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1 the Opioid Epidemic: Montgomery County s Response Age 0 4 Amoxicillin Age 4 12 Ritalin Age Appetite Suppressants Age No-Doz Age Prozac Age Zantac 65 1 Everything Else

2 Learnings from the Offered Training. This session will provide an overview on the impact of the opioid epidemic in Montgomery County, Maryland as well as the affects of opioid use in apply substance abuse environment ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

3 Learning Objectives. Identify Understand Discuss Understand Discuss Identify current trends in Montgomery County versus the rest of the state Understand the impact of the Governor declaring a state of emergency Discuss Maryland s current laws pertaining to the prescription drug monitoring program, the Opioid Intervention Teams and its relationship to the Statewide Opioid Overdose Coordinating Committee Understand the coordination between public safety and behavioral and public health. Discuss prevention, outreach efforts, treatment continuum and effective programs ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

4 1.04m Residents 33% Foreign Born 55% Racial-ethnic Minority Seven Zip Codes of Extreme Need 36% growth in our senior population by Projection for 2025 is 196,000 35% of 159,010 children in the public school system receive FARMS Served over 97,000 households in Fiscal Year The average client used more than two services from the Department Serving almost 31,000 uninsured adults, children and pregnant women Montgomery County Department of Health and Human Services has a staff of 1,641 with over 134 programs Caseloads grew significantly in FY15 but have declined since: SNAP -10% TCA -16% MA -55% Information about Montgomery County, Maryland. Our County by the Numbers. 4

5 One Director Centralized Administrative Functions Moving towards single client record support by an interoperable database Uniform intake form to identify all service needs Designated entire HHS Entity as HIPAA covered including social service and income support programs How is the Department of Health and Human Services Organized? ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

6 Services and State Department Connections. 1. Aging and Disability Services 5 and 6 1, 2, 4, 5 and 6 1, 2, 3, 4, 5 and 6 3 and 6 2. Behavioral Health and Crisis Services 3. Children, Youth and Family Services 1 and 6 1 and 6 3 and 6 2 and 6 4. Public Health Services 5. Services to Prevent and End Homelessness 6. Community Outreach 2, 3 and 6 3 and 6 1 and 6 3, 4 and 6 6

7 Behavioral Health within the Health and Human Services Enterprise

8 The Behavioral Health Continuum. ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

9 This declaration authorizes all local emergency agencies to cut through the red tape with more flexibility for prevention, treatment and enforcement efforts. He creates the Opioid Overdose Coordinating Committee. Governor Declares a State of Emergency

10 Overdose Data for Montgomery County Between 2015 and % increase in overdose deaths Fentanyl deaths for the same time period increased by 147% Heroin deaths increased by 30% 63% increase in the administration of Narcan as rescue medicine to counter overdoses ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

11 A TOTAL OF 503 ADMINISTRATION OF NARCAN TOOK PLACE IN HERE ARE THE TOP 5 ZIP CODES ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

12 ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

13 Table 1 Total Number of Drug and Alcohol-Related Deaths 1, 2 (Montgomery County) and Year-to-Date 2017 through June YTD State Montgomery County Includes deaths that were the result of recent ingestion or exposure to alcohol or another type of drug, including heroin, cocaine, prescription opioids. Benzodiazepines, and other prescribed drugs. 2 Includes only deaths for which the manner of death was classified as accidental or undetermined. 3 Counts for 2017 are not complete. Table 2 Number of Opioid-Related Intoxication Deaths 1,2 (Montgomery County) and YTD 2017 Through June YTD State of Maryland Montgomery County Includes deaths that were the result of recent ingestion or exposure to prescription and illicit opioids. 2 Includes only deaths for which the manner of death was classified as accidental or undetermined. 3 Counts for 2017 are not complete. 13

14 Table 3 Number of Heroin-Related Intoxication Deaths 1, 2 (Montgomery County) and Year-to-Date 2017 through June YTD State Montgomery County Includes deaths that were the result of recent ingestion or exposure to heroin. 2 Includes only deaths for which the manner of death was classified as accidental or undetermined. 3 Counts for 2017 are not complete. Table 4 Number of Fentanyl-Related Intoxication Deaths 1,2 (Maryland) and YTD 2017 Through June YTD State of Maryland Montgomery County Includes deaths that were the result of recent ingestion or exposure to prescription and illicit fentanyl. 2 Includes only deaths for which the manner of death was classified as accidental or undetermined. 3 Counts for 2017 are not complete. 14

15 Table 5 Number of Prescription Opioid-Related Intoxication Deaths 1, 2 (Montgomery County) and Year-to-Date 2017 through June YTD State Montgomery County Includes deaths that were the result of recent ingestion or exposure to prescription Opioids. 2 Includes only deaths for which the manner of death was classified as accidental or undetermined. 3 Counts for 2017 are not complete. Table 6 Number of Cocaine-Related Intoxication Deaths 1,2 (Maryland) and YTD 2017 Through June YTD State of Maryland Montgomery County Includes deaths that were the result of recent ingestion or exposure to cocaine. 2 Includes only deaths for which the manner of death was classified as accidental or undetermined. 3 Counts for 2017 are not complete. 15

