OPIOID ADDICTION IN THE BLUEGRASS REGION
POLICY AND IDEAS OF HOW TO MINIMIZE THE IMPACT
On Friday, December 8, 2017 a drug policy panel convened to discuss ideas on how to address the regional opioid epidemic and possibly identify strategies to help minimize the impact. There were 77 individuals who attended from many organizations and government agencies around the Bluegrass Region. The panel included seven (7) speakers in the morning followed by lunch and then a strategic discussion and open forum used to identify the main issues and create several strategies of how to address the issues.
In order to gain some understanding of the scope of the Opioid epidemic there are a few statistics that should be shared. First, the opioid epidemic has arisen from abuse of prescription drugs and painkillers, such as morphine, methadone, buprenorphine, hydrocodone, oxycodone, (some brand names include Vicodin, Percodan, Tylox, Demerol, Palladone, Percocet, and Oxycontin). Patients become addicted to these substances, which leads to prescription forgery, black-market pill sales, and a shift to the cheaper opioid – Heroin.
Second, drug overdose deaths in the US has increased dramatically (quadrupled) since 1999. Of all drug over-dose deaths, six (6) out of every ten (10) are caused by opioids. In 2015 alone there were 20,101 overdose deaths related to prescription pain relievers, and another 12,990 overdose deaths from heroin1. Overdose deaths in Kentucky during the same time frame exceeded 1,400 people. This is startling as it means that fully seven-percent (7%) of all overdose deaths that occurred in the U.S. happened in Kentucky.
|Opioid Deaths in the Bluegrass Region2|
|County||Deaths||Population||Deaths per 1,000 People|
The first panel was made up of three (3) individuals from different sectors of the workforce who are specifically dealing with the drug epidemic, including Dr. Ryan Stanton, M.D., Kathy Miles from the NCC Boyle County Agency for Substance Abuse (ASAP), and Amy Baker, program coordinator for Substance Abuse and Violence. Each panel participant spoke about their experience dealing with addicts, the specifics of which shall be discussed below.
Dr. Ryan Stanton, MD
Dr. Stanton played a video where he narrates a compilation of statistics and proposed solutions of how to recover those who are addicted. He made many good points within the video starting with a discussion of addiction in general. He states that addiction means that you no longer have the ability to decide to avoid the substance, that your brain in essence tells your body that you need that substance to survive, like the body needs food, or water, or oxygen. He gave an example of mice who were given opioids and in the tests, these addicted mice would forego food and water and instead press the button for the drug and would eventual starve to death. We, humans, are similar. The opioids act on the reward center of the brain – the natural dopamine. The opioids rewire the brain and has more effect on young children and teenagers than adults.
After this above discussion, he then went on to show evidence that the current epidemic was brought on by several studies in the 1980’s that basically stated that there was a low risk of addiction from opioids. The studies were then used as a way of monitoring pain and overall pain management. Opioids however, have reset our pain thresholds.
It is interesting to note that the United States consumes more than 90% of all manufactured opioids (99% of Hydrocodne). When opioids are used our pain thresholds are changed and shift our overall ability to sense pain. For instance, the more you take the more you need to dull the pain. When you stop taking the opioids you become more sensitive to the pain you had before and are less able to deal with that pain.
Oxycontin, another opioid was developed in 1996 and was marketed as addiction free. The 1980 study mentioned above was used to show the low risk. As such, when it was released its use exploded. This included 32,000 coupons for free prescriptions, over 20,000 education programs, and over 50% of the prescriptions were being written by the primary care physicians with no training in pain management. Profit went from $45 million to $3.1 billion – one of the most profitable drugs in the US.
Enter heroin, the stronger and cheaper alternative to the opioids that the addicted individuals were getting in the pain clinics. Dealers then took heroin to middle America.
Now, the primary fight against the addiction is Narcan or Naloxine which act as goal keepers for the body by blocking or inhibiting the opioids from binding in the brain. They, however, have low endurance and only last about 45 minutes.
To combat this heroin dealers are adding additional drugs such as fentanyl. One of the areas hardest hit is the Appalachian region.
It is clear that there is a major problem. There needs to be an intervention to get these people into recovery programs. Without recovery, these individuals will either change the substance they are taking to increase the effect or they will die.
