2018 Annual Injury Prevention Reportopiatecollaborative.cuyahogacounty.us/pdf_OpiateCollaborative/en-U… · our taskforce members working behind the scenes to end this epidemic and

* Featuring Sub-Grantees (Partners funded through our ODH Injury Prevention grant).

2018INJURY

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2018 ANNUAL REPORT www.ccbh.net • 216-201-2000

2018 INJURY PREVENTION REPORT

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T The Cuyahoga County Opiate Task Force was created in 2010 with 6 individuals as a response to the ODH campaign titled, “Prescription for Prevention”. The experience held by coalition members have resulted in the successful creation and implementation of prevention strategies and a growing awareness throughout the community. Although all members of the coalition play an important role, key agencies include: Cuyahoga County Medical Examiner’s Office, The ADAMHS Board of Cuyahoga County,

Westshore Enforcement Bureau (WEB), Cuyahoga County Common Pleas Court, the Community Awareness and Prevention Association (CAPA), the MetroHealth System and Recovery Resources. The task force now is comprised of over 250 individuals. One of the major partners of the CCOTF, includes MetroHealth Office on Opioid Safety (Project Dawn) has distributed 9175 kits, with a documented 1490 reversals since its’ inception in 2013.

In 2015, Governor Kasich signed House Bill 4 giving local law enforcement the authority to carry naloxone. Realizing the benefits of first responders having this life saving medicine, the CCBH collaborated with the Cuyahoga County Sheriff’s Office, United States Department of Justice for Northern Ohio and WEB creating an education plan to increase local law enforcements’ awareness on the benefits carrying naloxone and the resources available through Ohio Mental Health and Addiction Services. Since 2015, CCTOF members provided education to local law enforcement agencies within Cuyahoga County. Currently 59 communities are carrying naloxone resulting in 622 reversals since 2015. In addition to saving lives, witnessing the change in the historical views of substance abuse from local law enforcement perspective has helped reduce the stigma of the disease which always had been looked at as a moral failure. By reducing stigma, programs such as Safe Passages have been established.

The CCOTF has been instrumental in assisting community members and agencies connect with needed resources. In addition, we have helped to create taskforces on a national level in Atlanta and Virginia and locally in Medina and Lorain counties.

The efforts of our subcommittees: treatment and recovery, and outreach and education and the tireless work of all of our taskforce members working behind the scenes to end this epidemic and END the stigma.

What started with just 6 people has expanded into a large, very successful and dedicated group that works every day to end this epidemic. And we will continue in the coming years to collaborate, to convene, to partner, and support.

Thank you.

http://www.ccbh.net

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2018 INJURY PREVENTION REPORTNaloxone Accessibility

Accessibility to Naloxone continues to improve. In 2018, a publicly available interactive map was created that showed pharmacy and Project DAWN locations where naloxone is available without a prescription. Currently there are 209 pharmacies and 4 Project DAWN locations offering naloxone in Cuyahoga County. There is also a mobile unit and all EMS vehicles are able to provide the public with naloxone.

EpiCenter Data

On average Cuyahoga County emergency rooms treated 7 patients a day in 2017 for opioid related presentations. There was a 56.7% increase in visits related to cocaine/opioid polysubstances in 2017 compared to 2016. Prescription opioids were the only drug category to show a decrease (16.7% change from 2016).

Unintentional Opioid-Related Deaths, 2016 1,2,3

In Cuyahoga County, the rate of Opioid-related deaths was 38.2 per 100,000 people in 2016. The rate for the City of Cleveland was more than 1.5 times higher at 61.8.

Across all demographic groups (i.e. age, gender, and race/ethnicity), unintentional opioid-related mortality rates were higher for the city of Cleveland compared to Cuyahoga County overall.

The White, non-Hispanic population had rates that were three (Cuyahoga County overall) to six times (city of Cleveland) higher than Black, non-Hispanics.

Unintentional opioid-related mortality rates for males were approximately one-and-a-half times higher than for females.

