Partnership for Change: Decreasing prescription drug diversion in Kennebec County Nancy Findlan Charles J. Rumsey IV Alison Jones Webb 2008 International Symposium on Pharmaceuticals in the Home and Environment: Catalysts for Change November 10, 2008 1

Partnership for Change: Decreasing prescription drug diversion in Kennebec County     

Presentation overview

Prevention Framework Community Law Enforcement Health Care Providers Q&A 2

Substance Abuse Prevention: Why bother?

Treatment admissions for opioid dependence: Kennebec County

300 200 100 0 19 95 19 97 19 99 20 01

Year

20 03 20 05 Kennebec County Other opiates and other synthetics Kennebec County Heroin/Morphine Maine Office of Substance Abuse Treatment Data System: https://portalx.bisoex.state.me.us/jav/osa_tdsreports/home.do

accessed July 24, 2008 3

Substance Abuse Prevention: Why Bother?

Unintentional Drug Overdoses Kennebec County, Top 5 Towns

140 120 100 80 60 40 20 0

20 02 20 03 Waterville 20 04 Augusta Winslow 20 05 Oakland 20 06 Winthrop Maine Health Information Center 4

Substance Abuse Prevention: Why bother?

 

Access to treatment

Nationwide, 15.2% of individuals with past-year opioid use disorder received some form of formal treatment or counseling in the past year.

If 437 individuals received treatment for opioid use disorder in Kennebec County in 2006, then 2,875 did not receive treatment.

William C. Becker et al Opioid use disorder in the United States: Insurance status and treatment access. Drug and Alcohol Dependence 94 (2008) 207-213.

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Universal, Selective and Indicated Substance Abuse Prevention Indicated Prevention

Target: individuals with identified precursors of alcohol or drug abuse.

The targeted individuals exhibit early signs of substance abuse and other problem behaviors, such as falling grades among students, known problem consumption or conduct disorders, alienation from parents, etc.

Selective Prevention

Target: high risk groups.

The targeted groups may be distinguished by characteristics such as age, gender, family history, or economic status (e.g. children of substance abusers).

Universal Prevention

Target: the entire population

. Interventions target an entire population (local community, school district, etc.).

Karol L. Kumpfer, “Prevention of Alcohol and Drug Abuse: What Works?” in

Strategic Plan for Interdisciplinary Faculty Development

, Association for Medical Education and Research in Substance Abuse, 2002.

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Environmental Substance Abuse Prevention

Environmental Prevention: Regulatory or community level interventions to deter drug consumption

Indicated Selective Universal •

Reduce Access (server trainings, enforcement of laws, etc.)

•

Reduce Demand (health education, warning labels, etc.)

•

Change community environment (media campaigns, counter advertising, etc.)

Karol L. Kumpfer, “Prevention of Alcohol and Drug Abuse: What Works?” in

Strategic Plan for Interdisciplinary Faculty Development

, Association for Medical Education and Research in Substance Abuse, 2002.

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Evidence-based interventions  Office of Substance Abuse SPF-SIG Strategy Approval Guide http://www.maine.gov/dhhs/osa/prevention/community/spfsig/doc uments/StrategyApprovalPacket_RevisedFinal_11-13-07.doc

 National Registry of Evidence-based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration http://nrepp.samhsa.gov/  National Institute of Drug Abuse www.nida.nih.gov/Prevention/Prevopen.html

 The Community Guide http://www.thecommunityguide.org/ 8

Prevention Strategies Targeting Youth

Community

 Greater Waterville Area Communities for Children and Youth Prevention Coalition   Community of Promise with the America's Promise Network Recipient of Office of National Drug Control Policy’s Drug Free Communities Grant  Recipient of Maine Office of Substance Abuse Essential Services Grant and Strategic Prevention Framework State Incentive Grant 9

Youth Prescription Drug Use in Kennebec County Kennebec County Maine 2002 14.4% 17.7% 2004 15.7% 16.6% 2006 11.7% 12% In 2006, nearly 20% of high school seniors reported having “ever used” prescription drugs (Kennebec County 19.2%; Maine 19.7%).

Maine Youth Drug and Alcohol Survey, 2002, 2004 and 2006 10

Youth Prescription Drug Use in Greater Waterville Area  Prescription Drug Use Students in grades 6 –12  Smaller % of students reported misusing prescription drugs in 2006 compared to 2002 and 2004.

 5% of students reported they have misused prescription drugs 10 or more times in their lifetime Maine Youth Drug and Alcohol Survey, 2004 and 2006. Schools included Messalonskee Middle and High School, Waterville junior high and high school, Winslow junior high and high school, Lawrence junior high and high school.

