Governor s Roundtable on Substance Abuse August 9, 2013 200 Chesapeake Blvd., Elkton MD Stephanie Garrity, Cecil County Health Officer, welcomed those in attendance, announced that the Governor was running late and that the meeting would begin without him. County Executive Tari Moore welcomed the panel and those in the audience. Tari noted that Cecil County officials and community organizations work well together with limited resources. Tari reported, The Health Department budget decreased significantly from a high of $ 67 million to a low of $37 million. We hope state policy makers will reinstate an appropriate core funding formula based on identified needs and responsibilities. Executive Moore highlighted the Neighborhood Youth Panel, a program for young first time offenders with a success rate of 90%. She closed saying We all want to be part of the solution, we are ready and willing. Dr. Joshua Sharfstein, Secretary, DHMH, acknowledged Health Officer Stephanie Garrity and reminded everyone that we are here today in a spirit of working together to address the problems of Substance Abuse in Cecil County specifically the alarming amount of overdose deaths, and how to prevent more deaths from occurring. The main message today is that the state wants to be supportive of Cecil County. Dr. Sharfstein presented recently gathered statistics that report high numbers of overdose deaths in Maryland, and Cecil County. He explained that every county in the state of Maryland has been asked to put together a plan and that Cecil County s plan would be presented later in the meeting. There are more over dose deaths than homicides in the state of Maryland. The panel will be looking at ways to prevent these deaths. Chief of Staff, ONDCP Regina LaBelle reports that the White House has developed a plan to address the over dose deaths in America and will support Maryland and Cecil County in their efforts to prevent future over doses. The ONDCP has seen the effects of chronic drug use across the country; they are here to present best practices and offer resources and assistance. A power point was presented showing the marked increase in unintentional over doses in the last decade. Studies revealed most of the increase is due to opiate/pain medications. Last year showed a decline in opiate OD s, but a rise in heroin OD s. Over the last five years Cecil County has run a close second to Baltimore City, both showing numbers that are twice the average of other counties in the state. A new database called Prescription Drug Monitoring Program (PDMP) will begin to be available to all providers this fall. The PDMP will track all patients who are prescribed medicine. A provider will be able to track the amount of opiates prescribed to a patient, and if that patient is receiving prescriptions from more than one provider. This system will also be able to link patients to effective treatment, and help in communication across state lines.
Law enforcement will also have limited access to the PDMP. Ken Collins, Cecil County Health Department, presented a power point presentation reviewing the Cecil County Plan to Prevent Over Doses. Cecil County has shown a slight decrease in OD s in 2012. Mr. Collins reported that there has been a 50% increase in those enrolling, and receiving active treatment. In five years we have increased access to treatment by 96%, showing that overdoses are preventable. The Health Department personnel want to show addicts that their life has value. Mr. Collins recognized the efforts of the Local Drug and Alcohol Abuse Council of Cecil County, as well as those working in the Health Department. Mr. Collins listed some of the programs that are available in Cecil County some of which are listed here: public awareness and education, PDMP, fixed local drop boxes for unused medications, Local Law Enforcement Partnerships, Partnerships between the North East Police and North East Library for drug take back programs, educational opportunities for physicians, peer recovery, and outreach. Mr. Collins touched on the medicine called Naloxone, more commonly known as Narcan, a medicine that stops overdose immediately. Governor Martin O Malley arrived and acknowledged the large crowd by saying: There is strong evidence that the people of Cecil County will join forces to save lives. Governor O Malley reports that when a community recognizes a problem and then addresses it with community support and action, positive results will follow as proven recently in Salisbury and Annapolis. He stated that treatment has been expanded across the state by 26%, and continued saying: I have no doubts that if we collaborate, hold ourselves accountable, we can save lives. Public Safety and Public Health is of upmost importance. Stephanie Garrity introduced all elected officials in attendance, as well as the officials sitting at the table with Governor O Malley. She then turned the meeting to Open Discussion. Dr. Gayle Jordan Randolph, Deputy Director, DHMH asked for a show of hands: How many people know someone who is struggling with addiction or is in recovery? (Many, if not most, raised their hands). Dr. Randolph explained that she is a child and adult psychologist and that she uses a systems approach to problem solving. A systems approach that deals with many processes in attempting to fix the complex issues facing the addict, not just addiction alone. The Department of Health and Mental Hygiene has a full line of services to offer people, at any level of addiction. Services that include outpatient treatment, intensive in patient treatment, medication assistance, recovery housing, and recovery support. The state wants to support outcomes that support the addict, their family and employers.
