Blueprint for Substance Abuse and Misuse Prevention, Treatment and Control. One Care of Southwest Virginia, Inc.

Transcription

1 Blueprint for Substance Abuse and Misuse Prevention, Treatment and Control One Care of Southwest Virginia, Inc.

2 ThetranquilityofSouthwestVirginiaisoneofitgreatestassets OneCareofSouthwestVirginia s BlueprintforSubstanceAbuseandMisuse Prevention,TreatmentandControl madepossiblebyagrantfromtheverizonfoundation OneCareofSWVA,Inc. P.O.Box3768Radford,VA24143 FirstprintingJune2011 The Southwest Virginia Health Authority is pleased to have provided encouragement and input to One Care in support of the development of this Blueprint and is pleased now to add its endorsement to its contents and vision. 2

3 BlueprintforSubstanceAbuseandMisuse Prevention,TreatmentandControl 1

4 BlueprintforSubstanceAbuseandMisusePrevention,TreatmentandControl TABLEOFCONTENTS 1. LetterofIntroductionfromVirginia sswvalegislativedelegationandfederal Representatives 2. Introduction:Challenges,NeedsandSolutions 3. ThePlanningProcess 4. TheContext:RegionalHealthDatafocusedonSubstanceAbuse&MentalHealthin SouthwestVirginia 5. ResultsofthePlanningDistrictMeetings GoalStatements,ObjectivesandRelative Timelines 6. Appendices AppendixI TextofLetterofInvitation AppendixII MATRIofBlueprintGoalsandObjectiveswithNear,IntermediateandLongtermTime FrameCharacteristicssummarized AppendixIII Thankyou! AppendixIV RegionalPlanningDistrictCommissionMeetingHandout What swrongwiththispicture? AppendixV AboutOneCare o Mission,Vision,Values o StrategicGoals o ServiceRegion AppendixVI Adopt ARecommendation 2 3

5 SouthwestVirginiaAssets 4 3

6 LetterofIntroduction June 2011 Dear Reader, There is much to celebrate in Southwestern Virginia. We are a proud, astute and tenacious people with a rich culture that extends back many generations. But the health of our culture and the extraordinary resilience of our families are being threatened by the confluence of poverty, poor health choices regarding diet, exercise and tobacco abuse, limited access to health care and, over the past decade, a persistent increase in substance abuse and misuse, particularly prescription drugs. It is hard to overstate the problem of substance abuse in Central Appalachia, including the counties of Southwestern Virginia. The facts that you will see in this Blueprint are stark: there is a mounting death rate from the unintentional, fatal overdose of prescription drugs; an escalating number of children in foster care due to substance abuse; and, an increasing level of drug-related crime. Finding solutions to this deepening crisis has been extremely difficult because of the magnitude of the problem across all of Central Appalachia, limited resources, growing but still very limited treatment options and the lack of a coordinated approach. But there is hope. Thoughtful and dedicated people, agencies and coalitions in our region have been working diligently on improving this situation for a number of years. And over the past year, leaders from health, government, education, law enforcement, and the business and faith communities in our region have come together with the treatment and recovery communities to give birth to a coordinated approach for our area, moving us toward a posture of prevention, a recovery-oriented system of care and other systems-based solutions. While the region has long welcomed partnership from external sources, we know we cannot merely sit and wait for help as substance abuse ravages our communities. With the leadership of our regional consortium, One Care, and the encouragement of our Southwest Virginia Health Authority, this Blueprint was created to provide a summary of the scope and characteristics of the region s substance abuse issues. Vision and mission statements were written to unite us in addressing these problems and a set of specific goals and objectives were designed to provide a roadmap for our regional comprehensive response, the opportunity to discover new solutions, and a call to action our internal and external partners can rally around. We welcome your assistance in adopting or implementing any of these needed actions or identifying others and recognize and applaud the many areas where some of this work is already ongoing; in many places and by many hands. This Blueprint gives testimony to our belief that a committed community is the best solution to significant problems. We believe that all available resources, both within and outside our region must now be garnered for lasting personal, community and policy change involving education, prevention, treatment and control. Because we have some of the most severe challenges in the 5 4

7 nation, we must now strive to become one of the best and healthiest places to live, learn, work and play. We invite you to engage with this Blueprint, be part of the solutions it offers, and add your voice to transforming our health and securing our future prosperity. Sincerely, Senator John S. Edwards Senator W. Roscoe Reynolds Senator Phillip P. Puckett Delegate Joseph P. Johnson, Jr Delegate Clarence E. Bud Phillips Delegate Ward L. Armstrong Delegate Terry G. Kilgore Delegate James M. Shuler Delegate David A. Nutter Delegate Charles Bill W. Carrico, Sr. Delegate Anne. B. Crockett-Stark Delegate Charles D. Poindexter Delegate James W. Morefield The following elected representatives express their support of One Care s mission: James H. Jim Webb, Jr., U. S. Senator Mark R. Warner, U.S. Senator Howard Morgan Griffith, U.S Congressman 6 5

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9 Introduction:Challenges,NeedsandSolutions If you wish to know the road up the mountain, you must ask the person who goes back and forth on it. Ancient Proverb ThemissionofOneCareofSouthwestVirginiaistodecreasesubstanceabuseandmisuse,andrelatedsocial, economicandhealthfactorsthroughplanning,policy,data,andadvocacy.ineffortstofulfillitsmission,one CarehasfocusedondevelopingaBlueprintforSubstanceAbuseandMisuse:Prevention,Treatmentand Control.Thesethreecomponentsareseenasalogicalresponsetothethreeprimeelementsofthe drug market,namely(1)potentialusers,(2)users,and(3)sellers. Attentionisfocusedonpreventingpotentialusersfromenteringintosubstanceabuse,treatingandassisting drugusersintheirrecoveryfromdrugabuseandaddiction,andcontrollingdrugavailabilityandthebehavior ofthosesellingdrugs.thevisionforthisblueprintwasdevelopedinresponsetothesouthwestvirginia HealthAuthority sgoalofaddressingsubstanceabuseandaddictioninourregionandgivesdirectionto achievingthatgoal.theprocessofdevelopingthisstrategicplaninvolvedthereviewofcurrentresearchon substanceabuseandaddiction,includingeffectiveevidencebasedpractices;evaluatingandassessing communityneeds;andholdingfourcommunityforumsineachofourplanningdistrictstoincorporatethe viewsoftheresidentsofsouthwestvirginiaandconcernedcitizensfrombeyondourborders.theresulting goalsandobjectivesrepresenta roadmap formovingforwardasaregiontobetteraddresstheepidemicof substanceabuseandaddictioninsouthwestvirginia. TheproblemofsubstanceabuseandaddictionhasseverelyimpactedthecommunitiesofSouthwestVirginia. Increasesinaccidentaloverdoses,substanceexposedinfants,emergencyroomvisits,drugrelatedcrime,and childrenenteringfostercarearealldirectlyrelatedtotheincreaseinratesofsubstanceabuseandaddiction. Themonetarycostoftheseproblemsisenormous,withtheStateofVirginiaconservativelyestimating$613 milliondollarsbeingspentontheeffectsofsubstanceabusein2006.thisfiguredidnotaccountformany relatedcostsandtheactualfigureislikelymuchcloserto$1billiondollarsannually,withtaxpayersbearing theburden.beyondthefinancialexpenseisthepersonalandfamilialcost:brokenfamilies,childabuseand neglect,poorhealth,joblessness,homelessness,isolation,anddesperation.theproblemofsubstanceabuse andaddictionisgrowingandbothourcurrentandpreviouseffortstoprevent,treat,andcontrolithavenot yetturnedthistragictide.itisclearthatweneedtoimproveourresponse. Thefollowinggoalsandobjectivesprovidestrategicstepsforimplementingsuchachange.Theyareclearand measurable,anddrawupontheideasexpressedfrommanydifferentperspectivesincommunityforums throughoutourregion.implementingthesegoalsandobjectiveseffectivelyrequiresanapproachthatis groundedbydocumentedsuccess.suchanapproachiscommunicatedthroughoutthegoalsandobjectives, butwheretreatmentisconcerneditisexplicitlyidentifiedinthegoalstocreatearecoveryorientedsystem ofcare.allofthegoalscanbebestachievedthroughacollaborativesystemthatworksdeliberatelytowards integrationandcanrespondquicklyandappropriatelytotheneedsoftheindividual,thefamilyandthe community. Whethertalkingabouteducatingthecommunity,developingenvironmentalstrategiesforprevention, expandingaccesstotreatment,supportingtherecoverycommunity,orestablishingdrugcourts,theworkis betterachievedthroughanefficient,coordinatedresponsethatinvolvesmultipledisciplines,agencies,and 8 7

10 individuals.arecoveryorientedsystemofcaremovesusforwardincombiningthestrengthsofvarious groupsandfillingthegapsthatcurrentlyexistwithourseparate,andtoooftenpoorlyalignedortoo fragmented,approaches. Researchshowsthatsuchanintegrated,coordinatedcommunityresponsefocused onrecoveryismoreeffectiveinpreventing,treating,andmanagingthechronicconsequencesofsubstance abuseandaddictionthanaresponsethatisfragmentedorfocusedprimarilyonpenalties. ARecoveryOrientedSystemofCarecreatesasystematicresponse,onethatisfast,fluidandflexible,meeting needsastheyariseandchangingthroughoutthecontinuumofcare.suchasystemofcareincorporates effortsfromallinthecommunity,makingtheprocessofrecoverymoreseamlessandholistic.arecovery OrientedSystemofCareiscreatedbythecommunity,forthecommunity.Itfunctionsandismaintainedby agencies,coalitions,groups,andindividualspartneringforrecovery.asthegoalsandobjectivescontainedin thisdocumentunderscore,buildingandoperatingarecoveryorientedsystemofcareisourbestresponseto thesuccessfultreatmentofsubstanceabuseandaddictionandaddressingthe buyer sideofthistragic market. Asthedocumentalsoclearlyidentifies,themarketthatwouldsellharmfuldrugstopotentialbuyersforprofit canalsobefrustratedbypreventionandeducationefforts.theblueprintcallsforacomprehensiveand multilayersustainedcampaignaimedatcreatingwisermoresophisticatedindividualslesspronetoignorance ofthedangersortotheliterallypoisonousmessagesandtemptationsofsubstancemisuseandabuse. Finally,thesellerside thesuppliersofthismarketmustbebettercontrolled.thesuppliercantakemany formsincludinga friend ataparty,afamilymemberwholeavespainmedicinebottlesaccessibletochildren orothers,adupedlicensedprescriberoradeliberatedealer.therearecontrolopportunitiesatmanypoints onthissupplychainandthisblueprintdescribesmanymeasurablewaystofrustrateandcurtailthesupplyside ofthismarketequation. Asweknowfromourlifeexperience,seldomisthereasingle, magicbullet solutionforproblemsthathave manyunintendedandseriousconsequences.witnesstheseemingsolutionofputtingpseudoephedrine behindthecountertocurtailmethamphetamineproduction.itworkedforatime,butthewithoutasolid RecoveryOrientedSystemofCarefortheexistingaddicts,thedemandremained,profitcouldbemadeand themarketdevelopedother,morepervasiveandsometimesmoredangerousroutesofsupply. Evenifwecouldwaveamagicwandandstopeveryprescriptionthatwouldultimatelybemisusedorabused frombeingwrittenordispensed,the market wouldrespondandwewouldfindthatothersupplierswould moveintofillthevoid.ashasbeenthecaseinotherplaces,wemightfindsuchnewsupplierstobeofthe moredangerous,violentandruthlessvariety.historyandheadlinesinstructus:thisisnoteasy.thesubstance abusemarketislikethehydraofgreekmythology,cutoffoneheadandtwomoregrowback.simplefixesor solutionsthataddressonlyonepartofthemarket,howeverwellintendedorlogicalintheirconception,have notbeensuccessfullongtermandarefraughtwithunintendedconsequences.theapproachforalongterm solutionforthisepidemicmustbemultilayered,multifacetedandaddressalltheplayersinthemarket includingexistingusers,thoseatriskforuseandthosewhosupply.thatiswhatthisblueprintseekstodoand withthesupportofourcommunity,canaccomplish. 9 8

11 EffortstoAddressSubstanceAbuseinSouthwestVirginia 10 9

12 ThePlanningProcess Inthespringof2010,OneCareofSouthwestVirginia,Inc.embarkedonaprocessthatwouldserveasaguide toreducingsubstanceabuseandmisuseinsouthwestvirginia.modeledontheworkofthesouthwest VirginiaHealthAuthority,OneCaredeterminedthatacomprehensivestrategicblueprintwasthemost effectivetooltoserveasthatguide.onecareworkedcloselywithover16substanceabusepreventionand treatmentcoalitionsinsouthwestvirginiatodeterminethataseriesofmeetingsneededtotakeplaceineach ofthefourplanningdistrictsinsouthwestvirginia.inordertobuildthefoundationfortheblueprint,apriority wassettobeinclusiveoftreatmentproviders,employers,humanservicesagencies,localgovernment, legislators,lawenforcement,therecoveryandfaithcommunitiesandotherconcernedcitizens.a comprehensivedatabasecontainingmorethan2800nameswasdevelopedandonecareextendedinvitations toabroadrangeofparticipantswhowouldoffertheirperspectiveontheissues. Eachofthemeetingswasleadbyaprofessionalfacilitatorwhoemployedaprocessconducivetofrank discussionandmaximizedtheamountofinformationandperspectivesgatheredinordertoaccurately representthesituationinsouthwestvirginia.theendproductofthosemeetingswasacomprehensivelistof strengths,weaknesses,opportunities,threatsandpotentialpointsofadvocacy.alsoincludedintheinitial documentswerepreventionandtreatmentstrategiesneededtomeetthemissionofreducingsubstance abuseandmisuseinsouthwestvirginia.afterthemeetings,ablueprintwritingteamwasformedto transformthemorethan200actionitemsreceivedintomeasurablegoalsandobjectives.whilethetasks includedidentifyingandeliminatingredundanciesintheinitialdocuments,ahighprioritywasplacedon preservingtheintegrityandspiritoftheideasandrecommendationsprovidedineachofthefourplanning districts. TheBlueprintwritingteamgroupedthestatementsbycategory.Likemindedstatementsandideaswere combinedand,whereneeded,rewordedformeasurability.oncethistaskwascompleted,thestatements wereagaincategorizedasgoalswithcorrespondingobjectives.additionally,thewritingteamdevelopeda timeframethatwasfelttoberealistictoaccomplisheachobjective.thetimeframeswereidentifiedasnear term(n)at02years,intermediateterm(i)at35yearsandlongterm(l)at610years.eachmemberofthe writingteamcontributedmanyhoursofprofessionaltimeinpreparingthisdocument,giventheextensive amountofinformationthatwasreceivedfromtheregionalmeetingsandtheprocessoforganizingand analyzingthedatainamannersuitableforpublication

