Substance Misuse and Mental Health Archives - Page 9 of 12

Substance Misuse and Mental Health

Over one million Americans struggle with a substance misuse disorder. Alarmingly, we are experiencing a set of epidemics, as more than one million people have died in the past decade from drug overdoses, alcohol misuse and suicide. If these trends continue, drugs, alcohol and suicide could take the lives of an estimated 1.6 million Americans in the next 10 years.

Many factors contribute to drug and alcohol misuse and suicide, including family and social relationships, social and emotional development, childhood trauma, lack of economic opportunity and the cycle of poverty. There is an urgent need to invest in evidence-based, multisector programs and interventions that help people at crisis points and that address the root causes of these deaths.

New Data Shows Drug Overdoses Increased in 40 States and Washington, D.C.

Opioids Put Death Rates on Worst Case Scenario Track for the Nation

December 21, 2017

Washington, D.C., December 21, 2017 – In 2016, 63,632 Americans died from drug overdoses, an increase of 21 percent over 2015, according to data released by the Centers for Disease Control and Prevention (CDC) today. This represents a 50 percent increase over five years and 225 percent increase since 1999.

Trust for America’s Health’s analysis of the data found that:

Overdose rates increased in 40 states and Washington, D.C. between 2015 and 2016.
Seventeen states had increases of 25 percent or more. The largest increases were in Washington, D.C. (109 percent), Maryland (59 percent) and Florida (46 percent). Rates decreased in nine states.
The highest 2016 drug death rates were in West Virginia (52.0 per 100,000 deaths), Ohio (39.1 per 100,000 deaths) and New Hampshire (39.0 per 100,000 deaths).
In 2016, 24 states and Washington, D.C. had rates above 20 per 100,000 deaths. In 2005, no state had a rate above 20 per 100,000 deaths and only five states had rates above 15 per 100,000 deaths.

Around two-thirds of these deaths were opioid-related. The increase was largely driven by the continued escalation of deaths from fentanyl and other synthetic opioids –topping 19,410 in 2016, up from 9,580 in 2015 and 5,540 in 2014. This is an increase of more than 70 percent for a third year in a row – highlighting the evolving nature of the opioid epidemic, expanding to include more lethal, illicit drugs. Heroin-related deaths totaled around 15,500 and there were 14,500 prescription painkiller deaths. Death from all other drugs other than fentanyl and other synthetic opioids only rose by 3 percent.

The rapid rise in drug deaths is putting the country on a “worst case” scenario track – where these deaths could reach 163,000 per year by 2025 if recent trends hold, based on projections in a recently released TFAH and Well Being Trust (WBT) report Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy. The report calls for a comprehensive, multi-prong approach to respond to the “despair deaths” of drugs, alcohol and suicide – from immediate harm reduction to a long-term strategy to bolster the nation’s resilience.

“The escalating growth of opioid deaths is downright frightening – and it’s getting worse,” said John Auerbach, president and CEO of TFAH. “Every community has been impacted by this crisis and it’s getting lots of headlines, yet we’re not making the investments or taking the actions needed at anywhere near the level needed to turn the tide.”

“These are not simply numbers – these are actual lives. Seeing the loss of life at this dramatic rate calls for more immediate action,” said Benjamin F. Miller, PsyD, Chief Policy Officer, Well Being Trust. “Our fractured approach to a multi-systemic issue isn’t enough and it isn’t working. We collectively need to take a more comprehensive and systemic approach, beginning with prevention through recovery and treatment, to double down on investing in systems change for real results.”

Additional TFAH Analysis

Certain demographics had particularly high rates of drug overdoses in 2016, including: men (26.2 per 100,000) and 35 to 44-year-olds (35.0 per 100,000).
Synthetic opioids including fentanyl had the largest increase in the number of deaths between 2015 and 2016 (103 percent increase); heroin and natural and semisynthetic opioids (including most commonly prescribed opioid medications) also increased by 19 percent and 14 percent respectively.
Synthetic opioid death rates have been increasing dramatically in the past few years. In 2013, deaths were at 1.0 per 100,000; in 2014, 1.8 per 100,000; in 2015, 3.1 per 100,000; and in 2016, they reached 6.2 per 100,000. This a six-fold increase in three years.

