Stark County Opiate Task Force

Stark County Opiate Task Force Allison Esber, MSSA, LSW, OCPSA Systems Initiative Manager April 10, 2017 Partner Solutions Informatics Forum for Next Gen Users in Behavioral Health

What does StarkMHAR do? Vision People of Stark County live enriched lives through wellness and recovery What we do Advance public mental health and addiction prevention, treatment and recovery in Stark County through funding, advocacy and education. Mission People of Stark County have access to a state-of-the-art mental health and recovery system of care.

Opiates Can be illicit or prescribed Most common is Vicodin, Darvon, Darvocet, Opana, Talwin, Dilaudid, Demerol, OxyContin, Fentanyl and Heroin Most are Schedule II and III substances Heroin is a Schedule I substance- high potential for abuse and no acceptable medical use. FDA recently approved OxyContin for children, previously Fentanyl patches.

Opiates Typically injected, smoked, swallowed or snorted Causes euphoria, drowsiness, impaired coordination, dizziness, confusion, nausea, sedation, feeling of heaviness in the body, slowed or arrested breathing, constipation. Increased risk of endocarditis, hepatitis, HIV, addiction, fatal overdose

State vs Stark County Statistics Ohio has experienced a 440% increase in drug related deaths (1999 2011) Prescription drugs, pain meds and polypharmacy ingestion Opioids (prescription opioids and/or heroin) were involved in 65.4 percent of all unintentional drug overdose deaths in 2011 Stark County has experienced a 471% increase in drug related deaths (2000 2011)

Stark County Overdose Deaths 2013-2016 Year Overdose Deaths Heroin/Fentanyl specific overdose deaths 2013 45 20 2014 66 37 2015 75 46 2016 * 105 64 *2016 data unofficial as final reports from coroner s office are pending

The relationship between prescription painkillers and heroin Approximately 45% of heroin user start with prescription drugs such as Vicodin and OxyContin Estimated annual cost of unintentional drug overdose in Ohio: Types of costs Fatal costs Non-fatal/hospital admitted costs Medical $4.9 million $19.1 million Work Loss $1.2 billion $5.2 million Quality of Life $2.2 billion $7.6 million Total $3.5 billion $31.9 million

Year 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Epidemics of Unintentional Drug Overdoses in Ohio, 1979-2012 1,2,3 2000 1500 1000 Prescription drugs led to a larger overdose epidemic than illicit drugs ever have. Prescription Pain Medication (Opioids) Heroin & Rx Opioids 500 Heroin Crack Cocaine 0 Source: 1 WONDER (NCHS Compressed Mortality File, 1979-1998 & 1999-2005) 2 2006-2011 ODH Office of Vital Statistics, 3 Change from ICD-9 to ICD-10 coding in 1999 (caution in comparing before and after 1998 and 1999) 8

Evolution of the epidemic Direct to Consumer Advertising FDA approval of powerful and addictive opiates (OxyContin- 1996, Zohydro) Intractable Pain Act of 1998 (Before 1990, opioids were used sparingly) The incorporation of the 5th Vital Sign - 1999 Medicare and Medicaid Grading Systems-2006

Fentanyl

Fentanyl http://www.pbs.org/newshour/rundown/fentanyl-deadlier-heroin-single-photo

Stark County Statistics According to Ohio Department of Health s 2014 Ohio Drug Overdose Preliminary Data: General Findings: Stark County had 21 Fentanyl related overdose deaths in 2014. Stark County Coroner Data: Of the 75 Overdose deaths in 2015, 37 of those were Fentanyl related. Stark County Coroners office reports 111 Overdose deaths for 2016. ODH Number of Unintentional Stark County Overdose Deaths 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 16 25 25 30 21 39 40 35 42 59 75 Sources: Ohio Dept. of Health, Center for Public Health Statistics & Informatics in partnership with the Violence and Injury Prevention Program; and US Census Bureau (population estimates) Stark County Coroner s Office

Clearly there is problem What are we doing?

