Michelle L. Louisville, LCSW, CAP, ICADC Substance Abuse Treatment Program Coordinator Fayetteville Veterans Affairs Medical Center April 5, 2018

Transcription

1 Michelle L. Louisville, LCSW, CAP, ICADC Substance Abuse Treatment Program Coordinator Fayetteville Veterans Affairs Medical Center April 5, 2018

2 Objectives of today s presentation I. Understanding the Opioid Epidemic A. Global and National Trends B. Active Duty and Veterans compared to civilians C. North Carolina statistics II. Opioid Use Disorder (OUD) A. Brief overview of criteria B. Misuse signs & symptoms of OUD C. How OUD affects learning and the body III. Treatment options A. Fayetteville VA Medical Center treatment B. VA resources C. Local community resources IV. Questions & Comments 2

3 Global Perspective Opioid Epidemic The World Health Organization (WHO) estimated in 2015 (UNODC Research, World Drug Report 2017 Booklet 2 & 3). Supply of opium and heroin Ø 6,380 tons of opium plant Ø 4,300 tons processed heroin Ø 2,080 tons consumed as opium Global users Ø 35 million people use opioids Ø 17.7 million people use opiates Global drug raids Ø 587 tons opium Ø 80 tons heroin Ø 9.6 tons morphine Approximately 2.1 million people in the United States have substance use disorder related to prescription opioids. 3

4 Opioid Prescriptions Dispensed by US Retail Pharmacies The total number of opiate prescriptions dispensed by retail pharmacies in the United States rose from 76 million in 1991 to 207 million in (NIDA, March 2014). 4

5 Opioid Epidemic statistics in People died every day from opioid-related drug overdose 11.5 million People misused prescription opioids 42,249 People died from overdosing on opioids 2.1 million People were diagnosed with an opioid use disorder 948,000 People used heroin 170,000 People used heroin for the first time 2.1 million People misused prescription opioids for the first time 17,087 Deaths attributed to overdosing on commonly prescribed opioids 19,413 Deaths attributed to overdosing on synthetic opioids other than methadone 15,469 Deaths attributed to overdosing on heroin $504 billion In economic costs Sources: National Survey on Drug Use and Health, 2 Mortality in the United States, 2016 NCHS Data Brief No. 293, December 2017, 3 CEA Report: The underestimated cost of the opioid crisis,

6 History of the Opioid Epidemic 6

7 Trends for Active Duty According to the 2011 Department of Defense Health Related Behaviors Survey of Among Active Duty Military Personnel 15.2% active duty service members used prescription drugs in the past 30 days 24.9% active duty service members used prescription drugs in the past 12 months 61.2% active duty service members reported lifetime use of prescriptions drugs 57.7% active duty service members admitted using prescription pain relievers during military career 96.4% active duty service members received prescription to manage pain 48% of opioid users were years of age 19.7 % Enlisted E1-E4, 46.5% NCO, E5-E9, 23.4 % Warrant Officer, 29.1% Officer 7

8 Trends for Active Duty cont. According to the 2011 Department of Defense Health Related Behaviors Survey of Among Active Duty Military Personnel Prescription drug use for male and female service members for all branches was two times more than civilian population 9 % male, 12 % female; active duty -18.7% male, 26.9% female Non-medical prescription drug use doubled from 2002 (2 percent) to 2005 (4 percent) for active duty personnel Non-medical prescription drug use tripled from 2005 to 2008 to 11% Pain reliever prescriptions written by military physicians quadrupled between 2001 and 2009 to almost 3.8 million. Prescription Target All services Civilian Prescribed for service member Prescribed for someone else 89.6% 19.7% 3.7% 54% Other source 6.8% 15.5% 8

9 North Carolina Trends In 2015 there were more than 1,100 opioid-related deaths NC has experience 73% spike in opioid-related deaths since 2005 Several of the counites served by Fayetteville VAMC County 2005 Opiate Related Deaths 2015 Opiate Related Deaths Bladen 0 5 Brunswick Catawba 9 17 Harnett 7 10 Johnston 8 23 Moore 4 11 Onslow New Hanover Pender 1 14 Robeson 5 11 Sampson 0 5 Wayne 3 9 9

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12 Opioid Use Disorder Criteria DSM-V diagnosis guide definition of Substance Use Disorder is now based on a problematic pattern of substance use leading to clinically significant impairment or distress over a 12-month period, as manifested by following criteria: 1. Social or interpersonal problems 2. Failure to fulfill obligations at work, school, or home. 3. Repeated use resulting in physically hazardous situations 4. Cravings or urges 5. Tolerance 6. Withdrawals 7. Difficulty controlling use/substance taken in larger amount and for longer period than intended 8. Desire to curt down or unsuccessful attempts to quit 9. Significant amount of time obtaining, using, or recovering 10. Neglecting activities 11. Continue to use despite negative consequences 12

13 Signs & symptoms of Opioid misuse 13

14 What we do The Substance Abuse Treatment Program is an outpatient treatment of substance use disorders (alcohol, drug and/or tobacco). We provide Veterans with an evidencebased, holistic and Veteran-centered treatment so they can move forward on the path to recovery and wellness. We also provided medication assistance for substance use disorders. You can t change what s going on around you, until you change what s going on within you. 14

