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Opioid Educational Summit Solutions and Resources Community Initiatives
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Solutions and Resources
Community Initiatives
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WELCOME!
Opioid educational summitSeptember 13, 2016
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Tonight’s Schedule
• 6:00PM – 6:15PM: Welcome and Introductions
• 6:15PM – 7:30PM: Speaker’s Forum• 7:30PM – 8:00PM: Q&A• 8:00PM: Post event reception with light
refreshments
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Speakers Forum• Dr. Dennis McCluskey, MD, Summit
Psychological Associates• Dr. Doug Smith, MD, Chief Clinical Officer,
ADM Board• Jan Kenepp,Territory Business Manager,
Alkermes• Deborah Walsh, Ph.D., Summit
Psychological Associates• Allyse Adams, PC, LICDC, Oriana House
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Dr. Douglas Smith
Doug Smith, M.D., DFAPAMedical Director/CCO,
Summit County ADM Board Associate Professor and Director of
Public and Community Psychiatry, NEOMED
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THE OPIATE EPIDEMIC IN OHIO
The Opiate Task Force
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The U.S. comprises 4.6% of the world population,
yet we consume 80% of the world’s opiates and99% of the world’s hydrocodone (Vicodin)
Opiates are involved in over 70% of admissions to ADM Crisis Center for detox and drop-in services
10% of patients presenting to primary care providers suffer from addiction
By the Numbers…
Unintentional drug poisoning is now the leading cause of accidental death in the U.S.
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0
500
1000
1500
2000
Year
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1980
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2012
Epidemics of unintentional drug overdoses in Ohio, 1979-20121,2,3
Source: 1WONDER (NCHS Compressed Mortality File, 1979-1998 & 1999-2005) 22006-2011 ODH Office of Vital Statistics, 3Change from ICD-9 to ICD-10 coding in 1999 (caution in comparing before and after 1998 and 1999)
8
Prescription drugs led to a larger overdose epidemic than illicit drugs ever have.
Prescription Pain Medication
(opioids)
Crack CocaineHeroin
Heroin & Rx opioids
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In 2008, There were 14,800 Prescription Painkiller Deaths
Taken from http://www.cdc.gov/homeandrecreationalsafety/rxbrief/
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15
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16
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Prescription Drugs
• 67 narcotic pills for each Citizen of Ohio • Kids raid drug cabinet- “skittles” parties• ADHD meds, pain meds commonly
abused• Oxycontin• Opana• Morphine
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Increased Exposure
Increased Substance Abuse
Epidemic
Self-medicating habits of baby
boomers
Direct-to-Consumer
Marketing of Rx
Availability and Marketing of
New Extended Release Rx
Opioids
Changing Rx Pain
Management Guidelines
Pain as 5th Vital Sign
Overall Growth in Rx Use:• New and better
preventive drugs• HC insurance pressure
Widspread Diversion of Rx Drugs:• Internet• Pill Mills• Deception/Scams• Theft
Perceived Legitimacy
and Safety of Rx Drugs
Contributing Factors
ODH Violence and Injury Prevention Program
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John R. Kasich, GovernorOrman Hall, Director
Governor’s Ohio Cabinet Opiate Action Team MISSION STATEMENT: The Opiate Action Team attacks the opiate epidemic on behalf of Ohioans to end opiate abuse by reforming prescribing practices for appropriate pain management, punishing those involved in illegal activity, and treating those who are addicted to enable them to return to productive lives.Workgroups:
• Enforcement• Treatment• Professional Education = prevention• Public Education = prevention• Recovery Supports
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Summit County Response
• Alcohol Drug Addiction and Mental Health Services Board (ADM) has launched pilots and initiatives– Opiate Task Force– County Jail Linkage
• VIVITROL• Invega Sustenna
– Low dose suboxone with counseling
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Opiate Task ForceCommittee Chair(s) Short Term Goal Long Term Goal
Criminal JusticeChief Vince Morber- BPD;
Lisa Disabato-Moore- SCJC
Implement DAWN Kit Protocols for Law Enforcement
Enhance legal Consequences for Traffickers- Inclusive of prescribers
Public Awareness &
Youth/FamiliesDarryl Brake- SCCP Opiate
Summit/Conference:
Develop online OTF presence: Include website and social media
Healthcare
Bob Stokes –CHC;
Gary Thrasher MD- Oriana House
1. Increase OARRS utilization by prescribers
2. Promote Emergency Room Rx Guidelines
Increase Access to Medication Assisted Treatments (MATs)
PolicyAdvocacy
Jerry Craig- ADM Host Legislative breakfast
Establish local Platform/Agenda to inform legislative actions
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Treatment Options
Detoxification Residential treatment Outpatient programs Medications assisted treatmentsMethadone (Agonist) Buprenorphine (Partial Agonist)* Naltrexone (Antagonist) Suboxone (partial agonist/antagonist)*
* DATA 2000 named drugs
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OD and Detox 2015• ADM Crisis Center
– 1577 Detox admissions, 68% due to opiates • Over 4 per day !
