2 Port Gamble S'Klallam Tribe HANDOUTS & LINKS 1. THOR plan - - PowerPoint PPT Presentation

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2 Port Gamble S'Klallam Tribe HANDOUTS & LINKS 1. THOR plan - - PowerPoint PPT Presentation

Feb 06, 2024 372 likes •861 views

Tribal Healing Opioid Response Background & intro to THOR Panel Health advisory committee Share our process Learn from you, have a conversation about what works Terminology, data, summit, panel, whats

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  • Tribal Healing Opioid Response
  • Background & intro to THOR
  • Panel
  • Health advisory committee
  • Share our process
  • Learn from you, have a conversation about what works
  • Terminology, data, summit, panel, what’s next

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HANDOUTS & LINKS

1. THOR plan 2. THOR Community Handout (July 2017) 3. Opioid Pain Agreement (draft) 4. Narcan Standing Orders 5. Narcan Training Guide 6. PGST Good Samaritan code 7. Helpful Links:

  • https://aims.uw.edu/
  • https://addiction.surgeongeneral.gov/surgeon-generals-

report.pdf

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OPIATE

Opiate refers to natural substances that come from opium. Opium extracted from the poppy and contains chemical compounds, including morphine and codeine.

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OPIOIDS

Medicines/drugs that bind to the same receptors as opiates, but do not occur naturally, known as semi-synthetic or synthetic

  • pioids.

Synthetic opioids

  • fentanyl & methadone

Semi-synthetic opioids

  • xycodone & hydrocodone

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OPIATE OR OPIOID?

Opioid: natural, synthetic, or semi-synthetic substances Opiate: naturally occurring substances within the opioid class

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OPIOIDS SPELLED OUT

Morphine Codeine Thebaine Diacetylmorphine (Heroin) Hydrocodone (Vicodin) Oxycodone (Oxycontin) Oxymorphone (Opana) Hydromorphone (Dilaudid) Tramadol Fentanyl Methadone

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Naturally occurring opioids– also called opiates Semi-synthetic opioids Synthetic

  • pioids
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12.4 12.3 34.4 1.1 1.2 15.1 1 5 10 15 20 25 30 35 40 White Black AIAN Hispanic Asian Pacific Other Rate per 100,000 Race/Ethnicity

Rates of Opioid Overdose Deaths by Race/Ethnicity, WA State 2011-2015

Source: WA DOH Death Certificates Includes all intent of drug-related deaths with the additional ICD-10 codes of T40.0, T40.1, T40.2, T40.3 or T40.4

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OPIOIDS IN OUR STATE & REGION

2015 Drug Injector Survey - Statewide

1036 Valid Responses

  • 22% overdosed in past 12 months
  • 52% witnessed overdose in past 12 months
  • 47% said they or someone else had called 911
  • 46% carry naloxone
  • 50% hooked on rx opiates prior to heroin
  • 51% interested in getting help to cut down or quit but only 2

people in treatment (in our county)

http://adai.uw.edu/pubs/infobriefs/2015druginjectorhealthsurvey.pdf

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OPIOID SUMMIT

January 30, 2016 Opioid Summit: 3-County Coordinated Response

Results from assessment and planning phase From planning to action

WA State Plan & 3-County proposed plan 14+ tribal council & staff attended

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2017 WASHINGTON STATE INTERAGENCY OPIOID WORKING PLAN

Goal 1: Prevent opioid misuse and abuse Goal 2: Treat opioid dependence Goal 3: Prevent deaths from overdose Goal 4: Use data to monitor and evaluate

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Improve prescribing practices Expand access to treatment Distribute naloxone to people who use heroin Optimize and expand data sources Priority Goals Priority Actions

http://www.doh.wa.gov/YouandYourFamily/PoisoningandDrugOverdose/OpioidMisuseandOverdosePreventi

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OUR RESPONSE

How to make this meaningful for PGST? Executive Director called f/u opioid meeting Tribal council members, police department, wellness staff, chief medical officer, youth workers and more Reviewed state and county plan and adopted our

  • wn Tribal Healing Opioid Response

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Goal 1: Prevent Opioid Misuse and Abuse

