SAN DIEGO COUNTY S RESPONSE TO THE OPIOID CRISIS

Transcription

1 SAN DIEGO COUNTY S RESPONSE TO THE OPIOID CRISIS Linda Bridgeman Smith, Substance Abuse Prevention Services County of San Diego, Health & Human Services Agency, Behavioral Health Services Statewide Substance Use Disorder Conference, August 21-23, 2018

2 LEARNING OBJECTIVES 1) Describe formation of the San Diego County Prescription Drug Abuse Task Force (PDATF) 2) Describe successful partnerships 3) Identify key accomplishments

3 MAGNITUDE OF THE PROBLEM References: The US Opioid Epidemic. Assistant Secretary for Public Affairs (ASPA), Health & Human Services, 15 June 2017,

4 CALIFORNIA OPIOID DASHBOARD ZIP CODE DEATHS Opioids (Pine Valley) Heroin All drugs (Balboa Park) Methadone (Camp Pendleton) Benzodiazepine (Pala) ZIP CODE RX Buprenorphine (Rancho Santa Fe) Opioid+Benzodiazepine (Campo, Jacumba) New Start LA Opioids

5 SCALE OF THE PROBLEM Approximately 125 MILLION opioid pills were sold in San Diego County in 2016 (almost 38 pills per person)

6 HOW WE GOT HERE When used properly, medicines are important in healthcare Opioids used to be reserved for the most severe forms of pain, such as cancer and end of life care Changes in recognition and treatment for pain In the late 1990 s, opioid prescribing changed for chronic pain (patient bill of rights, 5 th vital sign, decade of pain control and research, CA pain management standards) These changes, coupled with the multi-million $$$ advertising campaigns (including direct to consumer) and lobbying efforts by the pharmaceutical agencies, led to the [more] commonplace prescribing of and use of opioids References: Franklin GM. Opioids for Chronic Non Cancer Pain: a Position Paper of the American Academy Of Neurology. Neurology. 2014;83:

7 WHAT WE DID

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9 FEDERAL PREVENTION STRATEGIES STRATEGIC PREVENTION FRAMEWORK 1. Information Dissemination Strategy 2. Education Strategy 3. Alternatives Strategy 4. Problem Identification/Referral Strategy 5. Environmental Prevention Strategy 6. Community-Based Process Strategy

10 LOCAL STRATEGY

11 ENVIRONMENTAL PREVENTION Reduces the risk of AOD/SUD related problems by focusing on and managing the locations and settings where use/sales occur.

12 BACKGROUND & TIMELINE

13 San Diego County 18 Municipalities 18 Reservations 10 Military bases 4 State universities, 7 community colleges Borders Orange, San Bernardino, Riverside & Imperial Counties Mexico International Border Tourist destination: international airport, cruise terminal, major attractions

14 POLITICAL LEADERSHIP It is the policy of the Board of Supervisors that: COUNTY OF SAN DIEGO, CALIFORNIA BOARD OF SUPERVISORS POLICY Subject: County Prevention Policy Policy Number: A The County shall initiate and sustain a process of creating conditions and fostering personal attributes that promote the health, well-being, safety and self-sufficiency of individuals, families and communities. 2. A prevention approach will guide and be incorporated into the full range of County programs for individuals, families and communities. 3. All new programs, plans and policies will be evaluated in terms of their support for and conformity with the County Prevention Policy. 4. Prevention will be a priority of the Board as it develops State and federal legislative initiatives. To the maximum extent possible, funding will be provided for prevention based services. 5. The Board of Supervisors and County staff will take a leadership role in collaborating and establishing partnerships with educational institutions, private and community-based organizations, and other governmental agencies to implement the County Prevention Policy. Established: (51)

15 Lead to That Result in Alcohol, tobacco & other drug use

16 METHAMPHETAMINE GENNY ROJAS ut-death-sentence-upheld-child-murdertorture-case-2011jun02-story.html IN 1995, when a meth user stole a National Guard tank and went on a rampage in San Diego County, the issue of methamphetamine use was in the public arena.(5 /17/1995) 1997 Bus RDVSM04 RDVSM04

17 SAN DIEGO COUNTY Supervisor Dianne Jacob directs HHSA and PSG to: Form a multi-disciplinary Strike Force Develop recommendations and action plan December Board adopted 17 recommendations Report Card established Meth Hotline established

18 SAN DIEGO COUNTY MSF REPORT CARD

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20 SUBSTANCE USE DISORDER PREVENTION SYSTEM

21 SAN DIEGO COUNTY PRESCRIPTION DRUG ABUSE TASK FORCE

22 THE RX* PROBLEM Don t Be Afraid To Do The Right Thing Define The Problem Identify Partners Establish a Plan *The symbol "Rx" is usually said to stand for the Latin word "recipe" meaning "to take." It is customarily part of the superscription (heading) of a prescription.