Drug Overdose Deaths, by State
State	2015 Drug Overdose Rate Deaths per 100,000	2016 Drug Overdose Rate Deaths per 100,000	2016 Rates, Highest to Lowest	Percent change, 2015-2016	2025 Worst Case Scenario Projections Deaths per 100,000
Alabama	15.7	16.2	35	3%	45.5
Alaska	16.0	16.8	32	5%	46.9
Arizona	19.0	20.3	25	7%	54.0
Arkansas	13.8	14.0	38	1%	38.9
California	11.3	11.2	45	-1%	35.0
Colorado	15.4	16.6	34	8%	44.6
Connecticut	22.1	27.4	12	24%	62.8
Delaware	22.0	30.8	9	40%	60.0
D.C.	18.6	38.8	4	109%	52.7
Florida	16.2	23.7	17	46%	45.4
Georgia	12.7	13.3	39	5%	36.6
Hawaii	11.3	12.8	40	13%	33.4
Idaho	14.2	15.2	36	7%	36.9
Illinois	14.1	18.9	28	34%	39.7
Indiana	19.5	24.0	16	23%	54.0
Iowa	10.3	10.6	47	3%	29.0
Kansas	11.8	11.1	46	-6%	32.7
Kentucky	29.9	33.5	6	12%	82.1
Louisiana	19.0	21.8	22	15%	52.6
Maine	21.2	28.7	11	35%	57.0
Maryland	20.9	33.2	7	59%	59.9
Massachusetts	25.7	33.0	8	28%	74.3
Michigan	20.4	24.4	15	20%	63.7
Minnesota	10.6	12.5	41	18%	32.4
Mississippi	12.3	12.1	42	-2%	33.6
Missouri	17.9	23.6	18	32%	49.2
Montana	13.8	11.7	44	-15%	40.1
Nebraska	6.9	6.4	51	-7%	20.0
Nevada	20.4	21.7	23	6%	59.4
New Hampshire	34.3	39.0	3	14%	88.7
New Jersey	16.3	23.2	19	42%	45.9
New Mexico	25.3	25.2	13	0%	67.5
New York	13.6	18.0	30	32%	41.5
North Carolina	15.8	19.7	26	25%	44.4
North Dakota	8.6	10.6	48	23%	23.4
Ohio	29.9	39.1	2	31%	80.3
Oklahoma	19.0	21.5	24	13%	52.4
Oregon	12.0	11.9	43	-1%	41.2
Pennsylvania	26.3	37.9	5	44%	71.9
Rhode Island	28.2	30.8	10	9%	82.1
South Carolina	15.7	18.1	29	15%	44.2
South Dakota	8.4	8.4	50	0%	22.9
Tennessee	22.2	24.6	14	11%	63.9
Texas	9.4	10.1	49	7%	27.1
Utah	23.4	22.3	20	-5%	60.7
Vermont	16.7	22.2	21	33%	48.3
Virginia	12.4	16.7	33	35%	34.8
Washington	14.7	14.5	37	-1%	45.2
West Virginia	41.5	52.0	1	25%	110.9
Wisconsin	15.5	19.3	27	25%	42.2
Wyoming	16.4	17.6	31	7%	46.1

Source: National Vital Statistics System, CDC; TFAH, WBT Projections from Pain in the Nation: The Drug, Alcohol and Suicide Crises and the Need for a National Resilience Strategy.

Notes: The CDC’s National Vital Statistics System data has a separate category for methadone and does not include it in the fentanyl/synthetic opioid category. The state death rates from CDC are age-adjusted. See CDC’s reports Drug Overdose Deaths in the United States, 1999–2016 and Drug Overdose Deaths in the United States, 1999–2015 for additional data and analysis.

Recommendations from Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy

Pain in the Nation calls for the creation of a National Resilience Strategy that takes a comprehensive approach by focusing on prevention, early identification of issues and effective treatment. The report highlights more than 60 research-based policies, practices and programs, including:

Improve Pain Management and Treatment by helping people heal physically, mentally and emotionally. Approaches must acknowledge that there are different types of pain and experts from mental health, medical care and other disciplines must develop team-based solutions that focus on proactively addressing pain before it gets worse.
Stem the Opioid Crisis with a full-scale approach – including promoting responsible opioid prescribing practices (such as provider education and best practices for Prescription Drug Monitoring Programs); public education about misuse and safe disposal of unused drugs; “hotspot” intervention strategies; anti-trafficking to stop the flow of heroin, fentanyl and other illicit drugs; and expanding the use and availability of rescue drugs, sterile syringes and diversion programs.
Address the Impact of the Opioid Epidemic on Children – and the Need for a Multi-Generational Response that includes substance use disorder treatment for parents and wrap-around services for children and families, including grandparents and other relatives who help care for children, and expand support for the foster care system. Model programs have been twice as effective in helping mothers achieve sobriety, reduced state custody placement of children by half and had a return on investment of $2.22 for every $1 spent on child welfare programs.
Expand and Modernize Mental Health and Substance Use Disorder Treatment Services – Toward a Goal of Focusing on the “Whole Health” of Individuals by prioritizing innovative integrated delivery models for rural and underserved urban areas and expanding the provider workforce, including those who can deliver medication-assisted treatment. Some effective substance use treatment programs have a return of $3.77 per $1 invested.
Prioritize Prevention, Reduce Risk Factors and Promote Resilience in Children, Families and Communities by limiting trauma and adverse experiences, which have the biggest long-term impact on later substance misuse, and promoting better mental health. For instance, nurse family home visiting programs have a return of $5.70 for every $1 invested, and early childhood education programs have a $4 to $12 return for every $1 invested.
Reboot Substance Misuse Prevention and Mental Health in Schools by scaling up evidence-based life- and coping-skills programs and inclusive school environments and increasing the availability of mental health and other services.

Top school substance misuse prevention programs have a $3.80 to $34 return for every $1 invested; social-emotional learning programs have an $11 for $1 return; and school violence prevention (including suicide) programs have a $15 to $81 for $1 return.

The Pain in the Nation report was supported by grants from WBT and the Robert Wood Johnson Foundation (RWJF). Data analysis and projections were provided by the Berkeley Research Group.

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. Twitter: @HealthyAmerica1

Mental Health is Vital to Preparedness and Response

By Dr. Octavio N. Martinez, Jr., MD, MPH, MBA, FAPA, Executive Director, the Hogg Foundation for Mental Health at The University of Texas at Austin

This story was published in Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism.

The health effects from a public health emergency go way beyond the physical, taking an enormous mental toll in the immediate aftermath and the years following—and often can harm our children the most.

