SUBSTANCE USE IN MONTANA Overview: Scope of the Problem and Current - - PowerPoint PPT Presentation

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SUBSTANCE USE IN MONTANA Overview: Scope of the Problem and Current - - PowerPoint PPT Presentation

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SUD SUMMIT | NOVEMBER 7TH, 2017 SUBSTANCE USE IN MONTANA Overview: Scope of the Problem and Current State Actions presented by : KATIE LOVELAND MPH, MSW Loveland Consulting LLC Reference Documents STATE PERSPECTIVES Reference Documents

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SUBSTANCE USE IN MONTANA

Overview: Scope of the Problem and Current State Actions KATIE LOVELAND MPH, MSW

Loveland Consulting LLC presented by :

SUD SUMMIT | NOVEMBER 7TH, 2017

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Reference Documents

STATE PERSPECTIVES

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Reference Documents

NATIONAL PERSEPCTIVE

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What we do (and do not) know about addiction in Montana

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Substance Use Disorders are common in our state

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66,500

dependent on or abusing alcohol

Adults 18+

18,000

dependent on or abusing illicit drugs

Source: National Survey on Drug Use and Health, 2012-2014
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One in ten Montana adults is dependent on or abusing alcohol

  • r illicit drugs.
Source: National Survey on Drug Use and Health, 2012-2014
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One in four young adults used illicit drugs in the last month

Source: National Survey on Drug Use and Health, 2012-2014
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Alcohol misuse and abuse is the most common SUD

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Montana’s rates

  • f alcohol use,

binge drinking, and heavy drinking are all higher than those in the US

Source: Behavioral Risk Factor Surveillance System 2015

58% 54% 16% 20% 8% 6%

CURRENT USE BINGE DRINKING CHRONIC DRINKING

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One in three high school students reports alcohol use in the last month

Source: Youth Risk Behavior Survey, 2015

61% of students who report drinking also engage in binge drinking behavior.

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Percent of traffic fatalities that are alcohol related

34%

29%

Alcohol is a key driver of Montana’s traffic fatality rate which is almost twice that of the US

Source: National Highway Traffic Safety Administration
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More than 13%

  • f all deaths

among individuals aged 20-64 in Montana are due to excessive drinking.

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Marijuana is the most commonly used illicit drug.

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One in five high school students used marijuana in the last month.

Source: Youth Risk Behavior Survey, 2015
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The number for young adults is one in four.

Source: National Survey of Drug Use and Health, 2012-2014
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10 Year Trends in Substance Use YOUTH ADULTS

Marijuana All other illicit drugs, alcohol and cigarettes Marijuana All other illicit drugs

Source: YRBS 2007-2017, National Survey on Drug Use and Health, 2012-2014
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Year 2005 69% 57% Year 2015

Marijuana constitutes the majority

  • f criminal

drug violations in Montana

2256 of 3959 violations 1748 of 2539 violations

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Opioids are the most deadly illicit drug used in Montana.

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Montana has 70 opioid prescriptions for every 100 residents

Source: Centers for Disease Control and Prevention. US State Prescribing Rates, 2016.
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138 people died from drug

  • verdose

in Montana in 2015.

More than half died of

  • pioid overdose.
Source: Montana DPHHS Vital Statistics.
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SLIDE 22 1.4 3.2 4.1 5.2 7.7 6.2 5.3 4.2 Age-adjusted death rate per 100,000 Peak in 2008-2009

Unlike national trends, Montana’s death rate for opioid

  • verdose has trended down in the past few years
Source: Montana DPHHS Vital Statistics.
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Montana’s justice system is increasingly driven by substance use-related crimes.

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Total Annual Drug Offenses, 1980-2018

216 917 1163 1414 3633 5425 6119 5011 8110 1980 1985 1990 1995 2000 2005 2010 2015

559% increase from 1980 to 2015

Source: Montana Board of Crime Control
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Felony and misdeameanor arrest for drug offenses, 2009-2015

Source: Justice Reinvestment Project, Montana Department of Justice data 2534 2483 2398 2929 3137 3503 3735 911 1045 1046 1245 1419 1717 1834 2009 2010 2011 2012 2013 2014 2015 Misdemeanor drug arrests Felony drug arrests

101% increase in felony drug arrests from 2009- 2015

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Top 5 Adult Felony Conviction Offenses

Possession of drugs Possession of drugs Criminal endangerment Felony DUI Theft Burglary Criminal endangerment Theft Distribution

  • f drugs

Felony DUI

Source: Montana Department of Corrections, 2012-2016
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A justice system driven by SUD related crimes experiences more

Probation and Parole Violations Failures to appear Bail & bond revocations 109% 98% 189%

Source: Justice Reinvestment. 2009-2015

from 2009- 2015

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SUD cases are overloading Montana’s justice system

PRISONS

At capacity-female population has grown 30% since 2012

JAILS

67% increase in MT’s jail population from 2011-2013

PUBLIC DEFENDER CASES

Criminal case duration has increased to 1.5 years

COURTS

District court case filings have increased 21% since 2009 Source: Justice Reinvestment, Department of Corrections, Office of the Court Administrator and Office of the Public Defender
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Methamphetamine is a key driver

  • f justice system involvement

and is trending sharply up.