Lead Department Partner Department

1A: Promote best practices for prescribing

Health Wellness, CHR

1B: Raise awareness of risks including

  • verdose; reduce stigma

Wellness Re-entry, Court, Health

1C: Prevent opioid misuse in communities, particularly with youth

Chi-e-chee, Youth, Education Wellness, Health

1D: Promote safe storage and disposal

  • f prescription medicine

Health Police

1E: Decrease the supply of illegal

  • pioids

Police Court

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Goal 2: Expand Access to Opioid Use Disorder (OUD) Treatment

Lead Department Partner Department

2A: Expand capacity of health providers to recognize signs of opioid misuse

Health, Wellness Police

2B: Increase access to & utilization of best practices OUD treatment in communities

Wellness Health, Reentry

2C: Increase access to & utilization of best practices OUD treatment in the criminal justice system

Reentry Wellness, Police

2D: Increase capacity of syringe exchange programs to provide overdose prevention training including naloxone and to engage clients in supportive services

Health Wellness

2E: Reduce withdrawal symptoms in newborns

Children & Family Health, Wellness, ECE, Chi-e- chee

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Goal 3: Prevent deaths from overdose

Lead Department Partner Department

3A: Educate community to know how to recognize and respond appropriately to an overdose

Chi-e-chee Human Resources, Wellness, Health

3B: Increase availability of overdose reversal medication naloxone

Health Police, Wellness, Natural Resources

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SAM WHITE CHIEF OF POLICE

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Tribally run Closed reservation 24-hour service 10 staff

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PREVENT DRUGS ON RESERVATION

Proactive patrols Targeting active houses & vehicles Surveillance If you think your neighbor is a drug dealer

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PREVENTING DIVERSION

Drug take back

  • Secure box in lobby of tribal

government building

  • Police pick up

Medication lock box

  • In coordination with health services

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PREVENTING DEATH

Tribal Code: Good Samaritan provision Narcan in every vehicle with every officer Coordination with health and wellness

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COMMUNITY ENGAGEMENT

Town Halls Attend meetings Restorative work Operation ID & Home Safety Survey Resource handout

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JOLENE GEORGE BEHAVIORAL HEALTH DIRECTOR

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WELLNESS

Substance abuse & mental health counseling 15 FTEs: 5 MH, 4 CD, MA, transport, office manager Group & individual counseling Suicide prevention MAT

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COMMUNITY ENGAGEMENT

General Council

  • March 2017

Opioid Town Hall

  • December 2016
  • October 12, 2017

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MEDICATION ASSISTED TREATMENT

Staffing: 2 MDs, 1 ARNP, supported by MA Suboxone & Vivitrol Program Structure

  • Counseling, individual and group
  • Random call backs

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DEPLOYING NARCAN

(NASAL NALOXONE)

Unexpected barrier/delay (account set up) Standing Orders

  • Clinic & County

Community Outreach & Training Staff Training

  • Wellness & Health (train the trainer)
  • Police, Natural Resources and more

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BEHAVIORAL HEALTH INTEGRATION

Active effort

  • Tribal Council support
  • Qualis PALs – state Medicaid Transformation
  • Joint Business & Finance Office
  • Cross training medical assistants
  • Vision/Strategic planning session
  • LCSW in primary care clinic

THOR is a good example

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LUKE MCDANIEL, MD MEDICAL DIRECTOR

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Port Gamble S'Klallam Tribe

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HEALTH

Only Indian Health Care provider in Kitsap County, Washington Outpatient, primary and urgent

  • FT Family Medicine, PA, Pediatrician one day/week
  • 4 RNs, 1 LPN, 5 CHRs, 4 MAs

Dental User Pop: 1695

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CHRONIC PAIN MANAGEMENT

Opioids don’t work

  • Tachyphylaxis & hyperalgesia

Opioid Pain Agreement Patients think opioids work, already dependent Education, leadership, patients, THOR… Dramatic decrease in rx

  • 18% decrease one year, 75% seven years
  • Multiple reasons, further evaluation needed

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BEHAVIORAL HEALTH INTEGRATION