Only multi-pronged approaches are effective in this epidemic Prevention Treatment Enforcement Policy/Legislative

Prescriptions Per Capita 2008

Prescriptions Per Capita 2014

Opiate Task Force Treatment Providers Prevention Providers Community members Hospital/Medical Health Departments Law Enforcement Faith-based Foundations Justice system Grassroots organizations Family organizations Education Housing Businesses Media Coroner s office Community organizations Individuals in recovery

Opiate Task Force Strategies Engage the community with a unified goal, coordinate strategies and pool resources Coordinate and facilitate local opiate prevention and education activities Coordinate and facilitate medical professionals around prescribing practices involving opiates Create/enhance a support group for individuals and families that have been impacted by opiate addiction Establish a fatal overdose review committee

Opiate Task Force Activities Day of Remembrance and Renewal Coordinate Opiate Prevention town hall meetings across the county Host Opiate Symposium Support SOLACE Assist Drug Free Stark County for Drug Take Back Days Distribute Naloxone overdose kits to the community & law enforcement Support local & national events to raise awareness and reduce stigma

Project DAWN

Drug Collection Boxes 17 boxes in Stark County Over 18,000 pounds of medications collected in boxes alone Alliance City Police Department Canton City Police Department Jackson Township Police Department Magnolia Police Department Massillon Police Department Navarre Police Department North Canton Police Department Perry Township Police Department Stark County Sheriff s Office Brewster Police Department City of Canal Fulton Police Department Louisville Police Department Marlboro Township Police Department Minerva Police Department Ohio State Highway Patrol Plain Township Hall Uniontown Police Station

Drug Take Back Days Date Pounds Collected Cost September 25, 2010 1,001 April 30, 2011 2,913 $3,366.82 October 29, 2011 2,480 $1,502.41 April 29, 2012 3,628 $1076.45 September 29, 2012 3,226 $1,586.62 April 13, 2013 5,582 $1,403.93 October 26, 2013 2,459 $1,667.90 April 26, 2014 2,594 $851.48 September 27, 2014 2,081 $0 September 26, 2015 1,392 $0 September 24, 2016 1,138 $0 Total 28,494 pounds $11,455.61

Treatment 10 AoD prevention programs 15 AoD treatment programs 13 AoD and MH treatment programs (co-occurring programs) 32 AoD or MH recovery support programs 6 MH consultation programs (school based) 3 MH prevention programs 16 MH treatment programs

Treatment Detoxification Services: Sub-acute detox: Crisis Intervention and Recovery Center Ambulatory Detox: RECOR (Regional Center for Opiate Recovery) NEW program Project DAWN: CommQuest Crisis Intervention and Recovery Services Adolescent outpatient and intensive outpatient services: CommQuest Stark County TASC (for court involved youth) Adolescent Residential Treatment: Bright House 12 bed facility for females ages 15-18 Smith House 18 bed facility for males ages 15-18 Adult Outpatient Services: CommQuest: three locations Crisis Intervention and Recovery: dually diagnosed people with mental health and substance use disorders CommQuest: Dually diagnosed people with mental health and substance use disorders Adult Residential Treatment: Deliverance House: 16 bed facility for women aged 18 an older Wilson Hall: 24 bed facility for men aged 18 and older Medication Assisted Treatment: CommQuest. Services include methadone, buprenorphine (Suboxone), extended release naltrexone (Vivatrol)

Enforcement Canton Municipal Court Recovery Court Stark County Common Pleas Drug Court/Chance Program Law Enforcement Assisted Diversion (LEAD) Pre-booking diversion for MH, AoD, Co-occurring Good Samaritan Bill Project DAWN for Law Enforcement

Policy Healthcare professionals Prescription Drug Grant- Stark County Health Department Goal MAT Harm reduction strategies SWAP- Canton City Health Department Law Enforcement Drugged Driving- DRE/ARIDE Funding for prevention, treatment, and recovery

Getting Involved Opiate Task Force Drug Take Back Day- Save the Date- September 2017 Advocate for yourself and loved ones

Connecting to Services 1. Contact the service provider directly 2. Access to Behavioral Healthcare at Goodwill Campus, 408 Ninth Street, S.W. Suite 3300 Canton, 44707, 330-617-4747 For non-linked individuals with Medicaid or no insurance Make appointment or walk-in Diagnostic assessments Connection to a case manager Short-term counseling availability Connection to community providers within 14 days

Behavioral Health Emergency If an adult or youth is experiencing a behavioral health emergency: Crisis Intervention & Recovery Center, Inc. crisis hotline: 330-452-6000 Text 4HOPE to Crisis Text Line at 741-741 Crisis Intervention Team (CIT) trained officer Educated on various diagnoses Trained to appropriately intervene in a behavioral health emergency situation.