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Youth Prescription Drug Use in Greater Waterville Area

Prescription Drug Misuse: All Grades (2004 and 2006 Lifetime Use Previous 30-day Use Number of Times Used 2004 2006 2004 2006

NO USE 87.9 91.0 93.1 95.3 1-2 TIMES 3-5 TIMES 6-9 TIMES 10 OR MORE 5.4 2.1 1.9 2.6 3.2 1.9 0.8 3.1 4.7 1.2 0.9 0.1 2.1 0.9 0.5 1.2 Maine Youth Drug and Alcohol Survey, 2004 and 2006. Messalonskee Middle and High School 12

Environmental Prevention Strategies    Educate parents about their responsibilities with regards to limiting access of prescription drugs, proper use of prescription drugs and proper disposal Parent Media Campaign Social Hosting 13

Indicated Prevention Strategies    Educate youth about the dangers of misusing prescription drugs and the risks associated with misuse or abuse Boomerang Diversion to Assets Program 14

Environmental Prevention Strategies

Law Enforcement

Forging Partnerships to Reduce Access/ Abuse of Pharmaceuticals 15

Working Together  Waterville Police Department:   31 sworn officers 2 officers assigned exclusively to drug investigations  Networking with numerous law enforcement/ community health organizations  Education about current trends in street level abuse   Serve as source of information to medical community Foster relationships to improve open communication 16

Working Together   Kennebec Valley Drug Task Force:  Includes members from 5 municipal/county law enforcement agencies   Share intelligence, manpower, equipment Mainly target prescription and “hard” drugs Northern Kennebec Underage Drinking Task Force:  Numerous agencies and community partners    Conduct enforcement/compliance Education around underage drinking Encounter/enforce various drug violations 17

Working Together  Maine Chiefs of Police Association  This fall, MCOPA endorsed the efforts of the Maine e-Prescribing Interest Group to advocate for Maine’s doctors to be able to prescribe controlled substances in a paperless environment:   Reduces/eliminates use of paper prescriptions May reduce opportunity for theft, forgery and/or diversion 18

Innovative Programs  Waterville Police Department’s Crime Tip Information Form:  Allows area citizens to report illegal drug activity anonymously  Information is forwarded to on-duty supervisors for review and action  Can be accessed through:  www.waterville-me.gov

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Innovative Programs  Waterville Police Department’s Prescription Drug Diversion Program:  Monthly mailing/email    Maintains up-to-date list of offenders charged in northern Kennebec County for prescription or “hard” drug crimes or diversion crimes Mailing includes picture and other public information Made available to doctors, emergency department staff, pharmacists 20

Prescription Drug Diversion Program  A tool for healthcare professionals to consider when determining whether/how to prescribe pharmaceuticals  Partnership with local law enforcement, District Attorney’s Office, healthcare professionals  Enthusiastically received by community  The program is being replicated by numerous law enforcement agencies across the state 21

Prescription Drug Diversion Program 22

Moving Forward     Key for law enforcement is continued investigation and enforcement to disrupt supply Waterville Police Department will continue to seek ways to engage our healthcare partners in dialogue to affect the problem We will continue to cooperate with community efforts such as “take back” programs Please contact us for more information!

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Environmental Prevention Strategies

Health Care Providers

MaineGeneral Medical Center’s Prevention Center  Recipient of Strategic Prevention Framework State Incentive Grant   Reduce Access: Prescription Monitoring Program Reduce demand: Alcohol/drug screening [brief intervention, referral, treatment] 24

Maine’s Prescription Monitoring Program      Legislation passed in 2003 Scheduled drugs (II, III, and IV) All transactions saved in centralized, relational database Data collection began in July of 2004 Data is submitted twice a month from over 300 pharmacies (both in and out of state) 25

Maine’s Prescription Monitoring Program  Free service for registered prescribers  Online access to database for b ackground check (patient history report) on prescriptions of Schedule II, III, and IV drugs for current and new patients  red flags of potential addiction and/or diversion (e.g., “doctor-shopping”)  Automatically generated Threshold Reports  Coordinate care with other prescribers  Sub-accounts for use by non-prescribers 26

How do Prescribers use PMP in Kennebec County?

If you find through PMP that a patient is receiving prescriptions from multiple providers, what is your typical course of action?

90.2

100 80 60 40 20 0 39.2

25.5

58.8

29.4

23.5

2008 survey of MaineGeneral Medical Staff 27

How do Prescribers use PMP in Kennebec County?

80.00% 60.00% 40.00% 20.00% 0.00%

What criteria do you use when you consider checking a patient record in PMP?

74.50% 64.70% 29.40% New patient Monitor current patient Other Most common “other” responses:   Suspicious patient behavior New patients requesting narcotics 2008 survey of MaineGeneral Medical Staff 28

Alcohol/drug Screening     Promote evidence-based screening tools Educate health care providers about substance abuse treatment options Promote substance abuse treatment services Promote treatment access lines 29

Alcohol/drug Screening 30

Alcohol/drug Screening  Promote on-line self-assessment at worksites, schools, in the community, etc.

www.alcoholscreening.org

www.drugscreening.org

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Contact Information  Nancy Findlan, Project Director, Greater Waterville Area Communities for Children and Youth Prevention Coalition [email protected]

 Charles J. Rumsey IV, Deputy Chief of Police, Waterville Police Department [email protected]

 Alison Jones Webb, Public Health Specialist, MaineGeneral Prevention Center [email protected]

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