Orange County Heroin Task Force Implementation Update. George Ralls M.D. Director of Health & Public Safety Orange County Government

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1 Orange County Heroin Task Force Implementation Update George Ralls M.D. Director of Health & Public Safety Orange County Government

2 Presentation Outline Overview of Data Orange County Heroin Task Force Naloxone Legislation Implementation of Task Force Recommendations Federal and State Funding

3 Drug Overdoses KILL MORE Than Cars and Guns 52,404 people died from drug overdoses (33,091 involved an opioid) 37,757 people died in car crashes 36,252 gun deaths (including homicides and suicides)

4 FL Heroin-Related Deaths (Cause of Death) Jan-June Heroin-Related Deaths

5 FL Heroin-Related Deaths 2014

6 FL Heroin-Related Deaths 2015

7 Ninth Circuit Heroin-Related Deaths Ninth Circuit Orange & Osceola Orange County

8 Hospitals Costs Across the State 2014 Heroin Overdose Poisonings (AHCA) 1,364 Heroin-Related Emergency Department Visits Inpatient Hospitalizations Estimated Cost of Heroin Epidemic Tops $1 Billion a year in Florida

9 Heroin-Related ED Visits Orange County, Florida (FL Dept. of Health, Orange County & AHCA) Emergency Department Facility Florida Hospital East 131 Orlando Health 104 Florida Hospital Orlando 43 Winter Park Memorial Hospital 34 Dr. Phillips Hospital 31 Health Central 18 Florida Hospital Apopka 14 Arnold Palmer Medical Center 3 Number of Emergency Department Visits TOTAL 378 ( )

10 Heroin-Related ED Visits Orange County, Florida 2015 (FL Dept. of Health, Orange County & AHCA) Emergency Department Facility Florida Hospital East 142 Orlando Health 73 Florida Hospital Orlando 35 Dr. Phillips Hospital 24 Winter Park Hospital 16 Health Central 10 Florida Hospital Apopka 8 TOTAL 308 Number of Emergency Department Visits

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14 FL Fentanyl-Related Deaths (Cause of Death) Jan- June Fentanyl-Related Deaths

15 Fentanyl-Related Deaths District Nine Medical Examiner Highest Number of Fentanyl Related Deaths: West Palm Beach Miami Dade Orange County Manatee County

16 Fentanyl-Related Deaths District Nine Medical Examiner Orange County Fentanyl- Related Deaths Illicit Fentanyl Analogues- 19 Deaths in Orange Co Furanyl Fentanyl Acetyl Fentanyl Butyryl Fentanyl

17 Fentanyl Deadly Super Pill in Central Florida April FDLE warned citizens about deadly Super Pill sold on our streets Counterfeit pills that look like Oxycodone, Percocet and Xanax Contains lethal amounts of Fentanyl Two confirmed deaths related to counterfeit pills in Orange County

18 Orange County Heroin Task Force

19 Orange County Heroin Task Force Created by Mayor Jacobs and co-chaired by Sheriff Demings - August Community Leaders Four subcommittees created in areas of Law Enforcement, Healthcare, Education & Prevention & Treatment Met for six months Task Force approved 37 recommendations Heroin Task Force Advisory Committee oversees implementation of recommendations

20 SUPPLY DEMAND

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22 Naloxone Naloxone is an opioid antagonist Works by blocking opiate receptor sites which reverses or prevents toxic effects of narcotic (opioid) analgesics In addition to IV use, can be given intranasal or intramuscular Quick onset of action Duration of action minutes - patients need continued monitoring

23 Types of Naloxone Administration

24 Naloxone use by Law Enforcement Law Enforcement: 1,171 law enforcement officers now carry naloxone in County Orange County Sheriff s Office Orlando Police Department UCF Police Department FDLE Belle Isle Police Department Windermere Police Department Sheriff s Office had administered naloxone 106 times to save lives and Orlando Police Department has administered naloxone 14 times

25 Wider Access to Naloxone by the Public Naloxone Overdose Prevention Law June 2015 HB751 Emergency Treatment and Recovery Act Prescribers Immune from Criminal Prosecution Prescribers Immune from Civil Liability Prescriptions Authorized to 3 rd Parties Layperson Immune from Civil Liability Florida s Naloxone Law Amended Non-Patient Specific Standing Order Effective July 1, 2016

26 Wider Access to Naloxone by the Public Walgreens and CVS have naloxone available in Orange County with Standing Order (Fall 2016) Cost of nasal spray naloxone (Narcan ) approximately $130-$140 Most healthcare plans cover portion of cost Orange County Medical Clinic provides nasal spray naloxone for indigent/uninsured

27 Orange County Heroin Task Force Law Enforcement: Bond Amounts for Heroin Trafficking increased Advocated for establishing a Fentanyl Trafficking Charge - Formerly diversion prosecuted as possession - Signed into law June 14th; effective date 10/1/17

28 Orange County Heroin Task Force Orange County Corrections: June 2016 Orange County Jail Naloxone Program 497 inmates provided with naloxone 1st Jail in Florida to provide naloxone to inmates Funded by Department of Justice Grant Naltrexone Pilot Program 1158 inmates screened for interest in the program 107 qualified for treatment after full screening 47 patients received injection

29 Orange County Heroin Task Force Community Education and Outreach: Created Naloxone Training Video for non-medical audience Improved Awareness and Collaboration about Neonatal Abstinence Syndrome Orange County Drug Abuse Summit focused on NAS with over 100 medical, treatment and community-based professionals

30 Orange County Heroin Task Force Education and Prevention: Mayor Jacobs launched the Heroes Against Heroin website

31 Orange County Heroin Task Force Education and Prevention: Chasing the Dragon: The Life of An Opiate Addict Documentary Screening Orange County & US Attorney s Office Appropriate for high school students, young adults, parents and community members discussion guide included Heroin Educational Toolkit launched in March toolkits distributed to 30 agencies in Central Florida

32 Orange County Heroin Task Force Treatment: Contract Condition for Substance Abuse Treatment Providers to Register with 211 Orange County Substance Abuse Treatment Contracts and DCF Substance Abuse Contracts Annual Heroin Conference from the Poppy Plant to Recovery: A Central Florida Perspective (approximately 200 in attendance) Increase Communication and Access to Medication-Assisted Treatment Conducting professional trainings on Medication-Assisted Treatment and Reducing Stigma

33 Federal and State Opioid Funding 21 st Century Cures Act $1B in grants for states to combat opioid abuse during the next two years Comprehensive Addiction Recovery Act $181M comprehensive effort to address prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal Governor issues Declaration of Emergency on Opioid Crisis May 3, 2017 Florida received SAMHSA Opioid Targeted Response Grant - $54M over two years

34 Orange County Heroin Task Force Implementation Update George Ralls M.D. Director of Health & Public Safety Orange County Government