CFRP staff members Anita Jacobson, Catherine Ahern, Tammy Whan, and Brad Thibodeaux receive a delivery of naloxone kits at Morrill Hall on URI’s Kingston Campus.
Led by URI’s College of Pharmacy with support from the Rhode Island Department of Health, the Community First Responder Program distributes lifesaving naloxone kits and offers education about the opioid overdose epidemic where it’s needed most.
By Anna Vaccaro Gray ’12, M.S. ’16
It’s a typical Saturday morning at the South Kingstown Farmers Market. Stands feature fresh vegetables, coffee, honey, baked goods, flowers—and naloxone. URI’s Community First Responder Program (CFRP) is at the market offering free medication that can rapidly reverse an opioid overdose. The location is intentional: The CFRP aims to be as accessible—and as much a fixture of the community—as the local farm stand.
Anita Jacobson, Pharm.D. ’98, clinical professor of pharmacy and director of the CFRP, sets up tables at farmers markets and other community events, working with pharmacy and nursing students to educate community members about substance misuse, how to recognize an overdose, and how to administer naloxone.
The CFRP first started distributing the prefilled nasal sprays at farmers markets in the summer of 2020. Jacobson recalls that people stopping by the CFRP table would often mention that they didn’t know anyone using drugs but wanted to be prepared just in case. Others would burst into tears, sharing stories of loved ones lost to overdoses. Still others talked about family members struggling with addiction.
“We heard every kind of story you can think of,” she says, looking back to those early days of the CFRP. “And we gave out tons of naloxone.” Making space for these conversations while also providing a lifesaving medication exemplifies CFRP’s mission: Remove the stigma associated with opioid misuse, keep people alive and healthy, and empower communities to proactively tackle this growing crisis.
A LIFESAVING ANTIDOTE
According to the Rhode Island Department of Health (RIDOH), opioid overdose is the leading cause of accidental death in Rhode Island. Last year, 404 Rhode Islanders died of an overdose, compared to 436 people in 2022. The rate of overdoses has been significant in recent years as the unregulated drug supply has become more lethal, largely due to illicitly manufactured contaminants such as fentanyl and drugs like xylazine, a veterinary sedative, which is not approved for human use. RIDOH’s data indicates that last year, 85% of overdoses involved opioids, and 78% involved fentanyl, specifically.
Naloxone (also known by its brand name, Narcan) can reverse an overdose from opioids—including heroin, fentanyl, and prescription opioid medications—and restore normal breathing. There is a short window of time to intervene before oxygen deprivation causes significant or fatal damage. A prefilled nasal spray is one form of naloxone that can be used without a prescription. All 50 states have a good Samaritan law that protects against civil or criminal liability for helping someone experiencing a drug overdose, and many states go further, protecting against arrest for drug-related offenses.
Jacobson compares naloxone to other safety tools, noting that everyone should have it on hand, even with prescription opioids, because mistakes can happen. “It’s like having a fire extinguisher,” she says. “Nobody wants to have a fire, but we all have fire extinguishers on hand just in case. Having a fire extinguisher is not stigmatized. You can want something to not happen, and also be prepared in case it does.”
COMMUNITY IMPACT
The 7% decrease in overdose deaths last year is the first decline in Rhode Island in four years. “While difficult to measure precisely as there are so many factors that affect the overdose crisis, the availability of naloxone has, without a doubt, been vital to our response and has most certainly impacted the decrease in fatal overdoses,” says Nya Reichley, community outreach coordinator for the Drug Overdose Prevention Program at RIDOH. Faculty and students at URI have played a meaningful role in distributing naloxone both to the public and to harm-reduction organizations around the state.
In fall 2019, Jacobson led a team from URI’s College of Pharmacy, College of Nursing, College of the Environment and Life Sciences, and Cooperative Extension in securing a $1 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Department of Health and Human Services, to establish the CFRP. They focused on underserved rural areas of the state, utilizing the connections Cooperative Extension has established through its agricultural outreach program, educating people about opioids and offering essential resources to address misuse.
The CFRP, now run by Jacobson and three full-time staff members and housed in URI’s College of Pharmacy, has expanded. In fall 2021, RIDOH asked the program to lead naloxone distribution for the entire state—establishing CFRP as the hub for ordering, processing, labeling, storing, and distributing intranasal naloxone—about 50,000 kits annually. “To my knowledge, this is the first time a university’s college of pharmacy has taken the lead on providing community-based naloxone distribution,” Jacobson says.
CFRP director Anita Jacobson.
CFRP’S MISSION: Remove the stigma associated with opioid misuse, keep people alive and healthy, and empower communities to proactively tackle this growing crisis.
Since their work has been fully funded by RIDOH, they have given out an estimated 150,000 naloxone kits. About 16,000 of them have been distributed directly to the public at places such as markets and libraries. And because the CFRP is now a licensed wholesale distributor, even more have been given to nonprofit recovery and harm-reduction organizations around the state. “Collaborating with the CFRP has been invaluable to Rhode Island’s overdose response, and their work has set Rhode Island apart from other jurisdictions in response to the overdose crisis,” notes Reichley. “Dr. Jacobson highlights the importance of pharmacists in our efforts.”
The CFRP’s model is novel for two reasons: Kits are free, and personal information is not required. Toni Sullo, Pharm.D. ’24, says that the cost of the medication is prohibitive for many. “Despite payment assistance programs, most people leave the pharmacy without naloxone due to its price,” she says. “It felt really impactful to work with the CFRP and eliminate any cost barrier that would prevent someone from being equipped with this life-saving medication.”
