1. RESPONSE TO THE HEROIN EPEDEMIC

2. Significance of the Problem

3. Significance of the Problem
Recognized that there was a rise in use of prescription medication
Recognized that there was a decrease in heroin
Beginning to hear stories from constituents about difficulties in accessing care
Concern about an emphasis on Mental Health Treatment and a lack of emphasis on Addictions Treatment

4. UD Center for Drug & Health Studies
Using Delaware’s Prescription Drug Monitoring Program, crime statistics and toxicology reports from the Division of Forensic Science from 2013 to late 2014, preliminary research from UD’s Tammy Anderson found:
A 7% increase in prescription opiates.
Prescribing rate increased from prescriptions per 1,000 people to 1,117 prescriptions per 1,000 people.
People age 50+ saw the largest increases in fentanyl and other opiate prescriptions, especially in southern Delaware.
Overdose “hot spot” neighborhoods scattered across the state.

5. CALL TO ACTION Gathered interested legislators to meet with Governor
Gathered interested legislators to meet with the Secretary
Went to an NGA sponsored training in Atlanta with key health department staff and legislators
Developed a plan of action
Initiated a system redesign

6. Addiction: Focus on 3 Fronts
Fighting drug use and addiction is complex and requires work across government departments and in concert with others along 3 fronts:
Prevention/Education
Treatment/Recovery
Criminal Justice/Law Enforcement

7. Guiding the Process
Met with Stakeholders from government, private sector and community to identify the problems as they saw it
Developed a series of actions as a result of the meetings to address policy responses, system redesign, and criminal justice modification
Established a connection with health department to monitor

8. ACTION
Gathered together law enforcement, health care workers, community representatives, community advocates providers, and legislators
Identified system strengths and weaknesses
Identified adequacy of the system
Identified problems with access and payment
Identified problems with communication

9. ISSUES IDENTIFIED Treatment system was not adequate to meet the demand
Policies not adequate to meet the new shift in use from opiate drugs to heroine
Overdoses increasing and drugs corrupted with fentynal
Too many individuals entering the justice system instead of receiving appropriate treatment

10. Path Forward
Meet with the Governor to establish priorities potential funding needs
Meet with legislators to identify legislation to address overdoses and make access to treatment easier
Meet with the the Division of Substance Abuse and Mental Health to address system redesign
Meet with law enforcement and criminal justice systems to address alternative approaches to address the addicted individual
Work with Public Health to addrerss the medical community and prescribing practices

11. GOVERNOR Discussed with Governor the service needs for the State
Present to the Governor the system redesigns developed in the Atlanta academy
Identify the budget resources needed for the new system
Work with the Governor to develop oversight for physicians

12. Legislature
Developed legislation to allow for individuals to call the police and EMS to respond without the danger of being arrested. (Good Samaritan Law)
Develop legislation that allowed for the training and distribution of Narcan
Review the sentencing laws and service for those arrested for drug related charges
Work with Professional Regulations around developing prescribing practices
Require education about addiction in schools

13. Prevention and Education
Beginning with the previous school year, all high school students must receive 15 hours of drug & alcohol prevention education before graduation.
Working with the schools to deliver a more effective message
Developing a strong prevention message For the community

14. Prevention and Education
24/7 Drug Take-Back collection containers now at 14 police stations statewide.
Surgeon General sent a letter to 2.3M clinicians asking them to take the pledge to reduce the impact of addiction epidemic by:
Educating themselves on how to treat pain safely and effectively;
Screening patients for opioid use disorder and connect them to treatment;
Talking about addiction as the chronic brain disease that it is in order to reduce public stigma.

15. Systems Redsign Withdrawal Management
In November 2015, DHSS opened a downstate withdrawal management center, which added:
16 medical beds;
12 23-hour medical assessment slots;
outpatient slots.

16. Withdrawal Management
With the new withdrawal management center in Kent County joining the existing center in New Castle County, the total public withdrawal management services available statewide:
32 medical detox beds
24 23-hour medical assessment slots
outpatient slots

17. Residential Treatment
Beginning in February 2016, DHSS went from 78 total beds in one location to 95 beds in 4 locations:
Gateway for men at Delaware Hospital for the Chronically Ill (47);
PSI for women in Dover (16);
PSI for men in Dover (16);
Connections for women in Delaware City (16).

18. Sober Living Beds
DHSS had increased the total of sober living beds from 60 beds to 120 beds:
New Castle County: 58 (34 men; 24 women)
Kent County: 28 (20 men; 8 women)
Sussex County: 34 (22 men; 12 women)

19. Other State Services
Young adult opiate residential treatment: From 16 to 32 beds (when provider finds new location in Kent or Sussex)
Outpatient treatment: Expanding services to include full continuum of support – partial hospitalization, expanding intensive outpatient and traditional outpatient provider network
Recovery Response Center (RRC): Opened in Newark in July 2016 to serve New Castle County.

20. Criminal Justice/Law Enforcement
DOC Commissioner Robert Coupe says 60% of those incarcerated impacted by addiction.
Department of Correction redesigning Crest and Key programs, which are 25 years old.
Focus on re-entry to provide a handoff to continuing treatment in the community.

21. Law Enforcement Partnerships
Law enforcement embracing fact that addiction is a disease and they cannot arrest their way out of epidemic. Two new programs started in past year:
Hero Help: With DHSS and DOJ, New Castle County Police will offer treatment option to individuals instead of arrest.
Angel Program: Active users who walk into Dover PD will be connected to treatment through Connections and “angel” volunteers.

22. Advancing Public Health with Law Enforcement
Delaware one of four states chosen for NGA Learning Lab on data-sharing.
NGA providing expertise to work out data-sharing agreements, hosting agency and analysis – 6 month action plan
Data/information will be used by law enforcement, ME’s office, public health and treatment services.

23. Policy Development Prescription Drug Action Committee
In response to the epidemic, Gov. Markell created the Prescription Drug Action Committee (PDAC) in February 2012.
Mission is to coordinate public, private and community efforts across the spectrum.
Co-Chaired by Public Health Director Dr. Karyl Rattay and Medical Society of Delaware Past President Dr. Randeep Kahlon.
Comprehensive recommendations to combat drug abuse, misuse and diversion statewide. PDAC report: pdf

24. Prescribing Regulations
Secretary of State Jeffrey Bullock issued proposed opiate prescribing regulations for clinicians. State regulations will mirror CDC guidelines:
For acute injury or procedure, maximum initial 7-day supply of an opioid medication can be prescribed.
Beyond 7-day supply, practitioner will be required to check patient’s prescription history in State’s Prescription Monitoring Program (PMP), along with informing patient of risks of potential addiction.
For patients being treated for chronic pain, practitioners must check State’s PMP and administer a urine drug screening at least twice a year; must also consider and discuss alternative treatment options with a patient and do a risk assessment.