The county rate was slightly higher than the state of Ohio (32.9) and almost three times as high as the national rate (13.3), where the city of Cleveland mortality rate was significantly higher than the county, state and nation.

Cuyahoga County

For access to pharmacies that provide Narcan (naloxone) without a Prescription,

please click on this interactive map.

http://opiatecollaborative.cuyahogacounty.us/en-US/Project-DAWN.aspx

1. 2018 Cuyahoga County Community Health Assessment / 2018 Community Health Needs Assessment. Adopted by University Hospitals on September 27, 2018.

2. Cuyahoga County Board of Heath (CCBH) using Vital Statistics provided by the Ohio Department of Health (ODH).

3. Seth P, Scholl L, Rudd RA, Bacon S. Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants — United States, 2015–2016. MMWR Morb Mortal Wkly Rep 2018;67:349–358. Available at: http://dx.doi.org/10.15585/mmwr.mm6712a1. Accessed May 13, 2018.


http://opiatecollaborative.cuyahogacounty.us/en-US/Project-DAWN.aspx

http://dx.doi.org/10.15585/mmwr.mm6712a1

http://dx.doi.org/10.15585/mmwr.mm6712a1

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2018 INJURY PREVENTION REPORT

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T Preliminary data from 2017 (not shown) suggest that unintentional opioid-related mortality rates remain a local, state, and national public health epidemic.

This map shows the percent of ER visits due to prescriptions and illicit drugs by home zip code of the patient with the proportion of Naloxone administered by EMS in those same zip codes.

Map created and analysis performed by Epidemiology, Surveillance and Informatics at the Cuyahoga County Board of Health, June 2018, Becky Karns. Source: Data were taken from EpiCenter, a web-based surveillance tool administered through the Ohio Department of Health. EpiCenter categorizes/classifies information from the chief complaint recorded in emergency room (ER) visits. Records of patients initially considered for inclusion in this report had visits that were grouped under the “Drugs” classifier. This included records that had “overdose” indicated.Source: Naloxone distribution by Cuyahoga County Emergency Services (EMS) Jan. 2017-Dec. 2017. Ohio Department of Public Safety Division of EMS, the Ohio EMS Incidence Reporting System, (EMSIRS).

Cuyahoga County Emergency Room VisitsDue to Select Prescriptions and Select Illicit Drugs

by Home Zip Code of Patient and Doses of Naloxone Given byEmergency Medical Services (EMS)

January - December, 2017

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CUYAHOGA COUNTY MEDICAL EXAMINER’S OFFICE

4. Cuyahoga County Medical Examiner Office. Heroin/Fentanyl/Cocaine Related Deaths in Cuyahoga County. 2018 September Update. 10/4/18.

Source: Cuyahoga County Medical Examiner’s Office revised 12-13-18

The CCMEO provides detailed information on overdose deaths throughout the year to the Opiates Task Force and the community. This information keeps the community informed of the changing demographics that have been occurring in this epidemic. In the fall of 2018, the CCMEO presented information that highlighted both the enormity and the shift in opioid-related deaths.

CURRENT PUBLIC HEALTH EMERGENCY 4 At least 6 fatalities since Dec. 1

Fatal Cases due to heroin/fentanyl/analogs in NOVEMBER - at least 48 (39 cases pending testing):

28 - City of Cleveland Residents; 15 - Suburban Residents- Beachwood, Bedford, Brook Park, East Cleveland, Euclid (3), Garfield Heights (4), Lakewood (2), Parma (2), Parma Hts. (3), Solon, Strongsville and University Hts., and, 4 - Out of County– Akron (Summit), Eastlake, Mentor (Lake), Medina (Medina) and 1 - Unknown

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Heroin Carfentanil Fentanyl All Opioids (not inc. Fentanyl a�er 2013) TOTAL DRUG OD DEATHS All Opiate/opioid

Cuyahoga County Overdose Deaths 2006-2018* Most Common Drugs (*projected based upon es�mated cases as of Dec.13, 2018)


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TRENDS - At least 466 victims have died from heroin/fentanyl/analog or in combination through November in 2018. This compares to 495 through November of 2017 and 456 in 2016. 2018 total is at least 568 fatalities when including cocaine as well.

