DHCS Tribal MAT Project

Transcription

1 DHCS Tribal MAT Project Melissa Eidman & Valentine Antony California Consortium for Urban Indian Health August 2018 CaliforniaConsortiumforUrbanIndianHealth CCUIH StrengtheningTheOrganizationsThatStrengthenOurCommunities The California Consortium for Urban Indian Health CCUIH) is an alliance of ten (10) Urban Indian Health Organizations that supports health promotion and access for American Indians living in cities throughout California. CCUIH s mission is to facilitate shared development resources for our members and to raise public awareness in order to support a health and wellness network that meets the needs of American Indians living in urban communities. OUR MEMBERS American Indian Health and Services Santa Barbara, CA Bakersfield American Indian Health Project Bakersfield, CA Fresno American Indian Health Project Fresno, CA Friendship House San Francisco, CA Indian Health Center of Santa Clara Valley San Jose, CA Native American Health Center Oakland, San Francisco, Richmond, CA Native Direction s Inc. Manteca, CA Sacramento Native American Health Center Sacramento, CA San Diego American Indian Health Center San Diego, CA United American Indian Involvement Los Angeles, CA 1

2 CCUIH CORE PROGRAMING Community Health Organizing CCUIH leads collaborative, community health organizing efforts to increase access to and improve the quality of health care for Urban Indian communities. We leverage UIHO clinic leadership, as well as grassroots community-guided efforts, to address policy needs and health care inequities for American Indians in California. Training and Technical Assistance CCUIH provides facilitation of culturally appropriate training and technical assistance seminars for consortium members and systems partners. Public Education and Civic Engagement CCUIH is dedicated to increasing visibility of Urban Indians, not only to bring knowledge of Urban Indian issues to the general public and policy decision-makers, but also to build a sense of belonging for Urban Indians through reflections of self and community in healthcare setting and online. Policy Advocacy CCUIH is a statewide resource on Urban Indian health information and related policy decisions. CCUIH monitors legislation and policy regarding local, state, and federal health care initiatives to ensure that Urban Indians are included in planning efforts to increase health care access and reduce health disparities of marginalized groups CCUIH PROJECTS Traditions of Health aims to improve the integration of behavioral health and primary care for Urban Indians by advancing the cultural revitalization efforts of Urban Indian Health Organizations (UIHO) in California. Red Woman Rising supports culturally responsive domestic violence services for Urban Indians by increasing public awareness and enhancing collaborations between Urban Indian health organizations, domestic violence service providers and traditional healers. Strengthening Patient Access and Community Engagement (SPACE) is a comprehensive approach, including assessment and T/TA, to building UIHO clinic capacity for engagement work with Urban Indian patients. Each Mind Matters reduces stigma and discrimination against people seeking mental health services and promoting wellness and resiliency in our California Urban Indian communities. Tribal MAT is a partnership between DHCS, CCUIH, and CRIHB and aims to increase access to medication assisted treatment for opioid use disorder in Tribal and Urban Indians Health Programs in CA. OPIOIDS What is an opioid? Opium like substances that activate opioid receptors, commonly used for pain relief. Includes: Prescription opioids: hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine, codeine, and fentanyl Illicitly produced opioids: heroin and fentanyl Some medication assisted treatments: Methadone and buprenorphine What isn t an opioid? Everything else. People commonly mistake cocaine, methamphetamines, ecstasy, LSD, GHB, Ketamine, other club drugs, or steroids for opioids. These are not. 2

3 THE CREATION OF AN EPIDEMIC Commonly accepted sequence of events: Pharmaceutical Companies Claimed that prescription opioids were not addictive Healthcare System Physicians began to prescribe opioids at greater rates Addictive Properties misuse, abuse, and diversion led to the spread of addiction and opioid overdoses Cheaper Alternatives illicit manufacturing drastically increasing the number of deaths from opioids Roughly 21-29% of patients prescribed opioids for chronic pain misuse them. 80% of people who use heroin misused prescription opioids first. 1 1 NIH National Institute on Drug Abuse DEVELOPING OUD 8-12% of people prescribed opioids for chronic pain develop OUD. 1 Opioids reduce the sensation of pain broadly and can make a person feel relaxed and produce a state of euphoria. When used for extended time or without medical need, one can develop opioid dependence/opioid use disorder. Uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences. Believed to be associated with the brain s reward pathways (dopamine). Ending use of opioids can be difficult on one s own. There is no one treatment option best for everyone, but medications are available to assist patients in their path toward wellness and recovery. 1 NIH National Institute on Drug Abuse TRENDS IN OPIOID USE DISORDER (OUD) From 2010 to 2016, the rate of OUD diagnoses increased nearly 500%. 1 Every day, an average of 115 Americans die from an opioid overdose. 2 In 2016, 66% of overdose deaths involved an opioid. 2 Illicit manufacturing of Fentanyl has complicated and exacerbated the growing epidemic. From July 2016-Sept 2017, the number of opioid overdose related emergency department visits increased by 30% American Indians and Alaska Natives per 100,000 experience opioid related fatalities, representing 3 times the rate for Black Americans and Hispanic Whites. 3 1 Blue Cross and Blue Shield Association 2 Centers for Disease Control and Prevention (CDC) 3 National Indian Health Board 3

