Opioid Task Force Kick-Off Meeting. February 29, 2016

Transcription

1 Opioid Task Force Kick-Off Meeting February 29, 2016

2 Scope of the Opioid Problem and Data Review Olivia Kasirye, MD, MS County Public Health Officer

3 OVERVIEW The Opioid Epidemic Opioid Task Force Development Prevention Strategies 3 2/29/2016

4 The Opioid Epidemic 4 2/29/2016

5 Definition: Opioids are any of various compounds that bind to specific receptors in the central nervous system and have analgesic (pain relieving) effects including prescription medications such as oxycodone (OxyContin), hydrocodone (Vicodin), morphine, methadone, codeine and illicit substances such as heroin and fentanyl. 5 2/29/16

6 Adverse Effects of Opioids on the Brain 6 2/29/16

7 National Statistics Since 2000, the rate of deaths from drug overdoses has increased 137%, with a 200% increase in deaths due to opioids* Nearly 2 million Americans age 12 or older abused or were dependent on opioids in 2013** 20% to 30% of opioids prescribed for chronic pain are being misused*** Rate of addiction is 10%*** Sources: *MMWR/January 1, 2016/Vol.64/ **CDC National Center for Health Statistical Vital Statistics Report ***International Association for the Study of Pain 7 2/29/2016

8 Teen Prescription Drug Misuse & Abuse 23% report having abused Rx medication at least once in their lifetime 31% believe it s okay to use prescription drugs that were not prescribed to them to deal with an injury or pain, as long as they are not getting high 22% say their parents don t care as much if they are caught using Rx drugs without a prescription, compared to getting caught with illegal drugs. Source: US DEA Office of Diversion 8 2/29/2016

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12 DEATHS BY OPIOID POISONING ( ) YEAR CALIFORNIA 1,469 1,651 1,784 1,971 1,909 1,898 1,712 1,934 SACRAMENTO COUNTY Source: California Department of Public Health EpiCenter Injury Online Database 14,328 Deaths in California from Deaths in Sacramento County from /29/2016

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14 Opioid Task Force Development 14 2/29/2016

15 Purpose of Opioid Task Force Identify and implement numerous high priority initiatives Share resources & knowledge Provide coordinated provider & community education Develop policy recommendations & best practices the opioid epidemic! 15 2/29/2016

16 Structure of Opioid Task Force Quarterly meetings beginning February 2016 Subcommittees 1. Engaging Medical community, overdose prevention 2. Public education, media and advocating for change 3. Early intervention, treatment, and recovery 4. Safe medication disposal 16 2/29/2016

17 Who Are The Players? Alcohol & Drug Services Behavioral Health Emergency Services Hospitals & Service Providers Dept. of Human Assistance Law Enforcement Non-profits & community groups Public Health Pharmacies Probation Schools & Universities Social Services Waste Management Youth Representatives Not exhaustive - others? 17 2/29/2016

18 Prevention Strategies 18 2/29/2016

19 Understanding the Local Epidemic Data Sources Analysis Prescription data CURES database Identify high prescribers, unsafe prescribing etc. Death & Injury Data Multi-cause of death files OSHPD Hospital ED & Patient discharge data Look at trends, distribution, populations affected 19 2/29/2016

20 Access to Resources Disseminate Information Provider newsletters Community education o Patients o Parents & teens o Older adults Poison Control Resource Availability Treatment & referrals o Substance abuse o Mental health o Pain management Support groups Naloxone 20 2/29/2016

21 Current Treatment Available and Need for Capacity Building Uma K. Zykofsky, LCSW Director, Behavioral Health Services Alcohol & Drug Administrator

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23 What Works and Leads to Positive Outcomes? Prevention Self-Motivation for Treatment Mandated Treatment Partnerships/Collaborations Evidence-Based Practices Appropriate length and type of treatment episodes based on need Balanced continuum of care inclusive of all types of treatment, sober living environments, and recovery support services 23 2/29/16

24 Alcohol and Drug Services Continuum of Care Prevention Services Education Services-DUI Programs Outpatient Treatment Services Intensive Outpatient Treatment Services Medication-Assisted Treatment Detoxification & Residential Treatment Services Transitional Housing/Sober Living Environments Handout: Alcohol & Drug Services Continuum of Care 24 2/29/16

25 Countywide Collaborations Jail/Corrections Public Health Primary Health Child Protective Services Mental Health Dept. of Human Assistance Probation Community Collaborations Contracted Providers Community-Based Organizations (CBOs) Prevention Initiatives (Coalition) Sacramento Steps Forward (Homeless Services) 25 2/29/16

