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Dr. John McAuliffe Medical Director, Sauk Prairie Memorial Hospital
Sharon Boesl, Ph.D., LMFT
Mental Health and Recovery Services Sauk County Department of Human Services
Slides are courtesy of:
The Opioid Epidemic
0 2,000 4,000 6,000 8,000
10,000 12,000 14,000 16,000 18,000
Rx Opioids Heroin
Opioid Pain Relievers Driving U.S. Overdose Epidemic, Heroin Catching Up
Original Data Matt Gladden, CDC
(overdose deaths can involve multiple drugs - not mutually exclusive)
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Epidemiology Wisconsin
p Death certificates p Hospital discharge and emergency
department data p Prescription Drug Monitoring Program
(PDMP) p Medical Examiner or Coroner data p Emergency department encounter data p Wisconsin Ambulance Run Data System
Surveillance: Data Sources and Systems
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Wisconsin Age-Adjusted Injury Death Rate, 1999-2013
40
45
50
55
60
65
70
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
27% increase
CDC WISQARS, 9/2/2015
Leading Injury Death Rates, Wisconsin Residents, 1999-2013
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
1999
20
00 20
01 20
02 20
03 20
04 20
05 20
06 20
07 20
08 20
09 20
10 20
11 20
12 20
13
Dea
ths
per
10
0,0
00
peo
ple
Year
Falls
Drug Overdose
Motor Vehicle Traffic-related
Age-adjusted, Source: DHS, OHI
5
708 deaths
Wisconsin Unintentional Drug Poisoning, Age-Adjusted Death Rates, 1999-2013 All Races, Both Sexes, All Ages―ICD-10 Codes: X40―X44
2.3 3.0 3.3
4.4 5.0 5.3
6.7
7.9 8.4
7.7 8.1 8.3
9.6 10.1
12.5
0
2
4
6
8
10
12
14
Rat
es p
er 1
00
,00
0
122 deaths
CDC WISQARS: National Center for Injury Prevention and Control, CDC Data Source: NCHS Vital Statistics System for numbers of deaths. Bureau of Census for population estimates.
Number of Drug Overdose Deaths Involving Opioid (morphine-like) Pain Relievers and Other Drugs, Wisconsin, 1999–2014
Source: DHS, OHI 3.5Xincreaseinheroin,from2009(77)to2014(267)
0
50
100
150
200
250
300
350
400
450
1999
20
00
2001
20
02
2003
20
04
2005
20
06
2007
20
08
2009
20
10
2011
20
12
2013
20
14
Opioid pain relievers (T40.2-T40.4) Benzodiazepines (T42.4)
Heroin (T40.1)
Cocaine (T40.5)
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Source: DHS, OHI 4b=All Prescription Opioid Analgesics, except Methadone
Overdose Deaths by Age Group and Opioid Type, 2010-2014 (Any Mentions)
<15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
OPIOIDLSMTD(4b) 8 18 83 142 149 150 167 226 230 189 89 73
HEROIN(5) 17 150 194 140 115 74 70 72 40 28 7
0
50
100
150
200
250
Five
Yea
r (t
otal
cou
nt)
Rate of Deliveries With Maternal Opioid Use, Rate of Neonatal Abstinence Syndrome, Wisconsin, 2009–2014
2009 2010 2011 2012 2013 2014 Maternal Opioid Use 335 506 719 842 1001 1041
NAS N=227 305 384 398 540 508
12 Source: DHS 12
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p Chronic untreated heroin use is associated with: n Risk of fetal growth restriction n Abruptio plancentae n Fetal death n Preterm labor n Exposure to episodes of withdrawal
n The lifestyle issues associated with illicit drug use also create risk for the mother and developing fetus.
Effects on Pregnancy
Neonatal Abstinence Syndrome
Infants with neonatal abstinence syndrome may have uncoordinated sucking reflexes leading to poor feeding, become irritable, and produce a high-pitched cry. Long term outcome study of infants with in utero exposure to opioid exposure are limited. From: Committee Opinion, The American College of Obstetricians and Gynecologists (May 2012).
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Actions to Prevent Opioid Harm and Abuse
Reversal Naloxone Access
Policies Supporting all sectors
Education • Prescriber
education • Community
education • Naloxone
access
Tracking and Monitoring
• Prescription Drug Monitoring System (PDMP)
• Surveillance
Enforcement • Identification verification at
pharmacies • Law enforcement training
on prescription drug misuse and diversion
Medication Disposal • Keeping medications safe at home • Proper medication disposal guidelines
consistent with FDA standards • Community take-back programs
Treatment Options • Treatment Centers • Outpatient and residential
treatment at state-funded treatment providers
Our local project: Sauk County Medication Assisted Treatment
Grant
The grant’s goals: 1. Increase medication assisted treatment as an option for sobriety and increase the
number of providers in each area to provide better access to treatment.
2. Utilize the C.A.R.E. concept/process (Community Activated Recovery Enhancement) as a model in four (4) strategic locations and include community stakeholders in all aspects of developing a coordinated response to this alarming health issue. 3. Utilize all existing funding resources FIRST for treatments including individual’s existing health care funding such as private insurance/Medical Assistance. 4. With oversight and State approval some funds (about 25%) are designated for gap populations–individuals who are particularly vulnerable and in need of services and community support (individuals transitioning from incarceration, pregnant, individuals with Hepatitis C, and uninsured individuals.)