– 2,314 Drop-ins• Over 6 per day !
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Public Awareness and Education
– A group of key individuals and organizations committed to reducing the tragic consequences of opiate abuse in Summit County through education, collaboration, and the wise use of available resources. Including the OTF speakers bureau
Numerous people in the community have connected with the Opiate Task Force for education and assistance, including:
Prescribers - Recent legislation now require prescribers, MD’s, dentists, and pharmacists to consult the Ohio Automated Rx Reporting System. OARRS to prevent overprescribing/abuse. Prescriber education.
Initiatives
People in recovery Physicians Family members Clergy Judges
Police and Fire chiefs School representatives Elected officials Public health Treatment/prevention providers
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Court Diversion Programs
Turning Point - Common Pleas Judge Thomas A. Teodosio. Treatment in lieu ofconviction. Structure – Participants are court monitored for up to one year. Participantsmust remain compliant to court treatment recommendations and other court orderedmandates such as probation and community service.
Crossroads - Serves children with substance abuse/dependence problems and mentalillness. Intensive probation lasting a minimum of one year with regular courtappearances. The program also works with parents and children to strengthen andimprove the family unit through counseling.
Drug Court – Akron Municipal Court Judge Joy Malek Oldfield and the Oriana House -“Through Drug Court, less-serious, drug abuse offenders have the opportunity to havetheir charges dismissed once they successfully meet all the demands of the year-longprogram, including treatment, aftercare, sobriety, case management and drug freestatus.”
https://courts.ci.akron.oh.us/programs/drug_court.htm
Initiatives
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Treatment centers - Various treatment centers offer various services such as inpatient, outpatient, detox, medicated assisted treatment (MAT), and aftercare. For a complete listing of available services, call:
ADM Central Assessment - 330-996-7730 Edwin Shaw Rehab – 330-436-0950 Community Health Center - 330-434-4141
Detox centers Inpatient
ADM Crisis Center 330-996-7730 Ambulatory (outpatient)
Edwin Shaw Rehab 330-436-0950 Community Health Center 330-434-4141
Recovery housing
Resources
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Resources Project DAWN – A free community based drug overdose
education & naloxone distribution program for the reversal of opiate overdoses, in conjunction with calling 911. Free DAWN kits for Summit County residents are available by attending a clinic at one of these facilities:
Edwin Shaw Rehab - 405 Tallmadge Road, Cuyahoga Falls 44221 every Thursday at 9am, 10am, 11am. 330-436-0950
Summit County Health Department -1867 W. Market St. Akron 44313 every Tuesday at 3pm, 4pm, 5pm. 330-812-3983
http://www.healthy.ohio.gov/vipp/drug/ProjectDAWN.aspx
Medication Drop Boxes – D.U.M.P. (Dispose of Unused Medications Properly) For a location near you visit http://scphoh.org/ENVIRONMENTAL/ENV-
Dump.html
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HIDDEN IN PLAIN SIGHT –COPLEY/BATH POLICE EXHIBT“The departments constructed what appears to be the bedroom of the averageteenager. But items that are taken for granted as nothing but the usualaccessories may actually be signals that the teenager could be involved in riskyand even illegal activity including substance abuse, underage drinking, eatingdisorders, sexual activity and more. Exploration and interaction with the exhibit isencouraged. Adults in attendance will be able to get an up-close look at the itemsin the room and be shown how they can be used. Participants will be enlightened,educated and astonished.”
For more information visit http://www.copley.oh.us/hidden-in-plain-site/hidden-in-plain-sight/menu-id-555.html
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Summit County SOLACE Family Support Resource
“to educate, serve, and provide resources to teens and families affected by addiction.”
