Part 1: How The MetroHealth System’s Office of Opioid Safety and Project DAWN Scales Opioid Safety in Cleveland, Ohio  | Innovator Spotlights Series | Value of Partnerships in Population Health

The Innovator Spotlight Series features thought-provoking discussions highlighting diverse areas of healthcare innovation. Today’s focus is how we can address the opioid epidemic.

In the first of three interviews, we feature MetroHealth’s Melissa Federman, Director of the Office of Opioid Safety, and Stephanie Shorts, Program Coordinator of Project DAWN and the Syringe Service Program.

MetroHealth is a Cleveland-based health system and the sole safety net hospital in Cuyahoga County. MetroHealth operates four hospitals, four emergency departments, 20 health centers, and treats 300,000+ patients, two-thirds of whom are uninsured or on Medicare or Medicaid.  MetroHealth employs 600 doctors, 1,700 nurses, and 7,800 employees, and is an academic medical center affiliated with Case Western Reserve University School of Medicine.

Continue reading to learn how MetroHealth’s Project DAWN is driving opioid-related change in Cleveland, Ohio.

What does Project DAWN stand for and how did it come into existence? 

Stephanie: Project DAWN stands for Deaths Avoided With Naloxone. It is an Ohio-based program, operated by the Ohio Department of Health and named for a young woman named Dawn, who lost her life to an opioid overdose early in the epidemic.

Melissa: We founded the second Project DAWN site in Ohio in 2013. Prior to the development of the Office of Opioid Safety and expansion of our Project DAWN program, we partnered with a local syringe service program to distribute naloxone, but at the time, this required one of our staff to be physically present.

At what point did MetroHealth centralize and coordinate opioid-related efforts? 

Melissa: Ten years ago, our emergency medicine physicians were on the frontline of the opioid crisis and were seeing daily overdoses and fatalities. One of these doctors, Joan Papp, MD, understood the value of Naloxone, a life-saving drug, and wanted to find a way to make it more accessible to the community.

MetroHealth led the local response in opioid stewardship and access to Naloxone.

Stephanie: We’ve also witnessed increased needs from our community over the last five years which is best served through a coordinated response. Specifically, there’s been increased need for access to Naloxone, syringe services, harm reduction services, and medication-assisted treatment for opioid use disorder and in the jails.

How did MetroHealth balance investment in Project DAWN versus other areas? 

Melissa: Project DAWN is mostly grant-funded allowing us to provide services free of charge. In its infancy, we sought support and buy-in from MetroHealth leadership, which was crucial.  With leadership’s buy-in, we’ve increased Project DAWN’s visibility, so much so that at a MetroHealth annual meeting, a few hundred attendees received free Naloxone kits. I was working with a community based organization at the time and was impressed because that is what public health should look like – getting needed resources out into the community, raising awareness, and engaging leaders.  

What services does Project DAWN offer today? 

Melissa: Project DAWN offers free Naloxone kits to high-risk individuals, front-line personnel, and community members through our mobile clinics and hospital departments. We also provide safe injection supplies, syringes, other harm reduction resources, along with connections to patients and community members who use drugs.  We have partnered with the ADAMHS Board to install Emergency Naloxone Cabinets throughout the county for rapid access and have installed a free 24/7 access Harm Reduction vending machine outside of the MetroHealth Emergency Department.  

What types of internal and external partners were needed to scale Project DAWN? 

Melissa: There are so many kinds of partners: funders, policymakers, health departments, the state officials, syringe service partners, substance use disorder treatment organizations, and more. When you’re dealing with an epidemic, it’s vital to partner with other organizations – no one agency can do everything.

Stephanie: We’re a part of the Opioid Hospital Consortium, US Attorneys Opioid Taskforce, and overdose fatality review meetings – and these bring us closer to other types of partners. We have a mobile unit to support clothing donations, food scarcity, and linkage to other treatment services. We pride ourselves on working with wide-ranging agencies to best support community members.

Melissa: While we do outreach, we also do in-reach. We’ve focused on internal programming to promote opioid stewardship – reducing opioid prescribing, reducing risky co-prescribing, and increasing Naloxone prescribing. We have a pharmacist in our office who provides 1-on-1 education with each department in the health system. We also have data dashboards which show relevant opioid and Naloxone activities at the individual provider level. We’re very happy with the outcomes of these programs: we’ve seen a 25% system-wide reduction in opioid prescribing, a 60% decrease in opioid and benzodiazepines co-prescribing, and an increase in Naloxone prescribing.

Stephanie: We have received reports of over 7,000 successful overdose reversals since our program began in 2013, which really shows what we do is making a difference.

What are the biggest lessons learned since the inception of Project DAWN? 

Melissa: You must be flexible and adaptable. During Covid, we needed to find an innovative way to distribute supplies to our communities; for instance, if our mobile unit broke down, we needed to be ready to set up a tent.

Stephanie: Flexibility is key because the drug supply is always changing. Also, it’s critical to continuously listen to patients and respond to their needs. If you don’t listen to patients, they won’t show up. It is important for us to be IN the community and serve patients the way they want to be served. Ultimately, we want to be a one-stop-shop that leads to patients getting the care they need, while building relationships to help engage patients in treatment when they are ready.

What can other health systems take away from your experience? 

Melissa: There are so many places to start – and know this takes time! We’ll share three. First, identify where your gaps are and assemble a team who are passionate about this work. Second, don’t reinvent the wheel. Opioid safety is a well-known challenge, so find partners for information-sharing and collaboration (e.g., sharing Epic workflows). And third, focus on fostering community partnerships who share similar focus or can fill a need your program cannot.

What’s the vision of Project DAWN in the next five years? 

Melissa: We have many ambitions, building our current programs. We hope to establish a safe smoking protocol and provide supplies, expand into the east side of Cleveland where a disproportionate number of non-Hispanic and Black Clevelanders reside and where the highest opioid fatality growth is taking place, and partner with the medical examiner’s office to test needle residue to be able to provide more direct education to patients. We also hope to expand our low threshold opioid use disorder treatment clinic.

Stephanie: I’d love to have a standalone building and collocate our offices and resources (e.g., an area for syringe exchange, Naloxone clinic, clothing donations, a food pantry, and more) versus scattered resources.

Let’s connect!  

Are you interested in discussing opioid safety programs? Are you a clinician on the front lines? If so, what have you witnessed? What are your challenges and successes? Reach out to talk more. 

Stay tuned till next week when we will be continuing our conversation on the opioid epidemic with another transformative voice, Dr. Justine Welsh from Emory Healthcare. 



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