The Opiate Epidemic: What Works & What Doesn’t

ByFairfield County Sheriff, Dave Phalen

And

Orman Hall, Executive DirectorFairfield County Alcohol, Drug Addiction and Mental Health

Board

Fairfield County, Ohio

Core Concept

Crime slips into our community in places where we have let the fabric of our society wear thin.

Criminal Activity

Small percentage of the populationSame locations85% of theft-related crime is drug

related.

Important Dates

1979 – 1980: Crack Cocaine hits our communities

2006 – 2009: Heroin hits our communities

Key Statistics – Fairfield County Jail

127% - Increase in inmates between 2001 and 2008.

212% - Increase in drug arrests between 2003 and 2008.

375% - Increase in heroin users among new arrests between 2003 and 2008.

Fairfield County Jail

$349,064 – The estimated cost of incarcerating opiate addicts in 2003.

Fairfield County Jail

$349,064 – The estimated cost of incarcerating opiate addicts in 2003.

$2,501,786 – The estimated cost of incarcerating opiate addicts in 2008.

Causes of opiate addiction in our community

Widespread use of opiate analgesics

Increased availability of Heroin as a replacement drug

Price

Written in 1829

“The police are the public and the public are the police. The police are only members of the public who are paid to give full-time attention to the duties that are incumbent upon all citizens in the interest of community welfare and existence.”

Sir Robert Peel

What works

Law enforcement Treatment Education Drug Court Non-conventional: Grace Haven

Police

Enforcement Knock and Talk Landlord Training

U.S. Opiate Treatment Admission Trends

0%

5%

10%

15%

20%

Pe

rce

nt

of

Ad

mis

sio

ns

2000 2001 2002 2003 2004 2005 2006 2007

Year

Opiates as a Percent of Alcohol and Other Drug Treatment Admissions in the United States (Years 2000 - 2007)

Heroin Other Opiates

Figure 1. Opiates as a Percent of Alcohol and Other Drug Treatment Admissions in the United States (2000 – 2007) 1

Ohio Opiate Treatment

Admissions Trends

0%

5%

10%

15%

20%

Perc

en

t o

f

Ad

mis

sio

ns

2000 2001 2002 2003 2004 2005 2006 2007

Year

Opiate as a Percent of Alcohol and Other Drug Treatment

Admissions in the State of Ohio (2000 to 2007)

Heroin Other Opiates

Figure 2. Opiates as a Percent of Alcohol and Other Drug Treatment Admissions in the State of Ohio (2000 – 2007)2

Fairfield County, Ohio Opiate Treatment Admission Trends

4%5% 6%

8%10%

15%

31%

0%

5%

10%

15%

20%

25%

30%

35%

Perc

en

t o

f A

dm

issio

ns

2002 2003 2004 2005 2006 2007 2008

Year

Fairfield County Ohio Opiate Treatment Admission Trends (2002 - 2008)

Figure 3. Fairfield County Ohio Opiate Treatment Admission Trends (2002 – 2009*)3

0 50 100 150

Richland

Amanda

Clear Ck.

Hocking

Liberty

Walnut

Bloom

Greenfield

Rush Ck.

Berne

Violet

Pleasant

Lancaster

Admissions

Fairfield County, Ohio Opiate Treatment Admissions by Township

Figure 4. Fairfield County Ohio Opiate Treatment Admissions by township for 2008.4

Fairfield County- Jail Days

Figure 5. Opiates as a proportion of total Fairfield County jail days (2003 and 2008)5

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

1990 2003 2008

Opiate

Non Opiate

No

Opiates Opiates

  Present Present

Age Group    

18 - 25 40.4% 53.6%

26 - 35 38.3% 25.0%

36 - 45 11.7% 16.1%

46 - 55 7.4% 5.4%

56 -65 2.1% 0.0%

   100%  100%

Fairfield County - Jail DaysBy Age and Opiate Status

Table 1. Jail Admissions by age and Opiate Status, Calendar Year 2008.6

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Non-Opiate Opiate

FEMALE MALE

Fairfield County - Jail DaysBy Age and Opiate Status

Figure 5. Opiates as a proportion of total Fairfield County jail days by gender (2003 and 2008) 7

Components of the Fairfield County Drug Court Program

Judicial intervention and oversight Frequent drug screens Intensive outpatient therapy Case management and rehabilitative

services (employment and housing). Suboxone for opiate addicted clients

Phases of Municipal Drug Court - Continued

Phase 1 – three monthsDrug court participants meet weekly with judge to

receive court orders and report on compliance. Participants must meet with probation and submit to three random drug tests weekly. Participants are not allowed to work but are required to attend intensive outpatient therapy and focus on recovery issues.