4 (MAT) MEDICATION ASSISTED TREATMENT The use of medications in conjunction with behavioral therapies and counseling to treat substance use disorder and prevent overdose. Opioid Use Disorder Treatment Medication Methadone Buprenorphine Naltrexone Mechanism Agonist Partial Agonist Antagonist Reduce/ eliminate withdrawal symptoms x x Blunt/block effects of other opioids x x x Reduce/ cravings x x x eliminate opioid Opioid Overdose Reversal Naloxone for emergency overdose reversal. AFFINITY AND ACTIVITY Activity: Heroin > Buprenorphine. (Naloxone = NONE) Affinity: Heroin < Naloxone < Buprenorphine OPIOID OVERDOSE Mechanism Opioids inhibit chemoreceptors that control respiration Respiratory depression No oxygen to the brain Signs of Overdose Inability to wake Blue/grey lips & fingernails Pinpoint pupils Slow, irregular, or stopped breathing NALOXONE Displaces and replaces opioid Fast-acting and short-lived Opioid overdose reversal Life saved! 4

5 CHALLENGES IN MAT Stigma MAT is a crutch, People on MAT are just using a different drug to get high, not really in recovery, trading one addiction for another Treatment availability gap CA: 47-70% treatment gap 1. Classic forms of treatment and tribal culture may not be supportive Narcotics/Alcoholics Anonymous don t see a person using MAT as clean and sober. MAT is often out of the scope of work and off mission for residential treatment centers. FACT: When incorporated with counseling and other psychosocial supports, MAT is an effective way of stabilizing an opioid-addicted individual. Additionally, these medications increase the likelihood that a person will remain in treatment and decrease the probability of overdose. 2 1 CHCF CA health care foundation 2 NIH National Institute on Drug Abuse THE TRIBAL MAT PROJECT OVERVIEW Through DHCS and in partnership with The California Rural Indian Health Board, UCLA, USC, Telewell Behavioral Medicine, and Two Feathers. Multipronged approach to reduce prevalence of OUD and opioid overdose deaths: OUD Prevention MAT Access Expansion Naloxone Access Expansion Support System Development & Involvement MAT CHAMPIONS Connect, communicate, and coordinate activities between: Project collaborators Other Indian programs Non-Indian MAT providers CA Hub & Spoke entities. 5

6 MAT CHAMPIONS (CONT.) Host meetings and trainings around MAT services. Communication regarding available OUD services. Administrator, healthcare provider, & community leader trainings on OUD prevention, MAT, buprenorphine waivers, & opioid safety coalitions Disseminate materials produced through the course of the project. NARCAN PURCHASE, TRAINING, & DISTRIBUTION Purchasing Narcan Nasal Spray from Adapt Pharma Distributing Narcan to Urban Indian stakeholders Providing educational materials and training on: 1. Overdose prevention, recognition, and response 2. Narcan administration and aftercare CULTURALLY ADAPTED OPIOID CAMPAIGN Developing, collecting, and disseminating culturally tailored materials addressing: OUD prevention, treatment, and recovery Medication assisted treatment and access Safe opioid prescribing and disposal OUD Stigma reduction Suicide prevention 6

7 LOCAL OPIOID COALITIONS Multidisciplinary collection of organizations across the system working together to address the Opioid Epidemic. Subcontracting local opioid coalition participation by Tribal and Urban Indian health organizations to: 1. Participate in an existing coalition. 2. Develop a local opioid coalition to serve all populations in a county. 3. Develop a local coalition to serve local Indian community. 4. Participate in statewide opioid coalition to serve Indian communities to be developed by CCUIH. California Indian Opioid Safety Coalition (CIOSC, Kiosk ) RESEARCH & EVALUATION Participating in evaluation conducted by UCLA and USC. Participate in annual surveys to discuss implementation barriers and facilitators. Evaluation of training and program implementation THE OPIOID NEEDS ASSESSMENT PROJECT (ONAP) Working with UCLA and USC to create and implement a needs assessment. Collaborating with university staff in the creation and implementation of health program administrator, provider, and community member questionnaires and interviews. 7

8 BARRIER ONE Providers/cultural practices that hold reservations against using MAT Is it really clean though? Physician Fatigue BARRIER TWO Organizations who don t believe this is a priority for their community Meth is the real problem BARRIER THREE Engaging persons with SUD stigma reduction strategies, meeting people where they are both physically and mentally 8

9 BARRIER FOUR Helping and encouraging Tribal and Urban Indian Health Programs who are broadly dispersed geographically to develop collaborative relationships with each other and/or their local opioid coalitions BARRIER FIVE Tapering vs. Long-Term Use What does long term recovery look like? WHAT ARE SOME BARRIERS YOU HAVE COME UP AGAINST? 9

10 Thank you! Valentine Antony Melissa Eidman 10