Successful Strategies for Community Change, Part 2 Fred Wells Brason II CEO, Project Lazarus Connie M. Payne Execu=ve Oﬃcer, Statewide Services, Administra=ve Oﬃce of the Courts
Learning Objec=ves 1. Outline strategies for community coali=ons to protect their health. 2. Explain the role naloxone can play as part of a comprehensive overdose preven=on program. 3. Outline the considera=ons and partnerships that must be made in the early stages of planning and implemen=ng an Adult Drug Court.
Disclosure Statement • Fred Brason has a ﬁnancial rela=onship with proprietary en==es that produce health care goods and services. This rela=onship are with: Purdue Pharma and Covidien. • Connie Payne has no ﬁnancial rela=onships with proprietary en==es that produce health care goods and services.
COLLABORATION Project Lazarus believes that communities are ultimately responsible for their own health and that every drug overdose is preventable. We are a non-profit organization that provides training and technical assistance to community groups and clinicians throughout North Carolina and beyond. Using experience, data, and compassion we empower communities and individuals to prevent drug overdoses and meet the needs of those living with chronic pain. “A PUBLIC HEALTH APPROACH TO OVERDOSE PREVENTION” STATEMENT OF R. GIL KERLIKOWSKE, DIRECTOR OFFICE OF NATIONAL DRUG CONTROL POLICY EXECUTIVE OFFICE OF THE PRESIDENT AUGUST 23, 2012“Project Lazarus is an exceptional organization—not only because it saves lives in Wilkes County, but also because it sets a pioneering example in community-based public health for the rest of the country.”
Uninten=onal Poisoning Deaths by County: N.C., 1999-‐2009 Prepared by Project Lazarus fwith an Sta=s=cs, Source: N.C. State Center or Health unrestricted educational grant1from Purdue by Vital Sta=s=cs-‐Deaths, 999-‐2009 Analysis Pharmapidemiology and Surveillance Unit Injury E LP, NED1013563/31/13 7
Cost of Hospitaliza=ons for Uninten=onal Poisonings: NC, 2008 • Average cost of inpa=ent hospitaliza=ons for an opioid poisoning*: $16,970. • Number of hospitaliza=ons for uninten=onal and undetermined intent poisonings**: 5,833 • Es=mated costs in 2008: $98,986,010 Does not include costs for hospitalized substance abuse *Agency for Healthcare Research and Quality ** NC State Center for Health Sta=s=cs, data analyzed and prepared by K. Harmon, Injury and Violence Preven=on Branch, DPH, 01_19_2011 Source: NC CSRS
Survey Proﬁle of NC Coun=es Local Health Departments 89 Departments/100 Coun=es 78% Response
Traditional interventions intended to prevent drug abuse have not been able to stop overdose deaths in North Carolina.
Survey: NC County Health DirectorsCommunities lack of information, tools and leadership to prevent ODs. Source: 2011 Project Lazarus Health Director Survey
Differences in opioid utilization suggest complex phenomena that are independent of pharmacology. Large cities have relatively fewer peoplereceiving opioids than small counties. Areas with the highest opioid prescribing also have the highest poverty. Source: NC CSRS and US Census
THE HUBI. Public Awareness – is particularly important because there are widespread misconceptions about the risks of prescription drug misuse and abuse. It is crucial to build public identification of prescription drug overdose as a community issue. That overdose is common in the community, and that this is a preventable problem must be spread widely.II. Coalition Action - A functioning coalition should exist with strong ties to and support from each of the key sectors in the community, along with a preliminary base of community awareness on the issue. Coalition leaders should also have a strong understanding of what the nature of the issue is in the community and what the priorities are for how to address it.III. Data and Evaluation - The early data that you will need includes certain health related information like number of emergency department visits and hospitalizations due to overdose, number of overdose deaths, number of providers in the county who actively use the PDMP, number of prescriptions and recipients for opioid analgesics dispensed and other controlled substances.
Coalition Development Community forums must be repeated to motivate the necessary stakeholders to take action. Community coalitionsmust be provided tools tomake their own strategic plans and design locallyappropriate interventions.
