Rotary Action Group for Addiction Prevention Launches Toolkit for Measuring Social Impact of Prevention Projects

Rotary Action Group for
Addiction Prevention
Special Consultative Status at ECOSOC UN
Partner United Nations Offoce for Drugs and Crime

Organising a local addiction
prevention project

Panel
• Panel coordinator and moderator:
• Johan Maertens, co-founder and Chair scientific committee
• Introduction
• Kalyan Banerjee, PRIP and Chair RAG AP
• Toolkit for project development and social impact measurement
• Rakoen Maertens, PhD Candidate, member scientific committee RAG AP
• Elina Kushnir, Rotary International Research Team

Projects
• Shacklefree project RAG AP Chapter India
• Gulam Vahanvaty, Trustee TRF and vice-Chair RAG AP
• Rotary and my book the Preventable Epidemic
• Arun Gupta, MD
• Project SMART Changing Lives/Saving Lives
• Larry Kenemore, coordinator RAG AP Chapter Nort America

Introduction
Statements
• Addiction is everywhere
• Prevention best ROI
• As early as possible (UNODC)
• Involves the whole community
• Rotarians initiate actions
• Rotary clubs support
Actions
• Toolkit projects
• Toolkit measuring social impact
• Every Rotary Club 1 action changes
the world
• Join RAG AP

RAG-AP Impact Toolkit
Rakoen Maertens
rakoen@maertens.international
@RakoenMaertens
RAG-AP Scientific Committee
University of Cambridge
Social Decision-Making Lab

What impact did the project make on
● Individuals
● Families
● Communities
POSITIVE and NEGATIVE

“Interventions are evidence based”
● No recent evaluation
● Tested in different target group
● Long-term analysis missing
● Outdated impact measurement framework
● Not looking at every level
○ individual, family, community
● Ignores negative effects
● No data available
=> Hard to gauge actual impact
=> What about value for money/energy?

Impact on Community
Quality of Evidence
Bronze Label Silver Label Gold Label

RAG-AP Impact Toolkit
https://tinyurl.com/RAGAP-ImpactToolkit

1. Setting up a Project Committee

2. Performing a Needs Assessment

3. Developing an Impact Measurement Plan

Project Level
● Impact Officer
● Data Collection
● Impact Reports
RAG-AP Level
● Support
● Funding
● Quality Control

RAG-AP Social Impact Tool
● Data-Driven
● Comprehensive Community Assessment
● Latest Science
● Evidence Quality Label
● Impact Label
● Linking to Rotary Areas of Focus and UN SDGs
● Long-Term Evaluation
● Impact Reports

Chapter India
Chapter India

ROTARY CLUBOF MUMBAIGHATKOPAR(RCMG)– RID 3141
RCMG through the support of RAGAP (International), specifically through RI Districts
and Clubs in Belgium did a Global Grant for Addiction Prevention and Treatment.
For addiction treatment trained 2500+ family physicians in the field of Addiction
Medicines, and For Addiction Prevention launched Unplugged and developed
Shacklefree Programme.
Trained more than 1000 school teachers for Unplugged to be implemented by them in their
respective schools.
Sponsored a cause based passport club for focus on addiction prevention, awareness and
treatment Rotary Club of Addiction Prevention 3141-RECAP
Chapter India

Other Rotary International Districts Of India
Under guidance,
motivation and leadership
of RAGAP (India) Chairman
PRIP Kalyan and Vice Chair
Past TRF Trustee Gulam all
the districts of India are
now active in the Addiction
Prevention activities and
projects
They organize awareness
lectures in schools and
collages, various Rotary
Clubs in their districts,
organize street plays and
poster competitions
RID 3142 conducted two
large virtual seminars with
more than 30,000
participants and having chief
guest as celebrity cricketer
Mr. Kapil Dev having huge
impact and mass awareness
Chapter India

