Eastside Human Services Forum

Who is Eastside Human Services Forum? Local City & County Government Nonprofit Human Service Providers United Way of King County Eastside Interfaith Social Concerns Council Hospitals School Districts Corporations Private Philanthropic Foundations

What does Eastside Human Services Forum do? Foster strong public & private partnerships to assure a stable network of health and human services for the benefit of all East King County Residents.

King County Heroin and Prescription Opiate Addiction Task Force member and Chair or Co- Chair of each of the implementation committees Principal Research Scientist, University of Washington, Alcohol and Drug Abuse Institute Affiliate Associate Professor, School of Public Health, University of Washington 2016 Washington State Public Health Leadership Award for his extensive work in addressing the opioid epidemic Served as Senior Science Advisor for the Office of National Drug Control Policy in the Executive Office of the President in 2012. Caleb Banta-Green

King County Drug Trends 2016 Caleb Banta-Green, PhD MPH MSW Principal Research Scientist, Alcohol and Drug Abuse Institute Affiliate Associate Professor, School of Public Health University of Washington June 13, 2017

Police evidence testing Source: WA State Patrol Crime Lab Analysis: Alcohol and Drug Abuse Institute http://adai.uw.edu/wadata/

Recovery Helpline, King County

Note-Major data change in 2016

Source: King County Medical Examiner Analysis: Alcohol and Drug Abuse Institute

Fentanyl deaths There were 22 fentanyl-related deaths in King County* A few were Rx fentanyl Some were unknown/suspicious fentanyl Others were fentanyl-related drugs Illicit fentanyls seem to be in powder and pills locally Two examples of types seized by local police in 2016: Looks like 30mg oxycodone Looks like 15mg oxycodone Actually fentanyl Actually furanyl fentanyl, heroin, U-47700, alprazolam http://adai.uw.edu/pubs/pdf/2017fentanyldeaths.pdf

Prescription Opioids distributed in WA State (DEA ARCOS) The total number of daily doses of opioids sold to hospitals and pharmacies in WA State peaked in 2011 at 112 million. The increase over time was enormous, it has since declined modestly. http://adai.washington.edu/wadata/arcosopiates.htm

OXYCODONE MORPHINE (heroin metabolite) $80 $10 & easier to get

Opioid Use Disorder Treatment Connecting people to care BUILDING KNOWLEDGE AND DEMAND Opioid Use Disorder Education De-Stigmatizing OUD OUD Treatment Education De-Stigmatizing OUD Treatment Meds CONNECTIONS Meeting people where they are Deciding on treatment options Treatment Decision Making Finding treatment Real time availability- Geographic & $$$ TREATMENT Social support Counseling Treatment medications Care setting Medication type

Opioid use disorder Is treatable. Treatment medications are the standard of care Most people will do best on medications Many will also benefit from social support/counseling Treatment medications- Support recovery You can be on treatment medication AND in recovery Reduce fatal overdose rates by 50%

Continuum of care for opioid misuse Prevent inappropriate initiation of opioids Treat Opioid use disorder Manage pain & opioids safely Improve function & Reduce morbidity & mortality Overdose Infectious disease Death Populations General public Prescribers Patients Youth Populations Addiction Pain Populations Addiction Pain Opioid user Social network & Police Interventions Supply reduction Law enforcement Prescribing practices Pain management practices Lock boxes Rx disposal Prescription Monitoring Demand reduction Education Health beliefs Medication beliefs Pain/Stress Settings Medical care/pharmacy Schools Homes Interventions Opioid treatment meds Psychosocial Social/recovery support Health care/pain management Complementary health Housing Settings Medical Clinic Hospital/ER Community/PH/NGO Drug treatment programs Drug court Jail/Prison Interventions Health care/pain management Opioid treatment meds HIV/HCV treatment meds Housing OD ed./naloxone Syringe exchange Safe consumption sites Good Samaritan Response Settings Community/PH/NGO Medical Clinic Hospital/ER Pharmacy Drug treatment programs Drug court Jail/Prison Developed by Caleb Banta-Green calebbg@uw.edu 01/19/17

King County Opioid Task Force Chairs Dr. Jeff Duchin Public Health Brad Finegood Behavioral Health 32 members Met April-Sept 2015 in public Implementation work ongoing Comprehensive website http://www.kingcounty.gov/depts/community-human-services/mental-healthsubstance-abuse/task-forces/heroin-opiates-task-force.aspx

Resources adai.uw.edu

Questions and Answers

Best Practices Panel Utilization of Narcan/Naloxone Jeff Clark Fire Chief, Eastside Fire & Rescue Treatment & Screening Practices in Schools Jerry Blackburn Program Manager for Substance Abuse Prevention Services, Friends of Youth Secure Medicine Return Programs Margaret Shield, Principal, Community Environmental Health Strategies

Opioid overdose antidote May be used by health professionals or laypersons Opportunities to expand distribution of naloxone Utilization of Naloxone

Treatment & Screening Practices in Schools School-based I/PS Services/MIDD Parent education efforts School-based health centers SBIRT Universal screenings

Prevention: Secure Medicine Return Programs Margaret Shield PhD Community Environmental Health Strategies LLC www.cehstrategies.com

Mind Your Meds Safe Kids Talk to your kids and family members about the risks of medicine misuse and abuse. Safe Use Take meds as directed. Never share your meds. If prescribed pain meds, take lowest possible dose. Safe Storage Keep all medicines in secure place. Count your pills. Lock them up. Safe Disposal Protect your family and the environment: use a secure drop box for safe disposal of unused medicines.

