the heroin epidemic - sbm webinar ppt rev2- june 4

8/9/2019 The Heroin Epidemic - SBM Webinar PPT Rev2- June 4

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June 4, 2015

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Erica Clute-Cubbin, J.D., CADC Attorney and Counselor

Goldin & Associates, P.L.L.C

Email: [email protected]

Phone: 248.208.0500

Lauren Rousseau, J.D. Attorney and Professor

Western Michigan University-Cooley

Law School


Phone: 248.751.7800, ext. 7756

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mailto:[email protected]






How bad is it? How did we get here?

What are we doing about this? Communi ty act ion

State actio n

Federal action

What else should we do? Q&A

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Overdose deaths have more than doubled since 1999.

There were 44,000 drug overdose deaths in 2013 =120 deaths per day.

Increase in overdose deaths has been driven largely

by op io ids such as Vicodin, Norco, Hydrocodone,Percocet, OxyContin … and heroin.

2 Mil lion American abuse prescription opiates daily,and 44 die each day from overdose of these drugs.

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Emergency room visits due to prescription opioidsincreased 112% between 2006 and 2010 – to nearly180,000 v is its .

Admissions to treatment for prescription opioid

addiction inc reased 500% from 2000 to 2012 in 37states.

Between 2007 and 2013, the number of annual heroinusers almost doubled , from 161,000 in 2007 to

289,000 in 2013.

Deaths involving heroin more than tr ip led from 2007to 2013, to just over 8200.

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Heroin -related deaths inc reased 139% between theperiod 1999-2002 and 2010-2012.

Adm iss ions to treatment for heroin addiction almost

doubled between 2000 and 2012, from 6500 to 12,700.

Heroin -related deaths in 2013 inc reased 66% over2012, for a total of 369 lives lost. An addit ion al 472

died in 2013 due to other opio id drugs .

Drug overdose deaths overal l increased more than thenational average, growing 18% in 2013 for a total of1500 lives lo st .

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Inadequate physician education coupled with grossoverprescribing of opioid medications.

U.S. comprises 4.5% of the global popu lat ion , yet

prescribes more than 80% of the world’s opiates.

In 2010, there were 254 m i l lion op io id prescr ipt ion s

fi l led , totaling $8 billion in sales.

Biggest selling drug class in the U.S.

1 out of every 5 doctor visits ends with an

opioid prescription.

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Minimal medical school education on addiction.

Erroneous bel ief propagated by pharmaceuticalcompanies that op iates are non-add ict ive when usedfor pain.

Pharmaceutical Companies Sued

Purdue Pharma pled guilty in 2007 to m isleading doc tors

and pat ients about the addict ive nature of OxyCont in.

City o f Chicago and two count ies in Cal i fornia fi led

separate lawsuits against f ive pharmaceut ical companies in2014 fo r misleading marketing of opio id medicat ion s.

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Increased tolerance.

Pain pills are expensive.

Increased supply, low cost of heroin.

SAMHSA: 4 out of 5 new heroin userspreviously abused prescription painmedications.



Prescription pain pills are a gateway drug .

Overprescribing of opioid pain medicationshas changed the face of the heroin addict.

Historically, heroin addicts were mostly male,disproportionately black, very young, and frominner city neighborhoods.

Today, more than hal f of heroin u sers arewomen, a major i ty are white, and many arefrom m iddle-c lass subu rb ia.

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Rise of grassroots, nonprofit organizations Fam il ies Against Narcot ic s (FAN)

MiHope

Commun i ty Parent

RADEO Bryan’s Hope

Focused on: Pol icy ch ange

Educat ion

Prevention

Suppor t

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Nonprofits’ critical goal: Elim inate the

STIGMA

assoc iated w i th the disease of

add ic t ion .

Stigma encourages:

Barriers to treatment

Lack of research fund ing

Inadequate treatment Inc arcerat ion no t treatment

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Naloxone (Narcan) Legislation:

Opioid antagonist “reverses” an overdose.

33 states have passed legislation allowing “3rd party

prescribing” to family and friends of opioid addicts.

CDC Study : Over 10,000 opiate overdo ses reversed

since 2010 by laypeople adm inister ing Naloxone.

WHO: Better distr ibut ion o f Naloxone could save asmany as 20,000 lives each year.

Some states al low OTC distr ibut ion of Naloxone.



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Michigan Naloxone Legislation:

Doctor c an dispense naloxo ne to indiv idual at r isk o f

experiencing op iate overdose, and to family, fr iend,

or other indiv idual in a posi t ion to assist su ch an

indiv idual .

Commun ity heal th organizations can dispense

naloxone to “at risk” individuals, family or friends if

done with val id prescr ipt ion and at no charge.

Implementat ion o f the legis lat ion has been slow.



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Good Samaritan Laws

Protects person who cal ls 911 to save an overdose

vic t im from being p rosecuted on drug charges.

Enacted in 27 states, bu t no t in Michigan.

State Government Campaigns

Oakland Cty Crisis Intervention Training

80 law enforcement personnel attended 40 hour

training to learn h ow to better interact w ith

ind iv iduals w ith mental heal th d isord ers/SUDs.



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Gloucester, MA, Police Dept. “Angel” Program: Any add ic t who walks in to the po l ice dept w i th h is

drugs and paraphernal ia and wants help w i l l get it .

No dru g charges w i l l be f iled.

Naloxo ne wi l l be made avai lable to anyon e who

wants i t , free of charge.

“The stigma associated with heroin and

opiate addiction is over. Police officers

are here to help you not judge you.”



Sobriety Courts

There are 32 drug courts in Michigan and a grow ingnumber of “specialty” courts dealing with SUDs(e.g., mental health, veterans , human traff ick ing ).

