Community Solutions to Heroin Addiction Challenges

Orlando, Florida

C4

IHI SummitApril 20 – 22, 2017

#IHISummit

Disclosures

These presenters have nothing to disclose

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Session Objectives

Identify methods for building cross-sector coalitions to

address substance abuse issues that have an impact on

healthcare entities

Provide examples of how disparate community

organizations can take concrete steps to solve complex

community issues

Describe ways to involve those directly affected by

substance abuse (family and caregivers) in the planning

and actions taken to improve prevention and treatment

options in a community

Session Faculty

Matt Guy– President and Owner, Accelerated

Transformation Associates

Lindsay Reeves– Systems of Care Coordinator, Health

Soultions

Our Vision…5

Change Ideas

Three Levels of Activation:

• Activating individuals:

Community organizing,

storytelling, facilitative

leadership

• Activating organizations:

Community collaboration and

governance

• Activating communities

Understanding community

assets, participatory decision

making

Mapping Your Assets

Community Asset Mapping:

A Shift From Needs-Focused Approach

Needs Assets

• Focus on deficiencies • Focus on strengths

• Result in fragmentation of responses to local deficiencies

• Build relationships among people, groups, and organizations

• Make people consumers of services; builds dependence on services

• Identify ways that people and organizations give of their talents and resources

• Give residents little voice in deciding how to address local concerns

• Empower people to be an integral part of the solution to community problems and issues

Asset Based Community Development

(ABCD)

John McKnight and John Kretzman

Built on the notion that communities have

never been built on their deficiencies, rather

on the capacities and assets of the people

and the place.

Does not imply ignoring problems and needs

and throwing out rational, strategic planning;

rather it is a rallying point for collective action.

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Some Lessons

“You have one mouth and two ears, use

them proportionally”

Decisions are made by the those who show

up.

Assume that you will need to lose a bit of

control for much, much more power.

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Road Games

Getting/Keeping People Involved

Stop asking “What’s the matter?”

Start asking “What matters to you?”

*Shamelessly borrowed former former IHI CEO Maureen

Bisognano

“Can you tell us

what people who

live here have

done together to

make things

better?”

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Building Communities From the Inside Out, 1993

Where It Began…14

Complex issues require complex solutions. This one is going to take the entire

community coming together and working toward a brighter tomorrow.

Multi-Phase Community Public Forum

Exploring: Unpack and Understand the Issues

Wednesday, March 9, 2016 — 5:30 to 7:30 pm

Constructing: Roll Up Your Sleeves and Help Plan

Thursday, March 17, 2016 — 5:30 to 7:30 pm

Moving Forward: Organize Implementation of

Evidence-Based Programs and Practices

Tuesday, May 3, 2016 — 5:30 to 7:30 pm

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Exploring: Unpack and Understand the

Issues

• Origins of the Problem

• Scope of the Problem

• Costs of the Problem

• Brainstorm Strengths and

Barriers

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Origins of the Problem

• 12.7% of new illicit drug users began with prescription pain relievers.

• Opioid analgesic (pain reliever) sales increased nearly four-fold between 1999 and 2010

• Four-Fold increase in opioid (narcotic pain medication) overdose deaths

www.SAMHSA.gov 2014 NSDUH Report

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Origins of the Problem

According to National Institute on Drug Abuse (NIDA):

• Abuse of prescription opioid pain medications such as Oxycontin and Vicodin open the door to heroin abuse.

• Nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before starting to use heroin.

• Individuals reported taking up heroin because it is cheaper and easier to obtain than prescription opioids.

