We honor ourselves when we speak out for recovery. We show the world that recovery matters because it brings hope and peace into the lives of individuals and their loved ones. ~ Beth Wilson The only person you are destined to become is the person you decide to be. ~ Ralph Waldo Emerson Success is the sum of small efforts, repeated day in and day out. ~ Robert Collier

1. GOVERNOR DAVID IGE
MULTI-AGENCY EFFORTS CREATE STATEWIDE STRATEGY
DECEMBER 1, 2017
HONOLULU – The Hawaii State Department of Health today announced the
unveiling of the Hawaii Opioid Initiative action plan, a statewide road map for
prevention and treatment of opioid and other substance misuse issues. The
plan was created through a collaborative, multi-agency approach that began in
July.
“Fortunately, Hawaii has not yet experienced the magnitude of the opioid crisis
seen in other parts of the country,” said Gov. David Y. Ige. “While emerging
issues and concerns in the state are on the rise, we have been given a relatively
unique opportunity to proactively respond, prepare and prevent the crisis from
reaching the same magnitude.”
The Statewide Action Plan is a comprehensive strategy to aggressively
counteract the increased abuse and misuse of opioids in Hawaii. The plan is
designed to sustain a system-wide, coordinated and proactive response to not
only opioids, but also methamphetamine and other prevalent drugs. The
collaborative efort is led by the Department of Health, together with the
Department of the Attorney General, Department of Human Services Med-
QUEST Division, Department of Public Safety Narcotics Enforcement Division
and a wide range of community groups.
To halt the looming opioid threat, the state is moving forward with the
Statewide Action Plan on opioids, portions of which have already been
implemented. The plan identifes six key focus areas:
• Treatment Access: Improve and modernize healthcare strategies and
access for opioid and other substance misuse treatment and recovery
services.
• Prescriber Education: Improve opioid and related prescribing practices
by working with healthcare providers and payers.

2. • Data Informed Decision Making: Implement system-wide routine data
collection, sharing and dissemination to increase knowledge and
inform practice.
• Prevention and Public Education: Improve community-based programs
and public education to prevent opioid misuse and related harms.
• Pharmacy-based Interventions: Increase consumer education and
prescription harm management through pharmacy-based strategies.
• Support Law Enforcement and First Responders: Coordinate operations
and services, support specialized training for frst responders and
assure efective laws and policies.
The plan's objectives include establishing a coordinated entry system to process
substance use disorder treatment referrals for primary care providers;
implementing year-round “drop-of and take back” sites at a minimum of two
county police stations within the state for safe and secure disposal of unused
medications; and implementing a standing order to allow pharmacists to
dispense Naloxone to reduce the incidence of opioid deaths due to overdose.
“This plan is a living document and should be viewed as a beginning rather
than an end,” said Edward Mersereau, chief of the Hawaii Department of
Health Alcohol and Drug Abuse Division. “To maintain momentum, working
groups will continue to meet to track progress and to expand or adjust the plan
as additional data and outcomes are obtained.”
Opioids are highly-addictive narcotic substances commonly prescribed to treat
pain. Opioid pain relievers are generally safe when taken for a short time as
prescribed by a doctor. However, regular use of opioids can lead to
psychological dependence, and when taken in combination with alcohol and
other depressants may stop a person’s breathing and heart altogether, resulting
in death.

3. Nationwide, 140 Americans die each day from drug overdoses, with 91 caused
by opioids, according to the U.S. Centers for Disease Control and Prevention
(CDC). In Hawaii, drug overdose deaths account for 23 percent of all fatal
injuries which include deaths from prescription opioids, according to the
Hawaii Department of Health Emergency Medical Services and Injury
Prevention System Branch. Hawaii currently ranks 43rd in the nation in drug
overdose deaths.
HAWAII OPIOID INITIATIVE
A STATEWIDE RESPONSE FOR OPIAD
AND OTHER SUBSTANCE ABUSE ISSUES
https://health.hawaii.gov/substance-abuse/fles/2013/05/The-Hawaii-Opioid-Initiative.pdf
_____________________________________________________________
NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)
HAWAII OPIOID SUMMARY
Revised February 2018, accessed July 8, 2018
https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/hawaii-opioid-
summary
Opioid-Related Overdose Deaths
In 2016, there were 77 opioid-related overdose deaths in Hawaii—a rate of 5.2
deaths per 100,000 persons—less than half the national rate of 13.3 deaths per
100,000 persons. Since 2013, heroin-related overdose deaths increased from 10
to 20 deaths while prescription opioid overdose deaths remained steady. Only
one year of data exist for synthetic opioid-related deaths and so comparisons
across years are not possible.
Opioid Pain Reliever Prescriptions
In 2013, Hawaii providers wrote 51 opioid prescriptions for every 100 persons
(approximately 717,000 prescriptions)—the lowest prescribing rate in the
country. Since then, opioid prescriptions in the United States have declined,
with a nearly 11.1 percent decline in Hawaii from 2013 to 2015, resulting in an
estimated 45.3 opioid prescriptions per 100 persons (646,000 prescriptions) in
2015 (IMS Health, 2016)

