Opioids

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This epidemic has affected the health, social, and economic welfare of every county in the state of Ohio. Listed below are proposed “solutions” based on empirically positive results from methods used in various communities, states, and countries that are also dealing with this extremely complicated issue. As our research continues, this page and list will be updated.

Encouraging Appropriate Use

Increase use of Prescription Drug Monitoring Programs (PDMP) – Ohio’s PDMP is known as the Ohio Automated Rx Reporting System (OARRS). Established in 2006, this statewide database helps prescribers and pharmacists avoid potentially life-threatening drug interactions or identify individuals fraudulently obtaining controlled substances from multiple health care providers, a practice commonly referred to as “doctor shopping.” The information also is available to law enforcement officers and health care regulatory boards during active investigations. In the state of New York, when they made it mandatory for prescribers to check the state’s PDMP before prescribing opioids in 2012. They saw a 75% drop in patients’ seeing multiple prescribers for the same drugs by 2013.

Improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain

Emphasis on patient education on the safe storage and disposal of prescription opioids

Treatment & Recovery

Increasing Mental Health & Addiction Care

Improving Treatment Availability and Affordability for Those Most in Need

Expanding Access to NaloxoneStudies from recent pilot programs demonstrate that lay persons are consistently successful in safely administering naloxone and reversing opioid overdose. Current evidence supports the extensive scaleup of access to naloxone.

Buprenorphine Maintenance Treatment – Used in the treatment of patients with opioid dependence to alleviate withdrawal symptoms, suppress opiate effects and cravings, and decrease the risk of overdose. Fudala and colleagues (2003) found that during the double-blind trial both of the buprenorphine-based treatments significantly reduced opiate use. The percentage of urine tests that were opiate negative was 17.8 percent in the buprenorphine and naloxone combination treatment group and 20.7 percent in the buprenorphine-only group, compared with 5.8 percent in the placebo group.

Tracking EMS Date – Cincinnati has created a powerful internet dashboard showing EMS runs for the previous six months and since 2015, helping emergency responders and social workers determine where to concentrate efforts. City officials have used the dashboard to become more efficient with public services and save money. Trumbull County has a limited sharing of data that mixes drug overdoses with other incidents, removes demographics and location. An analysis shows the reports to be sometimes confusing.

Treating Addiction in Prisons – People most vulnerable to overdoses are those who have stopped using for a period of time and return to the same environment in which they used drugs previously. Some jails in Ohio have created in-house education and treatment in an effort to steer inmates away from abuse after release. One very successful program nationwide is located in California. Provides intensive treatment to male inmates with substance abuse problems during the last 9 to 12 months of their prison term. This program is promising because inmates who completed both the prison and aftercare therapeutic community (TC) showed a rate of reincarceration of 8.2 percent, compared to the typical 34% seen by these kinds of inmates. Overall, inmate substance abuse treatment is associated with the following resultsReduced relapse, reduced criminality, reduced recidivism, reduced inmate misconduct, increased the level of the offender’s stake in societal norms, and increased levels of education and employment upon return to the community.

Harm Reduction

Needles & Syringe Exchange Programs – By exchanging used for new syringes, heroin users are less likely to develop infections, contract HIV or hepatitis C, each of which would significantly increase health care costs. The exchange also encourages users to not discard infected needles in parks and parking lots because they have value, and also provides one more opportunity for health-care workers to have contact with victims, encourage treatment. Summit and Cuyahoga counties have programs open to all.

Medicine recycling or disposal – When prescription medicines are no longer needed it is important to dispose of them properly to help reduce harm from accidental exposure or intentional misuse. According to a National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer. Medicine disposal sites removes addictive painkillers and other unused prescription drugs from the house. Multiple locations in the Mahoning Valley have drop-off boxes, and they also are at police departments statewide. In Youngstown, hospitals also accept prescription drugs.

Youth Prevention

Adults in the Making (AIM) Program – A family-centered preventive intervention designed to enhance the family protective process and self-regulatory competence to deter escalation of alcohol use and development of substance use problems. There have been two studies reviewing the effectiveness of the program. Overall, the preponderance of evidence from both studies indicates that the AIM program has a positive impact on deterring the use of alcohol, drugs, and involvement in other risky behaviors among AIM participants.

Start Talking – According to  the National Center on Addiction & Substance Abuse, 90% of Americans who meet the medical criteria for addiction started smoking, drinking or using other drugs before age 18. With data and a growing number of personal experiences, educators are creating programs targeted at students most at risk. National Public Radio recently profiled a new class at South Webster High School in the southern tip of Ohio. Students read about the epidemic, how it came to be and learn that “drugs are a national crisis, not just a family catastrophe.” Ohio’s “Start Talking” website is filled with resources for schools, churches, organizations and governments.

Effective Law Enforcement & Sentencing Policies

County task force – Opioid task forces are a starting point for reviewing what works in other communities and applying those concepts to local work. Mahoning and Trumbull are part of a Mahoning Valley law enforcement task force, but have not created teams that view the epidemic through the lenses of education, intervention and treatment; neighboring Columbiana County has.