We must do more to know how to ensure mental health and physical health go hand-in-hand in response planning and efforts. We must also do a far better job of increasing our mental health workforce and ensuring and increasing access to mental health services both during and after an emergency.

Using Data to Plan for Maintaining Access to Mental Health Services

To prepare for any type of emergency, communities must be aware of vulnerable populations—typically children, the elderly and those who have an underlying medical condition or are mentally ill. We have gotten better at identifying where groups of these populations live.

And, we should also be able to access databases to predict what portion of a certain population might have substance use disorders, for example—and then understand what kind of continued treatment and medication are needed and where they might best be distributed.

Paired with this, we should be able to identify geographically which communities will have the hardest time bouncing back from an emergency and will need more resources.

While some neighborhoods might have good infrastructure and better access to transportation and physical and mental health services, others will struggle. The neighborhoods that will struggle should be identified in advance and plans created to help them. And, we can create plans based on any number of scenarios: fires, floods, wind damage, loss of power, etc. If you combine all the knowledge and data together, you can then coordinate resources and everyone has a chance to be healthy.

Long-term Strategies to Improve Responses to Emergencies

We also must acknowledge that human connections are incredibly important. In-between disasters, preparedness work should focus on strengthening families and communities so they are resilient enough to weather an emergency.

For example, after Hurricane Katrina, New Orleans developed community leaders specifically focused on mental wellness, resilience and recovery. The gains in improved access to care and lessened stigma were noticeable—and these should help ensure responders and communities can work together to forge a better response during the next emergency.

While this is by no means a quick fix, taking a long-term approach to emergency preparedness and community health will pay dividends in improved health of the entire population. We should bring this research to other cities and communities that will likely face similar events.

Additionally, psychological effects can take years to manifest and get under control—especially if there isn’t access to mental health services. We learned from Hurricanes Katrina and Sandy that PTSD and suicidal ideation increased dramatically after these events. However, if we were able to step in earlier and connect individuals with mental health professionals, it’s likely these issues and potentially other health issues (substance use disorders, increased anxiety, depression, etc.) could have been prevented or lessened.

Further, while we are getting better at recognizing that mental health is a key component to physical health, the workforce in this area is inadequate—and we’ve known this for a while, especially as the opioid epidemic has continued. By increasing our workforce and ensure they have the right skill sets; we could help tackle the opioid epidemic and better prepare our communities to bounce back from a disaster.

Additional Research is Needed

The devil is often in the details and coordination among the various federal, state and local agencies, organizations and others must be improved. To do so, the nation has to prioritize funding into research and assessments post emergencies—so we can truly understand how these events affect the mental health and stability of a community at a population level.

While the National Institutes of Health has a Disaster Research Response Project, it needs to better include measures on mental health and substance use disorders. We must take each disaster as a learning opportunity that can prepare us for the next one and enable us to save more lives. Increasing research would also help build a network of behavioral health disaster experts.

First Responders

Our first responders and volunteers must be trained to identify and assist people who exhibit psychiatric symptoms, i.e., in “psychological first aid.” And, going beyond this training, we know that mental health must be better integrated with the traditional health services.

Responders and volunteers must also be cared for—they are at risk for suffering secondary psychiatric distress themselves. We need better ways to monitor them during but also after the crisis to ensure they are receiving the appropriate interventions and care.

Part of the solution is increased mental health providers, which would serve many roles: keeping our first responders in good shape, filling gaps in mental health services and, by increasing access to care, hopefully preventing someone from developing a serious and chronic mental health illness.

Quite simply, if we intentionally make mental health part of our preparedness and response systems it will have untold benefits for communities before, during and after an emergency—we will build resiliency and improve well-being.

New Report: More than 1.6 Million Americans Could Die from Drugs, Alcohol and Suicide During Next Decade – A 60 Percent Increase from Previous 10 Years

Study Highlights Solutions, Calls for National Resilience Strategy

November 21, 2017

Washington, D.C., November 21, 2017 – Deaths from drugs, alcohol and suicide could account for 1.6 million fatalities over the coming decade (2016 to 2025) according to a new report, Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy, released today by the Trust for America’s Health (TFAH) and Well Being Trust (WBT).

This would represent a 60 percent increase compared to the past decade, if recent trends hold, based on an analysis conducted by the Berkeley Research Group (BRG) for this report. From 2006 to 2015, there were 1 million deaths from these three causes.

Nationally, in 2015, there were 127,500 deaths from drugs, alcohol and suicide. The epidemics currently are responsible for 350 deaths per day, 14 per hour and one every four minutes.
According to the report’s projections, this could reach 192,000 per year by 2025 (39.7 deaths per 100,000 in 2015 compared to 55.9 per 100,000 in 2025).
At a state level, in 2005, 21 states and Washington, D.C. had death rates from these three causes above 30 per 100,000, and only six states had death rates above 40 per 100,000.
As of 2015, 48 states and Washington, D.C. had rates above 30 per 100,000, 30 were above 40 per 100,000 and five states had rates above 60 per 100,000, including New Mexico which had the highest rate of 77.4 per 100,000.
By 2025, 26 states could reach 60 deaths per 100,000 – and two states (New Mexico and West Virginia) could reach rates of 100 deaths per 100,000.

