the opioid epidemic - adventist healthcare · appetite suppressants age 18 ... *source: maryland...

the Opioid Epidemic: Montgomery County’s Response

Age 0 – 4Amoxicillin

Age 4 – 12Ritalin

Age 12 – 18Appetite

Suppressants

Age 18 – 24No-Doz

Age 24 – 38Prozac

Age 38 – 65Zantac

65 ——Everything

Else

1

This session will provide an overview on the impact of

the opioid epidemic in Montgomery County, Maryland

— as well as the affects of opioid use in apply substance

abuse environment

Learnings from the Offered Training.

ADVENTIST HEALTHCARE SYMPOSIUM | THURSDAY, NOVEMBER 2, 2017 2

Identify

Identify current trends in

Montgomery County versus the rest of the state

Understand

Understand the impact of the

Governor declaring a state of

emergency

Discuss

Discuss Maryland’s current laws

pertaining to the prescription drug

monitoring program, the

Opioid Intervention Teams and its

relationship to the Statewide Opioid

Overdose Coordinating Committee

Understand

Understand the coordination

between public safety and

behavioral and public health.

Discuss

Discuss prevention, outreach efforts,

treatment continuum and

effective programs

Learning Objectives.


4

1.04m Residents

33% Foreign Born

55% Racial-ethnic Minority

Seven Zip Codes of Extreme Need

36% growth in our senior population by

2025.

Projection for 2025 is 196,000

35% of 159,010children in the public school system receive

FARMS

Served over 97,000 households in Fiscal Year 2017. The average client

used more than two services from the

Department

Serving almost 31,000 uninsured adults,

children and pregnant women

Montgomery County Department of Health and

Human Services

has a staff of 1,641 with over 134 programs

Caseloads grew significantly in FY15 but have declined since:

SNAP -10%

TCA -16%

MA -55%

Information about Montgomery County, Maryland.Our County by the Numbers.

5

One Director

Centralized Administrative

Functions

Moving towards single client record support by an interoperable

database

Uniform intake form to identify all service

needs

Designated entire HHS Entity as HIPAA

covered – including social service and income support

programs

How is the Department of Health and Human Services Organized?ADVENTIST HEALTHCARE SYMPOSIUM | THURSDAY, NOVEMBER 2, 2017

Services and State Department Connections.

1. Aging and

Disability

Services

2. Behavioral

Health and

Crisis Services

3. Children,

Youth and

Family

Services

4. Public Health

Services

5. Services to

Prevent and

End

Homelessness

6. Community

Outreach

5 and 6 1, 2, 4, 5 and 6 1, 2, 3, 4, 5 and 6 3 and 6

1 and 6 1 and 6 3 and 6 2 and 6

2, 3 and 6 3 and 6 1 and 6 3, 4 and 6

6

Behavioral Health within the

Health and Human Services

Enterprise

The Behavioral Health Continuum.


This declaration authorizes all

local emergency agencies to cut

through the red tape with more

flexibility for prevention,

treatment and enforcement

efforts. He creates the Opioid

Overdose Coordinating

Committee.

Governor Declares a State of Emergency

Between 2015 and 2016 — 40% increase in overdose deaths

1

Fentanyl deaths for the same time period increased by 147%

2

Heroin deaths increased by 30%

3

63% increase in the administration of Narcan as rescue medicine to counter overdoses

4

Overdose Data for Montgomery County.


2085046

2087439

2090435

2091032

2087823


A TOTAL OF 503 ADMINISTRATION OF NARCAN TOOK PLACE IN

2017. HERE ARE THE TOP 5 ZIP CODES.

Table 1 | Total Number of Drug and Alcohol-Related Deaths1, 2 (Montgomery County)

2007 – 2016 and Year-to-Date 2017 through June3

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 YTD

State 815 694 731 649 671 799 858 1041 1259 2089 1172

Montgomery County 56 46 44 38 44 48 52 65 70 102 521Includes deaths that were the result of recent ingestion or exposure to alcohol or another type of drug, including heroin, cocaine, prescription opioids. Benzodiazepines, and

other prescribed drugs.2Includes only deaths for which the manner of death was classified as accidental or undetermined.3Counts for 2017 are not complete.