15 How to get started SATP has open access without an appointment at 2300 Ramsey Street, Bldg. 47 Monday-Fridays 8:00 am 3:00 pm for an initial screening. Veterans can schedule an appointment by calling Toll free: ext 5483/7770 Phone: ext 5483/7770 The Fayetteville VAMC SATP location has Saturday appointments available by appointment only. 15

16 Community Referral Is the Veteran eligible for services? Register with VA in person at 2300 Ramsey Street location or verify by calling Health Benefits at ext 6016 Medical records of current medication dosage, UDS results Current psychotropic medication Treatment records talk therapy, groups 16

17 July 2012 FVAMC SATP began providing Suboxone to Veterans diagnosed with Opioid Use Disorder. Fayetteville VAMC currently has 450 Veterans diagnosed with an Opioid Use Disorder. Average Veterans served per month in SATP are 665 for individual appointments, 855 for groups. 20% of Veterans in Cumberland County have SUD and treated at FVAMC. 17

18 SATP has physical locations in Fayetteville VAMC, Wilmington HCC, and Jacksonville Community Based Outpatient Clinics (CBOCs). SATP provides substance abuse treatment at Hamlet, Goldsboro, Robeson (Pembroke), and Sanford through tele-health services. 18

19 Ambulatory Detox SATP Services Flow sheet Smoking Cessation PCP MH Provider Self Referred Three sources of SATP referrals NO Screening is complete Yes Ambulatory Detox Substance Use Screening SATP Intake: -Consent -BAM/AUDIT/DAST -Sched. Nurse Prac. -Sched. Psychiatrist -Sched. Tx Plan Yes Opioid Use Disorder Opioid MAT: -Screening -Agreement -ROI Opioid Replacement Tx Team SATP TX Services 4/4/18

20 Screening does not mean enrollment in services. The program is voluntary. FVAMC SATP does not offer inpatient detox nor residential treatment services. SATP staff has the capability to make referrals to an inpatient substance use disorder facility within the VAMC. SATP clinic has over 1200 visits per month by Veterans for groups and individual sessions in FY18. 20

21 Interdisciplinary Team Program Coordinator Psychiatrist Psychologist Nurse Practitioner Nurse Social Worker Addiction Therapist 21

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23 Outpatient services offered are : 1. Motivation for Change groups 2. Intensive Outpatient program IOP, Aftercare, and Recovery Management groups 3. Opioid Replacement Treatment program 4. Tele-health groups for CBOCs 5. Smoking Cessation program 6. Seeking Safety PTSD/SUD 7. Evidence Based-Practices > Behavioral Couples Therapy, Cognitive Processing Co-Occurring and Prolonged Exposure, Motivational Interviewing, Chronic Pain/SUD 23

24 Outpatient services offered (continued): 8. Ambulatory Detoxification (outpatient for alcohol withdrawals) 9. Co-occurring group topics depression, anxiety, bi-polar, etc Emotional Regulation/DBT Informed group 11. NC licensed facility for DWI 12. Inpatient psychiatrist group & screenings, medical unit screenings 13. Medication assistance treatment for SUD 24

25 Medication Assistance for substance use disorders Alcohol Naltrexone/Vivitrol Acamprosate/Campral Disulfiram/Antabuse Smoking Cessation Wellbutrin/Bupropion Lozenges Gum/Parasympathomimetic alkaloid Patch/NicoDerm Chantix/Varenicline Opioids Naloxone/Narcan Training Kit Buprenorphine/Suboxone 25

26 Primary locations point of contact Fayetteville VAMC SATP: 2300 Ramsey Street, Building 47 Fayetteville, NC Toll free: ext 5483/7770 Phone: ext 5483/7770 Jacksonville VA CBOC 4 Josh Court Jacksonville, NC ext 2058 Wilmington HCC 1705 Gardner Road Wilmington, NC ext

27 Resources available online 1. Substance Abuse Treatment Program 2. Primary Care Mental Health Integration 3. Suicide Prevention brochure 4. Whole Health Program coming May Recovery Resource Guide (Cumberland & surrounding counties) 6. Veteran friendly applications for smartphones 7. DOD Caregiver Resource Directory Cape Fear Valley - Cohen Network information 9. Support groups for substance use: Ø AA/NA meeting link Ø SMART Recovery link Ø Celebrate Recovery link 27

28 References 24 Shocking Opiate Addiction Recovery Statistics (October 27, 2014). Health Research Funding. Retrieved from County-by-County Figures: The Opioid Crisis in North Carolina. (May 2017). North Carolina Office of the Governor. Retrieved from Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel, Available online North Carolina Health News (July 27, 2017). Four North Carolina Cities Make Top 25 List for Opioid Abuse. Retrieved from Opioid Overdose. (August 30, 2017). Centers for Disease Control and Prevention. Retrieved from Universal Health Coverage, World Health Organization, World Drug Report Retrieved from Veterans and Military Families (September 15, 2017). Substance Abuse and Mental Health Services Administration. Retrieved from 28

29 Questions and comments Michelle L. Louisville, LCSW, CAP SATP Coordinator Fayetteville VAMC Bldg. 47, Rm. 111 Fayetteville, NC Phone: (910) ext Fax: (910)