Download Strategies to Address Opioid Misuse in Macomb County 2011

Macomb County Office of Substance Abuse (MCOSA)
Strategies to Address Opioid Misuse in Macomb County:
Recommendations
June 2011
BACKGROUND
The Macomb County Office of Substance Abuse has been concerned with the number
of heroin deaths, hospitalizations and growing treatment admissions trends over the
past several years related to opioid use. With input from the Strategic Prevention
Framework - Strategic Planning Team and support of the MCOSA Advisory Council, an
epidemiological study was commissioned to explore the actual data and trends
surrounding this issue, resulting in a compiled “burden document”. The document
confirmed that opioid prescription drug use among teenagers and heroin addiction
among young adults is rapidly becoming a major problem in Macomb County, with dire
consequences for the users, their families and local communities.
Subsequent to dissemination of the document and related information to key
stakeholders, three focus groups were held to solicit input regarding potential strategies
for addressing the opioid problem in Macomb County. Separate focus groups were
facilitated in the areas of prevention, treatment and recovery and explored possible
causes for rise in use, public perceptions, system impact, service gaps, and potential
strategies to combat the issue.
Many common themes and strategies emerged from the focus groups; the details of
which are included as attachments. Major concerns included: the overuse and misuse
of prescription opioids; the lack of perceived risk of opioid drugs: the ease of availability
of both prescription and illicit opioids; the younger onset of problematic use and the
unique challenges in treating them; the rapid progression from opioid prescription drug
use to heroin use and addiction; and the devastating effects from their use, especially
the rise in opioid related deaths.
RECOMMENDATIONS
The following recommendations were derived in part from information gained from the
focus groups. Other sources included staff research and participation in state level
meetings focusing on opioid problems, input from MCOSA Advisory Council members
and years of collective experience in managing a substance abuse treatment and
prevention system of care. While developing recommendations, MCOSA considered the
current substance use delivery system, which continues to be racked by dwindling
resources and increased service demand. This circumstance makes it difficult to add
new services, without adversely affecting existing services. Thus, many of the
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recommendations may actually be system enhancements as opposed to major shifts in
service delivery.
It should be noted that MCOSA has already taken action to reduce its waiting time for
treatment, by A) requiring outpatient treatment agencies to utilize group treatment as a
cost effective and clinically appropriate strategy to serve more clients, and B) by offering
pre-treatment group services to individuals waiting for funding so as to enhance their
readiness for change before entering intensive services. The current peer support pilot
project is also designed to assist clients with a history of recurrent treatment admissions
to overcome obstacles to recovery and reduce the need for future residential treatment.
Although not exclusive to the opioid problem, these measures do allow for greater
recovery opportunities for opioid users and all others in need of MCOSA funded
treatment.
Another factor incorporated into these recommendations is the Bureau of Substance
Abuse and Addiction Services and the Substance Abuse and Mental Health Services
Administration’s initiative to transform the state’s substance use disorder system to a
Recovery Oriented System of Care (ROSC). ROSC will promote greater participation of
individuals in the recovery community in MCOSA’s treatment and prevention service
continuum, in an effort to increase the number of individuals in Macomb County with
Substance Use Disorders (SUD) who will be able to achieve long term recovery. Further
detailed discussion pertaining to ROSC occurs in segment on Recovery; it should be
noted, however that many of the recommendations are made with this shift in mind.
Prevention
The area of Prevention plays a major role with regards to the recommendations being
made. The increasing use of opioids by high school aged individuals is problematic, but
it is also an age group that is reachable to receive modified programming that
addresses specific information so they will be more receptive to hear the messages.
Many of the recommendations below can be readily incorporated into existing
prevention services.
Core strategies to be addressed through Prevention Services include: increasing
information and awareness related to opioid issues; increasing awareness of
consequences to users; identifying support systems; increasing risk perception
associated with opioid misuse; and reducing inappropriate access to addictive
prescriptions. Each of these areas will consist of multiple-tier approaches.