The study found, however, that these numbers may be conservative, especially with the rapid rise of heroin, fentanyl and carfentanil use. If the nation continues along recent trajectories, death rates would actually double to 2 million by 2025.

TFAH and WBT also created a new feature interactive tracking the recorded and projected change in rates from 1999 through 2025.

“These numbers are staggering, tragic – and preventable,” said John Auerbach, president and CEO of TFAH. “There is a serious crisis across the nation and solutions must go way beyond reducing the supply of opioids, other drugs and alcohol. Greater steps—that promote prevention, resiliency and opportunity—must be taken to address the underlying issues of pain, hopelessness and despair.”

Current Nationwide Trends

Drug overdose deaths tripled between 2000 and 2015 (with a total of 52,400 deaths in 2015), with rural community opioid-related death rates increasing seven-fold. Provisional data shows drug overdoses could exceed 64,000 in 2016, with fentanyl deaths alone accounting for 21,000 of these deaths (and fentanyl-related deaths doubling between 2015 and 2016);
Alcohol-induced deaths increased 37 percent between 2000 and 2015, reaching a 35-year high at 33,200 deaths in 2015. This excludes alcohol-attributable deaths related to injury and violence;
Suicide deaths increased by 28 percent between 2000 and 2015 to more than 44,000 deaths (as of 2015). Rural suicide rates are 40 percent higher than in metro areas;
As of 2015, more than 43 million Americans experienced a mental health issue, more than 20 million had a substance use disorder and more than 8 million experienced both – and these numbers are likely to be underestimates due to stigma and lack of available treatment; and
Only around one in 10 people with substance use disorders receive recommended treatment.

Report Calls for a National Resilience Strategy

“We’re facing a generational crisis. And it calls for bigger and bolder action. Simply creating new programs to address one piece of the problem is insufficient—we need more robust and systematic change. The good news is: we know a lot about what works and can make a difference,” said Benjamin F. Miller, PsyD, Chief Policy Officer, Well Being Trust. “This report highlights the need for investments that take a whole-person approach to wellbeing—encompassing the physical, mental, emotional and spiritual aspects of wellbeing—to truly address the drivers of pain, ultimately saving lives.”

Improve Pain Management and Treatment by helping people heal physically, mentally and emotionally. Approaches must acknowledge that there are different types of pain and experts from mental health, medical care and other disciplines must develop team-based solutions that focus on proactively addressing pain before it gets worse.
Stem the Opioid Crisis with a full-scale approach – including promoting responsible opioid prescribing practices (such as provider education and best practices for Prescription Drug Monitoring Programs); public education about misuse and safe disposal of unused drugs; “hotspot” intervention strategies; anti-trafficking to stop the flow of heroin, fentanyl and other illicit drugs; and expanding the use and availability of rescue drugs, sterile syringes and diversion programs.
Address the Impact of the Opioid Epidemic on Children – and the Need for a Multi-Generational Response that includes substance use disorder treatment for parents and wrap-around services for children and families, including grandparents and other relatives who help care for children, and expand support for the foster care system.Model programs for families struggling with opioid and other substance misuse disorders have been twice as effective in helping mothers achieve sobriety, reduced state custody placement of children by half and had a return on investment of $2.22 for every $1 spent on child welfare programs.
Lower Excessive Alcohol Use through evidence-based policies, such as by increasing pricing, limiting hours and density of alcohol sales, enforcing underage drinking laws and holding sellers and hosts liable for serving minors.For example, a 10 percent increase in the price of alcoholic beverages is shown to reduce consumption by 7.7 percent.
Prevent Suicides by expanding crisis intervention services; anti-bullying and social-emotional learning in schools; and support systems for Veterans; and better integrating mental health into primary care.For instance, the Zero Suicide model program has shown 80 percent reductions in suicides.
Expand and Modernize Mental Health and Substance Use Disorder Treatment Services – Toward a Goal of Focusing on the “Whole Health” of Individuals by prioritizing innovative integrated delivery models for rural and underserved urban areas and expanding the provider workforce, including those who can deliver medication-assisted treatment.Some effective substance use treatment programs have a return of $3.77 per $1 invested.
Prioritize Prevention, Reduce Risk Factors and Promote Resilience in Children, Families and Communities by limiting trauma and adverse experiences, which have the biggest long-term impact on later substance misuse, and promoting better mental health.For instance, nurse family home visiting programs have a return of $5.70 for every $1 invested, and early childhood education programs have a $4 to $12 return for every $1 invested.
Reboot Substance Misuse Prevention and Mental Health in Schools by scaling up evidence-based life- and coping-skills programs and inclusive school environments and increasing the availability of mental health and other services.Top school substance misuse prevention programs have a $3.80 to $34 return for every $1 invested; social-emotional learning programs have an $11 for $1 return; and school violence prevention (including suicide) programs have a $15 to $81 for $1 return.

The report was supported by grants from WBT and the Robert Wood Johnson Foundation (RWJF). Data analysis and projections were provided by the Berkeley Research Group. The full report is available on TFAH’s website at www.healthyamericans.org.

2015 STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES AND 2025 PROJECTIONS

Based on an analysis of new state-by-state data from the Centers for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER), current (2015) and projected (2025) rates of deaths per 100,000 people from drugs, alcohol and suicide from highest to lowest were:

Note: 1 = Highest rate, 51 = lowest.