4. _____________________________________________________________
DRUG USE BY STATE: 2018's PROBLEM AREAS
By John S Kiernan, Senior Writer & Editor. WalletHub
May 14, 2018, accessed July 8, 2018
https://wallethub.com/edu/drug-use-by-state/35150/#main-fndings
Drug abuse has a long and storied history in the United States, and we’ve been
“at war” with it since 1971 under the Nixon administration. But no matter who
is in ofce, the federal drug budget continues to increase. It's moved from
$23.8 billion in 2013 to almost $27.5 billion in 2017.
The current administration seems to be taking a hardline approach to drug use.
President Donald Trump and Attorney General Jef Sessions have advocated for
strict sentences for drug-related ofenses, even as far as the death penalty in
some cases.
Given the uncertain future and lack of signifcant progress to date, it's fair to
wonder where drug abuse is most pronounced and which areas are most at risk
in the current political climate. This report attempts to answer those questions
by comparing the 50 states and the District of Columbia across 20 key metrics,
ranging from arrest and overdose rates to opioid prescriptions and meth-lab
incidents per capita.
DRUG ABUSE BY STATE
HAWAII
Overall Rank Total Score Drug Use & Law Drug Health
#1=Biggest Addiction Enforcement Issues &
Problem Rank Rank Rehab Rank
46 33.62 15 9 47
_____________________
Fewest Opioid Prescriptions per 100 people : 50 Hawaii
Most Substance Abuse Facilities per 100,000 Drug Users : 50 Hawaii

5. OPIATE AND COCAINE USE UP IN Q2 2018 WORKFORCE DRUG TESTS
By Anna Hrushka. Pacifc Business News.
July 6, 2018, accessed July 8, 2018
https://www.bizjournals.com/pacifc/news/2018/07/06/opiate-and-cocaine-use-up-in-q2-2018-
workforce.html
Opiate and cocaine use in Hawaii are up compared to last year, according to
second quarter workplace drug testing results released by Diagnostic
Laboratory Services on Friday.
Positive tests for opiates were up 6.9 percent and cocaine increased 18 percent
compared to Q2 2017.
Marijuana use was down 1.8 percent year over year, while synthetic urine was
up 1.7 percent compared to last year.
Month to month, DLS said marijuana use declined 4 percent from Q1 to Q2
2018, and synthetic urine use increased 9.2 percent during the same period.
Positive testing for opiates jumped 22 percent from Q1 to Q2, and cocaine had
a slight decline of 2.9 percent for the same period.
"Although the percent change in the positive rate for marijuana is less than 10
percent, this change is signifcant because marijuana is the drug detected the
most in workplace drug test programs, in Hawaii and nationally. It's also nice
to note that our workforce positive rates for marijuana are comparable to
national tests," Steven Brimmer, DLS scientifc director of toxicology, said in a
statement.
"Our second highest positives are for synthetic urine, used by people to try to
disguise drug use. Despite these challenges, workplace drug programs continue
to assist employers interested in providing a safer work environment, improved
morale and productivity and lower costs due to absenteeism, worker's
compensation claims and healthcare related costs."
The medical testing laboratory said its quarterly sample size typically includes
between 7,000 to 10,000 drug tests.

