1. What does the $4.4 mil (FHM $) purchase for services: Prevention Services:

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1 Prevention Services: Works to prevent and reduce substance abuse and related problems by providing leadership, education and support to communities and institutions throughout Maine. FHM prevention dollars support the infrastructure throughout Maine to prevent use of alcohol and other drugs through a variety of community grants, support contracts and backbone services that help measure effectiveness of what is being purchased. Intervention Services: Targets people at risk or in the early stages of developing substance abuse problems and to minimize future problems. The Prescription Monitoring Program s goal is assist Prescribers & Pharmacies in reducing the misuse and diversion of schedule medications that are highly addictive. Treatment & Recovery Services: The treatment team works with the statewide provider network to assure access to a full continuum of quality treatment services 1. What does the $4.4 mil (FHM $) purchase for services: Prevention Services: Prevention Services Overall Impact with Reduction in FHM dollars: Total Direct Services Impact: # of contracts to community based service providers: 31 Total Funding: $2,025,715 FHM Loss: $670,460 % Loss Total Funding: 35.8% SFY 2010, 28 Healthy Maine Partnership (HMP) coalitions statewide served 221 towns with substance abuse prevention strategies. These HMPs worked with over 100 Law enforcement departments to increase effectiveness of underage drinking laws; they worked with 63 agencies and worksites to educate 4,193 parents about the importance of monitoring their teens. Youth Substance Abuse Prevention Programs/ Youth Empowerment and Policy Project and Student Intervention and Reintegration Program grants: OSA contracted with 13 local providers to implement 7 distinct evidence-based prevention programs targeting youth and serving 1296 participants. (Support for these programs are provided with FHM funding.) Higher Education Alcohol Prevention Partnership (HEAPP): provided technical assistance and training to 23 of Maine s 34 colleges and universities in the past 3 years. Campuses serve over 86% of students enrolled at college in Maine. Mini-grants were provided to 15 colleges/universities annually to implement evidence-based strategies to reduce underage and high-risk drinking. HEAPP trained over 500 individuals from Maine college communities in the past 2 years on evidence-based substance abuse prevention and intervention strategies or 1

2 models for college settings. Prevention Media Campaign: Media is utilized to increase awareness about substance abuse. This includes radio/tv air time, printed materials, and web-based promotion to cost-effectively provide healthy messages to prevent the consequences related to substance abuse. OSA s current campaign has three components: 1) MaineParents.net: Parents have a major role to play in keeping their child from underage alcohol and other drug use. High School students who think they will not be caught by their parents are 3.3 times as likely to drink and those who don t believe their parents think it is wrong for them to drink regularly are 2.4 times as likely to drink. 2) Maine.gov/WorkAlert: This campaign is for small businesses to assist with setting up a comprehensive drug-free workplace. 3) Maine.gov/PartySmarter: This campaign for year olds, includes messages to reduce high risk use, as well as provide additional information to educate about low risk alcohol decisions. These Prevention funds are leveraged to obtain a variety of federal funds both for the state system and for local grant capacity. Maine was one of only three states in the nation to recently garner a 3 year grant to work on enforcing underage drinking laws (OJJDP s Enforcing Underage Drinking Laws). With Drug Free Community grantees, Maine community coalitions compete for $500,000 per year for 5 years. Intervention Services (Prescription Monitoring Program): The overall Impact with reduction in FHM dollars: Service Impact: 2,541 providers and pharmacists Total Funding: $318,803 ($199,218 Federal + $119,585 FHM) FMH Loss: $119,585 % FHM Loss Total Funding: 37.51% Total Impact: With no funds to purchase an electronic system the entire program would need to shut down. The FHM helps fund & pay for the electronic web based Prescription Monitoring Program, which currently has 2,287 medical providers and 254 pharmacists participating in the program. Treatment & Recovery Services: The overall impact with reduction in FHM dollars to treatment services: Total Direct Service Impact: # of contracts to community based service providers: 41 Total Funding: $12,937,863 FHM Loss: $3,961,520 % Loss Total Funding: 30.62% Direct Impact to Correction s services: # of contracts to community based service providers: 13; Total Funding: $3,630, FHM Loss: $1,596,844.50; % Loss Total Funding: 43.99% Direct Impact to Residential/Emergency Shelter/Detoxification Level of Care: # of contracts to community based service providers: 13 2