Increase Information and Awareness
 Increase presentations to medical professionals (nurses, physicians,
pharmacists, etc) specific to signs and symptoms of opioid use/misuse
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Work with local coalitions and Macomb Prevention Network (MPN) to provide
technical assistance and data on this issue (painkillers/narcotics and
amphetamines)
Offer parenting classes to the community with an enhanced focus on prescription
misuse (signs, symptoms and the linkage to heroin addiction)
Augment “Parent Nights” with information that focuses on narcotic and
amphetamine addiction
Explore ways to educate coalitions on the Michigan Automated Prescription
System (MAPS) and promote the use of this data for their local community
Work toward encouraging regular use of MAPS by pharmacies and physician
offices
Continue to collect data to drive decisions on this topic as it becomes available
Increase Awareness of Consequences to Users
 Educate communities and coalitions on legal issues regarding sharing
prescription medication, prescription misuse and heroin abuse
 Expand working with the Chippewa Valley Coalition to include outreach to the
medical community, hospice, and home health care on this issue
 Supplement the Jail Prevention Service program with information related to the
consequences, both physical and legal, regarding narcotic and heroin/opioid drug
use
 Explore ways to partner with the prosecutor’s office, police departments, and
judges to determine the consistency of opioid related legal consequences
 Develop methods to increase community based strategies to youth on legal
issues related to consequence for sharing/selling prescription medication
Identify Support Systems
 Work with student assistance programs and coalitions to identify teen self help
groups in the county and make this information more accessible
 Share identified teen resources with the Youth Council and teen service
organizations (YMCA, Boys and Girls Clubs, parks and recreation, etc.)
 Add teen support groups to MCOSA “help cards” that are distributed at
prevention activities
 Identify sections in the “Right Connection” that can be enhanced regarding teen
support groups
 Contact 211 system to ensure they have teen support groups identified
Increase Risk Perception Associated With Addiction
 Enhance knowledge of physical consequences associated with narcotics and
amphetamines during educational classes to increase perception of risk
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associated with prescription drug misuse (Lifeskills, Project Alert, Beyond
Trauma)
Work with Project Vox to spread message of risk associated with prescription
drug abuse and the correlation to opioid use
Identify ways to work with parent groups and coalitions to spread message on
the link between prescription misuse and heroin use
Increase awareness of the relationship between prescription misuse and
progression to heroin for classroom presentations
Work with student assistance programs and Macomb Intermediate School
District to increase perception of risk with students utilizing “Above the Influence”,
or other social media campaigns
Reduce Inappropriate Access to Addictive Prescriptions
 Increase the number of coalitions working with local police departments to install
“drop boxes” to reduce the access to unused medications
 Work with community organizers to increase the number of coalitions that will
host “Drug Take Back Days”
 Inform nursing students about procedures and location of “drop boxes”
 Develop opportunities to encourage physician offices to use MAPS system to
help identify ‘doctor shopping’ patients
 Work with the Bureau of Substance Abuse and Addiction Services to access
Macomb data from the MAPS system
 Consider methods encouraging hospices to spread information on proper
disposal of medications
 Supplement older adult programs with signs and symptoms of narcotic abuse
and information on why proper disposal of unused medication is an important
community issue
Treatment
Recommendations related to treatment needs of individuals experiencing opioid abuse
and dependency focus on the following needs: improving engagement in treatment,
addressing issues related to waiting lists for services (due to lack of funding), expanding
the current array of treatment services and addressing issues related to treating the
younger population of clients presenting for opioid treatment. Many of these identified
needs overlap, as do the recommended approaches to address the issues.
