The Opioid Epidemic: Strategies & Solutions · 1. Despite our efforts, the opioid epidemic in Waukesha Co continues to worsen 2. Opioid use among older adults is a concern in Waukesha

Building Safe, Healthy, and Drug Free Communities

The Opioid Epidemic: Strategies & Solutions

Dorothy Chaney, M.EdPresident, WI Community Health AllianceCADCA Consultant

4/3/2018

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Goals For Session

• Look at the opioid issue from a preventionperspective

• Talk about challenges that coalitions often face – the expanded definitions of prevention

• Explore a community approach that shows some significant signs of success

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Session Components

• Data – looking broader than opioids• What the evidence says about effective

strategies• Pillars Approach – a best practice developed

in Europe and adopted in Canada – and now Wisconsin

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Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids. – Centers for Disease Control and Prevention (CDC)

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“From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a

worsening of the opioid overdose epidemic…”

63,632 drug overdose deaths in 2016CDC, March 2018

Despite Our Efforts – The Epidemic Worsens

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69.7% increase in the Midwest

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Assessing The Problem

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What is the extent of the Problem?

• Which drugs are being used?

• How are the drugs being used?

• How much? How often?

• Who is using the drugs?

• Where and when are the drugs being used?

Do we want to address the substance use problem or the opioid problem?

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There is Science To Guide Our Efforts

Tracking & Monitoring

Medication Disposal

Harm Reduction

Education

Limit Size of Prescriptions - Availability

Multi-Faceted Approach – Community Coalitions

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Education

Prescribers

Parents

Older AdultsYouth

Patients

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And…It Doesn’t Always Start with RX

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So How Do We Address This Complex Problem?

Harm Reduction

Underage Drinking Prevention“It Doesn’t Start With Heroin”

Overdose Prevention

HIV Prevention

Prevention of Neonatal Abstinence Syndrome

Prevention of Substance Use Disorder

Prevention of Progression from Rx to Heroin

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So How Have Other Countries Responded to the Epidemic

And what can we learn?

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Increasing Numbers of heroin addicts – rose to tens of thousands

Swiss 3 Pillar Drug Policy: Law Enforcement; Therapy; Prevention

Law Enforcement: based upon strict prohibition

Treatment: included MAT

Prevention: messages related to harms of drug use. Some groups were starting to advocate for legalization of all drugs –but failed in referenda

Drug Use in Switzerland in the 1980’s

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Despite the 3 pillars, injection heroin use continued to grow – and numbers of users gathered in large groups –sometimes thousands

In some cities – authorities tolerated “Needle-Parks” Open Drug Scenes – thousands of drug users injected, sold heroin

Slum-like; horror stories of children living there with Drug-using parents; drug users dying; human waste everywhere


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“Finally, the misery and violence in the open drug scenes in major cities became intolerable, incompatible with the self-image of a well-organised society….”

Source: European Addiction Research: “Understanding Swiss Drug Policy Change and the Introduction of Heroin Maintenance Treatment.” Kahn, Khazaal, Thorens, Zullino, Uchtenhagen


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Harm Reduction includes: housing and social support, street and prison work, supervised injecting rooms (13 in 8 cities), drug testing, needle exchange, methadone programs and heroin-assisted treatment.

Results: 70 per cent of opiate or cocaine users now receive some form of treatment. The number of drug injectors with HIV has halved, as has overdose mortality among injectors.**

**Source:”Swiss Recipe For Dealing With Drug Addiction Proves A Success” www.watoday.com.au

Switzerland: 4th Pillar

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Switzerland Outcomes

• Still high rates of use for cocaine, marijuana, ecstasy

• Limited prevention messages

• Acceptance of drug use – but no movement to legalize

• Heroin is no longer used by the young. Heroin is seen as a “loser drug”, leading to sickness and death.

• Some see Swiss Drug Policy as a success – others see it as a failure

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• Vancouver's Four Pillars Drug Strategy (2005) is a coordinated, comprehensive approach that balances public order and public health in order to create a safer, healthier community.

• Harm reduction• Prevention• Treatment• Enforcement

Source:http://vancouver.ca/people-programs/four-pillars-drug-strategy.aspx

4 Pillars Vancouver

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UNIVERSAL

Vancouver’s harm reduction programs include the supervised injection site, needle exchanges and community health services. Vancouver has 24-hour-a-day access to needles through low-threshold, peer-based needle exchanges, mobile exchanges and needle exchanges attached to primary health care services.

North America’s first Supervised Injection Site (SIS), InSite, opened in Vancouver in September 2003.

Source:http://vancouver.ca/people-programs/four-pillars-drug-strategy.aspx

Harm Reduction

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UNIVERSAL

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InSite combined with increased MMT resulted in a reduction of overdose deaths, transmission of HIV and Hepatitis C.

