Taos Alive Improving a Community in Pain By Julie Martinez CPS

About Taos County

About Taos Alive Community Based Coalition 12 Sectors (Youth, Parents, Business, Media, Schools, Youth Serving

Organizations, Law Enforcement Agencies, Religious or Fraternal Organizations, Civic or Volunteer Groups, Healthcare Professionals, Government Agencies, Other Organizations involved in Reducing Substance Abuse) along with other interested community organizations and individuals including OMI.

DFC Funded October 2010 SPF (Substance Abuse Prevention Framework)

Assess their prevention needs based on epidemiological data, Build their prevention capacity, Develop a strategic plan Implement effective community prevention programs, policies and practices, and Evaluate their efforts for outcomes.

Taos Alive Vision Statement: Taos County residents will live in a community

that is safe, secure and drug free.

Mission Statement: Taos Alive unites and creates community efforts to reduce substance abuse in Taos County.

Goals: The Taos Alive Coalition will work to achieve the following goals in alignment with Drug-Free Communities:

1.Increase community collaboration among Taos County residents, organizations and government to achieve the coalitions mission.

2.Reduce substance abuse in Taos County.

7 Strategies to Success

Prescription Drug Abuse Initiative of Taos Alive Sub-Committee began September 2011

Extensive Community Assessment

Extensive Strategic Planning

Environmental Strategies

Participate in DEA Take Back including promotion and facilitation

2 Permanent Drop Boxes (Taos & Questa)

Brochure for Rx Prescriptions (All pharmacies, Provider officers and other locations)

Movie Theater Ad, Radio Ads, Newspaper Ads

Opiate Prescribing Guidelines HCH ER, Penasco Clinic & Taos Medical Group

Naloxone Pilot Program

Other Environmental Strategies

Presentation to youth Presentation to Seniors and Senior Centers Provide Lock Box’s to Hospice and those at high risk Revise School Policy to address prescription drugs in schools Promote using PMP Information to Community though social media (website, facebook, twitter, pintrist,

wordpress) www.taosalive.org Participate in Recovery Oriented Systems of Care (Recovery Friendly Taos) Participate in Taos County DWI Participate in Crisis Systems of Care Co-Sponsor of 1st Annual Substance Abuse Summit October 2012 C0-Sponsor of Community Screening of Anonymous People Work with OMI Resource Directory Brochure and information to realtors Collect Data (OMI, EMS, YRRS, Community Norms Survey, PMP) In the works PHO-Opiate Prescribing Guidelines (Community Guidelines) Coordinate for First Responders (First Level) to carry and administer Naloxone

RX Take Back Fall 2011- Not involved Less than 2 lbs April 28, 2012 – 44 Pounds • Taos Police • Tribal Police • Taos County Sherriff September 29, 2012 – 60 Pounds • Taos Police • Tribal Police • State Police • Taos County Sherriff • Questa Police • Colorado State Troopers April 27, 2013 – 100 pounds • Taos Police (Ancianos Senior Center, Taos Police) • Tribal Police (TP Senior Center, TP Police Dept) • State Police (Walgreens) • Taos County Sherriff (Penasco Community Center) • Questa Police (Questa Police Dept) October 26, 2013

Permanent Drop Boxes Taos/Questa

Brochure for Prescriptions

Lockyouremeds.org

Radio

Theater Advertisement

Pre

scribe

r T

rain

ing

Prescriber Training

(Treating Chronic Pain in New Mexico: Addressing Best Practices, Addictions, and Current Regulations. The course is approved by the NM Medical Board to fulfill the 5 hour requirements related to management of Chronic Pain with controlled substances.) Via video conference in Taos County. February 23, 2013

Holy Cross Hospital ER Opiate Prescribing Guidelines

Naloxone Project

Integration and cooperation between government agency, community coalition, non profit hospital and for profit private medical practice.

Part of an overall strategy is to decrease opiate overdoses (see OD slide)

Reduce access Reduce inappropriate Prescription use Improve poising intervention early intervention drug treatment and recovery integrate mental health care provide substance abuse prevention (see slide)

Program is modeled off of Lazarus.

Idea is harm reduction targeted at Rx opioid meds to reverse OD and keeping people alive until they can seek treatment. Also help prevent accidental OD for children or adults taking sedative combinations.