Table 2 | Number of Opioid-Related Intoxication Deaths1,2 (Montgomery County)

2007-2016 and YTD 2017 Through June.3

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 YTD

State of Maryland 628 523 570 504 529 648 729 888 1089 1856 1029

Montgomery County 35 29 31 25 28 36 40 53 59 84 431Includes deaths that were the result of recent ingestion or exposure to prescription and illicit opioids.2Includes only deaths for which the manner of death was classified as accidental or undetermined.3Counts for 2017 are not complete.

13

Table 3 | Number of Heroin-Related Intoxication Deaths1, 2 (Montgomery County)


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 YTD

State 399 289 360 238 247 392 464 578 748 1212 568

Montgomery County 17 14 16 12 11 22 28 33 37 48 271Includes deaths that were the result of recent ingestion or exposure to heroin.2Includes only deaths for which the manner of death was classified as accidental or undetermined.3Counts for 2017 are not complete.

Table 4 | Number of Fentanyl-Related Intoxication Deaths1,2 (Maryland)


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 YTD


Montgomery County 2 0 1 1 0 2 0 8 27 43 321Includes deaths that were the result of recent ingestion or exposure to prescription and illicit fentanyl.2Includes only deaths for which the manner of death was classified as accidental or undetermined.3Counts for 2017 are not complete.

14

Table 5 | Number of Prescription Opioid-Related Intoxication Deaths1, 2 (Montgomery County)


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 YTD

State 301 280 251 311 342 311 316 330 251 418 211

Montgomery County 20 17 19 14 20 18 16 19 23 26 111Includes deaths that were the result of recent ingestion or exposure to prescription Opioids.2Includes only deaths for which the manner of death was classified as accidental or undetermined.3Counts for 2017 are not complete.

Table 6 | Number of Cocaine-Related Intoxication Deaths1,2 (Maryland)


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 YTD


Montgomery County 20 12 7 4 12 12 13 10 5 11 71Includes deaths that were the result of recent ingestion or exposure to cocaine.2Includes only deaths for which the manner of death was classified as accidental or undetermined.3Counts for 2017 are not complete.

15

Table 7 | Number of Alcohol-Related Intoxication Deaths1, 2 (Montgomery County)


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 YTD

State 189 176 163 161 161 195 239 270 310 582 267

Montgomery County 17 15 9 10 16 15 13 18 15 22 171Includes deaths that were the result of recent ingestion or exposure to alcohol.2Includes only deaths for which the manner of death was classified as accidental or undetermined.3Counts for 2017 are not complete.



Drug Use and Overdose

Trends Among Children

and Adolescent

7.6% of middle school and 12.5% of high school students have abused prescription medication

1

1.5% of middle school and 3.1% of high school students have used heroin

2

In contrast, 5.4% of middle schoolers and 24.7% of high schoolers report current use of alcohol

3


Prescription Drug Use and Heroin Use | Calendar Year 2014**Source: Youth Risk Behavior Survey for Montgomery County


Alcohol Use, Prescription Drug Abuse, Heroin Use for MCPS

Middle and High School Students | *Source: Youth Risk Behavior Survey for Montgomery County 2014

5%

25%

8%

13%

2%3%

0%

5%

10%

15%

20%

25%

30%

Middle School High School

Calendar YearCurrent Alcohol Use Prescription Drug Heroin


Estimated Counts of Students Reporting Alcohol Use, Prescription Drug

Abuse, and Heroin Use for MCPS Middle and High School Students*

35,267

47,450

2,6805,931

529 1,4711,904

11,720

300

5,300

10,300

15,300

20,300

25,300

30,300

35,300

40,300

45,300

Middle School High School

Stu

den

t

Enrollment Prescription Drug Heroin Alcohol

*Source: Maryland MSDR Attendance Data for MCPS Middle and High School Students 2017, YRBS Survey Results for MC Middle and High School Students 2014.