COMMUNITY ENVIRONMENTAL Family SITUATION Peers Schools Military Medical Individual HumanTribal Biological Service Psychological Faith Social Media Spiritual Civic Courts Youth Senior Law Treatment Services Enforcement Local Gov’t/Health
The WHEELCommunity Education - efforts are those offered to the general publicand are aimed at changing the perception and behaviors around sharingprescription medications, and improving safety behaviors around theiruse, storage, and disposal. “Prescription medication: take correctly, store securely, dispose properly and never share.”Prescriber Education - Chronic pain is recognized as a complicatedmedical condition requiring a substantial amount of knowledge and skillfor appropriate evaluation, assessment, and management. Reached viaCME, Lunch and Learn, Grand Rounds, Webinars, Medical CaseManagement Meetings – Prescribers Toolkit 1) Pain Agreements 2) Use of PDMP 3) Urine Screens 4) Assessment modalities - SBIRT a. Treatment options and local referral network
Hospital Emergency Department (ED) Policies - it is recommended thathospital EDs develop a system-wide standardization with respect toprescribing narcotic analgesics as described in the Project Lazarus/Community Care of NC Emergency Department Toolkit for managingchronic pain patients: 1) Embedded ED Case Manager 2) “Frequent fliers” for chronic pain, non-narcotic medication and referral 3) No refills of controlled substances 4) Mandatory use of PDMP 5) Limited dosing (10 tablets)Diversion Control - Supporting patients who have pain, particularly thosewho are treated with opioid analgesics, is an important form of diversioncontrol: take correctly, store securely, dispose properly and never share. - Law Enforcement, Pharmacist and Facility training on forgery,methods of diversion and drug seeking behaviorPain Patient Support - In the same way that prescribers benefit fromadditional education on managing chronic pain, the complexity of living withchronic pain makes supporting community members with pain important. “Proper medication use and alternatives”
Harm Reduction – Naloxone rescue medication to reverse opioid overdose A script gives patients specific language that they can use with their family to talk about overdose and develop an action plan, similar to a fire evacuation plan. Prescribetoprevent.org
Harm Reduction – Naloxone rescue medication to reverse opioid overdoseThe North Carolina Medical Board has issued a statement supporting the use ofnaloxone to prevent overdoses: “…The prevention of drug overdoses is consistent withthe Board’s statutory mission to protect the people of North Carolina. The Boardtherefore encourages its licensees to cooperate with programs like Project Lazarus intheir efforts to make naloxone available to persons at risk of suffering opioid drugoverdose.”AMA, June 19, 2012 “Fatalities caused by opioid overdose can devastate families andcommunities, and we must do more to prevent these deaths,” said Dr. Harris.“Educating both physicians and patients about the availability of naloxone andsupporting the accessibility of this lifesaving drug will help to prevent unnecessarydeaths.”NADDI supports nasal naloxoneThe National Association of Drug Diversion Investigators (NADDI) has taken a positionto encourage law enforcement agencies to adopt policies that would allow officers tocarry nasal naloxone with them to administer to individuals involved in a an opioidoverdose. Proper training and certification by the proper authority of each state helps toensure proper use of nasal naloxone on those in distress due to a drug overdose.
Drug treatment and RecoveryAddiction treatment, especially opioid agonist therapylike methadone maintenance treatment or office basedbuprenorphine treatment, has been shown to dramaticallyreduce overdose risk. Unfortunately, access to treatmentis limited by two main factors:• Availability and accessibility of treatment options,• Negative attitudes or stigma associated with addiction in general and drug treatment.
Can coalitions help reduce Rx drug abuse?• Counties with coalitions had 6.2% lower rate of ED visits for substance abuse than counties with no coalitions (but this could be due to random chance)• However, counties with a coalition where the health department was the lead agency had a statistically significant 23% lower rate of ED visits (X2=2.15, p=0.03) than other counties.• In counties with coalitions 1.7% more residents received opioids than in counties without a coalition.• Coalitions may be useful in reducing the harms of Rx drug abuse while improving access to pain medications at the same time.• More professional coalitions may have a greater impact on reducing Rx drug harms.
Wilkes County NC ! RESULTS www.projectlazarus.org Fred Wells Brason II 26
The overdose death rate dropped 69% in two years after the start of Project Lazarus and the Chronic Pain Initiative.
Wilkes County Opioid Prescribing Wilkes County had higher than state average opioid dispensing during theimplementation of Project Lazarus and the Chronic Pain Initiative. Access to prescription opioids was not dramatically decreased. Source: NC CSRS
Wilkes County Overdose Script History In 2011, not a single OD decedent had an opioid prescription from a Wilkes County prescriber. The fundamental risk:benefit ratio for opioids can be altered for the better through a community-wide approach.
NC Statewide Collaborative Kate B. Reynolds Charitable Trust - Office of Rural Health NC Alliance for Health Community Care NC Project Lazarus* – Governors Institute for SA – UNC Injury and Prevention Research Center*(includes NC Div. of Public Health CDC Transformation Grant and MAHEC CMS InnovationsGrant)NC Medical Board/NC Medical Society/NC Hospital AssociationNC College of Emergency Physicians/Family Practice/Physicians AssistantsNC Div. MHDDSAS/OTP’s/PDMPSBI/NC Sheriffs AssociationCarolinas Poison CenterDental SocietyFQHCPrevention OrganizationsCoalitions
Informationprojectlazarus.org communitycarenc.org Dr. Mike Lancaster mlancaster@N3CN.orgFred Wells Brason IIFWBrason2@projectlazarus.orgRobert Wood Johnson Community Health Leader Award 2012 Additional efforts underway in NM, VA, TN, OH, MD, ME, OK, etc.