23 VICTIM Aaron Rubin, Oxycontin Overdose Survivor When Aaron Rubin graduated from Poway High School in 2000, he was a charismatic, outgoing athlete and a loyal, dedicated friend who was admired and respected by his peers. He planned to work with his dad, make lots of money and travel the world. Five years after graduation, Aaron s plans came to an abrupt halt when he overdosed on OxyContin. The overdose caused Aaron to have a heart attack and two strokes, leaving him unable to walk, feed himself or speak. Now, at age 28, he is completely dependent on others for his care.

24 LOCAL LAW ENFORCEMENT In 2008, the San Diego Sheriff s Department Narcotics Team issued a public bulletin regarding an increase in oxy use. THE OXY EPIDEMIC HITTING CLOSE TO HOME! If you have kids between the ages of 14 and 25, this is a must read! This article was written to educate law enforcement officials and parents about the emerging OxyContin epidemic in Southern California and the symptoms of individuals, specifically teenagers and young adults, abusing OxyContin. Background In May 2008, detectives from the South East Narcotics Team (SENT) began to see a rise in the abuse of Oxycodone as arrests for possession and sale of OxyContin in Poway and Santee increased significantly. SENT Detectives responsible for conducting follow-up investigations related to these arrests immediately recognized that OxyContin was becoming an increasing trend among teenagers and young adults. In July 2008, SENT detectives began coordinating investigative efforts with agents from the Drug Enforcement Administration (DEA) and Integrated Narcotics Task Force (NTF). Since then, detectives and agents have arrested over 20 individuals on charges ranging from simple possession of OxyContin, possession for sale of OxyContin, and possession of heroin. The majority of these arrests were in the Poway, Santee and Ramona areas of San Diego County. In September of this year, the District Attorney s Office put together a task force with components from the DEA, NTF, Bureau of Narcotic Enforcement and local law enforcement agencies. The task force is currently gathering intelligence and working on long term solutions to address this problem.

25 INFORMATION

26 OxyContin Task Force Launched San Diego County has witnessed a significant increase in the abuse of the painkiller Oxycontin. This month, San Diego County District Attorney Bonnie M. Dumanis, Sheriff Bill Gore, Supervisor Pam Slater-Price, the prevention community and approximately 20 other agencies teamed together to announce the formation of a first-of-its-kind task force to combat the uprising abuse of OxyContin and Oxycondone. "Because OxyContin can lead to heroin abuse, we have seen an up-tick in heroin traffic - in addition, we are also seeing abusers of OxyContin increasingly committing residential burglaries, armed robberies, prescription fraud, check fraud and even prostitution in an attempt to support their on-going habit," said DA Dumanis. At a news conference held in October, the task force announced its primary function is to address the oxycontin/oxycondone abuse problem through four methods: law enforcement, education, legislative issues and treatment. U.S. Customs and Border Protection, the Naval Criminal Investigative Service and the San Diego Police Department are among the 20 agencies and departments currently aligned with the task force. If you know someone who needs help, contact the Oxy Hotline at or find them on Facebook and search for Oxy Task Force. SOURCE:

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28 EXCLUSIVE: OVERSTATING THE OXYCODONE PROBLEM North County Times July 27, 2010 For nearly two years, the county's top leaders ---- the sheriff, the district attorney, supervisors have declared abuse of the prescription painkiller oxycodone, or OxyContin, to be an "epidemic" among high school students and people in their 20s. They formed a regional task force and warned of widespread oxycodone abuse, addiction and death among young people, particularly those in the more affluent areas of North County. "We're seeing more and more teenagers using OxyContin and dying from OxyContin," District Attorney Bonnie Dumanis said at a June 22 panel on public safety. But prosecution, emergency room and medical examiner's records tell another story. Data collected from 2006 to 2009 suggest official statements about the extent of the problem and its reach among people under 25 have been overstated and, in some cases, misleading. Young people, it turns out, are not the primary users and victims of the drug; middle-aged people are. 28

