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HomeMy WebLinkAboutPSCC 072018 Backup Initial Strategic PlanTreasure Coast Opioid Task Force Initial Strategic Plan Introduction The Treasure Coast has not been spared the Opioid Crisis that is ravaging our nation. Nationally, this opioid overdoses catapulted to the leading cause of accidental death for adults under the age of 44. In Florida, there were 5,725 opioid related deaths in 2016. Fentanyl related deaths statewide increased by 97%. On the Treasure Coast, while the numbers of deaths involving oxycodone, hydrocodone, and methadone remained relatively stable from 2015-2016, the number of deaths involving heroin or morphine from 2015-2016 rose from 46 to 56, representing an increase of about 22%. However, of extreme concern, is the increase in fentanyl and fentanyl analog related deaths. In 2015, the number of fentanyl and fentanyl analog deaths combined was 25. In 2016, the number of deaths involving fentanyl was 63 and fentanyl analogs was 36, for a combined total of 99 deaths, representing an increase approaching 300%. This precipitous rise in just one year is indicative of the need for a crisis response. It is important to note that the Florida Medical Examiner's Report separates deaths into two categories, one in which a particular substance is considered to be the direct cause, or one in which the substance is considered to be merely present at the time of death. In many cases, multiple substances were present at the time of death. This indicates that the problem that is faced is largely complicated by polysubstance misuse issues. Alcohol, benzodiazepine(s) and cocaine related deaths continue to rise, in addition to the opioid problem. However, the 300% increase in deaths related to fentanyl and its analogs on the Treasure Coast represents the clear local crisis imperative. This opioid crisis affects not only the individuals who are addicted or who have died, but the entire family and larger community. Families are devastated. Children are left without parents. First responders witness the suffering on the front lines when responding to overdose calls. Emergency room and hospital staff are touched by the tragedy and gravity of this problem. Child welfare and mental health staff deal with children who suffer as a result of their parent's addiction. And tragically, the Treasure Coast welcomed 89 newborns in the last year with Neonatal Abstinence Syndrome or who as newborns experienced the noxious effects of opioids either in the placenta or breast milk. The Opioid Task Force of the Treasure Coast represents the multidisciplinary collaboration of individuals, professionals from healthcare, professionals in addiction treatment, law enforcement and first responders, child welfare, government (local and state), and the justice community who have gathered to mitigate the suffering in this community. The Task Force especially invites the voices of those in recovery and families impacted by this crisis to join the effort. N Assessment /Scope of the Problem Addiction is a complex social and biological problem. There are many individual and social factors associated with addiction, including but not limited to homelessness, mental illness, unemployment, neurobiological factors and psychological or emotional trauma. However, several factors can be identified that directly contribute to the upsurge of the current opioid crisis specifically on the Treasure Coast, including the resurgence of heroin and the introduction of synthetic opioids. Data collection is needed to further define the crisis by connecting demographic and geographic variables specific to this community. The Task Force has anecdotally described multiple barriers and gaps impeding problem solution. These briefly include: Data collection gaps Lack of inpatient treatment (detoxification) beds, especially for the indigent Insufficient Medication Assisted Treatment services, especially for the indigent Transportation for individuals to treatment and from emergency rooms directly to treatment Insufficient prescribers knowledgeable about addiction and/or willing to provide Medication Assisted Treatment Insufficient obstetrical services for opioid addicted mothers Insufficient credentialing of "Sober Homes" Difficulty hiring those in recovery to assist in this effort (for example, to go into hospitals to assist those who have overdosed in seeking treatment) Undiagnosed/Not addressed psychological trauma Stigmatization of those struggling with addiction Many of the action items of the various subcommittees directly address these gaps and barriers. Development of the Opioid Task Force of the Treasure Coast and Strategic Plan At the end of 2016 and beginning of 2017, several interested community members and representatives of several organizations met to discuss the scope and severity of the opioid problem in St. Lucie County. By mid 2017, as reports indicated that the numbers of overdose deaths had reached crisis proportions, it was decided by this group that the community needed a broader and more integrated response. The original small group researched the responses of other communities to this opioid crisis. The structure and plans of county and regional task forces both in Florida and the nation were reviewed. It was determined that others were initially successful using a subcommittee structure to create a plan and address the problem. Modeled after other task forces, the original group convened a meeting of multiple stakeholders from many interested disciplines on August 10, 2017 and the Opioid Task Force of the Treasure Coast was born. Over 60 individuals from law enforcement, first responders, justice and legal professions, hospitals, addiction treatment facilities, health departments, local and state officials from all four counties of the Treasure Coast, including Indian River, Martin, Okeechobee and St. W Lucie Counties attended that first meeting and many of the monthly meetings held since. Subcommittees were developed based on task forces of other communities. Together, the Opioid Task Force of the Treasure Coast, a non -funded, non-governmental organization of community leaders, stakeholders and individuals is collaborating to fulfill its determined mission as stated below. Mission The stated mission of the Opioid Task Force of the Treasure Coast is... to reduce opioid use and overdose deaths through the combined efforts of multiple community stakeholders on the Treasure Coast. Overview of the Plan This plan represents a dynamic attempt to address the opioid crisis in this community. As circumstances change, as new evidence arises, or as new