Carfentanil: 56 FATAL CASES in 2016; 191 in

2017; 24 confirmed fatal cases in 2018

as of 12/13/18

Rate of African American deaths involving fentanyl is 20.00% of all victims so far in 2018, a rate above 2016 (14.5%), and essentially at same level as the 20.33% in 2017. At least 35 cocaine related deaths occurred in November 2018 (at least 340 for 2018), with at least 26 being mixed with Fentanyl, Heroin or both (at least 198 for 2018).

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CCMEO Fentanyl-related fatali�es among African Americans 2014-2018*

*(Red - Projected for remainder of year, as of December 1, 2018)

Fentanyl (YTD) Fentanyl (Projected)


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CCMEO Overdose Deaths involving Cocaine 2006-2018The Explosion of Cocaine

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VICTIMS - Victims’ ages range from 23 - 74

31 Male victims; 17 Female victims; 14 African American victims; 34 Caucasian victims (3 hispanic victims)

CUYAHOGA COUNTY MEDICAL EXAMINER’S OFFICE

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MetroHealth’s Office of Opioid Safety (OOS) is a department focused on promoting opioid safety through education, advocacy and treatment. The office opened in the summer of 2017 under the strong leadership of OOS Director and Emergency Medicine Physician Dr. Joan Papp. The department has since grown to include more than a dozen employees with backgrounds ranging from public health, social work, nursing, pharmacy, education, anthropology, and chemical dependency. Since the department’s inception, the breadth of services has grown substantially to include programs and initiatives throughout the hospital system and in the greater community in the following areas: • Provider and system-wide education; • Creation of a system-based Opiate Task Force; • Expansion of MetroHealth’s Project DAWN program; • Expansion of substance use disorder services in the emergency department through case management; • Ascent ED Peer Support access for patients; • An Alternative to Incarceration Program within the Cuyahoga County Jail; • A quick response team program for overdose survivors in Parma and 5 western suburbs (Rocky River, Bay Village, Fairview Park, Westlake and North Olmsted); and • Increased resource support for opioid prescribing and case management for patients at greatest risk of opioid overdose.

OFFICE OF OPIOID SAFETY

Safer Opioid Prescribing Town HallsThe department’s first educational task was to provide a Safer Opioid Prescribing town hall training mandated for all system providers licensed to prescribe narcotics. The educational objectives of the town halls include: • Identify processes and tools for safe opioid prescribing • Discuss the impact of federal and state laws pertaining to opioid prescribing • Integrate assessment and management tools to mitigate drug misuse and monitor effective patient adherence to drug regimens

Town hall provider attendees received the following supportive materials following lecture attendance: • Safer opioid prescribing module • Safer opioid prescribing quick reference guide • Safer opioid prescribing supportive literature booklet • Patient education brochures

To help with system-wide dissemination, OOS identified “champion” providers from varying departments throughout MetroHealth. These champions agreed to attend a train-the-trainer Safer Opioid Prescribing lecture lasting 2 hours and accounting for 2 continuing medical education credits. Following, the champions then provided town hall trainings for their own departments. Further champion roles and responsibilities included: • Serve as leader on opioid safety issues for their department • Lead department town halls and future educational events • Membership in the MetroHealth Opioid Safety Task Force • Liaison between champion department and Office of Opioid SafetyIn a year’s time, Office of Opioid Safety Director lead over 50 town hall trainings and OOS Champions led over a dozen trainings reaching over 925 providers accounting for approximately 98% of present provider staff.

