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The Challenge of Opioid Addiction
Valerie Valcour RN, Health District Director Carol Plante, Healthy Lamoille Valley * September 3, 2014
2
Lamoille Valley Opiate Summit - 2014
Purpose: Build a web between local efforts
and the greater community Spark innovative strategies
Vermont Department of Health
3
Lamoille Valley Opiate Summit - 2014
AGENDA State of the State Gallery Walk Recap of June Governor's Opiate Summit Break Sharing Groups – “What struck you?” Wrap Up – Next Steps
Vermont Department of Health
4
PREVENTION
Effective prevention addresses various risk and protective factors that can either increase or decrease substance use/abuse.
Vermont Department of Health
Risk & Protective FactorsThe Root Causes +/-
5
PREVENTION
Place Matters Health is where we live, work, learn, play
& pray.
Vermont Department of Health
Opioids – including prescription painkillersand heroin – are powerful drugsthat can be powerfully addictive.
Facts About the Problem
Vermont Department of Health
7
The numbers are going in the right direction.
Vermont Department of Health
2002/3 2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/120
5
10
15
20
25
9%8%
7% 7% 7% 6% 6% 6% 7%6%
15%13% 13%
15%14% 13% 14% 13% 13%
12%
3% 3% 3% 3% 3% 3% 3% 3% 4% 3%
Non-medical use of prescription pain relievers% Vermonters reporting non-medical use in the past
year, by age group12-17 18-25 26+
8
Heroin use among Vermonters is low and stable.
2% of high school students reported ever using heroin in 2013 (Youth Risk Behavior Survey)
This is down, although not significantly, from 3% in 2011
Fewer than 1% of Vermonters ages 12+ reported using heroin in the past year in 2011/12 (NSDUH)
This is unchanged from 2010/11
In 2011/12 Vermont had a significantly lower prevalence of heroin use compared to the United States
Vermont Department of Health
9
Non-medical pain reliever use is related to heroin use.
NSDUH found that recent (12 months preceding interview) heroin incidence rate was 19 times higher among those who reported prior non-medical pain reliever use than those who did not
NIDA reports that nearly half of young people who inject heroin, surveyed in three recent studies, reported abusing prescription opioids before starting to use heroin.
Vermont Department of Health Source: National Survey on Drug Use and Health, 2003-2012
10
Heroin deaths are on the rise in Vermont.
Vermont Department of Health Source: Office of the Chief Medical Examiner
Note: Total opioid includes un-identified opioids. Heroin and prescription opioids are not mutually exclusive.
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
10
20
30
40
50
60
70
31
44
5552
47 47
39
52
4650
61 2 4 2
51
9 9
20
36
46
56 55
4952
39
61
54
68
Drug-related deaths involving an opioidTotal # by drug type, January 1, 2004 - December
31, 2013Rx Opioid Heroin Total Opioid
• These are big numbers for our small state
• 50+ die from opioid poisoning every year
• Young people are most at risk• Addiction is a lifelong chronic disease• Costs are high – families and
communities torn apart • young lives shattered • treatment, health care, law enforcement, corrections, human services $$$
Why do we call this a crisis?
12
The number of people treated is up since 2004.
Vermont Department of Health
Source: Alcohol and Drug Abuse Treatment Programs
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
1,000
2,000
3,000
4,000
5,000
6,000
1,1991,455
1,8972,113
2,2722,630 2,622
2,944 3,478
4,043
State-funded substance abuse treatment system# admissions by primary substance of abuse, Vermont
Alcohol Marijuana/Hashish Heroin/Other Opioids All Others
13
The number of people treated for heroin is up.
Vermont Department of Health
2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
500
1000
1500
2000
2500
3000
671
710
722631 617 694 623 654
913
1,375
513
719
1,139
1,4251,602
1,867 1,946
2,210
2,4772,596
15 26 36 57 53 69 53 80 89 72
State-funded substance abuse treatment system# admissions for opioid abuse/dependence, by type of opioid,
VermontHeroin Other Opioids/ Synthetics Non-prescription Methadone
Source: Alcohol and Drug Abuse Treatment Programs
14
Age at first use for opioids is older than for alcohol.
Vermont Department of Health
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 660
100200300400500600700800900
1,000
Average age of first use of opiates and alcohol in the Vermont state-funded substance abuse
treatment system
Opiates Alcohol
Age of First Use
Source: Alcohol and Drug Abuse Treatment Programs, admissions 2005-2011
15
People seek treatment for opioid addiction sooner.