16 Table 7 Number of Alcohol-Related Intoxication Deaths 1, 2 (Montgomery County) and Year-to-Date 2017 through June YTD State Montgomery County Includes deaths that were the result of recent ingestion or exposure to alcohol. 2 Includes only deaths for which the manner of death was classified as accidental or undetermined. 3 Counts for 2017 are not complete. ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

17 Drug Use and Overdose Trends Among Children and Adolescent ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

18 Prescription Drug Use and Heroin Use Calendar Year 2014* *Source: Youth Risk Behavior Survey for Montgomery County % of middle school and 12.5% of high school students have abused prescription medication 1.5% of middle school and 3.1% of high school students have used heroin In contrast, 5.4% of middle schoolers and 24.7% of high schoolers report current use of alcohol ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

19 Alcohol Use, Prescription Drug Abuse, Heroin Use for MCPS Middle and High School Students *Source: Youth Risk Behavior Survey for Montgomery County % 25% 25% 20% 15% 13% 10% 5% 0% 5% 8% Middle School 2% Calendar Year Current Alcohol Use Prescription Drug Heroin High School 3% ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

20 Student Estimated Counts of Students Reporting Alcohol Use, Prescription Drug Abuse, and Heroin Use for MCPS Middle and High School Students* 45,300 40,300 35,300 30,300 25,300 20,300 15,300 10,300 5, ,267 2,680 Middle School 47,450 5, ,904 1,471 High School 11,720 Enrollment Prescription Drug Heroin Alcohol ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2, *Source: Maryland MSDR Attendance Data for MCPS Middle and High School Students 2017, YRBS Survey Results for MC Middle and High School Students 2014.

21 Completed Suicides, Overdose Fatalities, Suicide Attempts and Drug Related ER Visits Seen at Local Hospital ERs for MC Residents (6-18 vs age group) * Suicides Suicide Attempts Overdose Deaths Drug Related ER Visits 6-18 yrs yrs ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2, *Source: Maryland Department of Health Vital Statistics Annual Report , Drug and Alcohol Intoxication Deaths for Montgomery County

22 Fatal Overdose vs. Non-fatal Overdose Cases* *Source: Montgomery County Fire and Rescue EMS Incident Report FY17 YTD In FY17, a total of 471 Narcan related incidents were reported by Montgomery County Fire and Rescue Team. 3% of these overdose cases are for 6-18 year olds, while 14% are from year old age group. So far, no overdose fatalities was observed for children and adolescents under 18 years of age in the county. ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

23 Many Voices for Smart Choices Coalition Substance Use Needs Assessment Amongst Youth and Young Adults ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

24 SABG studied the following consumption and consequence patterns for underage and young adults:* Alcohol Use Binge Drinking Marijuana use Non-Medical Prescription Drug Use Lifetime Heroin Use ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2, *Substance Abuse Block Grant (SBAG) Montgomery County Collaboration Council and Montgomery County Department of Health and Human Services October 2017

25 Prioritization Assessment Table* High Impact Moderate Impact Low Impact High Likelihood of Change Moderate Likelihood of Change Non.medical use of prescription drugs Underage Drinking Heroin Low Likelihood of Change Binge Drinking Marijuana ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2, *Substance Abuse Block Grant (SBAG) Montgomery County Collaboration Council and Montgomery County Department of Health and Human Services October 2017

26 Consumption Rates of Montgomery County High School Students by Drugs* 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Alcohol Binge Drinking Marijuana Prescription Drugs Heroin ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2, *Substance Abuse Block Grant (SBAG) Montgomery County Collaboration Council and Montgomery County Department of Health and Human Services October 2017

27 ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

28 Average Non-medical Use of Pain Relievers in the Past Year ( ) Amongst year olds Age Group Age Group Maryland Montgomery County ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

29 The County s Strategic Response

30 Working on Several Fronts. Coordinate and Increase Education and Public Awareness Activities in the County BetheOne Campaign Community forums on SUD Educational Forums on Good Samaritan Laws, etc. Coordinate and Increase Substance Use Prevention Activities in the County Interdiction and Law enforcement Naloxone Training and Distribution Drug Takebacks Deflection and Diversion ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

31 Additional Strategy Areas: Improve the integration and sharing of state and local data by Monitoring, Planning and Rapid Alerts and Responses Communication Liaison with State Opioid Overdose Coordinating Council Promote Increased Access to Treatment/Recovery and Support Overdose and Overdose Death data integration and sharing State OOCC coordination and communication Hospital- Community Coordination Targeted response and action planning Local Overdose Intervention Team coordination and communication Community based treatment Rapid communication of spikes and trends in overdoses Recovery and Aftercare ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