Offenses are court specific.

No violent offenses, drug delivery or manufacturingcharges.

One-size-f i ts-al l model leads to challenges.

2nd, 7th and 9th Circuits have held that required attendanceat 12-step meetings violates the First Amendment.

Most do not allow mental health medications such asAdderall, Xanax, Suboxone.

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Automated Prescription System-MAPS

Used to ident i fy and prevent d rug divers ion at the

prescr iber, pharmacy, and patient level.

Pharmacies and doctors requ ired to register with

MAPS and report on dispensing certain control led

substances.

Designed to reduce “doctor - shopping”.

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Involuntary Commitment Statute

Substance use added as possib le basis forinvo luntary comm itment in June 2014.

Al low s court to order invo luntary treatment if i t f indsthat a person has a SUD that is veri f ied by a healthprofession al; is a danger to self or o thers; and canreasonably benefi t from treatment.

Requirements o f statute may make i ts useimpract icable.

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Welfare Drug Testing Legislation

Enacted in December 2014 – Requires DHS to createa one-year pi lot p rogram in w hich state welfarerecip ients suspected of d rug use wi l l be drug tested.

Posit iv e test – Ind iv idual must enter d rug treatment.Benef its cu t of f i f treatment or drug test is refused.

Goal: To help welfare recip ients o vercom e addic t ion.

Crit ics: Test ing is cost ly, no t a pro ven deterrent todrug use, inadequate treatment resources, ch i ldrenw i l l su ffer.

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Proposed 2016 Federal Budget Requests h istor ic levels of funding to address the

opio id epidemic - $133 m i l lion.

Comprehensive Addiction Recovery Act

Would designate between $40 and $80 m il l ion towards

expanding p revent ion, improving treatment, and

support ing recovery.

FDA Accountability for Public Safety Act

Would make i t mo re di ff icul t for new and generic

op ioid drugs to ob tain FDA app roval .



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Secure Responsible Drug Disposal Act:

DEA regu lat ions f inal ized in Sept 2014 expanding types

of locat ions that wi l l accept unwanted m edicat ions.

Affordable Care Act

Requires mo re insurance plans to com ply w i th theMental Health Pari ty & Add ict ion Equi ty Act o f 2008,

which requi res heal th insurers to p rovide mental heal th

coverage that is coextensive w ith benefi ts offered for

care of o ther chron ic diseases.

All health insurance sold on the Health InsuranceExchanges and provided in Medicaid programs mustinclude treatment services for SUDs.



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In 2010, private insurers paid 55.6% of all medical

expenditures, but only 20.8% of addict ion spending.

Private insu rers co vered on ly $5.8 bi l l ion o f the $28 bi l l ingtotal spent on add ict ion treatment.

65% of people receiv ing treatment used Medicaid o r oth er

publ ic fun ds , and 27% used Medicare

Individuals with private insurance are 3 to 6 timesLESS likely than those with public insurance toreceive specialty addiction treatment.

Only 1 in 9 people struggling with

addiction receive treatment.



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Most treatment facilities and drug courts programs areabstinence-based, but studies have shown betteroutcomes with “medication-assisted treatment” (MAT).

Methadone – Full opioid agonist, long lasting, “opiate-

replacement” therapy.

Suboxone (Buprenorph ine) – Part ial op ioid agon ist , long last ing

with “ceiling” on euphoric effect, “opiate- replacement.”

Vivi t ro l (Nal t rexon e) – An opio id blocker.

Federal government is encouraging treatment facilities toinclude MAT in their treatment options, and has threatenedto “de-fund” treatment courts that refuse to include MAT

as a treatment option.



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Provide Greater Access to Quality Care

Histor ic al ly, there has been a waitlist to get intotreatment due to fund ing issu es.

With the new legis lation and ACA, there is now

funding avai lable bu t a lack of treatment beds and

treatment specialists .

We need avai labi l i ty o f quality treatment that is ofgreater duration.



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Regulate Recovery Residences

Homes for people in early recovery that providestruc ture and recovery su ppo rt are a cr i tica l part of therecovery cont inuum .

Due to the opioid epidemic, the average age inrecovery homes is dropping from early 30s to mid-20s.

Current ly, these homes are neither regulated norl icensed, presenting a situat ion ripe for abuse.

National Alliance of Recovery Residences – a vo luntaryorganizat ion w ith standards that m ight be used as atemplate for mandatory standards and l icensingrequirements.



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Criminal Justice Reform

NIDA: 23 m i l lion Americans are addicted to alcoho land other drug s at an est imated annual cost o f mo rethan $365 bil l ion per year.

330,000 Americans are incarcerated due to drug

offenses at an annual cost of more than $10 billion.

Addiction is a disease, and prison isn’t treatment.Criminal reco rds make addic t ion recovery di f f icu l t , asi t is hard to get housing and employment.

Government is “seeing the light”:

Federal sentencing reforms effective November 2014.

Michigan’s 2014 expansion of expungement legislation.



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Recovery Support for Youth

Recovery High Schools: 14 states have at least one,

w i th several states having more than one.

There are no Recovery High Schools in Michigan.

Collegiate Recovery Programs: More common than

recovery high schools .

Michigan h as col legiate recovery p rog rams at Michig an State

Universi ty, Eastern Mich igan Universi ty, and Universi ty o fMichigan.



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Erica Clute-Cubbin, J.D., CADC Attorney and Counselor

Goldin & Associates, P.L.L.C


Phone: 248-208-0500

Lauren Rousseau, J.D. Attorney and Professor

Western Michigan University-Cooley

Law School


Phone: 248-751-7800, ext. 7756





the heroin epidemic - sbm webinar ppt rev2- june 4

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