Improve Engagement in Treatment
 Ensure timely access to treatment services. Implement NIATx strategies to
reduce wait time to enter treatment where needed
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Increase retention of clients in treatment. Implement NIATx strategies to increase
engagement where needed
Provide timely access to alternative services when there is a wait for funded
services
Explore options to include Peer Support Services, Case Management,
Readiness or supportive group treatment if funds for a higher level of care are
not available
Provide priority admissions to clients actively participating in alternative services
while waiting residential or methadone treatment openings over those not active
in services
Eliminate Wait Time to Treatment
 Review the length of stay allocated for each level of care for any needed
improvements
 Improve identification of Readiness to Change to better match services to stage
of change
 Explore and develop as appropriate, alternative treatment levels that address
the safe housing needs for clients requiring intensive services by offering an
expanded array of residential treatment levels and by partnering with recovery
homes to bring services to the clients needing less intensive treatment
Expand Service Array
 Expand the current service array to incorporate the Recovery Oriented System of
Care (ROSC) within the MCOSA system, including more early intervention,
assistance with transitions between levels of care and expand recovery services
beyond traditional treatment services
 Explore the feasibility of expanding the use of Suboxone to outpatient
detoxification from opioids and early recovery maintenance, particularly with the
younger opioid user who has a shorter history of dependency
 Seek potential alternative detoxification options which can reduce the
expenditure on sub-acute services and provide more access to this needed
service
 Promote the expansion of alternative recovery housing to provide for safe living
environments for clients in recovery
 Increase the number of peer support specialists and case managers in the
treatment system to better link clients with community resources and supports
 Explore the possibility of having people in recovery come to treatment sites to
connect clients to self help and recovery community
 Encourage more treatment programs to offer alumni groups
 Encourage more treatment providers to offer self help support groups at the
treatment site
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Address Needs of Younger Clients
 Explore ways to provide more contemporary modes of treatment and revise
practices to engage and retain younger clients in treatment
 Consider utilizing more technology in services (ex: computers, tablets, use of cell
phones)
 Recruit/retain therapists and staff who are successful at engaging the younger
population in treatment
 Promote the formation of young person’s recovery groups to better engage them
in treatment and self help
Recovery
As previously indicated, MCOSA will be working in collaboration with many
stakeholders, including representatives of the recovery community, substance use
disorder providers, Board and Advisory Council members, prevention coalitions and
other relevant partner agencies to develop a Recovery Oriented System of Care
(ROSC). The purpose of this endeavor is to promote greater participation and
integration by individuals in the recovery community in MCOSA’s Treatment and
Prevention service continuum, to increase the number of individuals in Macomb County
with substance use disorders who will be able to achieve long term recovery. Efforts
toward achieving this goal, along with other recovery focused interventions are outlined
as follows:
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Initiate a planning forum with key stakeholders to begin development of a ROSC
for Macomb County (Scheduled June 23, 2011)
Evaluate of the existing Peer Support Services pilot study in place at Sacred
Heart, with an eye toward expanding peer supports in other areas of the
continuum of care
Work more closely with the recovery community and 12-step organizations to
increase the number of support groups for teenagers and young adults
Explore the feasibility of establishing support groups in schools, community
colleges, or other areas where young people gather
Encourage establishment of 12-step orientation groups specifically directed
toward younger users
Continue to support Project Vox, a local recovery advocacy group, to help
promote recovery and anti-stigma focused messages. It also is believed Project
Vox will helps to create a more supportive environment for individuals in and
seeking treatment for SUD.
Explore the efficacy of establishing a recovery home to fill an existing gap in
intensive services
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CONCLUSION
MCOSA, along with committed stakeholders, will continue to explore ways to implement
these recommendations in a timely and effective manner. New concepts and services
that are created over time from the ROSC transformation will also be developed with
these goals in mind.
Working together with our community partners, we can reduce the negative impact of
opioid and other substance use issues in our community. By simultaneously addressing
the problems from prevention, treatment and recovery approaches, we can have a
greater impact in improving the sustained recovery of individuals and healthy
communities for all Macomb County residents.
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ATTACHMENTS
PREVENTION FOCUS GROUP NOTES
January 21, 2011
1.
What are you seeing or hearing in the community regarding prescription
abuse?
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2.
How much does the general public understand about the risks of
prescription abuse?
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3.
There have been 6 deaths in our school district from heroin
Concerned drug use is going underground
Youth say drugs are easy to get
Coalition members have been asked to talk to their doctors about
prescription abuse
School data is incomplete, because they are not reporting what type of
drug a student was suspended for
Students confirmed that abuse of prescription drug is growing, especially
Adderal and Vicodin
Baby formula is starting to be locked up in stores because people are
stealing it and selling it to party stores for drug money. A lot of property
crimes lead back to drugs
The public knows very little
Parents don’t believe kids are stealing their prescriptions
Drug addicts are making false reports so they can get free refill/get
another prescription
Parents will give their kids pills for pain and they don’t understand they
shouldn’t be giving them drugs that belong to another (sharing drugs)
There is a lot of misuse of Adderal in schools
A lot of prescription drug abuse comes from “social norming” -ads on TV
from drug companies, kids see parents take medication for problems so
think use is ok
Need to look at a way to target prescription abuse in schools- high risk
period for kids is between 8th & 9th grades
Need to be more specific about prescription message-say no
Kids are well networked –cell phones, face book – know how to get drugs,
talk about using
We need to use social media to get the antidrug message out as well as
the drug companies do
Why do you think prescription drug abuse is on the rise?