32 Montgomery County Opioid Intervention Team (OIT). Established in response to Governor s executive Order establishing a state of emergency related to the opioid epidemic OIT is a broad and growing group that has come together to build a coordinated county-wide response to preventing addiction with specific focus on addressing opiate addictions 4 Pillars of OIT Work Public Education and Awareness Public Safety/overdose Prevention Access to Treatment Coordination, Communication and Planning ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

33 Public Education Public Education in schools and communities on substance abuse // Good Sam Laws. HHS, SAO, MCPS, MPD, others all taking on parts of this role. Community forum series on Substance abuse in MoCo. Designed to move around the county to key spots to educate and give the community a change to learn about the risks and how to prevent addiction. BTheOne.Org public awareness campaign targeted to school aged youth and young adults on potentially life-saving actions they can take when they see a peer in trouble with drugs or feeling suicidal. ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

34 Prevention Resources for Youth and Young Adults. Underage Drinking Prevention Resources. Montgomery County Dept. of Health and Human Services (MCDHHS), Collaboration Council (CC), Arise and Flourish, Brave and Bold Coalition, Dept. of Liquor Control (DOLC), MC Public Schools (MCPS). Prevention education, outreach, free tools and resources, school clubs (e.g. Breaking the Cycle of Addition and S.A.D.D.), MCPS s Under 21 Activity grant recipient/prevention coalition, DOLC s Keepin It Safe Coalition, CC s Many Voices Smart Choices Coalition (MVSC) - Communities Mobilizing for Change), community partnerships, special events and professional development. ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

35 Prevention Resources for Youth and Young Adults (Continued). Non.Medical Use of Prescription Drugs Prevention Resources. MCDHHS, MVSC, CC, Arise and Flourish, Brave and Bold Coalition, Heroin Action Coalition, MCPS, MCPD, MC Sheriff s Office, MC States Attorney s Office (SAO), Governor s Office, MC Bar Association, AODAC, Montgomery County Fire and Rescue Service (MCFRS), and the Universities at Shady Grove. Prevention education, awareness, free tools and resources, events/forums (e.g. Save a Life Montgomery; SAO s Speak Up, Save a Life and Teen Court; CC s MVSC Coalition; and Gov. Hogan s Heroin and Opioid Task Force), partnerships and collaborations, free tools and resources, Opioid Misuse Prevention Program (OMPP) Social Marketing Campaign and media interventions/expanding prescription drug lock-box & drop off locations, websites (e.g., Clear the Cabinet), PSA and social media (e.g., twitter, IG) presence. ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

36 Public Safety Naloxone training and dispensing both to the public, school health nurses and law enforcement. Doing this for the past two years and now expanding the locations where people are trained and equipping them with Naloxone. MPD responds to over 3000 calls a year related to BH and SRD In partnership, we established STEER (Stop, Triage, Engage, Evaluate, Refer) to do outreach with nonfatal overdose victims and get them into the county treatment system Drug take back days and drop boxes sponsored by MPD to give families a place to safely dispose of their old medications. ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

37 Access to Treatment and Support. Coordination of discharge planning and care planning with hospitals and community providers for patients who are being discharged from the hospital following a non-fatal overdose A broad spectrum of addictions treatment services o Residential detox and extended residential stay at Avery Road o o o o o o o Half-way houses for men and women with young children Outpatient and intensive outpatient addictions treatment services Medication Assisted Treatment programs Drug Court Also we have Jail Addictions Services (JAS) addictions treatment program for incarcerated residents and Comprehensive Re-entry Program for offenders who are returning to the community. We also have a diversion and treatment programs called SASCA for adolescents. To support persons in recovery we have a growing number of Peer Recovery services and providers ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

38 Coordination, Communication and Planning. 1 2 Making greater use of data to track where overdoses are occurring as a guide to where to target prevention and intervention resources. Identify spikes in overdoses when reported by our hospitals that may signify the distribution of a deadly combination of drugs on the streets ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

39 Resources in Montgomery County. For Overdose Emergencies 911 For Montgomery County Department of Health and Human Services Referrals 311 Behavioral Health Crises Crisis Center Non-emergency assessment and referrals ACCESS (coordinated entry for all behavioral health referrals) and SASCA for youth For education and public awareness opportunities Many Voices for Smart Choices through our Collaboration Council Montgomery County Prevention Office Child Adolescent Mental Health Offices Silver Spring Rockville Our Treatment Manager who coordinates Naloxone Training ADVENTIST HEALTHCARE SYMPOSIUM THURSDAY, NOVEMBER 2,

40 Uma S. Ahluwalia, Director Department of Health and Human Services 401 Hungerford Drive Rockville, Maryland

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