13 Vision/Mission Inputs Outputs/Outcomes Implementation/ Impact Problem Statements Community Input Health Resources Data/Evidence Current Activities Workforce Outcomes Short-term Vision One Care s vision is to be a model for achieving significant reduction in substance abuse and related social, economic and health factors by building and supporting community partnerships. Single Integrated Strategic Plan Objectives Resouces & Funding Goals Outcomes Mid-Range Systems Outcomes Long-term Mission One Care of Southwest Virginia is committed to decreasing substance abuse and misuse, and related social, economic and health factors through planning, policy, data, and advocacy. 11

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15 TheContext:RegionalHealthDatafocusedonSubstanceAbuse&MentalHealthin SouthwestVirginia Descriptionoftheregionanddatasources ThisreportcontainsinformationontheVirginiaDepartmentofHealthSouthwest(SWVA)PlanningDistricts (Lenowisco(PD1),CumberlandPlateau(PD2),MountRogers(PD3)andNewRiver(PD4)andtheStateof VirginiausingdatathatwereavailablebyApril2011frommultiplepublicdatabases.Somemorerecentdata sourcesmaybeavailablefromthestatepoliceusingarrestrecordsorfromthelocalcommunityservice Boards(CSBs)basedoninformationgainedviafacetofaceevaluationmadeduringemergencymentalhealth crisisevaluations,whichtypicallyincludeasubstanceabuseassessment.however,thosedataarenot currentlyavailable.availabledatawereanalyzedandtheresultsarereportedbelow.populationdatais basedonthe2010censusonlinedatabase 1. Population BasedonthemostrecentdatafromtheU.S.Census 2,7.25%(n=579,982)ofVirginia spopulationofover8 millionpeople(n=8,001,024)liveinthefourpds.accordingtothemostrecentcensusestimates,thereisa contrastinpopulationmovementtrendsinthecommonwealthofvirginiaasawholecomparedtoswva. Statewide,Virginiaby2010hadanoverallincreaseinresidentsofabout13%,whichcomparestothe14% increaseinvareportedin2000.thereare134countiesandcitiesinthestateand21arelocatedinswva. Accordingtotheestimateddata,thereare36counties/citiesthatwereanticipatedtohaveadeclineintheir population.ofthese,10werelocatedinswva,whichindicatesthathalf(47.6%)ofthecities/countiesin SWVAwereestimatedtohaveadeclineintheirpopulationfrom2000to2009.Theactualresultsusing2010 censusdatashowthat8countiesinswvalostpopulation,8countiesgainedfrom05%oftheirpopulation,4 countiesgainedfrom610%oftheirpopulationandonlyonecountygained13%ofitspopulation,whichwas thesameasthestaterate.insummary,consideringall4pd,thetotalpopulationincreases3%(n=15,518).the attachedpdffileshowsthenumbersandpercentageofpopulationgain/lossbycounty.montgomerycounty showedthelargestgainandgrayson&buchananshowedthegreatestloss.pds Race&PlaceofBirth Accordingthe2010census,94%oftheresidentsinSWVAareWhiteand3.0%areAfrican/Americanwith3%in othergroupscomparedto68.6%whoarewhiteinva,19.4%areaawith12.0%othergroups.thepopulation ofhispanicsinswvaisverysmall.inswva,69%ofthepopulationwasborninthestateand29%migrated fromotherstateswithinus,typicallysouthernstates.invirginia52%ofthepopulationwasborninthesame stateand38.5%areusmigrants[nodataavailableyet].otherracesarelowerinfrequencies.5.5%wereasian invirginiacomparedto1.2%inswva.somepeopleinvirginiareportedhavingtwoormoreraces,3.1%inthe (USCensushttp:// January

16 Stateand1.2%inSWVA.Lessthan1%reported other ;beinglowerintheproportioninswvathaninthe State. Figure1.WeldonCooperCenterMapusingnonpublicdata,SWVAislocatednear/intheoval. Education,Poverty&Income Accordingtothe2000Census,theeducationalattainmentforpeople25yearsandolderinVirginiawashigher thaninswva.inswva,29.9%ofthepopulationattendedschoolbutdidnotcompletehighschoolcompared to17.5%ofthepopulationofva.abouthalfofthepopulationinboththeregionandthestateasawhole completedhighschoolorcompletedhighschoolplussomecollegeuptoanassociatedegree(52%inswva and54%inva).however,thoseinswvaaresignificantlylesslikelytohavereceiveda4yearcollegedegree orhigher.inswva,14.4%ofthepopulationhadabachelor sdegreeorhighercollegeorgraduatedegree comparedto29.5%ofthepopulationofvawhohadabachelor sdegreeorhigher.fromthematchcounty healthranking,70%ofthepopulationwithinthe4pdshasreportedhighschoolgraduationinswva comparedto76%invaand50%hassomecollegeinswvacomparedto65%inva.thenumbersofpeople livinginpovertyissignificantlyhigherinswvathaninva.fromcensus2000,thepercapitalincomelevelof thisregionis67.1%ofthestate.onaverage,thepercapitalincomeinswvawas$16,079whileitwas $23,975fortheVA.The estimatedmedianfamilyincomewas1.6higherinthestatethanthe SWVA($72,733inthestatevs.$45,340inSWVA.FromtheMATCHcountyhealthranking,24%ofthechildren areinpovertyinswvacomparedto14%onthestate. EmploymentandHealthInsurance ThemostcurrentdatafromtheBureauofLaborStatistics,fromJan2010toFeb2011,showedVAhadarate of6.4%unemployedpeoplewhileinswva,itrangedfrom6.9to13.4%acrosscountieswith26,350people withoutjobs,onaverage10.6%ofthepeopleinlaborforcewereunemployed.theseratesexcludethosewho aredisabledandnolongerlookingforwork.thesmallareahealthinsuranceestimatesfromthecensus Bureauprovideannualestimatesoftheadultswithouthealthinsurancecoverage.Anestimated15%oftheVA populationfrom1864yearsoldinvirginiaiswithoutinsurancecoverage.theestimatedratesinswvarange from12to26%.theseestimationshavevariabilityaccordingtothevirginiadepartmentofhealth(vdh).vdh 14 15

17 hasestimatedthat12.6%ofthevirginiaresidentsdidnothaveinsurance;and20.5%,23.5%,20.3%and15% ofthepopulationbetween18and64inplanningdistrict1to4,respectivelydidnothaveinsurancein2010. MortalityRateforAllCauses ThecrudemortalityrateforallcausesinVAis752deathsper100,000peopleusinganaveragefor TheaveragemortalityrateinSWVAis1,161deathsper100,000(averagefrom ). OverallMentalHealth AccordingtoVDH,9.3%oftheadultsinVirginiareportedfrequentpoormentalhealthdays,whichmaybe relatedtountreatedpsychiatricdisordersand/orsubstanceabuseorpoorsocioeconomicconditions.swva hastwopdswithsignificantlyhigherfrequencyofreportsofpoormentalhealth.onaverage,16%ofthe SWVApopulationreportedhavingpoormentalhealthdays.Also,theestimatednumberofdaysresidents havepoormentalhealthdaysishigherinswvathaninthestate.fromthecentersfordiseasecontrol(cdc) BehavioralRiskFactorSurveillanceSystem(BRFSS),thenumberofdaysofpoormentalhealthisestimated usingtheaveragenumberofdaysthatanadultlivinginthecountyrespondedtothequestion Thinkingabout yourmentalhealth,whichincludesstress,depression,andproblemswithemotions,forhowmanydaysduring thepast30dayswasyourmentalhealthnotgood? InSWVA,theaveragewas4.83dayscomparedto3.2 daysinthestate.morepeopleinpd1and2whopresentedatacommunityserviceboard(csb)displayed overtindicationofdangertoselfthaninva(47.5%inswvacomparedto37.1%va). EstimatedRatesofSubstanceAbuseinSWVAandVA DrugandAlcoholAbuse Basedonthe datafromtheNationalSurveyonDrugUseandHealth(NSDUH),thecreatedvariable fortheregionofvirginiathatincludedmostofswvaalsoincluded19countiesthatwerenotinswva.as such,theinformationthatfollowsislimitedinwhatitshowsspecificallyaboutswvabypd(dataforspecific countiesinswvaisnotcurrentlyavailablefromthensduh).overall,thissnapshotofva,whichincludes DanvilleandLynchburg,hassomewhathigherestimatedsubstanceuseinalmostallcategoriesmeasuredin thesurvey,alcohol,tobacco,andillegaldrugcomparedtothestate.however,thedifferencesarenot statisticallysignificant.thesurveyestimationisamongpeople12yearoldandover. BingeDrinkingRatesandTobaccoUse AnnuallytheCenterforDiseaseControlandPrevention(CDC)estimatestheBingeDrinkingpercentageand otherriskfactors,suchastobaccouse,withinthepopulationusingthebehavioralriskfactorsurveillance System,whichconsistsonarandomdigitaldialsurvey.Responsesarebiasedtowardthosewithtelephone andwillingnesstoparticipate,whichmaymissthehighestusers.however,similarresidentofvirginiacanbe compared

18 BingeDrinking ResidentsinSWVAarelesslikelytoreportbingedrinkingthanarethosestatewidewhoparticipateinsurveys. Usingthe data,itisestimatedthat9.12%ofthepopulationinSWVAreportengaginginbinge drinkingcomparedto14%ofthepopulationwhoreportbingedrinkinginthestateasawhole.thebinge drinkingrateisthepopulationover18yearsoldwhoconsumedmorethan4drinksinarowforwomenor5 drinksinarowformenofalcoholicbeveragesonasingleoccasioninthepast30days. TobaccoUse TheChronicDiseasePreventionandControlDepartmentinVirginiaDepartmentofHealthhasreportedthe tobaccousebyplanningdistrictconcludingthatpd1and3havethehighestcurrentsmokingrateinthestate (>29%).PD3hasthehighestpercentageofadultsreportingsmokingallowedinthehome(45%)whilethe stateis24%.alsoinpd3,45%oftheemployedadultsreportedthatsmokingisallowedinindoorworkareas meanwhilethestaterateisonly25%. NegativeConsequencesAssociatedwithSubstanceAbuseand/orMentalHealthProblems Onestudyofover20,000Medicaidclaimsfromsixstatesfoundthat52.5%ofpatientshadbothhighseverity ofpsychiatricandsubstanceusedisorders,19.8%hadhighseverityofsubstanceusedisordersandlow severityofpsychiatricdisorders,19.4%hadhighseverityofpsychiatricdisordersandlowseverityofsubstance usedisorders,withonly8.2%havinglowseverityofbothsuggestingthatcommunityprovidersandpolicy makersmustconsidertheoverlappingconditionsinplanning(mcgovernetal.,2007). 3 Theproblemsassociatedwithsubstanceabuseand/ormentalillnessincludeunemployment,homelessness, caraccidents,childreninfostercare,violence,unintendedinjuries,suicide,homicide,andmanyothers.direct linkstosubstanceabuseandtheoutcomesnotedaboveweremadetothefullestextentpossible;otherwise ratesarestatedwithoutrespecttodocumentedcause.ratesofunemploymentarereportedabovesinceitis notpossiblewiththeexistingdatatodeterminewhetherornotunemploymentwasrelatedtosubstance abuseand/ormentalillness. RatesforanumberofhealthandbehavioralproblemsarehigherinthisSWVAregionthaninthestate.For example,11.4%ofinjuryrelateddeathsoccurredinswvawhileonewouldexpecttheratetobeinparity withthepopulationataround7.24%ifallthingswereequal. CarAccidents Accordingtothe2009FatalityAnalysisReportingSystem,therewere695caraccidentsregisteredinthestate. In32.7%(227)oftheaccidents,thedriverwasdrunk.ForSWVA,in21%(n=16)oftheaccidentsthedriverwas drunkcomparedto32.7%(277)oftheaccidentsstatewide.however,themotorvehiclecrashdeathratein SWVAisdoublethatofthestate.Virginiahasacruderateof13deathsper100,000andSWVAis26deaths 3 McGovernMP,ClarkRE,SamnalievM.(2007)Cooccurringpsychiatricandsubstanceusedisorders:Amultistatefeasibilitystudy ofthequadrantmodel.psychiatricservices,58(7),

