CommStat 3/29/18 SubStat What is it? SubStat is a mechanism to - - PowerPoint PPT Presentation

▶
commstat 3 29 18 substat
SMART_READER_LITE
LIVE PREVIEW

CommStat 3/29/18 SubStat What is it? SubStat is a mechanism to - - PowerPoint PPT Presentation

Aug 10, 2023 27 likes •569 views

CommStat 3/29/18 SubStat What is it? SubStat is a mechanism to identify individuals involved with Opioid addicted behavior (i.e. overdoses) with the goal of the access to treatment offering. Information from SubStat is brought back to the

slide-1
SLIDE 1

CommStat 3/29/18

slide-2
SLIDE 2
slide-3
SLIDE 3

SubStat

What is it?

SubStat is a mechanism to identify individuals involved with Opioid addicted behavior (i.e.

  • verdoses) with the goal of the access to treatment
  • ffering.

Information from SubStat is brought back to the involved police departments to inform officers.

slide-4
SLIDE 4

Who is involved:

Burlington Police Department (1/17) Colchester Police Department (1/17) South Burlington Police Department (1/17) Winooski Police Department (1/17) Essex Police Department (7/17) Milton Police Department (7/17) Shelburne Police Department (10/17) New as of 3/18/18: Richmond Police Department Vermont State Police Hinesburg Police Department Williston Police Department

  • States, Attorney
  • DOC – Field
  • DCF – Local
  • Field Director
  • Street Outreach
  • Vermont Information Center
  • Chittenden County Opiate Alliance
slide-5
SLIDE 5

Overdose Data

7/1/17 through 3/22/18

Gender

Male Female

21/75 Female - 54/75 Male

Fatal/Non-Fatal

Fatal Non-Fatal

62/75 Non-Fatal – 13/75 Fatal

slide-6
SLIDE 6

Since July 1st, 2017, the SubStat group has discussed 194 separate police interactions.

Breakdown of Involvements Discussed

Overdoses (Non-Fatal and Fatal) Drug Possessions Untimely Deaths Assists Theft Other

slide-7
SLIDE 7

5 10 15 20 25 30 35 40 45

Overdoses Per Town 7/1/17-3/22/18 (Fatal and Non-Fatal)

Burlington - 39 Winooski - 11 Colchester - 11 South Burlington Milton - 4

slide-8
SLIDE 8

2 4 6 8 10 12 14 16 18

Winooski - 15 Burlington - 9 Cholchester - 6 South Burlington

  • 5

Milton - 4 Incidence Rate per 10,000

Fatal and Non-Fatal Overdoses by Town, per 10,000 Residents

Colchester -

slide-9
SLIDE 9

5 10 15 20 25 12-19 20-29 30-39 40-49 50+ Incidence Rate per 10,000 Age Category (years)

Fatal and Non-Fatal Overdoses by Age Category and Sex per 10,000 Residents

Male Female

slide-10
SLIDE 10

Lessons Learned Thus Far

  • 1. The need for the “law enforcement” community to meet
  • 2. The need to look at the significant role of “law

enforcement” within this epidemic

  • 3. The need to pay attention to Opioid data to tell us the

stories of our successes and failures

  • 4. The need to further connect to social services and ensure

point of service treatment when needed

slide-11
SLIDE 11

Data Discussion

Kayla Donohue, MPH kayla@unitedwaynwvt.org kdonohue@bpdvt.org

slide-12
SLIDE 12

How can we use data?

  • To respond to

today’s needs

  • Manage our teams

better

  • Improve efficiency
  • Inform policy

Establish that our interventions lead to lasting change

  • How much did we

spend?

  • How much did we do?
  • Is anybody better off?

Data for Action Data for Impact

https://ssir.org/articles/entry/using_data_for_action_and_for_impact

slide-13
SLIDE 13

What do we need?

  • Access to accurate data
  • Measurable research questions
  • Ex. How do burglary rates correlate with opioid use in

Chittenden County from 2013-2017?