Why “SHACKLEFREE”?
Famous Dictionary creator Samuel Johnson said:
“ The Chains of Habit are too weak to be felt,
until they are too strong to be broken”.
Concept Development
• Grew out of a VTT by team from RID 3141 to Ghent University at Belgium for learning,
understanding and adopting Unplugged program developed by seven European Universities
for Addiction Prevention at school level
• Which developed into Unplugged India with the help of TISS team and
• Dr. Anuradha Sovani, who was then with University of Mumbai.
• Rtn Yogesh Zaveri was team leader and Dr. Johan Maertens and Rtn. Kathleen Van Rysseghem
were the Host for the VTT.
• Unplugged subsequently developed into Mini Unplugged India
Chapter India

Key features of ‘SHACKLEFREE’
Focuses on
Substance as
well as Non
Substance
Addiction
Prevention
Allows
outreach to
Senior School,
Junior College
as well as
College
Students.
Piloted and
field tested
with older
students than
Unplugged.
Content
developed
largely with
Student
involvement.
Incorporated
into Counseling
Psychology
syllabus, so that
Trainers are
trained every
year and helps
Rotary in
Capacity
Building of
Trained
Professionals
for Addiction
Prevention.
Resources developed
under the projectare:
a)Facilitators’Manual
b)Training of Trainers
Handbook
c) Resource Package for
Addiction prevention
d)Children’s books on
addiction prevention

a) Facilitators’Manual – 52 Pages
b) Training of Trainers Handbook– 410 Pages
Chapter India

c) ResourcePackagefor Addiction prevention - 136pages
Chapter India

IMPORTANT FEATURES OF SHACKLEFREE
• Text
• …
Using these three manuals,
Counselors can create their
own workshops for half day,
one day, two days or spread
over a longer time, as per the
needs of the
Institution/Community they
are working with.
The Counselor
working there has
the best insight into
what exactly will
work in that setting.
Volunteers (Rotary as
well as others) can
help in marketing the
concept, popularizing
the modules and
manpower support
Chapter India

Strong National and International Support
PRIP Rtn. Kalyan Banerjee and
Past TRF Trustee Rtn. Gulam
Vahanvatihave taken personal
interest in the Addiction
Prevention Activities, Launched
India chapter of RAGAP(India)
and enrolled interest of 14+
RI Districts of India.
PRIP Kalyan personally
released the Manuals
and also felicitated
participant students.
International Ethics
Committee is created by
Dr. Johan Maertens,
with India representation by
Dr. Anuradha Sovani
Chapter India

Children’s Books series VIK STORIES
Along with the Shacklefree Manuals, Dr. Sovani has also written interesting
Children’s Books series - VIK STORIES - for silent and autonomous awareness of
the subject of addiction prevention, soon this series has become popular
among children and parents and have received wide appreciation, since they
work in building attitudes when children are young and impressionable.
Few Books’ title pages are displayed in next few slides.
The second series on Inclusion is Uploaded on Kindle.
Now Dr. Sovani is releasing another series of books on Inclusion.
Chapter India

A BOX OF TREASURES
A BROKEN DAY
AN UPSIDE DOWN WORLD
EARTHWORMS AND SNAKES
Chapter India

UNDER THE BLUE SKY
CATS DOGS AND BATS
SPECIAL FRIENDS
SHARING SPACES
Chapter India

DIFFERENT MINDS
Brains that Glow
A new journey has begun where
the ShacklefreeProjectDesigning
& Developmentended……..
There is much scope for Rotary
Internationalthrough RAGAP to
step in onto any of these avenues
By Collaborating with IPH,
Responsible Netism, AACCI, Vik
Stories and Children’s Literature….
A NEW JOURNEY
Chapter India

Shacklefree Developedand Launched underGlobal Grantby
RotaryClub of MumbaiGhatkopar– RID 3141
Chapter India