6. _
OPIATE AND COCAINE USE UP, MARIJUANA DOWN IN SECOND QUARTER
By Web Staf KHON2
July 6, 2018, accessed July 8, 2018
https://www.khon2.com/news/local-news/opiate-and-cocaine-use-up-marijuana-down-in-
second-quarter/1287644779
HONOLULU (KHON2) - In a reversal from last quarter, opiate positive rate in
workplace testing showed a 22% jump from Q1 to Q2 2018, but only a 6.9%
increase from 2Q 2017, said Steven Brimmer, Ph.D., scientifc director of
Toxicology at Diagnostic Laboratory Services. Cocaine had a slight decline,
2.9% , from Q1 to Q2 2018, but use was up 18% in comparison to Q2 2017.
Marijuana use declined 4.0% from Q1 to Q2 2018 (2.89% to 2.78%), down 1.8%
year over year, and synthetic urines use crept up 9.2% from 1.15 percent in Q1
2018 to 1.26% in Q2, and up year over year at 1.7%.
“Although the percent change in the positive rate for marijuana is less than
10%, this change is signifcant because marijuana is the drug detected the most
in workplace drug test programs, in Hawaii and nationally. It's also nice to note
that our workforce positive rates for marijuana are comparable to national
tests,” Brimmer said.
“Our second highest positives are for synthetic urine, used by people to try to
disguise drug use,” Brimmer added. “Despite these challenges, workplace drug
programs continue to assist employers interested in providing a safer work
environment, improved morale and productivity and lower costs due to
absenteeism, worker's compensation claims and healthcare related costs.”
Amphetamine use was up from Q1 to Q2 2018 (0.78% to 0.80%), but down 16%
in comparison to Q2 2017.
Last year, the U.S. Department of Transportation announced a change in their
testing to include four semi-synthetic opioids: hydrocodone, oxycodone,
hydromorphone and oxymorphone that began on January 1, 2018. Some
common names for these are OxyContin, Percocet and Vicodin.

7. The addition of these drugs is a change in Federal workplace testing. The
testing for these drugs is a result of the country's opioid epidemic. Hawaii does
not yet test for these drugs.
DLS' quarterly sample size typically includes between 7,000 to 10,000 drug
tests.
_____________________________________________________________
OPIATE AND COCAINE USE IS CLIMBING AMONG HAWAII'S WORKFORCE
By Moanike'ala Nabarro. KITV4
July 6, 2018, accessed July 8, 2018
http://www.kitv.com/story/38591494/opiate-and-cocaine-use-is-climbing-among-hawaiis-
workforce
Nearly 10,000 tests from companies and ofces across the state are sent to the
Diagnostic Laboratory Services in Aiea.
Recent results show opiate use rose by 22 percent so far this year.
Opiates include heroin and prescription drugs.
“This is all very very regional and the use is going to be driven by economics
and availability,” Dr. Steven Brimmer, Diagnostic Laboratory Services said.
Cocaine use also climbed up 18 percent compared to this time last year.
Brimmer says use of the powdery street drug is also on the rise in the mid-west
and southeast portions of the U.S.
Research shows those opting to take harsher drugs could be coming of highly
addictive pills.
“The vincodins, the oxycodones, as that source either dries up or becomes too
expensive then those users if they're not cured at that point, will look for other
sources the obvious other sources heroin in this case,” Brimmer said.

8. Other key fndings include positive marijuana results dipping down slightly by
nearly 2 percent.
Diagnostic Laboratory Services says that's encouraging since its the most
detected drug in workplace test programs.
“If you tell people that they're going to be tested and their job relies on it. Most
people are smarter enough not to do it. That makes a better employment place.
That saves cost for the employer. That's just a big beneft generally for society
as a whole,” Brimmer said.
_____________________________________________________________
DRUG POLICY FORUM URGES GOVERNOR TO RECONSIDER
MISGUIDED INTENT TO VETO
CRUCIAL MEDICAL CANNABIS & OPIOID BILL
By Drug Policy Forum of Hawaii
June 25, 2018, accessed July 8, 2018
http://dpfhi.org/press-release-governor-ige-should-reconsider-misguided-intent-to-veto-crucial-
medical-cannabis-opioid-bill/
HONOLULU, HI –.Today, Governor Ige announced his intent to veto SB2407,
which would add “opioid use, substance use, and withdrawal symptoms
resulting from the treatment of those conditions” to the list of ailments legally
treatable with medical cannabis.
DPFHI urges the Governor to reconsider this decision in light of developments
in other states, previous additions of conditions via legislation signed by the
Governor himself and how this bill aligns with the intent behind his State of
Hawai'i Opioid Initiative Action Plan.
The following is a statement by DFPHI Executive Director Carl Bergquist:
'”This announcement is misguided since Hawai'i has the chance to join the
vanguard of other states like Pennsylvania and New Jersey in approving
medical cannabis against opioid and other substance use.

