Addressing the Opioid Crisis in Small and Rural Communities in - - PowerPoint PPT Presentation

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Addressing the Opioid Crisis in Small and Rural Communities in - - PowerPoint PPT Presentation

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Addressing the Opioid Crisis in Small and Rural Communities in Western Massachusetts CONSTANCE HORGAN, SCD AND ROBERT BOHLER, MPH Based on Massachusetts Health Policy Forum Issue Brief by Robert Bohler, MPH, Michael Doonan, PhD, and Constance

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Addressing the Opioid Crisis in Small and Rural Communities in Western Massachusetts

CONSTANCE HORGAN, SCD AND ROBERT BOHLER, MPH Based on Massachusetts Health Policy Forum Issue Brief by Robert Bohler, MPH, Michael Doonan, PhD, and Constance Horgan, ScD September 6, 2019

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We Join in Thanking the Funders of This Forum

#addressingtheopioidcrisis #WesternMA

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Best Practices and Innovative Programs Extent of the Opioid Crisis in Western Massachusetts Unique Challenges in Western Massachusetts Recommendations

OVERVIEW

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Issue Brief: Approach and Themes

  • Extensive literature search
  • Publicly available data and secondary data analysis
  • 24 semi-structured interviews with five key stakeholder groups: providers,

community coalitions, criminal justice, government officials, and harm reduction specialists

Approach

  • Importance of community collaboration
  • Rehabilitative role of the criminal justice system
  • Need to engage more people on medications for opioid use disorder (MOUD)
  • Expansion of harm reduction and recovery support services

Themes

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The Problem : Epidem iology

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MA Opioid Overdose Death Rate Significantly Higher than National Average

5 10 15 20 25 30

1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

United States Massachusetts Source: Henry J. Kaiser Family Foundation (2019)

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Opioid Overdoses are Increasing in Western Mass

Source: Massachusetts DPH and U.S. Census *Per 100,000 People

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Fentanyl is Increasing in Western MA

20 30 40 50 60 70 80 90 100

2015 2016 2017 2018

Presence of Fentanyl in Opioid-Related Overdose Deaths

Western Mass Rest of State Projected Western Mass Projected Rest of State Source: Brandeis/IBH team. Data obtained through contract with Massachusetts DPH for 2015-2017 *2017 data is preliminary *2018 WMA data point is preliminary from Northwest DA Office; 2018 MA data point is preliminary state-level fentanyl percentage in opioid OD’s

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County-level Prevalence of Opioid Use Disorder

Berkshire County Ham pden County Franklin County Ham pshire County

Source: Barocas et al. (2018)

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Opioid Prescribing Higher in Western Mass

% of Population Receiving Schedule II Opioid Rx Total Num ber of Dosage Units Per Capita

Massachusetts

3.5 4.1

Franklin County

4.6 6.4

Berkshire County

4.5 5.1

Ham pshire County

3.8 5.5

Ham pden County

4.5 5.9

Source: Massachusetts DPH (2019) – 1st Quarter of 2019

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Who is at Greatest Risk?

History of nonfatal

  • verdose

Recently incarcerated Homelessness Diagnosed mental illness Mothers with

  • pioid use

disorder Those prescribed

  • pioids >3

months Low socioeconomic status* History of trauma*

Source: Massachusetts DPH, Chapter 55 Report * - Denotes from Interviews

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The Problem : Costs and Consequences

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Economic Impact

Cost of Opioid Crisis in MA:

$15.2 billion (2017)

$9.7 billion = Productivity losses $4.5 billion = Health care costs $50 0 m illion = Criminal justice costs $550 m illion = Public safety costs

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Industry-Specific Impacts

Source: Massachusetts DPH (2018)

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Intergenerational and Community Impact

Criminal Justice System Neonatal Abstinence Syndrome Grandparents Foster Care System

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Unique Challenges in Western Massachusetts

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Unique Challenges in Western Massachusetts

Access to Treatment

  • Medications for Opioid Use

Disorder (MOUD)

  • Transportation
  • Rural Isolation
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Unique Challenges in Western Massachusetts

Upstream Factors

  • Socioeconomic Distress
  • Trauma
  • Housing
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Unique Challenges in Western Massachusetts

Stigma

General public Medical professionals MOUD People in recovery

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Best Practices and Innovative Models in Western MA

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BEST PRACTICES

Com m unity Collaboration Prevention Early Intervention Treatm ent Recovery Support Services Harm Reduction

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Community Collaboration

Best Practices

  • Different types of

coalitions

  • Aligned leadership

Innovative Models

  • Hampshire HOPE
  • Opioid Task Force
  • Berkshire Opioid Abuse

Prevention Collaborative

  • Hampden County Addiction

Taskforce

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Prevention

Best Practices

  • Use of Prescription

Drug Monitoring Program (PDMP)

  • Academic detailing
  • Education on safe

storage and disposal

  • Prevention coalitions

Innovative Models

  • Young Adult Empowerment

Collaborative

  • Franklin Family Drug Court
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Early Intervention

Best Practices

  • Models targeting high-

risk populations

  • Integration of

addiction services in primary care

Innovative Models

  • Drug and Addiction

Recovery Team (DART)

  • Engaging Mothers for

Positive Outcomes with Early Referrals (EMPOWER)

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Treatment

Best Practices

  • Providing MOUD
  • Increasing touchpoints for

initiating MOUD

  • Access to entire treatment and

recovery continuum of care

Innovative Models

  • Franklin County Sheriff’s

Office

  • After Incarceration

Support Systems (AISS)

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Recovery

Best Practices

  • Recovery community
  • rganizations
  • Support for all pathways of

recovery

  • Recovery support services

Innovative Models

  • Recovery support centers

(8 in Western Mass)

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Harm Reduction

Best Practices

  • Syringe service programs

(SSPs)

  • Naloxone distribution
  • Safety education
  • Tapestry
  • Harm Reduction

Hedgehogs

Innovative Models

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Recommendations

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Recommendations

  • 1. Increase and improve treatment workforce regarding trauma-informed care and

physiology of addiction

  • 2. Support and expand municipal-based coalitions and strengthen county-based

coalitions

  • 3. Continue interventions that lead to cautious opioid prescribing practices
  • 4. Increase capacity of MOUD and increase MOUD initiation at vital touchpoints
  • 5. Increase treatment role of the criminal justice system
  • 6. Provide a robust and comprehensive treatment and recovery continuum of care

that is supported by payors

  • 7. Use low bandwidth technology as a cost-effective way to deliver services to

underserved areas

  • 8. Support the increased distribution of naloxone and other harm reduction strategies
  • 9. Provide funding that is sustainable for the entire continuum of care
  • 10. Address upstream factors related to OUD
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Unique Challenges in Western Mass but also Unique Opportunity to Come Together

Communities/ Leaders Health Care Systems and Other Organizations Task forces and Coalitions Academics

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Thank you!