Phases of Municipal Drug Court - Continued

Phase 2 – three months

Participants report to the court bi-weekly. Focus on employment and other rehabilitative issues begins.

Phases of Municipal Drug Court - Continued

Phase 3 – six months

Participants report monthly to judge. Maintaining employment and abstinence are major priorities. Upon successful completion of phase three, participants graduate and are released from probation.

Phases of Municipal Drug Court - Continued

After Care – four months

This phase is voluntary. Participant checks in with probation and voluntarily submits to drug screens twice a month. The focal points of this phase are maintaining sobriety, maintaining employment, and avoiding new charges.

Use of Suboxone in Opioid Addiction Treatment in Fairfield County

What Is Suboxone?Suboxone® is a combination of buprenorphine and naloxone. To be taken only under the supervision of a qualified physician.

How Does Suboxone Work? Suboxone provides the patient with a mild opiate effect, ideally just enough to reduce or eliminate opiate cravings. More importantly, It also blocks the effects of all other opiates.

Fairfield County PhilosophyTo use the smallest amount of Suboxone required to eliminate opiate cravings and block the effect of other opiates. The goal of public AOD (alcohol and other drug) treatment in Fairfield County is complete recovery and eventual abstinence from the use of harmful drugs.

Patient Recovery With cravings eliminated and withdrawal fears calmed, Suboxone® permits a person to focus on recovery and treatment. Underlying treatment issues can be more effectively addressed once the effects of the opioid are no longer present.

Important Fairfield County Statistics

75% of all Adult Drug court clients in Fairfield County have an opiate addiction.

In 2008 there were an estimated 44,725 jail days accounted for by opiate addicts in the Fairfield County Jail.

Over two years, 14,000 days of jail for drug court were participants suspended for a total cost savings of $910,000.

Medication costs at the jail for drug court participants have decreased by 66%.

Important Fairfield County Statistics - Continued

Among opiate addicted clients receiving Suboxone - 62% successful treatment and discharge rate.

Among opiate addicted clients not receiving Suboxone, 87% relapse and are terminated unsuccessfully.

Successful Opiate Discharges With Suboxone

Successful62%

Not Successful

38%

Successful Opiate Discharges Without Suboxone

Suc c es s f ul

13%

Not Suc c es s f ul

87%

1. Myers, Rhonda. (June, 2009). Unpublished presentation from the National Association of Drug Court Professionals Annual Meeting. Anneheim, CA. The Treatment Episode Data Set (TEDS), Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). United States Department of Heath and Human Services.

2007http://oas.samhsa.gov/teds2k7highlights/TEDSHighl2k7Tbl6a.htm http://oas.samhsa.gov/teds2k7highlights/TEDSHighl2k7Tbl6b.htm 2006

http://oas.samhsa.gov/teds2k6highlights/Tbl6a.htm http://oas.samhsa.gov/teds2k6highlights/Tbl6b.htm 2005

http://oas.samhsa.gov/teds2k5/TEDSHi2k5Tbl6a.htm http://oas.samhsa.gov/teds2k5/TEDSHi2k5Tbl6b.htm 2004http://oas.samhsa.gov/TEDS/2k4TEDS/TEDSHi2k4Tbl6a.htm http://oas.samhsa.gov/TEDS/2k4TEDS/TEDSHi2k4Tbl6b.htm 1993-2003

http://oas.samhsa.gov/2k5TEDS/teds_03_tbl2.1a.htm http://oas.samhsa.gov/2k5TEDS/teds_03_tbl2.1b.htm http://oas.samhsa.gov/2k5TEDS/teds_03_tbl4.2a.htm

2. The Treatment Episode Data Set (TEDS), Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). United States Department of Heath and Human Services.

http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_web_table?t_state=OH

Bibliography

3. Public-Private Solutions. 108 W. Main Street – Suite A. Lancaster, Ohio 43130. Jim Averill, PPS Director. Robert Peare, Programmer/Analyst. c/o http://www.fair-mh.org (740) 654-0929.

4. Ibid.5. Phalen, Dave and Orman Hall. (May 2009) Unpublished Utilization Review Study of Fairfield County Jail Admissions.

Lancaster, Ohio 43130.6. Ibid.7. Ibid.

Bibliography - Continued