3 Total Funding: $6,077,109; FHM Loss: $1,840,658; % Loss Total Funding: 30.29% Direct Service Assertive Community Treatment, HIV Services, Overdose Prevention and Women s Case Management: # of contracts to community based service providers: 7; Total Funding: $825,185 FHM Loss: $200,450; % Loss Total Funding: 24.29% Direct Service Out Patient Level of Care: # of contracts to community based service providers: 16; Total Funding: $2,405, FHM Loss: $323,567.19; % Loss Total Funding: 13.45% 2. What does OSA get for those purchased services (ie. what do we get for performance & outcomes from those services)? Prevention: Healthy Maine Partnerships: Outcomes from the Evaluation of Maine s Strategic Prevention Framework State Incentive Grant show that Maine s rate of past month alcohol use declined from 43% in 2005 (the first year of the SPF) to 32% in 2009.,These declines are far greater than the current national trends in underage alcohol use, where rates actually increased in 2007 to 45% before decreasing slightly to 42% in Prevention Media: MaineParents.net is a strong component in a state system to decrease youth alcohol use. For SFY 2010, the website produced 9,055 web hits. Maine.gov/workalert - Workplace Prevention programs help lower recruitment and training costs, worker s compensation costs and result in fewer work related accidents. For SFY 2010, the website produced 2,282 web hits. Maine.gov/partysmarter promoting responsible alcohol use had produced 11,130 web hits. HEAPP: Survey results from Maine campuses who worked with HEAPP show: 26% more likely to have not had a drink in the 30 days prior to the survey 29% less likely to have missed a class as a result of their AOD use. 37% more likely to support disciplinary consequences 23% less likely to have done something they later regretted. Intervention (Prescription Monitoring Program): Health care providers: 2,287 Maine Prescribers and 254 Maine dispensers receive notification when patients received unsafe levels of scheduled drugs. They can also log in to the secure online database that allows them to check patients histories before prescribing or dispensing a drug. Licensing Boards: Licensing board executives and investigators access the database for investigations of questionable activity by prescribers, pharmacists, and patients. Law enforcement: The Office of the Attorney General and the US Attorney s Office, on behalf of the Maine Drug Enforcement Agency and other law enforcement agencies, access the database via grand jury subpoena in order to further their investigations into prescription drug diversion. 3

4 Office of MaineCare Services (DHHS): MaineCare s Program Integrity Unit accesses this database to further their fraud investigations. Office of the Chief Medical Examiner (AG s Office): Investigators with the chief medical examiner access the data for investigations into the cause of death in drug-related cases. Researchers: Researchers in-state and nationally have access to aggregate and de-identified data, which is increasingly being used for public health and public policy research. Treatment & Recovery Services: SFY2010 Treatment Data System reports 5007 clients are funded by OSA dollars or are Self-Pay (subsidized by OSA dollars). A 30.62% reduction in FHM dollars would result in 1,533 less consumers able to be served. Adult Drug Treatment Courts served 190 clients in SFY2010. If these clients were to be incarcerated for the period of time they were served by the drug courts would have cost the State of Maine $8,432,010. Individuals served with Criminal Justice as a referral source (2,795 individuals) in SFY2010 who were essentially diverted from incarceration would have cost the State of Maine $124,039,305, if they were incarcerated for that year. Individuals who were severely addicted who were incarcerated in Maine in 2006 and received intensive residential treatment (Differential Substance Abuse Treatment/DSAT)while incarcerated had a recidivism rate of 16% compared to a rate of 31.6% for those who did not receive treatment (Muskie School of Public Service, 2009). Of 110 incarcerated individuals served between the years of who completed the DSAT program and were released, 94 of them have not returned to prison. This yields an 85% success rate or a 6% recidivism rate. (Spectrum Health Systems, Inc.) Transitional Programming within the correctional institution system yielded a 91.4% completion rate in 2009.Family Drug Treatment Courts served 64 clients in 2010 with 21 graduations, 32 children reunified, and 4 drug free babies born. The additional medical costs associated with the delivery of a drug-addicted baby are estimated to range from approximately $1,500 to $25,000 per day (Cooper, 2004). Neonatal intensive care expenses can range from $25,000 to $35,000 for the care of low-birth-weight newborns and may reach $250,000 over the course of the first year of life (Office of Justice Programs, 1997). Continuous care expenses through the age of 18 years for developmentally delayed children can be as high as $750,000 (Janovsky & Kalotra, 2003). 4 of these babies saved the State of Maine upwards of $4,000,000 in their first year of life by treating their mothers. Additionally, at a rate of $56,465 per year for a child to be in foster care, the 32 children reunified saved the State of Maine $1,806, If the $4.4 mil of FHM is reduced, what would the SAPT BG be reduced if our MOE is further placed in the red (Currently $500k in 4