SUCCESSFUL STRATEGIES FOR COMMUNITY CHANGE Part 2 Thursday, April 4, 2013 9:45 am – 10:45 am April 2 – 4, 2013 Omni Orlando Resort at ChampionsGate
LEARNING OBJECTIVES • Outline the considera=ons and partnerships that must be made in the early stages of planning and implemen=ng an adult drug court. • Outline the considera=ons and partnerships necessary to develop a mutualis=c rela=onship between community coali=ons and local adult drug courts.
WHAT IS DRUG COURT: brieﬂy • Mission: to stop the abuse of alcohol and other drugs and related criminal ac=vity • Creates communica=on and rela=onship between criminal jus=ce system and treatment system • Beneﬁts: – For society: lower recidivism, breaking cycle of addic=on and CJ involvement, etc. etc. – For defendant: sobriety, possible dismissal of charge (diversion), reduce =me on proba=on, lesser penalty, reuniﬁca=on with family/friends • More info: www.nadcp.org
10 KEY COMPONENTS DCs across country (& interna=onally) operate under 10 Key Components #10. Forging partnerships among drug courts, public agencies, and community based organiza=ons generates local support and enhances drug court program eﬀec=veness. Components #1-‐#9: www.nadcp.org
ADULT DRUG COURT TEAM • Judge • Circuit Court Clerk • Treatment • Proba=on Oﬃcer • Community • Prosecutor Representa=ves • Defense Amorney • Voca=onal Rehabilita=on • Law Enforcement Representa=ve • Case Manager • GED Representa=ve
STEERING COMMITTEE MEMBERS • Principle drug court partners/team members; • Community leaders and/or those passionate about recovery, involved in the community AND who follow through • Variety of disciplines/professions
STEERING COMMITTEE • Members with strong involvement in other community coali=ons/ organiza=ons • May form non-‐proﬁt 501(c)(3) • Assists in policy guidance/advice for DC • Assists in variety of life-‐skills educa=on • Conduit for fundraising & resources
STEERING COMMITTEE: FORMING • Educa=on and buy-‐in: coali=ons/agencies must be educated re drug courts – requirements, accountability, etc. • Most helpful: judge taking staﬀ/case manager to meet with community leaders • Also helpful: other DC team members and staﬀ/case manager mee=ng with organiza=ons • Invite community leaders to DC gradua=ons
NO STEERING COMMITTEE; No problem Research local community coali=ons • Check with Secretary of State website re 501 (c)(3) corpora=ons • Ask known organiza=ons, churches, Salva=on Army, Proba=on Oﬃcers, United Way Develop a list of resources • Speciﬁc people • Speciﬁc groups/organiza=ons
MUTUAL BENEFITS DRUG COURT COMMUNITY -‐ Funding for gradua=ons, -‐ A project that truly helps special events & changes lives -‐ Loca=on for community -‐ Receives community service hours service work/hours -‐ Educates community re -‐ Staﬀ can present on addic=on substance/alcohol abuse, -‐ Group able to educate/ treatment, educa=on discuss variety of life-‐ skills
ADDITIONAL BENEFITS, a glimpse Community has more ci=zens who: – Pay taxes – Pay child support – Do not u=lize jail space Drug Court has more ci=zens who: – Understand addic=on as a disease – Understand necessity for treatment resources – Are willing to hire DC par=cipants
ADDITIONAL BENEFITS, speciﬁcs Saved town of Mt. Washington over $3,000 by volunteering to repair and paint city-‐owned oﬃces Mt. Washington Mayor so pleased, 3 other nearby towns have asked to partner with Drug Court DC grads have been asked to join coali=ons; helps maintain energy & involvement with substance abuse issues DC grads hired by community service sites
ADDITIONAL BENEFITS, speciﬁcs Annual community sponsored drug-‐free and drug-‐ free awareness events – Fatherhood Ini=a=ve (held at state park each May) – Spring clean-‐up (PRIDE – Personal Responsibility in a Desirable Environment) – Easter egg hunt – Christmas meal and giqs Par=cipants and staﬀ volunteer to set-‐up, clean-‐up, “man” booths, etc. -‐ now fes=vals request par=cipant involvement
ADDITIONAL BENEFITS, speciﬁcs DC provides speakers to share their stories: • Police Department training –part of the new recruit training is to amend DC and amend substance abuse & addic=on training • Faces of Substance Abuse Conference • Paren=ng groups in need of a speciﬁc substance abuse topic • Agency for Substance Abuse Preven=on (ASAP) • Mayor’s Alliance
ADDITIONAL BENEFITS, speciﬁcs 5K DRUG AWARENESS RUNS: Run for Recovery Run Away from Drugs – DC par=cipant Jesse H.; drug of choice -‐ oxycon=n; other drugs-‐ cocaine, benzos and alcohol – addict nearly 20 yrs While in DC & in recovery, approached local UNITE Board to start a 5k run to raise substance abuse awareness & preven=on Run is now in its 5th year