Shacklefree Launch – 26.02.2022
Chapter India

THE PREVENTABLE EPIDEMIC
A Frontline Doctor’s Experience and Recommendations
to Resolve America’s Opioid Crisis
Arun Gupta, MD, author
Monroe(Michigan) District 6400.
Chair, MAT N. America, RAG-AP
Rotary International, Houston Annual meeting June 6th
2022
RAOE Foundation, is a non-profit committed to improving access to care and
reducing overdose deaths for patients with opioid addiction in America
Resolve America’s Opioid Epidemic Foundation
Chapter North America

Resolve America’s Opioid Epidemic Foundation is a 501(c)3 status
RAOE Foundation.org
RAOE Foundation, is a non-profit committed to improving access to
care and reducing overdose deaths for patients with opioid addiction
in America
Mission & vision statement: Educate & Advocate the policy makers &
provide community support

CDC reports Opioid Use Disorder (OUD) is preventable
and deaths were unintentional
• Former CDC Director, Redfield said: We are losing too many Americans, too early
and too often, to conditions that are preventable." Drug overdoses claimed the
lives of 70,237 people in United States in 2017, according to the official
tally released by the CDC. Most of these deaths were unintentional. 702,000
died between 1999-2017
• Mortality among individuals wait-listed for medication-assisted treatment is
high.
• According to SAMHSA & ASAM, in 2020, 41 million young Americans are at risk
for SUD & about 39 million do not have access to care.

Why areyoung Americans dying fromdrugs?
• Since 2000, USA manufactured & consumed 93% of all world narcotics.
However, there has been a 53% reduction on narcotic manufacturing
in US from 2016.
• 99% of US doctors have no training in pain or addiction medication.
• More than 1,000 doctors shut down in last 20 years, scaring the rest of
doctors
• Fentanyl, Heroin, methamphetamine, and cocaine caused 80% of
deaths.
• Addiction doctors have unnecessary, limits, regulation, and oversight
because of which they cannot prescribe remedies.
• Street drugs are cheaper, deadlier and easy to find.

702,000 dead from 1999-2017,
91,000 in 2020, & 103,000 in 2021
Effective treatment Buprenorphine
available since 2002
Lack of Access
9 out of 10 patients withOUD don’t have access to treatment
Inability to Deliver Life Saving Medicine
Only 1% of doctors actively prescribe MAT (MedicationAssisted Treatment)
No formal education
Addictionis not taught in medical school and residency in USA
Federal Regulations
Unnecessary regulations, limits, and oversight in addiction medicine

Number of OpioidUsage Deaths in The Past 22 years
(Opioid Usage Disorder)
CDC data- https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Number of Deaths in Past 22 years Vs Doctors
available in America
(Medication Assisted Treatment)
American Society of
Addiction Medicine
American Board of
Addiction Medicine
American Academy of
Addiction Psychiatry

Federal Legislation impacting OUD
▪ HarrisonNarcotic and Tax Act of 1914 legislated psychoactivedrugs and prohibiteddoctors from
prescribing those drugs. A physician cannot prescribe another addictivedrug for any addictive
condition.
○ Methadoneis Class 2
○ Suboxone/Buprenorphineis Class 3
○ Naltrexone is not very effective in keeping remission or preventing relapse
• The Drug Addiction Treatment Act of 2000 caps the number of addictedpatientsa physiciancan
treat at any one time to 30 through the first year following certification, expandableto 100 patients
thereafter. No other medicationshave such restrictions,including the prescriptiondrugs people
get addicted to and die from.
Like many well-intentionedlaws, the unintended consequences are significant. Reasons to
end these arbitrary government-mandatedlimits on life-saving care

DIVERSION CONTROL 42 CFR 8.12(c) (2).
An OTP must develop and maintain a current “Diversion
Control Plan” or (DCP) as part of its quality assurance
program.
The goal of a DCP is to reduce the scope and significance of
diversion and its impact on communities. Each program’s
DCP should make every effort to balance diversion control
against the therapeutic needs of the individual patient.
We are not addressing OD deaths & Opioid crisis in
America”, By Dr Arun Gupta