Meetings are held at First United Methodist Church of Akron located at 263 East Mill St. Akron, OH 44308
Contact: [email protected]
Facebook page: https://www.facebook.com/solacesummitcounty
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Project DAWN Kit
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Opiate Task ForceData Dashboard:
• The Opiate Task Force asked to establish key data indicators to be tracked over time. These data points will be used as a platform for measuring the opiate problem and any efforts to combat it. Initial indicators will include,
• Neonatal Abstinence Syndrome (NAS) incidence rate• # Opiate Doses Dispensed- Summit County vs. Ohio• # Opiate Dosed per capita- Summit County vs. Ohio• # Overdose Responses by EMS• # Overdose reversals by EMS• # Overdose Deaths- Total, and Opiate involved • Pounds of unused medications turned in to drop boxes• Average Wait Time for residential treatment, by gender
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Opiate Task ForceRecent Initiatives Update
• ADOLESCENT DAYTIME DETOX TREATMENT PROGRAM (COMMUNITY HEALTH CENTER)
• The county’s only program for adolescents (12-18 yrs.) for safe, medically supervised detox from opiates began on October 1, 2015.Additionally, the program is now providing VIVITROL and Suboxone for adolescents.Contact: Tiffanie Ferguson (330-315-3789)
• MOBILE RESPONDER (ORIANA HOUSE)• From January 2015 to May 2016, the On-Call Resource Advocate
(OCRA) received a total of 77 calls with 49 of them being males and 28 of them being females. 43 clients accepted the referral to the ADM Crisis Center for either Central Assessment or Detox. 23 of which kept their referral appointment. Contact: Felicia Tibbs (330)-996-7730
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OPIATE DOSES DISPENSED PER CAPITA:Summit County & State of Ohio
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Time PeriodHeroin
withNarcan
Heroin without Narcan
Other Overdoses Avg/Day Naloxone
reversals*
2014 448 - - 1.46 269
2015 556 - - 1.52 662*
2016 474 125 411 2.23/4.74 474**
2016 numbers refer to January to July 2016. The Average per day rate of 2.23 refers to the number of Heroin overdoses with narcan.The 4.74 average refers to the total overdoses per day.
Heroin Overdoses (Akron) by EMS responses
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lth Total overdose deaths: 350 (303 = opiates)
189 attributed to heroin or fentanyl (54%)63 – heroin126 - fentanyl114 - other types of opioids
Total overdose deaths: 144 101 attributed to heroin or fentanyl (70%)
Summit County 2015
2015 Statistics
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Comparison of Opiate Deaths from 2015 to 2016
02468
10121416
January - June 2016preliminary data
2016 is preliminary data and is not official
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D.U.M.P. Box Disposal Sites
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Time PeriodReceivedOverdose Education
Received DAWN Kit
2015 524 3542016 (as of 8/22/2016) 510 265
• *Program Started 2/1/15 at SCPH• ~Includes community based Project DAWN clinics in addition to regularly scheduled
clinics• ** Numbers include only SCPH DAWN Clinic as of 6/6/2016
SCPH Performance Target: In FY2016, 375 Project DAWN kits will be distributed to Summit County residents
DAWN Kits Dispensed
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Deterra Project• 40,000 bags were donated to Summit County Community
Partnership.– 15,000 smaller pouches (10-15) pills to pharmacies
• ACME is the primary pharmacy– 25,000 larger pouches to three main populations:
• Seniors• Family/Friends of addicts• Parents
• If each of these pouches are used to capacity, there will be 1.3 million fewer pills available to fall into the wrong hands in Summit County
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Deterra Bags
• Simple, safe disposal of medication
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How can Opiate Task Force Help?• Education, speakers bureau, resources and
materials• Access to help and prevention resources –
OTF website• Individuals in Recovery to share their stories
– e.g. Recovery does happen• Project DAWN Clinics• Opportunities to get involved, e.g. join task
force, become a speaker, etc. • Consultation and support
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www.summitcountyopiatetaskforce.org
or call the ADM Board at330.762.3500
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Dr. Dennis McCluskey• Graduated from the University
of Alabama School of Medicine in 1976 and completed his residency at Good Samaritan Hospital.
• Board certified in Family Medicine and is currently employed at Summit Psychological Associates.
• Long-time advocate for accessible and qualitative public health, recently joined Summit Psychological to help expand the VIVITROL Treatment Program.