• Crushing prescription opioid pills to snort or inject the powder provide initiation into these methods

National Institute on Drug Abuse: Heroin. Retrieved from https://www.drugabuse.gov/publications/drugfacts/heroin on March 6, 2016

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Origins of the Problem: Pueblo County

According to Parkview Medical Center ED doctors:

• At least one ED admission each day has a heroin-related symptom March 4, 2016

• Often, multiple admissions per day have a heroin-related symptomMarch 4, 2016

Parkview Medical Center 2015 Drug-Related Overdose Statistics

• Overdose admissions – 46

• Heroin OD admits – 6

• Overdose ( primary complaint in ED) - 99

• Ingestion (primary complaint in ED) – 203

• Most overdose admissions are complex combination drug admissions

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Origins of the Problem: Pueblo County

Opioid Related Overdose Deaths

20

0

2

4

6

8

10

12

14

2000-2002 2003-2005 2006-2008 2009-2011 2012-2014

Opioid Overdose Death Rate per 100,000 People

Colorado

Pueblo County

Origins of the Problem: Pueblo County

Heroin Related Overdose Deaths

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0

1

2

3

4

5

6

2000-2002 2003-2005 2006-2008 2009-2011 2012-2014

Heroin Overdose Death Rate per 100,000 People

Colorado

Pueblo County

Scope of the Problem

Pueblo County Jail Statistics

Approximately 1700+ opiate protocol prisoners per year

Access Point Pueblo: Local Needle Exchange

470 individuals signed up, ~25 new clients each month, 50-

70 avg. exchanges per week, busiest week ~80 exchanges

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Access Point Pueblo

Data from July 2015- June 2016

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0

50

100

150

200

250

300

350

400

450

Total Visits

Scope of the Problem

Pueblo Fire Department

140 Narcan uses in 2015

Colorado Public Radio Investigation

Southeastern Colorado makes up 6% of the state population and 18% of the admissions for heroin treatment

Colorado Public Defender’s Office

168,000 cases per year, over 50% are drug related

Pueblo Police Department

Heroin seizures were up 5X in 2015

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Scope of the Problem

We don’t understand the

true breadth and depth of

how many people are using

heroin in the community

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Costs of the Problem

Pueblo County Jail Costs

Cost for routine prisoners: $75/day

Cost for opiate protocol prisoners: ~$90/day due to extra

services

Legal Costs

Colorado Public Defender’s annual budget: $86M

More than 50% is drug related

Additional costs incurred from Police and Courts

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27

= $5

28Each day we house an opioid protocol prisoner is equal to...

$15 per day

29Over the course of a year, this adds up to…

1200 Cups of Coffee

Costs of the Problem

Medical Costs

Attributed to Drug related ER Visits, EMS and Jail OD

Patients, Pueblo Fire Department Narcan use, etc.

HIV and Hepatitis C

18% of HIV cases in Colorado are thought to be linked to

drug use at an estimated lifetime cost of $600,000

60%-80% of Hepatitis C cases are linked and cost

~$100,000 over the lifetime to treat

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Costs of the Problem

Crime Costs

Many property crimes, burglaries, shop lifting, car break

ins, identity theft, are thought to be drug related

Other Costs

Loss of employment, interrupted employment, ability to

obtain employment, interrupted treatment- risk of OD, start

over, discouragement

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Constructing: Roll Up Your Sleeves and

Help Plan

• Centralized Position Statement

• Three Distinct Focus Areas

• Strengths/Opportunities

• Brainstorming What Could Be

for Pueblo

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What Does Success Mean?

The goal is to implement an

integrated, community-wide

system to reduce heroin and

opioid addiction and its negative

effects in Pueblo County.

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Three Focus Areas

Community Prevention Resources

Providers and Treatment Centers

Law Enforcement

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Strengths: Community Prevention Resources

• Parenting classes

• Nonprofits, ie Salvation Army, Posada, etc. known to be good resources and supported throughout the community

• Many services available outside of addiction services: DSS, Catholic Charities, SECAHEC, Wayside Cross, transitional services, etc.

• Community develops resources and places where needed

• Addicts helping addicts recover

• Nursing schools with students

• Community willing to work together in solving problems, dedicated folks willing to address the issue

• Awareness of the issue is improving

• Efforts to address the stigma about behavioral health

• Many alternates to drugs: nature center, tennis courts, basketball slabs, bike trails, skate park

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Strengths: Providers and Treatment Centers

• Two hospitals, Parkview, St. Mary Corwin, acute medical care is excellent

• Dr. Pollack has Medicaid eligible slots available for treatment

• Parkview Chemical Dependency Unit: Accudetox trained specialists, integrated dual diagnosis program, 12-step recovery community, aftercare

• Prescription Drug Monitoring Program to find out what a patient has been prescribed