ideas are generated, the plan will be adjusted accordingly. It represents the collaborative effort of individuals, stakeholders, and subcommittees. This plan is an initial plan intended only to provide structure and guidance for the initial activities of the Task Force. Further, this plan is not intended to address every possible aspect of this systemic opioid crisis. For example, law enforcement is working diligently to address the flow of illegal opioids and other substances into this community and their efforts fall outside the scope of this plan. In addition, this plan is meant to address those items within the purview of local individuals and organizations. Efforts that are better addressed at the state and national level are not part of this local plan. Structure of the Opioid Task Force of the Treasure Coast Steering Committee The initial Steering Committee is composed of the chairpersons of each subcommittee, elected by the subcommittees. In addition, initially, the interim chairperson and subsequently the chairperson of the Opioid Task Force of the Treasure Coast will serve on the Steering Committee. The primary responsibilities of the Steering Committee are to coordinate subcommittee activities, determine and disseminate meeting schedules, disseminate pertinent information to the full Task Force, and report the progress of the various subcommittees to the full Task Force. In order to leverage data analytics, the Steering Committee will partner with local academic professionals and researchers to assist in determining metrics designed to measure progress and to make data driven decisions. The Steering Committee is also responsible for ongoing monitoring and updating the Strategic Plan. In addition, the Steering Committee will identify and work to develop partnerships with individuals and organizations that may provide expertise or expert counsel to the Task Force or who might wish to become part of Task Force activities. Subcommittees Six subcommittees, modeled after other opioid task forces from around the state and nation, were created. These include the following: Education and Awareness Public Safety Healthcare Treatment Data Funding (created later, in November, 2017) In addition, at the Task Force Meeting in December, 2017, the Healthcare Subcommittee added individuals interested in working on the problem of Neonatal Abstinence Syndrome. Each Subcommittee elected a Chairperson and was tasked with determining goals and an action plan. While there are six separate subcommittees, much of the work required to combat this crisis is dependent on multidisciplinary collaboration. None of the committees work in isolation. Multiple Task Force members attend multiple subcommittee meetings to provide assistance and expertise and to share information. Initial Strategic Plan Public Safety Sub -committee First responders play a critical role in addressing the opioid crisis. As happens in any emergency situation, law enforcement and first responders who arrive at the scenes of overdoses save lives, and at the same time are themselves subjected to the trauma of this crisis. Many of the first responders on the Treasure Coast carry and administer Narcan, the overdose antidote. Because of their direct line role in dealing with overdose victims, members of Public Safety may be in a position to steer individuals toward treatment. Further, in order to combat this crisis, those in Public Safety are also responsible for dealing with the legal ramifications of opioids in the community. Since the inception of the Task Force, the members of the Public Safety Subcommittee have identified several initiatives listed below. The plan is to advance the initiatives through the work of individuals, separate committees within the sub -committee itself, or as an entire committee. 1. Diversion (warm hand offi: Create a process whereby addicts in need of service can turn their contraband drugs andlor paraphernalia in to a law enforcement officer and receive help for their addiction. 2. Data: Gather and maintain overdose and overdose death data in the four -county area, track numbers on a monthly basis and make data available to Task Force. 3. Training: Identify immediate and long-term training needs for public safety professionals and other Task Force members to enhance stakeholder responses to incidents. 4. Legislative: Monitor legislative initiatives and work within the Task Force and within other formal associations (FPGA, FSA) to strengthen laws to combat manufacture, possession, sale, and use as well as address fraud and other crimes affiliated with patient brokering. Healthcare Subcommittee As is the case with first responders, members of the healthcare subcommittee are also on the front line of this crisis. The Opioid Crisis, as is true with all addictions, is a chronic health problem that must be solved from the same perspective as other chronic health problems. As such, healthcare professionals are in the best position to identify the presence of a chronic substance misuse issue. Likewise, healthcare professionals play a critical role in pain management and prescribing/managing pain medication. Physicians and nurses deal with the consequences of addiction and overdose in hospital and office settings including issues such as HIV, Hepatitis C and other infections. Maternal/infant healthcare workers witness the devastating effects of this crisis on newborns. Given the broad issues of maternal addiction, opioid addiction/ overdoses and sequelae, and pain management, the healthcare subcommittee has identified the initiatives below. Included in this plan are the AMA Opioid Task Force recommendations including that physicians should register and use state prescription drug monitoring programs, enhance education and training, support comprehensive treatment for pain and substance use disorders, help end stigma, co - prescribe naloxone to patients at risk of overdose, encourage safe storage and disposal of opioids and all medications (AMA, 2017). 1. Warm Handoff Develop a process in which those who enter the Emergency Room in local hospitals either because of overdose or other consequences of opioid addiction will receive information and encouragement to enter treatment and will be directly admitted to treatment program of their choice. 2. Increase number ofprescribers using PDMP (Prescription Drug Monitoring Program) 3. Provide medical/nursing education re: pain management and prescribing practices that are evidence based, to both hospital and home and community based medical/nursing services 4. Encourage prescribers to co prescribe naloxone to those at risk for overdose, and to encourage and educate patients re: safe storage and disposal of opioids S. Provide expertise and education in conjunction with Education and Awareness Subcommittee to the general public and interested stakeholders re: Opioid addiction and overdose. 