Coalition Strategies Across The Continuum of Care Dorothy J. Chaney M.Ed. CADCA Consultant Building Safe, Healthy, and Drug Free Communities
Overview and Objectives: By completing this training participants will be able to: Identify the different aspects of prevention across the opioid continuum of care Recognize root causes at each stage of the continuum Clarify their coalition s role in addressing the Opioid crisis Develop strategies for engaging coalition partners and community members in addressing the Opioid crisis 2
Session Overview I. Overview of the Opioid Epidemic II. The Opioid Continuum of Care III. The Role of the Coalition IV. Next Steps: Community Engagement in Addressing the Opioid Crisis
Opioid Use in the United States Source: http://www.narconon.org 4
Some Good News 'Epicenter' of N.J.'s opioid epidemic may be getting better -NJ.com, May 2018 Opioid use on the decline Last year, Ocean County saw a 36.4-percent reduction in the number of cases in which Narcan was administered by ether police or emergency medical technicians in 2017, down to 621 from 977 the year before, NJ Cares reported. Over that same two-year period in Monmouth County, Narcan was used in 6 percent fewer cases, from 714 to 671. 6
The Numbers Continue to Grow
Opioid Misuse & Abuse -Data Painkiller Prescribing Varies Widely Between States CDC. Prescribing data. http://www.cdc.gov/drugoverdose/data/prescribing.html. Accessed 6/8/2015. 8
Opioid Misuse & Abuse -Data Reason for Most Recent Rx Pain Reliever Misuse Source: SAMHSA Key Substance Use and Mental Health Indicators in the US: Results from the 2016 National Survey on Drug Use and Health 9
Opioid Misuse & Abuse -Data Opioid Misuse Last Year Source: SAMHSA Key Substance Use and Mental Health Indicators in the US: Results from the 2016 National Survey on Drug Use and Health 10
Opioid Misuse & Abuse -Data Opioid Overdoses Source: Centers for Disease Control and Prevention 2015 11
Opioid Misuse & Abuse -Data Opioid Calls to Poison Control Centers Source: http://www.aapcc.org/alerts/opioids/ 12
Opioid Misuse & Abuse -Data Heroin Use Has Alarmingly Increased Across the US Among Men and Women, Most Age Groups, and All Income Levels Heroin use more than doubled among young adults ages 18 to 25 in the past decade More than 9 in 10 people who used heroin also used at least 1 other drug 45% of people who used heroin were also addicted to prescription opioid painkillers CDC Vital Signs. Today s heroin epidemic. http://www.cdc.gov/vitalsigns/pdf/2015-07-vitalsigns.pdf. Accessed 7/14/2015. 13
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Discussion What does the data look like in your community? What is the substance most used by youth? 15
Opioid Use The & Overdose River Story Prevention Moving Upstream: A Story of Prevention & Intervention 16
A Public Health Approach Community Coalition Community Coalitions Agent Root Causes (Risk Factors) Host Agent Community Environment 18
IOM Continuum of Care Source: National Research Council and Institute of Medicine. (2009). 19
Opioid Continuum of Care Opioid Misuse & Abuse Prevention Treatment & Recovery Primary ATOD Prevention Harm Reduction & Overdose / Death Prevention 20
Opioid Continuum of Care Intervention Prevention Treatment & Recovery Health Promotion Harm Reduction & Overdose / Death Prevention 21
Opioid Continuum of Care Primary ATOD Prevention Comprehensive primary prevention programs, practices, and approaches are programs and services provided for both the general population, and targeted sub-groups who are at high risk for substance abuse. Primary prevention is directed at individuals who do not require treatment for substance abuse. 22
Opioid Continuum of Care Opioid Misuse and Abuse Opioid Misuse is identified as: The use of an Rx drug without a prescription from a physician, e.g. receiving or stealing from a friend / relative Taking an Rx opioid simply for the experience or feeling the drug causes or for any reason other than prescribed Taking an Rx opioid in a different manner than prescribed, e.g. crushing and injecting or taking a higher dose than prescribed Use of licit or illicit opioids in combination with other substances e.g. alcohol, marijuana, etc 23
Opioid Continuum of Care Harm Reduction Harm reduction strategies mitigate risks associated with prescription drug misuse and overdose. Harm Reduction strategies do not focus solely on preventing prescription drug use and initiation, rather they are designed to reduce death, disability, and other negative consequences associated with NMUPD and overdose. Source: SAMHSA, Preventing Prescription Drugs Misuse. 24
Opioid Continuum of Care Overdose / Death Prevention Overdose / death prevention seeks to: Prevent people from overdosing by identifying individuals and populations are risk for overdose before an overdose occurs. Prevent deaths from overdose emergency medical personnel, health care professionals, caregivers, and patients increasingly are being trained in the use of the opioid, antagonist naloxone and other medicines. 25
Opioid Continuum of Care Treatment and Recovery Opioid Dependence and Addiction: Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm. 26
Opioid Continuum of Care Harm Reduction & Overdose / Death Prevention Primary ATOD Prevention Opioid Misuse & Abuse Prevention Treatment & Recovery Preventing and limiting the impact of opioid use and abuse 27
Discussion Does your coalition have a shared understanding of the definitions of prevention? Do you think its important that they do? Why?
