Prescription Drug and Heroin Abuse

in Fairfax County: Recent Trends and

Strategies for Prevention

Presentation to the Board of Supervisors Human Services Committee

December 9, 2014

Background

• The national death rate from heroin overdoses has doubled in the past two years, to 2.1 deaths per 100,000 persons annually.

• Local stories have been chronicled in the media.

• In September, the Board directed staff to review the issue.

• In October, Police convened a stakeholder meeting, kicking off the process of developing a comprehensive strategy.

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Stakeholder Involvement to Date

• Police

• Sheriff

• Fire and Rescue

• Commonwealth’s Attorney

• Parents/Community

• Fairfax County Public Schools

• Community Services Board

• Health

• Neighborhood and Community Services

• Unified Prevention Coalition

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Prescription Drug and Heroin Use

• Prescriptions of opioids for use as painkillers have grown dramatically over the past two decades

• Opioid use can create dependency, resulting in addiction and heroin use

• Heroin user demographics have changed, trending younger

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Data Issues

• There is no single measure, or small number of measures, that can adequately provide a clear and comprehensive overview of the prevalence and impact of opioid abuse.

• Complications include:– medical coding,

– self-reporting,

– relatively small raw numbers at the local level, and

– the variety of types and names of opioid drugs.

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Opioid Overdose Deaths, Sales, & Treatment Admissions, United States, 1999–2010

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0

1

2

3

4

5

6

7

8

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Rate

Year

Opioid Sales KG/10,000

Opioid Deaths/100,000

Opioid Treatment Admissions/10,000

Sources of Pain Relievers for Nonmedical Use Among Past Year Users 12+ Years Old, United

States, 2012.

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Number of Heroin Overdoses and Fatalities, Fairfax County

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0

10

20

30

40

50

60

70

2012 2013 2014*

Overdoses

Fatalities

*2014 is through November

100 89107

48

100135

213 210

389422

398 415

487

414

468508

0

100

200

300

400

500

600

2007 2008 2009 2010 2011 2012 2013 2014

Nu

mb

er

of

De

ath

s

2014 is estimated based on data through June 30, 2014

Heroin Prescription Opiods

Number of Fatal Heroin & Prescription Opiate Overdoses, Virginia, 2007-2014

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EMS Patient Contacts,Fairfax County

Demographics

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2%

10%

35%

27%

17%

7%

2%

15-19

20-24

25-34

35-44

45-54

55-64

65+

Fairfax County EMS Contacts, Suspected Heroin Overdose,

2011-2014

Fatal Heroin Overdoses by Age, Virginia,

2013 - July 11, 2014

30-Day Use of Select Substances, FCPS 8th, 10th, 12th graders, 2010-2013

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0

5

10

15

20

25

2010 2011 2012 2013

Pe

rce

nt

Re

po

rtin

g

Alcohol

Binge Drinking

Cigarettes

Marijuana

Painkillers

Other Rx

Heroin

Similar and Related Efforts

• Combat Heroin and Prescription Drug Abuse, New York State

– http://combatheroin.ny.gov/

• Winchester/Valley Addiction Action Committee

• Prince William County

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Governor’s Task Force on Prescription Drug and Heroin Abuse

• Included in the A Healthy Virginia action plan

• Five issue areas:

– Education and awareness

– Treatment

– Storage and disposal

– Enforcement

– Data and monitoring

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New Resources

• CSB Heroin/Opiates Web Page

http://www.fairfaxcounty.gov/csb/heroin-opiates/

• Police Heroin Tip Line

1-844-373-3634

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Fairfax Framework for Prevention

• Five strategic areas:– Education and awareness– Treatment– Prescription drug storage, disposal, and monitoring– Enforcement– Data and monitoring

• Objective(s) for each area• Potential strategies• Existing efforts• Opportunities for partnership, collaboration and

adaptation

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Education and Awareness

• Objective: Increase public awareness of the dangers of misuse and abuse of prescription drugs and heroin and their connection to each other.

• Potential Strategies: – Website: information, referral, resources

– Seminars and other public events; speakers bureau

– Messaging: print, web, social media, and other media

– School curriculum

– Messaging tools for elected officials

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Prescription Drug Storage, Disposal, and Monitoring

• Objective: Increase safe disposal of unused prescription drugs.

• Potential Strategies:

– Expanded drug take-back

– Public education on safe disposal

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Prescription Drug Storage, Disposal, and Monitoring

• Objective: Promote best practices in prescribing opioids.

• Potential Strategies:

– Painkiller prescribing guidelines

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Prescription Drug Storage, Disposal, and Monitoring

• Objective: Monitor the prescription use of opioids.

• Potential Strategies:

– Parent education on monitoring medication

– Public education on safe storage

– Education for coaches, physical therapists, and athletic trainers to monitor athletes who have been prescribed painkillers

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Treatment

• Objective: Facilitate access to opioid addiction treatment.

• Potential Strategies:

– Recommended treatment services, counseling, and information on adherence to standards of treatment for addiction

– First responders referrals to treatment

– Service directories and navigation supports

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Treatment

• Objective: Incorporate training on the County’s availability and use of Naloxone by first responders to treat individuals who have overdosed on opioids.

• Potential Strategies:

– Training for first responders, health care providers, and others on the use of Naloxone by Fairfax County FRD

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Treatment

• Objective: Expand opportunities for peer support components in treatment and recovery programs.

• Potential Strategies:

– Incentives for incorporation of peer support into recovery and treatment

– Recruitment and training of participants

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Enforcement

• Objective: Prioritize access to treatment over prosecution in law enforcement of opioid use and overdose.

• Potential Strategies:– Review options for drug courts, diversion, and

referrals

– Good Samaritan law

– Accessible means of referrals for first responders

– Review of Police Department guidelines and/or policy for how to handle opioid use and overdose

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Enforcement

• Objective: Increase prosecution of illegal heroin and opioid distributors/dealers.

• Potential Strategies:

– Expanded use of a regional grand jury process to expedite indictments of suspected dealers

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Data and Monitoring

• Objective: Monitor local trends in prescription drug and heroin use to identify needs and monitor progress.

• Potential Strategy:– Identify key indicators and align data sets and measures

where possible

– “Prescription Drug and Heroin Abuse Report Card”

• Objective: Evaluate the strategies included in the final strategic plan.

• Potential Strategy:– Evaluation plans for identified strategies

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Next Steps

• Identify and engage stakeholders.

• Develop action plans, including leads and coordination strategies.

• Coordinate with Governor’s Task Force.

• Explore alternative funding strategies.

• When feasible, begin implementation.

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Recommendations

• Direct staff to present the plan, with funding and policy requirements, to the Board at an upcoming Human Services Committee meeting.

• Ensure opportunities exist to include strategies in the next year’s legislative program.

• Direct staff to develop strategies for an expanded drug take-back program, to include funding and resource requirements.

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Questions?

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Contacts

Capt. Paul Cleveland, Police

paul.cleveland@fairfaxcounty.gov

703-802-2711

Jesse Ellis, Neighborhood & Community Services

jesse.ellis@fairfaxcounty.gov

703-324-5626

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