Youth and Opiates: Trends and Interventions in Oregon By Richard Harris, Assistant Director May 21, 2010
Youth and Opiates Prescription drugs including opiates increasingly becoming part of the youth and young adult experience; perceived as being less harmful than illicit drugs. Heroin chic of 1970 s repeated again in the 1990 s (music, film, fashion), recent resurgence in the last few years. Increase in use of non-prescribed pain relievers coincides with an increase in the use of heroin; represents a double dose. Lack of access to heath care coverage prominent for those between the ages of 18-25. 2
Trends in non-medical use of prescription pain relievers among youth After marijuana use, the second most common form of illicit drug use in the United States is non-medical prescription pain relievers. 183,000 of Oregon s youth and young adults reported past year marijuana use in 2005-2006 (Annual Averages). Among Oregon s youth and young adults 80,331 between the ages of 12-25 reported use of a prescription pain reliever not prescribed for their use (2006-2007); Use declined among youth ages 12 to 17 from 3.2 percent in 2002 to 2.7 percent in 2007 (National Trend). However, use increased among young adults ages 18-25 from 4.1 in 2002 to 4.6 percent in 2007 (National Trend). Source: (NSDUH special report, 2009) National Survey of Drug Use and Health 2006-2007 3
Prescription Opioid Deaths Age distribution of prescription opioid deaths, Oregon, 1999-2009 Oregon Public Health Division- Injury Prevention Program 40 35 33.1 Percen nt 30 25 20 15 10 8.66 18.7 26.5 10.98 5 0 0.9 1.46 0.51 4
Opioid poisoning hospitalizations Age distribution of unintentional opioid poisoning hospitalizations, ti Oregon, 1997-2007 30 Oregon Public Health Division- Injury Prevention Program 25 25.29 Percent 20 15 16.95 18.43 11.43 11.57 10 8.61 5 0 2.49 0.47 4.77 5
Percent of Opioids: Primary substance for admission 12 Percent of primary drug for age 18-25 enrolled in treatment 10 Perce ent of total 8 6 4 2 Heroin Non-prescription methadone Other Opioids 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year case opened Note: In 2009 80% of all new cases the primary substance for admission were either alcohol, amphetamines or marijuana. Source: CPMS (Client Process Monitoring System for non-duii clients) AMH, D.W. 6
Who Needs Addiction Treatment in Oregon?. Age Group Estimate abuse and/or dependency People served in public system Percent of need met 12 to 17 19,956 [1] 5,844 29% 18 to 25 81,743 [2] 13,088 16% 26+ 163,896 [3] 38,112 23% [1] Estimates are based on the annual National Survey of Drug Use and Health (2007). [2] Ibid. [3] Ibid 7
Early Assessment and Support Alliance (EASA) & Early Assessment and Support Team (EAST) ercentage of EAST Clients P Hospitalization, School and Work by Time in the EAST Program (2002-2008) 80 40% of the participants p in the EAST program were hospitalized in 70 the three months prior to beginning 60 service. Three months into the programs hospitalizations are 50 reduced to 10% of the participants 40 and continue to decrease over time. At the same time the percent 30 of participants working or in school 20 shows continuous improvement. This model can be adapted to 10 serve youth and young adults 0 experiencing opioid addiction. Less than 3 months 3 to 6 mos 10 to 12 mos 16 to 18 mos Time in EAST Program 8
Oregon s Prescription Drug Monitoring Program (PDMP) 2009 legislative session response to public health issue of detecting inappropriate use, abuse and diversion of prescribed controlled substances; Development and implementation of Oregon PDMP; PDMP is an electronic system; monitors all Schedule II, III, and IV controlled substances; Collects patient, prescribing practitioner and pharmacy information; Placed in the Public Health Division of Department of Human Services by the legislature; AMH supportive of legislation and program placement; July 1, 2010 target date for implementation. 9
Intensive Treatment and Recovery Services (ITRS) ITRS, a collaboration between AMH and Children, Adults and Families (CAF) serves parents with addictions at risk of entering or already in the child welfare system. Services include: outpatient services, residential treatment for parents with their child and recovery supports (peer mentoring, housing, transportation and child care). Since launch of program in July of 2007: Reduction in length of stay in family foster care; 6.8 months for reunified children under ITRS compared to 8.9 months for children whose parents received services in 2005-2007; Approximately 868 or 40 percent reunified with their parents, saving $1.7 million a month in foster care costs. (As reported by CAF in early 2010) 10
Recovery focus AMH promotes resilience and recovery for people of all ages. Recovery, a process of healing and transformation leading to a meaningful life in the community. Goals: Achieving long-term abstinence with or without the aid of medications; re-establishing positive social relationships; and involvement in a recovery community. There are many roads to recovery. Managing addiction recovery involves person-centered strategies including access to a network of community-based services. 11
Oregon Health Authority; The Opportunity As of July 1, 2011 most health care related functions in the state move into the Oregon Health Authority (OHA). The OHA is overseen by a nine-member, citizen-led board called the Oregon Health Policy Board. DHS and OHA will be sister agencies linked by many shared administrative services. It's a new way of doing business with a set of partners who have not worked together in the past; a chance to be creative and innovative. 12
OHA and Federal Health Reform Improving the lifelong health of Oregonians. Integration of physical, addiction and mental health care services. Expansion of Oregon s health care system to ensure every adult has access to health care in the future by 2014. Presently, thanks to the 2009 Legislature opportunity to enroll in health care coverage expanded to all uninsured children (under 19) in the state. Increasing the quality and availability of care for all Oregonians. Lowering or containing the cost of care so it's affordable to everyone. 13
Challenges and opportunities AMH provides leadership and support to keep young people at home, in school and out of trouble. Need research and data driven decision making to guide evidence based/best practices. Prevention, early interventions, treatment and recovery focusing on youth and young adults. Connect with youth and young adults in their social and physical environments. Address the stigma associated with addictions. National Quality Forum Standards of Care Screening, Brief Intervention, Referral and Treatment (SBIRT) Early Interventions Medication Assisted Treatment 14