Rx and Heroin Abuse :Taking Action
Dan Hicks, Manager, Prevention Services
November 21, 2014
Rx Abuse & Heroin: Increasing Awareness
Young people are abusing prescription drugs at
alarming rates. These drugs act on the same brain
systems as illegal drugs and pose similar risks for
dangerous health consequences.
Page 2
After marijuana,
prescription and
over-the-counter medications
account for most of the
commonly abused drugs
among high school seniors.
Rx Abuse & Heroin: Increasing Awareness
Rx Abuse & Heroin: Increasing Awareness
Page 4
Local Prevention Efforts
• Community Forums
• RX Multi-Agency Workgroup
• Media Campaigns
• Education Outreach
• RX Take Back Day
• Disposal Bins County-wide
• Recovery Month Conference
Prescription Drug Abuse: What You Can Do
Parent Handouts
RX Billboard Campaign
Prescription Drug Abuse Billboard Campaign – June 2011 in
Ojai on Hwy 33
Rx & Heroin Abuse: Ventura County
RESPONDS
Page 8
The Prescription Drug Abuse and Heroin Workgroup was launched in February 2012
• in response to the growing problem of prescription pain medication and heroin
• Labeled a nationwide crisis and
epidemic, reports from professionals and the community - far from immune.
• Confronting prescription drug and heroin abuse was essential to protecting the public health and safety of all citizens, including youth– JOINT EFFORTS
Selected Data Sources – mobilizing LOCAL action
• State PDMP: C.U.R.E.S. data -
ongoing
• State California Healthy Kids Survey bi-annual
• Local Medical Examiner/Coroner
annual update
• Local Adolescent Treatment survey
new/unique
• Local Jail Inmate survey
new/unique
Convened in early 2012, including
Alcohol and Drug Programs (ADP)
Public Health Department
Sheriff’s Department
County Office of Education
County Health Care Agency / Ambulatory Care
Subject Matter Experts by invitation
Focused on nature and scope of the LOCAL problems
KEY: Membership rank- can speak for their agencies
1. LOCAL MATTERS! – data speak to your needs, and
community direction
2. USE MULTIPLE INDICATORS – use PDMP and other
sources; see our “Ventura County Responds” report
3. PARTNERSHIP MAKES THINGS POSSIBLE –
examples: custom survey administration in jails;
data sharing agreements, “mining” existing data
Accidental
Deaths From 2008-2012
1: Professional Development
2: Enforcement and Security
3: Education and Awareness
4: Safe Schools
5: Prevention Policy and Research
16
Rx & HEROIN ABUSE: Ventura County RESPONDS
TARGET 1: PROFESSIONAL DEVELOPMENT
GOAL: Expand professional training and development
Rx & HEROIN ABUSE: Ventura County RESPONDS
ACTIONS
1.1
Prescriber Training
Problem: Low utilization of PDMP among prescribers locally.
Local Action: Training for Health Professionals (DDS, RN, MD)
Case Example: Elinore McCance-Katz, MD, PhD, Chief
Medical Officer, Substance Abuse and Mental Health Services
Administration (SAMHSA), presented one of the first in a
projected series of health care professional trainings, What
Every Prescriber Should Know About Addiction to Pain
Medicines.
Rx & HEROIN ABUSE: Ventura County RESPONDS
ACTIONS
1.1
Prescriber Training (cont’d)
Problem: Limited opportunities for facilitated enrollment in CURES
Local Action: C.M.E. events, Grand Rounds, physician registration
Case Example: Medical Director for Behavioral Health hosting
medical education with emphasis on importance of CURES, and
‘value added’ opportunity for real-time registration by attendees
Rx & HEROIN ABUSE: Ventura County RESPONDS
“Health care professionals who prescribe...are in a key
position to balance the benefits of prescribing opioid
analgesics to treat pain against the risks of serious
adverse outcomes including addiction, unintentional
overdose, and death. Opioid misuse and abuse, resulting
in injury and death, has emerged as a major public health
problem. Appropriate prescribing practices and patient
education are important steps to help address this public
health problem.”
– FDA Blueprint for Prescriber Education, 2013
In Ventura County, we believe LOCAL ACTION matters…
Rx & HEROIN ABUSE: Ventura County RESPONDS
TARGET 2: ENFORCEMENT & SECURITY
GOAL: Support law enforcement, monitoring and
security to enhance public safety by deterring
drug misuse, abuse and diversion.