  • Weaning people off opioids needs to go hand in

hand with addiction treatment

  • Primary care MD at Wellness practicing addiction

medicine

  • Mental health problems complicate treatment of

physical health disorders

  • Cognitive behavioral therapy for chronic pain
  • 98% of Wellness pts are also PC pts

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HARM REDUCTION

Narcan

  • Standing Orders – keep nuts and bolts here
  • Policy – for broad concepts
  • Data driven messaging

Needle Exchange

  • Successful
  • Message: exchange, not supply

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SUCCESS

Examples abound

  • Transition to MAT
  • Non-opioid treatment only
  • Exercise, mental health, non-opioid meds, etc.
  • PRN opioids only
  • Decreased dosage

Prevention is better

  • Surgeon General’s Report on Alcohol, Drugs,

and Health

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TRISHA IVES PREVENTION COORDINATOR

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YOUTH PREVENTION

Youth Services Serves K-12 grades and young adults Monday-Saturday 6 staff Support groups, culture, recreation, leadership, outings, mentoring, etc.

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YOUTH PREVENTION ACTIVITIES

Tae Kwon Do Fitness Initiatives Hiking Basketball T-ball Skate Camps Prevention weekend Red ribbon week Youth Prevention Summit Youth Leadership Group Youth Annual Honoring Youth Employment workshop College trips Thrive conference Youth & Elder Socials Cultural classes; Beading Cedar/wool weaving Cooking traditional fish Archery Regalia making Canoe journey Pow-wow’s Autism Acceptance Walk Child abuse Prevention Walk Places of Importance

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CEDAR CAMP

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WEEKLY SUPPORT GROUPS

4-5 grade, middle & high school; boys and girls

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TEEN AND PARENT RETREATS

Parent retreats

  • Birth – 5th Grade

Teen & Parent Retreats

  • 6-12th grade

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COMMUNITY PREVENTION

CHI-E-CHEE (Klallam word for “the workers”) Vision Committed to working together to provide a safe, healthy Tribal community with bright futures for our youth and future generations. Mission The mission of the Port Gamble S'Klallam Tribe’s Chi-e-chee is to promote healthy families through the elimination of alcohol, tobacco and other drug abuse in the Port Gamble S'Klallam community, in accordance with the Tribe’s culture, values, and traditions. Executive Director suggested Chi-e-chee as lead group for THOR

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KAROL DIXON HEALTH SERVICES DIRECTOR

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Port Gamble S'Klallam Tribe

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TIMELINE

Opioid Town Hall – Dec 1, 2016 3 County Summit – Jan 30, 2017 Director / Staff work General Council – March 2017 Chi-e-chee adoption & meeting monthly Department work continued throughout NIHB – Sept 26, 2017 Town Hall – Sept 27, 2017 the work continues…

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ONGOING PROCESS

Monthly Tribal wide meetings Review progress, update plan

1. Discuss what are we doing 2. What do we want to do? 3. How much does it cost? 4. Who is on point?

Appointed a lead staff person to THOR THOR Logo Next: community engagement, town hall, funding

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FUNDING & COLLABORATION

Right thing to do Significant cost & commitment Leadership Collaborations with other departments

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TRIBAL SPECIFIC DATA & EVALUATION

Tribal Specific Data Pull

  • Needle exchange, opioid dependence, rx

Requested technical assistance

  • NPAIHB Epi Center
  • Kitsap County
  • Olympic Community of Health

Evaluation

  • How will we know it is working?
  • What do we measure?

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Port Gamble S’Klallam Tribe Artist & Designer jeffreyveregge@gmail.com www.jeffreyveregge.com 360-516-0406

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THANK YOU!

Jolene George Behavioral Health Director 360-297-9674 jolenes@pgst.nsn.us Sam White Police Chief 360-297-9685 swhite@pgst.nsn.us Trisha Ives Prevention Coordinator 360-297-6276 tives@pgst.nsn.us Karol Dixon Health Services Director 360-297-9641 karold@pgst.nsn.us Luke McDaniel, MD Medical Director 360-297-9617 lmcdaniel@pgst.nsn.us

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