29 p 1 NUMBER OF UNINTENTIONAL DRUG/ALCOHOL RELATED DEATHS, All Drug/Med/Alcohol All Rx Deaths

30 PDATF TODAY

31 GOAL Increasing use of prescriptions drug in unlawful and illicit ways adversely affects public health and safety. Objective: Reduce access to prescription drugs for illicit and/or non-medical use: Increase medical community, others to educate & reduce the use of harmful medications & ensure safe disposal Annual Report Card Develop policy recommendations to appropriately reduce quantities of pain medications to meet necessary medical needs appropriately, while avoiding harms due to over-prescribing. 31

32 LOGIC MODEL

33 Prescription Drugs RISK AND PROTECTIVE FACTORS 1. Overprescribing and overuse of pain medicines. 2. Diversion of prescribed medicines for nonprescribed use. 3. Youth access to/misuse of prescribed medicines. 1. Safe prescribing guidelines. 2. Understanding doctor shopping and identifying potential pill mills. 3A. Awareness of safe disposal sites and events. 3B. Proper/safe storage of medications. 33

34 ACCOMPLISHMENTS

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36 *Local Prescription Drug Abuse Plan (2008) * Oxy Task Force (2009) * Take Back & Secure Drop Boxes (2010) * Safe Pain Medicine Prescribing Guidelines in Emergency Depts/EDs, NACo Award (2013) Statewide implementation (2014) 36

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38 Reduce Access: Proper Disposal 1. Take Back Events Partnered with the DEA Record amounts Over 30,000 lbs. a year collected Annually +40 sites in county National Take Back Oct 27 th 2. Collection Boxes Police Stations through the County

39 ANNUAL REPORT CARD

40 Prescription drug abuse on rise, San Diego County officials say July 9, 2012: County officials released their prescription drug abuse first "report card" Monday during a news conference in San Diego. Among those who presented the results were Alexis Lovell, who survived a prescription drug overdose at age 21, county Health and Human Services Agency director Nick Macchione and Supervisor Pam Slater Price.

41 SAN DIEGO DEATH DIARIES 254 deaths with prescribed 254 deaths 12 month Rx data prior to death 68 CURES Data No CURES medications in received prescription in the 12 months prior to their death as reported in Controlled Substance Utilization Review and Evaluation System (CURES) 80% have multiple medications 186 Only 28% doctor shoppers 69% chronic users 16.5% compliant 41

42 IT S NOT JUST OPIOIDS! OPIOIDS BENZODIAZEPINES SLEEP STIMULANTS OTHER 33 Medications; 4366 Rx Hydrocodone 123 Chloriazepoxide 17 Oxazepam 3 Oxycodone 84 Tempazepam 17 Oxymorphone 3 Clonazepam 44 Methadone 14 Phenobarbitol 3 Zolpidem 43 Fentanyl 13 Chloral Hydrate 2 Alprazolam 39 Buprenorphine 11 Dronabinol 2 Lorazepam 37 Amphetamine 7 Zaleplon 2 Morphine 32 Testosterone 6 Clorazepate 1 Carisoprodol 30 Triazolam 6 Estrogen 1 Codeine 27 Lunesta 4 Lisdexamefetamine 1 Diazepam 26 Lyrica 4 Methylphenidate 1 Hydromorphone 20 Phentermine 4 42

43 NATIONAL HEADLINES 44

44 NATIONAL 8/10/17: President Trump declared opioid crisis a national emergency A Commission on Combatting Drug Addiction and the Opioid Crisis Recommendations (draft, 7/31/17): Increase treatment capacity including medically assisted treatment/mat; issue naloxone w/opioids Prescriber education; increase use of CDC opioid guidelines; Prescription Drug Monitoring Program/PDMP coordination including VA healthcare system Interdiction & enforcement resources to stop illicit drugs including fentanyl National prevention strategy for schools, communities 45

45 CHALLENGES 1. $$$$$$$ 2. Infrastructure 3. Partnerships

46 THANK YOU BELIEVE IN SUPER HERO'S Linda Bridgeman Smith County of San Diego Health & Human Services Agency, Behavioral Health Services