1. The Opioid Crisis in Connecticut
Quinnipiac University
Opioid Summit
November 9, 2018

2. DMHAS
Lead state agency for adult mental health and substance use services
Nearly 107,000 served by DMHAS system of care in FY17
Two State hospitals and 6 State-operated Local Mental Health Authorities
134 non-profit agencies provide individuals with substance use and mental health services
Prevention, Treatment and Recovery Support
Treatment and support for adults only (18+)
Prevention services across the lifespan

3. Nationally Northeast has been hard hit
Since 2007, nearly a 150% increase in heroin abuse or dependence
Heroin use has more than doubled among young adults ages in the past decade
In many cases, prescription painkiller misuse leads to heroin use
New England has highest overdose rate out of other comparable regions in the country
Physicians were previously under pressure for not treating pain aggressively enough, now prescription painkillers are everywhere

4. Heroin and Other Synthetic Opiates
Less expensive than prescription opiates
Increased availability
High purity
Synthetic opiates
Even less expensive than heroin
More potent
Fentanyl, carfentanil, furanyl fentanyl
Average price for a bag of heroin (10 mg) is $10 (some places as low as $4 or $5)
Oxycodone costs $40 for 40 mg pill or $80 for 80 mg pill on the street
Fentanyl is 25-50x stronger than heroin and 100x stronger than morphine
Carfentanil is said to be 10,000x stronger than morphine
These vials show the lethal dosage of each drug. Carfentanil is significantly more potent.
Photo credit: Paige Sutherland/NHPR

5. Connecticut Accidental Drug Intoxication Deaths
*Some deaths had combinations of drugs; pure ethanol intoxications are not included.
** These include Acetyl Fentanyl, Furanyl Fentanyl, Carfentanil, Fluorobutyryl Fentanyl, Butyryl Fentanyl, and U47700,
NOS, not otherwise specified.
Updated 9/12/18

7. Opioid-Related Legislation in Connecticut
“Good Samaritan Law” protects individuals from arrest for possession of drugs/paraphernalia when calling 911 for help in an overdose situation (2011)
Naloxone, a life-saving medication used to reverse opioid overdoses, can be prescribed by trained pharmacists (2015)
Also protections for individuals administering naloxone in the event of an overdose (2014)
Limits on prescribing of opioid medications
5-day limit for minors (2017)
72-hour limit for prescribers to prescribe to family members in an emergency (2018)

8. Alcohol and Drug Policy Council (ADPC)
Chaired by DMHAS and Dept. of Children and Families
Tasked by Governor Malloy to coordinate state substance abuse prevention and treatment efforts and develop recommendations on addressing the state’s opioid crisis
Subcommittees working to implement recommendations
Prevention, screening and early intervention
Treatment and recovery supports
Recovery and health management
Criminal justice

9. Connecticut Opioid Response (CORe) Initiative
Governor Malloy engaged the Connecticut Opioid Response (CORe) team to supplement and support the work of the ADPC by creating a focused set of tactics and methods for immediate deployment
Tactics include:
Increase MAT use among incarcerated
Increase access to buprenorphine
Increase accessibility to naloxone
Educational efforts with media, agencies, health care and public health personnel
Diverting individuals from the legal system to the health care and treatment system

10. DMHAS Prevention Activities
Public messaging
LiveLOUD campaign getting ready to launch
Promote drop boxes and drug take back days
Participate in a number of community task forces, workgroups and advisory boards across the state to coordinate efforts
Federal funding for communities to prevent prescription drug misuse in teens & young adults
Some agencies are working to fund community drop boxes
Statewide messaging: TV and radio interviews, PSA, posters, infographics, information sharing on social media
Expanding access to Narcan
Pharmacists have ability to prescribe Narcan
Allow prescribing of Narcan to family members or friends
Good Samaritan Law
State Police required to carry Narcan in their cruisers
Legislative proposal requiring municipalities to have first responders equipped with and trained on Narcan
Strengthening the Prescription Monitoring Program
Requiring all prescribers to check Connecticut’s Prescription Monitoring Program (PMP) prior to prescribing any controlled substance to patients
Requiring that pharmacists input data on prescriptions of controlled substances to the PMP every 24 hours
Improving prescriber education
Requiring mandatory continuing education for all prescribers (doctors, APRNs, dentists and physician assistants) on addiction and pain management.
Coordinating a statewide response through the Connecticut Alcohol and Drug Policy Council
Group is developing a uniform prevention message, a unified website and public service announcements

11. Federal Grants 25 different initiatives
State Targeted Response (STR) Grant
$5.5 million each year for two years ( )
Increased access to Medication Assisted Treatment (MAT)
Implemented MAT induction at Osborne DOC pre-release center
State Opioid Response (SOR) Grant
$11.1 million each year for two years ( )
Funding for DOC to provide MAT to inmates pre- and post-release
Street- and shelter-based MAT in New Haven and one other urban center (TBD)
Fund “Law Enforcement Assisted Diversion” (LEAD) for Hartford and New Haven police departments

12. Broad Spectrum of Services Serving Individuals in Recovery from SA
Inpatient Detox
SA Residential Treatment
SA Residential Long-Term
SA Outpatient and IOP
DMHAS Recovery Houses
Methadone Maintenance Treatment
Broad Spectrum of Services Serving Individuals in Recovery from SA

13. Unduplicated Individuals Served Annually
(includes DMHAS-funded and non DMHAS-funded services)
Level of Care
Utilization
Inpatient Detox
11,356
SA Residential Treatment
7,223
Residential Long Term Care and Halfway House
1,834
SA PHP, IOP and OP
43,352
Methadone Maintenance Treatment (MMT)
21,570
*FY2018 (7/1/2017 to 6/30/2018)

14. ACCESS Line
Statewide toll-free number for people seeking treatment and information about treatment and services
Answered 24/7
Detox screening via conference call with the caller, ACCESS Line operator and detox provider
If person is recommended for detox, stays on the phone until an available detox bed is located
Transportation to detox is available when necessary

15. Addiction Bed Availability Website
Real-time bed availability for DMHAS addiction beds

16. Recovery Coaches in EDs
Launched in Spring 2017, with 4 EDs (Manchester Memorial, Lawrence + Memorial, Backus and Windham)
Recovery coaches go to EDs and connect individuals with substance use disorders to services
Peer staff have personal experience that helps in a unique way with engagement and linkage to treatment and recovery supports
Expanded in late-2017 with 4 new EDs: Danbury, Saint Francis, Day Kimball and Midstate Medical
Two more hospitals (TBD) are being added

17. Recovery Coach Referrals (March 1, 2017 – June 30, 2018)

18. Recovery Community Centers
Drop-in community centers
Three locations: Bridgeport, Hartford, Windham
Peer-to-peer recovery support services
Recovery meetings
Recovery training series
Family support
Recovery coaching
Recovery social events

19. What YOU Can Do

20. Know Your Children and Grandchildren
Get involved in their school
Know their friends and their friends’ parents
Educate them about the dangers of prescription medications and other drugs

21. Talk With Your Doctor When being prescribed medication
Ask if there are alternatives to opioids for pain management
Ask if you need that many refills
Ask about a plan for long-term pain management, if necessary

22. Monitor Your Medications
Count your medications
Make sure they are locked and secure

23. Get Rid of Unwanted Meds
Bring any unused pain medications to a local drop box or to a drug take back event for disposal ASAP