19 per100,000.statisticoncaraccidentsduetobeinghighorintoxicatedorbecomingunconsciousarenot available.theserateswerecalculatedusingreportsofthenationalvitalstatisticssystemfrom2000to2006 bythenationalcenterforhealthstatisticsatcdc. SubstanceAbuseandChildreninFosterCare AccordingtotheVirginiaDepartmentofSocialServices,approximately19percentofchildrenenteringfoster careinvirginiahaveanindicatorofparentdrugabuseandabout6percentofparentalcoholabuseinthe fiscalyears withineachplanningdistrict,therewassubstantialvariationamongthelocal departmentsofsocialservicesinindicatingbothparentdrugandalcoholabuseforchildrenenteringfoster care. ParentDrugAbuse AlloftheplanningdistrictsinSWVAexceededthestatewiderateofindicationofparentdrugabuseassociated withchildreninfostercareduringthistimeperiod.nearlyonethird(32%)ofentriesintofostercareforswva indicatedparentdrugabuse.withintheswvaentries,overhalfoftheentries(58%)werefrompds1and2. PlanningDistricts1and4hadthehighestratesofparentindicatorsofdrugabuseduringthisthreeyear period.therateinpd1(42%)wasmorethandoubletherateforthestateandinpd4(33%)wasalmosttwice thestatewiderate. ParentAlcoholAbuse AlloftheplanningdistrictsinSWVAexceededthestatewiderateofindicationofparentalcoholabuse associatedwithchildreninfostercareduringthistimeperiod.however,onlytherateinpd3appeared substantiallyhigherthanthevarate.inpd3,11%ofthechildreninfostercarehadaparentalcoholabuse indicatorcomparedtothestatewiderateof6%,inotherpdsthepercentageisaround9. InjuryRelatedDeaths Injuryrelateddeathsincludedeathbyanymeansincludingsuicideandhomicide.InVirginia,37,857deaths occurredduetoinjury,whichisarateof51deathsper100,000peoplecomparedto76deathsper100,000 peopleinswvaor11.8%(4,468)ofthedeathsoccurredinswva..during ,theinjuryageadjusted deathrateinpd2istwicethatofva. Overall rates of death by suicide and homicide may result from different mechanisms; such as the use of firearms, poisoning (overdose of any substance such as alcohol, drugs or any other substances). Further examination of suicide by poisoning, which is mostly related to overdose death due to substance abuse, is reported separately. However, these may be under reports since some suicides and homicides may also have involved substance abuse that was not documented

20 DeathsbySuicide Countingonlysuicides,theageadjusteddeathrateinsomePDsinSWVAisalmosttwicetherateoftheState. ThetotalnumberofsuicidesinVirginiais8,302,ofwhich12.13%(n=1,007)oftheeventswereinSWVA.The Virginiasuicideageadjusteddeathrateis11deathsper100,000and17deathsper100,000peopleinSWVA. Mostrecentannualdatashowthattherewere160suicidedeathsduetopoisoning(e.g.drugoverdose)in SWVA,or11.1%oftheVAcases(n=1,446).AgeadjusteddeathratesarehigherinthefourPDsofSWVAthan inva.itis2.9per100,000infarswvaand1.9per100,000peopleinthestate.lenowiscorateismorethan twicethestaterate. DeathsbyHomicide Countingonlyhomicides,ageadjustedmortalityrateislowerinSWVAthaninVA.Therewere4,243deathsin Virginiaduetohomicideofwhich226deaths(5.3%)occurredinfarSWVA.Deathratesare4.0and5.6per 100,000peopleinSWVAandVirginia,respectively.Therewereonly11homicidesduetopoisoning;however, noneofthemoccurredinswva. FatalUnintendedDrugOverdoses In2008,theVirginiaMedicalExaminerreportedthefataldrugoverdosesratesincountiesinPD1and2in SWVA.Theageadjusteddeathratefromfataldrugoverdosewas40%comparedto8.3%forthestate.The rateinswvacountieswasfrom2.5to6timesthestaterate(8.3per100,000). CrimeDataRelatedtoDrugsandNarcoticOffenses Anumberoflawviolationsarecausedbypeoplewhouse,produce,ordistributedrugs.In2009,therewere 44,952drug/narcoticoffensesinVA.AccordingtotheVirginiaStatePolicecrimereport,thenumberofdrug narcoticoffensesisdecreasingovertimeinvirginiaafter2007.in2009,therewere1,163feweroffensesthan in2008and2,837fewerthanin2007.the2009drug/narcoticoffenserateforvais570per100,000people.it islowercomparedwiththerateinswva.inswva,therewere3,623drug/narcoticoffensesfor2009.the SWVAdrug/narcoticoffensesrateis629per100,000.ThechanceofoccurrenceofadrugoffenseinSWVAis higherthaninthestate(12.7%vs.9.11%). ViolencerelatedtoDrugDealinginVirginia Therewere48casesofaggravatedassaultwherethecircumstanceswasdrugdealing.Inaddition,therewere 2,161violentcrimeoffenseswheretheoffender(s)wassuspectedofusingdrugs,includingalcohol.In26 violentcrimes,somedrugs/narcoticswereusedastypeofweapon.moreover,therewere6,155property crimeswheretheoffender(s)weresuspectedofusingalcoholordrugs.robberycases(214)wereexcludedin propertycrimesgiventhattheyarealsoconsideredasviolentcrimes.atotalof$1,204,999indrug/narcotics and$15,688inequipmentwerestoleninaburglaryorobtainedwithafraudulentprescription.in2009,73.2 %($882,201)wasrecoveredfordrugs/narcoticsand5.5($858)inequipment.Ondrugsarrests,marijuana rankedthehighestwith61.1%of32,619arrested.evenchildrenunder10yearsofagewerearrestedfor 18 19

21 marijuanause,butnootherdrug.themonthofmarchconsistentlyshowedthehighestarrestsandoffenses reported. ArrestsandArrestsforDrugOffences TherearemorearrestsforcrimesinSWVAcomparedtoVA,butnotsignificantlymorearrestsrelatedto drugs/narcotics.inva,therewere345,884arrests,whichisanarrestrateof4,388per100,000people comparedtoanarrestrateof5,441per100,000inswva.ofallarrests,almost9%(31,054)occurredin SWVA.InVA,30,074caseswereregisteredduetodrug/narcoticoffenses.Ofthetotalarrests,2,582(8.6%) occurredinswva.the2009drug/narcoticarrestrateswere452/100,000peopleinswvaand382/100,000 peopleinthestateasawhole.therearetwotypeofcrimethatarecategorizedintwogroupsthegroupa includesmurder,kidnapping,assault,drug/narcoticoffences,etc.andthegroupbincludesdrivingunder influence,drunkenness,etc.theincidenceofarrestwaslowerforcrimesincategoriesofgroupathangroup Bcategories.ThearrestrateforgroupAinSWVAis2,116/100,000and1,747/100,000inVA. TreatmentFacilitiesinVirginia OneCareisindebtedtotheHealthyAppalachiaInstituteandM.LeonVerdin,M.S.,Biostatisticianand ElizabethL.McGarvey,EdD,AssociateProfessorofPublicHealthSciencesUniversityofVirginiaSchoolof Medicinefortheirworkincompilingandsummarizingthisdata

22 OneofmanyculturalattractionsinSouthwestVirginia 20 21

23 RESULTSOFTHEPLANNINGDISTRICTMEETINGS GOALSTATEMENTS,OBJECTIVES&RELATIVETIMELINES GOALSANDOBJECTIVES:BLUEPRINTFORSUBSTANCEABUSEPREVENTION,TREATMENTANDCONTROL Goals(lettered)andObjectives(numbered) BlueprintTaxonomy (N)Nearterm=02years (I)Intermediateterm=35years (L)Longterm=610years A. ImproveTreatmentAccessforsubstanceabusingoffenderstoreduceincarcerationcosts,recidivismand familydisruptionandreturnusersbacktogainfulactivity. 1) AdvocateforfundingofandexpansionofexistingDrugCourtTreatmentProgramsin100%of SWVAlocalities(N/I) 2) DoublethenumberofestablishedDrugCourtsinSWVA(currently2)localitiesby2013.(N) 3) ProvideSWVAelectedandjudicialofficialswithreturnoninvestmentinformationonDrugCourts versusincarceration(n) 4) FundandexpandexistingDrugCourtTreatmentProgramsin100%ofSWVAlocalities(I) B. EncourageandsupportexpansionofMutualSupport/PeerRecoveryinSWVA. 1) EstablishatleasttwoMutualSupport/PeerRecoveryGroupsin100%ofSWVA slocalities(i) 2) SupportanelectronicclearinghouseofinformationaboutMutualSupport/PeerRecoveryGroup meetings,placesandtimes(n) 3) PromoteMutualSupport/PeerRecoveryPromotionintheCommunityEducationCampaign(I) 4) SupportPeerRecoveryGroupsgearedtowardsadolescentSAGroupWork(I) 5) Challengeeachfaithcommunitywithmorethan200memberstoopentheirdoorstoatleastone peerrecoverygroup(n) 6) FosteratleastoneAA,NAorsimilarpeerrecoverygroupin50%ofjailsintheregion(I) C. Expandtreatmentoptionsandcapacityandpromoteexistingtreatmentoptions. 1) Promoteexistingtreatmentresourcesfortobaccocessation(N) 2) Createpositivemessagesaboutthebenefitoflocallyavailabletreatmentoptionsincluding methadoneclinicsandresidentialtreatment(l) 3) Establishademonstrationprojectaimedatpartnershipsbetweenbehavioralhealth(CSB)and primarycareclinic(fqhcorprivatepractice)toprovidecreativecollaborativetreatment opportunities(n) 4) Increasereimbursementforintensiveoutpatientsubstanceabusetreatmentservices(I) 5) UtilizeSouthwestVAMentalHealthInstituteinMarionfornewinpatientsubstanceabuseservices (N) 6) Raisetaxesonalcoholandcigarettestoreduceconsumptionanduseadditionalfundsfor preventionandtreatmentactivities(i) 7) Worktowardhaving5%ofallprivatepracticesofferingmedicationassistedtherapyforopiate dependenceinthreeyears;alwaysincollaborationinternallyorexternallywithindividualand/or grouppeerorprofessionalcounselingtherapy(i) 8) Developatleastonelongtermresidentialsubstanceabusetreatmentfacilityineachplanning district(l) 9) Increasefundingforsubstanceabusingadolescenttreatmentgroups(I) 10) Establishatleastonedetoxificationfacilityineachplanningdistrict(I) 21 22

24 11) Developatleastoneregionalwomen streatmentprogramgearedspecificallytowardthe treatmentandprevention/educationofwomen,withaprioritytowardpregnantwomen(i) D. ReducetheincidenceofSubstanceAbuseinSWVA. 1) Assurethatatleastoneprofessionalsociety(e.g.MedicalSocietyofVA,VADentalAssociation,VA NursingAssociation,andVAPharmacistsAssociation)adoptsPrescriptionDrugAbusemitigationas apriority(i) 2) RequirereportingofsuspecteddrugdiversionanddoctorshoppingbyLicensedHealthCare Provider s(lhcp)anddispensersofscheduleii,iii,andivmedication(n) 3) EncouragepharmaciststoprovidefacetofaceverbalcounselingforScheduleIIcontrolled substancesfornewprescriptionsorprescriptionchanges(i) 4) Implement SBIRT (ScreeningBriefInterventionReferralandTreatment)intworegionalprimary careoffices,twoemergencydepartments,threehealthdepartments,sixcommunityhealthcenter sitesandeightcommunityserviceboardsites(i) E. EncouragegreatercollaborationamongLawEnforcementAgenciesandothersworkingtocontrolillegal SubstanceAbuse. 1) Expandabilityoflocallawenforcementtowork/augmentcolleaguesinotherjurisdictions(I) 2) Reducesalesofalcoholandtobaccotominorsbyexpandinglocallawenforcementcompliance checkpartnerships(i) 3) AssistVAStatePoliceineducatingPrescribersandDispensersregardingtheroleofDrugDiversion Agents(N) 4) Achieveavisiblelawenforcementeducationalpartnershipwith10%ofactivePTAs/schoolparent groups(i) 5) Provideinitialandsemiannualtrainingfor25%oflawenforcementinSAofficersregarding substanceabuse,usespeakersbureauforthispurpose(i) 6) Exploretheadvisabilityofrequiring/allowingimmunityforCommonCarrierstodivulgereasonable suspicionofillegaldrugdelivery(i) 7) Provideseminarstargetedtojudgesandattorneysregardingphysicianassistedtreatmentand monitoringinadrugcourtcontext(n) 8) Ensurethatatleastonedrugcourtwillworkdirectlywiththesupportofaphysiciantrainedin addictionmedicine(i) 9) Createreentrycoalitionstoincludecustodial,treatmentandservicepartnersinatleast50%of thelocalitiesservedbyonecarewithinthreeyears(n) 10) Implementanevidencebasedapproachtodecreaserecidivismby25%inatleasttwolocalprison populationsinthreeyears(i) 11) Developaforumtocreatestrongercommunicationbetweenjudges,Commonwealthattorneysand localsheriffdepartmentsineffectivelyusingdrugcourts(n) 22 23