Source: http://idpc.net/alerts/2014/10/the-four-pillars-revisited-a-5-part-series-about-vancouver-drug-policy

Vancouver: Outcomes

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Prevention Pillar extremely underfunded and ineffective

Inadequate access to mental health services for youth in Vancouver schools

Researchers state that what prevention does exist in schools begins too late


Vancouver: Outcomes

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Treatment Pillar:

Patchwork treatment system, some public and some private

Inconsistent approaches

A lot of disagreement on Methadone Maintenance Treatment


Vancouver: Outcomes

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Law Enforcement Pillar:

Drug Treatment Courts in Canada still controversial –there are 2800 drug treatment courts in USA – and only 6 in Canada.


Vancouver: Outcomes

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There is much debate over whether or not current city officials have abandoned the Pillars approach, and there is a resurgence of opioids in the city.

2016 a public health emergency was declared

At the federal level – there was little support for the pillars approach and it negatively impacted outcomes in Vancouver

https://www.theglobeandmail.com/opinion/why-canada-is-no-longer-a-leader-in-global-drug-policy/article23225460/

http://idpc.net/alerts/2014/10/the-four-pillars-revisited-a-5-part-series-about-vancouver-drug-policy

Vancouver: Outcomes

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Wisconsin

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Pillars:1. Treatment2. Law Enforcement3. Harm Reduction4. Prevention5. The Work Place

Wisconsin

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• Provided a framework for communities

• Served as the catalyst for the establishment of many county level task forces

Wisconsin

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Waukesha Task Force Based Upon Two Frameworks

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Law Enforcement

Work Place

Drug Affected Infants

Prevention

Treatment

Harm Reduction

Waukesha Co Heroin Task Force

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Prevention Pillar –Networks all of the

agencies/coalitions working on prevention initiatives in the county:• Hidden in Plain Sight• Stairway to Heroin Series• School health classes and events• Parent groups and educational

nights• Local DFC coalition is one partner

at the table


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Prevention Pillar Key messages:

• It doesn’t start with heroin• Parents still don’t think it’s a problem• Kids are getting it everywhere


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Harm Reduction Pillar –Educating jail inmates about risk for overdose after

release–Seeking to increase presence of needle exchange –Naloxone trainings–Advocated for additional funding for Naloxone


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Law Enforcement Pillar• Advanced Roadside Impaired Driving Enforcement

(ARIDE) classes• Crisis Intervention Trainings (CIT)• Implementation of nasal Narcan by Sherriff's

Department• Drug Collection Boxes/Take Back Events• Coordinating efforts with Methamphetamine

initiatives

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Workplace Pillar• Educational events• Public Health providing information for employers• Developing informational website• Partnership with Waukesha County Business

Alliance

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Treatment Pillar• Promoting 2-1-1 as a point of contact for referrals

and encouraging providers to become listed• Promoting events to assist with insurance

enrollment• Outreach to medication assisted providers• Identifying & Reducing Treatment Barriers• Established a Provider Network

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Drug Affected Infants Pillar • Developed a referral binder for providers• Developed website• Networked with methadone providers • Providing community education• Linking resources between providers and groups

such as Safe Babies/Healthy Families, Public Health, and HHS Birth to Three

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• Work collectively to reduce drug related deaths• Each Pillar has expertise in their own area• The task force is not a coalition• Unlike Switzerland & Vancouver, there is a strong

emphasis on prevention


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2018 - Expanding Scope

• In 2017, Waukesha Co Community Health Assessment identified opioids as a top community priority

• In 2018, Waukesha Co Heroin Task Force is aligning with Waukesha County CHIP process – adding resources and expanding the work as a top community health priority

• Three priority areas for Task Force in 2018:1. Despite our efforts, the opioid epidemic in Waukesha Co continues to

worsen2. Opioid use among older adults is a concern in Waukesha Co3. Too many children are impacted by prenatal drug use in Waukesha Co

Emphasis upon Re-energizing Prevention Pillar Treatment Pillar - increasing access to MAT

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Lessons Learned

• Opioid Epidemic is Complex – many sides• Requires a coordinated, comprehensive approach• Pillars approach can be very effective in identifying the many

sides to the elephant• Aligning systems and approaches is a critical first step – this

epidemic is complex and systems changes and alignment will lead to improved outcomes.

• Prevention Is KEY – and we must not forget to go upstream –or we will always be reacting

• Prevention must focus on the drug of initiation – alcohol, marijuana, tobacco – whatever your data tells you

4/3/2018

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Thank you!

Questions?

[email protected]

Documents

The Opioid Epidemic: Strategies & Solutions · 1. Despite our efforts, the opioid epidemic in Waukesha Co continues to worsen 2. Opioid use among older adults is a concern in Waukesha