  • Priorities
  • Prevention
  • Enforcement
  • Treatment
  • Recovery
  • Desired outcomes or targets
  • Ex. Reduce burglaries by 20% by 2020.
slide-14
SLIDE 14

What do we have?

  • Hub & Spoke Data
  • Median days to treatment, monthly and overall
  • Number of new service requests and new admissions
  • Average days to treatment, monthly and overall
  • Number of individuals on the waitlist
  • Number of admissions by TNQ Score category
  • Number of individuals discharged or transferred
  • Total number of clients
  • Number of waivered service providers
  • SIREN Data for Emergency Medical Services
  • Police Data
  • Vermont Department of Health
  • University of Vermont Medical Center
slide-15
SLIDE 15

200 400 600 800 1000 1200 1400 1600 1800 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 2017 2018

Individuals Receiving MAT in Chittenden County Hub & Spokes, by Provider

Total Spoke Hub CHCB Community Lund Maple Leaf Total UVM MC Howard Spoke COGS ATP

Data Source: Vermont Department of Health and Opioid Care Alliance of Chittenden County

slide-16
SLIDE 16

Data Source: Vermont Department of Health and Opioid Care Alliance of Chittenden County

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 2017 2018 Spokes 607 595 651 641 629 663 605 658 545 507 706 531 539 Hub 971 976 994 994 1009 984 964 970 985 1004 1007 1016 1014 200 400 600 800 1000 1200 1400 1600 1800

Individuals Receiving MAT at Chittenden County Hub and Reporting Spokes

slide-17
SLIDE 17

Data Source: Vermont Department of Health and Opioid Care Alliance of Chittenden County

CHCB 51% Total UVM MC 19% Howard Spoke 14% ATP 5% Lund 5% COGS 3% Community 3%

Percent of Individuals Receiving MAT at Reporting Spokes

12-month average (Feb. 2017-Feb. 2018)

  • f individuals treated

at spokes = 606

slide-18
SLIDE 18

Data Source: Howard Center Triage Report

138 130 93 87 62 53 59 23 80 84 71 58 58 41 23 24 7 11 15 10 16 17 67 75 67 44 47

20 40 60 80 100 120 140 160

Chittenden County Hub-Level Active Waitlist Volume & Average Wait Time

# Individuals Waiting Average Days to Treatment per Month Median Days Waiting

slide-19
SLIDE 19

35 37 46 43 34 25 38 44 37 42 39 30 38 29 40 28 46 53 39 40 23 24 7 11 15 14 16 17

10 20 30 40 50 60

Chittenden County Hub-Level Admission Volume & Average Wait Time

# Individuals Admitted Average Days to Treatment

Data Source: Howard Center Triage Report

slide-20
SLIDE 20

What do we have?

  • Hub & Spoke Data
  • SIREN Data for Emergency Medical Services – OD Surveillance
  • “Overdose/Abuse of Opiate”
  • Incident date, time, district
  • Medications given (Naloxone/Narcan)
  • Medication administration route
  • Police Data
  • Vermont Department of Health
  • University of Vermont Medical Center
slide-21
SLIDE 21

11 27

25 50 75 100 125 150 175 May Jun Jul Aug Sep Oct Nov Dec Monthly EMS Incidents with Primary Provider Impression of “Overdose / …” in District 03 (Chittenden Cty), 2017 Overdose / Opiate Overdose / Any

45 109

25 50 75 100 125 150 175 May Jun Jul Aug Sep Oct Nov Dec Monthly EMS Incidents with Primary Provider Impression of “Overdose / …” in VT, 2017

Data Source: SIREN EMS Incident Reports

VT EMS Responses to Overdose Incidents

slide-22
SLIDE 22

3 23 19 78

10 20 30 40 50 60 70 80 90 Chittenden Cty. (D3) Vermont Preliminary EMS Incidents with Primary Provider Impression of “Overdose / …” By Region, Jan 2018 Overdose / Opiate Overdose / Any 1 2 3 4 5 6 7 8 2 4 6 8 10 12 14 16 18 20 22 Preliminary VT EMS Incidents with Primary Provider Impression of “Overdose / …” By Hour of Day, Jan 2018 Overdose / Any Overdose / Opiate

Data Source: SIREN EMS Incident Reports

  • Jan. 2018 SIREN Data w/ Time of Incident
slide-23
SLIDE 23

What do we have?

