Building Safe, Healthy, and Drug Free Communities
The Opioid Epidemic: Strategies & Solutions
Dorothy Chaney, M.EdPresident, WI Community Health AllianceCADCA Consultant
4/3/2018
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Goals For Session
• Look at the opioid issue from a preventionperspective
• Talk about challenges that coalitions often face – the expanded definitions of prevention
• Explore a community approach that shows some significant signs of success
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Session Components
• Data – looking broader than opioids• What the evidence says about effective
strategies• Pillars Approach – a best practice developed
in Europe and adopted in Canada – and now Wisconsin
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Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids. – Centers for Disease Control and Prevention (CDC)
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“From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a
worsening of the opioid overdose epidemic…”
63,632 drug overdose deaths in 2016CDC, March 2018
Despite Our Efforts – The Epidemic Worsens
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69.7% increase in the Midwest
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Assessing The Problem
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What is the extent of the Problem?
• Which drugs are being used?
• How are the drugs being used?
• How much? How often?
• Who is using the drugs?
• Where and when are the drugs being used?
Do we want to address the substance use problem or the opioid problem?
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There is Science To Guide Our Efforts
Tracking & Monitoring
Medication Disposal
Harm Reduction
Education
Limit Size of Prescriptions - Availability
Multi-Faceted Approach – Community Coalitions
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Education
Prescribers
Parents
Older AdultsYouth
Patients
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And…It Doesn’t Always Start with RX
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So How Do We Address This Complex Problem?
Harm Reduction
Underage Drinking Prevention“It Doesn’t Start With Heroin”
Overdose Prevention
HIV Prevention
Prevention of Neonatal Abstinence Syndrome
Prevention of Substance Use Disorder
Prevention of Progression from Rx to Heroin
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So How Have Other Countries Responded to the Epidemic
And what can we learn?
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Increasing Numbers of heroin addicts – rose to tens of thousands
Swiss 3 Pillar Drug Policy: Law Enforcement; Therapy; Prevention
Law Enforcement: based upon strict prohibition
Treatment: included MAT
Prevention: messages related to harms of drug use. Some groups were starting to advocate for legalization of all drugs –but failed in referenda
Drug Use in Switzerland in the 1980’s
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Despite the 3 pillars, injection heroin use continued to grow – and numbers of users gathered in large groups –sometimes thousands
In some cities – authorities tolerated “Needle-Parks” Open Drug Scenes – thousands of drug users injected, sold heroin
Slum-like; horror stories of children living there with Drug-using parents; drug users dying; human waste everywhere
Drug Use in Switzerland in the 1980’s
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“Finally, the misery and violence in the open drug scenes in major cities became intolerable, incompatible with the self-image of a well-organised society….”
Source: European Addiction Research: “Understanding Swiss Drug Policy Change and the Introduction of Heroin Maintenance Treatment.” Kahn, Khazaal, Thorens, Zullino, Uchtenhagen
Drug Use in Switzerland in the 1980’s
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Harm Reduction includes: housing and social support, street and prison work, supervised injecting rooms (13 in 8 cities), drug testing, needle exchange, methadone programs and heroin-assisted treatment.
Results: 70 per cent of opiate or cocaine users now receive some form of treatment. The number of drug injectors with HIV has halved, as has overdose mortality among injectors.**
**Source:”Swiss Recipe For Dealing With Drug Addiction Proves A Success” www.watoday.com.au
Switzerland: 4th Pillar
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Switzerland Outcomes
• Still high rates of use for cocaine, marijuana, ecstasy
• Limited prevention messages
• Acceptance of drug use – but no movement to legalize
• Heroin is no longer used by the young. Heroin is seen as a “loser drug”, leading to sickness and death.
• Some see Swiss Drug Policy as a success – others see it as a failure
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• Vancouver's Four Pillars Drug Strategy (2005) is a coordinated, comprehensive approach that balances public order and public health in order to create a safer, healthier community.
• Harm reduction• Prevention• Treatment• Enforcement
Source:http://vancouver.ca/people-programs/four-pillars-drug-strategy.aspx
4 Pillars Vancouver
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UNIVERSAL
Vancouver’s harm reduction programs include the supervised injection site, needle exchanges and community health services. Vancouver has 24-hour-a-day access to needles through low-threshold, peer-based needle exchanges, mobile exchanges and needle exchanges attached to primary health care services.
North America’s first Supervised Injection Site (SIS), InSite, opened in Vancouver in September 2003.
Source:http://vancouver.ca/people-programs/four-pillars-drug-strategy.aspx
Harm Reduction
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UNIVERSAL
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InSite combined with increased MMT resulted in a reduction of overdose deaths, transmission of HIV and Hepatitis C.
