Traci C. Green, PhD, MSc Jody Rich, MD, MPH

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1 Traci C. Green, PhD, MSc Jody Rich, MD, MPH

2 Strategic Plan highlights Comments & Responses from public, stakeholders Input and discussion Next steps

3

4 Death rate for U.S. non-hispanic whites (USW), U.S. Hispanics and six comparison countries, aged (Source: Proceedings of the National Academy of Sciences.)

5 Mortality by cause among white non-hispanics ages (Source: Proceedings of the National Academy of Sciences.)

6 Use as prescribed Illicit users Young Legal problems Other illicit drugs Snort, inject Prescribed Misusers Psychiatric problems Older More women Pain, medical problems Oral (Medically healthy) Abusers Combined with alcohol Younger More men Low/no pain Oral, snort TC Green, R Black, JM Grimes-Serrano, SH Budman, SF Butler. Typologies of Prescription Opioid Use in a Large Sample of Adults Assessed for Substance Abuse Treatment. PLoS ONE (6(11): e27244).

7 Interventions Demand Prescriber Toolkit Clinician Prescription Monitoring Program Resources Targeted Medical Education Public Awareness Campaign Expanded treatment (especially medication assisted treatment) Recovery centers Supply Prescriber Toolkit Clinician Prescription Monitoring Program Resources Targeted Medical Education Medication Dropbox es at Police Stations Harm Structural Naloxone Distribution to those at risk Naloxone Access for all First Responder Prevention Good Samaritan Law Drug Poisoning as part of HEALTH Injury program BHDDH Emergency regulations: drug treatment programs HEALTH Emergency regulations: pharmacy and prescriber Reporting/data collection for surveillance and evaluation

8 2009 Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q1* total Total illicit drug Acetyl Fentanyl Outbreak Illicit, Synthetic Fentanyl Outbreak 60 illicit & med medication Source: RI Office of State Medical Examiner

9 40 Total accidental drug deaths opioid of any type illicit drug (other than THC) fentanyl of probable illicit source *provisional data

10

11

12

13 Responsive, flexible, interdisciplinary Bridge & Create better data Emergent trends, public health surveillance protocols Specimen collection, rapid testing Innovate interventions Public Health, Public Safety partnerships, responses Invest in highest risk settings Massive Demand Reduction efforts, investments Prioritize Evidence-Based Treatment, Recovery Supports Mitigate Risk & Reduce Stigma at every opportunity

14 Change in Attitudes among Law Enforcement Overdose prevention for people who use drugs is a waste of time and money Drug users can stop using drugs whenever they want to First responders (police, fire) have a role to play in injury prevention, including overdose prevention Improved Law Enforcement knowledge, self efficacy to respond to overdose Behavior Change: Police Actions at scene of overdose Pre-training: 13% Active response; 61% Passive, 26% nothing/don t know/missing Post-training: 58% Active response pre_c post_ Environmental change over time: MA: Dramatic, improved community-police relations Source: Saucier, Zaller, & Green, All police 1+ OD py <1 OD py State Police Sherrif/Capitol Municipal

15 Locally derived, data driven, evidence based Sustainable Responsive Extraordinary Measureable Stigma-reducing Dashboard : public facing, privileged stakeholder access for transparency, accountability Communication strategy to market approach

16 Treatment Strategy: Every Door is the Right One Medication assisted treatment at every location where opioid users are found medical system (EDs, hospitals, clinics), criminal justice system, opioid treatment programs, community Buprenorphine and Methadone in Baltimore: Schwartz et al. AJPH 2013.

17 Naloxone distribution in Rhode Island January 2014 to June 2015 by distribution source and route (IN=intranasal, IM=intramuscular). Source: RI DOH Leverage PMP for tracking Naloxone dispensing & develop a parallel system for tracking other trainings/dispensing (e.g., ED provision, police use, community), affordable sustainable source for community & first responders, & de-stigmatize indication for naloxone by establishing naloxone prescription as standard of care with any C2, syringe sale, or opioid+benzo prescription or fill within 30 days

18 Source: Park TW et al., BMJ 2015 Reduce dangerous prescribing of benzodiazepines through PMP alerts, guidelines for MAT and pain/benzo use, provider education & detailing

19 Source: L. Samuels, 2015 Large-scale expansion of peer-based recovery coach reach and capacity ED, prison, community, outbreak based street outreach

20 Workgroups Primary prevention, school and family based prevention initiatives, early intervention Recovery supports, including housing

21 Implementation Workgroups Short and long term implementation plans Volunteers: Task Force members and other members of the public 90 minute meetings, twice per month 10 member limit Sign up on strategicplanri.org

22 Questions/Comments

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