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Kids take drugs from medicine cabinets at home and sell it in school. To t
hem, it’s no big deal
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4.
What strategies do you think are needed to change these risk factors?
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5.
Kids are very well “networked” with cell phones and texting. The problem
with cell phones in schools is that parents won’t allow the schools to take
the phones away
You can’t tell if kids are using drugs like you can with smelling pot or
alcohol
School of choice causing problems as some kids come in from other areas
just to set up their selling network with other kids
The schools are so large, it’s hard to see everything going on
You can be still “functioning” on Vicodin, that the kids think it’s no big deal,
they don’t realize it’s hard to get off it and they find out they need to take it
just to function; “if I’m functioning, I’m not an addict.”
No support groups for kids after they shared their story
Multi-tier marketing
Kids need to hear different messages than parents
Have recovery people tell their story, focusing on the consequences of
use (don’t glorify use)– what it was like to lose control; this makes it more
real with people
Use small focus groups for young people in recovery to tell their story and
have follow up services available
Teach people healthier ways to deal with stress and problems
Get people connected to recovery groups early on
We need more NA and AA meetings for young people. This helps them to
understand they are not the only one. We need to link NA & AA with the
schools and community
Need to teach brain chemistry to students and keep repeating the
message
There needs to be more consequences, more consistency especially
when an officer stops kids
Health care professionals need to be aware of the problem (learn about
MAPS)
How would you go about informing people that inappropriate prescription
and over-the-counter drugs use is an issue and is not safer than illegal
street drugs? What is the best way to communicate these messages to
students? To parents? To general community?
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Parents need to learn more. Kids need to hear message
Health care community needs to get the message. They are not trained in
substance abuse
Use movie ads and posters like the one FAN did
Drug companies should be required to provide warning/messages, maybe
mandated by the federal government
Need to let people know legal consequences of sharing/selling/giving
prescription drugs to others– it’s not as clear as heroin use
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6.
Use Take Back Drug Projects, make it easier and more known how to get
rid of or protect drugs
Create awareness of the abuse problem because we are not going to be
successful in decreasing pain medication be prescribed. We also need to
have awareness about locking up your medications
What strategies or approaches do you think would work for heroin issues?
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Talk about the link between prescription drug abuse and heroin use, use
personal stories
Kids need to hear it from their peers in a non-threatening environment.
Need to hear that drug dealers just want your money – they don’t care if
you die.
Talk about the lack of control that you have when you do drugs
Educate parents about the paraphernalia associated with drug abuse
Work with DEA to urge all police departments to have take back programs
Put together a program for coalitions to buy to give to their communities.
Approach local clubs (Rotary, VFW) to provide funding for
programs/projects
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ATTACHMENTS
TREATMENT FOCUS GROUP
January 25, 2011
1.
How does the Macomb County Opioid Report relate to what you are seeing
at your agency? Any issues, changes to treatment strategies?
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2.
Providers are struggling to catch up with the “immediate response” and
“quick fix” mentality from the opioid population
Challenge is with the media and the “no pain” mentality
Younger generation has no concept of recovery and treatment- they want
an immediate fix
Suboxone is being utilized as the wonder drug for opioid treatment
Clients are only staying a few days in Detoxification services and leave
before transferring to Residential treatment
Current delivery of treatment is not working for this generationsuggestions entailed deliver treatment electronically, provide video games,
change sleeping patterns etc.
Accessibility of narcotic prescriptions is the leading cause to opioid
dependence
Narcotic prescriptions are over-prescribed and cheap
How is the growing demand for opioid use services affecting your
program?