26 Collaborations with Criminal Justice Driving Under the Influence (DUI) Programs Drug Diversion Program Prop 36 Program Adult Drug Court Juvenile Drug Court Co-Occurring Mental Health Court In Custody Alcohol and Drug Screening and Assessments-Jail/Department of Corrections 26 2/29/16

27 Collaborations with Public Health & Primary Health Public Health Opioid Task Force Development Human Immunodeficiency Virus (HIV) Services Sexually Transmitted Disease (STD) Services Primary Health Primary Care Center Alcohol and Drug Screenings Case Management Services Linkage to Appropriate Alcohol and Drug Treatment 27 2/29/16

28 Collaborations Child Protective Services Nationally Recognized Family Drug Courts Dependency Drug Court Early Intervention Family Drug Court (EIFDC) These courts refer clients to outpatient treatment, residential treatment, detox, and case management/recovery support services 28 2/29/16

29 Collaborations with Mental Health Homeless Services (Guest House) Alcohol and Drug Assessment and Referral Education Groups, Outreach Co-Occurring Mental Health Court Services Outpatient Treatment Residential Treatment CalWORKs Program (Mental Health & Dept. of Human Assistance) Outpatient Treatment Detox, Residential Treatment Mental Health Navigators Linkage to services 29 2/29/16

30 Alcohol & Drug Services Treatment Data Fiscal Year Modality Total Number Admissions Number of Admissions Opiates as Primary Drug of Choice % of Clients with Opiates as Primary Drug of Choice Outpatient - Adult 1, % Outpatient - Youth % Residential 1, % Detoxification % Medication-Assisted Treatment 2,159 2,139 99% TOTALS 6,104 2,638* 43% 30 2/29/2016

31 Current Challenges Increased Service Demand Residential Treatment Detoxification Services Medication-Assisted Treatment Lack of Sober Living Environments Aftercare Services Youth Residential Facilities Re-entry/Support Services Need for Capacity Building Limited Funding Residential Treatment Detoxification Services Limited Targeted Services Severely Mentally Ill Homeless Developmentally Disabled Older Adults Wait Lists = Delay in Treatment Residential Treatment Detoxification Services Access to Care Locations Transportation 31 2/29/2016

32 Residential Treatment Services Increased demand for Residential Treatment Residential Treatment Facilities for Adults Only No Youth Residential Treatment Facilities Limited capacity due to funding constraints Total Beds = 319 Average Wait Time = 3 months 32 2/29/16

33 Detoxification Services Increased demand for Detox Services Detox Facilities for Adults Only (only 4 providers) No Youth Detox Facilities Limited capacity due to funding Total Beds = 12 Average Wait Time = days 33 2/29/16

34 Medication-Assisted Treatment (MAT) Number of MAT Clients Served Fiscal Year Number of MAT Clients Served Fiscal Year % Increase From Prior Year 4 contracted MAT Service Providers (Methadone Providers) 5 locations 1,300 2,150 65% Need to increase capacity MAT keeps people productive, in the workforce and helps to stabilize and improve level of functioning 34 2/29/16

35 Increase Collaboration/Partnerships Prevention, Education and Awareness Capacity Building for Treatment Services Explore Funding Opportunities Decrease Waitlists Coordinate with current Prevention and Statewide efforts 35 2/29/16

36 ON THE HORIZON: Drug Medi-Cal (DMC) Organized Delivery System (ODS) Waiver Goals Improve Substance Use Disorder Services through a Statewide organized service delivery system Full continuum of multiple levels of funded evidencebased services Increase program oversight, compliance and quality assurance Improve coordination with other service systems 36 2/29/16

37 DMC-ODS Waiver Implementation *5-Year State-Wide Demonstration Project* 53 Counties Expressed Interest Phase I Bay Area (in progress) Phase II Southern California Phase III Central Valley (Sacramento County) Phase IV Northern California Phase V Tribal Delivery System Steps for Waiver 1. County to develop Implementation Plan 2. County to develop Fiscal Plan 3. Department of Health Care Services to approve County rates 37 2/29/16

38 Drug Medi-Cal Waiver Services & Requirements (Opt-in Model) BOLD = new services and requirements Services Early Intervention Outpatient Services Residential Treatment Medication-Assisted Treatment (MAT) Withdrawal Management Additional Medication-Assisted Treatment (MAT) Recovery Services Case Management Physician Consultation Requirements Coordination with Criminal Justice and Hospitals Increased Quality Assurance 38 2/29/16

39 Opioid Task Force 39 2/29/16