Attachment 3. Efforts to Address the Opioid Epidemic in Clark County

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1 Attachment 3 Effrts t Address the Opiid Epidemic in Clark Cunty

2 Overview Backgrund Current wrk SNHD Challenges Next Steps

3 Backgrund Drug verdses are nw the leading cause f death amng Americans under 50 Despite recent declines, piid prescribing is still high and incnsistent acrss the U.S. 82 piid pain prescriptins per 100 Nevadans (2015) Every 1 ¼ hurs a persn in Nevada visits an ER with an piid related diagnsis (2015) Every 1 hur a persn in Nevada is admitted int a hspital fr an piid related diagnsis (2015) 18.4 verdse deaths per 100,000 Nevadans (2015)

4 Backgrund, cnt. Each year since 2008, mre Clark Cunty residents have died frm piid verdses than frm firearms and mtr vehicle traffic accidents Opiid-invlved verdse rates were highest in the year ld age range cmpared t ther age grups in Clark Cunty Nn-Hispanic Whites had the highest death rate frm piid analgesic pisnings in Clark Cunty

5 The Perfect Public Health Prblem Preventable Upstream Surveillance Cnvening Rle Respnse n multiple frnts Practitiner Guidance Educatin (prviders & cmmunity) Plicy & Systems Change Unintended cnsequences M. Willis, Natinal Rx Abuse & Herin Summit. Health Plan f Califrnia

6 SNHD Opiid Advisry Cuncil Infrmal frmatin Nv 2016 Wh: Gv t agencies, cmmunity grups, health care prviders, and many thers Missin: Develp a systems-level respnse t the suthern Nevada piid crisis thrugh evidence-based strategies and unique cmmunity cllabratins. Lng-Term Gal: Shared resurces, cnsistent messaging and activities acrss the regin, and unified plicy develpments Needs Assessment and Strategic Actin Plan

7 SNHD Surveillance Cnduct piid-related surveillance and reprt n epidemilgical findings in Clark C. Mnitring rates f fatalities, emergency rm visits, and hspitalizatins Identifying high-risk ppulatins Develping imprved and real-time surveillance methdlgies Wrk with Office f Infrmatics t: Develp an nline data dashbard t display trends in prescribing practices frm the Prescriptin Drug Mnitring Prgram Visualize trends in piid-related mrtality, emergency rm visits, and hspitalizatins

8 SNHD Media Campaign Plan and air media campaigns Fcus: the impact f prescriptin piid misuse n individuals and families Partnership: Philadelphia Department f Public Health TV spts Mediums: televisin, radi, mbile/desktp banners, and billbards Launched: August 28 th September 30 th Visit ur piid educatin web page n the website.

9 SNHD Letter t Opiid Prescribers Date: July 7, 2017 Target audience: Primary care prviders/prescribers in suthern Nevada. Reviewed by multi-disciplinary cmmunity partners Letter and extensive resurces sheet Purpse: prvide actinable guidance, resurces, and a public health perspective n the piid crisis in suthern Nevada

10 SNHD Harm Reductin Effrts Prvide harm reductin training n tpics including: drug related HIV and Hepatitis C, harm reductin, drug-related stigma, and verdse preventin Facilitate the Suthern Nevada Harm Reductin Alliance mnthly that includes: Missin: T imprve the health and well-being f peple wh use drugs by reducing drug-related stigma, verdses and the harmful effects f drugs within the Suthern Nevada Cmmunity regardless f their circumstances. Gal: T decrease verdse rates in peple wh inject r use drugs Subcmmittees: Awareness/Educatin/Outreach, Treatment/Recvery, Leadership, Cmmunity Advisry Bard Participate in mnthly utreach t peple experiencing hmelessness as part f a cllabrative team t deliver tertiary preventin t PWID thrugh Hepatitis C educatin and testing, educatin and distributin f bleach kits

11 Challenges Many, many mving parts with many different agencies Lack f real-time data n verdse deaths Barriers t implementing medicatin assisted treatment Diverse cmmunity ppulatins invlved