2025 PROJECTIONS, STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES

1. New Mexico (105.7); 2. West Virginia (99.6); 3. Wyoming (88.8); 4. New Hampshire (88.1); 5. Alaska (84.4); 6. Kentucky (81.3); 7. Rhode Island (79.7); 8. Arizona (75.8); 9. Montana (75.6); 10. Nevada (75.0); 11. Ohio (74.6); 12. Oregon (72.8); 13. Maine (71.5); 14. (tie) Oklahoma (70.0) and Utah (70.0); (tie) 16. Colorado (67.8) and Tennessee (67.8); 18. Pennsylvania (67.7); 19. Massachusetts (66.6); 20. Michigan (65.9); 21. Vermont (65.8); 22. Idaho (63.4); 23. Washington (63.3); 24. Connecticut (61.2); 25. Indiana (61.0); 26. Delaware (60.4); 27. Florida (59.6); 28. (tie) Louisiana (58.5) and Missouri (58.5); 30. South Dakota (57.4); 31. Wisconsin (55.5); 32. South Carolina (55.4); 33. Arkansas (54.2); 34. North Carolina (53.1); 35. (tie) District of Columbia (52.2) and Maryland (52.2); 37. Alabama (51.9); 38. Kansas (49); 39. California (48.9); 40. North Dakota (47.4); 41. Minnesota (47.3); 42. Iowa (46); 43. Virginia (44.9); 44. Georgia (44.6); 45. (tie) Illinois (44.4) and 45. New Jersey (44.4); 47. (tie) Hawaii (43.3) and New York (43.3); 49. Mississippi (42.8); 50. Texas (38.9); 51. Nebraska (37.7).

2015 STATE-BY-STATE DRUG, ALCOHOL AND SUICIDE DEATH RATES

1. New Mexico (77.4); 2. West Virginia (67.4); 3. Wyoming (66.4); 4. Alaska (63); 5. New Hampshire (60.6); 6. Montana (56.7); 7. Kentucky (56.1); 8. Arizona (55); 9. Rhode Island (54.5); 10. Oregon (54); 11. Nevada (53.8); 12. Maine (51.1); 13. Ohio (50.8); 14. Oklahoma (50.5); 15. (tie) Colorado (49.7) and Utah (49.7); 17. Vermont (47.6); 18. Tennessee (47.3); 19. Idaho (47.1); 20. Pennsylvania (46.3); 21. Washington (45.9); 22. Michigan (45.8); 23. Massachusetts (44.9); 24. South Dakota (43.8); 25. Indiana (43); 26. Florida (42.9); 27. (tie) Connecticut (41.9) and Delaware (41.9); 29. Missouri (41.7); 30. Louisiana (41.2); 31. Wisconsin (39.9); 32. South Carolina (39.7); 33. Arkansas (39.5); 34. North Carolina (37.7); 35. Alabama (36.8); 36. Kansas (36); 37. (tie) District of Columbia (35.7) and North Dakota (35.7); 39. California (35.4); 40. Maryland (35.1); 41. Minnesota (34.5); 42. Iowa (33.9); 43. Virginia (32.3); 44. Georgia (31.9); 45. Illinois (31.3); 46. Hawaii (31.2); 47. Mississippi (30.9); 48. New Jersey (30.5); 49. New York (30); 50. Texas (28.4); 51. Nebraska (28.2).

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Trust for America‘s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. Twitter: @HealthyAmerica1

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community wellness. www.wellbeingtrust.org. Twitter: @WellBeingTrust

Kentucky Injury Prevention and Research Center’s Work to Prevent Substance Misuse

In 2005, the Kentucky Injury Prevention and Research Center (KIPRC) began focusing on transportation-related injuries under the state’s Fatality Assessment Control and Evaluation Program. KIPRC travels to sites of worker fatalities, investigates the causes, and ultimately makes behavioral, administrative and engineering control recommendations that would prevent future occupational deaths.

The first investigation was of a truck driver who was only 23 miles from his start point when he went through a busy intersection then up an embankment before crashing. The toxicology report found that he had methamphetamines and benzodiazepines in his system.

The next month, they had another case that was related to drugs. KIPRC quickly made the recommendation to build a statewide drug database focused on identifying truck drivers who tested positive for drugs and ensuring that job applications to other trucking companies would be aware of their previous substance use history.

From that point, analyses of multiple data sets became an integral part of Kentucky’s efforts to fight what became the opioid epidemic.

Comprehensive Data Sources

After they identified the drug-related pattern in transportation-related truck driver deaths, they examined all their data sources—spanning emergency department, trauma, crash, inpatient hospital, mortality, and workers’ compensation data, etc.—and produced comprehensive reports on drug overdoses.

The information KIPRC provided resonated with what the State Department for Public Health was finding—as they had begun to see spikes in drug overdoses in the data they monitor and manage.

KIPRC collaborated with the state’s prescription drug monitoring program called KASPER, which produces reports showing all Schedule II through V prescriptions dispensed for a person over a specified time period.

To further enhance the PDMP reports, the Bureau of Justice Assistance funded KIPRC and the PDMP to develop and implement an algorithm that calculates milligram morphine equivalents and make them available to physicians in PDMP patient reports to inform appropriate opioid prescribing. This also included a separate algorithm to calculate overlapping opioid and benzodiazepine prescriptions.

Additionally, the PDMP added a flag to the electronic reports that identifies elevated MME situations where it might be appropriate for the physician to also co-prescribe naloxone, mostly when the physician is prescribing opioid medications. To further the use of naloxone, KIPRC worked with the Kentucky Department of Criminal Justice Training to train more than 900 law enforcement officers on the proper use and administration.