9. As the Pennsylvania Secretary of Health, Dr. Rachel Levine, said when she
recently approved the use of medical cannabis against substance use disorders,
this is not meant to be a “substitute” for other proven treatments but rather to
act as “another tool” against this devastating disease. As a state that pioneered
the legalization of medical cannabis, and now has dispensaries serving the
patient population, it makes sense that we embrace this kind of progressive
outlook rather than bury it in process that will lead to prolonged sufering.
The Governor's Opioid Initiative, in which DPFHI participated, calls for
“alternatives” to opioids.
We submit that SB2407 can and should be part of those alternatives when it
comes to dealing with the scourge known as the opioid epidemic.”
Bergquist added, “In announcing his intent to veto this important piece of
legislation, Governor Ige referred to a 'professional process' that helps evaluate
conditions for medical cannabis. While such a process exists, it is passive and
actually sees the Department of Health, rather than an independent panel of
experts like e.g. in New Mexico, evaluate submitted petitions instead of itself
proposing new conditions to be added. It is meant to be a complement rather
than the exclusive way to add new conditions. This is why conditions have
been added via legislation in Hawai'i, including post-traumatic stress disorder
(PTSD) in 2015 and just last year in 2017, four other conditions (lupus,
epilepsy, multiple sclerosis and rheumatoid arthritis) were added this way. The
addition of PTSD in particular has helped well over a thousand sufering
patients. Moreover, the idea behind this particular bill comes from the
Legislature's own Oversight Working Group on Medical Cannabis, which is
comprised of experts and patients, and sat for over a year before submitting its
fnal report to the Legislature.”

10. CONGRESSWOMEN HANABUSA AND GABBARD OPPOSE GOVERNOR IGE'S
INTENT TO VETO BILL ALLOWING MEDICAL MARIJUANA TO TREAT
OPIOID ABUSE
Ofce of Congresswoman Colleen Hanabusa'.June 27, 2018 Press Release
https://hanabusa.house.gov/media-center/press-releases/congresswomen-hanabusa-and-
gabbard-oppose-governor-ige-s-intent-veto
WASHINGTON, D.C. – Congresswoman Colleen Hanabusa and Congresswoman
Tulsi Gabbard issued the following statements today in opposition of Governor
David Ige’s intent to veto SB 2407 SD1 HD1 CD1, a bill that would permit the
prescription of medical marijuana to combat opioid abuse in Hawaii.
“America is managing an opioid epidemic that is killing an average of 91
Americans a day. Medical cannabis provides similar relief for chronic pain
patients without the possibility of a fatal overdose. We need to explore every
opportunity to help our citizens who are battling addiction to pain killers and
other prescription drugs. This is a life or death issue,” said Congresswoman
Colleen Hanabusa. “We know that states that administer medical cannabis
programs have much lower opioid addiction rates, and opioid overdoses drop
by an average of 25%. According to the March issue of the Journal of Health
Economics, 'Dispensaries – retail outlets that sell marijuana to qualifed patients
– contribute to the decline in opioid overdose death rates.' We urge the
Governor to reconsider and allow the bill to become law to increase access to
medical cannabis for patients dealing with opioid abuse.”
Rep. Tulsi Gabbard said: “We are in the middle of an ongoing opioid epidemic
in this country and Hawai’i is on the front lines – there are 191 drug-related
deaths per year, as well as almost 500,000 active opioid prescriptions, which is
enough to serve a third of our population. With such a stark increase in
prescription opioid use and dependence, heroin and synthetic drug overdose,
and emergency room visits over the last decade, we must allow legal access to
medical marijuana to help prevent opioid addiction and opioid-related deaths.
This legislation has the potential to save people's lives in Hawaii - states like
Pennsylvania and New Jersey that have adopted similar policies have seen
addiction rates drop and opioid abuse deaths decrease by over 20%.
Understanding that people’s lives are at stake, I urge Governor Ige to
reconsider and sign this legislation into law now.” [Emphasis Supplied]

11. DRUG ABUSE BY STATE
PENNSYLVANIA
Overall Rank Total Score Drug Use & Law Drug Health
#1=Biggest Addiction Enforcement Issues &
Problem Rank Rank Rehab Rank
10 50.54 41 40 38
Most Overdose Deaths per Capita : 5 Pennsylvania
_____________________________________________________________
DRUG ABUSE BY STATE
NEW JERSEY
Overall Rank Total Score Drug Use & Law Drug Health
#1=Biggest Addiction Enforcement Issues &
Problem Rank Rank Rehab Rank
29 40.53 35 10 42
Highest % of Teenagers Who Were Ofered, Sold or Given an Illegal Drug
on School Property : 1 New Jersey
Most Drug Arrests per Capita : 5 New Jersey
Lowest % of Adults With Unmet Drug-Treatment Needs : 51 New Jersey
Source: DRUG USE BY STATE: 2018's PROBLEM AREAS.
By John S Kiernan, Senior Writer & Editor. WalletHub.
May 14, 2018, accessed July 8, 2018
https://wallethub.com/edu/drug-use-by-state/35150/#main-fndings
/wallethub.com/edu/drug-use-by-state/35150/#main-fndings