START-SD program begins new work to reduce overdose rates

South Dakota State University’s program to address substance use disorder in South Dakota has received additional funding to combat substance use overdose.

A new award of $300,000 from the Health Resources and Services Administration will result in a one-year program titled START-SD: Overdose Response (START-SD-OR), which will increase access to naloxone and fentanyl test strips, provide education and training on naloxone use and distribution, develop an anti-stigma campaign and expand access to peer recovery coaches.

START-SD — short for Stigma, Treatment, Avoidance and Recovery in Time for South Dakota — is a HRSA grant-funded program that has been working to address substance use disorder in South Dakota since 2019.

Previously, START-SD work has focused on prevention, treatment and recovery services for opioid use disorder and psychostimulant use disorder. Through this new funding, the START-SD work will expand to specifically address substance overdose in South Dakota.

What is START-SD: Overdose Response?

Erin Miller, project director for START-SD-OR, says one of her designs for the program is “to continue to reduce the harm in our communities that is caused by substance use disorder.”

The overall goal of the program is to “reduce morbidity and mortality associated with substance use disorder in target communities among adults ages 18-54 through promotion of harm reduction strategies, education and training with health care facilities to improve treatment, and increasing access to treatment and recovery services through education, training and placement of peer coaches.”

Between 2016 and 2020, there were more than 2,400 drug-related hospitalizations and 684 drug-related deaths in South Dakota, according to Miller.

Patricia Ahmed, co-project director, explained, “In rural areas, services for individuals with substance use disorder are severely limited.” She noted this is particularly a problem in emergency situations, as emergency responders have much longer response times in rural areas.

The START-SD-OR program specifically targets Yankton, Lyman, Roberts and Hughes counties. Ahmed explained that “these counties are highly vulnerable to opioid overdoses and health issues related to opioid use disorder.” Some reasons for this include limited access to mental health services, substance use disorder treatment and counseling services.

To complete this work, SDSU and the START-SD team are partnering with several organizations across South Dakota, including the South Dakota Foundation for Medical Care, Emily’s Hope, the University of South Dakota, Straight Up Care, Face It TOGETHER and the Coteau des Prairies Health Care System.

Distributing naloxone and fentanyl test strips

Ahmed explained that through this work, the START-SD team wants to bridge the gap in rural areas by connecting rural residents with needed recovery services, facilitate access to naloxone and distribute fentanyl test strips.

According to the Centers for Disease Control and Prevention, “Naloxone is a lifesaving medication that can reverse an overdose from opioids—including heroin, fentanyl and prescription opioid medications—when given in time.

“Fentanyl test strips are a low-cost method of helping prevent drug overdoses and reducing harm. They are small strips of paper that can detect the presence of fentanyl in all different kinds of drugs.”

The South Dakota Foundation for Medical Care will assist the START-SD team with pharmacy outreach and educational programming to facilitate distribution and proper use of naloxone and fentanyl test strips.

Nancy McDonald, vice president of the South Dakota Foundation for Medical Care, said that through the project, “we can play an integral role in equipping communities with the tools, resources and interventions that reduce harm and save lives. Distribution of naloxone to community members can play a crucial role in saving a life when an emergency medical response may be delayed.

Combating stigma

An important objective of the program is also to combat stigma related to substance use disorder. According to Ahmed, “Anti-stigma campaigns can lead to improved overdose rates by increasing the likelihood of individuals with substance use disorder seeking treatment.”

Emily’s Hope, a nonprofit organization raising awareness of the opioid epidemic, will partner with START-SD to combat stigma related to substance use disorder and increase knowledge and awareness.

According to Angela Kennecke, president and CEO of Emily’s Hope, “Our mission to remove the stigma associated with substance use disorder resonates strongly with the goals of START-SD-OR. ... Together, we hope to bring about real change, helping individuals find the critical care they need and fostering a society that supports, understands and embraces those in the journey toward recovery."

Supporting peer recovery

Miller noted another key objective of the START-SD-OR program: “To expand access to peer recovery coaches through recruiting and training new peer recovery coaches.”

Melissa “Mo” Dittberner, a lecturer at the University of South Dakota, CEO of Straight Up Care and an expert in peer recovery, explained that “evidence-based practices show that peer support can help reach people right where they are with the individual support they need.”

“The importance of peer support is the rapport and connection that comes from working with people who have been there. ... Peer specialists are a crucial piece of the care team puzzle and can work with a person in recovery at any and every step of the way.”

Through the START-SD-OR program, Straight Up Care will provide peer support training for virtual peer coaches and provide peer support sessions for those impacted by substance use disorder throughout the target counties.

Face It TOGETHER, a nationally focused addiction wellness nonprofit, will continue to partner with the START-SD team for this program. Through the START-SD-OR program, Face It TOGETHER will provide peer coaching services to qualifying patients either in person or via telehealth and assist with anti-stigma messaging.

Additionally, through the program, Face It TOGETHER will recruit, hire and train one peer recovery coach to provide services in Roberts County, through a partnership with the Coteau des Prairies Health Care System in Sisseton. 

“We look forward to partnering with START-SD and fellow consortium members to create an impact in responding to substance use disorder overdoses by bringing together this unique conglomerate of substance use disorder resources and services,” Michaela Johnson, director of pharmacy and clinic operations at Coteau des Prairies, said.

Looking forward

The START-SD-OR program began on Sept. 1 and will conclude Aug. 31, 2024.

Miller and Ahmed have high hopes for the year and are confident the program will see success through collaboration with its partners.

“The overall goal is to reduce mortality and morbidity related to substance use disorder in these four rural South Dakota counties by promoting harm reduction strategies, educating and training in health care facilities, and increasing access to naloxone, fentanyl test strips and peer recovery services,” Ahmed said.

Miller added, “Substance use disorder can impact anyone, and although there are many people and organizations doing great work to reduce the impact of substance use disorder, we still have more work to do and people who still need help in South Dakota.”

Learn more about START-SD-OR and all the START-SD projects.