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MetroHealth Cuyahoga County Project DAWN (Deaths Avoided With Naloxone)MetroHealth’s Project DAWN program, an opioid overdose education and naloxone distribution program, was created because of the critical need for free access to the lifesaving antidote naloxone amidst a harrowing community overdose crisis. In the program’s first year in 2013, Project DAWN provided 376 naloxone kits to individuals at risk of opioid overdose. Since then, the program has provided over 11,000 kits to lay responders with reports of over 1,900 opioid overdose rescues. Over the past five years, the program has grown substantially to try and meet the needs of Cuyahoga County. What started out as a one-day clinic at two partnering organizations, the Cuyahoga County Board of Health and Circle Health Services, has now grown into a daily operation with the support of program staff including a Medical Director, Manager, one full-time and two part-time Program Assistants. Agency collaborations have also allowed MetroHealth Project DAWN to reach more individuals in the community with the support of agency staff, partnerships and clinic space including: • The Cuyahoga County Board of Health • Circle Health Services • Cleveland Emergency Medical Services (EMS) • Cleveland Department of Public Health’s McCafferty Health Center • Hispanic UMADAOP • MetroHealth Police Department Currently, Project DAWN operates five walk-in sites open to the community including its newest site devoted to serving the public and syringe exchange clients accessing Circle Health’s mobile syringe exchange unit at the Hispanic UMADAOP. Project DAWN kits are also provided to individuals and their families who have survived an overdose through Cleveland EMS and MetroHealth’s Hope after Overdose Outreach Project (HOOP) quick response team, as well as through MetroHealth’s Mother and Child Dependency Program. MetroHealth Project DAWN engages extensively in the community by offering trainings and distributions to the public. During 2018, MetroHealth Project DAWN provided 63 community overdose prevention and response trainings and distributions providing over 900 Project DAWN narcan kits. In addition, the program helped to approve over 40 service entity naloxone protocols, which equipped qualifying

agencies with training and naloxone. Through strategic planning and with the support of data from the medical examiner’s office, Project DAWN strives to continuously adapt to the growing needs of the community.

Alternatives to Incarceration ProjectProject DAWN not only saves lives by equipping lay responders with narcan, but it can also be a bridge between other services offered by the Office of Opioid Safety such as the Alternatives to Incarceration Project. This project, a partnership between MetroHealth and the Cuyahoga County Corrections Center, is an innovative program to increase access to medication assisted treatment (MAT) for qualifying inmates in lieu of incarceration. The ATI project consists of the following distinct components: 1) An expedited process to identify and assess inmates with opioid use disorder (OUD) 2) An enhanced process to secure an alternative to incarceration program pre-trial 3) Initiation of MAT during incarceration 4) Enhanced “warm hand-off” plan to connect inmate with ongoing OUD treatment 5) Incorporation of peer support during incarceration and as a part of the post-release care planOhio Department of Health funds helped program staff to build the infrastructure needed to implement this program. In building a program of this kind, the following components proved essential in preparing for program launch: • Application and approval of Institutional Review Board (IRB) research program protocol • Improvement of OUD identification system for CCCC inmate population • Improvement of judge protocol and referral process for inmates with OUD • Provision of supplemental education for stakeholders • Coordination of monthly stakeholder meetings • Recruitment of judges for program participation • Securing and maintenance of relationships with treatment providers • Construction of electronic health record ATI project workflow build

Since program launch, ATI staff have completed 42 level of care assessments within CCCC. Out of those 42, twelve inmates have been referred to treatment, and eleven inmates have been admitted to treatment.

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Due to the rapid and alarming increase in drug overdose deaths, community partners realized the need to establish a county-wide task force to address these issues. The Task Force is comprised of dedicated professionals from areas such as drug treatment/recovery, education, health care, law enforcement, medicine, prevention specialists, mental health services, concerned citizens, and public health. Recognizing that addiction is a disease, the members strive to increase awareness to the dangers associated with the misuse of opiates as well as to implement strategies and policies that will have a positive impact this epidemic.

DAWN includes all documented naloxone saves through DAWN including police reversals. Does not include EMS administra�ons:

(1,903 doses in 2015, 5,156 in 2016 and 7,745 dose administra�ons in 2017).