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METHAMPHETAMINE AND HEROIN VIOLATIONS

214 900 2005 1200 600 300 2010 2015 561 236 1243 4 7 116

427% increase in meth violations and 1557% increase in heroin violations from 2010-2015

Source: Montana Board of Crime Control Methamphetamine Heroin
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DIVISION OF CRIMINAL INVESTIGATION CASES

68 103 143 151 219 232

50 100 150 200 250 2010 2011 2012 2013 2014 2015

Marijuana Methamphetamine Drug Diversion (pills) Cocaine Heroin Ectasy

54% of all cases involve meth

Source: Montana Department of Justice, DCI administrative data
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SUDs are also a key contributor to child welfare concerns in our state.

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THE MAJORITY OF CHILD AND FAMILY SERVICES PLACEMENTS HAVE SUD INDICATED

65% 35%

BUYER 01 BUYER 01 BUYER 01 BUYER 01

Substance use not indicated Substance indicated

Source: DPHHS Child and Family Services Administrative Data, April 2016
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THE MOST COMMON SUBSTANCE INDICATED IN CFSD PLACEMENTS IS METHAMPHETAMINE

BUYER 01 BUYER 01 BUYER 01 BUYER 01

Methamphetamine 46% 18% 17% 20% Alcohol Marijuana Prescription drugs or unknown

Source: DPHHS Child and Family Services Administrative Data, April 2016
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CFSD District Court Filings are up sharply

2500 1000 1500 2000

130% increase from 2009-2015 2321 1006

Source: Office of the Court Administrator
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SUD treatment and payment systems are undergoing a massive shift nationally and in Montana.

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Shift in Understanding of SUD “Addiction is a moral failure” “Addiction is a chronic, relapsing brain disease”

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MAJOR SHIFTS IN SUD TREATMENT

Treatment limited to SUD providers Routine screening, treatment in team-based primary care settings Chronic disease management including medication assisted treatment Building a continuum of care, emphasis on community-based treatment Abstinence model Focus on inpatient beds Treatment not covered by insurance, funded by federal block grants + state dollars Coverage mandated Medicaid expansion Professional peer support and recovery Informal recovery support

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Montana’s Model Historically:

SUD treatment provided by 33 state approved providers ( Max=1 per county)

New Model

INTEGRATING AND EXPANDING CARE

More state approved providers SUD treatment being integrated into primary care, hospitals and mental health- shifting focus to community based care

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Medicaid Expansion

Covered comprehensive SUD treatment for expansion adults 90%+ of cost covered by federal dollars Practices can now be reimbursed for SUD care for adults who qualify for Medicaid-not capitated Allowed Montana to re-allocate federal block grant dollars traditionally used to treatment in new ways

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Remaining Challenges: Access

Only 7% of Montanans with an SUD are receiving treatment Only 6% of state approved providers care for pregnant women and children Most current providers don’t treat co-occurring mental illness or medical illnesses that can interfere with recovery

Source: Manatt Health, 2017
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Remaining challenges: MAT access

SUD Patients receiving Medicaid Assisted Treatment in Outpatient Care

50% 25% 56 1 23 6 27% 8% Source: Manatt Health, 2017

Only 16 physicians in Montana are certified to prescribe buprenorphine

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To learn more

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NOT OFTEN PRESENT IN THE OFFICIAL SYSTEM 90% of those with SUD not receiving treatment. TRAUMA HISTORY, EARLY ONSET OF SUBSTANCE USE ACCESS TO TREATMENT IS LIMITED, ESPECIALLY IN RURAL AREAS PRIMARY ENTRY INTO TREATMENT IS THROUGH THE JUSTICE SYSTEM SUD IS ONE CONCERN OF MANY HEALTH AND FINANCIAL WORRIES

LIVED EXPERIENCE OF SUBTANCE USER IN MT

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To learn more

See maps in the Substance Use in Montana Report

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WHAT INDIVIDUALS WITH LIVED SUD EXPERIENCE IN MONTANA WANT YOU TO KNOW

Talk to more addicts and people in recovery. Understand our perspective. Addiction is a disease, not just bad choices. We face a lot of stigma. Accessing treatment, housing and jobs is a challenge.

Source: Focus group themes, Montana Healthcare Foundation, June 2017

“ “

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WHAT INDIVIDUALS WITH LIVED SUD EXPERIENCE IN MONTANA WANT YOU TO KNOW

We want to be treated with compassion but the system is based on punishment and fear. We worry that our criminal history will define us forever. We need to make it easier for children and parents to get help. Caring professionals make a big difference.

Source: Focus group themes, Montana Healthcare Foundation, June 2017

“ “

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Health and justice partners in Montana are working together in new ways to address SUD.

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INNOVATIONS IN SUD IN MONTANA

DRUG TREAMENT COURTS MAT HUB AND SPOKE MODEL

JUSTICE REINVESTMENT 24/7 PROGRAM AND OTHER MONITORING INITIATIVES MORE STATE APPROVED PROVIDERS

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To learn more

Stay tuned for today’s speakers & learn from other summit participants

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Thank you

QUESTIONS? Katie Loveland 406-431-9260 lovelandk@gmail.com