Attachment 3 Effrts t Address the Opiid Epidemic in Clark Cunty
Overview Backgrund Current wrk SNHD Challenges Next Steps
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)
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 45-54 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
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, 2017. Natinal Rx Abuse & Herin Summit. Health Plan f Califrnia
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
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 https://piid.snhd.rg/
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 www.gethealthyclarkcunty.rg website.
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
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
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
Cntact Jessica Jhnsn, MPH CHES Health Educatr II 702-759-1268 jhnsnjes@snhd.rg
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 www.gethealthyclarkcunty.rg 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 2018. 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
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 15-20 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: 1. 2017 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
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