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(* 2018 based on preliminary data thru October 1)


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Recovery Resources is proud to report that we have made tremendous strides in educating Northeast Ohio college campuses on the dangers associated with prescription medication abuse and supporting their efforts to create policies that reduce the impact of substance abuse on their campus. This year we facilitated seven trainings where we certified 135 college students in Mental Health First Aid, a training disseminated by the National Council for Behavioral Health, which includes an action plan for supporting someone who may be experiencing a mental health and/or substance use-related crisis. Additionally, we have dispelled myths and misconceptions related to the opioid epidemic through our participation at three health/safety events and two small- classroom presentations.

Moreover, through our leadership of the Cuyahoga Campus Mental Health Coalition comprised of stakeholders from 8 different higher education institutions, the Alcohol, Drug and Mental Health Services Board of Cuyahoga County, MetroHealth Hospital, and other non-profit organizations including the Cleveland Rape Crisis Center, we created an opportunity for Vince Caraffi of the Cuyahoga County Opiate Task Force to update members on the challenges associated with the current opioid epidemic. This presentation helped us to field a discussion on how members can encourage their institutions to prioritize having Naloxone accessible to their security personnel. We also invited a representative from MetroHealth Hospital’s Project DAWN program to facilitate a training and Naloxone distribution to interested parties at our quarterly meeting in July. Thus, these collaborations have culminated in Cleveland State University’ development of a Substance Use Prevention and Pathways of Recovery Team (SUPPRT) who has scheduled two Project DAWN trainings this year, hosted an event focused on dispelling myths associated with opioid abuse, and worked on policies to support substance-free activities and potential housing options on campus.

Partners in health. Partners in hope.

3950 Chester Avenue, Cleveland, Ohio 44114 | 216.431.4131 | Fax: 216.431.4133 | www.recres.org

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The Medina County Opiate Task Force has made great strides over the past year. The task force goals include; bringing the community together, describing services available, identifying gaps in service areas, developing needs-based programming as well as building a cohesive coalition and subcommittees. In 2018 our coalition has planned, developed, and implemented services for addiction including expanded treatment options, support for families, programming to increase awareness and outreach.

Medina County accomplishments include: • Developing Kinship Connect - a group that provides support and connection to services for grandparents raising grandchildren. They link families to resources, provide structured support group, offer a bi-annual legal seminar, and conduct trainings on medication safety issues • Created a grief support group for families who have lost a loved one to addiction. This group runs six weeks and they now have an alumni group. • Expanded the Family Matters support group from Medina to a new group in Wadsworth. • Partnered with the Safe Rx Regional Collaborative to provide Deterra bags to senior citizens. • Expanded Project DAWN distribution to a monthly site in Wadsworth and a series of special outreach locations throughout the county. • Celebrated the opening of the Community Assessment and Treatment Services (CATS) Residential Treatment unit in Wadsworth.

In April, the task force acknowledged individuals that have led our community to develop and support opi-ate recovery efforts. Awards went to the following:

Bob and Jeanie Brandt- Robby’s Voice

Stefanie Robinson-Ohio Guidestone

Sherriff Tom Miller- Medina County Sheriff’s Office

Matt Hiscock-Wadsworth Drug Free Community Coalition

From L-R: Krista Wasowski, Health Commissioner, Matt Hiscock, Stephanie Robinson, Sheriff Miller, Bob & Jeannie Brandt, Tiffany Shelton, ADAMH Board Planning & Program Director

• Planning, developing, and implementing a Certified Peer Recovery Support Network with a hub to open in spring 2019. • Worked with 2-1-1 to develop script that ensures appropriate referrals for opiate and addiction related services. We are also conducting quarterly updates to make certain all county resources are listed with 2-1-1. • Developed an Opiate Response Team funded through a grant. • Held special programs throughout the county for International Overdose Awareness on August 31st • Printed and distributed “What Are the Drugs in Your Child’s World” brochures. • Worked with Medina County Police Chiefs Association to educate the public on Issue 1