Ms. Miles joined the panel as the local ASAP coordinator and shared some “take-aways” from her work in Boyle County. Her background has included 40 years of work as a clinician and a program director with substance abuse and mental health patients. She said that Lexington and Scott County came down and warned them that heroin was in their community. Heroin babies were being born in their local hospitals as proof. In order to be successful to fight this is to make sure the community knows you are in this fight for the long haul and that education is very important. We cannot just represent the facts but to present stories – humanize the situation.
In spite of expanded Medicaid and other insurance options there is not enough money for treatment coverage. Her organization has helped raise money for treatment and travel to the treatment centers as there are zero facilities in Boyle County.
It is important to build upon the resources each community has, including the faith based community. Include the local government and request to receive regular reports from the organizations that are working in this area. Address the needs of the local jail – should it be expanded, or should other programs be created in the jail itself, i.e. volunteer intensive outpatient programs.
Statistics show that even if these people go through the programs in the jail and then, when they are released, if they don’t have a job lined up, many will repeat offend and end up back in jail.
Creation of prevention materials and school programs is important and should include education of other drugs and alcohol, not just opioids.
Inevitably HOPE is important and the success stories should be shared to help instill this hope in addicts that there can be a future.
Her starting statements included that recovery is possible and there is always hope and we need to focus on these beliefs. These opioid drugs are devastating both to the addict and the family of the addict. There have already been more than 2,000 doses of Narcan given this year (2017) alone. Treatment for these folks is needed. Each city needs to create a taskforce. Although none of these entities can solve this on their own. You need to include many groups and people in your taskforce to increase success rates, including universities, County/City attorneys, detention centers, health department, Fire, EMS, Police, City and County “decision makers,” and the faith base community.
She then presented a document that was created by the faith based community called “Empowering Communities.”
She then discussed a “locator” called Get Help Lex which is located at GetHelpLex.org. This website helps individuals find resources or places of treatment.
Following the presentations there was a brief period of time allotted for questions and answers. Some of the topics of discussion surrounding the question and answer portion after Panel 1 included a discussion of how much of the fentanyl being used is illegal, that there is a huge job issue for these addicts coming out of jail, and that peer recovery is important. These people need to be taught life skills.
The second panel was made up of four (4) individuals from diverse areas of employment including Amanda Peters, the Northern Kentucky Heroin Impact Response Team Coordinator, Dickie Everman, the Celebrate Recovery Coordinator, Randy Gooch, the Jessamine County Health Director, and Reagan Taylor, Judge Executive of Madison County. Included below is a summary of the presentation.
Spoke about her task force purpose to maximize resources but reduce tax payer burden. Their goal is to reach all addicts and to facilitate treatment for these individuals. She used the term “no wrong door into treatment.”
She then stated that there is a meth resurgence above heroin in northern Kentucky.
Her program is increasing early intervention through pre-arrest programs. In order to do this the community needs to partner with the Police department and first responders. However, this response to drug issues is increasing their financial burden and decreasing their efficiency with other patrol related responsibilities.
The quick response teams include a police officer, an EMT, and an addiction service personnel that is licensed to assess individuals through home visits and other potential pathways for finding these addicts and getting them into treatment. They received a grant through CARIF core funding to help increase this program for training and personnel support.
It is important to not only prevent drugs on the street but also the over-prescribing, and prescription stealing in families. When some of these people are on a 40 pills a day at $40 a pill then this $1600 habit makes it real easy to switch to the $5 heroin instead. This program will help prevent access. We also need to prevent overdose with on-demand treatment by getting their hospital to create a bridge clinic.
The third part of this is support. Some of the companies involved are creating recovery atmosphere with peer support specialists, and holding recovery meetings. Employers need to create policy that isn’t “one-and-done” but focuses on the ongoing issues with withdrawal and recovery.
Mr. Everman spoke on behalf of Celebrate Recovery, a faith based recovery program. He did state that he had addiction issues when he was younger including alcohol and cocaine, etc. He stated that Celebrate Recovery is a focus of his church’s ministry and that he has seen individuals who are prescribed drugs for an injury that turns into an addiction.
The recovery program places women within women and men with men in the groups. The group either uses testimony or has a lesson which goes through the steps of recovery. The program also includes help for children and teenagers. Celebrate Recovery is a program to help the whole family of the addict as all are suffering.
He has set up Celebrate Recovery in prison where the inmates run the program.
