DANE COUNTY OPIATE OVERDOSE SURVEY (10/12 1/13) & FOCUS GROUP (1/13)

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DANE COUNTY

OPIATE OVERDOSE SURVEY

(10/12‐1/13)

& FOCUS GROUP

(1/13)

Lisa Bullard‐Cawthorne, MS, MPH, PHMDC

Suryadewi Edi Nugraheni, MD, MA

Stop the Drug Overdose Epidemic Initiative

Summit Reunion

April 8, 2013

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Overdose Survey & Focus Group

• Purpose:

– S: To get a sense of the number of overdoses in community (not already known) – S: To get information about overdose experience, getting help, and perceptions & views about current laws & practice to assist with local policy & programming – S: To enquire about treatment & recovery related‐issues – FG: To share results with a cross‐sectional group to determine possible interventions

• Participants:

–

Survey: 1101 people

• 504 current & past drug users [needle exchange (194) and Methadone Clinic clients (189‐25%); 121 people in recovery (Recovery Solutions of Wisconsin)] • 330 (33%) Dane County law enforcement (DC Police Chief’s Ass.) • 267 (27%) Dane County EMS (DC EMS Chief’s Ass.)

–

Focus group: 30 people

• 15 people in recovery • 15 service providers & others (EMS, police, treatment & needle exchange providers, parent, public health, safe communities)

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Opiate Overdose Prevalence in Dane County

• Opiate‐related deaths and poisoning (overdose) hospital visits

have increased in past decade.

–

Deaths: 14 in 2000 to 45 in 2010; in 2012 ‐77 poisonings (

about 50 O‐R)

–

Hospital admitted & ED visits: 125 in 2001 to 270 in 2011

• Many opiate overdoses occur in the community, known by

Naloxone deployment EMS calls or prevention program.

–

EMS Calls: 178 in 2009 to 300 in 2012 (Madison Fire & EMS)

• Does not include 16 other Dane County EMS that can administer Naloxone

–

ARCW ‘Lifepoint Prevention Program’: From 2005, 404 reported peer

saves. (In Southern Region, 2,158 reported saves)

* Naloxone or Narcan® is an antidote to reverse respiratory depression caused by opiate overdose

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Opiate overdoses are

COMMON in DC communities

783 (75%) witnessed or at scene of opiate overdose (218) (287) (99) ₍₉₀₎ (89) “ It may be beneficial to consider adopting a harm‐ reduction approach in order to decrease the number of OD deaths.” (Police)

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165 (33%) people had personal overdose experience ; 65% more than once

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Inaccurate information found in

surveys & focus group

• Used presentations & focus group to provide

research‐based evidence and accurate

information.

• Examples of misinformation:

–

Calling 911 after an overdose will only bring the

police

–

Needle exchange programs encourage drug use

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Calling 911 & Reasons NOT Calling 911

•55% (167) of current and past drug users DID NOT call 911 after overdose

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Worried about police/charges:

Arrests not always made

Arrests made 50% of the time; victim more than bystander “In my opinion, one of the main reasons people overdose and die is because the people around them are afraid to call 911, because they fear they will get in trouble. Lives would be saved if the police would not arrest the people trying to help.” (Person in Recovery)

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Focus Group Discussion:

How do we encourage more people to call 911?

• Increase community education on how to deal with an

opiate overdose and the value of EMS' assistance

• Inform public that police are available to help save lives

and do not always arrest at the scene

• A person in recovery: Getting arrested helped him seek

treatment; however, there should be criminal immunity

if they call 911 at an overdose scene.

• District Attorney makes final decision about treatment vs

jail.

• Police have discretion about whether it is appropriate to

arrest and sometimes feel that it might help someone

get treatment

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Who Administered Narcan

(184) (32)

ACCESS TO NARCAN TO SAVE LIVES

“Anything to promote awareness about OD in the community would be beneficial. EMT‐Basics and First Responders should be approved for use of nasal Naloxone.” (EMS)

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Focus Group Discussion:

How do we increase access to Narcan to save lives?

• Importance of a variety of options for administration:

(EMTs, police, peer drug users, school personnel……)

–

Allow all EMTs (basic) to administer (nasal)

–

Consider piloting police administration in some Dane

County communities (nasal)

–

Develop a program like the Lazarus Program in North

Carolina (trains family and friends of chronic pain patients

and those at risk of addiction).

• Need for adequate training and education to recognize

an OD and how to save someone’s life

• Increase public education class, e.g. CPR

*Information note: nasal version of Narcan® is more expensive than the vial to administer by needle

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Missed opportunity

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Turning point to become clean & sober

Methadone clients & people in recovery

“I myself wanted to stop and I also have kids that I didn't want to see me addicted to drugs; its not fair to me or them.” (Current Drug User)

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Barriers and challenges to

treatment & recovery

• Barriers to receiving treatment

–

Lack of insurance or funding for services

–

Lack of trust of service providers

–

Fear of treatment

• Challenges in maintaining treatment

–

Lack of insurance or funding for services

–

Lack of transportation

–

Lack of family support

• Challenges faced in recovery

–

Family issues

–

Mental health concerns

–

Legal issues

“I tried for almost two years to find help and get into a Methadone program, but I found most of the time it was just easier to find drugs than it was to get help. I hope and wish someday it will be easier for people to find help they need.” (Methadone Clinic Client)

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Focus Group Discussion:

How to encourage more people to get into successful recovery?

• Treat dual diagnosis (substance abuse and mental health)

– Address the difficulties with co‐occurring support (substance abuse and mental health) for those with Medicaid.

• Need for dental care resources for those who are on MA or

uninsured (get to the cause of pain)

• Provide support systems for those that are clean and sober

(in recovery)

– Provide job training and opportunities for those in recovery – Need for recovery organizations – Need for peer counselors and recovery coaches

• Provide resource information for family and friends

– Promote Parent Addiction Network: treatment and recovery resources (“one stop shop”) – Plan “AODA health fair” for people with addiction issues or maintaining sobriety , or their loved ones needing support, including treatment providers, law enforcement, medical people, harm reduction entities, alternative pain providers, recovery groups