5 the red)? Office of Substance Abuse, Department of Health and Human Services All SA Services Maine s Substance Abuse Prevention Treatment Block Grant Maintenance of Effort Agreement would be in non compliance. The amount of non compliance would be $3,656,163. SAMHSA could reduce the SAPT BG grant by an additional $1.36 million (based on a 20.2% of noncompliance). This with the reduction of $4.4 million of FHM would total a loss of over $5.66 million to the State of Maine to provide Substance Abuse Services. 4. With $4.4 mil being reduced from the FHM, it is probable to expect our SAPT BG award to get reduced proportionately; that would require OSA to further reduce SA services; what would the SA Services Continuum look like for Prevention, Intervention, & TX and Recovery services with federal BG money potentially being lost? Prevention Services: Prevention service statewide would lose most of its capacity and be unable to sustain outcomes. Funding for substance abuse prevention has decreased by over 4 million dollars per year over the last year. FHM portion of prevention s budget is a 25% of total prevention funding. This would not only affect all current contracts, but will decrease and impact local capacity to compete on a national level for funding. The state would lose its effectiveness in competing for federal funding. Intervention Services: If the proposed FHM reduction occurs, the amount of OSA SAPT Block Grant Funding will be jeopardized SAPTBG is OSA s sole source for paying for our portion of the school based survey, Maine Integrated Youth Health Survey which provides data to approximately 47 school systems biannually. Further financial impact to the department: OSA would have to cease operation of the PMP program: OSA could no longer draw down the funds on two federal grants and one private grant, which are supporting not only enhancements to the program, but public health and safety research. SAPT Block Grant pays for 1 Data &Research staff position (salary and benefits), rent for a position, and contributes toward the State of Maine s Indirect. Treatment & Recovery Services: If the proposed FHM reduction occurs, OSA could expect the landscape of behavioral health (addictions treatment) to change dramatically. Since the most expensive service OSA purchases is at the residential services, OSA would be left to eliminate these services from the SA continuum. OSA would work with Providers to have people served at the next appropriate level of care, Intensive Out Patient. The greater issue is that there will be a proportional reduction in the SAPTBG funding that will impact all services (direct & indirect) so that OSA may only be able to purchase Out Patient as a level of care for treatment. 5. In lieu of the cost report & the rising figures & national attention to illicit drug misuse/diversion, what can OSA/Maine expect will happen to these figures with less prevention, intervention, and treatment services being provided? Prevention Services: Maine can expect an increase in rates of substance use for both youth and adults. Alcohol, marijuana and prescription drug use is already at a concerning level. Prescription drug diversion continues to be of concern to legal systems throughout Maine. Without a system to address risk factors for misuse of prescription drugs, diversion and need for treatment will increase. Maine has seen a decrease in youth alcohol use over the last several years, bypassing the nation s rates. Without sustained programming, these numbers will reverse, 5