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Length of stay is down – clients leaving treatment early
Clients need detoxification services, but there is always a wait list
Clients do not want to experience pain they just wants a quick fix- difficult
to deliver effective treatment; very sensitive to pain/discomfort due to
effects of opioid use
Younger clients are coming to treatment only because they ran out of
money, haven’t experienced other losses/pain
The younger opioid users lack motivation to get and stay clean- just
looking for a place to stay
Field of Addictions is not turning out younger therapists - Population
demands the need for professionals who are younger to provide
treatment.
Challenges with retaining younger professionals due to the credentialing
requirements
Some younger professionals who are working in the field do not see a
problem with using narcotic prescriptions drugs
Challenges with getting therapists to provide new therapy strategies when
they want to stay “old school” in their therapeutic interventions
Critical to connect the right therapist with the right client
Younger clients’ attitude/behavior ticking older clients off
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3.
What needs to be done to more effectively treat this problem?
Service Gaps?
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Change Treatment approach by not allowing clients to be on the wait list
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Engage clients in services immediately, while on waiting list- adjust level
of care later
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Contemporary mode of treatment needs to be implemented- i.e.
computers, tablets, revise treatment programming etc.
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Technology needs to be a prominent resource- i.e. allow cell phones in
treatment
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Review the Length of Stays allocated for each level of care
Main concerns for our system – how to address the problem?
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Getting through to medical community that prescription drug use is a huge
problem- differences in pain management philosophy
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Re-evaluate pain management- older adults even ones in recovery can
become addicted to pain medications (due to injury, etc.), and even heroin
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Lack of transportation and housing
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Non-priority clients are wait-listed and access is limited for detoxification
and residential treatment services
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Need for alternative treatment options- defining ROSC within our system
of care
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Lack of motivation for treatment
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Require all clients to be put into a group while on the waiting list for
residential treatment.
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Link the client with a peer support specialist at the initial screening
appointment to assess motivation for treatment.
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Need to provide wraparound services at the treatment centers
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Are there harm reduction strategies that the system could support? What
are they?
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Suboxone - utilized as a detox medication and is also an abused drug on
the streets
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County does not cover the cost
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Medicaid will cover the cost under formulary drugs
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Need for alternative detoxification methods
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Need for alternative recovery housing- client’s home environments are not
safe
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How could our system utilize the recovery community to assist in treating
individuals with opioid dependency?
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Need to provide support groups at the treatment agencies- recovery
individuals can be a key to their engagement.
Form young people’s recovery group
Use Project Vox for support/outreach
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Have recovery person come to treatment to make connection to
community meetings
State is moving forward with ROSC for a more integrated system between
those in treatment and the recovery community.
ROSC looks like a cost cutting “tactic” more than a good system of care.
Partnering with medical facilities and doctors.
Current Service Gaps
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Housing – limited transitional housing available; need more supportive
housing options
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Residential treatment - need to develop an effective alternative that is
connected to housing
General Comments
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Overall System - focus on the different levels
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Treatment to adapt to the needs of the population served – substance use
trends will continue to change over time
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Focused and driven by local group needs, not State level needs
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Show legislators numbers & charts to advocate for an increase in funding
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Show that secondary diagnoses increase due to substance use. Invest in
substance use services and they would save in other areas (jail services,
welfare, etc.)
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Approach health care cost saving –the cost of treating one overdose vs.
providing substance use disorder treatment services; save money by
providing SUD treatment due to cost of secondary issues
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Suggestions for Providers to obtain survey information from individuals
who have relapsed vs. first time treatment clients
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Find out the reasons of why individuals are more prone to relapse
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Set up focus groups within your organization if the need is identified
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ATTACHMENTS
RECOVERY FOCUS GROUP
February 4, 2011
1.
How does the MCOSA Prescription/Opioid Report fit with what you know
about recent/current drug patterns in Macomb County?
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2.
As noted in the report, Macomb County has seen a dramatic rise in the
abuse of prescription and opiate based drugs, especially heroin. This has
resulted in numerous dire consequences for young drug users (18-25),
including doubling the number of heroin and other opiate drug overdoses
in three years. What suggestions could you share which may help in trying
to reverse the trend?
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3.