  • Hub & Spoke Data
  • SIREN Data for Emergency Medical Services
  • Police Data
  • SubStat Incidents – Chittenden County
  • Crime Rates (burglary, theft, fraud, trafficking, etc.)
  • Opioid-related events
  • Calls for service
  • Vermont Department of Health
  • University of Vermont Medical Center
slide-24
SLIDE 24

1 2 3 4 5 1.2-1.16 1.16-1.30 1.30-2.13 2.13-2.27 2.27-3.13 Opioid-Related Overdose Calls Responded to by BPD, CPD, SBPD, MPD, EPD, SPD & WPD per SubStat Period

Data Source: Valcour Incident Report

16

Non-Fatal Opioid-Related Overdose Incidents Among SubStat Partners Since Jan. 4th

1

Fatal Opioid-Related Overdose Incidents Among SubStat Partners Since Jan. 4th

SubStat Opioid-Related Overdose Incidents

slide-25
SLIDE 25

What do we have?

  • Hub & Spoke Data
  • SIREN Data for Emergency Medical Services
  • Police Data
  • Vermont Department of Health
  • Fatal overdoses
  • Prescription drug monitoring reports
  • BRFSS & YRBS data briefs
  • University of Vermont Medical Center
slide-26
SLIDE 26

39 58 51 70 63 74 96 101 35 44 37 45 26 31 35 33 1 9 10 21 34 33 43 39 4 5 6 12 17 28 49 67 20 40 60 80 100 120 2010 2011 2012 2013 2014 2015 2016 2017

Number of Accidental and Undetermined Opioid- Related Fatalities Among Vermont Residents

All Opioids Rx Opioid (No Fentanyl) Heroin Fentanyl

slide-27
SLIDE 27

11 16 16 17 13 17 21 28 10 12 10 13 5 4 3 8 4 3 5 8 10 12 9 1 3 1 5 8 13 20 5 10 15 20 25 30 2010 2011 2012 2013 2014 2015 2016 2017

Accidental or Undetermined Opioid-Related Fatalities Among Chittenden County Resident

All Opioids Rx Opioid (No Fentanyl) Heroin Fentanyl

slide-28
SLIDE 28

17 18 19 20 24 35 16 17 13 17 21 28 5 10 15 20 25 30 35 40 2012 2013 2014 2015 2016 2017

Accidental and Undetermined Opioid-Related Fatalities in Chittenden County and Among Chittenden County Residents

Occurred in Chittenden County Chittenden County Residents

slide-29
SLIDE 29

What do we have?

  • Hub & Spoke Data
  • SIREN Data for Emergency Medical Services
  • Police Data
  • Vermont Department of Health
  • University of Vermont Medical Center
  • Opioid-related Emergency Department encounters
  • Discharge Disposition
  • Zip code of residence
slide-30
SLIDE 30

5 10 15 20 25 30 Jan MarMay Jul Sep Nov Jan MarMay Jul Sep Nov Jan MarMay Jul Sep Nov Jan 2015 2016 2017 2018

Data Source: University of Vermont Medical Center

Monthly UVM Medical Center ED Encounters Coded as “Opioid OD” & “Opioid Poisoning”

slide-31
SLIDE 31

9 21 13 31 30 51 61 28 33 44 44 41 19 10 20 30 40 50 60 70 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1* 2015 2016 2017 2018

UVMMC Emergency Department Encounters Coded as “Opioid OD” & “Opioid Poisoning”

* Data for Jan. and Feb. 2018 only Data Source: University of Vermont Medical Center

slide-32
SLIDE 32

* Data for Jan. and Feb. 2018 only Data Source: University of Vermont Medical Center