DOH grant $$ with a pilot project mandated by DOH in 4 areas in the state with Taos leading the way. Plan to track data.

Currently dispensing naloxone from El Centro Family Health, Tri County Community Services, Health Partners Systems,

Penasco Clinic, CATCH at Holy Cross, Taos Medical Group , Pharmaceutical Care HCH, Taos County Detox, and currently working on it being dispensed at Jails, Family Practice and First Responders.

Connected with the NM Poison Center to support our efforts. They have our info and can give guidance to prepare naloxone and help with the OD in general.

Education performed with the first responders in Taos, police, fire so they know what we are doing and can recognize the kits.

Safecom

mu

nity.n

et

Patient Education

for Narcan

Kit

Taos Pilot Flow

Project Phases

What’s not working or Recommendations Nationally

Stop Promotion of prescriptions through media PMP interface state by state

State Wide Step down treatment Medical Reimbursement for treatment OMI’s ability to dispose of medications at scene of death

Locally Need Drug Recognition Officer Series of step-down Medical Treatment (Medical Detox, In-Patient Treatment, Transitional living, Intensive

Outpatient Treatment, Outpatient Treatment and maintenance) Crisis Intervention Support from elected officials and policy makers

Below recommendations are from “Creating a Community-Based Medical Home for Addiction and Chronic Pain Care in Taos County” by Dr. Jaye Swoboda, Taos Alive Coalition Member and Champion. Need prescribing guidelines for not just opiates but also for other psychoactive drugs (i.e. benzodiazepines and

stimulants) A common template for clinicians to use in electronic charting on chronic pain and addiction patients. A common controlled substance contract for use by all clinics rather than each clinic having their own. A registry of patients who have contracts or who violate contracts that will be used not to restrict care but rather to

intensify case management efforts. Hiring a pharmacy technician to run prescription monitoring profiles and coordinate data point collection for

feedback to individual clinicians and clinics on their performance and patterns of practice. Clinicians can and will change practices if given accurate feedback on their behavior and have achievable goals.

Having a “standard operating procedure” to follow when the management of acute pain (i.e. post-operative or trauma induced) dovetails with chronic pain treatment.

Ongoing CME activities, coordinated by the hospital and the University of New Mexico, which support clinicians and their systems in delivering care to a difficult population.

Identification of outliers in the prescribing arena, understanding the issues which may create this status, and assisting those clinicians in addressing the needs of their patients with, when appropriate, non-pharmacologic strategies. This may require disciplinary action on rare occasion and it is best that the community practitioners establish their own monitoring rather than relying on outside forces. The root of this potentially practice-altering component is the collection of and feedback regarding behavior.

Open discussion and presentation of best-practice models.

Acceptance of, integration with, and reimbursement to non-allopathic practitioners who have evidence-based and more affordable practices for treating chronic pain.

Training for and use of community heath workers who can expand the playing field for where patients receive services and fill in the gaps between agencies. This component is a key piece of creating a true medical home.

Identification of and tracking of measurable indices for assessing clinician behavior over time. Examples of such data include prescribing data from the

Prescription Monitoring Program Use of clinical tools such as the World Health Organization’s pain management step ladder and

screening tools (i.e. AUDIT, COWS, smoking status) Percent of patients receiving concurrent prescriptions for opiates and benzodiazepines Number of buprenorphine providers and patients receiving opiate agonist therapy, percent of providers

using the PMP and the number of profiles generated. The number of patients who use ED services for addiction or chronic pain related disorders (including

trauma) Number of hospital days stemming from addiction or pain-management issues Percent of people who use opiates chronically who are contracted (including percent who violate their

contract) Percent of patients who receive urine toxicology screening to assess compliance with treatment

regimens or who concurrently use illicit drugs Percent of clinicians who can demonstrate via review of records use of “universal precautions” in

prescribing opiates Measurement of community awareness regarding prescription drug safety (currently done by Taos Alive) Number of patients receiving ambulatory detoxificaton services Numbers of accidental deaths and overdoses Use of narcan reversal EMT calls involving alcohol and prescription drug abuse or intoxication Patient satisfaction surveys. Rational prescribing and treatment for chronic pain and addiction should lead to measurably improved

patient satisfaction as well as clinical outcomes.