opioid task force kick-off meeting · 19 2/29/2016 understanding the local epidemic ... • primary...

Opioid Task Force

Kick-Off Meeting

February 29, 2016

Scope of the Opioid Problem

and

Data Review

Olivia Kasirye, MD, MS County Public Health Officer

2/29/2016 3

The Opioid Epidemic

Opioid Task Force Development

Prevention Strategies

OVERVIEW

Opioid Task Force Kick-Off Meeting

The Opioid Epidemic

2/29/2016 Opioid Task Force Kick-Off Meeting 4

5

Definition: Opioids are any of various compounds that bind to specific receptors in the central nervous system and have analgesic (pain relieving) effects including prescription medications such as oxycodone (OxyContin), hydrocodone (Vicodin), morphine, methadone, codeine and illicit substances such as heroin and fentanyl.

2/29/16 Opioid Task Force Kick-Off Meeting

6

Adverse Effects of Opioids on the Brain


2/29/2016 7

Since 2000, the rate of deaths from drug overdoses has increased 137%, with a 200% increase in deaths due to opioids*

Nearly 2 million Americans age 12 or older abused or were dependent on opioids in 2013**

20% to 30% of opioids prescribed for chronic pain are being misused***

Rate of addiction is 10%***

National Statistics

Sources:

*MMWR/January 1, 2016/Vol.64/

**CDC National Center for Health Statistical Vital Statistics Report

***International Association for the Study of Pain


2/29/2016 8

23% report having abused Rx medication at least once in their lifetime

31% believe “it’s okay to use prescription drugs that were not prescribed to them to deal with an injury or pain, as long as they are not getting high”

22% say their parents don’t care as much if they are caught using Rx drugs without a prescription, compared to getting caught with illegal drugs.

Teen Prescription Drug

Misuse & Abuse

Source: US DEA Office of Diversion


2/29/2016 9 Opioid Task Force Kick-Off Meeting


DEATHS BY OPIOID POISONING (2006-2013)

YEAR 2006 2007 2008 2009 2010 2011 2012 2013

CALIFORNIA 1,469 1,651 1,784 1,971 1,909 1,898 1,712 1,934

SACRAMENTO COUNTY

106 79 94 83 89 68 64 111

14,328 Deaths in California from 2006-2013

694 Deaths in Sacramento County from 2006-2013

Source: California Department of Public Health EpiCenter Injury Online Database

Opioid Task Force

Development


2/29/2016 15

Identify and implement numerous high priority initiatives

Share resources & knowledge

Provide coordinated provider & community education

Develop policy recommendations & best practices

Purpose of Opioid Task Force


the opioid epidemic!

2/29/2016 16

Quarterly meetings beginning February 2016

Subcommittees 1. Engaging Medical community, overdose prevention

2. Public education, media and advocating for change

3. Early intervention, treatment, and recovery

4. Safe medication disposal

Structure of Opioid Task Force


2/29/2016 17

Who Are The Players?

Alcohol & Drug Services

Behavioral Health

Emergency Services

Hospitals & Service Providers

Dept. of Human Assistance

Law Enforcement

Non-profits & community groups

Public Health

Pharmacies

Probation

Schools & Universities

Social Services

Waste Management

Youth Representatives

Not exhaustive - others?


Prevention Strategies


2/29/2016 19

Understanding the Local Epidemic

Data Sources

Prescription data CURES database

Death & Injury Data Multi-cause of death files

OSHPD Hospital ED & Patient discharge data

Analysis

Identify high prescribers, unsafe prescribing etc.

Look at trends, distribution, populations affected


2/29/2016 20

Access to Resources


Disseminate Information

• Provider newsletters

• Community education o Patients

o Parents & teens

o Older adults

• Poison Control

Resource Availability

• Treatment & referrals o Substance abuse

o Mental health

o Pain management

• Support groups

• Naloxone

Current Treatment Available

and

Need for Capacity Building

Uma K. Zykofsky, LCSW Director, Behavioral Health Services

Alcohol & Drug Administrator

22 2/29/16 Opioid Task Force Kick-Off Meeting

Prevention Self-Motivation for Treatment Mandated Treatment

Partnerships/Collaborations

Evidence-Based Practices

Appropriate length and type of treatment episodes based on need

Balanced continuum of care inclusive of all types of treatment, sober

living environments, and recovery support services

23

What Works and Leads to Positive Outcomes?


