Community Solutions to Heroin Addiction Challenges

Transcription

1 Orlando, Florida C4 Community Solutions to Heroin Addiction Challenges IHI Summit April 20 22, 2017 #IHISummit

2 Disclosures 2 These presenters have nothing to disclose

3 Session Objectives Identify methods for building cross-sector coalitions to address substance abuse issues that have an impact on healthcare entities Provide examples of how disparate community organizations can take concrete steps to solve complex community issues Describe ways to involve those directly affected by substance abuse (family and caregivers) in the planning and actions taken to improve prevention and treatment options in a community

4 Session Faculty Matt Guy President and Owner, Accelerated Transformation Associates Lindsay Reeves Systems of Care Coordinator, Health Soultions

5 Our Vision 5

6 Change Ideas Three Levels of Activation: Activating individuals: Community organizing, storytelling, facilitative leadership Activating organizations: Community collaboration and governance Activating communities Understanding community assets, participatory decision making

7 Mapping Your Assets

8 Community Asset Mapping: A Shift From Needs-Focused Approach Needs Focus on deficiencies Focus on strengths Assets Result in fragmentation of responses to local deficiencies Build relationships among people, groups, and organizations Make people consumers of services; builds dependence on services Identify ways that people and organizations give of their talents and resources Give residents little voice in deciding how to address local concerns Empower people to be an integral part of the solution to community problems and issues

9 Asset Based Community Development (ABCD) 9 John McKnight and John Kretzman Built on the notion that communities have never been built on their deficiencies, rather on the capacities and assets of the people and the place. Does not imply ignoring problems and needs and throwing out rational, strategic planning; rather it is a rallying point for collective action.

10 Some Lessons 10 You have one mouth and two ears, use them proportionally Decisions are made by the those who show up. Assume that you will need to lose a bit of control for much, much more power.

11 Road Games

12 Getting/Keeping People Involved Stop asking What s the matter? Start asking What matters to you? *Shamelessly borrowed former former IHI CEO Maureen Bisognano

13 13 Can you tell us what people who live here have done together to make things better? Building Communities From the Inside Out, 1993

14 Where It Began 14 Complex issues require complex solutions. This one is going to take the entire community coming together and working toward a brighter tomorrow.

15 Multi-Phase Community Public Forum 15 Exploring: Unpack and Understand the Issues Wednesday, March 9, :30 to 7:30 pm Constructing: Roll Up Your Sleeves and Help Plan Thursday, March 17, :30 to 7:30 pm Moving Forward: Organize Implementation of Evidence-Based Programs and Practices Tuesday, May 3, :30 to 7:30 pm

16 Exploring: Unpack and Understand the Issues 16 Origins of the Problem Scope of the Problem Costs of the Problem Brainstorm Strengths and Barriers

17 Origins of the Problem % of new illicit drug users began with prescription pain relievers. Opioid analgesic (pain reliever) sales increased nearly four-fold between 1999 and 2010 Four-Fold increase in opioid (narcotic pain medication) overdose deaths NSDUH Report

18 Origins of the Problem 18 According to National Institute on Drug Abuse (NIDA): Abuse of prescription opioid pain medications such as Oxycontin and Vicodin open the door to heroin abuse. Nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before starting to use heroin. Individuals reported taking up heroin because it is cheaper and easier to obtain than prescription opioids. Crushing prescription opioid pills to snort or inject the powder provide initiation into these methods National Institute on Drug Abuse: Heroin. Retrieved from on March 6, 2016

19 Origins of the Problem: Pueblo County 19 According to Parkview Medical Center ED doctors: At least one ED admission each day has a heroin-related symptom March 4, 2016 Often, multiple admissions per day have a heroin-related symptom March 4, 2016 Parkview Medical Center 2015 Drug-Related Overdose Statistics Overdose admissions 46 Heroin OD admits 6 Overdose ( primary complaint in ED) - 99 Ingestion (primary complaint in ED) 203 Most overdose admissions are complex combination drug admissions

20 Origins of the Problem: Pueblo County 20 Opioid Related Overdose Deaths Colorado Pueblo County Opioid Overdose Death Rate per 100,000 People

21 Origins of the Problem: Pueblo County 21 Heroin Related Overdose Deaths Colorado Pueblo County Heroin Overdose Death Rate per 100,000 People

22 Scope of the Problem 22 Pueblo County Jail Statistics Approximately opiate protocol prisoners per year Access Point Pueblo: Local Needle Exchange 470 individuals signed up, ~25 new clients each month, avg. exchanges per week, busiest week ~80 exchanges

23 Access Point Pueblo 23 Data from July June Total Visits

24 Scope of the Problem 24 Pueblo Fire Department 140 Narcan uses in 2015 Colorado Public Radio Investigation Southeastern Colorado makes up 6% of the state population and 18% of the admissions for heroin treatment Colorado Public Defender s Office 168,000 cases per year, over 50% are drug related Pueblo Police Department Heroin seizures were up 5X in 2015

25 Scope of the Problem 25 We don t understand the true breadth and depth of how many people are using heroin in the community

26 Costs of the Problem 26 Pueblo County Jail Costs Cost for routine prisoners: $75/day Cost for opiate protocol prisoners: ~$90/day due to extra services Legal Costs Colorado Public Defender s annual budget: $86M More than 50% is drug related Additional costs incurred from Police and Courts

27 = $5 27

28 Each day we house an opioid protocol prisoner is equal to $15 per day

29 Over the course of a year, this adds up to Cups of Coffee

30 Costs of the Problem 30 Medical Costs Attributed to Drug related ER Visits, EMS and Jail OD Patients, Pueblo Fire Department Narcan use, etc. HIV and Hepatitis C 18% of HIV cases in Colorado are thought to be linked to drug use at an estimated lifetime cost of $600,000 60%-80% of Hepatitis C cases are linked and cost ~$100,000 over the lifetime to treat

31 Costs of the Problem 31 Crime Costs Many property crimes, burglaries, shop lifting, car break ins, identity theft, are thought to be drug related Other Costs Loss of employment, interrupted employment, ability to obtain employment, interrupted treatment- risk of OD, start over, discouragement

32 Constructing: Roll Up Your Sleeves and Help Plan 32 Centralized Position Statement Three Distinct Focus Areas Strengths/Opportunities Brainstorming What Could Be for Pueblo

33 What Does Success Mean? 33 The goal is to implement an integrated, community-wide system to reduce heroin and opioid addiction and its negative effects in Pueblo County.