In 2016, KIPRC helped create training for advanced practitioner registered nurses on the epidemic. During the training, nurses were educated on querying the PDMP, possible alternative opioid prescribing strategies, Kentucky’s opioid prescribing regulations, and care of patients with pain in both acute and primary care settings. Later that year, the program was extended to physicians. And, to date, more than 1,500 controlled substance prescribers have received training.

KIPRC additionally performs ad hoc data requests, allowing counties and state agencies to ask for a certain slice of data that is specific to their communities and populations. It can also be broken down by age, substance, and whether there are overlapping diagnoses for illnesses like HIV, Hepatitis C and endocarditis.

Going forward, a KIPRC epidemiologist is overlaying public health and public safety data that looks at heroin and methamphetamine trafficking arrests, possession arrests and related emergency department visits, hospitalizations, and overdose deaths to find hot and cold spots. Future analyses will include fentanyl and other drugs as well as comprehensive drug seizure data.KIPRC also manages the Drug Overdose Fatality Surveillance system, which draws on multiple data systems (autopsy reports, death certificates, coroner investigation, the state PDMP, etc.).

The results are used to inform legislative policymaking and provide info to stakeholders to advocate. For example, data pulled from the 2013-2015 reports found that in one-third of overdoses, gabapentin was involved. With this knowledge, the state made gabapentin a Schedule V substance and fully integrated it into the PDMP in July 2017.

Kentucky is the only state in nation that requires—when no specific cause of death is determined—decedent testing for controlled substances. Previously, 70 percent of drug overdose death certificates listed the specific drug(s) involved in drug overdose deaths. Now, 81 percent of drug overdose death certificates list the specific drug(s) involved in the fatal overdose.

Going Beyond Data

A KIPRC community coalition specialist goes into counties with the highest overdose death rates to provide technical assistance and strategic planning to establish or improve drug overdose prevention programs and initiatives.

KIPRC is also establishing a website with a substance use disorder treatment availability locator – so people can get help. They are working with every single treatment provider in the state to update their treatment slot availability on a nightly basis. The website will become live in January 2018 and will include available level of care, treatment type and payment type accepted.

North Carolina’s Comprehensive Approach to Preventing and Reversing Drug Overdoses

Early in 2000, state public health surveillance identified a surge of deaths in North Carolina. The Centers for Disease Control and Prevention conducted an investigation into the increase, finding the main driver was unintentional drug overdoses from prescription drugs.

In 2003, the Governor created the Task Force to Prevent Deaths from Unintentional Drug Overdoses, which helped establish the North Carolina Controlled Substances Reporting System (CSRS), which was the state’s prescription drug monitoring program (PDMP).

Since then, North Carolina has implemented a variety of measures to prevent deaths from drug overdoses. With increased access to data from the PDMP and a brighter light shined on the issue, public health continued to collect data, finding, in 2007, that Wilkes County, in the northwest part of the state, had the third highest drug overdose death rate in the country.

Child Fatality Task Force

North Carolina’s Child Fatality Task Force (CFTF)—a standing committee of the general assembly that is composed of 10 legislators and numerous technical advisors—is essentially the policy component of the state’s child death review system.

CFTF provides a unique opportunity for the public health community to present data and bring in outside experts, including law enforcement and subject matter and harm reduction experts. Everyone sits in a room, discusses policies and gets on the same page. Most bills addressing the overdose epidemic since 2010 have come from CFTF, including revisions to CSRS and increasing/improving naloxone access laws.

Project Lazarus

Established in 2007, Project Lazarus— a public health model based on the twin premises that overdose deaths are preventable and that all communities are responsible for their own health—was one of the first initiatives designed to respond to the extremely high overdose mortality rates in Wilkes County.

“Project Lazarus Offers Communities & Individuals Access To:

Coalition formation, capacity building, & sustainability.
Chronic pain management.
Safe prescribing practices for providers.
Opioid overdose education, awareness, & safe medication usage materials.
Naloxone, the opioid overdose rescue medication.
Project Pill Drop, a community based medication disposal program.
Lazarus Recovery Services, a peer guided recovery support program.
Local & state data on overdose and poisoning rates.
Local & state funding sources for overdose prevention work.”

The University of North Carolina Injury Prevention Research Center (UNC IPRC) evaluated Project Lazarus and found an initial drop in the overdose death rate of 40 percent, which grew to a 69 percent decline in 2011. The program has since be brought statewide.

University of North Carolina Injury Prevention Research Center

The University of North Carolina Injury Prevention Research Center (UNC IPRC) is a key partner in addressing the overdose epidemic. UNC IPRC provides evaluation, research, training, and technical assistance to partners and programs working to combat the opioid epidemic.

Drug Takebacks

In 2009, Safe Kids North Carolina, located in the Office of the Chief Fire Marshall worked with the State Bureau of Investigation and a diverse group of partners to develop Operation Medicine Drop. Since its establishment, Operation Medicine Drop has collected and safely disposed of 89.2 million pills at more than 2,000 events and established a network of permanent drop boxes that serve most counties in the state.

NC DHHS noted that drug takeback programs are a great way to get the community involved and raise public awareness of the issue—it gives everyone a little skin in the game when they realize that items in their medicine cabinet could be fueling the drug epidemic. This process helped move the conversation upstream to ensuring people knew of the problems and the steps they could take to prevent people from developing a substance use disorder.