Rx & HEROIN ABUSE: Ventura County RESPONDS
ACTIONS
2.1
Safe and Secure Rx Disposal
Safe and confidential Rx disposal bins now actively used and supported by law
enforcement in all 10 cities across the county. Board Supervisors raised local standard by unanimously declaring
Every Day is Take
Back Day
in Ventura County.Rx & HEROIN ABUSE: Ventura County RESPONDS
Ventura County Board of Supervisors declaration: Every Day is Take Back Day
Rx & HEROIN ABUSE: Ventura County RESPONDS
2.3
Ventura County Interagency Pharmaceutical Crimes Unit
Problem: Illegal prescribing of Rx opioids at the local level
Local Action: Established Pharmaceutical Crimes Task Force,
Ventura County Sheriff’s Office (VCSO), the Ventura County
Pharmaceutical Crimes Unit includes members of law enforcement from VCSO, Simi Valley PD, DA’s Office, others.
Case Example: The main mission of the task force is combating the
transfer of legal medication to the illegal market.
* Fifty-four arrests were made in the first six months * 120,000 pharmaceutical pills seized
* CURES records important to several recent MD investigations * More than 60 search warrants, with $1.5 million+ in assets seized
TARGETS FOR ACTION
PDMP value begins with prescriber policies, and grows
local and even regional inter-agency cooperation.
“The Ventura County Interagency Pharmaceutical Crimes Unit, in
conjunction with LA County Health Authority Law Enforcement
Task Force (HALT) and the California Medical Board, concluded
five month investigation into a “pill mill”. Detectives learned of
this criminally operating medical clinic through a tip from a local
Simi Valley pharmacist. The had previously contacted every
pharmacy in Ventura County during the Summer of 2013 and
made them aware of the task force.”
One Case: Doctor Shopping, MDs at clinic investigated,
3,000+ scripts written in name of 1 doc, 5 arrests
Rx & HEROIN ABUSE: Ventura County RESPONDS
TARGET 3: EDUCATION & AWARENESS
GOAL: Increase outreach and education for parents,
patients and the public to raise awareness of
prescription drug and heroin abuse problems
and solutions.
Rx & HEROIN ABUSE: Ventura County RESPONDS
3.2
Drug Disposal Campaign
A multimedia campaign on the importance of safe and secure drug disposal was directed to the public from a variety of angles, including a billboard on CA
Highway 33, newspaper and radio ads, medicine chest reminder
magnets, clinic posters and
brochures. Concurrent outreach to real estate professionals
warned of the risks of medicine chest thefts during open houses.
Rx & HEROIN ABUSE: Ventura County RESPONDS
3.4
Ventura County’s Rx Drug Abuse Summit
More that 240 local treatment and prevention professionals,
healthcare experts, law enforcement, policymakers and other
key stakeholders learned about CURES and local strategies.
Rx & HEROIN ABUSE: Ventura County RESPONDS
TARGET 4: SAFE SCHOOLS
GOAL: Collaborate with schools, PTAs and Ventura
County Office of Education (VCOE) to increase
communication channels and prevention
opportunities for teachers, parents, students
and school personnel.
Rx & HEROIN ABUSE: Ventura County RESPONDS
4.2
Teacher Education
Teachers are vital for educating students about substance abuse. A “Working Together” insert was developed especially for teachers as a companion to the “What You Need to Know About Rx Abuse and Heroin” brochure. The
materials help teachers deliver concise prevention messaging to students at the most teachable moments.
Rx & HEROIN ABUSE: Ventura County RESPONDS
4.4
Systematic School-based Data Collection
The data collected from youth through surveys administered in schools provides invaluable information for effective collaborative prevention efforts. The Rx Workgroup will continue support of systematic school-based data collection and reporting, like the
California Healthy Kids Survey, to gauge the prevalence of
prescription drug misuse and heroin abuse among students in Ventura County.
LIFETIME USE BY VENTURA COUNTY STUDENTS:
• 14% of 9th graders and 20% of 11th graders reported misusing Rx painkillers
• 4% of 9th graders and 5% of 11th graders reported using heroin
Rx & HEROIN ABUSE: Ventura County RESPONDS
TARGET 5: PREVENTION POLICY & RESEARCH
GOAL: Expand Advance continued research and data
analysis to develop key policy actions addressing
Rx and heroin abuse.
Rx & HEROIN ABUSE: Ventura County RESPONDS
5.1
Tracking Local Data
To better understand the prevalence and impacts of
prescription drug and heroin abuse in Ventura County,
relevant multiagency data from 2008 through 2012 were
collected and analyzed. By developing an established
baseline, the Rx Workgroup was able to create a tracking
tool for ongoing monitoring, analysis and shared reporting
of abuse trends over time.
CURES data, in combination with local data,
are now being used to: plan educational
interventions, measure progress and plan
new Targets for Action.
Rx & HEROIN ABUSE: Ventura County RESPONDS
5.2
Special Local Research
HIGHLIGHTS
• 32% of respondents reported heroin use in their lifetime.