Family Drug Courts (FDCs) – Specialized courts within the justice system, which handle cases of child abuse and neglect that involve substance use by the child’s parents or guardians. FDCs are one method of addressing parental substance use disorders and parenting issues within the court and child welfare systems, using a collaborative, family-centered approach (Children and Family Futures 2015). “Ohio’s opioid epidemic is seen as the direct cause of an 11 percent increase in children in state custody over the past six years, according to the Public Children Services Association of Ohio,” Dina Berliner reports for The Athens News. Multiple studies have been done on the effectiveness of this approach, most coming back with positive results. One, in Tulsa, OK is associated with a 178 percent increase in the likelihood of reunification. The program provides parenting training in conjunction with substance abuse treatment to improve family relationships and increase the likelihood of reunification.

Drug/Treatment Courts – There are currently 67 adult drug courts in the state of Ohio. The state of New York has been found to have some highly effective Drug Courts. One in Brooklyn, NY which offers substance abuse treatment for nonviolent felony and misdemeanor drug offenders. Rempel and colleagues (2003) found that participation in the Brooklyn Treatment Court (BTC) reduced recidivism by 27 percent after 3 years and by 18 percent after 4 years. Another highly effective Drug Court is in Bronx, NY which offers an alternative to probation and confinement for first-time nonviolent felony drug offenders. In this program, when examining the total number of convictions, the comparison group had almost twice as many as the drug court group (1.20 versus 0.68, respectively).

 

 

County Level Responses

Montgomery – With more than 220 members, the Montgomery County Community Overdose Action Team is an inter-agency collaborative that represents all aspects of the community, including law enforcement, the court system, behavioral health agencies, public health, hospital systems and community organizations. It operates using the Incident Command System Structure that was designed for emergencies. Each of eight branches meets monthly to work on specific problem areas related to the drug overdose crisis. Actions and priorities are developed for a 30-day operational period. In addition, the county team performed Sequential Intercept Mapping to identify areas that need be addressed. Contact the Community Overdose Action Team through Public Health – Dayton & Montgomery County at (937) 225-5700 or visit www.phdmc.org/coat.

Summit The Summit County Opiate Task Force uses local overdose rates and data from the Ohio Youth Risk Behavior Survey to inform strategic interventions. After the 2013 survey indicated one in six high-schoolers had used a prescription opioid medication without a prescription, and almost one in 20 had tried heroin, the Alcohol, Drug Addiction and Mental Health Services board invested in school-based and peer-led prevention activities. New treatment services, such as ambulatory detox, were added for youth addicted to opioids. Contact County of Summit Alcohol, Drug Addiction and Mental Health Board, (330) 762-3500 or adm@admboard.org.

Wood – Through community town hall meetings in churches and schools, a Wood County Opiate Task Force Facebook page and podcasts, family and friends of those addicted to opioids share stories, support and calls for action. To aid adults with addiction, a medication-assisted treatment program began within the courts; a new program began offering outpatient services for those waiting for residential treatment, the 211 Recovery Helpline Service was implemented, and both Bowling Green State University and Wood County Hospital hosted a lecture series for faculty and employees on the signs of addiction and the referral process for treatment. Contact Milan Karna of the Wood County Prevention Coalition at milankarna@users.smores.com.

Hancock – Adopted the Start Talking! program and introduced its own I AM ENOUGH campaign to promote drug prevention in school districts and at the University of Findlay. A career center video production class created a 30-second public-service announcement about prescription drug abuse, which received third place in a statewide contest. Contact Barbara Wilhelm, bwilhelm@hancockpublichealth.com.

Lucas – After a first responder has used naloxone to reverse the effects of opioid overdose for someone, the Lucas County Sheriff assists in identifying suppliers of the drug and follows up to help the person who overdosed enter treatment promptly. People who have survived overdoses are identified as “priority patients” and some enter treatment for addiction the day they are released from the hospital. Treatment resources have been increased through Medicaid expansion and levy funding to expand capacity in collaboration with providers. Contact the Drug Abuse Response Team in the Lucas County Sheriff’s Office at (419) 213-6582.

Other Nationwide Responses

Florida

In 2010 Florida regulated pain clinics and stopped health care providers from dispensing prescription opioid pain relievers from their offices, in combination with establishing a PDMP. In 2012, they saw more than a 50% decrease in oxycodone overdose deaths.

Vermont

Vermont has seen progress by gradually increasing spending for treatment at five regional centers that serve as hubs. Counselors occasionally reach out to people on the waiting list, moving active needle-users and pregnant women to the top. They also created a “Good Samaritan” law which gives immunity to anyone who calls an ambulance if someone has overdosed. Furthermore, the state has also put in place pilot programs in four counties to send addicts involved in minor crimes to treatment centers instead of jail; if they successfully complete treatment, they will never have the blot of incarceration on their records.

Washington

Law Enforcement Assisted Diversion (LEAD) – This initiative has been shown to markedly reduce criminality among addicts. A unique coalition of law enforcement agencies, public officials, and community groups collaborated to create this pilot program. LEAD diverts low-level drug and prostitution offenders into community-based treatment and support services – including housing, healthcare, job training, treatment and mental health support – instead of processing them through traditional criminal justice system avenues.