2014-15 Completed Suicides, Overdose Fatalities, Suicide Attempts and Drug Related

ER Visits Seen at Local Hospital ERs for MC Residents (6-18 vs 19-25 age group) *

*Source: Maryland Department of Health Vital Statistics Annual Report 2014-2015, Drug and Alcohol Intoxication Deaths for Montgomery County 2014-2015

8

515

1

752

14

225

24

915

0

500

1000

1500

Suicides Suicide Attempts Overdose Deaths Drug Related ER Visits

6-18 yrs 19-25 yrs


Fatal Overdose vs. Non-fatal Overdose Cases**Source: Montgomery County Fire and Rescue EMS Incident Report FY17 YTD

In FY17, a total of 471 Narcan related incidents were

reported by Montgomery County Fire and Rescue Team.

3% of these overdose cases are for 6-18 year olds, while

14% are from 19-25 year old age group.

So far, no overdose fatalities was observed for children and

adolescents under 18 years of age in the county.


Many Voices for Smart

Choices Coalition —Substance Use Needs Assessment Amongst

Youth andYoung Adults

Alcohol Use

1

Binge Drinking

2

Marijuana use

3

Non-Medical Prescription Drug Use

4

Lifetime Heroin Use

5


SABG studied the following consumption and

consequence patterns for underage and young adults:*

*Substance Abuse Block Grant (SBAG) | Montgomery County Collaboration Council and Montgomery County Department of Health and Human Services October 2017

High Impact Moderate Impact Low Impact

High Likelihood of

Change

Non.medical use of

prescription drugs

Moderate Likelihood

of Change

Underage Drinking

Heroin

Low Likelihood of

Change

Binge Drinking Marijuana


Prioritization Assessment Table*




0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Alcohol Binge Drinking Marijuana Prescription Drugs Heroin

2013 2014

Consumption Rates of Montgomery County High

School Students by Drugs*

0

1

2

3

4

5

6

7

8

9

12-17 Age Group 18-25 Age Group

Maryland Montgomery County


Average Non-medical Use of Pain Relievers in the

Past Year (2012-14) Amongst 12-25 year olds.

The

County’s

Strategic

Response

Coordinate and Increase Education and Public Awareness Activities in the County

BetheOne Campaign

Community forums on SUD

Educational Forums on Good Samaritan Laws, etc.

Coordinate and Increase Substance Use Prevention Activities in the County

Interdiction and Law enforcement

Naloxone Training and Distribution

Drug Takebacks

Deflection and Diversion

Working on Several Fronts.


Improve the integration and sharing of state and local data by Monitoring, Planning and Rapid Alerts

and Responses

Overdose and Overdose Death data integration

and sharing

Targeted response and action planning

Communication Liaison with State Opioid

Overdose Coordinating Council

State OOCC coordination and communication

Local Overdose Intervention Team coordination and communication

Rapid communication of spikes and trends

in overdoses

Promote Increased Access to

Treatment/Recovery and Support

Hospital-Community

Coordination

Community based treatment

Recovery and Aftercare

Additional

Strategy Areas:

ADVENTIST HEALTHCARE SYMPOSIUM | THURSDAY, NOVEMBER 2, 201731

Established in response to Governor’s executive

Order establishing a state of emergency related to the

opioid epidemic

OIT is a broad and growing group that has come together to build a

coordinated county-wide response to preventing

addiction with specific focus on addressing opiate

addictions

4 Pillars of OIT Work

• Public Education and Awareness

• Public Safety/overdose Prevention

• Access to Treatment

• Coordination, Communication and Planning

Montgomery County Opioid Intervention Team (OIT).


Public Education in schools and communities on substance abuse // Good Sam Laws. HHS, SAO, MCPS, MPD, others all taking on parts of this role.

01Community forum series on Substance abuse in MoCo. Designed to move around the county to key spots to educate and give the community a change to learn about the risks and how to prevent addiction.

02BTheOne.Org – public awareness campaign targeted to school aged youth and young adults on potentially life-saving actions they can take when they see a peer in trouble with drugs or feeling suicidal.

03

Public Education.



Montgomery County Dept. of Health and Human Services (MCDHHS),

Collaboration Council (CC), Arise and Flourish, Brave and Bold Coalition, Dept. of Liquor Control (DOLC), MC Public

Schools (MCPS).