Vermont Department of Health
0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 640
100
200
300
400
500
600
700
Elapsed time (years) between age of first use and age at treatment admission for daily users
of opiates and alcohol
Alcohol Opiates
Elapsed Time (Years)
Source: Alcohol and Drug Abuse Treatment Programs, admissions 2005-2011
Research shows that a comprehensive approach, using principles of effective prevention, intervention, treatment, recovery and enforcement, is most effective.
Making a difference
Vermont Department of Health
17
Substance Abuse Continuum of Care
Recovery Services
Vermont Agency of Human Services
Intensive Outpatient Treatment
Outpatient Treatment
Screening, Brief Intervention, Referral for
Treatment
Prevention Services
Highest Level of Care
Lowest Level
of Care
Fewest Numbe
r of People
Largest Numbe
r of People
Specialty Treatment Residential Opioid Hub
Opioid abuse and addiction is a complex problem with far-reaching consequences.
The good news is Vermonters excel at community action. With everyone working together, we can make progress.
Good News: We can do this!
Vermont Department of Health
2009 – 2013 Youth Risk Behavior Survey
Local Data
Vermont Department of Health
Current Rx Drug Use
Vermont Department of Health
2009 2011 20130
102030405060708090
100
Percent of students who ever misused a stimulant or pain reliever
LNSU LSSU OSSU VT
Source: Youth Risk Behavior Survey
Perception of risk of harm
Vermont Department of Health
2009 2011 20130
20
40
60
80
100
Percent of students who think people their age
risk harming themselves if they binge drink on weekends
LNSU LSSU OSSU VT
Source: Youth Risk Behavior Survey
Perception of risk of harm
Vermont Department of Health
2009 2011 20130
10
20
30
40
50
60
70
80
90
100
Percent of students who think people their age risk harming themselves if they
smoke marijuana regularly
LNSU LSSU OSSU VT
Source: Youth Risk Behavior Survey
Perception of risk of harm
Vermont Department of Health
2009 2011 20130
20
40
60
80
100
Percent of students who think people their age risk harming themselves if they smoke
a pack of cigarettes a day
LNSU LSSU OSSU VT
Source: Youth Risk Behavior Survey
Parental disapproval
Vermont Department of Health
2009 2011 20130
102030405060708090
100
Percent of students who think their parents think it is wrong or very wrong for them to
drink alcohol
LNSU LSSU OSSU VT
Source: Youth Risk Behavior Survey
Parental disapproval
Vermont Department of Health
2009 2011 20130
102030405060708090
100
Percent of students who think their parents think it is wrong or very wrong for them to
smoke marijuana
LNSU LSSU OSSU VT
Source: Youth Risk Behavior Survey
Parental disapproval
Vermont Department of Health
2009 2011 20130
102030405060708090
100
Percent of students who think their parents think it is wrong or very wrong for them to
smoke cigarettes
LNSU LSSU OSSU VT
Source: Youth Risk Behavior Survey
Effective Prevention
Vermont Department of Health
Evidence-based strategies
Population level
Multi-sector
Vermont Prevention Model
Partnership for Success
Vermont Department of Health
• Prescription Drug initiatives
• Community-wide education
• eCheckUp To Go
• State of Our Youth Campaign
• Youth Engagement
• Town Ordinances & Town Wellness Plans
• Saturation & Party Patrols
Healthy Community Design
Vermont Department of Health
• Addresses health issues and trends
• Built environment influences eating and activity patterns
• Increases access to walking, biking, outdoor recreation, local farms and food and community
gardens
* Creates opportunities that make it easier to eat healthy and be physically active
30
Lamoille Valley Opiate Summit - 2014
Gallery Walk Hub & Spoke Rapid Intervention Community Court Healthy Lamoille Valley – Partnership for
Success Healthy Lamoille Valley – Healthy
Community Design North Central Vermont Recovery Center
Vermont Department of Health
31
Lamoille Valley Opiate Summit - 2014
Governor’s Forum on Opiate June 16, 2014 Recap
Vermont Department of Health
32
Governor’s Forum
LV Charge to the Community – Address: Stigma
Host a viewing of Anonymous People http://manyfaces1voice.org/
Housing & Transportation Screening Workplace & School Environment Issues Family Support Women & Children It takes a Community
Vermont Department of Health
Lamoille Valley Opiate Summit - 2014
Refreshments
Networking
10 MINUTE BREAK
Vermont Department of Health
34
Lamoille Valley Opiate Summit - 2014
1. What did you learn from the gallery walk?
1. What intrigued you?2. What questions do you have about
prescription drug abuse and opioid use in Lamoille Valley?
3. What connection can you take or make?
1. How will you apply this info?
4. If you had a no cost or low cost strategy to combat the problem of opioid and prescription drug abuse, what would it be?
Vermont Department of Health