21st Century Prevention Amid the Opioid Crisis Gonzalo Cadima, Director - UWBCCBH&DP Jim Hall, Epidemiologist – NSU ARSH

Mission: “End the Epidemic” Block the Pipeline to Addiction Early Alcohol and Other Drug Use by Youth

Changes in Patterns of Substance Abuse More Poly-Substance Abuse Both Intentional And Unintended More Pharmaceuticals More Addictive More Deadly New Psychoactive Substances - Synthetic Drugs Contaminated Street Drugs

Fentanyl Analogue Contaminated Street Drugs Heroin Counterfeit Pills Cocaine Methamphetamine Mollys Any Powder or Liquid Drug

Presidential Commission Report March 2018 https://www.whitehouse.gov/sites/whitehouse.gov/ files/images/Final_Report_Draft_11-1-2017.pdf

Prevention under-utilized, ………..but cost-effective

Reflecting New Knowledge of the 21st Century Focused on the Brain and Neurology How People Communicate and How People Learn The “Parkland Generation” – Social Media

National Public Education Campaign As with HIV/AIDS in 1980’s Substance Use Disorders (Addiction) Not a moral failing But a chronic Brain Disease Evidence-Based Treatment available

Impacted Sectors of Society Individuals, Families and Friends, Communities

Impacted Sectors of Society - Individuals Neonatal Abstinence Syndrome

Source: Florida Agency for Health Care Administration Number of Neonatal Abstinence Syndrome Cases State of Florida: 2007-2016 21st Century Prevention Broward 2007 29 2012 69 35 2013 75 48 2014 71 73 2015 96 55 2016 N/A Source: Florida Agency for Health Care Administration Jim Hall upfrontin@aol.com

OPIOID EPIDEMIC COLLATERAL DAMAGE TO CHILDREN More than 4,000 babies born with Neonatal Abstinence Syndrome in Florida during 2016, an increase of over 1,000 percent from a decade ago. Substance abuse played a role in 67 percent of the cases where children were removed from their homes within 30 days of birth last year. There's been a 38 percent increase in the number of children under the age of 5 who have been removed from homes because of substance abuse in the past four years. In the first half of 2017, more than 60 percent of all removals were due to drug abuse --- nearly double the percentage just four years ago. The influx of children has resulted in a shortage of foster-care beds in Florida. Source: The News Service of Florida, January 2018

Impacted Sectors of Society - Individuals Neonatal Abstinence Syndrome Adverse Childhood Experiences Early intervention for children with risk factors Trauma Informed Prevention

Impacted Sectors of Society - Individuals (Continued) Foster Care Developmental Disorders Vast Majority are aged 16 to 34: Peak period of pregnancy, parenting, and adverse consequences Special issues for “Baby Boomers”

Impacted Sectors of Society – Families and Friends Prevention with Parent-Based Components Overdose Reversal with Naloxone

Impacted Sectors of Society – Communities Strategic Prevention Framework

Assess Build Evaluate Act Plan

Impacted Sectors of Society – Communities Strategic Prevention Framework United Way of Broward Commission on Behavioral Health and Drug Prevention Community Response Team Opioid Action Plan

Responding to Broward County’s Opiate Epidemic Opiate Action Plan

www.drugfreebroward.org Click on: Initiatives

Community Non-Profits Branch of Community Organization Resources Available Activities Contact Branches of Community Law Enforcement First Responders Medical Community Non-Profits Addiction Treatment Judicial Faith-Based Education County Government Media Business Sector Youth/Parents Federal Agencies

Community Non-Profits Branch of Community Organization Resources Available Activities Contact Branches of Community Law Enforcement First Responders Medical Community Non-Profits Addiction Treatment Judicial Faith-Based Education County Government Media Business Sector Youth/Parents Federal Agencies

Broward County Strategies to Address the Opiate Epidemic   Non-medical Rx use Prevention: 1. Promote compliancy of the CDC prescribing guidelines. 2. Increased disposal sites for Rx medication. 3. Education on safe Rx and OTC products use and secure storage of medications. 4. Increased use of the Prescription Drug Monitoring Program. 5. Information Dissemination: community engagement, education and outreach. 6. Media Engagement  Harm Prevention: 1. Education on safe needle usage 2. Education on the danger of new poisonous opiate analogs and trends 3. Promotion of Syringe Exchange Programs

Overdose Prevention: 1. Increase access to naloxone through pharmacies and law enforcement. 2. Cross-sector trainings and trainings for families and significant others on naloxone usage 3. Education and public awareness about the Good Samaritan Law 4. Collaborate with hospitals to provide referrals/discharge plan for individuals who have overdosed 5. Create a PSA and distribute through YouTube and Comcast   Treatment: 1. Medication-Assisted Treatment with emphasis on wrap-around services   Policy: 1. Increased funding and expansion for treatment facilities 2. Increased utilization of the Marchman Act 3. Implementation of the Designer Drug Enforcement Act

Impacted Sectors of Society – Communities Strategic Prevention Framework United Way of Broward Commission on Behavioral Health and Drug Prevention Community Response Team Opioid Action Plan Health Care System Education Environment Workplace Traffic Safety Criminal Justice System

Effective Prevention Components Consistent messages, Culturally-appropriate Repeated at Home Reinforced: Schools, Workplaces, & Community Organizations Delivered by influential adults and peers

Evidenced-Based Programs https://www.samhsa.gov/capt/sites/default/files/resources/ preventing-prescription-drug-misuse-strategies.pdf

Evidenced-Based Strategies Education Tracking and Monitoring Proper Medication Disposal Harm Reduction Multiple Component Programs

Evidenced-Based Strategies Education: Increase awareness for public and health care professionals. Teach how to properly dispense, store, & dispose of controlled substances. Tracking and Monitoring: Detect “doctor shopping” and Identify aberrant prescribers. Proper Medication Disposal: To limit access and availability as well as raise awareness of prescription drug misuse. Harm Reduction: Mitigate risks linked to misuse of medications. Reduce Deaths & Disabilities. Multi-Component Programs: Combine strategies to address multiple Risk Factors (e.g., lack of awareness, perceptions of harm, access and availability.)

Prevention Resources www.drugfreebroward.org/resources/

SBIRT Screening, Brief Intervention, Referral to Treatment

CRAFFT Car, Relax, Alone, Forget, Family or Friends, Trouble

CRAFFT Car, Relax, Alone, Forget, Family or Friends, Trouble

Take-Back Your Meds

Pharmacology 101 – Appropriate Use of medications

Mass Media Addressing: Hazards of substance use, Danger of opioids, Contaminated street drugs, and Stigma

Media Issues: Branding Media Literacy Effective for parents, not for youth Integrate national campaign with local evidence- based programs

Social Media and Web-based prevention #ReachMe

Mandatory Medical Education for Prescribers and Pharmacists