9 30 33 19 21 51 44 13 61 44 31 28 41 10 20 30 40 50 60 70

UVMMC Emergency Department Encounters Coded as “Opioid OD” & “Opioid Poisoning”

2015 2016 2017 2018 Quarter 1 Quarter 2 Quarter 3 Quarter 4 *

slide-33
SLIDE 33

9 10

8 9 9 15 12 11 15 14 11 9 11 13 1 3 5 6 9 6 3 5 5 7 7 11 12 12 12 22 17 18 28 18 15 13 17 16

5 10 15 20 25 30

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2018 2015-2017 Average 2015-2017 Min 2015-2017 Max

Data Source: University of Vermont Medical Center

Average Monthly UVM Medical Center Opioid- Coded ED Encounters, by Year

slide-34
SLIDE 34

Data Source: University of Vermont Medical Center

UVM Medical Center Opioid-Related ED Visits

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2015 2016 2017 2018

Discharge Disposition of UVM MC ED Encounters With Dx Code “Opioid OD/ Poisoning”, by Year

Transfer Other Rehab D/T to SNF w/ MCR Cert Deceased D/T Psych Hospital/Psych Dist PRT Unit Hospital w/PACHIPR D/T Different Type of Healthcare Facility D/T Court/Law Enforcement Psych Hospital or Psych Distinct Unit Other Hospital Hospice-Home Home Health Care Against Medical Advice Home or Self Care (Routine)

slide-35
SLIDE 35

Data Source: University of Vermont Medical Center

UVM Medical Center Opioid-Related ED Visits

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

2017-2018 Discharge Disposition of UVM MC ED Encounters With DX Code “Opioid OD/ Poisoning”, by Month

Transfer Other Rehab Home Health Care D/T to SNIF w/ MCR Cert Deceased D/T Different Type of Healthcare Facility Psych Hospital or Psych Distinct Unit Against Medical Advice Home or Self Care (Routine)

slide-36
SLIDE 36

In The News: MAT in Prison

slide-37
SLIDE 37

Senate Bill S. 166 – Expanding MAT in Prison

slide-38
SLIDE 38

“Americans call opioid abuse an epidemic because it kills more people in the United States than murder and car accidents combines. It has proven more fatal than AIDS. It is like fighting the entire Vietnam War every year, with the same death toll. The problem is that we don’t treat it like an epidemic. If we did, we’d be halfway out of it already.” “Epidemics require the fast, widespread deployment of imperfect but effective interventions.” “The most effective opioid epidemic intervention that America is failing to deploy is widespread, low-barrier access to buprenorphine.” “Buprenorphine injections alone won’t work for everyone, and they aren’t as perfect as a plan that accounts for everything an addicted person needs, such as counseling, psychosocial support, housing and employment. But not going full-bore on buprenorphine for these reasons is allowing the perfect to deal a death blow to the good.”

More Buprenorphine Now

Chief Brandon Del Pozo Excerpts:

slide-39
SLIDE 39
slide-40
SLIDE 40

In a review of 4 randomized trials, interim treatment (daily medication & emergency counseling): ↓Illicit opioid use ↑ Retention ↓ Criminality ↑ Likelihood of entry into comprehensive treatment

slide-41
SLIDE 41
slide-42
SLIDE 42

Patients receiving interim buprenorphine treatment: ↑ Percent of specimens testing negative for illicit opioids ↓ Use of any intravenous drug

slide-43
SLIDE 43
slide-44
SLIDE 44

Opioid agonist treatment alone is effective in patients with opioid dependence, regardless of whether they receive counseling

slide-45
SLIDE 45
slide-46
SLIDE 46

3 treatment groups: 1) standard medical management one-weekly dispensing, 2) standard medical management thrice-weekly dispensing, 3) enhanced medical management thrice weekly dispensing All three groups: ↑ opioid-negative urine specimens ↑ maximum number of consecutive weeks abstinent from illicit opioids ↓frequency of illicit opioid use **But, not statistically significant among the 3 treatment groups

slide-47
SLIDE 47

There remains no clear evidence that cognitive behavioral therapy and contingency management reduce opiate use when added to buprenorphine and medical management in opiate users seeking treatment

slide-48
SLIDE 48

Safe Recovery is a program of the Howard Center that was started in 2000. It is a statewide professionally staffed recovery center for people who are addicted to heroin or prescription pain medications.

