Training of Addiction Treatment Providers in Massachusetts. Sarah Ruiz, MSW Bureau of Substance Abuse Services MA Department of Public Health

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1 Training of Addiction Treatment Providers in Massachusetts Sarah Ruiz, MSW Bureau of Substance Abuse Services MA Department of Public Health July 1, 2015

2 Naloxone and Overdose Prevention: MA Timeline 2005: Boston EMTs equipped with IN naloxone via special project waiver 2006: Boston & Cambridge public health community distribution 2007: State Pilot: Community distribution expansion 2008: Community Opioid Overdose Prevention Grants (SPF-SIG) 2010: State Pilot: First Responders police & fire 2011: OEMS regulations amended to permit Basic EMTs to carry IN naloxone 2012: 911 Good Samaritan Law and limited liability protection 2014: Public Health Emergency Declaration: First Responder Naloxone, Pharmacy Standing Orders, Accelerated PDMP Enrollment 2015: Governor Baker Opioid Work Group Recommendations include more branches of government

3 Sectors targeted for training in Overdose Prevention, Recognition & Response Opioid Users Families and Friends Addiction Treatment Program Staff Community Coalitions/ Community Forums Other Human Services Providers i.e. Homeless shelter staff Correctional Staff First Responders Prescribers Pharmacists

4 State Police Data and BSAS Data MA State Police suspected heroin overdose deaths reports not including the three largest cities in MA Data matching with BSAS Treatment Data Underscores the importance of partnership with Addiction Treatment Providers

5 Percentage of Enrollments with Reported Rescues by Location 2007-May 2015 Dataset can include multiple rescues per person Total rescues as a Percentage of Enrollments with Reported Rescues # of percent of total Enrollment Location By # of Rescues Enrollments enrollments Dataset can include multiple rescues per person Needle Exchange Program % Drop-in Center % Methadone Clinic % Drug/Alcohol Detox Center % Street Outreach % Residential Treatment/Halfway House % Emergency Department % Homeless Shelter % Other % Intensive Outpatient program % Community meeting % Medical clinic (OBOT or health center) %

6 Percentage of Enrollments with Reported Rescues by Location 2007-May 2015 Dataset can include multiple rescues per person Total rescues as a Percentage of Enrollments with Reported Rescues # of percent of total Enrollment Location By # of Rescues Enrollments enrollments Dataset can include multiple rescues per person Needle Exchange Program % Drop-in Center % Methadone Clinic % Drug/Alcohol Detox Center % Street Outreach % Residential Treatment/Halfway House % Emergency Department % Homeless Shelter % Other % Intensive Outpatient program % Community meeting % Medical clinic (OBOT or health center) %

7 Percentage of Enrollments with Reported Rescues by Location 2007-May 2015 Dataset can include multiple rescues per person Total rescues as a Percentage of Enrollments with Reported Rescues # of percent of total Enrollment Location By # of Rescues Enrollments enrollments Dataset can include multiple rescues per person Needle Exchange Program % Drop-in Center % Methadone Clinic % Drug/Alcohol Detox Center % Street Outreach % Residential Treatment/Halfway House % Emergency Department % Homeless Shelter % Other % Intensive Outpatient program % Community meeting % Medical clinic (OBOT or health center) %

8 Percentage of Enrollments with Reported Rescues by Location 2007-May 2015 Dataset can include multiple rescues per person Total rescues as a Percentage of Enrollments with Reported Rescues # of percent of total Enrollment Location By # of Rescues Enrollments enrollments Dataset can include multiple rescues per person Needle Exchange Program % Drop-in Center % Methadone Clinic % Drug/Alcohol Detox Center % Street Outreach % Residential Treatment/Halfway House % Emergency Department % Homeless Shelter % Other % Intensive Outpatient program % Community meeting % Medical clinic (OBOT or health center) %

9 Pharmacy Naloxone Standing Order 2014 MA Board of Registration in Pharmacy guidance permitted naloxone dispensing under a Standing Order Increasing number of pharmacies establishing naloxone standing orders - Walgreens, CVS, Eaton Pharmacies, Community Health Centers Pharmacy Access Technical Assistance:

10 BSAS Request for Information (RFI) Pharmacy Access to naloxone Promotion of pharmacy and treatment program partnerships for access to pharmacy standingorder dispensed naloxone. RFI: How could BSAS support pharmacy access to naloxone for clients in treatment? Such as by covering costs not covered by health insurance including prescription co-pays and coverage for uninsured clients

11 BSAS Contractual Requirements (2015 Standards of Care) All vendors are required to participate in BSAS work to prevent and reduce opioid overdose, by: supporting community opioid overdose prevention collaboratives, and by incorporating opioid overdose prevention, recognition and response into staff training, assessments, treatment plans, education, discharge plans and family support.

12 BSAS Contractual Requirements (2015 Standards of Care) Ensure staff are trained in preventing, recognizing and responding to overdose; Include review of overdose history (including witnessing overdose) in treatment assessments; Educate individuals served about opioid overdose prevention, recognition and response; Include opioid overdose risk reduction in treatment and discharge plans; Refer families and friends of individuals served to opioid overdose prevention resources, including community pharmacies which stock naloxone and/or have standing orders for naloxone.

13 Resources for Treatment Providers Practice Guidance: Integrating Opioid Overdose Prevention Strategies into Treatment (Best Practice Guidance) Statewide Training and Capacity Building Vendor, also a DPH naloxone pilot site focused on treatment providers

14 Treatment Provider Capacity Building Statewide training & capacity building vendor, Center for Social Innovation, Praxis, for BSASfunded treatment providers. - On-site staff training covers: Overdose prevention Risk reduction conversations Opioid Overdose Program Inventory Training materials and videos for staff to use On-site emergency response training, policies & protocols Risk Assessment in development

15 Training Challenges and Success by Sector in MA Sectors Opioid Users Families and Friends Community Coalitions/ Community Forums Addiction Treatment Programs Other Human Services Providers Correctional Staff First Responders School Nurses Prescribers Pharmacists Challenges/Successes Master Trainer Capacity Staff Turnover Self-Care/ Care for the Caregiver Capacity for in-person training Targeted educational materials Training of Trainers within existing training infrastructure Partnerships with leadership Greater need with standing order pharmacy access. Naloxone not always incorporated into Safe Pain Mgmt Trainings

16 Needs to support Addiction Treatment Providers What is needed to improve access to naloxone and to training Advocacy for coverage of naloxone by private insurers (including for 3 rd party) Reduction in cost of naloxone Funding for training and capacity building Targeted educational materials Federal leadership on role of addiction treatment providers and calls to other sectors to pursue training

17 Contact Information Sarah Ruiz, MSW MA Dept. of Public Health Bureau of Substance Abuse Services

P U B L I C H E A L T H A D V I S O R Y

P U B L I C H E A L T H A D V I S O R Y The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619Tel: 617-624-6000 Fax: 617-624-5206 www.mass.gov/dph

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