“One of the reasons community distribution is so successful is because it is anonymous,” Jacobson says. At community events, people are asked for basic demographic information when they pick up a kit, but it’s optional. “The program approaches outreach efforts with a health-equity lens to address disparities in overdoses and naloxone distribution,” Reichley adds.
The CFRP’s educational outreach has grown, as well. Through webinars and in-person workshops, the program has trained more than 1,050 law enforcement officers and 1,800 teachers, nurses, counselors, and administrators on overdose response. It offers continuing education programs for health-care professionals. More than 1,600 members of the public have attended live seminars on the opioid epidemic, and even more have been reached through events across the state.
Pharmacy and nursing students can work with the CFRP to earn community service hours, which are necessary for graduation and as part of the doctor of pharmacy degree’s six-week clinical rotations.
Kendra Walsh, Pharm.D. ’21, worked with the program from its inception to her graduation. Now a medical student at the Warren Alpert Medical School of Brown University, she says her experience with the CFRP was invaluable. “As I apply to anesthesiology residency programs,” she says, “my experiences with the CFRP really helped emphasize the importance of responsible, appropriate use of opioids, because we know what can happen when best practices are not adhered to.”
Anita Jacobson and Emily Lancor, Pharm.D. ’24, staff a table at a community event.
“One of the reasons community distribution is so successful is because it is anonymous.”
–Anita Jacobson, Director, Community First Responder Program and Clinical Professor of Pharmacy
“The opioid epidemic is part of what made me want to become a pharmacist in the first place, and working with the CFRP really confirmed that,” says Claire Burbridge, Pharm.D. ’24, M.B.A. ’24. “As I’ve started a yearlong residency, I’ve been seeking opportunities to work in harm-reduction or substance-use-disorder settings. I know I will be incorporating what I learned with the CFRP.”
LOCAL TO REGIONAL
With a $1.3 million federal grant from SAMHSA awarded in 2022, the CFRP expanded into a regional hub, creating partnerships with five institutions in Connecticut, Maine, Massachusetts, New Hampshire, and Vermont. The Rural Opioid Technical Assistance Regional Center operates through four partners in these states, and, among other aspects of the model built at URI, it now offers the CFRP’s online training modules for the public and continuing education for health-care professionals. Participants receive naloxone by mail from the CFRP. These five states also reported declines in fatal overdoses in 2023—ranging from a 4.1% decrease in Vermont to a 16.2% decrease in Maine.
While momentum for CFRP’s programs has been growing—it is the only organization focused on addressing overdose deaths in rural New England—this grant is only secure for another year. The future of these partnerships—and the services the institutions can offer as a result—is unclear after that. The committed funding from RIDOH, as well as additional grants such as a $250,000 award from the Rhode Island Foundation in 2021, ensures the work the CFRP is doing in Rhode Island will continue.
A PERSONAL PERSPECTIVE
A pharmacist since 1998, Jacobson has seen firsthand how a myriad of situations can lead to drug misuse. “I’ve seen people develop dependence on prescription opioids, or transition from prescription opioids to street drugs, or go in and out of detox and rehab,” she says. Her perspective is not limited to professional observations: In 2014, she lost a family member to a heroin overdose. “That’s what really galvanized me to get involved in naloxone distribution specifically,” she says. “It made me examine addiction and want to learn more about it.” According to RIDOH’s data, 84% of fatal overdoses, like the one in Jacobson’s own family, occur in a private setting. “If you don’t have the reversal agent there, you can’t make an intervention,” she notes.
CFRP director Anita Jacobson at a community educational presentation in Johnston, R.I.
The matter-of-fact, compassionate approach she brings to her work is informed by a depth of understanding only a seasoned health-care provider—one who has been privy to many personal stories and experiences, in addition to her own experience—could have. She is not judgmental. Instead, she offers solutions for how to move forward in ways that are both realistic and empowering.
“Working with Dr. Jacobson was amazing,” says Burbridge. “She is not only a great teacher but a great person, and I think this shines through when you look at the program as a whole. Seeing how much she has done for the state of Rhode Island through this program was very inspiring.”
“I was able to see how much of a difference one person can make,” she adds.
COMMUNITY CARE
The numbers are staggering: Overdose death rates in the United States are equivalent to a Boeing 737 plane crashing daily. About 1 in 3 Americans has lost someone to an overdose. However, many feel reluctant to talk openly about their experiences or seek help because of the stigma surrounding drug use. The CFRP works at the intersection of providing practical resources and changing the conversation about this complex issue. It has succeeded in creating an interdisciplinary, interagency response to this crisis, and CFRP staff seek to inspire that same collective strength on a community level.
While the goal is to ensure that everyone can respond to an overdose and have essential medication on hand, the underlying mission is deeper. “It’s not just about handing out naloxone,” Walsh says. “It’s about shaping perceptions and increasing understanding so our entire society can benefit.”
A sign on Jacobson’s office door features a quote from Dr. Seuss’s The Lorax: “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.”
“People usually think of police or fire and rescue departments as first responders,” Jacobson says. “We’re trying to build a community of first responders—people who have basic knowledge, training, and resources to help others who need it. If people are educated about this and know how to recognize an overdose and recognize someone caught in the cycle of substance-use disorder, we can save lives.”
PHOTOS: SETH JACOBSON; COURTESY CFRP
Be a Community First Responder
Interested in becoming a community first responder? Visit uri.edu/cfrp to complete an interactive 10-minute online module to learn more about the opioid epidemic, drug misuse, stigma, naloxone, and treatment and recovery options. When finished, you will be a certified responder and can request a free naloxone kit by mail.
At that link, you can also schedule a live webinar or in-person seminar for a group and donate to the CFRP. All contributions directly fund naloxone education and kit distribution.