Coalitions: Charged with Leading The Way The challenge: We are being looked to as the leaders in coordinating and implementing a comprehensive response to the Opioid Epidemic. How do we accomplish this while also keeping the focus on prevention? Recognizes the value of coalitions Risks it potentially moves us out of our lane
Community Coalitions Role of a Coalition in Achieving Community-level Change Impact a Defined Community Uses an effective planning framework Achieve Positive Outcomes Engage All Sectors of the Community Promote Comprehensive Strategies 30
Coalitions Mission & Vision What is your coalition s mission and vision?
Coalitions Mission & Vision What is your coalition s mission and vision? Is there a conflict between your mission and vision and The work you are being expected to do with the opioid crisis?
Role of Coalition Utilize the Strategic Prevention Framework Collect and analyze data Examine root causes/risk factors 33
34 Protective Factors Protective Factors are conditions in the individual and shared community environments which buffer youth from exposure to risk factors and increase the likelihood that youth live safe and healthy lives.
Root Causes (Risk Factors) Root Causes are conditions in the individual and shared community environments which increase the likelihood that youth become involved in substance abuse.
Root Causes (Risk Factors) Community Norms Laws and Enforcement Social Availability Underage Drinking Retail Availability Parental Attitudes Favorable Toward Use Promotion and Price of Alcohol Favorable Youth Attitudes (Low perception of risk) 36
Local Conditions How do the root causes operate in the community? What do they look like? 37
Create A Comprehensive Community Plan Strategies Targeting Individualized Environments Strategies Targeting the Shared Community Environment Family INDIVIDUAL YOUTH School Norms ALL YOUTH Regulations Faith Community Health Care Providers Availability
Comprehensive Strategies 39
Comprehensive Strategies Send flyers / meet retailers Training on sign restrictions Law Enforcement MOU Recognize retailers Alternative Ads Sign Removal City Ordinance 40
Discussion What is the role of a coalition within each of the elements of the Opioid Continuum of Care? 41
Root Causes ATOD Prevention Opioid Misuse and Abuse Opioid Misuse & Abuse Addresses both legal Rx drugs and illegal use of Rx drugs and other opioids (e.g., heroin). Source: http://masstapp.edc.org/sites/masstapp.edc.org/files/masscall2_guidance_document.pdf 42 42
Root Causes ATOD Prevention Opioid Misuse and Abuse Opioid Misuse & Abuse Individual Assessment for Risk of Opioid Abuse Source: NIDA - https://www.drugabuse.gov/sites/default/files/files/opioidrisktool.pdf 43 43
Root Causes ATOD Prevention Overdose Prevention Overdose Prevention Individual & community conditions include: Tolerance Mixing Opioids with other drugs Chronic Medical Conditions Mode of administration of the substance Previous nonfatal overdose Variation in strength and content of street drugs Using alone Source: Massachusetts Department of Public Health Opioid Overdose Education and Naloxone Distribution http://www.mass.gov/eohhs/docs/dph/substance-abuse/core-competencies-for-naloxone-pilot-participants.pdf 44 44
Root Causes ATOD Prevention Overdose Prevention Who is at Risk for Overdose? Those at increased risk of opioid overdose include persons: Receiving rotating opioid medication regimens Patients discharged from emergency medical care following opioid intoxication or poisoning Experience a legitimate medical need for analgesia, coupled with a suspected or confirmed history of substance abuse Completing mandatory opioid detoxification or abstinent for a period of time Recently released from incarceration and a past user or abuser of opioids Source: SAMHSA Opioid Overdose Prevention Toolkit 45 45
Root Causes ATOD Prevention Overdose Prevention Who is at Risk? Priority Groups for Intervention include: Active users Friends and family members Individuals leaving treatment Individuals currently on maintenance therapy Individuals released from prison with history of opioid use Individuals undergoing detoxification Source: SAMHSA Opioid Overdose Prevention Toolkit 46 46
Discussion How can coalitions use their expertise in community problem solving across the Continuum of Care? 47
Community Engagement: The Opioid Crisis What potential actions could your coalition take to: Facilitate a community discussion about how the community as a whole, addresses the entire continuum of care Engage other sectors, organizations, individuals who would be a natural fit to engage in leading the work for a given element of the continuum of care If the coalition is expected to lead some element of the work, how might the coalition organize itself effectively given the current work of the coalition?
Next Steps What are the next steps for your coalition? Who needs to be involved in these initial next steps?