25 F. Createacultureofresponsibilityforsubstanceusecontrolattheindividual,familyandcommunity level. 1) Createandfundacomprehensivecommunicationscampaignfordeploymentineachmediamarket inswva(n) i. Createcommunity/consumer/patientdemandforprescribersandpharmaciststohaveclear painmanagementprogramsforallintheirpracticesandprotocols. ii. Educatethegeneralpublicregardingproperstorageofmedication(seePartnershipfora DrugFreeAmericamaterials) iii. Educatethegeneralpublicregardingnotsharingorsellingabusabledrugs iv. Encouragealltobewillingtobedrugtested v. Encouragealltoaskfamilymembersaboutdruguse vi. Hostatalkshowfocusingonsubstanceabuseandinterviewindividualresources vii. Createa gettingclean showtospotlightsuccessfulandthechallengestosuccessful recovery( shop topbs)(17) viii. Postinformationinlocalpapersadvisingaboutlocaltreatmentservicesforhelp (Pills) ix. Provideeducationregardingproperuseofcontrolledsubstances x. Educatethepublicregardingthegeneticbasisforaddictionandthataddictionisa preventableandtreatablediseaseliketypeiidiabetes xi. FosterpublicawarenessofthedynamicsofaddictionPublicAwarenessoftheDynamicsof Addiction DukeUniversityGuilfordCounty,NCModel FACEITFacingAddiction CommunityEmpowermentInterventionTeamandSAYIT SubstanceAbuseYouth InterventionTeam allevidencebasedactivities xii. Encouragetheavoidanceoftobaccowhichisagatewaydrugforyouth xiii. IncreasecommunityawarenessoftreatmentprovidersandoptionsforSubstanceAbuse xiv. AdoptCelebrateRecoveryandsupporttherecoverycommunity xv. Worktoremovethestigmaofaddiction;acknowledgepreuseandpostusebiochemical differencesbetweenaddictsandnonaddicts xvi. Communicategenderdifferencesinvulnerabilitytoaddiction xvii. Communicatethatmanybehaviorstakentoharmfulexcessarerootedinbiochemicaland anatomicpathwaystoaddiction(e.g.overeating,drinking,sex,gamblinganddruguse) Acknowledgealmostuniversalvulnerability xviii. Stopor callout thesaleofdrugparaphernaliainconveniencestores engagestore ownersinlimitingthisactivity xix. ProvideinformationandstatisticalanalysisoftheSAissuestopartnerentitieslikePTAs, churches,schools,parentsandmakeexpertsavailabletoteachandprovidetoolsand strategiestothesegroups xx. DistributeaDVDoruseYouTubeorothermeanstargetedtointermediatestudents regardingtherisksofdruguse xxi. Partnerwithearlychildhood(PreK)education(e.g.SmartBeginnings)effortsand elementaryeducationtoreachchildrenearlyattheirlevelregardingallharmfulsubstances includingtobacco,alcohol,legalandillegaldrugs xxii. Involveparents/familiesinexplicit(profileactualcases)educationalactivitiestargetedat middleschool xxiii. Worktoincludethebiologyandpsychologyofaddictionintopublicschoolcurriculaand standardsoflearning(sol)goalsandobjectives xxiv. Encouragerecoveryresourcefulnessamongaddicts; beaddictedtorecovery ;counterthe ideathattreatmentisexpensive.peerrecoveryis free 23 24

26 xxv. WorkwithSeniororganizations(e.g.AARP,,AreaAgenciesonAging)toeducateseniors abouttherisksofmisuse,abuse,sellingandenablingdiversion xxvi. Targetphysiciansandprescribers/staffforspecificoutreachtoassistwithimplementation andadherencetobestpractices xxvii. CreateaSA/painmanagementworkplacewellnesscurriculaandencourageitsuse xxviii. Educatethegeneralpublicabouttheproperuseofmethadoneandthedistinctionbetween useforaddictiontreatmentanduseforpainmanagement xxix. Createanadcampaignaimedathighlightingthedangersandexcessesofunnecessary prescriptionsforbenzodiazepinesandsleepaids G. ExpandCommunityTreatmentOptionsandsupportpeerrecovery(groups). 1) CreateatleasttwopeerrecoverygroupsintheregionforVeteranshavingposttraumaticstress disorder(ptsd)oratriskforptsdorothermood/anxietydisorder(n) 2) Identifyanexistingorrecruitaregionalemployertodemonstrateatleastoneemploymentbased recoveryprogramwheretheofferandmaintenanceofemploymentisconditioneduponstayingin recovery(n) 3) Identifyorcreateasourceoftechnicalassistanceforemployerswillingtohaveanemployment basedrecoveryprogram(s),seekadviceofexistingimpairedprofessionalprograms(i) H. ExpandprofessionalandcommunitySAeducationalopportunities. 1) Seekactiveparticipationinsubstanceabuseeducationofatleastonemajorstatewidemedical professionalgroupandatleastonemajorpharmaceuticalsmanufacturer(n) 2) Createaspeakersbureauthatincludesbothacademicormedicalexpertsandrecoveredpersonsto speakindividuallyorinteam(n) 3) CreateaBehavioralHealthASSdegreeinalcoholanddrugcounselingassteptoCertifiedSubstance AbuseCounselorLicensure(I) 4) ProvidecoordinatedannualeducationalofferingsforSAtreatmentprovidersintheregionvia collaborationamonglocalpublicandprivatetreatmentprovidersandprofessionalsgroups(n) 5) RequireprescribersanddispensersofmedicationtoobtainatleastonehourofCMEonSAand painmanagementeachlicensureperiod(n) 6) FundanFTE/50,000populationpublichealtheducator/communityhealthworkersand/ordrug educatorsforsapreventionandoutreachtospecialpopulationsincludingpregnantwomen, veterans,andfamilieswithmultigenerationalsapatterns(i) 7) Developaprogramtargetedatnonprofessionalstobecomecommunitydrugeducatorssimilarto diabeteseducators(i) 8) PromoteSAasachronictreatablediseasemodel(aswithdiabetes)tomedicalprovidersand insurers(n) 9) Encourageundergraduatetrainingprogramsforprescribers,administratorsanddispensersof medications(e.g.physicians,nurses,pharmacists)toincorporateatleasttwohoursofdidactic educationregardingpathophysiology,screening,identificationandtreatmentofaddiction(i) 10) IdentifyorFundanFTE/100,000populationpublichealtheducator/communityhealthworkers and/ordrugeducatorsforsacounterdetailingandbestpractice marketing towardsprescribers (I) 24 25

27 I. ExpandSAeducationopportunitiesforkeycommunityleaders. 1) engageatleast60clergymembersinactivelycombatingsaintheircommunities(n) i. Provideclergywithresourcestoeducatetheircongregationandcommunities ii. ProvidetoolstoassistclergyandchurchleaderstoindentifysignsofSA iii. Haveengagedclergymembersdevelopanddeliverasermononceayearregardingthe misuseandorabuseofsubstances iv. Developasimplesermontemplate 2) HoldatleastonelocalandoneregionalSAcoalitionmeetingannuallyintheeveningtoallowcare providerstomoreeasilyattend(n) J. ExpandformalSubstanceAbuseeducationinSchools. 1) ImplementageappropriateSAeducationinK12healthclassesinatleastfourschooldistricts(I) 2) IncludeSAeducationandmedicationrelatedimpairmentinalldrivereducationclassesinhigh schoolinatleastfourschooldistricts(i) 3) Createschoolhealthcoordinatorpositionsinatleastoneregionalschoolsystemtoincludethe mandateddevelopmentofearly(k7 th )ageappropriatelifetimeathletics(e.g.,running, swimming)andarts(visual,performance)afterschoolschoolassistedprogramsandeplicitly incorporatestayhealthy(eatright,don tsmoke,don tusedrugs)educationandmessagingfor schoolbasedwellness(i) 4) Provideschoolbasedageappropriateearly(K7)lifetimeathletics(running,swimming)andarts (visualandperforming)opportunities,andexplicitlyincorporatehealthandwellnesseducation messagingintotheseactivities(i) K. Advocateformorerobustuserlevelinformationandcontrolofabuseandoverdosepronemedications. 1) PromoteGraphicWarninglabelsusinggraphicdepictionsand/orbasicelementaryreadinglevel language(i) 2) Expandregional TakeBack activities(n) L. SupportPolicyInitiativesgearedtowardsprimarypreventionofmisuseorabuse. 1) DonotallowforthewaivingofpharmacycounselingforScheduleIIcontrolledsubstances(I) 2) RequireprescriberstocompleteCMEpriortorecertificationoftheirDrugEnforcementAgency number/statelicense(i) 3) RequirePrescriptionMonitoringProgramaccessandperiodicreviewforprescribersanddispensers ofscheduledrugs(n) 4) RequireaPMPprofileforanypatientpriortoprescribingaScheduleII,III,orIVsubstance(N) 5) AdvocateforthesimultaneousmultistatesinglepointofaccessPMPprescriptionmonitoring programsandrequirephysicianstouseitassupportedbynasper(i) 6) Requireprovidersofmedicationassistedtreatment(e.g.methadoneandbuprenorphine)to periodicallyreviewpmponactivepatients(n) 7) Advocateforashallreportofsuspecteddrugdiversionbypatientsandprescribers/dispensersof potentiallyaddictivemedication(n) 8) RequirePharmaceuticalmanufacturerstoberesponsibleforproductsfromcradletograveto includepharmacybasedtakebackprogramsforunused/expireddrugs(i) 9) Banthesaleandmarketingofdrugparaphernaliaanddesignerdrugsinretailestablishments(N) 10) Requireperiodicsaliva,urineorhairbaseddrugscreeningforanypersonreceivingaScheduleII,II orivmedication,thedrugscreeningtoincludethedrugprescribedandothercommonlyabused medications(i) 25 26

28 11) Exploreevidencebasedprogramsthatusewebbasedexposureofconvicteddrugsellersfor reducingcrimeandrecidivism(n) 12) AdvocateformovingbenzodiazepinestoScheduleIIstatus(DrugEnforcementAgency)(I) 13) Achieveatleastonenosmokinginpublicplacesordinanceinatleastoneofourlocalitieseach year,postsignsatcommunityevents(n) M. Focusadditionalefforttowardsjobcreationandencouragementfordisabledadultsandunderemployed youngadultsthrougheducation,entrepreneurismandretraining. 1) Reducetheincidenceandprevalenceofunnecessaryregionaldisabilitybytwopercentinfiveyears (I) 2) Decreasetheunemploymentratefor1824yearoldsbytwopercentagepointsinfiveyears(I) N. IdentifygapsinregionalresearcharoundunderstandingSA,itsimpactandbestpractices. 1) Identifyorinitiateacomparativestudyoftherelativecostsofanystateprogramthatworkswith substanceabuserswhouseillegalsubstances(i) 2) EngageanUniversitytoidentifyaregionorlocalitythathassuccessfullyanddefinitivelyreducedits SAoroverdosedeathratesandidentifythekeyfactorsthatmaybeadoptedregionally(N) 3) EncourageagroupofengagedcommunitymemberstostudybestpracticesinSApreventionthat canbeimplementedlocally(n) O. Seekadditionalresourcesforcommunityandregionallevelcoordinationandcollaborationactivities. 1) Obtainorretainfundingforregionalconsortiumandcoalitionstafffrommemberentitiesand otherstakeholders(i) 2) Worktohaveatleast60%ofourcountiesandcitiesreceivingatleastoneDrugFreeCommunities grantby2013(n) 3) Seekstatesupporttodevelopa OneStop initialassessment,referralandcarecoordination resourceforconsumers(includinginfants,pregnantwoman)ofsatreatmentineachlocalityinan existingagencyasanentrypointintoarecoveryorientedsystemofcare(i) P. ExpandtheprofessionalSAworkforceavailableintheregion. 1) IdentifyasourceofloanrepaymentfortwolicensedSAprofessionalsannuallywhoagreetowork foraminimumperiodinanunderservedlocality(n) Q. ImplementaRecoveryOrientedSystemofCareregionally. 1) Worktocreateaunified,evidencebasedandconsistentregionaltreatmentSYSTEMthatlinks existingtreatmentresources,(behavioral,social,communitybased,faithbased,drugoffender rehabilitation,privatepracticeandothers)intoaseamlessyetflexiblerecoverysystemforabusers thatcreatesmeasurablesuperioroutcomesinaregionalrecoveryorientedsystemofcare(n) 2) DeveloparapidlyresponsivesystemofSAtreatmentforparentsandchildrentargetedtofamilies whosechildrenareatriskofcomingintofostercarethrufostercareprevention(i) 3) Assurebestpracticesforthecontinuedavailabilityofpainmanagementservicesinbothprimary careandspecialtysettings(n) 26 27