34 Three Focus Areas 34 Community Prevention Resources Providers and Treatment Centers Law Enforcement

35 Strengths: Community Prevention Resources 35 Parenting classes Nonprofits, ie Salvation Army, Posada, etc. known to be good resources and supported throughout the community Many services available outside of addiction services: DSS, Catholic Charities, SECAHEC, Wayside Cross, transitional services, etc. Community develops resources and places where needed Addicts helping addicts recover Nursing schools with students Community willing to work together in solving problems, dedicated folks willing to address the issue Awareness of the issue is improving Efforts to address the stigma about behavioral health Many alternates to drugs: nature center, tennis courts, basketball slabs, bike trails, skate park

36 Strengths: Providers and Treatment Centers Two hospitals, Parkview, St. Mary Corwin, acute medical care is excellent Dr. Pollack has Medicaid eligible slots available for treatment Parkview Chemical Dependency Unit: Accudetox trained specialists, integrated dual diagnosis program, 12-step recovery community, aftercare Prescription Drug Monitoring Program to find out what a patient has been prescribed Narcan available at local pharmacies Large support of treatment providers, ie Crossroads, Health Solutions, Pueblo Community Health Center, Circle Program, Victory Outreach Pueblo, El Pueblo Adolescent Treatment Community, Addicts to Athletes, counselors and outpatient treatment options Access Point Pueblo (Needle Exchange) serves as a point of access for those who want help In-house treatment program at the County Jail 36

37 Strengths: Law Enforcement 37 Builds relationships with youth in high schools Actively trying to stop the supply of drugs Collaborative effort with DA to implement holistic approach Drug courts, veterans court and mental health court Equipped officers with Narcan

38 What could be 38 Pueblo is a place that supports addicts looking for treatment options through the availability of treatment centers and Medication Assisted Treatment The community is educated about the harmful effects of heroin and opioid use and prevention for younger generations becomes a primary goal Law enforcement is equipped with proper community support resources to impact those looking for help Peer support becomes commonplace with a strong support network of addicts helping addicts

39 Moving Forward: Organize Implementation of Action Plans and Measurement Strategy 39 Focus Area Goals/Objectives Addition of Community Members Focus Group Measurement Strategy

40 Community Prevention Resources 40 Goal: The community prevention and resource group will provide education and resources to reduce opioid and heroin addiction and its negative effects in Pueblo County. Initiatives: Community-wide speaker series Focusing on bringing awareness to the work of the Heroin Task Force Speaker events will feature leaders of the focus area groups

41 Providers and Treatment Centers 41 Goal: As clinicians, we believe it is our duty to educate the public about the epidemic's impact on individuals, families and the community, while improving the availability and quality of prevention and treatment options based on the best available scientific evidence. All people with an addiction disorder deserve treatment. Treatment must be immediately available with a low threshold for entry. Treatment options must be flexible enough to address the varied situations of people, yet comprehensive. Every person seeking help, should be treated with the utmost care and respect.

42 Our Place 42 Initiatives: The key features of Our Place: Open 24/7 so when people are ready to quit they can get help Accessible to anyone seeking help for themselves or loved ones Focal point for EMS and law enforcement to bring appropriate addicts Center for a Police Assisted Addiction Recovery Initiative (PAARI) program Source of information about and access to available treatment options On-site case managers able to talk with and direct addicts to appropriate treatment Detoxification facilities and protocols for initiation of acudetox Medication assisted treatment (MAT) will be available from part-time, community providers a. Standardized intake process b. Patient management protocols c. EMR per DEA requirements d. Billing for providers Behavioral health counseling if not on-site, access to it in a timely manner Space for support groups and education forums for providers, patients and families

43 Law Enforcement 43 Goal: Continue collaboration to improve interactions between law enforcement and substance abusers. Initiatives: Diversion Program Modeled after LEAD in Seattle, WA Barriers associated with law enforcement jurisdiction Comprehensive Law Enforcement Plan Plan and procedure for dealing with addiction that is appropriate and effective for Pueblo.

44 Community Members 44 Goal: Provide a safe space for community members to share their stories about barriers and solutions associated with the issue Initiatives: Community Partnerships Existing community groups Family Support Resources

45 Measurement Strategy 45 Outcome Metrics for Heroin Task Force Number of Overdose Deaths per year Number of Opioid Protocol Prisoners per month Number of Unduplicated Needle Exchange Clients per month Number of Narcan Uses by First Responders per month

46 Measurement Strategy Cont 46

47 Successes 47 State-Wide Initiatives Medication Assisted Treatment Expansion Accudetox Expansion Community Collaborations Law Enforcement Diversion and Treatment Additional Resource for Access Point Pueblo

48 48

49 Contact Info 49 Matt Guy President and Owner, Accelerated Transformation Associates Lindsay Reeves Systems of Care Coordinator, Health Solutions