• Of those who reported lifetime heroin use, 45% indicated beginning with Rx opioids, then moving to heroin.
• Transition from prescription-type opioids to heroin was highest among the respondents in younger age groups. • Of respondents who ever misused Rx opioids, 61%
Rx & HEROIN ABUSE: Ventura County RESPONDS
5.4
Legislative Analysis
Active legislative analysis and reporting help inform and
shape some Target Actions.
EXAMPLE: Rx Workgroup carefully followed the recent
introduction, amendments and approval of CA Senate Bill
809 establishing CURES database funding and expansion.
Improvement of CURES will, in turn, advance
Workgroup’s goal to improve data links between
physicians, pharmacists and law enforcement,
ultimately benefitting public safety.
Rx & HEROIN ABUSE: Ventura County RESPONDS
5.5
Future Policy Actions
New policies and projects being studied and
considered by the Rx Workgroup include:
- Enhanced E.R. and ambulatory care opioid
prescription policies to patients and the public;
- Pharmaceutical product stewardship;
- Overdose education and prevention programs; and
- Drug-impaired driving;.
Rx RISK: Prescribers Portal
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In our Rx RISK: Prescribers Portal we provide links to our
resources and materials that may be used to inform patients
Working together to Prevent Opioid Abuse
For Health Care Providers:
Screen for addiction risk factors – See Opioid Risk Tool, etc.
•
Note symptoms of abuse
•
Whenever possible, report to CURES
Use tamper-resistant Rx pads, support anti-diversion w LE
•
Report lost or missing Rx pads
•
Consider smaller quantities of drugs with abuse potential
•
Rx abuse prevention signage in exam rooms (we have it!)
•
If you suspect abuse, say no to addictive drugs
Promote safe Rx use and secure disposal
Advocate for increasing CEU credit for prescribing training
VCkidsFYI: Text News for Parents
VCkidsFYI: Text News for Parents
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Free text message updates about: TEENS • DRUGS • ALCOHOL Get the facts. Keep kids safe.
Overdose Prevention Programs
• Make drug user health, safety & survival a priority
• Educate family, friends and loved ones about overdose prevention
• Have saved lives Nationally
• From 1996-2010, more than 53,000 individuals trained to respond • 10,171 overdose “reversals” reported during this time
• Majority of individuals trained are drug users, esp those leaving jail
• 60 programs distributing naloxone (at 200 sites) in 18 US states
• In 2012, 55% of naloxone distributed was injectable; 45% intranasal Locally
• Launched pilot program in October 2014
• Focus only on groups at elevated risk, small scale, required training
• Local data will inform pilot, and be used for outcome evaluation
Overdose Prevention and Rescue Project
You Can Save a Life.
Some signs of an overdose:
• Breathing slowly or not at all
• Unconscious
• Lips are blue
Call 911 Immediately
•Overdose is most common when:
• Tolerance is low after not using opioids (after jail or detox)
• Drugs are mixed especially with alcohol or benzos
• Resistance is down due to sickness or other health issues
• Using alone.
Overdose Rescue Project & Naloxone
Distribution
Rx Abuse & Heroin: ADP Treatment Services
•
Range of outpatient treatment services designed to help
individuals coping with a substance use disorder
•
Our services include screening, crisis intervention,
individual, group and family counseling, HIV education,
assessment and evaluation, referrals to
community-based services, and outreach to the community
•
We serve the entire County. Clinics located in Oxnard,
Ventura, Fillmore and Simi Valley. Specialized programs
for pregnant and parenting women, adolescents, and
co-occurring disorders
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ADP Youth Services Programs
Evidence-Based Curriculum
•
Multi-lingual staff & programming
•
Evidence-based treatment model
•
State certified Alcohol & Drug Counselors
•
Licensed staff
•
Therapist referrals
ADP Youth Services Programs
What We Offer
•
Prevention, education & intervention
•
Screening, assessment & referral
•
Drug testing
•
Access to detoxification referrals
•
Joint agency collaboration with mental health services
•
Crisis mental health emergency services
•
Collaborative inter-agency team approach
•
On-site HIV testing and counseling
•
Residential treatment referrals
3 steps to get help
Adult, Youth & Women’s Services
Contact Us – ADP Outpatient Locations
A New Start for Moms, 1911 Williams Drive, Suite 140, Oxnard 805.981.9250
Fillmore Center, 828 Ventura Street, Suite 250, Fillmore 805.524.8644
Oxnard Center, 1911 Williams Drive, Oxnard 805.981.9200
Simi Valley Center, 3150 E. Los Angeles Avenue, Simi Valley 805.577.1724
Ventura Center, 24 East Main Street, Ventura 805.652.6919
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