29 AutumnalongtheNewRiverTrailinSouthwestVirginia 2 27

30 APPENDICESIVI 28

31 AsnowcoveredGazeboinSouthwestVirginia 30 29

32 APPENDII TextofLetterofInvitationtoattendRegionalMeetings Asathoughtleader,stakeholderorcitizenconcernedaboutthetragicimpactofsubstanceabuseonour economy,ourchildren,ourfamiliesandourwonderfulwayoflifeinsouthwestvirginiaandcentral Appalachia,weinviteyoutocontributeyourbestactionableideasatoneoffourplannedregionalstrategic planningsessions.throughthisinclusiveprocess,wewillcreateourblueprintforsubstanceabuseand Misuse:Prevention,TreatmentandControl.Tofacilitateyourparticipationandcontribution,sessionswillbe heldthroughoutourregion.whetheryoulive,work,learnandplayinsouthwestvirginiaorinaneighboring regionorstate,wewantyourinput. Whiletherearescoresofpublicandprivateagencies,coalitions,faithbasedcommunities,business,recovery communities,electedofficials,professionalsandotherswhoareengagedinvitalworktoaddressaproblem thathasdisproportionallyimpactedourregion,webelievethereisaneedtofurthercollaborateandcontinue thisgoodwork,strategicallyleveragingourresourcesandourcommitment.informedbythegroundbreaking workofthesouthwestvirginiahealthauthority sblueprintforhealthimprovementandhealthenabled Prosperityweseektocreateablueprintwithsharedandmeasurablegoalsandobjectivesthatcaninformand invigorateourworkandspurustoenhance,fosterorcreateopportunitiesthatwilldramaticallyreducethe impactofsubstanceabuseandmisuseinourregion.togetherwecanstaunchthedrainonourregion s reputation,physical,economicandmentalvitalitycausedbysubstanceabuse. Thestatisticsarealltoowellknown.Withover200drugoverdosedeathseachyearinSouthwestVirginia since2003,atrates3,4and5timeshigherinsouthwestvirginiacommunitiesthaninournationorstate,we havelostmorethan2000peopletothisepidemicinthisdecade.thesearemothers,fathers,brothers,sisters, children,andfriends.theselossescannotcontinue.asterribleandtragicasthesedeathsare,theydonot begintocountthenumberoflivesimpactedthechildrenabandonedanddisplaced,thejailsfilledto overflowing,thehugepublicandprivateexpensesandtheeconomicopportunitieswehavelosttosubstance abuse.unfortunately,thisproblemisrisingrapidlyinotherpartsofourstateandnationaswell.fortunately, ourregionispositionedtobeamongtheleadersinaddressingit. OneCareofSWVAisaregionalconsortiumofcoalitionscommittedtodevelopthis Blueprint inaninclusive process.weunderstandthat iftheproblemisinthecommunity,thesolutionisinthecommunity andwe wantyou,asakeyleader,tobeapartofourmutualefforttowardsolutions.placematters,andherewehave aproudhistory,arichcultureandabeautifulplacetolive.wemustnotallowsubstanceabusetocontinueto robusofprosperity,healthandhappiness. Pleasejoinusononeofthedatesbelow. Thursday,July8,2010 RussellCountyConferenceCenter,Lebanon,VA Friday,July9,2010 DaltonCantrellHall,MountainEmpireCommunityCollege,BigStoneGapVA Thursday,July22,2010 WythevilleMeetingCenter,Wytheville,VA Friday,July23,2010 NewRiverValleyCompetitivenessCenter,Fairlawn,VA Allmeetingsare9a.m. 1p.m. Registrationandnetworkingwillbeginabouthalfanhourbeforeeachmeeting.Lunch,refreshmentsand publicationoftheblueprintwillbeprovidedthroughagenerousgrantfromtheverizonfoundation.to 30 31

33 RegisterfortheSummitgoto: scounty HealthRankings,TheBlueprintforHealthandHealthEnabledProsperity,anddirectionstotheseregional meetings. ThisimportanteventisspearheadedandmadepossiblebytheagenciesandcoalitionsthatmakeupOneCare ofswva.theseincludeourregionscommunityserviceboards,departmentsofhealthandsocialservices, recoveryandfaithbasedcommunities,businesses,legalandprofessionalcommunitiesandotherconcerned stakeholders.specialassistanceandsupportisprovidedbythesouthwestvirginiahealthauthority,healthy AppalachiaInstitute,EastTennesseeStateUniversityandVirginiaEconomicBridge. Sincerely, DelegateBudPhillips Chairman,SWVAHealthAuthority DavidCatellGordon CoDirector,HealthyAppalachia Institute Dr.JohnDreyzehner Chairman,OneCareofSWVA MarciaQuesenberry CoDirector,HealthyAppalachia Institute CarlMitchell ExecutiveDirector,SWVAand President&CEOVirginiaEconomic Bridge 32 31

34 WildflowersbloomalongareservoirinSouthwestVirginia 32 33

35 APPENDIII One Care of SWVA s Blueprint Goals And Objectives With Near, Intermediate And Long-Term Tim Frame Characteristics Summarized Goal A B C Related Objectives Brief Summary of Blueprint Wording N I L ImproveTreatmentAccessforsubstanceabusing offenders 1 AdvocateforfundingofandexpansionofexistingDrug CourtTreatmentProgramsin100%ofSWVAlocalities 2 DoublethenumberofestablishedDrugCourtsinSWVA (currently2)localitiesby ProvideSWVAelectedandjudicialofficialswithreturn oninvestmentinformationondrugcourtsversus incarceration 4 FundandexpandexistingDrugCourtTreatment Programsin100%ofSWVAlocalities EncourageandsupportexpansionofMutual Support/PeerRecoveryinSWVA 1 EstablishatleasttwoMutualSupport/PeerRecovery Groupsin100%ofSWVA slocalities 2 Supportanelectronicclearinghouseofinformationabout MutualSupport/PeerRecoveryGroupmeetings,placesand times 3 PromoteMutualSupport/PeerRecoveryPromotioninthe CommunityEducationCampaign 4 SupportPeerRecoveryGroupsgearedtowardsadolescentSA GroupWork 5 Challengeeachfaithcommunitywithmorethan200members toopentheirdoorstoatleastonepeerrecoverygroup 6 FosteratleastoneAA,NAorsimilarpeerrecoverygroupin50% ofjailsintheregion Expandtreatmentoptionsandcapacityandpromote existingtreatmentoptions 1 Promoteexistingtreatmentresourcesfortobaccocessation 2 Createpositivemessagesaboutthebenefitoflocallyavailable treatmentoptionsincludingmethadoneclinicsandresidential treatment 3 Establishademonstrationprojectaimedatpartnerships betweenbehavioralhealth(csb)andprimarycareclinic(fqhc orprivatepractice)toprovidecreativecollaborativetreatment opportunities 4 Increasereimbursementforintensiveoutpatientsubstance abusetreatmentservices 5 UtilizeSouthwestVAMentalHealthInstituteinMarionfornew 33

36 inpatientsubstanceabuseservices 6 Raisetaxesonalcoholandcigarettestoreduceconsumption anduseadditionalfundsforpreventionandtreatment activities 7 Worktowardhaving5%ofallprivatepracticesoffering medicationassistedtherapyforopiatedependenceinthree years;alwaysincollaborationinternallyorexternallywith individualand/orgrouppeerorprofessionalcounseling therapy 8 Developatleastonelongtermresidentialsubstanceabuse treatmentfacilityineachplanningdistrict 9 Increasefundingforsubstanceabusingadolescenttreatment groups 10 Establishatleastonedetoxificationfacilityineachplanning district 11 Developatleastoneregionalwomen streatmentprogram gearedspecificallytowardthetreatmentand prevention/educationofwomen,withaprioritytoward pregnantwomen D ReducetheincidenceofSubstanceAbuseinSWVA 1 Assurethatatleastoneprofessionalsociety(e.g.Medical SocietyofVA,VADentalAssociation,VANursingAssociation, andvapharmacistsassociation)adoptsprescriptiondrug Abusemitigationasapriority 2 Requirereportingofsuspecteddrugdiversionanddoctor shoppingbylicensedhealthcareprovider s(lhcp)and dispensersofscheduleii,iii,andivmedication 3 Encouragepharmaciststoprovidefacetofaceverbal counselingforscheduleiicontrolledsubstancesfornew prescriptionsorprescriptionchanges 4 Implement SBIRT (ScreeningBriefInterventionReferraland Treatment)intworegionalprimarycareoffices,two Emergencydepartments,threehealthdepartments,six CommunityHealthCentersitesandeightCommunityService Boardsites E EncouragegreatercollaborationamongLaw EnforcementAgenciesandothers 1 Expandabilityoflocallawenforcementtowork/augment colleaguesinotherjurisdictions 2 Reducesalesofalcoholandtobaccotominorsbyexpanding locallawenforcementcompliancecheckpartnerships 3 AssistVAStatePoliceineducatingPrescribersandDispensers regardingtheroleofdrugdiversionagents 4 Achieveavisiblelawenforcementeducationalpartnership with10%ofactiveptas/schoolparentgroups 5 Provideinitialandsemiannualtrainingfor25%oflaw 34

37 enforcementinsaofficersregardingsubstanceabuse,use speakersbureauforthispurpose 6 Exploretheadvisabilityofrequiring/allowingimmunityfor CommonCarrierstodivulgereasonablesuspicionofillegal drugdelivery 7 Provideseminarstargetedtojudgesandattorneysregarding physicianassistedtreatmentandmonitoringinadrugcourt context 8 Ensurethatatleastonedrugcourtwillworkdirectlywiththe supportofaphysiciantrainedinaddictionmedicine 9 Createreentrycoalitionstoincludecustodial,treatmentand servicepartnersinatleast50%ofthelocalitiesservedbyone Carewithinthreeyears 10 Implementanevidencebasedapproachtodecreaserecidivism by25%inatleasttwolocalprisonpopulationsinthreeyears 11 Developaforumtocreatestrongercommunicationbetween judges,commonwealthattorneysandlocalsheriff departmentsineffectivelyusingdrugcourts F Createacultureofresponsibility 1 Createandfundacomprehensivecommunications campaign G ExpandCommunityTreatmentOptions 1 Createatleasttwopeerrecoverygroupsintheregionfor Veteranshavingposttraumaticstressdisorder(PTSD)orat riskforptsdorothermood/anxietydisorder 2 Identifyanexistingorrecruitaregionalemployerto demonstrateatleastoneemploymentbasedrecovery programwheretheofferandmaintenanceofemploymentis conditioneduponstayinginrecovery 3 Identifyorcreateasourceoftechnicalassistancefor employerswillingtohaveanemploymentbasedrecovery program(s),seekadviceofexistingimpairedprofessional programs H ExpandprofessionalandcommunitySAeducational opportunities 1 Seekactiveparticipationinsubstanceabuseeducationofat leastonemajorstatewidemedicalprofessionalgroupandat leastonemajorpharmaceuticalsmanufacturer 2 Createaspeakersbureauthatincludesbothacademicor medicalexpertsandrecoveredpersonstospeakindividuallyor inteam 3 CreateaBehavioralHealthASSdegreeinalcoholanddrug counselingassteptocertifiedsubstanceabusecounselor Licensure 4 ProvidecoordinatedannualeducationalofferingsforSA treatmentprovidersintheregionviacollaborationamong 3 35

38 I localpublicandprivatetreatmentprovidersandprofessionals groups 5 Requireprescribersanddispensersofmedicationtoobtainat leastonehourofcmeonsaandpainmanagementeach licensureperiod 6 FundanFTE/50,000populationpublichealth educator/communityhealthworkersand/ordrugeducatorsfor SApreventionandoutreachtospecialpopulationsincluding pregnantwomen,veterans,andfamilieswith multigenerationalsapatterns 7 Developaprogramtargetedatnonprofessionalstobecome communitydrugeducatorssimilartodiabeteseducators 8 PromoteSAasachronictreatablediseasemodel(aswith diabetes)tomedicalprovidersandinsurers 9 Encourageundergraduatetrainingprogramsforprescribers, administratorsanddispensersofmedications(e.g.physicians, Nurses,Pharmacists)toincorporateatleasttwohoursof didacticeducationregardingpathophysiology,screening, identificationandtreatmentofaddiction 10 IdentifyorFundanFTE/100,000populationpublichealth educator/communityhealthworkersand/ordrugeducatorsfor SAcounterdetailingandbestpractice marketing towards prescribers ExpandSAeducationopportunitiesforkeycommunity leaders 1 Engageatleast60clergymembersinactivelycombatingSAin theircommunities 2 HoldatleastonelocalandoneregionalSAcoalition meetingannuallyintheeveningtoallowcareproviders tomoreeasilyattend J ExpandformalSubstanceAbuseeducationinSchools 1 ImplementageappropriateSAeducationinK12healthclasses inatleastfourschooldistricts 2 IncludeSAeducationandmedicationrelatedimpairmentinall drivereducationclassesinhighschoolinatleastfourschool districts 3 Createschoolhealthcoordinatorpositionsinatleastone regionalschoolsystemtoincludethemandateddevelopment ofearly(k7 th )ageappropriatelifetimeathletics(e.g., running,swimming)andarts(visual,performance)afterschool schoolassistedprogramsandeplicitlyincorporatestay healthy(eatright,don tsmoke,don tusedrugs)education andmessagingforschoolbasedwellness 4 Provideschoolbasedageappropriateearly(K7)lifetime athletics(running,swimming)andarts(visualandperforming) opportunities,andexplicitlyincorporatehealthandwellness 36

39 K L M educationmessagingintotheseactivities Advocateformorerobustuserlevelinformationandcontrol ofabuseandoverdosepronemedications 1 PromoteGraphicWarninglabelsusinggraphicdepictions and/orbasicelementaryreadinglevellanguage 2 Expandregional TakeBack activities Advocateformorerobustuserlevelinformationandcontrol ofabuseandoverdosepronemedications 1 Donotallowforthewaivingofpharmacycounselingfor ScheduleIIcontrolledsubstances 2 RequireprescriberstocompleteCMEpriortorecertificationof theirdrugenforcementagencynumber/statelicense 3 RequirePrescriptionMonitoringProgramaccessandperiodic reviewforprescribersanddispensersofscheduledrugs 4 RequireaPMPprofileforanypatientpriortoprescribinga ScheduleII,III,orIVsubstance 5 Advocateforthesimultaneousmultistatesinglepointof accesspmpprescriptionmonitoringprogramsandrequire physicianstouseitassupportedbynasper 6 Requireprovidersofmedicationassistedtreatment(e.g. methadoneandbuprenorphine)toperiodicallyreviewpmpon activepatients 7 Advocateforashallreportofsuspecteddrugdiversionby patientsandprescribers/dispensersofpotentiallyaddictive medication 8 RequirePharmaceuticalmanufacturerstoberesponsiblefor productsfromcradletogravetoincludepharmacybasedtake backprogramsforunused/expireddrugs 9 Banthesaleandmarketingofdrugparaphernaliaand designerdrugsinretailestablishments 10 Requireperiodicsaliva,urineorhairbaseddrugscreeningfor anypersonreceivingascheduleii,iiorivmedication,thedrug screeningtoincludethedrugprescribedandothercommonly abusedmedications 11 Exploreevidencebasedprogramsthatusewebbased exposureofconvicteddrugsellersforreducingcrimeand recidivism 12 AdvocateformovingbenzodiazepinestoScheduleIIstatus (DrugEnforcementAgency) 13 Achieveatleastonenosmokinginpublicplacesordinancein atleastoneofourlocalitieseachyear,postsignsat communityevents Focusadditionalefforttowardsjobcreationand encouragementfordisabledadultsandunderemployed youngadults 1 Reducetheincidenceandprevalenceofunnecessaryregional 37