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VIVITROLMEDICATION ASSISTED TREATMENT (MAT)
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What is Naltrexone• Opioid antagonist that is approved for the
treatment of both opioid dependence and alcohol dependence
• Non-opioid medication• Opioid receptor antagonist that binds to the
opioid receptors but instead of activating the receptor it effectively blocks them
• Prevents opioid receptors from being activated by agonist compounds such as heroin and prescription pain killers
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What is Naltrexone, Cont.• Reduces cravings and prevents relapse• Can be prescribed by any individual who is
licensed to prescribe medication• Both daily oral form and monthly injectable
form approved by the FDA for treatment of opioid dependence
• Oral naltrexone was approved for use in treating opiate addiction in 1984
• VIVITROL approved by the FDA in 2010 for opiate addiciton
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What is VIVITROL
• Injectable form of Naltrexone• Opioid blocker• Once monthly medication (injection)• When combined with counseling, it can
help treat alcohol dependence and/or relapse to opioid use
• VIVITROL is NOT: a narcotic, addicting, or pleasure-producing
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VIVITROL Treatment Program• Covered by Medicaid,
Medicare and Private Insurance
• Fifty-six (56) active clients are currently involved in the VIVITROL treatment program
• Treatment length - Typical up to 1 ½ years on VIVITROL – can be up to three years
• Clients can continue to access supportive programming after stops injections
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Medication Assisted TreatmentVIVITROL/Naltrexone
• VIVITROL is a once monthly injectable form of Naltrexone– Naltrexone is also available as a daily oral
medication– Naltrexone is not addictive– Naltrexone blocks the effect of all opioids– Naltrexone can be prescribed by a general
physician– Naltrexone lessens and can even remove
cravings for opioid drugs.
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TREATMENT OPTIONSSummit Psychological Associates and Oriana House
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When is Outpatient Treatment used• Outpatient program can be a follow up to a
residential stay, time in detox or after a jail stay
• Outpatient programming can be a stop gap while a client is waiting for residential services to be available
• Participating in outpatient programming is an option for reducing or eliminating a legal charge or jail time
• Some clients find success in an outpatient program that uses Medication Assisted Treatment
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What is Medication Assisted Treatment?
• Evidence-based treatment that addresses both physical and mental aspects of drug addiction
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Important Components of Medication Assisted Treatment?
• Medication is used to treat withdrawal, dependence and cravings
• Mental health therapies are used to treat emotional, and trauma concerns that may have existed prior to drug use and/or developed along side drug use
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Important Components of Medication Assisted Treatment?
• Intensive Substance Abuse Treatment to build new behaviors and coping skills
• Addressing basic needs through case management and recovery support services
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Best Practices
• Treatment that focuses on:• Health – manage the disease, live in healthy
way, mental health• Home – establish a stable and safe place to
live• Purpose – meaningful daily activities – work,
school, care of family, volunteering• Community - relationships and social
networks, sober supports
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Treating Opioid Addiction
PSYCHOLOGICAL EFFECTSCounseling targets the CORTEX
PHYSICAL EFFECTSMedication targets the LIMBIC REGION
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A Coordinated EffortSummit Psychological Associates• Mental Health and Addiction
Agency• Thirty (30), plus year history• Medication Assisted
Treatment – VIVITROL Treatment Program
• Outpatient treatment program
• Manages behavioral health services within Summit County Jail
Oriana House – RigelRecovery Services• Quality chemical
dependency treatment programs– Early Assessment– Relapse Prevention – Aftercare
• Ambulatory Detox• Rigel Recovery Services
– outpatient treatment services
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VIVITROL Treatment Program
• Collaborative effort between Summit Psychological Associates and Oriana House – Rigel Recovery Services.
Summit Psychological Associates Oriana House - Rigel
Evaluation for treatment Treatment readiness
Monthly Injections Intensive Outpatient
Mental health evaluations After care
Mental health treatment Support Groups
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Oriana House –Rigel Recovery Services
• At Rigel Recovery Services, we believe alcoholism and substance abuse are diseases that require an individual’s continuous commitment to recovery over the course of his or her life. Our treatment starts individuals on a multi-step journey to rehabilitation through their own admission of a problem, abstinence, avoidance of relapse, and a daily dedication to recovery.
• We are proud to be a part of this process and to assist individuals in regaining control of their lives.
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Target Population• Any individual with a opioid diagnosis.• Referrals come from:
– Community agencies– ADM (Central Assessment & Detox)– Probation and Parole– Physicians– Attorneys– Self– * No one will be turned away for treatment
services.
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What do we offer?• Substance use assessments• Opiate Enhanced Treatment
– Intensive outpatient treatment– Aftercare– Individual counseling
• Drug Testing• VIVITROL Treatment Program (VTP) –
Collaborated with SPA• Family Programming and Involvement
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Substance use Assessments
• A substance use assessment helps the client and the counselor determine the severity of the problem. – The client’s substance use of alcohol and/or
drugs is evaluated in order to determine an appropriate treatment plan and goals.