slide-49
SLIDE 49
  • 4,945 members of the syringe exchange
  • 228 clients have received treatment though the Hub and Spoke

model

  • 34% of clients came from outside of Chittenden county

Safe Recovery by the numbers, calendar year data 2017

  • The syringe exchange was visited 7,565 times
  • 1,338 clients visited the exchange
  • 6,414 people accessed syringe supplies through secondary exchange
  • 306 new syringe exchange clients
  • Clients from every county in Vermont accessed our services
  • 828 clients were referred to treatment

Who we are serving

  • 82% of clients have reported experiencing homelessness
  • 57% of clients have been incarcerated

General Safe Recovery Statistics

slide-50
SLIDE 50

Drug-Related Fatalities Involving Opioids 39 58 51 70 63 74 96 101

35 44 37 45 26 31 35 33 1 9 10 21 34 33 43 39 4 5 6 12 17 28 49 67

2010 2011 2012 2013 2014 2015 2016 2017 Total number of accidental and undetermined manner drug-related fatalities involving an opioid (categories not mutually exclusive) Total opioid Rx opioid Heroin Fentanyl

Source: Vermont Department of Health Vital Statistics System

slide-51
SLIDE 51

Data Source: VPMS 2017 Quarter 4

Statewide VPMS Quarterly Trends

6.9% 6.4% 6.0% 6.2% 6.2% 5.8% 5.2% 5.5%

Jan-Mar 2016 Apr-Jun 2016 Jul-Sep 2016 Oct-Dec 2016 Jan-Mar 2017 Apr-Jun 2017 Jul-Sep 2017 Oct-Dec 2017

Percent of Vermont Population Receiving at Least One Opioid Analgesic Prescription

*2016 population estimates had not been released at the time the previous quarterly reports were

  • published. Therefore, the percentages previously reported utilized 2015 population estimates and

are slightly different.

slide-52
SLIDE 52

Data Source: VPMS 2017 Quarter 4

Statewide VPMS Quarterly Trends

61.8 62.1 61.5 60.9 60.7 59.8 60.4 59.6

Jan-Mar 2016 Apr-Jun 2016 Jul-Sep 2016 Oct-Dec 2016 Jan-Mar 2017 Apr-Jun 2017 Jul-Sep 2017 Oct-Dec 2017

Vermont Average Daily MME by quarter and year

110,140,916 101,496,692 95,223,352 98,832,830 94,341,619 91,057,095 85,741,367 84,995,940

Jan-Mar 2016 Apr-Jun 2016 Jul-Sep 2016 Oct-Dec 2016 Jan-Mar 2017 Apr-Jun 2017 Jul-Sep 2017 Oct-Dec 2017

Vermont Total MME Dispensed by Quarter and Year

slide-53
SLIDE 53

Fewer Opioid Pain Relievers are Being Dispensed in Vermont - Total MME Opioid Analgesics per 100 Residents

73186 71543 73490 77095 68933 57019 50000 55000 60000 65000 70000 75000 80000 85000 90000 95000 100000

2012 2013 2014 2015 2016 2017

Data Source: VPMS Note: Prior to rescheduling tramadol was not reported to VPMS. On August 14, 2014 tramadol was changed from a schedule V to a schedule IV drug. There was a 26% decrease in dispensed opioids between 2015 and 2017, years that include tramadol.

slide-54
SLIDE 54
  • 4/19 (Thursday) 8:30-11:00 AM
  • Contois Auditorium

Next CommStat Meeting