Fentanyl class 2 or class 1?
• "They have some concerns," he said, adding that DEA is "trying to eliminate the
perception out there in the research community that it's going to be a hindrance.
• "Because Schedule I drugs have high risk of abuse, the DEA imposes strict
regulations for research applicants. It requires the drugs to be stored in a safe
bolted to the floor and each compoundmust have a separate DEA registration.
Trying to do research on Schedule I compoundsis really difficult for scientists
Now being labeled as weapon of mass destruction
Up to 10,000-fold more potent than morphine,¹ and often spiked into, or used
concomitantly with heroin, cocaine or methamphetamine, these analogues pose a
serious risk for overdose

TOP 4 Drugs Tiedto OUD Deaths
• Fentanyl, Methamphetamine, Heroin & Cocaine.
• Prescription drugs are not obtained legally in 98% of OD
deaths according to reports from Medical examiners.
• BUPRENORPHINE not reported in top 20 drugs,
• Schedule 3, but has a DCP on the treatment arm, Why?

WHERE ARE ALL THE ADDICTION DOCTORS?
• None of 179 (132+47) medical schools or 8887 residency programs in US teach addiction
• Less than 15 doctors were getting trained per year in the USA until 2015
• ~1700 addiction doctors in 2006
• ~4,000 addiction doctors in 2011
• ~ <20,000 active addiction providersin 2021
• 106,000 providers have ability to treat addiction
• MAT (but very limited & regulated for 21 years)
• Why do the remaining 990,000 US doctors refuse to treat addiction??

FAILEDOPIOIDRELATEDREGULATIONSIN THELASTDECADE
• Since 2010,16, statesintroduced around 1,300opioid-related bills and
enacted around 500.
• More than 50% of these policies target opioid prescribing. Thirty-three
states have enacted opioid prescription limits, while 11 have laws
governing pain clinics.
• Laws also included provisions for education and “takebackevents,”
which collect and remove unneeded medications from communities.
“Not only were states enacting these laws,” over this time period, “but
also making them stronger”
• CDC guidelines on opioid prescribing many of these laws are based on,
have been controversial, and are often described as “blunt
instruments.”
Reference: Rebecca L. Haffajee, JD, PhD, MPH, a U-M assistant professor of Health Management &
Policy

BARRIERSIN TREATMENTMUSTBE REMOVED
• Barrier #1: Enforcement:The critical line from Harrison Narcotic Act of 1914: “ In
the course of his professional practice, can no longer serve as a barrier to doctors”
• A Law-and-order approach to addiction has not worked for 100 years. It
must change.
• Barrier #2 : STIGMA: addiction has been incorrectly seen as moral failing.
• Despite Supreme Court's ruling in 1962,”Addiction is a chronic
treatable disease , not a moral failing
• Stigma towards treatment
Stigma towards success of treatment
• Barrier #3 Diversionof Suboxone:It is meant to save live… not addictive… proven
effective to keep people in Remission , prevent relapse & death
• 95% of patients do not access to MAT/ MOUD

THE SOLUTIONS
1. Rotary International to take up drug overdosedeaths, all DG’s support
2. ACGME TO INCULCATE ADDICTION TRAINING IN MED SCHOOLS
3. MANDATORY CME FOR ALL MEDICAL PROFESSIONALS ON ADDICTION
4. MANDATORY CME FOR ALL MEDICAL PROFESSIONALS ON BETTER VOLCABOLARY, EMPATHY &
HUMANITY
5. AMEND DRUG ADDICTION TREATMENT ACT OF 2000 TO REMOVE PATIENT CAPS, LIMITS &
REGULATION
6. RECLASSIFY BUPRENORPHINE,NO MORE DIVERSION CONTROL PLAN,
7. DROP THE COST TO A DIME
8. STRENGHTHEN LAWS FOR LAW ENFORCEMENT TO COUNTER ILLEGAL DRUGS
9. IMPLEMENT SENATE BILL 445 - MAINSTREAMINGADDICTION TREATMENT ACT OF 2021