Health Officer Stephanie Garrity discussed the recently issued report on Substance Abuse in Cecil County. She then asked the Roundtable participants what they think has contributed to the high over dose death rate in Cecil County. Sheriff Janney stated that many of the addicts do not understand the strength of the heroin or where it is coming from. There is a difference in New York heroin vs. heroin from Wilmington, Delaware. Dr. Ken Lewis, Union Hospital CEO stated that socio economic problems are a factor in the rise of heroin use, as well as a lack of services. We need a broader continuum of care and services. Residential care is also lacking. The roundtable participants discussed the use of Naloxone (Narcan). Department of Emergency Services Chief Richard Brooks reported that Cecil County just entered into a Pilot Program to allow EMT s to administer Narcan. Dr. Sharfstein reminded the audience that Legislation was passed in 2013 to allow a broader use and controlled distribution of Narcan in local communities. The Health Department is beginning to put this program together in Cecil County. Dr. Ken Lewis would like reciprocity with Delaware and the PDMP. Governor O Malley believes this is already in the works and Dr. Sharfstein confirmed that this is close to fruition. Dr. Sharfstein explained the opportunity to expand addiction treatment to include primary care doctors and commented on how Bupinorphine has also helped decrease the rate of OD s. Dr. Lewis suggested to the panel that a medical license require a course in addiction. Governor O Malley asked Where are the holes in care? Stephanie Garrity replied: Our largest gap is prevention. We need to do a better job at capturing our young people, get to them earlier with education and intervention services. Cory Fink, DJS, Regional Director explained the assessment process that all Juvenile Offenders receive upon intake. At the intake level 20% will admit to drug or alcohol use. As juveniles get deeper into the system there is a more comprehensive risk assessment. Dr. Randolph suggested several approaches to prevention: It should be ongoing and continuous. Give parents the tools they need to educate their children. Teach parents how to recognize changes in their children, how to communicate, parents should learn and embrace technology, be the bridge to services. Health Officer Garrity said the second biggest hole is the lack of a treatment facility in the county. Anyone wishing to receive detox services must be referred out of county, most to the
Whitsitt Center in Kent County. Whitsitt has a capacity of 48 patients, with a four to six week waiting list. There is no continuum or long term care after detox for Cecil County patients. The third hole is the misconception of medication therapy. Many in Cecil County look upon the methadone treatment as being bad, just another drug to replace the use of opiates or heroin. Judge Keith Baynes of the Cecil County Drug Court asked for a Juvenile Drug Court, a First Offender Program, and a Family Court. He stated that the Adult Drug Court cannot appropriately handle all offenders; he needs more resources to refer offenders who are seeking help. He went on to explain that many children are living in homes with parents who are addicts, and that they are in need of assistance. Judge Baynes continued saying that many offenders come back to the court as a re-offender. Nancy Turner, Director, Serenity Health, reported that because of the bad press in the community, many people did not seek treatment. She also stated that a local Judge ordered a client to get off methadone. Ms. Turner emphasized that methadone treatment is a social stigma in Cecil County and it needs to be addressed by the community. Elkton Police Chief Matt Donnelly reiterated the importance of education when it comes to the medicine people are taking. Younger people are trying heroin, this may be a reason for overdoses, according to both Dr. Randolph and Sheriff Janney. Dr. Sharfstein explained that people are much more susceptible to overdoses when they detox and or change methods of treatment. It is important to educate the public on the phases of all treatment. Cecil County Councilwoman Diana Broomell read a written statement requesting that the panel consider issues that were raised at an earlier meeting. A comprehensive list of issues that include: measuring success and oversight of clinics, effective oversight and prosecution of doctors over prescribing narcotics, measuring the success of the state STAT program, support locating a detox center in Cecil County, PMDP be enforced. Governor O Malley asked for a Safe Streets update from Colonel Marcus Brown, Superintendent, MSP. Colonel Brown reported that the police cannot arrest their way out of this problem. Law Enforcement is working with the Health Center to address a lot of the problems. Police are focused on the dealers, doctors, and pharmacies as well as scheduling drug take back programs. The Sequestration is holding up the HIDTA designation, however that should be progressing in September and Cecil County is first on the list. Dr. Sharfstein ended the roundtable discussion and moved onto questions that had been submitted by audience members.
