A Local Multifaceted, Multidisciplinary Approach to Opiate Overdose & Death

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1 A Local Multifaceted, Multidisciplinary Approach to Opiate Overdose & Death 2013 WPHA-WALHDAB Annual Conference Wednesday, May 22: 2:00-2:35 pm Lisa Bullard-Cawthorne, MS, MPH

2 OPIATE PREVALENCE IN DANE COUNTY

3 Poisoning in Dane County Leading Cause of Injury Death

4 Most Poisoning Deaths & Hospital Visits Result from Drugs Alcohol* huge impact on community 82% prescription, over-the counter, illicit drugs 62% prescription, over-the counter, illicit drugs

5 Large Numbers Go to Hospital for Drug Poisoning & Substance Abuse Disorder In 2011, there were more than 1,200 visits to the hospital (admitted and emergency department visits) for drug poisoning (injuries). 270 were opiate poisoning. Teens and young adults more affected (15-24) In 2011, more than 3,500 people are in the hospital for substance (drug) related disorder (abuse & dependence) More than 1000 were for opiate-related drugs.

6 Opiates are Abundant & Highly Addictive: Majority of Opiate Overdoses from Prescription Pain Medications Other opiates or opioid analgesics: Oxycodone (Oxycotin & Percocet) Hydrocodone (Vicodin) Hydromorphone Meperidine (Demerol) Fentanyl Codeine Morphine Opium Propoxyphene (Darvon) Tramadol (Ultram or Tramal) * Main Diagnosis Unintentional Poisoning ED visits and Hospitalization for Opiates and other Narcotics Dane County, Other opiates 257(61%) Methadone 35(8%) Heroin 103(25%) Hallucinogens Other Narcotics 23(6%) Opiate drug users often report starting their opiate addiction with prescription pain medications. Using E-codes PHMDC 2012

7 Opiate* Deaths & Hospital Visits Increased in Past Decade The number of opiate deaths tripled over decade (14 in in 2010). In 2012, there were 77 overdose deaths, about 50 were opiaterelated. (Medical Examiner data) *Opiate - any diagnosis

8 Opiate Overdoses: Narcan Administration in Community Madison EMS Calls: 178 in 2009 to 300 in 2012 Does not include 16 other Dane County EMS that can administer Naloxone ARCW Lifepoint Prevention Program : From 2005, 404 reported peer saves. (In Southern Region, 2,158 reported saves) * Naloxone or Narcan is an antidote to reverse respiratory depression caused by opiate overdose

9 Crude Rate per 100,000 Increase in Number of Dane County AODA Treatment Clients With Problematic Opiate Use Dane Co. AODA Treatment for Opiate All Opiates Heroin Other Opiate Drugs 2011: 316 opiate clients Years Dane County Department of Human Services

10 Data Driven Approach Raised awareness in community Generated interest by many stakeholders Mayor & County Executive support Summit (January, 2012) 130 people attended Summit Reunion (April, 2013) 75 people attended Steering Committee (May 13) key stakeholders

11 OPIATE OVERDOSE SURVEY

12 Overdose Survey to Gather Data Data Gathered: Number of overdoses in community (not already known) Information about overdose experience, getting help, and perceptions & views about current laws & practice to assist with local policy & programming Information about treatment & recovery related-issues Participants: Survey: 1101 people 504 current & past drug users [needle exchange (194) and Methadone Clinic clients (189-25%); 121 people in recovery (Recovery Solutions of Wisconsin)] 330 (33%) Dane County law enforcement (DC Police Chief s Ass.) 267 (27%) Dane County EMS (DC EMS Chief s Ass.)

13 Percent Opiate Overdoses are COMMON in DC Communities (287) Been to or witnessed overdose 81.6 (218) Law Enforcement EMS Current User Methadone Clinic Client Survey Respondent 78.8 (99) (90) (89) Person in Recovery 783 (75%) witnessed or at scene of opiate overdose It may be beneficial to consider adopting a harmreduction approach in order to decrease the number of OD deaths. (Police)

14 Percent 70% 60% Personal Overdose Experience of Current & Past Drug Users 63% 50% 40% (74) 30% 27% 20% 10% 22% (41) (50) 0% Current Drug User Methadone Clinic Client Person in Recovery Survey Respondant 165 (33%) people had personal overdose experience ; 65% more than once

15 Percent 70 Outcome of Person Experiencing Overdose Law Enforcement & EMS Responses (335) Other: Person recovered from combination of N & other medical intervention (14) Person taken to hospital (4) (20) Recovered w/o medical intervention (63) 5.3 (40) (27) Recovered Narcan Recovered other MI Person died Other

