By John S. Kilmer IV – Public Health Researcher & Recovery Advocate
🚨 Community Health Issue
The East Toledo area faces an intense opioid crisis because its overdose death rate reaches 38.7 per 100,000 people, which exceeds the state average (Ohio Dept of Mental Health and Addiction Services, 2023). The combination of high poverty rates (25%) and insufficient behavioral health and substance use treatment providers (1,125:1 ratio) makes the situation worse (County Health Rankings, 2023). The Lucas County Community Health Needs Assessment (CHNA) has determined that opioid overdose, mental health issues, and socioeconomic stress represent the most critical priorities (Lucas County Health Department, 2023). Addressing stigma among first responders is key to closing gaps in naloxone deployment and emergency care access.
🧠 Research Questions
- Will peer-led naloxone education increase first responder willingness to act during an overdose?
- Can stigma-reduction training measurably improve responders’ attitudes, as assessed by the Opening Minds Stigma Scale (OMS-HC) (Modgill et al., 2014)?
- What are the main perceived barriers preventing first responders from administering naloxone, and how can targeted training address them?
📚 Background
Research findings demonstrate that stigma functions as a primary obstacle which prevents effective overdose response (Tsai et al., 2019). The research by McGinty et al. (2015) demonstrates that treating addiction as a treatable condition decreases public stigma while boosting support for harm reduction policies. The implementation of peer-led education programs strengthens both the credibility and acceptance of naloxone initiatives (McDonald & Strang, 2022). Educational interventions that incorporate lived-experience narratives in training programs work to break stereotypes while promoting compassionate care (Livingston et al., 2012).
🔬 Research Methodology & Design
A mixed-methods design was selected following Creswell & Creswell’s framework (2018).
- Quantitative: Pre/post-surveys using OMS‑HC to measure stigma shifts, knowledge, and willingness scales.
- Qualitative: Follow-up interviews capturing perceptions, emotional impact, and cultural relevance.
- Participants: 40–50 first responders from EMS, police, and fire units in East Toledo.
- Timeline: One-hour training delivered over 4 weeks, with surveys and interviews at baseline and 8 weeks post-intervention.
🏙️ Setting & Demographics
East Toledo, bounded by the Maumee River and I-280, is predominantly working-class with an estimated 25,000 residents. Census data indicate over 25% of families live in poverty (US Census, 2022). Behavioral health provider shortages further limit intervention capacity (HRSA, 2023). First responders in these communities encounter high rates of overdose and mental health crises daily, emphasizing the need for stigma-informed training.
🔎 Objectivity & Bias
- Ethics: Approved by IRB, informed consent obtained.
- Anonymity: De-identified surveys and secure data handling.
- Neutrality: Interview questions were pilot-tested and open-coded to avoid bias.
- Stakeholder input: Peer recovery advocates and EMS leaders contributed to training design, reducing cultural blind spots.
📊 Data Collection & Alignment
Five alignment criteria guide this study:
- Mortality Rate—An urgent indicator reflected in the training need (Ohio Dept of Mental Health and Addiction Services, 2023).
- Provider Access—Training strengthens capacity where provider gaps exist (HRSA, 2023).
- Stigma—Measured using the established OMS-HC scale (Modgill et al., 2014).
- Peer-Led Model—Aligns with evidence of successful lived-experience education (Livingston et al., 2012).
- Policy Consistency—Matches CDC and state harm reduction guidance (CDC, 2023).
Conclusions & Evidence-Based Strategies
🌟 Community-Level Actions
- Distribute free naloxone and provide hands-on training through local initiatives like Project DAWN, which has been effective in overdose reversal efforts across Ohio (CDC, 2023). The success of these training courses depends on peer recovery coaches who lead them because their lived experience helps participants trust the training process.
- The program should organize monthly stigma-reduction forums that bring together first responders and peer advocates to create open discussions that transform public opinions. The forums serve dual purposes of education and humanization of addiction, which leads to increased empathy and decreased fear-based stigma.
- A multimedia awareness campaign should start through social media platforms and local news outlets, and flyers to promote harm reduction normalization and deliver consistent messages to underserved populations (McGinty et al., 2015). Storytelling combined with simple visual content helps to eliminate false information about opioid use disorder.
👨⚕️ Professional & Agency-Level Actions
- First responders should receive stigma-reduction training through continuing education programs. The training program should include interactive elements with real-world scenarios to make it more relevant and impactful for emergency personnel (Modgill et al., 2014).
- The training programs should incorporate OMS-HC evaluations (Opening Minds Scale for Healthcare Providers) to assess stigma-related attitudes. The validated tool provides measurable outcomes because it quantifies perceived results.
- The training sessions should be co-facilitated by peer recovery coaches who work with EMS and fire departments. The approach builds mutual understanding between participants while research indicates it enhances their knowledge and their attitudes toward opioid use disorder patients (Tsai et al., 2019).
🧠 Why These Strategies Matter
The proposed strategies are aligned with both CDC recommendations and research evidence supporting community-based and educational methods for stigma-reduction (CDC, 2023). The environment becomes more supportive of recovery when first responders receive training with peer advocates, and the public is engaged through forums and campaigns. The combination of community outreach with professional training and outcome tracking serves as a fundamental approach to reduce overdose deaths while building enduring trust and resilience in East Toledo.
References
Centers for Disease Control and Prevention. (2023). Overdose death rates. https://www.cdc.gov/drugoverdose/data/statedeaths.html
County Health Rankings. (2023). Lucas County, Ohio: Rankings data. https://www.countyhealthrankings.org/app/ohio/2023/rankings/lucas/county/outcomes/overall/snapshot
Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications.
Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.x
Lucas county health department feasibility study (2023, Jul 18). Mena Report
Modgill, G., Patten, S. B., Knaak, S., Kassam, A., & Szeto, A. C. (2014). Opening Minds Stigma Scale for Health Care Providers (OMS-HC): Examination of psychometric properties and responsiveness. BMC Psychiatry, 14(1), 120. https://doi.org/10.1186/1471-244X-14-120
McDonald, R., & Strang, J. (2016). Are take-home naloxone programmes effective? systematic review utilizing application of the bradford hill criteria. Addiction (Abingdon, England), 111(7), 1177–1187. https://doi.org/10.1111/add.13326
Rural residency planning and development program (HRSA) (2023). Federal Grants & Contracts, 48(1), 6. https://doi.org/10.1002/fgc.33399
Tsai, A. C., Kiang, M. V., Barnett, M. L., Beletsky, L., Keyes, K. M., McGinty, E. E., Smith, L. R., Strathdee, S. A., Wakeman, S. E., & Venkataramani, A. S. (2019). Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Medicine, 16(11), e1002969. https://doi.org/10.1371/journal.pmed.1002969
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