Prevention education, outreach, free tools and resources, school clubs (e.g. Breaking

the Cycle of Addition and S.A.D.D.), MCPS’s Under 21 Activity grant

recipient/prevention coalition, DOLC’s Keepin’ It Safe Coalition, CC’s Many Voices

Smart Choices Coalition (MVSC) -Communities Mobilizing for Change),

community partnerships, special events and professional development.

Prevention Resources for Youth and Young Adults.

Underage Drinking Prevention Resources.


MCDHHS, MVSC, CC, Arise and Flourish, Brave and Bold Coalition, Heroin Action Coalition, MCPS,

MCPD, MC Sheriff ’s Office, MC States Attorney’s Office (SAO), Governor’s Office, MC Bar Association,

AODAC, Montgomery County Fire and Rescue Service (MCFRS), and the Universities at Shady

Grove.

Prevention education, awareness, free tools and resources, events/forums (e.g. Save a Life

Montgomery; SAO’s Speak Up, Save a Life and Teen Court; CC’s MVSC Coalition; and Gov. Hogan’s

Heroin and Opioid Task Force), partnerships and collaborations, free tools and resources, Opioid

Misuse Prevention Program (OMPP) Social Marketing Campaign and media interventions/expanding

prescription drug lock-box & drop off locations, websites (e.g., Clear the Cabinet), PSA and social

media (e.g., twitter, IG) presence.

Prevention Resources for Youth and Young Adults (Continued).

Non.Medical Use of Prescription Drugs Prevention Resources.

• Doing this for the past two years and now expanding the locations where people are trained and equipping them with Naloxone.

Naloxone training and dispensing –

both to the public, school health

nurses and law enforcement.

• In partnership, we established STEER (Stop, Triage, Engage, Evaluate, Refer) to do outreach with non-fatal overdose victims and get them into the county treatment system

• Drug take back days and drop boxes – sponsored by MPD to give families a place to safely dispose of their old medications.

MPD responds to over 3000 calls a

year related to BH and SRD

Public Safety


Coordination of discharge planning and care planning with hospitals and community providers for patients who are being discharged from the hospital following a non-fatal overdose

A broad spectrum of addictions treatment services

o Residential detox and extended residential stay at Avery Road

o Half-way houses for men and women with young children

o Outpatient and intensive outpatient addictions treatment services

o Medication Assisted Treatment programs

o Drug Court

o Also – we have Jail Addictions Services (JAS) addictions treatment program for incarcerated residents and Comprehensive Re-entry Program for offenders who are returning to the community.

o We also have a diversion and treatment programs called SASCA for adolescents.

o To support persons in recovery we have a growing number of Peer Recovery services and providers

Access to Treatment and Support.

ADVENTIST HEALTHCARE SYMPOSIUM | THURSDAY, NOVEMBER 2, 201737

1

Making greater use of data to track where overdoses are occurring as a guide to where to target prevention and intervention resources.

2

Identify spikes in overdoses when reported by our hospitals that may signify the distribution of a deadly combination of drugs on the streets

Coordination, Communication and Planning.


For Overdose Emergencies

911

For Montgomery County Department of Health and Human Services’ Referrals

311

Behavioral Health Crises Crisis Center

240.777.4000

Non-emergency assessment and referrals

ACCESS – 240.777.1770 (coordinated entry for all behavioral

health referrals) and

SASCA for youth 240-777-1430

For education and public awareness opportunities – Many

Voices for Smart Choices through our Collaboration Council

301.610.0147

Montgomery County Prevention Office

301.777.1116

Child Adolescent Mental Health Offices

Silver Spring | 240.777.1450

Rockville | 240.777.1432

Our Treatment Manager who coordinates Naloxone Training

240.777.1116

Resources in Montgomery County.


Uma S. Ahluwalia, DirectorDepartment of Health and Human Services

401 Hungerford Drive

Rockville, Maryland 20850

240.777.1266

[email protected]

the opioid epidemic - adventist healthcare · appetite suppressants age 18 ... *source: maryland...

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