40 disabilitybytwopercentinfiveyears 2 Decreasetheunemploymentratefor1824yearoldsbytwo percentagepointsinfiveyears N Identifygapsinregionalresearch 1 Identifyorinitiateacomparativestudyoftherelativecostsof anystateprogramthatworkswithsubstanceabuserswhouse illegalsubstances 2 EngageanUniversitytoidentifyaregionorlocalitythathas successfullyanddefinitivelyreduceditssaoroverdosedeath ratesandidentifythekeyfactorsthatmaybeadopted regionally 3 Encourageagroupofengagedcommunitymemberstostudy bestpracticesinsapreventionthatcanbeimplemented locally O Seekadditionalresources 1 Obtainorretainfundingforregionalconsortiumandcoalition stafffrommemberentitiesandotherstakeholders 2 Worktohaveatleast60%ofourcountiesandcitiesreceiving atleastonedrugfreecommunitiesgrantby Seekstatesupporttodevelopa OneStop initialassessment, referralandcarecoordinationresourceforconsumers (includinginfants,pregnantwoman)ofsatreatmentineach localityinanexistingagencyasanentrypointintoarecovery OrientedSystemofCare P ExpandtheprofessionalSAworkforce 1 IdentifyasourceofloanrepaymentfortwolicensedSA professionalsannuallywhoagreetoworkforaminimum periodinanunderservedlocality Q ImplementaRecoveryOrientedSystemofCare regionally 1 Worktocreateaunified,evidencebasedandconsistent regionaltreatmentsystemthatlinksexistingtreatment resources,(behavioral,social,communitybased,faithbased, drugoffenderrehabilitation,privatepracticeandothers)into aseamlessyetflexiblerecoverysystemforabusersthat createsmeasurablesuperioroutcomesinaregionalrecovery OrientedSystemofCare 2 DeveloparapidlyresponsivesystemofSAtreatmentfor parentsandchildrentargetedtofamilieswhosechildrenareat riskofcomingintofostercarethrufostercareprevention 3 Assurebestpracticesforthecontinuedavailabilityofpain managementservicesinbothprimarycareandspecialty settings 38

41 SunlightglistensoffoneofthemanyhistorictrainstationsinSouthwestVirginia 39

42 APPENDIIII Thankyou! ThisstrategicplanningeffortandOneCareofSWVAreceivedagenerouscontributionfromtheVerizon Foundationforthehostingofthefourregionalplanningmeetingsandtheproductionofthisblueprint. Thispublicationwasalsomadepossiblethroughadditionaleffortandsupportprovidedbygenerousinkind contributionsfromthehealthyappalachiainstituteattheuniversityofvirginia scollegeatwise,east TennesseeStateUniversityandMountainEmpireCommunityCollege. Thefollowingindividualsandtheirorganizationshavegivengenerouslyoftheirtimeandtalents BlueprintWritingTeam Ms.VickyCollins,MA,LPC,Director,RadfordCityDepartmentofSocialServices Dr.GaryCrum,ExecutiveDirector,SWVaGraduateMedicalEducationConsortium,UVAWise Dr.JohnDreyzehner,MD,MPH,DirectorCumberlandPlateauHealthDistrict Mr.MarkLarsen,LPC,OccupationalEnterprises,Inc. Dr.SarahT.Melton,PharmD,BCPP,CGP,DirectorofAddictionOutreach,AssociateProfessorofPharmacy Practice,AppalachianCollegeofPharmacy Mr.CarlMitchell,ExecutiveDirector,OneCareofSouthwestVirginia,President&CEO,VAEconomicBridge Mr.MikeWade,CommunityRelationsSpecialist,NewRiverValleyCommunityServices RegionalMeetingFacilitators Mr.BruceBehringer,AssociateVicePresidentandExecutiveDirector,OfficeofRuralandCommunityHealth andcommunitypartnerships,divisionofhealthsciences,easttennesseestateuniversity Dr.GaryCrum,ExecutiveDirector,SWVaGraduateMedicalEducationConsortium,UVAWise Mr.DavidCattellGordon, DirectorofTelemedicine,UVAHealthSystemandCoDirector,UVAWise shealthy AppalachiaInstitute Ms.MarciaQuesenberry,ExecutiveAssistanttotheChancellor,DirectorofStrategicPlanningandCoDirector, UVAWise shealthyappalachiainstitute Dr.WendyWelch,CommunityOrganizer,HealthyAppalachiaInstitute BestPracticesTheImpactofSubstanceAbuse AFilm Ms.LoriGatesAddison,LCSW,CPP,PreventionCoordinator,CumberlandMountainCommunityServices Photographsprovidedby: Mr.TomCasteel Dr.JohnDreyzehner Mr.RobertFultz Ms.KimberSimmons OneCareBoardofDirectors2010 JohnDreyzehner,MD,MPH,FACOEM Chair Director,CumberlandPlateauHealthDistrict DerekBurton,RN ViceChair ProjectManager,SWVABehavioralHealthBoard VickyCollins,MA,LPC Secretary Director,RadfordCityDepartmentofSocialServices 41 40

43 JudyLilly Treasurer AssociateVicePresidentofNetworkInfrastructure&Services,VirginiaTech RonAllison AtLargeRepresentative ExecutiveDirector,CumberlandMountainCommunityServices HarveyM.Barker,Ph.D. ExecutiveDirector,NewRiverValleyCommunityServices EleanorS. Sue Cantrell,BPharm,MD DistrictDirector,LenowiscoHealthDistrict JeffFox,MS,MDiv. ExecutiveDirector,HighlandsCommunityServices RobertGoldsmith President&CEO,PeopleIncorporatedofVirginia MikeHall,ACSW Director,WytheCountyDepartmentofSocialServices RebeccaHolmes,LPC,CSAC DirectorofOutpatientServices,HighlandsCommunityServices DennisLee TazewellCountyCommonwealth sattorney,tazewellva SarahT.Melton,PharmD,BCPP,CGP DirectorofAddictionOutreachAssociateProfessorofPharmacyPractice,AppalachianCollegeofPharmacy LisaMoore,MSW ExecutiveDirector,MountRogersCommunityServicesBoard DonnaL.Muncy WesternRegionReEntrySpecialist,VirginiaDepartmentofCorrections SandyO Dell,LCSW SeniorVicePresident,VAOperationsMH/SADir SteveRay ExecutiveDirector,H.O.P.E./FreedomfromAddiction KarenSmith REMOTECoordinator,CumberlandMountainCommunityServices AletaSpicer ExecutiveDirector,OccupationalEnterprises,Inc. WardStevens AssistantVicePresidentforDevelopment,EdwardViaVirginiaCollegeofOsteopathicMedicine ArtVanZee,M.D. Physician,StoneMountainHealthServices DougVarney,MA CEO,FrontierHealth/PD1BHS ExecutiveDirector CarlMitchell,MS,CNPM ExecutiveDirector,OneCareofSouthwestVirginia&President/CEOVirginiaEconomicBridge Advisors/Liaisons/Partners L.T. Tom Hanes,J.D.,M.H.A.SandsAndersonMarks&Miller,P.C. BrianEveritt ConstituentServicesDirector,U.S.SenatorMarkR.Warner 41

44 DrewDensmore OutreachRepresentative,U.S.SenatorMarkR.Warner GwynDutton RegionalRepresentative,U.S.SenatorJimWebb MartinMash FieldRepresentative,U.S.SenatorJimWebb ReginaKinder SeniorCaseworkSpecialist,U.S.CongressmanRickBoucher OneCareBoardofDirectors 2011 JohnDreyzehner,MD,MPH,FACOEM Chair Director,CumberlandPlateauHealthDistrict SarahT.Melton,PharmD,BCPP,CGP ViceChair DirectorofAddictionOutreach AssociateProfessorofPharmacyPractice,AppalachianCollegeofPharmacy PracticeSite:CHealth,PC VickyCollins,MA,LPC Secretary Director,RadfordCityDepartmentofSocialServices RonAllison Treasurer ExecutiveDirector,CumberlandMountainCommunityServices DerekBurton,RN AtLargeRepresentative ProjectManager,SWVABehavioralHealthBoard HarveyM.Barker,Ph.D. ExecutiveDirector,NewRiverValleyCommunityServices PaulBenson Asst.ChiefMedicalExaminer,WesternDistrictOfficeoftheChiefMedicalExaminer EleanorS. Sue Cantrell,BPharm,MD DistrictDirector,LenowiscoHealthDistrict ReverendMikeCarter Pastor,CentralUnitedMethodistChurch KayCorvin,RN,COHNS OccupationalHealthNurse,KlöcknerPentaplast JeffFox,MS,MDiv. ExecutiveDirector,HighlandsCommunityServices RobertFultz,Jr. Pastor,FreedomofWorshipChurch CharlesE.Good(Charlie) President&CEO,FrontierHealth MikeHall,ACSW Director,WytheCountyDepartmentofSocialServices RebeccaHolmes,LPC,CSAC DirectorofOutpatientServices,HighlandsCommunityServices DennisLee TazewellCountyCommonwealth sattorney,tazewellva JudyLilly RetiredAssociateVicePresidentofNetworkInfrastructure&Services,VATech 42

45 DavidLinkous Planner,NewRiverHealthDistrict LisaMoore,MSW ExecutiveDirector,MountRogersCommunityServicesBoard DonnaL.Muncy WesternRegionReEntrySpecialist,VirginiaDepartmentofCorrections SandraO Dell,LCSW SeniorVicePresident,VAOperationsMH/SADir SteveRay ExecutiveDirector,H.O.P.E./FreedomfromAddiction ReginaSayers ExecutiveDirector,AppalachianAgencyforSeniorCitizens KarenSmith REMOTECoordinator,CumberlandMountainCommunityServices AletaSpicer ExecutiveDirector,OccupationalEnterprises,Inc. WardW.Stevens ExecutiveDirector,OMNEE,EdwardViaCollegeofOsteopathicMedicine ExecutiveDirector CarlMitchell,MS,CNPM ExecutiveDirector,OneCareofSouthwestVirginia President/CEOVirginiaEconomicBridge Advisors/Liaisons/Partners GwynDutton RegionalRepresentative,U.S.SenatorJimWebb BrianEveritt ConstituentServicesDirector,U.S.SenatorMarkR.Warner L.Thompson Tom Hanes,J.D.,M.H.A. SandsAndersonMarks&Miller,P.C. LouiseArnattKadiri OutreachRepresentative,U.S.SenatorMarkR.Warner MartinMash FieldRepresentative,U.S.SenatorJimWebb Inputsforthisblueprintwerealsoprovidedbythefollowingindividualswhoattendedthefourregional meetings. Dr.VirginiaAcalBaluyot,TruCareMedicalClinic,Physician DonnaAdkins,AppalachianCollegeofPharmacy,AssociateProfessor PatArnold,SmythCountyDSS,Director NickAsbury,BlandCountyBoardofSupervisors CarlAyers,FloydCountyDSS,Director J.Baldridge,VirginiaStatePolice HarveyBarker,NRVCSEx.Director 43

46 Dr.AmorBarongan,MD Dr.PabloBarongan,MD Dr.RogerBays,GeneralDentistry KristineBowers,CoalitiononAppalachianSubstanceAbusePolicy,Coordinator LesterBowman,AppalachiaPoliceDept ChrisBoyd,TazewellCountySheriff'sOffice,ChiefDeputy TonyaNoelBuchanan,PharmD,IHC,AppalachianCollegeofPharmacy,DirectorofExperientialEducation DerekBurton,SWVaBehavioralHealthBoard,ProjectManager ThomasJ.Cantwell,HighlandsCommunityServices,M.D. BillCarrico,VirginiaHouseofDelegates,Delegate TommyCasteel,WashingtonCountyDept.ofSocialServices,Director RickClark,GalaxPoliceDepartment,ChiefofPolice StephenClear,SouthwestVARegionalJails,Superintendent ButchColeman,LaurelForkVolunteerFireDepartment,Member CherylColeman,TriAreaCommunityHealthCenter,DirectorofCaseManagement VickyCollins,RadfordCityDSS,Director ChaplainJimCox,WytheCountySheriff'sOffice AnneCrockettStark,VirginiaHouseofDelegates,Delegate GaryCrum,GMEC HarryCundiff,BluefieldVa.PoliceDept.,ChiefofPolice DavidDarden,ClinchValleyMedicalCenter,CEO Dr.TPDavis,MD JerryL.Davis,VirginiaStatePolice,Lieutenant HarryDean,SmythCountyIDA,ViceChairmanSmythCo.IDA PennyDean,TwinCountyPreventionCoalition,President RhondaDotson,CarilionNewRiverValleyMedicalCenter,LCSW,LSATP,CSAC,ADS Dr.JohnDreyzehner,MD,MPH,CumberlandPlateauHealthDistrict,Director RonElkins,WiseCountyCommonwealth'sAttorney'sOffice,Commonwealth'sAttorney LarryFindley,VirginiaDepartmentofStatePolice,SpecialAgent ErikaFischer,Governor'sOfficeforSubstanceAbusePrevention,Director Dr.RachelFowlkes,SWVAHigherEducationCenter,ExecutiveDirector/AgencyHead JeffFox,HighlandsCSB Dr.BarbaraFuller,SouthwestVirginiaCommunityCollege,VicePresidentofInstruction LoriGatesAddison,CumberlandMountainCSB,Coordinator KennyGilley,WiseCountyIDA,Chairman JeffreyGordon,SouthwesternVirginiaMentalHealthInstitute,M.D. BobGose,BristolVa.Dept.SocialServices,Director JohnGraham,SmythCountyCircuitCourt,ClerkofCircuitCourt EveGreene,FrontierHealth AngieHall,DelegateDaveNutter,LegislativeAssistant CaseyHenshaw,FamilyPreservationServices,Inc.,RegionalDirector RobertHiss,PulaskiCounty,AssistantCountyAdministrator LeahHollon,ND,MPH,AppalachianCollegeofPharmacy,AssistantProfessor JudyHorne,NoahHornWellDrilling,Inc.,DirectorofHealthandSafety RonHouk,IndependencePoliceDept,Investigator PeterHuber,PulaskiCounty,CountyAdministrator Dr.LorriHuffard,WythevilleCommunityCollege,Dean,Science&HealthPrograms 44