12 Cntact Jessica Jhnsn, MPH CHES Health Educatr II

13

14 Opiid Preventin Effrts in Suthern Nevada Health District s Cmmunity Health Divisin July 2017 What is SNHD currently ding t address the piid issue? The Office f Chrnic Disease Preventin and Health Prmtin (OCDPHP) s Injury Preventin Prgram (IPP) and Office f Epidemilgy and Disease Surveillance (OEDS) wrk individually and cllabratively t address the impact f the piid issue in suthern Nevada. SNHD applies a spectrum f evidence-based strategies and best practices t individualand cmmunity-level effrts. The fllwing is a summary f the respnse and materials prduced t date: Cmmunity-Level Respnse Cllabrated with cmmunity members t lead in the develpment f an piid fact sheet and plicy recmmendatins fr the 2017 legislative sessin n behalf f the Suthern Nevada s Cmmunity Health Imprvement Plan (CHIP) Develped and distributed a letter n behalf f Dr. Jseph Iser t primary care prviders and prescribers in Suthern Nevada. The purpse f this letter was t prvide actinable guidance, resurces, and a public health perspective n the piid crisis in Suthern Nevada. Facilitate cmmunity intrductins and fster unique cllabratin amng cmmunity stakehlders, (e.g., intrductin f partners that resulted in HIDTA s Executive Directr speaking at Suthern Nevada Harm Reductin Alliance) Plan and air frthcming media campaigns that fcus n the impact f prescriptin piid misuse n individuals and families delivered thrugh testimnials. These messages have been audience tested by the Centers fr Disease Cntrl and Preventin, will include mediums such as televisin, radi, mbile/desktp banners, and billbards, and will run in crdinatin with Overdse Awareness Day activities (details belw n this event). Build, launch, and maintain a frthcming piid educatin web page n the website. Crdinate and c-lead the Suthern Nevada Opiid Advisry Cuncil (SNOAC) (als knwn as the Task Frce ) s quarterly meetings (average attendance 40 peple each quarter) including: agenda develpment, nte taking, and respnding t all requests by cmmittee members. SNOAC Missin: Develp a systems-level respnse t the suthern Nevada piid crisis thrugh evidence-based strategies and unique cmmunity cllabratins. Subcmmittees: Awareness/Educatin, Plicy/Legislatin, Infrastructure/Data, Steering cmmittee Subcmmittees In-develpment: Law Enfrcement, Medical/Prescriber Lng-Term Gal: Shared resurces, cnsistent messaging and activities acrss the regin, and unified plicy develpments Maintain listserv f nearly 200 individuals representing a variety f agencies frm varius sectrs t disseminate nging events, infrmatin, trainings, and ther materials as requested Supprt internal SNHD piid crdinatin meetings t discuss prgress n surveillance, harm reductin, verdse preventin, educatinal pprtunities, and media campaigns. Respnd t high-level rganizatin effrts frm cmmunity members t maintain cnsistent messaging, t include: Las Vegas Metrplitan Plice Department (LVMPD) s request fr pprtunities t cnsider diversin with prearrest and huse arrest ppulatins. These effrts will cmpliment an existing SNHD grant that prvides services, including referrals t substance abuse treatment and resurces, t peple living with HIV/AIDS in jail. State f Nevada request fr fcus grup participants t address pprtunities t further prviders trained in medicatin-assisted treatment (MAT) C-Presented t LVMPD Metr Executive Staff, in cllabratin with SNOAC members, updates n calitin wrk and a new prpsed diversin prgram titled Law Enfrcement Assisted Diversin (LEAD). LVMPD plans t implement LEAD in Wrk with SNHD s Office f Infrmatics t develp an nline data dashbard t display trends in prescribing practices frm the Prescriptin Drug Mnitring Prgram, as well as visualize trends in piid-related mrtality, emergency rm visits, and hspitalizatins Cnduct piid-related surveillance and reprt n epidemilgical findings, including mnitring rates f fatalities, emergency rm visits, and hspitalizatins; identifying high-risk ppulatins; and develping imprved and realtime surveillance methdlgies 1