6 leading to increased need for more expensive services such as interventions and treatment. Maine can expect an increase in consequences related to young adult substance abuse: Maine s High risk drinking rate is higher than the national average. Past year illicit marijuana use among this age group is much higher in Maine (36%) than the national average (28%) Intervention Services: The estimated cost of Substance Abuse in 2010 is $1,180,000,000. The projected cost of Substance Abuse in 2015 for the citizens of the state of Maine is one billion, four hundred fifty eight million dollars ($1,458,000,000) Treatment & Recovery Services: OSA/Maine can expect the numbers of those in need of treatment and unable to access it to increase exponentially. According to the 2007 Cost Report the largest single cost category was crime, accounting for an estimated $214.4 million, followed by mortality, with estimated costs totaling $204.2 million. Significant costs due to medical care ($186.8 million), morbidity ($155.6 million), and other related costs ($112.2 million) were also incurred. Without adequate treatment resources these amounts will increase dramatically. 6. Where/what service will these individuals show up when faced with little to no SA services (in what other costs & what other services)? Prevention Services: When prevention services are not available, more costly programming is necessary - such as diversion programs in the court system and substance abuse treatment. Youth who begin drinking before age 21 are more than 2x as likely to develop alcohol-related problems. Those who begin drinking before age 15 are 4 x as likely to become alcohol dependent than those who do not drink before age 21. Intervention Services and Treatment & Recovery Services: Without the availability of services in the community, individuals will present at: Hospital emergency rooms-drug poisonings & overdoses; Crisis Centers/Psychiatric Hospitals; Homeless & Emergency Shelters; Jails & Criminal Justice system. In 2009 there were 18,326 direct drug and alcohol arrests & an estimated 25,923 additional arrests where drugs or alcohol were involved. 86% of Maine s drug-related deaths are caused by pharmaceuticals: licit & illicit, alone or in combination. 7. What Substance Abuse Services would OSA be able to fund to sustained and maintained services given the $4.4 million reduction in FHM and probable reduction in the SAPT Block Grant of $1.36 million (prioritized programs, services, personnel, and strategies that can be sustained and maintained): Prevention Services HMP Grants: 27 grants/total now of $680,000 Less $140,000 FHM + $40,000 EUDL. = $500,000. {27 individual grants ranged from $42,500 to $21,250. Now range from $31,250 to $15,625. Each Public Health District had $85,000. Now $62,500.} SIRP Grants 4 grants $38,875 BG Prevention Media/ Ethos $300,000 Less $150,000 FHM = $150,000 BG 6

7 HEAPP $112,070 EUDL (Loss of College/University Minigrants) Alcohol Screening.org (from FHM to BG) $4,500 Synar (Tobacco Compliance) $100,000 BG KIT Prevention (from FHM to BG) $38,460 Maine Integrated Youth Health Survey $50,000 BG Intervention Services Prescription Monitoring Program Admin (funded 100% by DOJ/BJA grant): (1 contract MASAP) $165, 539 Prescription Monitoring Program Technical: (1 contract HID) $130,000 ( in SFY12 $40,035 will come from DOJ/BJA grant will need the rest from the State or SAPT BG = $91,624.11) PMP (NASCSA grant for detailed data analysis of PMP): (1 contract MMC) $19,189 PMP (NASPER grant for conversion of PMP to meet federal requirements): $40,047 Maine Integrated Youth Health Survey: (Prevention contributes $50,000 of SAPT BG and Intervention contributes $12,000 of General Funds ) toward 1 contract) $12,000 (D&R portion) Treatment Data System (Technology paid from DASIS): $125,421 Treatment data System (Technology paid by General Funds) :$42,096 Drug Treatment Corrections Database: (1 contract PWW) $15,000 from general funds DSAT Database: (1 contract 3 rd Stage) $49,920 (from DASIS) 7

8 Treatment Services Office of Substance Abuse, Department of Health and Human Services PNMI Residential Services: Ambulatory Detoxification Services/Emergency Shelter Services: $ 1,751,341 (3 contracts) All Correctional Programming (Drug Courts, DSAT, and SA services in the Institutions - Adult and Youth): $3,630,172 (13 contracts) Selected Outpatient and Intensive Outpatient Services: $2,261,979 (15 contracts) Women s Case Management Services: $440,000 (1 contract, statewide services) Overdose Prevention Services: $150,000 (3 contracts) Peer Supported Recovery Centers Cumberland, Penobscot, or Aroostook: $378,603 (1 contact) 8