16 GETTING HELP DURING OVERDOSE Calling 911 & Reasons NOT Calling % (167) of current and past drug users DID NOT call 911 after overdose Other 10 Worried about charges 36.3 Took them to hospital 7.4 Gave rescue breathing-woke up 11.4 Left in public place 4.9 Didn t want victim mad 13.9 No phone available 4.9 Worried about police 50.7 Gave Narcan- woke up 40.7 Person woke up on own Percent

17 Percent In my opinion, one of the main reasons people overdose and die is because the people around them are afraid to call 911, because they fear they will get in trouble. Lives would be saved if the police would not arrest the people trying to help. (Person in Recovery) Worried about Police/Charges: Arrests Not Always Made LE- Overdose victim LE- Bystander Direct opiate experience Arrests made 50% of the time; victim more than bystander No Yes

18 Percent ACCESS TO NARCAN TO SAVE LIVES Who Administered Narcan? (397) (184) 5 (21) EMS & Law Enforcement EMS Non-Medical (115) (74) Current or Past Drug User Anything to promote awareness about OD in the community would be beneficial. EMT-Basics and First Responders should be approved for use of nasal Naloxone. (EMS)

19 percent TREATMENT & RECOVERY MISSED Opportunity for Discussion 80 Treatment discussed at overdose scene Current Drug Users & Methadone Clinic Clients (94) (28) 0 No Yes

20 Turning Point to Become Clean & Sober Methadone clients & people in recovery Other 12.70% Withdrawal 75.50% Loss of employment 38.60% Children or family 10.90% Loss of relationships 56.40% Lack of stable housing 32.70% Financial concerns 64.10% Legal consequences Somebody died due to OD 36.40% 35.50% Health issues due to use 29.50% Hospitalized due to OD Unconcious due to OD 14.10% 16.40% I wanted to stop and I also have kids that I didn't want to see me addicted to drugs; its not fair to me or them. (Current Drug User)

21 Barriers and Challenges to Treatment & Recovery Barriers to receiving treatment Lack of insurance or funding for services Lack of trust of service providers Fear of treatment Challenges in maintaining treatment Lack of insurance or funding for services Lack of transportation (daily methadone treatment) Lack of family support Challenges faced in recovery Family issues Mental health concerns Legal issues I tried for almost two years to find help and get into a Methadone program, but I found most of the time it was just easier to find drugs than it was to get help. I hope and wish someday it will be easier for people to find help they need. (Methadone Clinic Client)

22 Benefits of Data Collection Brought together partners Generated discussion within target groups Police, EMS, people in treatment/recovery Encouraged discussion among mixed group to explore possible interventions First Focus Group (30 mixed group; ½ people in recovery) Plan for two more Focus Groups in 2013

23 STOP THE DRUG OVERDOSE INITIATIVE

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25 Overarching Awareness Campaign Produce The Solution Starts With Me video, starring partners of the Drug Poisoning Initiative: Stop the Overdose Epidemic Launch Use Only As Directed Public Education Campaign (Utah) Funded by Mayor award & matched funding Partnering w/ Madison Metro and possibly M Streets Safe Communities Website: Poisoning Prevention

26 Access 12 permanent drop-box locations across Dane County (municipality- law enforcement collaboration) Exploring avenues for a safe storage ( Lock It Up ) campaign Lock boxes or locked zip bags at time of pharmacy prescription pick-up; supported by health care organizations (voucher system)

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28 Prescribing Health Care Task Force - all local health care providers (medical, dental, pharmacy) Developed provider and patient education materials to be distributed within health care systems Sending series to all local dentists about opiate prescribing Recommended guidelines, patient card - parent addiction network and MedDrop info, prescribing practice survey

29 Overdose Intervention Pilot to allow EMS-Basics (5 EMS agencies) to administer nasal naloxone Pilot program to allow police (2 rural agencies) to be trained to administer nasal naloxone Education of prisoners on overdose risk after release from jail Promotion & support of ARCW Lifepoint Overdose Prevention Program (train peer drug users)

30 Drug Treatment & Recovery Integrated with Mental Health Care Parent Addiction Network parent resource for families on negotiating treatment options and criminal justice system (website) Expansion of treatment slots (opiate-assisted therapy) for Drug Court participants (majority are addicted to opiates (County Executive budget) Resource Fair for people in recovery (to be planned by Focus Group participants)

31

32 Substance Abuse Prevention 2-hour training session on Prevention of Youth Drug & Alcohol Abuse: What Works & What Doesn t - for School AODA workers, law enforcement, etc. Development & dissemination of youth and parent opiate abuse prevention training sessions (Spring 2013)

33 Multidisciplinary Partnerships Formed to Move Work Forward Local organizations represented on Steering Committee & in six strategy area workgroups Public Health Police; Judicial System, District Attorney Health Care (Medical, Dental, Pharmacy) EMS Substance Abuse Treatment Providers; Human Services Media Parents Schools & Youth Organizations Needle Exchange Providers

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