• Prevention Services

• Education Services-DUI Programs

• Outpatient Treatment Services

• Intensive Outpatient Treatment Services

• Medication-Assisted Treatment

• Detoxification & Residential Treatment Services

• Transitional Housing/Sober Living Environments

Handout: Alcohol & Drug Services Continuum of Care

24

Alcohol and Drug Services

Continuum of Care

Opioid Task Force Kick-Off Meeting 2/29/16

2/29/16 25

Countywide Collaborations

Jail/Corrections

Public Health

Primary Health

Child Protective Services

Mental Health

Dept. of Human Assistance

Probation

Community Collaborations Contracted Providers

Community-Based Organizations (CBOs)

Prevention Initiatives (Coalition)

Sacramento Steps Forward (Homeless Services)


• Driving Under the Influence (DUI) Programs

• Drug Diversion Program

• Prop 36 Program

• Adult Drug Court

• Juvenile Drug Court

• Co-Occurring Mental Health Court

• In Custody Alcohol and Drug Screening and Assessments-Jail/Department of Corrections

2/29/16 26

Collaborations with Criminal Justice


Public Health • Opioid Task Force Development • Human Immunodeficiency Virus (HIV) Services • Sexually Transmitted Disease (STD) Services

Primary Health • Primary Care Center Alcohol and Drug Screenings • Case Management Services • Linkage to Appropriate Alcohol and Drug Treatment

2/29/16 27

Collaborations with

Public Health & Primary Health


Nationally Recognized Family Drug Courts

• Dependency Drug Court

• Early Intervention Family Drug Court (EIFDC)

• These courts refer clients to outpatient treatment, residential treatment, detox, and case management/recovery support services

2/29/16 28

Collaborations

Child Protective Services


• Homeless Services (Guest House)

Alcohol and Drug Assessment and Referral

Education Groups, Outreach

• Co-Occurring Mental Health Court Services

Outpatient Treatment

Residential Treatment

• CalWORKs Program (Mental Health & Dept. of Human Assistance)

Outpatient Treatment

Detox, Residential Treatment

• Mental Health Navigators

Linkage to services

2/29/16 29

Collaborations with Mental Health


30

Modality Total Number

Admissions

Number of Admissions Opiates as

Primary Drug of Choice

% of Clients with Opiates as Primary

Drug of Choice

Outpatient - Adult

1,985

186 9%

Outpatient - Youth

567

9 2%

Residential

1,058

201 19%

Detoxification

335

103 31% Medication-Assisted Treatment

2,159

2,139 99%

TOTALS

6,104

2,638* 43%

Alcohol & Drug Services Treatment Data

Fiscal Year 2014-15

Opioid Task Force Kick-Off Meeting 2/29/2016

2/29/2016 31

Current Challenges

Increased Service Demand • Residential Treatment • Detoxification Services • Medication-Assisted Treatment

Need for Capacity Building

Limited Funding • Residential Treatment • Detoxification Services

Wait Lists = Delay in Treatment • Residential Treatment • Detoxification Services

Lack of • Sober Living Environments • Aftercare Services • Youth Residential Facilities • Re-entry/Support Services

Limited Targeted Services • Severely Mentally Ill • Homeless • Developmentally Disabled • Older Adults

Access to Care

• Locations

• Transportation


32

Residential Treatment Services

Increased demand for Residential Treatment

Residential Treatment Facilities for Adults Only

No Youth Residential Treatment Facilities

Limited capacity due to funding constraints

Total Beds = 319

Average Wait Time = 3 months


33

Detoxification Services

Increased demand for Detox Services

Detox Facilities for Adults Only (only 4 providers)

No Youth Detox Facilities

Limited capacity due to funding

Total Beds = 12

Average Wait Time = 30-45 days


4 contracted MAT Service Providers (Methadone Providers)

5 locations

Need to increase capacity

MAT keeps people productive, in the workforce and helps to stabilize and improve level of functioning

2/29/16 34

Medication-Assisted Treatment (MAT)

Number of MAT Clients Served

Fiscal Year 2013-14

Number of MAT Clients Served

Fiscal Year 2014-2015

% Increase From Prior Year

1,300

2,150 65%


Increase Collaboration/Partnerships

Prevention, Education and Awareness

Capacity Building for Treatment Services

Explore Funding Opportunities

Decrease Waitlists

Coordinate with current Prevention

and Statewide efforts


Improve Substance Use Disorder Services through a Statewide organized service delivery system

Full continuum of multiple levels of funded evidence-based services

Increase program oversight, compliance and quality assurance

Improve coordination with other service systems

36

ON THE HORIZON:

Drug Medi-Cal (DMC) Organized

Delivery System (ODS) Waiver Goals


*5-Year State-Wide Demonstration Project*

53 Counties Expressed Interest

• Phase I Bay Area (in progress)

• Phase II Southern California

• Phase III Central Valley (Sacramento County)

• Phase IV Northern California

• Phase V Tribal Delivery System

Steps for Waiver 1. County to develop Implementation Plan 2. County to develop Fiscal Plan 3. Department of Health Care Services to approve County rates

37

DMC-ODS Waiver Implementation


38

Drug Medi-Cal

Waiver

Services &

Requirements

(Opt-in Model)

Requirements

Coordination with Criminal Justice and Hospitals Increased Quality Assurance

BOLD = new services and requirements

Services

Early Intervention Outpatient Services Residential Treatment Medication-Assisted Treatment (MAT) Withdrawal Management Additional Medication-Assisted Treatment (MAT) Recovery Services Case Management Physician Consultation



Opioid Task Force

opioid task force kick-off meeting · 19 2/29/2016 understanding the local epidemic ... • primary...

Documents