House call from Rhode Island’s top doc

One of RIDOH’s groundbreaking programs is the overdose prevention center, which, Dr. Spencer pointed out, was informed by faculty research from the School of Public Health. As a result of this work, Rhode Island became the first state in the country to authorize a fully licensed and regulated harm reduction center. The facility provides a space for people with substance use disorders to use drugs under the observation of trained staff and access resources that support their recovery.

“Most fatal overdoses occur in isolation, as no one is there to revive them,” Larkin said. “That’s what the staff is there to do: provide them with a safe place to engage in use. Then if they show signs of overdose, staff can revive them with naloxone, Narcan, oxygen or CPR.”  

 Larkin recalled a speaker at the center’s opening–a family member of an overdose victim who was opposed to the center until tragedy struck her own family.  “One of the most important points she made during her talk is that addiction is a disease and people are enthralled to it,” he said, “and they will use regardless of all of the known dangers.”

Pointing to current challenges, Larkin discussed the White House administration’s proposed cuts to Medicaid, research funding, health equity and global health programs that contain outbreaks of infectious diseases like Ebola and the Marburg virus, which are currently emerging in the Democratic Republic of Congo and Tanzania, respectively. Spencer noted that U.S. funding for global health recently helped contain the Marburg virus in Rwanda, keeping the rest of the world safe by limiting the virus at its source.

“The first thing to recognize is that the current administration sees chaos as a strategy, and nothing could be more antithetical to public health or health care writ large than chaos,” Larkin said. “Our job is always to bring order out of chaos.”

 Regarding federal funding, Larkin explained that every health department in the country depends on it. For RIDOH, federal funds account for roughly 60% of the total budget.  “One of the challenges as director of the Department is to reassure my staff and not minimize the pretty substantial threats that we’re under,” he said. “But we will continue to rely on each other and will continue to hold true to our values both as people working at the Department and as Rhode Islanders.”

Since many of these issues need to be addressed by the governor, treasurer and legislative delegation, Larkin is working with state officials to determine which programs may be targeted and to develop strategies for shoring them up at the local level.

“There are still potential collaborations among states who have a like-minded consensus about how things should work in the world,” he said.