47 AnnHughes,MedicalSocietyofVirginia,DirectorofGovernmentRelations HollyHurley,AppalachianCollegeofPharmacy,AssistantProfessorofPharmacyPractice MikeHymes,TazewellCounty,BoardofSupervisors MichaelJennings,CarrollCountySocialServices,Director SarahJessee,WiseCountyCWAOffice NancyJohnson,RN,RookerPsychiatricServices,PC,RegisteredNurse SuzanneKerneyQuillen,WiseCountyCommonwealth'sAttorney'sOffice,DeputyCommonwealth'sAttorney DebraKincaid,Dr.CynthiaSouthernDDS ReginaKinder,CongressmanRickBoucher,SeniorCaseworkSpecialist JamesLane,NortonPoliceDept KarenLaPlante,CityofRadfordVJCCCA,ProgramCoordinator MarkLarsen,OccupationalEnterprises,Inc.,LPC Rev.ShirleyLarson,PearisburgPres.Church,Pastor JudyLilly,VirginiaTechAssociateVPofNetworkInfrastructureandServices(Retired) DavidLinkous,NewRiverHealthDistrict,EmergencyPlanner SarahMartin,GirlScoutsofVirginiaSkyline,FieldCoordinator DeborahMay,LifeCenterofGalax AliceMcDowell,MarionPediatrics DrJamesMcDowell,SmythCountyFamilyPhysicians LindaMcGee,PCPC ShawnMeek,VADOCPSCC,AssistantWarden SarahMelton,PharmD,BCPP,CGP,AppalachianCollegeofPharmacy,DirectorofAddictionOutreach, AssociateProfessorofPharmacyPractice G.JasonMiles,VirginiaStatePolice,Captain CarlE.Mitchell,Presdient&CEO,VirginiaEconomicBridge LisaMoore,MountRogersCommunityServiceBoard,ExecutiveDirector MatthewMullins,GladeSpringPoliceDepartment,ChiefofPolice DonnaMuncy,VADepartmentofCorrections,ReEntrySpecialist SherriNipper,GilesCountyDept.ofSocialServices,Director SandyO Dell,FrontierHealth,Sr.VicePresidentVAoperations JeanniePatrick,SouthwestVARegionalJails,AdministrativeLieutenant BrianPatton,RussellCountyCommonwealth sattorney PaulettePhillips,DickensonBehavioralHealth BrittneyPowers,DickensonBehavioralHealth MatthewPuckett,TownofSt.Paul,Virginia,PoliceOfficer MarciaQuesenberry,HealthyAppalachiaInstitute,CoDirector RogerRamey,NortonCityDSS,Director SarahRaskin,UniversityofArizona TheHonorableRadfordRay,TownofCleveland,Mayor WillieRichardson,VDEM GaryRoche,PulaskiPoliceDept,ChiefofPolice DouglasRogney,M.D.,WytheMedicalAssociates,Inc.,Physician Dr.GaryRooker,RookerPsychiatricServices,PC,Psychiatrist DonnaRountree,USPLeeCounty MonicaScalf,Nurse SamShelton,AustinvillePHChurch,Pastor KimberSimmons,VirginiaEconomicBridge 45 46

48 GlenSkinner,LENOWISCOPlanningDistrictCommission,ExecutiveDirector KristySlone,AppalachianCollegeofPharmacy,StudentPharmacist KarenSmith,CumberlandMountainCommunityServicesBoard,REMOTECoordinator R.D.Snead,RussellCountyIDA,ViceChairIDA KimberlySobey,BlandCo.DSS,Director AletaSpicer,OccupationalEnterprises,Inc.,ExecutiveDirector LeeSpiegel,PulaskiCommunityPartnersCoalition,CoalitionCoordinator CharlesStapleton,Jr.,WiseCountySheriff soffice,sgt. JonathanSweet,GraysonCounty,Administrator SteveTempleton,TownofGateCity,TownManager RexTester,TazewellCountyDSS,Director RitaTipton,TownofGateCity,ViceMayor DavidVaughn,FamilyPreservationServices,Counselor MikeWade,NewRiverValleyCommunityServices,CommunityRelationsSpecialist Dr.DavidWallace,Dr.DavidA.Wallace,DDS,MS JimWallis,PulaskiCountyDeptofSocialServices,Director CheriWarburton,NRVCS,DirectorofAdultClinicalandEmergencyServices KimWatkins,Dr.DavidA.Wallace,LPN,OralSurgeryAssistant SusanWestMarmagas,VTMasterofPublicHealth LindyWhite,SmythCountyCommunityHospital,CEO RandyWilliams,RussellCountyCommissionerofRev J.BrystonWinegar,HolstonMedicalGroup,MD MonaWoods,USPLee,PsychologyAssistant ClaudeWorrell,Va.StatePolice,Sgt. MarthaWunsch,AddictionMedicine,MD 46

49 FestivalsinSouthwestVirginia 47 48

50 AppendixIV What swrongwiththispicture? PlanningDistrictCommissionMeetingHandout What swrongwiththispicture?(officeofthechiefmedicalexaminer sannualreport,2008) Forthe5thyearinarow,thenumberofdrug/poisoningcasesincreasedwithanoverallincreaseof 91.4percentsince1999. Theoverallrateofdrug/poisoncauseddeathsforVirginiaresidentswas9.5per100,000people. Themajorityofcaseswereaccidents(78.1%),males(61.4%),whites(86.1%),and3544yearolds (27.2%). Narcoticswerethemostfrequentlyidentified(36.2%)followedbyantianxietymedications(15.6%). Twentythreeofthe735(3.1%)drug/poisondeathswereethanolonlydeaths. Whitesdiedfromprescriptiondrugs4.5timesthatofblacks;blacksdiedfromillegaldrugs1.6timesas whites. WesternVirginia(PDs14)has33.5%ofalldrugrelateddeathsinVirginia. Themajorityofalldrugrelateddeathsarebetweenages25and of735drugrelateddeathswerefromprescriptiondrugs(61%)

51 OfficeoftheChiefMedicalExaminer sannualreport,2008cont d. FHMOCombination Totalstatewidedeaths Oxycodone 87 Methadone 124 Fentanyl 50 Hydrocodone 45 Oxycodone& 12 Methadone Oxycodone&Fentanyl 6 Oxycodone& 16 Hydrocodone Methadone&Fentanyl 4 Methadone& 3 Hydrocodone Fentanyl& 7 Hydrocodone Oxycodone,Fentanyl& 1 Hydrocodone Oxycodone,Methadone 1 &Hydrocodone FHMOSubtotal Deathsbyaccident,homicideorsuicideinPDI accident, homicide or suicide in I Lee10accidental;2homicides;7suicidesOfthese2weredrugrelated,bothFHMO Norton1accidental;0homicides;2suicidesOfthese2weredrugrelated,bothFHMO Scott10accidental;1homicides;5suicidesOfthese3weredrugrelated,allFHMO Wise15accidental;0homicides;8suicidesOfthese8weredrugrelated,allFHMO 2008Deathsbyaccident,homicideorsuicideinPDII Buchanan 19accidental,2homicides,4suicidesin2008Ofthese,10weredrugrelateddeaths;7were FHMOcombination, Dickenson combination Russell combination 13accidental,1homicide,5suicidesOfthese,11weredrugrelateddeaths;8wereFHMO 15accidental,1homicide,10suicidesOfthese,5weredrugrelateddeaths;4wereFHMO Tazewell 16accidental,2homicides,4suicidesOfthese,13weredrugrelateddeaths;10wereFHMO combination;1washeroin/cocaine

52 OfficeoftheChiefMedicalExaminer sannualreport,2008cont d. 2008Deathsbyaccident,homicideorsuicideinPDIII Bland 2accidental,0homicides,0suicidesOfthese1wasdrugrelatedandwasFHMO Bristol 3accidental,2homicides,1suicideOfthesetwowere2drugrelated,bothFMHO Carroll 19accidental,0homicides,6suicidesOfthese,6weredrugrelated,allFHMO Galax 0accidental,2homicides,2suicidesNoneweredrugrelated Grayson 2accidental,2homicides,5suicidesNoneweredrugrelated Smyth 11accidental,3homicides,5suicidesOfthese,5weredrugrelated,allFMHO Washington 22accidental,0homicides,11suicidesOfthese,10weredrugrelated,9FMHO,one heroin/cocaine Wythe 24accidental,2homicides,8suicidesOfthese11weredrugrelated,allFMHO 2008Deathsbyaccident,homicideorsuicideinPDIV Floyd 5accidental;2homicides;1suicidesOfthese2weredrugrelated,bothFMHO Giles 9accidental;0homicides;3suicidesOfthese4weredrugrelated,allFMHO Montgomery 27accidental;3homicides;8suicidesOfthese13weredrugrelated,11FMHO Pulaski 19accidental;2homicides;2suicidesOfthese11weredrugrelated,allFMHO Radford 11accidental;2homicides;1suicideOfthese4weredrugrelated,2FHMO,1heroin/cocaine 50 51

53 EmergingEnterprisesandOpportunitiesinSouthwestVirginia 52 51

54 APPENDIV AboutOneCare In2009,OneCareofSouthwestVirginia,a501c(3)withrootsinsubstanceabuseissueswascalleduponby communityleadersandbegantotakeafocusedregionalapproachandlendastronger,moreunifiedvoiceonthe substanceabuse(sa)issuesaffectingvirginia sgreatsouthwest.thatcallwasembracedbyareinvigoratedboard andledtoaseriesofmeetingswherethedeterminationtofocusonpolicy,dataandadvocacyinthesaarena emergedandcoalesced. Today,OneCareofSWVAservesasaconsortiumof16substanceabusecoalitionsworkingthroughoutthe21 countiesandcitiesintheregion.the25memberboardofdirectorsincludesrepresentativesfromcommunity serviceboards,faithbasedorganizations,socialservicesandthehealthcare,highereducation,lawenforcement andrecoverycommunities.outreachtobusinessandindustryandseniorservicesorganizationsectorsisongoing. TheOneCareofSWVABoardoperatescollaborativelyandhasiscommittedtoundertakingabroadbasedstrategic planninginitiative ablueprintforthecontrolandmitigationofsubstanceabuseandmisuseinsouthwestvirginia facilitatedbythehealthyappalachiainstituteandwiththeencouragementofthesouthwestvirginiahealth Authority,regionalpartnersandelectedofficials OneCareMission,VisionandValues Mission:OneCareofSouthwestVirginiaiscommittedtodecreasingsubstanceabuseandmisuse,andrelated social,economicandhealthfactorsthroughplanning,policy,data,andadvocacy. Vision:OneCare svisionistobeamodelforachievingsignificantreductionsinsubstanceabuseandrelatedsocial, economicandhealthfactorsbybuildingandsupportingcommunitypartnerships. Values: Commitment Community Compassion Dignity Inclusiveness Integrity Openness Recovery Respect 52 53

55 OneCareStrategicGoals Buildandmaintainstrategicalliancesfortheprovisionofresources. Cooperatewithstrategicandcommunitypartnerstodocumentandaddressgapsinservice. Buildandmaintainaconsortiumofserviceprovidersforseamlessprovisionofservices. EnsurepeopleinSouthwestVirginiaareawareoftheavailableresourcesprovidedbyOneCareandour partners. ContinuousorganizationalandprocessimprovementandeffectiveleadershipforOneCare. BuildandexpandthetechnologicalinfrastructuretomeettheneedsofOneCare sstakeholders,partners andthecommunityatlarge. OneCareServiceRegion ThecountiesofBland,Buchanan,Carroll,Dickenson,Floyd,Giles,Grayson,Lee,Montgomery,Pulaski,Russell, Scott,Smyth,Tazewell,Washington,Wise,WytheandthecitiesofBristol,Galax,NortonandRadford