The first card pulled was a statement thanking the Governor and County Executive for working together on this issue. The second question asked how people from the middle class can get into treatment. Dr. Sharfstein replied that Medicaid can help cover some of the treatment for those that qualify. He also advised that people will begin to get help from the new Individual Market and can go online and receive support for affordable health care coverage. He went on to say that substance abuse and mental health support will be covered by this new insurance coverage. Untreated addiction is expensive. Three similar questions were grouped together regarding methadone treatment. Dr. Sharfstein explained that Methadone is an effective treatment towards recovery. While on methadone, an addict can take control of the previous chaos of addiction. It is not a goal to get off of Methadone, an addict coming off methadone greatly increases their risk for relapse. Dr. Randolph supported the methadone pathway, noting a person can choose their pathway to recovery. The next question/statement regarded the need for Mental Health Treatment alongside and complimentary to the rehabilitation of an addict. Dr. Ken Lewis stated that Union Hospital is looking at regional collaborative care. Dr. Randolph and Governor O Malley reported that they are consolidating the Addiction Administration and the Behavioral Health Administration. Integration of services will benefit the patient. The next question came from Robert Hodge: Does the lack of good job opportunities create an environment for increased illegal drug usage? Gov. O Malley stated that his number one priority is job creation. He stated: we have recovered 99% of the jobs we lost in the downturn of the economy. Yes, jobs are critically important. The next card pulled asked: Do you believe the glorification of drugs by TV and the silver screen encourage drug use? Regina LaBelle answered yes, If people believe that if there is no risk, than they are more likely to use. Youth attitudes are directly associated with drug use. The next card pulled asked: What about the safety of the family administering Narcan? Dr. Sharfstein answered: There must be training for those administering Narcan. We are in the process of certifying programs.
The next card pulled asked: What can be done to get more providers that can do a comprehensive mental health evaluation on adolescents? Dr. Randolph mentioned expanding a strategy called Telemental Health a patient is able to link up with a provider and telecommunicate. Stephanie Garrity advised that this is new in Cecil County and has been successful thus far. The Health Department would like to expand the hours. It was also mentioned that any pediatric provider can receive help from child psychiatrists in Baltimore, or statewide, in the same manor. The next card pulled asked: What are the best drug education programs for our schools? Regina LaBelle listed several programs that have been highly successful: Above the Influence, and Teen Rx. A complete list of programs can be found at the website for the Office of National Drug Control Policy at http://www.whitehouse.gov/ondcp/ The last card pulled posed a question from David Neff asking: How do we close the gaps? Dr. Sharfstein replied, Collaboration, working with the Health Department and aligning all programs and tools, he continued saying: Progress in Cecil County is critical in order for the state to move forward. Stephanie Garrity asked the Roundtable participants: If money were to become available to reduce substance abuse, how would you use it? Detox centers and Behavioral Health were the two items that had the most support from the audience. Governor O Malley replied that investing less money will not help us reach our goal. Several other answers s included prevention, public safety, education, expansion of the Narcan program, provider education, employment of rehabilitated addicts, and recovery homes. County Executive Tari Moore responded that she would apply money toward prevention programs and law enforcement. Dr. Lewis stated: we are a small, aligned community; the investments made by the state have a significant opportunity to bear fruit. This can be a laboratory; a strong hospital and community support all working together to address this issue can be measured, and proven successful. Ken Collins had two suggestions, first, the need for vocational opportunities; our clients need help getting jobs. Secondly, additional money is needed to expand recovery housing here in the County. Dr. Sharfstein commented that: Progress is possible.
County Executive Moore thanked the Governor and his staff for attending today s meeting. She noted: Cecil County is committed to solving this problem. We just need the resources to be able to help ourselves. Governor O' Malley thanked everyone. Your presence here is critical to be able to turn this around. We will follow up. We recognize that we need to do more in a more connected and collaborative way. We work against deadlines, we cannot wait another year. Have a monthly get together around this. Opportunities are here. Stay in touch, we can make progress. Every life is important. One Stop center should be here as well.