Source: http://idpc.net/alerts/2014/10/the-four-pillars-revisited-a-5-part-series-about-vancouver-drug-policy
Vancouver: Outcomes
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Prevention Pillar extremely underfunded and ineffective
Inadequate access to mental health services for youth in Vancouver schools
Researchers state that what prevention does exist in schools begins too late
Source: http://idpc.net/alerts/2014/10/the-four-pillars-revisited-a-5-part-series-about-vancouver-drug-policy
Vancouver: Outcomes
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Treatment Pillar:
Patchwork treatment system, some public and some private
Inconsistent approaches
A lot of disagreement on Methadone Maintenance Treatment
Source: http://idpc.net/alerts/2014/10/the-four-pillars-revisited-a-5-part-series-about-vancouver-drug-policy
Vancouver: Outcomes
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Law Enforcement Pillar:
Drug Treatment Courts in Canada still controversial –there are 2800 drug treatment courts in USA – and only 6 in Canada.
Source: http://idpc.net/alerts/2014/10/the-four-pillars-revisited-a-5-part-series-about-vancouver-drug-policy
Vancouver: Outcomes
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There is much debate over whether or not current city officials have abandoned the Pillars approach, and there is a resurgence of opioids in the city.
2016 a public health emergency was declared
At the federal level – there was little support for the pillars approach and it negatively impacted outcomes in Vancouver
https://www.theglobeandmail.com/opinion/why-canada-is-no-longer-a-leader-in-global-drug-policy/article23225460/
http://idpc.net/alerts/2014/10/the-four-pillars-revisited-a-5-part-series-about-vancouver-drug-policy
Vancouver: Outcomes
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Wisconsin
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Pillars:1. Treatment2. Law Enforcement3. Harm Reduction4. Prevention5. The Work Place
Wisconsin
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• Provided a framework for communities
• Served as the catalyst for the establishment of many county level task forces
Wisconsin
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Waukesha Task Force Based Upon Two Frameworks
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Law Enforcement
Work Place
Drug Affected Infants
Prevention
Treatment
Harm Reduction
Waukesha Co Heroin Task Force
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Prevention Pillar –Networks all of the
agencies/coalitions working on prevention initiatives in the county:• Hidden in Plain Sight• Stairway to Heroin Series• School health classes and events• Parent groups and educational
nights• Local DFC coalition is one partner
at the table
Waukesha Co Heroin Task Force
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Prevention Pillar Key messages:
• It doesn’t start with heroin• Parents still don’t think it’s a problem• Kids are getting it everywhere
Waukesha Co Heroin Task Force
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Harm Reduction Pillar –Educating jail inmates about risk for overdose after
release–Seeking to increase presence of needle exchange –Naloxone trainings–Advocated for additional funding for Naloxone
Waukesha Co Heroin Task Force
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Waukesha Co Heroin Task Force
Law Enforcement Pillar• Advanced Roadside Impaired Driving Enforcement
(ARIDE) classes• Crisis Intervention Trainings (CIT)• Implementation of nasal Narcan by Sherriff's
Department• Drug Collection Boxes/Take Back Events• Coordinating efforts with Methamphetamine
initiatives
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Waukesha Co Heroin Task Force
Workplace Pillar• Educational events• Public Health providing information for employers• Developing informational website• Partnership with Waukesha County Business
Alliance
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Waukesha Co Heroin Task Force
Treatment Pillar• Promoting 2-1-1 as a point of contact for referrals
and encouraging providers to become listed• Promoting events to assist with insurance
enrollment• Outreach to medication assisted providers• Identifying & Reducing Treatment Barriers• Established a Provider Network
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Waukesha Co Heroin Task Force
Drug Affected Infants Pillar • Developed a referral binder for providers• Developed website• Networked with methadone providers • Providing community education• Linking resources between providers and groups
such as Safe Babies/Healthy Families, Public Health, and HHS Birth to Three
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• Work collectively to reduce drug related deaths• Each Pillar has expertise in their own area• The task force is not a coalition• Unlike Switzerland & Vancouver, there is a strong
emphasis on prevention
Waukesha Co Heroin Task Force
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2018 - Expanding Scope
• In 2017, Waukesha Co Community Health Assessment identified opioids as a top community priority
• In 2018, Waukesha Co Heroin Task Force is aligning with Waukesha County CHIP process – adding resources and expanding the work as a top community health priority
• Three priority areas for Task Force in 2018:1. Despite our efforts, the opioid epidemic in Waukesha Co continues to
worsen2. Opioid use among older adults is a concern in Waukesha Co3. Too many children are impacted by prenatal drug use in Waukesha Co
Emphasis upon Re-energizing Prevention Pillar Treatment Pillar - increasing access to MAT
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Lessons Learned
• Opioid Epidemic is Complex – many sides• Requires a coordinated, comprehensive approach• Pillars approach can be very effective in identifying the many
sides to the elephant• Aligning systems and approaches is a critical first step – this
epidemic is complex and systems changes and alignment will lead to improved outcomes.
• Prevention Is KEY – and we must not forget to go upstream –or we will always be reacting
• Prevention must focus on the drug of initiation – alcohol, marijuana, tobacco – whatever your data tells you