AMENDDRUGADDICTIONTREATMENTACT OF 2000TO
REMOVEPATIENT CAPS
• CDC reported, “41 million patients are at risk of SUD”
• Current regulations with MAT doctor can only treat a maximum of 275 patients
per month
• US would need ~150,000 doctors to treat all the patients if all doctors were
allowed the maximum amount of patients
• Realistically we need 200,000 providers currently we have <20,000 providers.
• Currently 106,000 providers have X DEA/ ONLY 18,000 are active.
• Each of the current providers would have to treat 4,000 patients in the current
climate
Reasons to end these arbitrary government-mandated limits on life-saving care

REFERENCES
• American Society of Addiction Medicine (ASAM), my numerous mentors at
A.S.A.M.
• The Principles of Addiction medicine. IV
• www.drugs.gov
• www.niaaa.gov
• www.nida.gov.
• SAMHSA
• Goodmanand GilmanTextbook of Pharmacology.
• DSM –IV /V
• CMS.gov
• U.S. Department of Justice
• AccreditationCouncil for Graduate Medical Education (ACGME)
• ABAM.net American Board of Addiction Medicine
• The American Psychiatric Association (APA)
• American Academy of Addiction Psychiatry (AAAP)
• Medscape.com
Click to add text

Our Work is Cut Out for Us…

A Frontline Doctor’s Experience and
Recommendations to Resolve
America’s Opioid Crisis
Dr. Arun Gupta
USA TODAY Bestseller
Wall Street Journal Bestseller
#1 Barnes & Noble Worldwide
#1 Amazon Bestseller

HARMREDUCTION POLICIES(HRP)
• 39 million patients with substance use disorder have no access
to care.
• They are at a very high risk of dying, as per CDC.
• HRP, should be necessary for defined short-periods of time only.
• If all 39 million people have access to addiction providers, the US
will not need Harm Reduction Policies.

CDC. NCHS Data Brief. Published online November 29, 2018.
• An increase in deaths from drug overdoses and suicides contributed to a
decline in overall life expectancy in the United States, the CDC says. The
estimate of how long a person born in 2017 can expect to live in the
United States is now 78.6 years, a decrease of 0.1 year from 2016.
• The age-adjusted death rate for the entire US population increased by
0.4%, from 728.8 deaths per 100,000 population in 2016 to 731.9 in
2017.
• CDC. NCHS Data Brief. Published online November 29, 2018. No. 328, Full
text; No. 329, Full text; No. 330, Full text

WHY DRUG OVERDOSE
DEATH RATES ARE GOING UP
AND HOW CAN WE REDUCE
POLY DRUG OVERDOSE
DEATH RATES
IN AMERICA?
ChapterNorth America

Recognised by Rotary International
Special Consultative Status at ECOSOC UN
Chapter North America Project SMART
Chapter NorthAmeric

Project SMART Committee Chairs
School
Education
Matt Mittall
Medicine
and Drug
Disposal
Sieglinde
Warren
Awareness
Rod Riopel
Recovery
Raju Hajela
M.D.
Treatment
Arun Gupta
M.D.
ALL ROTARIANS AND EXPERTS IN THEIR FIELD

Our Story
After observing the failures of addressing the Opioid Crisis and Addiction in North
America, which was preventable, a Team of Rotarians, experts in their field, was
assembled to have a plan for Local Rotary Clubs' intervention.
After meetings, research, and a review of past history of all programs that have been
attempted, Project SMART was formed to address the Opioid Crisis.
We found that numerous organizations from Drug Coalitions to Drug Take Back Days had
been implemented and funded through Federal Taxpayer dollars over the past decade to
the tune of 60 billion dollars. https://https://www.samhsa.gov/grants-awards-by-
state
We also discovered that these taxpayer funded organizations were all
operating in silos afraid to talk to each other for fear of losing their funding.

