Orange County Heroin Task Force: A targeted approach to improving outcomes

Transcription

1 Orange Cunty Herin Task Frce: A targeted apprach t imprving utcmes Christpher Hunter, M.D., Ph.D. Directr, Orange Cunty Health Services Department Assciate Medical Directr, Orange Cunty EMS System

2 Cntents Neurbilgy f addictin Establishing targeted grups Overlapping themes and suggested interventins Subcmmittee prgress Putting it all tgether

3 Neurbilgy f Addictin Hw time and experiences shape ur brain

4 Neurbilgy f Addictin Meslimbic pathway Reward Neurtransmissin Dpamine Feedback Prcesses Receptr regulatin Plasticity

5 Adlescent Develpment Remdeling f dpaminergic system (emtinal cnnectins) Increased plasticity (sensitive t changes)

6 The Effects f Herin Opiids disinhibit the VTA, increasing dpamine release Creates euphria (reward) Strengthens PFC and hippcampal cnnectins (reinfrcing habits/memry) Als slw respiratry center in the Pns

7 The Effects f Chrnic Use Dwn-regulatin f DA receptrs and piid receptrs (tlerance) Hardwired cnnectins within PFC and Hippcampus (cues/assciatins)

8 Establishing Targeted Grups Translating Neurbilgy t Human Behavir

9 Fcused utreach Hw d we efficiently and effectively allcate ur resurces t reduce the verall burden f increased herin use n the cmmunity?

10 Targeted Apprach Ptential Users Infrequent Users Frequent Users

11 Overlapping Themes and Suggested Interventins Subcmmittees fund their way t several similar issues

12 Herin Task Frce Subcmmittees The prblem has been defined Subcmmittees frmed t explre different aspects f the issue and present ptential slutins A halfway pint check-up was perfrmed Subcmmittee meeting minutes Subcmmittee Chair meeting Law Enfrcement Subcmmittee utlier

13 Overlapping Themes Data Cllectin Prfessinal Training Cmmunity Educatin and Awareness Medicatin-Assisted Treatment Access t Care/Recvery Supprt

14 Herin Task Frce Subcmmittees Despite differing bjectives, there were 5 verlapping themes Subcmmittees Data Cllectin Prfessinal Training Cmmunity Educatin and Awareness Medicatin- Assisted Treatment Access t Care/Recvery Supprt Law Enfrcement Educatin and Preventin Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Healthcare Yes Yes Yes Yes Yes Treatment Yes Yes Yes Yes Yes

15 The Challenge Defining prgress Data Cllectin Multiple surces f infrmatin ver multiple disciplines N unified repsitry fr cllecting data N incentive fr reprting Ptential Slutin Integratin f prgrams (Yuth Behavir Surveillance, Mbile Crises, Hspitals, EMS, Medical Examiner) Department f Health in Orange Cunty surveillance reprting Legislatin: Mandatry reprting? Creatin f a data cllectin hub

16 Data Cllectin Hspitals Department f Health Law Enfrcement Health Services Data Cllectin Hub Service Prviders

17 Prfessinal Training The Challenge Multiple types f prfessinals interact with target grups at different stages Keeping a large, variable grup infrmed f evlving lcal resurces and changing standards f care Ptential Slutin Expand training fr existing cunselrs and case managers Prvide cntinuing educatin and credit fr physicians and prviders n Marchment Act and Prescriptin Writing Create prgrams fr schl nurses and educatrs t recgnize symptms Imprve awareness f diversin prgrams amng law enfrcement and legal cmmunity

18 Prfessinal Training Physicians 1. Recgnitin 2. Apprpriate care 3. Diversin Strategies 4. Accessing Resurces Law Enfrcement and Legal Cmmunity Prfessinal Training Schls, Universities Case Management

19 Cmmunity Educatin/Awareness The Challenge Traditinally difficult grups t reach Platfrms fr raising awareness have changed dramatically ver a generatin Unwillingness t recgnize the scpe f the issue Ptential Slutin Use f cntemprary language and scial media Cnsider prgrams within secndary educatin curriculum Develping peer-t-peer prgrams t engage the yunger generatin

20 Cmmunity Educatin/Awareness When dne apprpriately, peer educatin can be ne f the mst effective and empwering methds f wrking with yung peple acrss a range f scial issues like drug preventin, yuth health, crime and vilence. United Natins, Office n Drugs and Crime

21 Medicatin-Assisted Treatment Medicatin-Assisted Treatment (MAT) fr piid dependence using medicatins t reduce withdrawal symptms and curb craving, r prevent use/verdse Existing Medicatins Methadne lng acting piid, well-accepted therapy, federally regulated (requires structured dsing) Buprenrphine (Subxne) mre advanced than methadne, less regulatin (less structured), mre expensive Naltrexne (Vivitrl) blcks effects f piid, des nt reduce cravings/side effects, lng-acting single dse Nalxne rescue medicatin in case f verdse Mre successful as part f a cmprehensive treatment plan

22 Medicatin-Assisted Treatment The Challenge Access t medicatins Cst f medicatins fr medically indigent patients State and Federal regulatins Public acceptance Ptential Slutin Engaging with lcal pharmacies Structured Emergency Rm discharge planning Grant funding and price negtiatin Crrectins Health Services pilt prgram

23 Medicatin-Assisted Treatment Ptential Prgram fr Crrectins Health Services Arrest Herin User Incarceratin COWS prtcl Release Treatment Plan Rx fr Nalxne

24 Access t care/recvery Supprt The Challenge Navigatin f existing and develping prgrams is difficult Demand fr services currently verwhelms supply Ptential Slutin Expansin f lcal services Public-private partnership Grant funding Supprt prgrams that may bring better reimbursement rates t ffset csts Medicaid Expansin Crdinated entry prcess

25 Access t Care/Recvery Supprt Hspitals Crrectins Crdinated Entry Apprpriate Management On-site Heart f Flrida United Way Service

26 Legislative Wrkgrup Sme interventins may require legislative actin Mandatry reprting f herin/piid verdse by DOH Increased funding fr addictin receiving centers Increased access t licensing fr medicatinassisted treatment Expanded cding fr managed care rganizatins Medicaid expansin Prpse lcal wrkgrup/subcmmittee

27 Putting it all Tgether What rle d these interventins play with each targeted grup?

28 Ptential Users PREVENTION Cmmunity Educatin/Awareness Schls, religius establishments, parks, gvernment prgrams Peers and rle mdels

29 Infrequent Users Expanded resurces Crdinated care Jail diversin strategies Treatment/Recvery Supprt Access t care and medicatin-assisted treatment (maintenance therapy)

30 Frequent Users Safety/Risk Reductin Access t Medicatin-assisted treatment (rescue therapy) Crdinated care Related scial services (HMIS, Mental Health, etc)

31 Data Cllectin Prfessinal Training Targeted Apprach Ptential Users Educatin/Awareness Infrequent Users Treatment/Recvery Supprt Medicatin-assisted Treatment Frequent Users Medicatin-assisted Treatment Treatment/Recvery Supprt

32 Relatinship f Interventins Peace War Battle Educatin Preventin Treatment/Recvery Supprt Nalxne

33 Orange Cunty Herin Task Frce: A targeted apprach t imprving utcmes Christpher Hunter, M.D., Ph.D. Directr, Orange Cunty Health Services Department Assciate Medical Directr, Orange Cunty EMS System