6. Explore with a goal to develop services for opioid addicted pregnant women in order to decrease newborns with Neonatal Abstinence Syndrome. 7. Establish metrics to measure progress and report to Data Subcommittee Treatment Subcommittee Given that opioid addiction is a chronic disease, it should be treated as such. When the dire consequences of opioid addiction occur, that is, an overdose, individuals should be treated in the same way as those who have a heart attack. This means immediate access to treatment. Treatment might consist of emergency measures, inpatient hospitalization for medical complications, detoxification, or outpatient Medication Assisted Treatment, depending on the individual's needs and choices. However, access to services, except for emergency and medical hospital based services, particularly for the indigent, is limited. Also, addiction treatment facilities exist that are not properly credentialed or certified. The issue of non-FARR certified sober homes", particularly in South Florida, that engage in insurance fraud and patient brokering, is rampant. Finally, those challenged with addiction continue to be victims of stigmatization which impacts decisions to seek treatment. Given the issues of access, credentialing of facilities and stigma, the Treatment Subcommittee has identified the issues below. 1. Idents available inpatient and outpatient credentialed facilities in the community and provide list to law enforcement (particularly of FARR certified sober homes). 2. Work to increase treatment "beds" and access to Medication Assisted Treatment. 3. Work to decrease "wait time "for existing beds. 4. Work with Healthcare Subcommittee to develop and implement Warm Handoff system for Treasure Coast. 5. Provide naloxone and naloxone education to clients, families/significant others of those addicted. 6. Training: Provide training to professionals and general community regarding the addiction process, harm reduction, and addiction as a chronic disease. 7. Legislative: Advocate for provision offunding for more indigent beds in community. Education and Awareness Subcommittee Critical to the opioid fight is an aware and educated community. Education that is geared toward the understanding of addiction as a chronic disease is vital to reduce stigma. Specifically, education that targets those who misuse opioids and the significant others or individuals around them regarding signs of opioid addiction and overdose and what to do in case of overdose can serve to directly save lives. Likewise, the same individuals may benefit from an understanding of addiction as a chronic disease, as well as treatment options. Similarly, healthcare professionals themselves, as well as law enforcement, first responders, those in the legal system and all who are touched by this disease benefit from further education about substance misuse. The Opioid Task Force of the Treasure Coast recognizes that psychological trauma plays a significant role in the lives of individuals challenged with the opioid issue. The first step in assisting both the professional community and the general public in understanding how trauma contributes to this crisis is to provide education about trauma and trauma informed care. This will serve to reduce stigma as well. The Education and Awareness Committee has identified the following initiatives to focus on since the inception of the Task Force. The Education and Awareness Subcommittee will be working together with the other Subcommittees to carry these events and programs forward as well as tap into our personal and work place communities to share the mission. 1. Print Material: The Education and Awareness Subcommittee will create and distribute materials through multiple platforms, including but not limited to the taskforce members, first responders, law enforcement, and healthcare providers and to the general public. These materials will vary in topics surrounding opioids, overdose, misuse, signs and symptoms, prevention and general awareness. a. In collaboration with other subcommittees, develop informational material for distribution. b. In collaboration with other subcommittees, determine targeted audiences for activities. c. Creating a card to be handed out by law enforcement andfirst responders is the first print material that will be put together. d. Currently using what materials are available: SAMSHA for fact driven brochures and hand outs and 211 Helpline for Resource and Referral to local agencies. 2. Training and Speaking Engagements: Work with other subcommittees on planning and hosting trainings for the Task Force as a whole, providers in the community, as well as the community as a whole. These presentations will cover the topics of Trauma Informed Care, Narcan training, proper prescribing methods, How to know ifsomeone is taking opioids, Do's and Don'ts of Overdose, personal experiences and many more. 3. Social Media Presence: Creating a Social Media campaign is top priority. While working with the agencies represented on the taskforce we will be sharing information in an image form to allow for easy information sharing. Each member of the Task Force will be asked to share with their agencies. 4. Determine community events in which the Task Force can/should participate. S. Develop trauma informed education and begin delivery in community. Data Subcommittee Metrics, of course, should be used to drive targeted activities. Data is needed to inform decisions, identify trends and determine the progress related to specific outcomes. The Task Force has determined that there are both gaps in data collection and sharing, lack of shared definitions of data collected, and multiple agencies collecting different data. Given the above, the Data Subcommittee is working on the following initiatives: 1. Design and implement a process to collect and distribute data. 2. Determine gaps in data collection including determining shared definitions of data collected. 3. Idents academic or research sources to assist in data collection and analysis. Funding Subcommittee The Opioid Task Force of the Treasure Coast is an unfunded, non-governmental organization. However, some funds are needed to produce educational and other materials, provide expert speakers, etc. As such, the Funding Subcommittee was formed to do the following: 1. Determine funding needs and sources. 2. Determine process/structure accounting for funds.