56 AscenicviewinSouthwestVirginia 55 54

57 APPENDIVI Adopt a Substance Abuse and Misuse Recommendation Is your organization helping in the Prevention, Treatment and Control of Substance Abuse and Misuse in Southwest Virginia? If so, we want to recognize your efforts! One Care of SWVA s Blueprint for Substance Abuse and Misuse Prevention, Treatment and Control (OC-SB4RSA) is a 3-5 year strategic plan which tracks progress towards reducing substance abuse and misuse in Virginia s Great Southwest. There are several recommendations related to the successful implementation of the OC- SB4RSA. If you are already working on some aspect of one or more of these recommendations, or are considering doing so in any capacity, we need you to sign up! We want to make sure that your efforts are included. We also want to be able to highlight local, regional and statewide success stories! Please fill out the form below and check any recommendations that you or your organization is already doing or plans to do, and return your completed form to us table to be entered into a drawing. Name Title Agency/Organization Address Phone Number 56 55

58 A. Improve Treatment Access for Substance Abusing Offenders AdvocateforfundingofandexpansionofexistingDrugCourtTreatmentProgramsin100%of SWVAlocalities DoublethenumberofestablishedDrugCourtsinSWVA(currently2)localitiesby2013. ProvideSWVAelectedandjudicialofficialswithreturnoninvestmentinformationonDrug Courtsversusincarceration FundandexpandexistingDrugCourtTreatmentProgramsin100%ofSWVAlocalities B. Encourage and support expansion of Mutual Support/Peer Recovery in SWVA EstablishatleasttwoMutualSupport/PeerRecoveryGroupsin100%ofSWVA slocalities SupportanelectronicclearinghouseofinformationaboutMutualSupport/PeerRecoveryGroupmeetings, placesandtimes PromoteMutualSupport/PeerRecoveryPromotionintheCommunityEducationCampaign SupportPeerRecoveryGroupsgearedtowardsadolescentSAGroupWork Challengeeachfaithcommunitywithmorethan200memberstoopentheirdoorstoatleastonepeerrecovery group FosteratleastoneAA,NAorsimilarpeerrecoverygroupin50%ofjailsintheregion C. Expand treatment options and capacity and promote existing treatment options Promoteexistingtreatmentresourcesfortobaccocessation Createpositivemessagesaboutthebenefitoflocallyavailabletreatmentoptionsincludingmethadoneclinics andresidentialtreatment Establishademonstrationprojectaimedatpartnershipsbetweenbehavioralhealth(CSB)andprimarycare clinic(fqhcorprivatepractice)toprovidecreativecollaborativetreatmentopportunities Increasereimbursementforintensiveoutpatientsubstanceabusetreatmentservices UtilizeSouthwestVAMentalHealthInstituteinMarionfornewinpatientsubstanceabuseservices Raisetaxesonalcoholandcigarettestoreduceconsumptionanduseadditionalfundsforpreventionand treatmentactivities Worktowardhaving5%ofallprivatepracticesofferingmedicationassistedtherapyforopiatedependencein threeyears;alwaysincollaborationinternallyorexternallywithindividualand/orgrouppeerorprofessional counselingtherapy Developatleastonelongtermresidentialsubstanceabusetreatmentfacilityineachplanningdistrict Increasefundingforsubstanceabusingadolescenttreatmentgroups Establishatleastonedetoxificationfacilityineachplanningdistrict Developatleastoneregionalwomen streatmentprogramgearedspecificallytowardthetreatmentand prevention/educationofwomen,withaprioritytowardpregnantwomen UtilizeSouthwestVAMentalHealthInstituteinMarionfornewinpatientsubstanceabuseservices D. Reduce the incidence of Substance Abuse in SWVA Assurethatatleastoneprofessionalsociety(e.g.MedicalSocietyofVA,VADentalAssociation,VANursing Association,andVAPharmacistsAssociation)adoptsPrescriptionDrugAbusemitigationasapriority RequirereportingofsuspecteddrugdiversionanddoctorshoppingbyLicensedHealthCareProvider s(lhcp) anddispensersofscheduleii,iii,andivmedication 56

59 Encouragepharmaciststoprovidefacetofaceverbalcounseling forscheduleiicontrolledsubstancesfornew prescriptionsorprescriptionchanges Implement SBIRT (ScreeningBriefInterventionReferralandTreatment)intworegionalprimarycareoffices, twoemergencydepartments,threehealthdepartments,sixcommunityhealthcentersitesandeight CommunityServiceBoardsites E. Encourage greater collaboration among Law Enforcement Agencies and others Expandabilityoflocallawenforcementtowork/augmentcolleaguesinotherjurisdictions Reducesalesofalcoholandtobaccotominorsbyexpandinglocallawenforcementcompliancecheck partnerships AssistVAStatePoliceineducatingPrescribersandDispensersregardingtheroleofDrugDiversionAgents Achieveavisiblelawenforcementeducationalpartnershipwith10%ofactivePTAs/schoolparentgroups Provideinitialandsemiannualtrainingfor25%oflawenforcementinSAofficersregardingsubstanceabuse,use speakersbureauforthispurpose Exploretheadvisabilityofrequiring/allowingimmunityforCommonCarrierstodivulgereasonablesuspicionof illegaldrugdelivery Provideseminarstargetedtojudgesandattorneysregardingphysicianassistedtreatmentandmonitoringina drugcourtcontext Ensurethatatleastonedrugcourtwillworkdirectlywiththesupportofaphysiciantrainedinaddiction medicine Createreentrycoalitionstoincludecustodial,treatmentandservicepartnersinatleast50%ofthelocalities servedbyonecarewithinthreeyears Implementanevidencebasedapproachtodecreaserecidivismby25%inatleasttwolocalprisonpopulationsin threeyears Developaforumtocreatestrongercommunicationbetweenjudges,Commonwealthattorneysandlocalsheriff departmentsineffectivelyusingdrugcourts F. Create a culture of responsibility Createandfundacomprehensivecommunicationscampaign G. Expand Community Treatment Options CreateatleasttwopeerrecoverygroupsintheregionforVeteranshavingposttraumaticstressdisorder (PTSD)oratriskforPTSDorothermood/anxietydisorder Identifyanexistingorrecruitaregionalemployertodemonstrateatleastoneemploymentbasedrecovery programwheretheofferandmaintenanceofemploymentisconditioneduponstayinginrecovery Identifyorcreateasourceoftechnicalassistanceforemployerswillingtohaveanemploymentbasedrecovery program(s),seekadviceofexistingimpairedprofessionalprograms CreateatleasttwopeerrecoverygroupsintheregionforVeteranshavingposttraumaticstressdisorder (PTSD)oratriskforPTSDorothermood/anxietydisorder H. Expand professional and community SA educational opportunities Seekactiveparticipationinsubstanceabuseeducationofatleastonemajorstatewidemedicalprofessional groupandatleastonemajorpharmaceuticalsmanufacturer 57

60 Createaspeakersbureauthatincludesbothacademicormedicalexpertsandrecoveredpersonstospeak individuallyorinteam CreateaBehavioralHealthASSdegreeinalcoholanddrugcounselingassteptoCertifiedSubstanceAbuse CounselorLicensure ProvidecoordinatedannualeducationalofferingsforSAtreatmentprovidersintheregionviacollaboration amonglocalpublicandprivatetreatmentprovidersandprofessionalsgroups RequireprescribersanddispensersofmedicationtoobtainatleastonehourofCMEonSAandpain managementeachlicensureperiod FundanFTE/50,000populationpublichealtheducator/communityhealthworkersand/ordrugeducatorsforSA preventionandoutreachtospecialpopulationsincludingpregnantwomen,veterans,andfamilieswith multigenerationalsapatterns Developaprogramtargetedatnonprofessionalstobecomecommunitydrugeducatorssimilartodiabetes educators PromoteSAasachronictreatablediseasemodel(aswithdiabetes)tomedicalprovidersandinsurers Encourageundergraduatetrainingprogramsforprescribers,administratorsanddispensersofmedications(e.g. Physicians,Nurses,Pharmacists)toincorporateatleasttwohoursofdidacticeducationregarding pathophysiology,screening,identificationandtreatmentofaddiction IdentifyorFundanFTE/100,000populationpublichealtheducator/communityhealthworkersand/ordrug educatorsforsacounterdetailingandbestpractice marketing towardsprescribers I. Expand SA education opportunities for key community leaders Engageatleast60clergymembersinactivelycombatingSAintheircommunities HoldatleastonelocalandoneregionalSAcoalitionmeetingannuallyintheeveningtoallow careproviderstomoreeasilyattend J. Expand formal Substance Abuse education in Schools ImplementageappropriateSAeducationinK12healthclassesinatleastfourschooldistricts IncludeSAeducationandmedicationrelatedimpairmentinalldrivereducationclassesinhighschoolinatleast fourschooldistricts Createschoolhealthcoordinatorpositionsinatleastoneregionalschoolsystemtoincludethemandated developmentofearly(k7 th )ageappropriatelifetimeathletics(e.g.,running,swimming)andarts(visual, performance)afterschoolschoolassistedprogramsandeplicitlyincorporatestayhealthy(eatright,don t smoke,don tusedrugs)educationandmessagingforschoolbasedwellness Provideschoolbasedageappropriateearly(K7)lifetimeathletics(running,swimming)andarts(visualand performing)opportunities,andexplicitlyincorporatehealthandwellnesseducationmessagingintothese activities K. Advocate for more robust user-level information and control of abuse and overdose prone medications PromoteGraphicWarninglabelsusinggraphicdepictionsand/orbasicelementaryreadinglevellanguage Expandregional TakeBack activities 58 59

61 L. Advocate for more robust user-level information and control of abuse and overdose prone medications DonotallowforthewaivingofpharmacycounselingforScheduleIIcontrolledsubstances RequireprescriberstocompleteCMEpriortorecertificationoftheirDrugEnforcementAgencynumber/State license RequirePrescriptionMonitoringProgramaccessandperiodicreviewforprescribersanddispensersofschedule drugs RequireaPMPprofileforanypatientpriortoprescribingaScheduleII,III,orIVsubstance AdvocateforthesimultaneousmultistatesinglepointofaccessPMPprescriptionmonitoringprogramsand requirephysicianstouseitassupportedbynasper Requireprovidersofmedicationassistedtreatment(e.g.methadoneandbuprenorphine)toperiodicallyreview PMPonactivepatients Advocateforashallreportofsuspecteddrugdiversionbypatientsandprescribers/dispensersofpotentially addictivemedication RequirePharmaceuticalmanufacturerstoberesponsibleforproductsfromcradletogravetoincludepharmacy basedtakebackprogramsforunused/expireddrugs Banthesaleandmarketingofdrugparaphernaliaanddesignerdrugsinretailestablishments Requireperiodicsaliva,urineorhairbaseddrugscreeningforanypersonreceivingaScheduleII,IIorIV medication,thedrugscreeningtoincludethedrugprescribedandothercommonlyabusedmedications Exploreevidencebasedprogramsthatusewebbasedexposureofconvicteddrugsellersforreducingcrimeand recidivism(59)(n) AdvocateformovingbenzodiazepinestoScheduleIIstatus(DrugEnforcementAgency) Achieveatleastonenosmokinginpublicplacesordinanceinatleastoneofourlocalitieseachyear,postsigns atcommunityevents M. Focus additional effort towards job creation and encouragement for disabled adults and underemployed young adults Reducetheincidenceandprevalenceofunnecessaryregionaldisabilitybytwopercentinfiveyears Decreasetheunemploymentratefor1824yearoldsbytwopercentagepointsinfiveyears N. Identify gaps in regional research Identifyorinitiateacomparativestudyoftherelativecostsofanystateprogramthatworkswithsubstance abuserswhouseillegalsubstances EngageanUniversitytoidentifyaregionorlocalitythathassuccessfullyanddefinitivelyreduceditsSAor overdosedeathratesandidentifythekeyfactorsthatmaybeadoptedregionally EncourageagroupofengagedcommunitymemberstostudybestpracticesinSApreventionthatcanbe implementedlocally O. Seek additional resources Obtainorretainfundingforregionalconsortiumandcoalitionstafffrommemberentitiesandother stakeholders Worktohaveatleast60%ofourcountiesandcitiesreceivingatleastoneDrugFreeCommunitiesgrantby

62 Seekstatesupporttodevelopa OneStop initialassessment,referralandcarecoordinationresourcefor consumers(includinginfants,pregnantwoman)ofsatreatmentineachlocalityinanexistingagencyasan entrypointintoarecoveryorientedsystemofcare P. Expand the professional SA workforce IdentifyasourceofloanrepaymentfortwolicensedSAprofessionalsannuallywhoagreetoworkfora minimumperiodinanunderservedlocality Q. Implement a Recovery Oriented System of Care regionally Worktocreateaunified,evidencebasedandconsistentregionaltreatmentSYSTEMthatlinksexisting treatmentresources,(behavioral,social,communitybased,faithbased,drugoffenderrehabilitation,private practiceandothers)intoaseamlessyetflexiblerecoverysystemforabusersthatcreatesmeasurablesuperior outcomesinaregionalrecoveryorientedsystemofcare DeveloparapidlyresponsivesystemofSAtreatmentforparentsandchildrentargetedtofamilieswhose childrenareatriskofcomingintofostercarethrufostercareprevention Assurebestpracticesforthecontinuedavailabilityofpainmanagementservicesinbothprimarycareand specialtysettings Worktocreateaunified,evidencebasedandconsistentregionaltreatmentSYSTEMthatlinksexisting treatmentresources,(behavioral,social,communitybased,faithbased,drugoffenderrehabilitation,private practiceandothers)intoaseamlessyetflexiblerecoverysystemforabusersthatcreatesmeasurablesuperior outcomesinaregionalrecoveryorientedsystemofcare THANK YOU! Please return your completed form to One Care of SWVA. 60

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67 ApictureofhopeinSouthwestVirginia

68 Cover Photography by Tim C. Cox Photo/Graphics