Download RESONSE TO THE HEROIN EPEDEMIC

RESPONSE TO THE HEROIN
EPEDEMIC
Significance of the Problem
Chart Title
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
2002
2003
2004
2005
2006
2007
Heroin
2008
2009
2010
Other Opiates & Synthetics
2011
2012
2013
2014
2015
Significance of the Problem
• Recognized that there was a rise in use of prescription medication
• Recognized that there was a decrease in heroin
• Beginning to hear stories from constituents about difficulties in
accessing care
• Concern about an emphasis on Mental Health Treatment and a lack
of emphasis on Addictions Treatment
UD Center for Drug & Health Studies
Using Delaware’s Prescription Drug Monitoring Program,
crime statistics and toxicology reports from the Division of
Forensic Science from 2013 to late 2014, preliminary research
from UD’s Tammy Anderson found:
 A 7% increase in prescription opiates.
 Prescribing rate increased from 953.5 prescriptions per 1,000
people to 1,117 prescriptions per 1,000 people.
 People age 50+ saw the largest increases in fentanyl and other
opiate prescriptions, especially in southern Delaware.
 Overdose “hot spot” neighborhoods scattered across the state.
CALL TO ACTION
• Gathered interested legislators to meet with Governor
• Gathered interested legislators to meet with the Secretary
• Went to an NGA sponsored training in Atlanta with key health
department staff and legislators
• Developed a plan of action
• Initiated a system redesign
Addiction: Focus on 3 Fronts
Fighting drug use and addiction
is complex and requires work
across government
departments and in concert
with others along 3 fronts:
• Prevention/Education
• Treatment/Recovery
• Criminal Justice/Law
Enforcement
Guiding the Process
• Met with Stakeholders from government, private sector and
community to identify the problems as they saw it
• Developed a series of actions as a result of the meetings to address
policy responses, system redesign, and criminal justice modification
• Established a connection with health department to monitor
ACTION
Gathered together law enforcement, health care workers, community
representatives, community advocates providers, and legislators
• Identified system strengths and weaknesses
• Identified adequacy of the system
• Identified problems with access and payment
• Identified problems with communication
ISSUES IDENTIFIED
• Treatment system was not adequate to meet the demand
• Policies not adequate to meet the new shift in use from opiate drugs
to heroine
• Overdoses increasing and drugs corrupted with fentynal
• Too many individuals entering the justice system instead of receiving
appropriate treatment
Path Forward
• Meet with the Governor to establish priorities potential funding
needs
• Meet with legislators to identify legislation to address overdoses and
make access to treatment easier
• Meet with the the Division of Substance Abuse and Mental Health to
address system redesign
• Meet with law enforcement and criminal justice systems to address
alternative approaches to address the addicted individual
• Work with Public Health to addrerss the medical community and
prescribing practices
GOVERNOR
• Discussed with Governor the service needs for the State
• Present to the Governor the system redesigns developed in the
Atlanta academy
• Identify the budget resources needed for the new system
• Work with the Governor to develop oversight for physicians
Legislature
• Developed legislation to allow for individuals to call the police and
EMS to respond without the danger of being arrested. (Good
Samaritan Law)
• Develop legislation that allowed for the training and distribution of
Narcan
• Review the sentencing laws and service for those arrested for drug
related charges
• Work with Professional Regulations around developing prescribing
practices
• Require education about addiction in schools
Prevention and Education
• Beginning with the previous school
year, all high school students must
receive 15 hours of drug & alcohol
prevention education before
graduation.
• Working with the schools to deliver
a more effective message
• Developing a strong prevention
message For the community
Prevention and Education
• 24/7 Drug Take-Back collection containers now
at 14 police stations statewide.
• Surgeon General sent a letter to 2.3M clinicians
asking them to take the pledge to reduce the
impact of addiction epidemic by:
 Educating themselves on how to treat pain safely and
effectively;
 Screening patients for opioid use disorder and
connect them to treatment;
 Talking about addiction as the chronic brain disease
that it is in order to reduce public stigma.
Systems Redsign
Withdrawal Management
In November 2015, DHSS
opened a downstate
withdrawal management
center, which added:
16 medical beds;
12 23-hour medical
assessment slots;
30-100 outpatient slots.
Withdrawal Management
With the new withdrawal management
center in Kent County joining the existing
center in New Castle County, the total
public withdrawal management services
available statewide:
32 medical detox beds
24 23-hour medical assessment slots
60-200 outpatient slots
Residential Treatment
Beginning in February 2016, DHSS went from 78 total
beds in one location to 95 beds in 4 locations:
 Gateway for men at Delaware Hospital for the
Chronically Ill (47);
 PSI for women in Dover (16);
 PSI for men in Dover (16);
 Connections for women in Delaware City (16).
Sober Living Beds
DHSS had increased the total
of sober living beds from 60
beds to 120 beds:
New Castle County: 58
(34 men; 24 women)
Kent County: 28 (20 men;
8 women)
Sussex County: 34 (22
men; 12 women)
Other State Services
• Young adult opiate residential treatment: From 16 to 32 beds (when
provider finds new location in Kent or Sussex)
• Outpatient treatment: Expanding services to include full continuum of
support – partial hospitalization, expanding intensive outpatient and
traditional outpatient provider network
• Recovery Response Center (RRC): Opened in Newark in July 2016 to
serve New Castle County.
Criminal Justice/Law Enforcement
• DOC Commissioner Robert Coupe says
60% of those incarcerated impacted
by addiction.
• Department of Correction redesigning
Crest and Key programs, which are 25
years old.
• Focus on re-entry to provide a handoff
to continuing treatment in the
community.
Law Enforcement Partnerships
• Law enforcement embracing fact that
addiction is a disease and they
cannot arrest their way out of
epidemic. Two new programs started
in past year:
 Hero Help: With DHSS and DOJ, New
Castle County Police will offer treatment
option to individuals instead of arrest.
 Angel Program: Active users who walk
into Dover PD will be connected to
treatment through Connections and
“angel” volunteers.
Advancing Public Health with Law
Enforcement
• Delaware one of four states chosen for
NGA Learning Lab on data-sharing.
• NGA providing expertise to work out
data-sharing agreements, hosting
agency and analysis – 6 month action
plan
• Data/information will be used by law
enforcement, ME’s office, public health
and treatment services.
Policy Development
Prescription Drug Action Committee
• In response to the epidemic, Gov. Markell created the
Prescription Drug Action Committee (PDAC) in February 2012.
• Mission is to coordinate public, private and community efforts
across the spectrum.
• Co-Chaired by Public Health Director Dr. Karyl Rattay and Medical
Society of Delaware Past President Dr. Randeep Kahlon.
• Comprehensive recommendations to combat drug abuse, misuse
and diversion statewide. PDAC report:
http://www.dhss.delaware.gov/dhss/dph/files/pdacfinalreport20
13.pdf
Prescribing Regulations
Secretary of State Jeffrey Bullock issued proposed opiate prescribing
regulations for clinicians. State regulations will mirror CDC guidelines:
 For acute injury or procedure, maximum initial 7-day supply of
an opioid medication can be prescribed.
 Beyond 7-day supply, practitioner will be required to check
patient’s prescription history in State’s Prescription
Monitoring Program (PMP), along with informing patient of
risks of potential addiction.
 For patients being treated for chronic pain, practitioners must
check State’s PMP and administer a urine drug screening at
least twice a year; must also consider and discuss alternative
treatment options with a patient and do a risk assessment.