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FDA approved medications n Buprenorphine products (Suboxone and Subutex) n Naltrexone (Vivitrol) n Methadone
Medication-Assisted Treatment
Schedule III narcotic medication for the maintenance treatment of opioid dependence
n Reduces cravings and withdrawal symptoms n Available at OTPs and from DATA waived
physicians
Buprenorphine Products (Suboxone and Subutex)
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A prescription injectable medication containing naltrexone
n Administered once a month to prevent relapse to opioid dependence after detox
n Must stop all opiates 7-10 days prior to injection
Naltrexone (Vivitrol)
p Provides comprehensive services n Medication n Counseling n Case management n Recovery supports
p Uses many paths to recovery n Medical intervention n Professional treatment n Mutual support groups n Peer supports n Family supports n Faith supports
Medication-Assisted Treatment (MAT)
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p Develops diversion practices and policies p Develops Recovery-Oriented Systems of Care
(ROSC), an integrated care model:
Medication-Assisted Treatment (MAT)
--A framework to guide system transformation --A value-driven approach to structuring behavioral health systems --A network of clinical and non-clinical and supports --An initiative to find service gaps and community needs to transform
the community into a stronger support for life-long recovery
William White on Recovery Oriented Systems of Care (ROSC)
“This movement represents a shift away from crisis-oriented, professionally directed, acute-care approach with it’s emphasis on isolated treatment episodes, to a recovery management approach that provides long-term supports and recognizes the many pathways to healing.”
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p Screen and intervene in health care facilities p Establish relationships with natural supports
to promote early identification p Offer pre-treatment peer support groups p Use peers to welcome consumers p Offer peer mentors at first contact p Build linkages between levels of care through
peer-based recovery support services
Assertive Outreach and Engagement
State Funded
n Medication-assisted treatment training for prescribers and providers
n Heroin Opiate Prevention and Education (H.O.P.E.) Programs
Federally Funded (Grants) n Community Activated
Recovery Enhancement (C.A.R.E.) Project
n Prescription Drug Monitoring Program enhancement
n Prevention grants focus on prescription drugs
DHS Efforts
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Programs Offering Methadone for Opioid Addiction
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EauClaireMetroTreatmentCenter,EauClaire,715-834-1078
WisconsinComprehensiveTreatmentCenters,Wausau,715-845-3637
WisconsinComprehensiveTreatmentCenters,GreenBay,920-337-6740
WisconsinComprehensiveTreatmentCenters,Appleton(ValleyHealthServices),920-733-4443
AddictionMedicalSolutions,Oshkosh,920-232-2332
GundersonLutheranHealthSystems,LaCrosse,608-775-3395
PremierCareofWisconsin,FondduLac,920-926-0101
WisconsinComprehensiveTreatmentCenters,Sheboygan,920-458-6527
WisconsinComprehensiveTreatmentCenters,Madison(BadgerRoad),608-250-2512
WisconsinComprehensiveTreatmentCenters,Madison(MadisonHealthServices-WorldDairyExpoDrive),608-242-0220
WisconsinComprehensiveTreatmentCenters,Waukesha,262-549-6600
WisconsinComprehensiveTreatmentCenters,WestMilwaukee,414-672-3801
WisconsinComprehensiveTreatmentCenters,Milwaukee(RiverShores),414-967-7012
WisconsinComprehensiveTreatmentCenters,Milwaukee(10th Street),414-744-5370
WisconsinComprehensiveTreatmentCenters,Racine,262-598-1392
WisconsinComprehensiveTreatmentCenters,Beloit,608-361-7200
H.O.P.E.ProjectNorthCentralRegionOpioidConsortiumHeadquarters:Woodruff715-358-1221
Opioid Treatment Programs (OTP)
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AddictionMedicalSolutions,Onalaska,608-783-0506
Flipoverformoreoptionsdhs.wisconsin.gov/opioids/treatment.htm November2015
Newly Funded Opioid Treatment Programs
Opioid Treatment Services
Theseprojectsarefundedbyeitherstateorfederaldollarsandprovidearangeofservicestohelpindividualsovercomeanaddictiontoopioids.Theseprogramsdonotprovidemethadonemaintenancetreatment.
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H.O.P.E.Project:NorthLakesCommunityClinicHeadquarters:Ashland,715-682-5207
H.O.P.E.Project:NorthCentralRegionOpioidConsortiumHeadquarters:Woodruff,715-358-1221
H.O.P.E.Project:Libertas/PreveaHealthCollaborativeHeadquarters:Marinette,715-735-0095
C.A.R.E.ProjectHeadquarters:Baraboo,608-355-4200
dhs.wisconsin.gov/opioids/treatment.htm November2015
Medication-Assisted Treatment
Northern tier of Wisconsin: n Provide medication-assisted treatment to the
underserved and high-need areas in Wisconsin n Provide residential detoxification and
stabilization services n Reduce the rate of relapse and number of
deaths n Reduce the number of infants born to untreated
opioid addicted women n Create relationships with community providers
to improve treatment availability
H.O.P.E. Programs
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Sauk, Columbia, Richland counties: n Replicates a program originated by St. Vincent
DePaul in Prairie Du Sac n Involves community stakeholders committees n Expands the provision of medication-assisted
treatment n Employs Community Recovery Specialists
Employs dually credentialed clinician for assessments and treatment planning
n Adds a mobile nurse to support individuals who choose to detox at home
n Contracts with providers for treatment services, detox, outpatient, inpatient residential, etc.
C.A.R.E. Project
Elizabeth Collier State Opioid Treatment Authority Elizabeth.Collier@dhs.wisconsin.gov 608-267-7707 Andrea Jacobson Substance Abuse Treatment Coordinator andrea.jacobson@dhs.wisconsin.gov 608-261-0652
For More Information
dhs.wisconsin.gov/opioids/index.htm
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