PDMP

North Carolina has worked to improve CSRS to be a valuable tool to prescribers and dispensers to better manage pain and appropriate prescribing. In 2012, the Child Fatality Task Force convened a study group that resulted in the Revision to the CSRS Law in 2013. They added delegate accounts, shortened the time dispensers have to report data, and enabled proactive reporting from CSRS to licensing boards and prescribers.

In 2014, the Program Evaluation Division of the General Assembly conducted an extensive evaluation of CSRS, concluding that further funding and improvements of CSRS should be included in the state budget bill of 2015.

In 2017, the STOP Act— the most comprehensive bill in the state to address the opioid epidemic—became law. The Act includes mandated use of CSRS, limits on prescribing opioids in line with CDC’s Prescribing Guidelines, expansion of naloxone distribution, and numerous other provisions to address the opioid epidemic.

To develop the Act and identify evidenced-based strategies, NC DHHS worked with UNC IPRC, CDC’s Prevention for States Program, and national experts, including Corey Davis at the Network for Public Health Law.

The 911 Good Samaritan Law/Naloxone Access Act

Expanding access to naloxone has been an important part of North Carolina’s strategy to address the overdose epidemic and was a founding principle of Project Lazarus. The North Carolina Harm Reduction Coalition (NC HRC) has worked with the Law Enforcement community to gain their support for enactment of a series of naloxone laws since 2013.

Since the successful passage of naloxone-related legislation, NC HRC distributed more than 41,000 overdose rescue kits and confirmed 7,408 overdose reversals in North Carolina. Working with law enforcement agencies to develop naloxone programs has resulted in 164 law enforcement agencies with officers carrying naloxone and 403 reported law enforcement reversals by naloxone.

In 2016, the Naloxone Standing Order Law—enables any pharmacy in the state to offer naloxone without a prescription under the state health director’s standing order—Became law. The Standing Order Law was developed in response to requests from the retail pharmacy industry, which wanted to easily offer naloxone in their pharmacy outlets across the state.

After passage, DHHS developed a resource web site with UNC IPRC that contains technical resources on how to use the standing order. Nearly 1,400 pharmacies in the state offer naloxone under the standing order law.

The 911 Good Samaritan Law waived prosecution for individuals experiencing or witnessing an overdose who seek help by calling 911. The law also removed civil liabilities for doctors who prescribe naloxone and bystanders who use naloxone to attempt to save someone’s life and allowed community organizations to dispense naloxone with medical provider oversight.

Syringe Exchange

In 2016, North Carolina became the first state in the south to legalize syringe exchanges with passage of House Bill 972.

The years of work on harm reduction and everyone working together broke down the historical resistance of syringe exchanges and they were able to decriminalize needles. Advocates performed demonstration projects and worked with law enforcement early to identify legislation that the law enforcement community would find acceptable and help them in their daily work.

In addition, the argument was made that needle exchanges could save the state money—DHHS noted that Medicaid charges for Hepaticas C treatment went from $3.8 million in 2011 to $85 million in 2016

Following the legalization of the syringe exchanges, DHHS developed the Safer Syringe Initiative and registered 22 syringe programs in the first year of the law—reaching 19 counties.

Initially, to pass the Bill, language was included that prohibited the use of public funds to support exchanges. When the STOP Act passed, it included provisions that only prohibited the use of “State Funds,” enabling local health departments and other governmental units to use local funds to do needle exchange.

The DHHS sees needle exchanges and drug take programs as a way for communities to take direct action in the overdose epidemic.

Colorado’s Work to Prevent Substance Misuse and Suicides

Substance Misuse Prevention

In 2012, when the full scope of the opioid epidemic begun to become apparent, Colorado officials looked to the Colorado Department of Public Health and Environment (CDPHE) to make sense of the issue.

CDPHE synthesized, streamlined and provided important data to understand the problem and convened the important stakeholders and government divisions—across many disciplines.

Initially, CDPHE operated as an integrator by identifying best practice strategies, generating surveillance reports, and facilitating a series of roundtables focused on different aspects of the issue, from prescribing to dispensing to public awareness to treatment. State agencies used the information from these important convenings to create the Colorado Plan to Reduce Prescription Drug Abuse.

To better monitor progress, state-level leadership created the Colorado Consortium for Prescription Drug Abuse Prevention (Consortium), which provides a statewide, interuniversity/interagency framework designed to facilitate collaboration and serves as the strategic lead for implementing the Plan with active participation from the Governor’s Office and various state agencies.

The Consortium is comprised of nine work groups: Data and Research, the Prescription Drug Monitoring Program (PDMP), Provider Education, Public Awareness, Treatment, Safe Disposal, Naloxone, Heroin Response, and Friends and Affected Family Members. Each work group is co-chaired by a state agency and a university representative. As a whole, the Consortium comprises over 300 local, state and federal members. The Consortium’s structure helps facilitate collaboration between state agencies and university partners, making it possible to easily apply for, receive and leverage funding.

For their part, CDPHE focuses a significant amount of attention on primary prevention, specifically prescriber education and making the state’s PDMP easier to use and better integrated into practice. In Colorado, the PDMP is located in the Department of Regulatory Agencies, which handles professional licensing. During the 2014 legislative session, Colorado legislators passed a bill that aligned Colorado’s PDMP with best practice strategies including allowing: delegated access, unsolicited reports, mandated enrollment, and access by out-of-state pharmacists. This legislation also gave CDPHE access to PDMP data as a public health surveillance tool.

