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What Do Tennessee’s Regional Overdose Prevention Specialists (ROPS) Do?

Nestled deep inside the Bible Belt, Tennessee is big on tradition and conservative values. As you might imagine, harm reduction — reducing harm done to and experienced by drug users — isn’t very big here.

Here’s a good rule of thumb — the more left-leaning a state is, the more likely existing harm reduction infrastructure can be found there (e.g., California, New York). Places like Tennessee don’t have much in place; we’ve got seven organizations running state-approved Syringe Services Programs, at least one county health department-run syringe disposal program, and 25 Regional Overdose Prevention Specialists (ROPS).

What Do ROPS Do?

ROPS are employed by the Tennessee Department of Mental Health & Substance Abuse Services to hold NARCAN trainings and distribute naloxone. Beginning in November 2022, ROPS also began giving out fentanyl test strips.

As of January 2023, some ROPS stock fentanyl test strips from untested, disreputable brands. This isn’t ROPS’ fault, but that of TDMHSAS. To learn more about which brands we recommend, check out: What Are Fentanyl Test Strips?

The Background of ROPS

In late 2017, TDMHSAS announced its “TN Save a Life Program.” Ostensibly, this four-pronged program was rolled out due to the rash of opioid use and resulting opioid-related deaths that initially broke out some 10 to 15 years prior.

The TN Save a Life Program was designed to deal with fallout from the opioid epidemic and consists of the following components:

  • Project ECHO,” a campaign with Vanderbilt University touting the end goal of helping clinics, hospitals, and emergency rooms beef up access to medication-assisted treatment programs, a.k.a. opioid replacement therapy, through the provision of telemedicine services.
  • The creation of “regionally-specific resource guides.”
  • The staffing of 20 “Regional Overdose Prevention Specialists” throughout 13 regions within the Volunteer State. These people hailed from a variety of backgrounds, including “recovery, paramedics, and Certified Peer Recovery Specialists,” taken directly from the DMHSAS’s website. As of January 2023, there are 25 ROPS.
  • A state-wide media campaign.


Who Do ROPS Serve?

ROPS primarily serve first responders, addiction services providers and community-based groups, and people at high risk of overdose — as well as their family and friends.

These aren’t the only beneficiaries of ROPS — “all interested community members” can be trained in opioid overdose reversal.

What Do Trainings Consist of?

Just as there are three primary audiences, there are three main topics that ROPS’ training events cover:

  • Raising public awareness for facts about the opioid crisis and the trends that currently define it, how addiction works, and best practices for administering naloxone.
  • Attempting to nip drug-related stigma in the bud.
  • Spreading knowledge of harm reduction, why it’s important, and defining what the practice consists of.

How Can ROPS Improve?

While paid by the state through SAMHSA’s State Opioid Response funding, ROPS are employed and supervised by third-party non-governmental organizations such as local housing authorities and prevention coalitions. This setup has given ROPS great success in distributing naloxone to two of the three groups they serve — first responders and addiction services providers.

Still, most ROPS struggle to reach people who use drugs — the most important of the three groups they’re tasked with serving.

We speculate this is true for several reasons:

  1. Hiring decisions. To our knowledge, TDMHSAS refuses to employ people who openly identify as drug users. This harms most ROPS’ ability to establish trust with would-be participants, and oftentimes results in a lesser understanding of real-world drug use.

    DID YOU KNOW? Here at Tennessee Harm Reduction, one of our biggest strengths is that we’re openly drug user-run. We lead a coalition of drug user-run harm reduction programs in Tennessee.

  2. Regulatory boundaries. ROPS are required by TDMHSAS to train people on overdose response before giving them naloxone. Traditionally, these trainings have been upwards of an hour long and held in formal, town hall-style settings. Some ROPS offer over-the-phone trainings, but those can last 20 minutes or longer.

    DID YOU KNOW? We typically spend no more than one minute teaching new participants how to use naloxone. Since June 2021, our participants have reversed more than 190 overdoses — which tells us we must be doing something right.

  3. Lack of trust and relatability. For decades, social services providers and government agencies have mistreated people who use drugs (PWUD). It’s no surprise why most PWUD aren’t comfortable with the idea of getting harm reduction supplies from government workers.

    DID YOU KNOW? We run non-Memphis West Tennessee’s first and only syringe exchange. Over 95% of our participants use drugs, and over 90% inject drugs. Very few of our participants have utilized ROPS’ services.

Final Thoughts

Although they’re far from perfect, Regional Overdose Prevention Specialists are a valuable resource in distributing naloxone to institutions such as police and fire departments, EMTs, addiction services providers, and jails.

Are you a ROPS? Do you work for TDMHSAS, TDH, or with ROPS?

We’d love to help you improve your services. Reach out to us via our Contact page and let’s work!