• Narcan available at local pharmacies

• Large support of treatment providers, ie Crossroads, Health Solutions, Pueblo Community Health Center, Circle Program, Victory Outreach Pueblo, El Pueblo Adolescent Treatment Community, Addicts to Athletes, counselors and outpatient treatment options

• Access Point Pueblo (Needle Exchange) serves as a point of access for those who want help

• In-house treatment program at the County Jail

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Strengths: Law Enforcement

• Builds relationships with youth in high schools

• Actively trying to stop the supply of drugs

• Collaborative effort with DA to implement holistic

approach

• Drug courts, veterans court and mental health court

• Equipped officers with Narcan

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What could be…

Pueblo is a place that supports addicts looking for

treatment options through the availability of treatment

centers and Medication Assisted Treatment

The community is educated about the harmful effects of

heroin and opioid use and prevention for younger

generations becomes a primary goal

Law enforcement is equipped with proper community

support resources to impact those looking for help

Peer support becomes commonplace with a strong

support network of addicts helping addicts

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Moving Forward: Organize Implementation

of Action Plans and Measurement Strategy

• Focus Area Goals/Objectives

• Addition of Community

Members Focus Group

• Measurement Strategy

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Community Prevention Resources

Goal: The community prevention and resource group will

provide education and resources to reduce opioid and

heroin addiction and its negative effects in Pueblo County.

Initiatives:

• Community-wide speaker series

• Focusing on bringing awareness to the work of the Heroin Task

Force

• Speaker events will feature leaders of the focus area groups

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Providers and Treatment Centers

Goal: As clinicians, we believe it is our duty to educate the

public about the epidemic's impact on individuals, families

and the community, while improving the availability and

quality of prevention and treatment options based on the

best available scientific evidence.

All people with an addiction disorder deserve treatment.

Treatment must be immediately available with a low

threshold for entry. Treatment options must be flexible

enough to address the varied situations of people, yet

comprehensive. Every person seeking help, should be

treated with the utmost care and respect.

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“Our Place”

Initiatives:• The key features of Our Place:

• Open 24/7 so when people are ready to quit they can get help

• Accessible to anyone seeking help for themselves or loved ones

• Focal point for EMS and law enforcement to bring appropriate addicts

• Center for a Police Assisted Addiction Recovery Initiative (PAARI) program

• Source of information about and access to available treatment options

• On-site case managers able to talk with and direct addicts to appropriate treatment

• Detoxification facilities and protocols for initiation of acudetox

• Medication assisted treatment (MAT) will be available from part-time, community providers

• a. Standardized intake process

• b. Patient management protocols

• c. EMR per DEA requirements

• d. Billing for providers

• Behavioral health counseling – if not on-site, access to it in a timely manner

• Space for support groups and education forums for providers, patients and families

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Law Enforcement

Goal: Continue collaboration to improve interactions

between law enforcement and substance abusers.

Initiatives:

• Diversion Program

• Modeled after LEAD in Seattle, WA

• Barriers associated with law enforcement jurisdiction

• Comprehensive Law Enforcement Plan

• Plan and procedure for dealing with addiction that is appropriate

and effective for Pueblo.

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Community Members

Goal: Provide a safe space for community members to share their

stories about barriers and solutions associated with the issue

Initiatives:

• Community Partnerships

• Existing community groups

• Family Support Resources

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Measurement Strategy

Outcome Metrics for Heroin Task Force

Number of Overdose Deaths per year

Number of Opioid Protocol Prisoners per month

Number of Unduplicated Needle Exchange Clients per

month

Number of Narcan Uses by First Responders per month

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Measurement Strategy Cont…46

• State-Wide Initiatives

• Medication Assisted Treatment Expansion

• Accudetox Expansion• Community Collaborations

• Law Enforcement Diversion and Treatment

• Additional Resource for Access Point Pueblo

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Successes

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Contact Info

Matt GuyPresident and Owner, Accelerated Transformation Associates

atapueblo@gmail.com

719.248.7010

Lindsay ReevesSystems of Care Coordinator, Health Solutions

Lindsay.reeves@pueblotripleaim.org

719.252.9443

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