They’re coming in at a younger age
View of heroin now is like marijuana was; may get addicted but it’s not
deadly
Starting earlier with alcohol & marijuana then moving on to harder drugs
Lots of education but not enough
Risk and experimentation at young age; missing something in their lives;
want to feel a part of something
Seeing a graduation from prescription opiate use to heroin for either
financial reasons or not bottoming out until at heroin stage; desensitization
to heroin
Seeing peers use with no adverse reactions, make them think its “ok”
Need stronger education in the schools
Get school administration on board
Heroin is more pure than ever so they’ve lost the perceived risk
Prescription drugs, prescribed by a doctor so they can’t be risky
Easy access to prescription drugs, highly prescribed because of people
aging and achy
Heroin costs less than prescription drugs, that’s why they move to heroin
Deliver the message of recovery to show the cost of addiction and the
needed ongoing work for recovery
Are there ways which MCOSA could better utilize the recovery community
in treating individuals with Substance Use Disorders (SUDS)?
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Need to contemporize treatment; have younger people at meeting to help
others come back, relate
Have young people talk to youth with the right message
Ways to get around traditions in meetings
Peer supports/recovery coaches
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4.
Can you think of any harm reduction strategies that might prove helpful?
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5.
Give better understanding of what support groups are to reduce stigma
Come up with specifics then can take to their groups
Need smaller groups other than 12 Step groups
Utilize 12 Steps in a way that it’s not “labeled” a 12 Step group; integrate
into a younger age appropriate title
Need to approach “wealthier” communities about addiction and use
Addiction is a lifelong issue, just as physical health is; need to see it as a
public health issues to look at treatment/recovery as harm reduction
Bridge gap; reduce stigma
If Recovery community is open about their recovery, then others will seek
their help
Let the recovery community know what MCOSA needs and they will step
up to help
Provide an introductory program to the self help groups so people know
what to expect and ease them into meetings
More education of doctors and hospitals; use is not taken seriously
Emergency room is not the right place for detox or SA issue; they need to
move them out quick, not treat their problem
Suboxone is being used for management instead of detox; people are
getting addicted and the view is same as methadone
Suboxone prescribed for long term use; is only meant for short term use,
can cause health issues is used too long
Raise awareness that fun can be had without drugs and alcohol
Get people to see the painful side of addiction, what they stand to lose,
consequences so they take it seriously
Get community and police departments involved
Reduce stigma of AA and NA and education people on the 12 Steps
Make addiction a stronger public health issue
Do you think Macomb County would benefit from a recovery home?
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Yes, could pay a treatment provider to go to these homes to provide
therapy, etc.
Good idea, but there needs to be regulations.
People will use, families would try and help pay for the cost
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ATTACHMENTS
Prevention Focus Group Participants
Colleen Burke, L’Anse Creuse Community Action Coalition
Gary Burnett, Community Mental Health and MCOSA Advisory Council
Melissa DiPirro, CARE
Nancy Donahue, Macomb Family Services
Judy Hartwell, Congressmen Levin’s Office
Gen Klida, Utica Community Area Action Team
Patti Kovacs, Fraser Community Action Team
Lori Misch, Macomb County Sheriff
Gail Peterson, Alcohol Highway Safety
Jamie Siefert, CARE
Alycia Starr, Northwest Macomb Prevention Coalition
Barb Towner, Chippewa Valley Coalition for Youth and Families
John Willer, New Baltimore Police Department
Randy O’Brien, MCOSA
Helen Klingert, MCOSA
Dawn Radzioch, MCOSA
Nancy Jenuwine, MCOSA
Treatment Focus Group Participants
Heather Dombrowski, CARE
Bill Epling, CPI
Andy Konwiak, Eastwood Clinics
Phil LaCourse, Sacred Heart
Rick MacFarlane, Turning Point
Larry McCarrick, Eastwood Clinics
Sharon McRae, Bio Med
Jeff Oldham, Clinton Counseling Center
Sue Owens, Premier
Kameshia Rogers, Premier
Karen Stetson, Macomb Family Services
Grady Wilkinson, Sacred Heart
Randy O’Brien, MCOSA
Helen Klingert, MCOSA
Karen Slattery, MCOSA
Recovery Focus Group Participants
Joelene Beckett
Sean McGraw
Shannon Rozell
Alycia Starr
Justin
Randy O’Brien, MCOSA
Helen Klingert, MCOSA
Lisa Carrizales, MCOSA
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