He encourages these individuals to find a faith-based recovery program. The support is essential. These people feel like failures and need hope. We can help them get this hope and show them they are not the failures they think.
Mr. Gooch spoke about Jessamine County’s health and safe community’s coalition. Soon after he began work in Jessamine County they conducted a health needs assessment and improvement plan. During the assessment, they discovered that substance misuse and drug overdose was the greatest need in the community.
In order to address this issue, they believed they needed a strong coalition to build capacity. A new program came out – nationally accredited – promoted that the national safety commission. This program was used to bring accreditation to Jessamine County.
More than fifty businesses, organizations, and agencies came together to create this coalition partnership that help build safe communities accreditation.
These strategic partnerships are very important in order to address the complex issues related to drug addiction and treatment. With all the programs out there for drug recovery, we cannot underemphasize the need for prevention programs and education. One program is called Resilience for the Inward Journey.
Safe drug disposal is another prevention program. One company that works on this is called DisposeRX. In essence this company helps you dispose of the left over prescription drugs in the home. They use a product that when mixed with water and the drugs makes into a “goop” that can be thrown away.
Public Service Announcements are another form of education and prevention. Jessamine County created a PSA Awareness Video. Most drug overdoses occur within the age group of 35 to 40. This affects both rich and poor. Many people do not realize that four out of five heroin addicts began with a prescription addiction.
The PSA discusses the need to get help before one’s opioid addiction becomes a heroin addiction and possible fatal overdose. By using GPS locators and GeoFencing they can get the ad to begin playing on people’s phones when they are in certain areas (i.e. doctor’s offices, clinics, etc.).
Judge Reagan Taylor
Judge Taylor spoke about the Healing Center Project founded in Madison County. He highlighted several concepts that had been mentioned – life skills, community, intervention, prevention, hope, partnerships, faith, and treatment. All of these words denote the same common concerns and goals that we have for our communities.
One of his running platforms was the overcrowding of the jail. He wanted to reduce the population and burden on the public. He put together a taskforce of about fourteen people that studied number of indictments per year going back to 1978 and coupled that with a look at the rise in drug abuse. When they really evaluated Madison County’s needs they discovered they did not have a jail problem. They had a drug abuse problem. The indictments went from an average of about 100 to a spike of an average of 500 indictments. This year along they are looking at exceeding 1,000 indictments. It’s important to note that at least 80% to 85% of all those jailed are there for drug related reasons with a 75% recidivism rate.
If one looks at the statistics it would seem that the incarcerating and arresting is not working to reduce drug crime and drug abuse.
Currently, Madison County has a 184-bed detention facility and they are housing approximately 400 inmates. This year along they had to expend $330,000 to house inmates in other counties, and this continues to increase. They are spending more than $3,000,000 each year between the jail and the Sheriff’s departments just to balance their budgets. This is a major financial challenge. Obviously, we would be better off spending this money on quality of life issues, new blacktop etc., not detention.
Historically, the jails were not created to be treatment facilities. The State facilities were meant for the rehabilitation and treatment of inmates. Another issue facing counties is the judicial process. The cost to the County from the time a person is booked into the detention center to the time they are sentenced by the Judge and become a State inmate its about 75% is on the County’s time. They then receive credit for time served and are released which means the State only pays for 25% of that total cost.
All of this pointed to the fact that there was a massive need for change. Medicaid only funds for a 30-day treatment. After that 30-day initial treatment there are almost no other funding options. Add to this a lack of job or even if they have a job, if the addicts can’t budget and use their money wisely and have other basic life skills there is no reason to pour public money into this. They are not going to invest in more beds or another facility when that won’t solve the problem.
We cannot continue to kick the can down the road and use tax payer money to build more beds when that may not solve the problem. Our hope is to build a facility that diverts people from the judicial system to a long-term approach. So instead of investing $50 million in a new facility they will invest it as a GAP Funder, a funding mechanism that Medicaid doesn’t cover. Then partner with local leaders to help provide jobs through vocation training for these people.
The goal is to change the lives of individuals. There must be a collaboration between intervention, prevention, and recovery.
This second Q&A had many people stand and share their personal experiences in their own lives as well as the lives of affected family members. One example that stands out, was a woman whose son was a marine and fell into addiction while receiving help for an injury sustained in the service of our country. He passed away from an overdose. She has since created an organization (Project DARIS) to help with education about this epidemic.