Recently, Sheriff Tom Miller summed up the work of the Medina County Opiate Task Force. He de-scribed two incidents he heard about; a 4 year old that knew how to administer Narcan to save a parent, and another young child who knew how a parent used cocaine. Due to this, he shared there is more to be done. He stated, “Our work today is about saving not just this generation, but the next as well. We should be proud of our efforts and continue to work together!”

http://www.ccbh.net


SUBGRANTEE PARTNERSHIPS

In an effort to decrease drug overdoses, Lorain County Public Health held 11 outreach events for Lorain County residents. The events in 2018 provided overdose education to 322 people and 88 project DAWN kits were distributed. The focus of the outreach was for awareness and recognition of overdoses and prevention of deaths related to opioids overdoses for residents. The expansion of project DAWN increased the opportunity for those who have or know someone who has an opioid use disorder and to obtain a Narcan kit and to learn how to use nasal Narcan.

Outreach and awareness outreach was completed during the funding period. “Narcan Save A Life” Outreach and awareness events included the following activities: Signs were displayed in the paper towel holder from June 2018 through September 2018 and tear off pads were available at the checkout counter at Amherst Sunoco gas station.

Lorain County Public Health

free Narcan kit 440-322-6367

Stop opioid overdose deaths. Stop opioid overdose deaths.

Save a life.

Nasal naloxone (Narcan) stops & reverses an opioid overdose. Free Narcan kits +

training are available for anyone who wantsto prevent an opioid overdose death.

Walk-ins welcome on weekdays 8:00 AM – 4:00 PM* *After hours appointments available. Call 440-322-6367

Pick up a Narcan kit at:

Lorain County Public Health 9880 S. Murray Ridge Rd., Elyria, OH

6/18

Funding provided by ODH through Cuyahoga County Board of Health

Signs were displayed at the gas pumps and bag stuffers were distributed by the staff at Eaton Marathon from June through September. Media releases where completed in June and August. Signs were displayed on 4 Lorain County Transit buses from September through November.

Ads were displayed in the Chronicle and Morning Journal in September.

Expansion of capacity to address drug overdoses has been met by community events held throughout Lorain County and outreach and awareness by marketing promotions.

Expansion of capacity to address drug overdoses January – December 2018

12/10/2018 PDO/CCBH

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FUTURE STEPS OF THE PARTNERSHIP

Twitter.com/OpiateTaskForceFacebook.com/CuyahogaCountyOpiateTaskForce

For more information or to become a member, please visit our newly redesigned website:

www.opiatecollaborative.cuyahogacounty.us

In the year to come, Cuyahoga County Board of Health and our Community Partners will continue to work together to address this rapid and alarming increase in drug overdose deaths. Dedicated professionals from areas such as drug treatment/recovery, education, health care, law enforcement, medicine, prevention specialists, mental health services, concerned citizens, and public health will work tirelessly to end this epidemic. Recognizing that addiction is a disease, we strive to increase awareness to the dangers associated with the misuse of opioids as well as implement strategies and policies that will have a positive impact.

Questions?Please Contact:

April Vince, Injury Prevention Coordinator Cuyahoga County Board of Health

216-201-2001 ext. 1538 [email protected]

This work is funded either in whole or in part by a grant awarded bySupported by the Grant or Cooperative Agreement number, 1 NB01OT009127-01-00, funded by Center for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the centers for Disease Control and Prevention or the Department of Health and Human Services.

http://www.ccbh.net

https://twitter.com/OpiateTaskForce

http://Facebook.com/CuyahogaCountyOpiateTaskForce

http://www.opiatecollaborative.cuyahogacounty.us

http://www.opiatecollaborative.cuyahogacounty.us

mailto:avince%40ccbh.net?subject=

Documents

2018 Annual Injury Prevention Reportopiatecollaborative.cuyahogacounty.us/pdf_OpiateCollaborative/en-U… · our taskforce members working behind the scenes to end this epidemic and