6: Law Enforcement and First Responders
2017-11-08 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2017-11-09 Operational Working Group
2017-11-09 Working Group Meeting Focus Area 2: Prescriber Education & Pain Management
2017-11-15 The Executive Substance Use Policy Steering Committee
2017-11-16 Working Group Meeting Focus Area 4: Prevention & Public Education
2017-11-30 Working Group Meeting Focus Area 2: Prescriber Education & Pain Management
2017-12-01 Statewide Opioid Use and Other Substance Use Initiative Legislative Briefing
2017-12-14 Working Group Meeting Focus Area 6: Law Enforcement and First Responders
2018-01-03 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-01-11 Working Group Meeting Focus Area 2: Prescriber Education & Pain Management
2018-01-12 Operational Working Group
2018-01-18 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-01-23 Working Group Meeting Focus Area 4: Prevention & Public Education
2018-01-30 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-02-08 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-02-15 Working Group Meeting Focus Area 4: Prevention & Public Education
2018-02-26 Operational Working Group
2018-03-08 Working Group Meeting Focus Area 3: Data-Informed Decision Making & Evaluation
2018-03-19 Operational Working Group
2018-04-04 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-04-05 Working Group Meeting Focus Area 2: Prescriber Education & Pain Management
2018-04-18 Working Group Meeting Focus Area 3: Data-Informed Decision Making & Evaluation
2018-04-20 Operational Working Group
2018-05-01 Working Group Meeting Focus Area 4: Prevention & Public Education
2018-05-02 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-05-07 Working Group Meeting Focus Area 6: Law Enforcement and First Responders
2017-05-18 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-06-01 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-06-14 Working Group Meeting Focus Area 2: Prescriber Education & Pain Management
2018-06-15 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-06-26 Working Group Meeting Focus Area 6: Law Enforcement and First Responders
2018-06-29 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-07-06 Working Group Meeting Focus Area 3: Data-Informed Decision Making & Evaluation
2018-07-11 Working Group Meeting Focus Area 4: Prevention & Public Education
2018-07-16 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2018-07-17 Operational Working Group
2019-01-07 Operational Working Group
2019-01-08 Working Group Meeting Focus Area 3: Data-Informed Decision Making & Evaluation
2019-01-17 Statewide Opioid Use and Other Substance Use Initiative Legislative Briefing
2019-01-17 Working Group Meeting Focus Area 4: Prevention & Public Education
2019-01-18 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2019-01-31 Operational Working Group
2019-02-14 Working Group Meeting Focus Area 4: Prevention & Public Education
2019-02-15 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2019-02-15 Operational Working Group
2019-02-28 Working Group Meeting Focus Area 2: Prescriber Education & Pain Management
2019-03-01 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2019-03-08 Operational Working Group
2019-03-15 Working Group Meeting Focus Area 1: Treatment Access
2019-03-28 Working Group Meeting Focus Area 2: Prescriber Education & Pain Management
2019-04-11 Working Group Meeting Focus Area 4: Prevention & Public Education
2019-04-12 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2019-04-12 Operational Working Group
2019-04-23 Working Group Meeting Focus Area 3: Data-Informed Decision Making & Evaluation
2019-04-30 Working Group Meeting Focus Area 7: Screening
2019-05-02 Working Group Meeting Focus Area 2: Prescriber Education & Pain Management
2019-05-17 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2019-05-17 Working Group Meeting Focus Area 1: Treatment Access
2019-05-21 Working Group Meeting Focus Area 6: Law Enforcement and First Responders
2019-05-28 Working Group Meeting Focus Area 7: Screening
2019-06-13 Working Group Meeting Focus Area 4: Prevention & Public Education
2019-06-14 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2019-06-21 Operational Working Group
2019-07-12 Operational Working Group
2019-07-19 Working Group Meeting Focus Area 5: Pharmacy-Based Intervention
2019-07-19 Working Group Meeting Focus Area 1: Treatment Access

ACKNOWLEDGEMENTS

This document is the evaluation report of the Hawaiʻi Opioid Initiative, a partnership led by the Alcohol and Drug Abuse Division (ADAD) of the Hawaiʻi State Department of Health (DOH) with more than 100 different stakeholders and numerous public and private agencies across the state. This report is authored by Amber Ichinose, Sarah Kamakawiwoʻole, Shelley Liu, Uday Patil, Deveraux Talagi, Daniel Galanis, Edra Ha, and Victoria Fan of the University of Hawaiʻi at MānoaMyron B. Thompson School of Social WorkOffice of Public Health Studies.

The authors are grateful to Edward Mersereau, Ramon Ibarra, Tammie Smith, Amy Curtis, Jared Redulla, Gary Yabuta, Valerie Mariano, Liza Dernehl, Mary Guo, and all the executive steering committee members and Work Group Co-chairs and members for all their contributions to the Hawaiʻi Opioid Initiative and their participation in this evaluation report. The authors are also grateful to the Alcohol and Drug Abuse Division and the Centers for Disease Control and Prevention (CDC) and the Data-Driven Prevention Initiative (DDPI) for its financial support. All errors and omissions are our own. The University of Hawaiʻi Human Studies Program approved the evaluation of the Hawaiʻi Opioid Initiative as exempt on February 22, 2019 (2018-01094).

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Office of Public Health Studies, University of Hawaiʻi at Mānoa, 1960 East-West Road, Biomed D-204, Honolulu, HI 96822.

Recommended citation:  
University of Hawaiʻi at Mānoa. Hawaiʻi Opioid Initiative Report. Reported submitted to the Alcohol and Drug Abuse Division, Hawaiʻi State Department of Health. November 5, 2019.