– Assessments are accepted from Central Assessment and Detox
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Opiate Enhanced Treatment• Opiate Enhanced Treatment allows individuals
with an opioid diagnosis to attend Intensive Outpatient Treatment that is specific to the use of opioids.
• Rigel counselors introduce participants to additional supportive resources including detoxification, twelve step groups, family sessions, and peer support services.
**The goal is to provide a level of care specific to opioid use that assists with and increases the ability to cope with cravings, reduces relapse to opioid use, and facilitates lifestyle changes that support abstinence. **
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VIVITROL Treatment Program (VTP)
• Collaboration between Summit Psychological Associates (SPA) and Oriana House, Inc.
• Program includes:• Opiate Enhanced Treatment services• Psychiatric Diagnostic Assessment• Individual Mental Health Counseling• Monthly VIVITROL injection or oral
Naltrexone• Case Management Services• Drug testing
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VIVITROL Treatment Program (VTP)
• Case Management is offered to assist individuals in addressing life stressors outside of therapeutic needs.
• Will coordinate care with referring agencies and other providers (i.e. CSB, probation, physician)
• Will assist client in managing appointments and medication
• Will act as liaison between Rigel counselor, SPA mental health therapist and the SPA psychiatrist prescribing the VIVITROL.
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Benefits of MAT with VIVITROL• Clients report reduction to elimination of
cravings therefore significantly reduces the risk of relapse
• Blocks the effects of opiates • VIVITROL ensures medication compliance• VIVITROL eliminates impulsive use• Non addictive• Has no mood or mind altering effects• Minimal side effects
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Challenges of MAT with VIVITROL
• Clients struggle to acquire the 7 days necessary without any opiates in order to begin medication
• Cost• Detoxification resources• Insurance/pharmacy issues
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Family Involvement• Conjoint sessions• These sessions are held throughout the course of
treatment in which the client has the opportunity to bring their positive support person to meet with the counselor. The counselor, client and their support person will explore the treatment and recovery process as well as ways to maintain healthy support.
**The goal of is to educate family and friends of the treatment process while providing an environment for family and friends to show support in a way that promotes an honest and positive interaction**
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Family Involvement
• Family Matters– Throughout treatment and self-help meetings
clients will learn that healthy support is a key component to recovery. We do our best to support this by inviting the clients loved ones to engage in the treatment process and receive support themselves. Family members receive skills and tools to assist them with healthy living and setting boundaries with their loved ones.
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Summit Psychological Associates, Inc. – Medical Services in VTP
• Dr. McClusky completes a medical evaluation to determine readiness and appropriateness for VIVITROL Treatment
• Dr. McClusky and our medical assistant, Heather Moss provide the monthly injections.
• Clients have access to psychotropic medications if needed
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SPA – Mental Health Treatment in VTP
• Licensed clinicians who are trained in co-occurring disorders
• Use of Motivational Interviewing and Trauma Informed Care to assist clients in reaching their goals of sobriety and healthy functioning
• Seen on a weekly basis – can continue with MH treatment once end VIVITROL injections
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SPA –Case Management in VTP
• Assists clients in being successful through out their participation in the VIVITROL Treatment Program – setting up appointments, identifying barriers to attendance, helping to reduce barriers
• Assists with Medicaid application if needed• Assists client with any basic needs –
housing, transportation, access to sober recreational activities, financial
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Outcomes
60
53
30
35
52
24
17
26
17
0
10
20
30
40
50
60
70
Opioid Cravings Anxiety/Depression Physical Pain
Cravings and Health Effects
Entrance 3rd Injection 9th Injection
According to our latest data, clients report :
• Nearly 60% of clients come into the program with opioid cravings at least weekly
• By the 3rd injection, the percentage of clients reporting opioid cravings, at least daily, drops to 35%
• By the 9th injection, 83% report zero opioid cravings, with 13% reporting cravings on a weekly basis. Cravings multiple times a week, or daily, drops to 0%
• Decrease in anxiety/depression symptoms and decrease in physical pain
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Contact Information• Allyse Adams – Clinical Administrator • 330.996.2222 ext. 2915• Amanda Frye– Clinical Coordinator• 330.535.8181 ext. 411• Emily Nugent – Case Manager• 330.535.8181 ext. 401• Deborah Walsh, Ph.D. – Clinical Director• 330-535.8181• Lisa French– Program Assistant (scheduling)• 330.535.8181 ext. 408
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Q&A
QUESTIONS?
