Advocacy Workshop, National Rx Drug Abuse Summit, April 2-4, 2013. Successful Strategies for Community Change - Part 2 presentation by Fred Wells Brason II and Connie M. Payne.

1. 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

2. 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.

3. 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.

4. Preventing
opioid
poisonings
Promoting
responsible
pain
management

5. Our Partners and Sponsors

6. 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.”

7. 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, NED101356
3/31/13 7

8. 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

11. Survey
Profile
of
NC
Coun=es
Local
Health
Departments
89
Departments/100
Coun=es
78%
Response

12. Traditional interventions intended to prevent drug abuse have not
been able to stop overdose deaths in North Carolina.

13. Survey: NC County Health Directors
Communities lack of information, tools and leadership to
prevent ODs.
Source: 2011 Project Lazarus Health Director Survey

14. Differences in opioid utilization suggest complex phenomena that are
independent of pharmacology. Large cities have relatively fewer people
receiving opioids than small counties. Areas with the highest opioid prescribing
also have the highest poverty.
Source: NC CSRS and US Census

16. THE HUB
I. 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.

17. Coalition Development
Community forums
must be repeated to
motivate the necessary
stakeholders to take
action.
Community coalitions
must be provided tools to
make their own strategic
plans and design locally
appropriate interventions.

18. COMMUNITY
ENVIRONMENTAL
Family
SITUATION
Peers
Schools
Military
Medical
Individual
Human
Tribal
Biological
Service
Psychological
Faith
Social
Media
Spiritual
Civic
Courts
Youth
Senior Law Treatment
Services Enforcement
Local Gov’t/Health

20. The WHEEL
Community Education - efforts are those offered to the general public
and are aimed at changing the perception and behaviors around sharing
prescription medications, and improving safety behaviors around their
use, storage, and disposal.
“Prescription medication: take correctly, store securely,
dispose properly and never share.”
Prescriber Education - Chronic pain is recognized as a complicated
medical condition requiring a substantial amount of knowledge and skill
for appropriate evaluation, assessment, and management. Reached via
CME, Lunch and Learn, Grand Rounds, Webinars, Medical Case
Management Meetings – Prescribers Toolkit
1) Pain Agreements
2) Use of PDMP
3) Urine Screens
4) Assessment modalities - SBIRT
a. Treatment options and local referral network

21. Hospital Emergency Department (ED) Policies - it is recommended that
hospital EDs develop a system-wide standardization with respect to
prescribing narcotic analgesics as described in the Project Lazarus/
Community Care of NC Emergency Department Toolkit for managing
chronic 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 those
who are treated with opioid analgesics, is an important form of diversion
control: take correctly, store securely, dispose properly and never share.
- Law Enforcement, Pharmacist and Facility training on forgery,
methods of diversion and drug seeking behavior
Pain Patient Support - In the same way that prescribers benefit from
additional education on managing chronic pain, the complexity of living with
chronic pain makes supporting community members with pain important.
“Proper medication use and alternatives”

22. 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

23. Harm Reduction – Naloxone rescue medication
to reverse opioid overdose
The North Carolina Medical Board has issued a statement supporting the use of
naloxone to prevent overdoses: “…The prevention of drug overdoses is consistent with
the Board’s statutory mission to protect the people of North Carolina. The Board
therefore encourages its licensees to cooperate with programs like Project Lazarus in
their efforts to make naloxone available to persons at risk of suffering opioid drug
overdose.”
AMA, June 19, 2012 “Fatalities caused by opioid overdose can devastate families and
communities, and we must do more to prevent these deaths,” said Dr. Harris.
“Educating both physicians and patients about the availability of naloxone and
supporting the accessibility of this lifesaving drug will help to prevent unnecessary
deaths.”
NADDI supports nasal naloxone
The National Association of Drug Diversion Investigators (NADDI) has taken a position
to encourage law enforcement agencies to adopt policies that would allow officers to
carry nasal naloxone with them to administer to individuals involved in a an opioid
overdose. Proper training and certification by the proper authority of each state helps to
ensure proper use of nasal naloxone on those in distress due to a drug overdose.

24. Drug treatment and Recovery
Addiction treatment, especially opioid agonist therapy
like methadone maintenance treatment or office based
buprenorphine treatment, has been shown to dramatically
reduce overdose risk. Unfortunately, access to treatment
is limited by two main factors:
• Availability and accessibility of treatment options,
• Negative attitudes or stigma associated with addiction
in general and drug treatment.

25. 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.

26. Wilkes
County
NC
! RESULTS
www.projectlazarus.org
Fred
Wells
Brason
II
26

27. The overdose death rate dropped 69% in two years after the start of
Project Lazarus and the Chronic Pain Initiative.

28. Wilkes County Opioid Prescribing
Wilkes County had higher than state average opioid dispensing during the
implementation of Project Lazarus and the Chronic Pain Initiative. Access to
prescription opioids was not dramatically decreased.
Source: NC CSRS

29. 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.

30. 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 Innovations
Grant)
NC Medical Board/NC Medical Society/NC Hospital Association
NC College of Emergency Physicians/Family Practice/Physicians Assistants
NC Div. MHDDSAS/OTP’s/PDMP
SBI/NC Sheriffs Association
Carolinas Poison Center
Dental Society
FQHC
Prevention Organizations
Coalitions

31. Information
projectlazarus.org
communitycarenc.org
Dr. Mike Lancaster
mlancaster@N3CN.org
Fred Wells Brason II
FWBrason2@projectlazarus.org
Robert Wood Johnson Community Health Leader Award 2012
Additional efforts underway in NM, VA, TN, OH, MD, ME, OK, etc.

32. 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

33. 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.

34. DISCLOSURE
STATEMENT
Nothing
to
disclose

35. 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

36. 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

37. 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

38. RELATIONSHIPS

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. BOTTOM
LINE
Rela=onships

50. CONTACT
INFORMATION
Connie
M.
Payne
Execu=ve
Officer
Statewide
Services
Kentucky
Administra=ve
Office
of
the
Courts
conniepayne@kycourts.net