Best Practices and Foundation Forum Fred Wells Brason II fbrason@projectlazarus.org
Wilkes County, NC Manual labor dominates employment options in this county of 69,000.
Wilkes 4 Marvelous M s Moonshine Marijuana Meth Medicine
Who is Project Lazarus? Non-profit organization Believes that communities are ultimately responsible for their own health and that every drug overdose is preventable. Prevention Intervention - Treatment Preventing opioid/opiate poisonings Presenting responsible pain management Promoting Substance Use Treatment and Support services
Prescription Medication Use Prevent Intervene - Treat Overdose Who, What, When, Where, Why, How? Patient misuse Family/Friends sharing to self medicate Accidental ingestion Recreational User Substance Use Disorder/Treatment/Recovery
THE HUB I. Public Awareness is particularly important because there are widespread misconceptions about the risks of prescription drug misuse and abuse. It is crucial to build public identification of prescription drug overdose as a community issue. That overdose is common in the community, and that this is a preventable problem must be spread widely. Identify issue at local level Broad-based outreach all population groups II. Coalition Action - A functioning coalition should exist with strong ties to and support from each of the key sectors in the community, along with a preliminary base of community awareness on the issue. Coalition leaders should also have a strong understanding of what the nature of the issue is in the community and what the priorities are for how to address it. Community Sectors Why am I needed What do I need to know What needs to be done
THE HUB cont. and Evaluation Data Epidemiologic Profile of Unintentional Poisonings NC All poisoning deaths Opioid OD Heroin OD All Hospital and ED admission/visits; medicine and drugs Opioid patients Opioid prescribers Benzodiazepine patients Buprenorphine patients Prescription/patient sleep aid Prescription/patient stimulants Self-inflicted Hospital/ED; medicine and drugs Self-inflicted poisoning and opioid deaths
The SPOKES Community Education - efforts are those offered to the general public and are aimed at changing the perception and behaviors around sharing prescription medications, and improving safety behaviors around their use, storage, and disposal. Prescription medication: take correctly, store securely, dispose properly and never share. A prescriber can write appropriately, a pharmacist can dispense properly but once in the community?
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COMMUNITY Why am I/We needed What do I/We need to know What needs to be done
Prescriber Education Chronic Pain Initiative CPI PURPOSE Reduce risk of patient overdose Reduce risk of patient medication diversion Treatment of chronic pain - Exploring options in addition to/instead of medications Use of the Prescribers Toolkit Bio/Psycho/Social Assessment Overdose/Respiratory Depression Risks Use of Prescription Drug Monitoring Program (CSRS) Treatment Agreement Urine screens/pill counts Co-Prescribing naloxone Prescribing Abuse Deterrent Formulations
THE SPOKES cont. Hospital ED Prescribing Hospital Emergency Department (ED) Policies - 1) Embedded ED Case Manager 2) Frequent fliers for chronic pain, non-narcotic medication and referral 3) No refills of controlled substances 4) Mandatory use of PDMP (CSRS) 5) Limited dosing (10 tablets)
THE SPOKES cont. Diversion Control Project Lazarus - Project Pill Drop Diversion Control Law Enforcement, Pharmacist and Facility training on forgery, methods of diversion and drug seeking behavior. MA DPH Study: "at least" two out of every three people who died of an opioid overdose had been prescribed an opioid between 2011 and 2014. o But just 8.3 percent of those decedents had an active opioid prescription in the same month as their death,
NC Medication Disposal Initiative
THE SPOKES cont. Pain Patient Support Pain Patient Support - In the same way that prescribers benefit from additional education on managing chronic pain, the complexity of living with chronic pain makes supporting community members with pain important. Proper medication use and alternatives Take correctly, store securely, dispose properly and never share! Additional modalities: health and wellness, music, breathing, physical therapies, acupuncture, yoga, exercise, etc.
Drug treatment and Recovery Substance Use Disorder treatment, Unfortunately, access to treatment is limited by two main factors: Acceptance, Availability and Accessibility of treatment options Negative attitudes or stigma associated with addiction in general and drug treatment. Integration Law Enforcement Behavioral Health SA Treatment ED Health Department Medical Providers Labor and Delivery - OB/GYN buprenorphine, naltrexone, methadone, 12 Step, abstinence programs, residential, Peer Support
Survival Understand the Concept of Addiction FOOD WATER DOPAMINE
Drug Problem? Biological TBI, PTSD Cultural Environmental Depression Trauma Poverty Drug Problem Crime Death Finances Family Health Economics
Lazarus Recovery Services Lazarus Peer Guides (LPGs) offer friendly companionship and successful experience navigating the pathway toward recovery. We have: A stable recovery. A desire to enrich lives. Specialized training and certification to handle a crisis, an overdose, and save lives. Supportive Roles Empathic Support Resource Support Constructive Support Connective Support Lived Experience Problem-Solving: Crisis Intervention Community Navigation Family Involvement Support Groups
The Spokes - Naloxone - Increasing Access Respiratory depression/overdose prevention training Distributing a script that gives patients specific language they can use with their family to talk about overdose and develop an action plan, similar to a fire evacuation plan Naloxone access to community, tribal groups and military Third Party Prescribing Standing Orders Pharmacy Dispensing Program Distribution New Devices Federal/State Funding
Wilkes County Results Wilkes Scripts related to overdose 2008 82%, 2011 0% Wilkes School SA incidences 7.3 per 1000 2011-2012 4.9 2012-2013 3.4 2013-2014 2.5 2014-2015 SA ED visits down 15.3 % Involuntary commitments reduced/less SA calls Diversion Tips increased Crime 10% less I would say 90 percent of people illegally selling pills aren t getting it locally. I think local doctors are doing a heck of a good job with not prescribing excessively and to people with other than legitimate intentions. The pills in Wilkes Sheriff s Office cases mostly come from pain clinics outside the county, said Dancy.
LHD COALITION LEADERSHIP OD ED VISITS PER 1k OPIOID SCRIPTS A priori selected metric for risk-benefit COALITION FUNDING HELPS Funded coalitions had 18% lower rates than non-funded PROFESSIONAL COALITIONS WORKING Coalitions led by health departments had 26% lower rates PRELIMINARY ANALYSIS Much more to be done! Does not take into account the interventions themselves IS THERE A HEALTHY COUNTY BIAS? Propensity score modeling ahead This decrease represents 4 fewer ED visits per 3,000 opioid scripts in counties with Health Department-led coalitions. (20,000 NC ED visits - NC ED OD visit $12,000 Medicaid $72 million 2014)
IMPACT in NC Most effective strategies to immediately reduce overdose rates were prescriber education related to pain management and addiction treatment Policies designed to limit the amount of opioids dispensed in hospital emergency departments. Greater utilization of addiction treatment showed a delayed reduction in ED-related overdose visits. State and local strategies to prevent overdose should consider interventions within the healthcare system, and use community-based coalitions to build and sustain support for these interventions
Project Lazarus.org Fred Wells Brason II fbrason@projectlazarus.org Robert Wood Johnson Foundation Community Health Leader Award 2012