Rio Arriba County Turns The Corner On Opioids

Rio Arriba County


After a stunned silence, community leaders gathered in Española through the Rio Arriba Community Health Council to hear New Mexico Department of Health epidemiologists report out on new overdose data burst into applause. “We’re not used to hearing good news!” someone exclaimed.

The DOH epidemiology team was presenting data from a pilot Emergency Department Overdose Surveillance project kicked off in Rio Arriba County. Every month, a team composed of leadership from Presbyterian Española Hospital (PEH), PEH Emergency Department medical staff, Rio Arriba County Health and Human Services (RAHHS) and NMDOH officials meets to review overdoses. A Rio Arriba team of Case Managers outreaches to overdose survivors, offering services. The DOH follows up with prescribers when needed to offer advice about safe prescribing policies.

The team of DOH presenters informed delighted health council members that Rio Arriba is one of  only two counties in which DOH conducts overdose surveillance because it is the only county capable of response. “There’s no point in doing it, if you can’t refer folks anywhere,” said the presenter. “And it’s working.”

Overdose presentations at the PEH Emergency Department dropped a whopping 38% in 2019, from 166 in 2018 (the first year they were recorded) to 104 in 2019. Even more surprisingly, after decades of overdose deaths in the double digits, only one overdose death was recorded in the PEH Emergency Department in 2019. The DOH presenters attributed the change to the formation of the Opiate Use Reduction Network, a multidisciplinary group of health care agencies connected by centralized intensive case management provided through the County’s Health and Human Services Department. The project was funded through a Behavioral Health Investment Zone Project for five years. It is in its final year.

In 2015, there was a county-wide decrease in overdose deaths in Rio Arriba of approximately 30%. Rio Ariba Health and Human Services Director Lauren Reichelt attributed the drop to Phase 1 of the project: blanketing the streets with Naloxone.

“Deaths dropped 30% and remained at that level through 2018, while the number of non-fatal overdose visits to the Española ER steadily increased from 158 in 2012 to 347 in 2016. The fact that the overall OD death rate was steadily but slightly decreasing from 2012 to 2016 while the rate of ER visits for the same condition doubled tells me that people were following our advice to administer Naloxone and proceed to the emergency room. They were trusting us and that is huge,” she said. “Because the sudden drop in ER visits and deaths in 2019 seems to be accompanied by other positive indicators, I think it means that we have finally ramped up our ability to respond to a level that is beginning to meet the need. We are being effective.”

Reichelt cites anecdotal evidence from the case managers in the jail that the jail census has dropped approximately 30% from around 120 to 80 as another sign that the systemic intervention is working.

While countywide data is not yet out, and the overall death rate could remain high, Emergency Room data demonstrates the effectiveness of Rio Arriba’s coordinated response. Rio Arriba lead the nation in heroin overdose deaths for decades.

“It’s nice to be first in something good,” says Commission Chairman, Leo Jaramillo. “I don’t know how many counties across the US have begun to round the corner on the opioid epidemic, but I’m sure we are among the first!”