We also discovered,that after implementationof these programs the Opioidcrisis was worse off today
than when all the Federal funded programs began.
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
https://www.dea.gov/press-releases/2020/11/05/dea-and-partners-collect-record-amount-unwanted-medications-
during

We also discovered that even though we have lost
almost one million people to overdose deaths in the
past decade the number of addicts keeps growing!
https://www.cdc.gov/nchs/data/hus/2019/020-508.pdf
CURRENT NUMBER IS 21 MILLION AMERICANS
ARE ADDICTED UP FROM 19.6 MIILION IN
2019.
https://nsduhweb.rti.org/respweb/homepage.
cfm

School Education Medicine And Drug Disposal
Through local Rotary Club
provide in-school education
from 1’st grade to grade 12
programs about addiction.
Includes-Videos
Take Home
Handouts
In person speakers
Narcan Training
Provided at no costs to the
City, Citizens, Rotary Club
In home Safe Drug Disposal
bottles distributed to every
mailing address within the City.
Kiosks the only ones of their kind
can be placed anywhere such as
senior centers, Church lobbies,
Pharmacies.
Provided at no costs to the City,
Citizens, Rotary Club.
A Rotary exclusive program!
EDUCATION-PREVENTION-TREATMENTTO RECOVERY

Awareness Recovery
Is a comprehensiveprogram from
providing
• NarcanTrainingthrough local Rotary
Clubs that includes a free class and
NarcanKit to take home
• PublicRelations and Press releases
about Rotaryin the local community
and the OpioidCrisis!
• 1-HourPhysicianTrainingfor CE on
OpioidPrescribing
• 1-Hours DentistTrainingfor CE on
OpioidPrescribing
Providedat no cost to the City, Citizens,
Rotary Club.
A comprehensive database
through the local Rotary Club
providing real time verifiable
real-world data on
Recovery programs in the
local community that work.
This is exclusive to Rotary.
(Data is verified through Vista
Research)

Treatment
Increasing Treatment availability-
Removing Barriers- Advocating
for expanded treatment-
Advocating for increased
reimbursements-Advocating for
addition of more addiction
Physicians- providing a database
through the local Rotary club of
actual Treatment providers and
programs available in the local
community. A Rotary exclusive!
You have heard from Dr. Gupta
today for the need of Treatment
and programs in every community.
This is what will prevent further
deaths and growing number of
deaths. With this database we will
be able to pinpoint needs
throughout North America.

Treatment
NOTICE THE NUMBERS ARE THE SAME ALMOST 30 YEARS LATER!

How Success Rates Should be Scientifically Measured
RAG AP North America Project SMART will use only Peer-revieweddata-driven facts!

RAG AP North America Project SMART Provides the 4
Elements
INCREASE OUR IMPACT
DATA-DRIVEN-MEASURING WHAT WE DO
PLANNING AND PROVEN SOLUTIONS!
Project SMART makes the Rotary highly
visible in the community and provides real
data to the community of the community
results of Project SMART
INCREASE ABILITY TO
ADAPT
AND HAVE STAYING POWER.
Project SMART allows Rotary to stay
true to ourselves and stay ahead of
change in our next 115 years.
EXPAND OUR REACH
Project SMART and its high visibility
exposure in your community allow
people who share our drive to do the
same.
ENCHANCING PARTICIPANT
ENGAGEMENT
RAG AP NORTH AMERICA CHAPTER ACTION PLAN
Project SMART provides an avenue for club
members to engage with the club and the
community with the growth of our participants at
the center of all we do.
NORTH AMERICA
CHAPTER

NORTH AMERICA CHAPTER

Everyone asks-(The Environment?)
Project SMART through it’s Medicine and Drug Disposal Program helps
remove Pharmaceuticals from the environment by motivating citizens to
dispose of them properly and safely instead of flushing them or throwing
them in the trash which winds up in our drinking water

New paragraph
• Tekst in colomns
• …
• Second colomn
• …

Join Other Rotary Clubs and Have A
Project SMART Committee

Rotary Action Group for Addiction Prevention Launches Toolkit for Measuring Social Impact of Prevention Projects

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Rotary Action Group for Addiction Prevention Launches Toolkit for Measuring Social Impact of Prevention Projects