The Impact of Addiction on Oklahomans and the Mental Health System

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Darren Ward
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1 The Impact of Addiction on Oklahomans and the Mental Health System Presented by Carrie Slatton-Hodges Deputy Commissioner Oklahoma Department of Mental Health 1 and Substance Abuse Services

2 Background: Oklahoma s Treatment System o Oklahoma has a single agency that address both mental health and substance abuse services. o Oklahoma has never invested in behavioral health services at a level appropriate to meet demand.

3 Oklahoma s Treatment System Background (cont d): o And, in three out of the last four years, there have been cuts to the already underfunded treatment delivery system due to state budget challenges. The system operates beyond capacity. Tiered system of service delivery (too few opportunities to serve people at the community level before disease progresses leads to system backup/demand on services to treat higher acuity).

4 Oklahoma s Treatment System Despite challenges, Oklahoma has incredible outcomes for those who do access treatment and is a model in many areas (children s services, specialty courts, CJ diversion, Pay for Performance).

5 Oklahoma s Treatment System However, it is increasingly difficult to maintain these positive outcomes without resources, and system challenges are impacting all aspects of the system along with other state and community services: o High rates of mental illness and addiction o Incarceration o Law Enforcement Engagement o Hospital Emergency Rooms

6 Oklahoma s Treatment System Oklahoma consistently has among the highest rates of mental illness and addiction in the country (an estimated 986,000 Oklahoma adults experiencing mental illness and/or substance dependence in addition to 125,000 youth years of age).

7 Oklahoma s Treatment System There are 196,000 Oklahomans served by department annually (109,000 adults and 87,000 children/youth). This includes behavioral health Medicaid. The department provides substance abuse treatment to over 16,000 Oklahomans annually. On any given day, there are between Oklahomans on a waiting list for residential services.

8 Prescription Drug Abuse Oklahoma ranks No. 1 nationally for nonmedical use of painkillers for all age groups 12 and older in the past year. SAMHSA, However, Oklahoma saw the 2nd largest decrease nationally in opioid prescribing from down 18% and was one of only 12 states to see a decrease in the rate of drug overdose deaths (9%) from

Prescription Drug Abuse Still, Oklahoma had the 10th highest drug overdose death rate in the nation in 2014.

9 Prescription Drug Abuse Still, Oklahoma had the 10th highest drug overdose death rate in the nation in Of the more than 3,500 unintentional poisoning deaths in Oklahoma from , 74% involved at least one prescription drug. Opioids are the most common class of drug involved in overdose deaths in Oklahoma (85% of prescription drug related overdose deaths; 427 deaths in 2014).

10 40% Top 5 - Percent of Substance Abuse Treatment Admissions By Drug of Choice (Primary Only) Meth 30% Alcohol 20% Marijuana 10% Opiates Heroin 0% FY11 FY12 FY13 FY14 FY15 FY16 FY17

11 *In FY % of psychiatric inpatient and crisis unit admissions had a substance abuse issue, either as a co-occurring disorder or a substance induced psychosis. *

12 100% Inpatient/Crisis Unit Admissions Top 5 Drug of Choice (Primary/Secondary/Tertiary) 90% 80% 70% 60% 50% 40% Alcohol Marijuana Meth 30% 20% 10% 0% CY2011 CY2012 CY2013 CY2014 CY2015 CY2016 Opiates Cocaine

13 Inpatient Crisis Unit Previous Substance Abuse Previous Substance Abuse *

14 Related Challenges 82% of all DOC receptions need treatment for mental health or substance abuse issues. Oklahoma has the highest female imprisonment rate nationally (83% for non-violent crimes and 42% for drug crimes alone). Approximately 44% of men in prison and 69% of women have a mental health issue.

15 Related Challenges The projected growth of our prison population over the next 10 years (growth of 25%) will cost the state nearly $2 billion. The top offense among admissions to prisons is drug possession. The high incarceration rate (and increasing law enforcement engagement for crisis issues) is directly tied to a lack of behavioral health treatment opportunities particularly substance abuse.

16 100% Percent of Individuals with Department of Corrections Involvement 90% 80% 70% 60% 50% 40% Drug Related Parole Drug Related Probation Drug Related Incarceration DOC Inmates in Treatment 30% 20% 10% 0%

17 Related Challenges Oklahoma Children/Youth Oklahoma experiences extremely high rates of children becoming engaged in the foster care system, juvenile justice and experiencing adverse effects in school-based settings. Trauma among Oklahoma youth is a particular concern.

18 Related Challenges Oklahoma Children/Youth Poor ACE indicators including 30% of OK children experiencing economic hardship and has among highest rates of children experiencing trauma (OK was the only state with high prevalence in all eight ACEs). Approximately 17% of OK children experience three or more ACEs and 12% experience four or more.

19 Related Challenges Oklahoma Children/Youth Nearly 400 babies testing positive for drugs/alcohol at birth (over 10% showing signs of withdrawal). Substance abuse is a factor in 47% of all foster care placements and contributing factor in twothirds of all maltreated children in child protective custody.

20 Addiction Treatment Services ODMHSAS has increased capacity of the substance abuse treatment system to provide opioid addiction and recovery services, including the development of nine new Comprehensive Community Addiction Recovery Centers with satellite capacity. These full-service (onestop shop) SUD treatment systems offer medicationassisted ambulatory withdrawal management services.

21 Addiction Treatment Services 15 active Opioid Treatment Programs (methadone/buprenorphine clinics) 8 urban, 7 rural, with almost 5,000 patients with 4 more in development. (ODMHSAS maintains regulatory authority.) Implementation of an Electronic Wait List to streamline the intake process for residential treatment.

22 Summary Combined behavioral health system (creates opportunity). Unaddressed need at the community level stresses all other parts of the system (and community resources outside of the treatment system). Children are experiencing adverse effects caused by growing-up in addiction/generational cycles of poor outcomes/trauma. A comprehensive approach to addiction and utilization of a statewide public/private system is showing results.

Mental Conclusion Health Matters Follow us on social media. Website: www.odmhsas.

23 Mental Conclusion Health Matters Follow us on social media. Website: Facebook: Department

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