With the data in hand and important partners via the Consortium, CDPHE is using funds from the Centers for Disease Control and Prevention to implement and evaluate several pilot projects aimed at improving use of and access to the PDMP, including: integrating the PDMP with the state’s two health information exchanges; connecting electronic health records and the PDMP at eight outpatient clinics; and linking the PDMP to a software application that will allow improved access to the PDMP and better assess provider adherence to prescribing guidelines.

In addition to work on the PDMP, the Consortium encouraged multiple sectors to advocate for the purchase of naloxone—which the Attorney General decided to fund as a pilot in the 16 counties with the highest overdose rates. In conjunction, another member of the Consortium developed an app to track reversals from using naloxone. CDPHE is conducting an evaluation of the project. But, after just 2 months of data collection, there were nearly 150 reported overdose reversals. As the data continues to be collected, the results should make the case that there is a positive return on investment and that law enforcement is willing to use it.

Suicide Prevention

In July 2012, the Office of Suicide Prevention at CDPHE, Cactus Marketing Communications and the Carson J Spencer Foundation partnered to launch www.ManTherapy.org. The website aims to reach working-age men, who account for the highest number of suicide deaths in Colorado annually.

The three goals of Man Therapy are: 1) to change the way men think and talk about suicide and mental health; 2) to provide men (and their loved ones) with tools to empower them to take control of their overall wellness; and, 3) long-term, to reduce the number and rate of suicide deaths among men. Man Therapy removes traditional mental health language from the conversation and uses humor to help men feel welcome and at ease while visiting the site. The website provides information on depression and suicide, substance use, anger and anxiety, and includes statewide resources specific to finding support and services related to each issue.

In 2015, the Office of Suicide Prevention and the Commission identified Zero Suicide as a priority to better align, integrate and emphasize suicide prevention in Colorado’s health systems. In 2016, Colorado became the first state to pass legislation encouraging healthcare organizations and systems to adopt the Zero Suicide framework, which works to train primary healthcare staff to provide better treatment to individuals who might be contemplating suicide.

Additionally, the Office of Suicide Prevention partnered with Children’s Hospital Colorado, the Colorado School of Public Health, and the Harvard Injury Control Research Center to develop the Emergency Department Counseling on Access to Lethal Means (ED-CALM), which teaches emergency department providers how to educate parents/guardians of suicidal youth about the techniques and importance of restricting access to lethal means in the home.

Going Upstream

CDPHE has a number of efforts dedicated to upstream approaches to preventing youth substance misuse, violence and suicide. For example, CDPHE is currently funding 48 Colorado communities to implement Communities That Care, an evidence-based public health framework that encourages communities to take part in looking at their data, identify evidence-based strategies to address community problems, and implement those strategies to address those issues. The experience uncovered the connections between substance misuse and suicide rates and shown that efforts to prevent substance use work well on preventing suicides and violence.

To help youth even more, CDPHE implemented the Sources of Strength program, a school-based youth initiative focused on redefining school level social norms that has been shown to build positive feelings of connectedness between youth and their peers and communities.

In the program, youth advisors are carefully handpicked from different segments from the school to create leaders from all the peer groups. Those leaders are then educated on suicide prevention basics and are tasked with coming up with positive campaigns that are upbeat and engaging. Because they are peers, the activities are better positioned to get a wider population involved in activities—and research shows that kids involved in activities who are connected to their community are much less likely to commit suicide.

In addition to preventing suicides, building these protective factors extends to preventing sexual violence prevention, bullying and other dangerous and/or risky behaviors. Through the pilot programs, Colorado has begun to see reductions in sexual violence and bullying. CDPHE is currently partnering with researchers at the University of Florida and the University of Rochester to do a rigorous evaluation of Sources of Strength at 24 Colorado high schools to measure the impact the program has on preventing the perpetration of sexual violence, bullying and suicide.

Pain in the Nation: The Drug, Alcohol and Suicide Crises and Need for a National Resilience Strategy

Prevention and Public Health Fund Detailed Information

TFAH Statement: Strongly Opposed to the House Obamacare Replacement Bill

Washington, D.C., March 7, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“We are strongly opposed to the House Obamacare Replacement bill, which would repeal significant portions of the Affordable Care Act (ACA), including the Prevention and Public Health Fund.

Under this plan, millions of people could lose health insurance—a devastating blow to the health of many of our nation’s most vulnerable individuals and families. Without affordable insurance coverage we will see increased levels of preventable illnesses, injuries and deaths.

In addition, eliminating the Prevention Fund would erase 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget. Of that investment, $625 million directly supports state and local public health efforts to fight preventable diseases such as diabetes, heart disease and cancer.

Losing this funding would wreak havoc on our efforts to reduce chronic disease rates, immunize our children, stop the prescription drug and opioid epidemic and prepare the public health system to prevent infectious disease outbreaks.

We know how to prevent many chronic and infectious illnesses—which make up a significant portion of the $3 trillion the nation spends yearly on healthcare. If we lose access to health care coverage and to the Prevention Fund, our children, families and communities will suffer and ultimately costs will rise.

The bottom line? This Bill would make untold numbers of the American people less healthy.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.