A Public Health Approach to Illicit Drug Use

Transcription

1 A Public Health Approach to Illicit Drug Use Doug Smith, MSSW Senior Policy Analyst Texas Criminal Justice Coalition

2 We ve Got a Drug Problem in Texas Four rural Texas cities (Texarkana, Amarillo, Odessa, and Longview) are among the top 25 in the country for prescription opioid abuse rates. Health care costs related to opioids reached almost $2 billion in Texas in Drug overdose deaths rose by over 7% in 2016, many due to opioid (there were more methamphetamine deaths last year than every recorded)

3 And It Impacts Children About 43% of child abuse/neglect investigations and 66% of child removals occur due to concerns about caregiver substance use. In 2017, 52% of child fatalities caused by abuse or neglect included a caregiver actively using and/or under the influence of a substance that affected their ability to care for the child. Drug overdose is the top cause of maternal death during pregnancy and up to one year postpartum.

4 And People Have Trouble Getting Help In Texas, less than $1 out of every $1,000 of general revenue spending goes to substance use agencies (the national average is over $4 per $1,000). Forty-seven percent of those who begin drinking before the age of 14 later develop alcohol dependence, compared with only 9% of those who wait until they are 21 or older to start, yet evidence-based prevention programs reach only about half of the school districts in Texas. Only 5.8% of low-income Texas adults with a substance use disorder (and only 8% of low-income Texas youth ages 12-17) receive services through a community-based treatment provider.

5 A Lot of Trouble AVG DAYS ON WAIT LIST FOR HHSC FUNDED SUBSTANCE USE SERVICES INTENSIVE RESIDENTIAL - ADULT 15 RESIDENTIAL DETOXIFICATION - ADULT 13 INTENSIVE RESIDENTIAL (SPECIALIZED FEMALE) - ADULT 17 OUTPATIENT - ADULT 28 OPIOID SUBSTITUTION THERAPY (MEDICATION ASSISTED THERAPY) - ADULT 32 RESIDENTIAL DETOXIFICATION (SPECIALIZED FEMALE) - ADULT 10 AMBULATORY DETOXIFICATION - ADULT 10 CO-OCCURING PSYCHIATRIC AND SUBSTANCE ABUSE DISORDERS (COPSD) SERVICES 27 INTENSIVE RESIDENTIAL (WOMEN AND CHILDREN) - ADULT 16 OUTPATIENT (SPECIALIZED FEMALE) - ADULT 18 INTENSIVE RESIDENTIAL - YOUTH 7 INTENSIVE RESIDENTIAL - YOUTH -ROOM/BOARD (MEDICAID WRAP AROUND) 11 OUTPATIENT - YOUTH 20 OUTPATIENT - YOUTH (CYT WRAP-AROUND)

6 And the Criminal Justice System Must Deal with the Problem Crime/Arrest Trends in Texas Violent Crimes Property Crimes Felony DWI Drug Dealing Family Violence Drug Possession

7 Travis County Drug Possession Cases Filed in Travis County FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017

8 Public Health and Public Safety Invest in the Treatment Infrastructure Decrease wait times for treatment Improve access to medication assisted treatment Increase availability of treatment beds for people with co-occurring substance use and mental health disorders. Increase overall treatment bed availability. Invest in Harm Reduction, Outreach, and Prevention Recognize harm reduction strategies such as needle exchanges as a way to prevent disease and to provide referrals Create an outreach network to inform medical/social service providers, as well as people in need of substance use services, about the availability of services. Train medical personnel, social service providers, and first responders in motivational interviewing. Improve Recovery-Oriented Community Supports Increase the availability of Peer Recovery Coaches and utilize these coaches in wide array of settings, including emergency rooms, jail, and homeless shelters, and as outreach and harm reduction teams. Identify gaps in recovery housing and improve access to these safe and supportive aftercare strategies. Reorient Law Enforcement, Judges, Prosecutors, and Probation Officers Towards Community-Based Diversion [see below]

9 Stakeholders/Outcomes Include Public Health Experts in Planning Process Focus on outcomes beyond lowered recidivism Health outcomes such as decreased rate of HIV/HEP C Decreased Overdose Shorter wait times for treatment Greater access points Improved access to recovery communities and sober living environments