Strategic Planning Session
The strategic portion of the meeting following the panel discussions. Each table was tasked with creating three potential strategic goals that could be used to facilitate additional discussion and needed to focus on the drug epidemic. The three strategic goals from each table were grouped according to topic. All of the strategic goals fell into one (1) of five (5) main or general groups. These groups included Education (Prevention), Employment Opportunities (Re-Entry), Treatment Facilities, Enforcement, and Treatment Programs.
Each attendee was then given two votes to pick two of the five strategic goals what they felt were the top two methods that could be used to help address the Drug epidemic in the region. After the vote, the two top Strategic Goals were Education (Prevention) and Treatment Facilities.
The tables were then divided in half and assigned to create objectives for one of the two chosen strategic goals. As such, participants at four of the tables came up with objectives for Education, and the other half came up with objectives for treatment facilities.
A summary of the objectives discussed included the following:
- Prevention in schools – life skill instruction
- Prevention for adults – detention facility opportunities
- Prevention for adults – community, professional, government
- Funding resources – State, Feds, private?
- Better Counseling Services
- Holistic Education – school, faith, community, medical
- Follow-up and accountability (UK Truth and Consequences School Program)
- Mandated Curriculum
- Public awareness programs – social media, faith based, chamber of commerce, radio, TV, 311, PSA’s
- Stakeholders need to deliver same message
- Find more funding sources – varied
- Advocacy centers to connect people with care
- Standardize model to make opening centers easier more efficient
- Jail needs trained counselors
- Organization of facilities – main hospitals (acute detox), bridge clinics (long term care)
- Individualized treatment – evidence based, faith based, abstinence, MAT, Dual-DIA
- Holistic approach – life skills, vocation, after-care continuum, connections training
- Improve transitional living opportunities
- Analyze assets
- Support expanded facilities
- Expansion/ reform of Casey’s law – redirect funding, and crime prevention.
- https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf and https://www.cdc.gov/drugoverdose/epidemic/index.html
- https://odcp.ky.gov/Documents/2016%20ODCP%20Overdose%20Fatality%20Report%20Final.pdf and population information from the U.S. Census Bureau with calculations based on total number of deaths per 1,000 people.
ATTACHMENT – ATTENDANCE
|2||Amanda Peters||Northern Kentucky Heroin Impact Response Team Coordinator|
|Kim Moser||State Representative – Northern Kentucky|
|Lisa Cooper||Northern kentucky ADD, Executive Director|
|Ed Burtner, Mayor||Winchester|
|2||Reagan Taylor, Judge Executive||Madison County|
|1||Amy Baker||Program Coordinator for Substance Abuse and Violence Intervention (SAVI) LFUCG|
|2||Dickie Everman||Celebrate Recovery Coordinator|
|Derran Broyles||Scott County Jailer|
|Jon Larson, Esq.||Criminal Defense Attorney|
|Susan Rogers||Strategic Planning Consultant|
|Jim Adams, Judge Executive||Lincoln County|
|James Anderson, Judge Executive||Powell County|
|Orbrey Gritton, Judge Executive||Anderson County|
|David West, Judge Executive||Jessamine County|
|Eddie Carter, Mayor||Stanford|
|James Caudill, Mayor||Clay City|
|Sandy Goodlet, Mayor||Lawrenceburg|
|Walther Nolan, Mayor||Irvine|
|Dave Mauck||BGADD Board Member|
|Jeff Shropshire||BGADD Board Member|
|Chris Ford||Commissioner of Social Services, LFUCG|
|Anne Roberts||Chapter of GRASP|
|Stephanie Bowman||New Day Recovery Center|
|1||Kathy Miles||LMFT, LCADC, NCC Boyle County Agency for Substance Abuse Policy|
|Todd Justice, Major||Nicholasville|
|Jeff Fryman, Sergeant||Nicholasville|
|Ben Snyder, Detective||Nicholasville|
|Ethan Witt||Field Representative Senator Mitch McConnell|
|Jared Hollon, Deputy Judge||Scott County|
|2||Randy Gooch||Jessamine County Health Director|
|1||Dr. Ryan Stanton, MD|
|Ron Scott, City Manager||Danville|
|Rick Serres||City Commission|
|J.H. Atkins||City Commission|
|Kevin Caudill||City Commission|