Curbing the Impacts: How Opioids are Impacting Local Government Gaston Controlled Substances Coalition Team Members October 10, 2018

Panelists Velma V. Taormina, MD Todd Davis, MD Sheriff Alan Cloninger Tammy and Nazrul Chowdhury

Objectives Overview of the NC Opioid Action Plan (2017-2021) Overview of the Gaston Controlled Substances Coalition Tell our story…

NC Opioid Action Plan (2017-2021) 11/29/2018 NC Opioid Action Plan (2017-2021) Create a coordinated infrastructure Reduce oversupply of prescription opioids Reduce diversion and flow of illicit drugs Increase community awareness and prevention Make naloxone widely available Expand treatment and recovery oriented systems of care Measure our impact The NC Opioid Action Plan was released in June 2017. It is a 42 page document outlining different focus areas. www.ncdhhs.gov/opioids

NC Opioid Action Plan Goal? Reduce the number of unintentional opioid-related deaths by 20% by 2021.

What is our story? What do the numbers tell us? Who is impacted by this? Who is paying for this? Who do we need at the table? How are we going to sustain the work?

Gaston County Facts Ranks 74th of 100 NC counties in geographical size, but 7th in population About 217,000 residents, 13 municipalities, home to more than 700 churches Once a leading textile manufacturer, Gaston County’s mill system largely disappeared by 1990, but the influences of this culture remain a powerful force Looking at the issue within the context of Gaston County We are worse off health wise than our neighbors Goal to work in mill….then the mills leave Low literacy Mill work physically tough = chronic pain = self medication Helps to explain how we got to where we are. Engaging the churches is so important (ex. Teen pregnancy, diabetes)

Gaston County North Carolina Measure for the period 2011-2015 Gaston County North Carolina High school graduate or higher, persons 25 years + 82.9% 88.5% Bachelor’s degree or higher, persons age 25+ 19.0% 28.4% Median household income, 2015 dollars $42,429 $46,868 Per capita income in past 12 months, 2015 dollars $22,828 $25,290 With a disability, under age 65 years 12.1% 9.6% Because a good paying, lifelong job was immediately available in the textile mills, our educational levels lagged behind state norms.

History of Gaston County Tough manual labor, higher rates of injury and disability, higher unemployment & poverty, lower rates of education Gaston gained national attention in the 1980s as the Dilaudid capital of the US (most per capita prescriptions) Multigenerational use of pain killers and benzodiazepines Di-law-did: is an opioid pain med…used to treat moderate to sever pain Therefore Gaston County has a “history” of opioid abuse…this is not a new issue. However the overdosing is a new issue based on these drugs being used in combination with other things

County Medication & Drug Overdose Deaths by Intent County-level data: *USE CAUTION WITH LOW NUMBERS OF DEATHS* Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2016 Medication and drug overdose: X40-X44, X60-X64, Y10-Y14, X85. Analysis by Injury Epidemiology and Surveillance Unit

Gaston County’s Opioid Crisis Something changed in 2016: the number of deaths grew, opioid misuse and abuse moved from the shadows to a visible communitywide health problem Gaston County’s opioid problem arises from multiple needs and pathways. It is complex. For years, it was seen as the local management entity/managed care organization’s (LME-MCO) problem to deal with or fix

How will Gaston County respond? Gastonia Town hall Meeting – March 2016 Over 100 citizens attended Senior staff from our local hospital and the Gaston Community Healthcare Commission Healthcare Commission decided to focus on the opioid epidemic The complexity of this question was articulated at a town hall meeting organized by Gastonia City Councilman, Robert Kellogg, in March 2016 Over 100 persons attended, heard presentations, and asked questions of the panelists; this conversation clearly articulated great community pain and need Attendees included senior staff from our local hospital and the Gaston Community Healthcare Commission As a result, the Healthcare Commission decided to focus on the opioid epidemic

Community support Four key stakeholders: one hospital system 11/29/2018 Community support Four key stakeholders: one hospital system one LME-MCO one FQHC one Health Department Stakeholders have a history of collaboration that continues to grow Stakeholders agreed to provide resources to the Coalition CaroMont was the original funder of the Healthcare Commission, it is now funded by the four key stakeholders The Gaston County Health Department and Gaston Memorial Hospital – predecessor agencies to DHHS and CaroMont – established Gaston Family Health Services. GFHS has offices in two health department facilities and the two organizations share another facility. GFHS provides MAT to STAR patients. PHBM collaborates with CaroMont on funding psychiatric care for indigent residents and ensuring linkage to community-based aftercare. Has shared KB Reynolds grant with GFHS and continues to collaborate on integrated care initiatives. Works with DHHS and the Health Dept on STAR and other Medicaid initiatives. Engaged partners in development of daylong Opioid Summit in March 2016, for which Dr. McClellan was the keynote speaker. CaroMont helped fund our first CME event, dedicated a large portion of a speed-dating program to opioids, and hosts many of our meetings. GFHS staff organized and marketed the CME event. Partners Behavioral Health Management paid for Dr. McLellan to facilitate our Behavioral Health Summit and is testing and producing our brochure. Gaston-DHHS hosts the coalition website and provides it with a grant writer.

Opioid Epidemic Prescribers Affected families Social Services Law Enforcement Court System Syringe Exchange Program Behavioral Health Hospital Medication Assisted Treatment Faith-based Groups As you can, there are many entities that are tackling/affected by this problem.

Gaston Community Healthcare Commission Gaston Controlled Substances Coalition Steering Committee Controlled Substances Policy Adoption Committee Prescribers Measurements Community Education & Prevention Committee Clergy Opioid Outreach Subcommittee Medication Take-back Subcommittee Treatment Linkages Committee Opioid Overdose Response Team The Coalition has over 145 members representing more than 30 organizations

Todd Davis, MD What causes someone to become addicted to opioids? What is going on in their body and how does this impact their behavior? How is this impacting your hospital?

Sheriff Alan Cloninger How is the opioid crisis impacting first responders? What training are first responders receiving to deal with overdoses or with someone who has an addiction? What impact is this having on the justice and penitentiary system?

The Chowdhury Family Austin’s Story What should parents be looking for? What can the average person do to help address the issue of opioid abuse?

Gaston Controlled Substances Coalition’s Strategic Plan 11/29/2018 Gaston Controlled Substances Coalition’s Strategic Plan Created a coordinated infrastructure Reduce oversupply of prescription opioids Reduce diversion and flow of illicit drugs Increasing community awareness and prevention Make naloxone widely available Expand treatment and recovery oriented systems of care Measuring our impact

What is Next for You? Educate yourself on the signs and symptoms of drug use. Talk to your family members. Empty out your drug cabinets. Review the NC Opioid Action Plan Get involved. Support a cause. Not for us but for you.

Questions? velma.taormina@gastongov.com Not for us but for you.