About 1/3 of Medicines Sold to Households Go Unused For many reasons: Changes due to side effects or to find best treatment Use As Needed medicines expire before used. Medicines leftover after serious illness. Medicines leftover after end-of-life care, including strong pain relievers. Overprescribing. Many actions underway. Overpurchasing of OTCs, encouraged by advertising. Patient doesn t finish.

Many Types of Medicines Abused Commonly Abused Rx Drugs Opioids Stimulants Sedatives Anti-anxiety drugs Commonly Abused Over-The-Counter drugs cough/cold medicines (DXM) antihistamines diet pills laxatives, diuretics loperamide (Immodium) Adderall misuse among young adults rose 67% and ER visits increased, 2006-2011.

Secure Medicine Return: Safe for Your Family and Our Environment Secure and safe. Reduces access and risks. Helps prevent medicine abuse, poisonings, and overdoses. Environmentally sound. Keeps waste medicines from adding to pharmaceutical pollution. FDA, DEA, EPA, and local agencies recommend secure medicine return as better than trash disposal.

NEW! MORE CONVENIENT PHARMACY LOCATIONS! MED-Project Program in King County provided by drug manufacturers under county law Secure drop boxes at participating: Retail pharmacies Grocery Stores Clinics/hospitals Law enforcement agencies more than 80 locations! NARCOTICS & OTHER CONTROLLED DRUGS ACCEPTED medicinereturn.org

medicinereturn.org Which Medicines? ACCEPTED PRESCRIPTION DRUGS OVER-THE-COUNTER DRUGS PET MEDICINES pills, capsules, liquids, creams CONTROLLED SUBSTANCES Oxycontin, Vicodin, Ritalin, Xanax Image from NOT ACCEPTED INHALERS SHARPS VITAMINS/SUPPLEMENTS PERSONAL CARE PRODUCTS ILLEGAL DRUGS MEDICINES FROM BUSINESSES

Where? medicinereturn.org or 1-844-633-7765

Where? http://med-project.org/locations/king-county/convenient-kiosks MED-Project.org or call 1-844-633-7765

Prepaid Return Mailers For home bound & differentiallyabled residents 8 x11 envelope 8 ounces of unwanted medicines Call 1-844-633-7765 Request online www.med-project.org/locations/king-county Pick-up at King County Libraries & at Town Halls in Hunts Point, Yarrow Point & Beaux Arts Village Home healthcare professionals can request for patients

Secure Medicine Return Regulations in 4 Washington Counties WA ordinances enacted by local Boards of Health King County Snohomish County Kitsap County Pierce County & several more counties considering policy processes.

WA Secure Drug Take-Back Bill SHB 1047, Rep. Strom Peterson, 21 st LD Expands secure medicine disposal options to reduce risks of medicine poisonings, misuse, and environmental pollution. Improves convenience for residents by providing secure drop boxes in pharmacies and hospitals, as now allowed under the DEA Rule for take-back of controlled substances. Photo by Stephen Colebourne Ensures financial sustainability through a system the pharmaceutical industry funds and coordinates, relieving burdens on law enforcement, local agencies, and taxpayers. Modeled on successful local Board of Health Regulations in King, Snohomish, Kitsap, Pierce. Supported by law enforcement, fire fighters, public health agencies, prevention advocates, doctors, nurses, dentists, hospice and home care professionals, environmental organizations, and more!

Estimated Costs to Drug Manufacturers for Secure Drug Take-Back ~ 0.1% of annual medicine sales of $5.7 billion in Washington which is like investing a for public safety from every $10 in medicine sales Every pill bottle collected is another opportunity to stop an addiction before it starts. Representative Strom Peterson

What Can You Do? Help promote the new Secure Medicine Return program in King County Ask your local pharmacy or clinic to host a MED-Project drop box Support the WA Secure Drug Take-Back Bill Talk to family, friends, neighbors about Safe Storage & Secure Medicine Return Drop box locations in other parts of WA: www.takebackyourmeds.org

Prevention WINS rack card

Questions and Answers

15% Solution The 15% Solution is about noticing and using the influence, discretion, and power individuals have right now. --Keith McCandless We tend to think of the 85% as out of our control; therefore, the 15% is where substantial results can be achieved. 15 %

15% Solution Come up with your own 15% Solutions What is within your sphere of influence to be able to forge towards a positive solution? What can you do without more authority? What can you do without more resources? Reinventing the wheel is ok.

THANK YOU!