15 Harm Reductin Effrts Cnducted fcus grups with residents f Clark Cunty wh either were current r frmer injectin drugs users (i.e., peple wh inject drugs - PWID) t understand the characteristics f the injectin drug user cmmunity and gain insight int the participants perceptins f needle availability and dispsal practices. (In-depth reprt available upn request.) Develped and administered a PWID needs assessment, utilizing infrmatin frm the fcus grups, t learn mre abut the fllwing tpics: injectin practices, attitudes twards harm reductin, utilized cmmunity services, needle surces and dispsal practices, preferences fr needle supplies and services, etc. (In-depth reprt available upn request.) Prvide harm reductin training t cmmunity stakehlders n tpics including: drug related HIV and Hepatitis C, harm reductin, drug-related stigma, and verdse preventin (65+ cmmunity prviders have attended t date, including SNHD staff) Facilitated the Suthern Nevada Harm Reductin Alliance mnthly meeting (average attendance peple each mnth) that includes: Missin: T imprve the health and well-being f peple wh use drugs by reducing drug-related stigma, verdses and the harmful effects f drugs within the Suthern Nevada Cmmunity regardless f their circumstances. Gal: T decrease verdse rates in peple wh inject r use drugs Subcmmittees: Awareness/Educatin/Outreach, Treatment/Recvery, Leadership Cmmunity Advisry Bard: Cmprised f the cmmunity served by the SNHRA Participate in mnthly utreach t peple experiencing hmelessness as part f a cllabrative team t deliver tertiary preventin t PWID thrugh Hepatitis C educatin and testing, educatin and distributin f bleach kits (40+ distributed t date; pht sample kit attached) Plan cmmunity event fr Overdse Awareness Day (August 31, 2017) t include nalxne demnstratin; educatin n verdse and respnse; candlelight vigil fr thse lst t verdse. Overdse preventin kits including nalxne will be distributed fr all participants SNHD als participates in the fllwing cmmunity-lead services: HIV testing fr the AHF Mbile Van Unit; syringe access at the TRAC-B Exchange; hmeless services, recruitment, and referrals t services fr HELPSNV Prfessinal trainings (in-persn r nline) attended by SNHD staff t increase educatin and learn best practices frm neighbring cmmunities: Natinal Harm Reductin Cnference, Natinal RX Drug Abuse and Herin Summit, Natinal Sexual Health Cnference, Hepatitis C and Overdse Preventin Training, Harm Reductin Training, Suthern Nevada Addictive Disrders Training Prject (SNADTP) Screening Brief Interventin and Referral t Treatment (SBIRT) Training; Prescriptin Pain Killers: The Latest (and Greatest) Threat t Child Welfare ; Vegas PBS The Opiid Epidemic ; Medicatin Assisted Treatment: Ready, Set, Implement ; CASAT Trainings: Substance Abuse Preventin and Nevada Law SNHD has created the fllwing educatin and plicy dcuments t supprt piid effrts described abve: Suthern Nevada Opiid Legislative Fact Sheet 2. Opiid Prescriber Letter and Resurce Sheet 3. Overdse Preventin Cards (bth administratins f nalxne) 4. Bleach Kit Instructins 5. Drug-related Harm Reductin Trainings 6. Suthern Nevada Hepatitis C Resurce Directry 7. Cmmunity Services Referral List Next Steps: Current respnse effrts are funded primarily thrugh grants with limited scpes f wrk. If a brader fcus n piids is t be taken, we must acquire additinal resurces, i.e. funding and staff, t cntinue t address and prevent this issue using evidence-based practices. The fllwing are sme f the activities that culd be implemented with additinal resurces: 2

16 Opiid Preventin Effrts in Suthern Nevada Health District s Cmmunity Health Divisin July 2017 Sustain mass media campaigns and develp targeted campaigns aimed at pririty ppulatins. Increase nalxne access but als address verdse hlistically; ffer treatment, harm reductin message, prvide nalxne t victim and friends and family thrugh peer services. Wrk with lcal emergency rms and cmmunity agencies t develp an piid verdse diversin prtcl and referral prcess Cnvene health plans t share data n piid reductin effrts frm neighbring states and discuss readiness/barriers t implement effrts in Nevada Design a phne applicatin that can, in real-time, address piid verdse and supprt verdse preventin Increase educatin, resurces, and strategies t implement rapid testing f hepatitis C preventin and treatment with SAPTA prviders Make recmmendatins n increasing treatment pprtunities fr uninsured and under-insured ppulatins in suthern Nevada Develp a prvider resurce guide fr PWID with prvider advcates Cllabrate with specialty curts and LVMPD s implementatin f LEAD Prvide cntinuing educatin units (CEUs) fr harm reductin trainings 3

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