Rx Drug Use and Misuse: Prevention and Treatment Programs at the State/Community Level Presenters: • Travis Fretwell, MAC, NCAC II, CCS, Director, Georgia Department of Behavioral Health and Developmental Disabilities • Kevin Gabbert, MSW, LISW, IAADC, Access to Recovery Project Director, Iowa Department of Public Health • Monica Wilke-Brown, LMSW, Director, Screening, Brief Intervention and Referral to Treatment Project, Iowa Department of Public Health Federal Track Moderator: Mitra Ahadpour, MD, DABAM, Medical Officer, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration
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Rx Drug Use and Misuse:Prevention and Treatment Programs
at the State/Community LevelPresenters:• Travis Fretwell, MAC, NCAC II, CCS, Director, Georgia Department of
Behavioral Health and Developmental Disabilities
• Kevin Gabbert, MSW, LISW, IAADC, Access to Recovery Project Director, Iowa Department of Public Health
• Monica Wilke-Brown, LMSW, Director, Screening, Brief Intervention and Referral to Treatment Project, Iowa Department of Public Health
Federal Track
Moderator: Mitra Ahadpour, MD, DABAM, Medical Officer, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration
Learning Objectives
1. Identify at least three strategies to prevent prescription drug misuse, abuse, and diversion.
2. Understand the importance of collaboration between various governmental entities and non-traditional partners to prevent prescription drug abuse and misuse.
3. Learn methods for expanding treatment service systems to include MAT in addressing opioid use disorders.
4. Learn about opportunities to leverage existing funding sources to meet client treatment/recovery.
Strategic Prevention Framework for Partnerships for Success (SPF-PFS):• Prevent the onset and reduce the
progression of substance misuse, prioritizing underage drinking among persons age 12 – 20, prescription drug misuse among persons age 12 -25 or both.
• Strengthen prevention capacity and infrastructure at the State, tribal, and community levels.
Medication Assisted Treatment (MAT)-Prescription Drug and Opioid Addiction:• Increase the number of individuals receiving MAT
services with pharmacotherapies approved by the FDA for the treatment of opioid use disorder.
• Increase the number of individuals receiving integrated care.
• Decrease illicit drug use at 6-months follow-up.
TRAVIS FRETWELL
OFFICE OF BEHAVIORAL HEALTH PREVENTION
MARCH 29 , 2016
Georgia Department of Behavioral Health
and Developmental Disabilities (DBHDD)GEN Rx Project
6Georgia Department of Behavioral Health and Developmental Disabilities
DBHDD Vis ion :
Easy access to h igh-qual i ty care that l eads to a l i fe o f recovery and dependence for the people we serve .
DBHDD Miss ion :
To lead an accountab le and effect i ve cont inuum of care to support people wi th behaviora l hea l th chal l enges , and in te l lectua l and deve lopmenta l d i sab i l i t i es in a dynamic hea l th care env i ronment .
Department of Behavioral Health and Developmental
Disabilities
7Georgia Department of Behavioral Health and Developmental Disabilities
Office of Behavioral Health Prevention
8Georgia Department of Behavioral Health and Developmental Disabilities
Science Based Prevention
Strategic Prevention Framework
9Georgia Department of Behavioral Health and Developmental Disabilities
TO REDUCE MISUSE/ABUSE OF PRESCRIPTION DRUGS AMONG 12-25 YEAR OLDS IN
CATOOSA, EARLY, AND GWINNETT COUNTIES .
Awarded SAMHSA’s SPF-PFS II in 2012 for 3 years.Recently awarded the SPF-PFS 15 to continue
GEN Rx through October, 2020.
10Georgia Department of Behavioral Health and Developmental Disabilities
GEN Rx Goals/Objectives
Reduce Availability of Rx drugs
Decrease Access to Rx drugs
Increase Peer and Family Norms that Discourage Rx Drug Misuse/Abuse
Increase Perception of Rx drugs Risk/Harm
11Georgia Department of Behavioral Health and Developmental Disabilities
GEN Rx Target Communities:- Catoosa- Early- Gwinnett
12Georgia Department of Behavioral Health and Developmental Disabilities
GEN Rx Strategy Alignment
ONDCP Recommended Strategies:1 – Safe Storage2 – Secure Disposal3 – Education/Awareness4 – Enforcement
13Georgia Department of Behavioral Health and Developmental Disabilities
GA Prescription Drug Abuse Prevention Initiative and Collaborative
• Rx Drug Drop Boxes• Medicine Safes• Drug Disposal• PDMP• Pill Mills & Doctor
Shopping• Educational Videos
14Georgia Department of Behavioral Health and Developmental Disabilities
CATOOSA COUNTY PREVENTION INITIATIVE
Catoosa County
15Georgia Department of Behavioral Health and Developmental Disabilities
EARLY CHOICES
Early County
16Georgia Department of Behavioral Health and Developmental Disabilities
CETPA
Gwinnett County
17Georgia Department of Behavioral Health and Developmental Disabilities
GEN Rx Successes
Key Stakeholder Engagement at the Local and State Level
Detailed Work Plans as a Measurement Tool to Determine Progress
Innovative Programs and Activities
Alignment with National and State Strategies
Community Readiness Assessment Level Increases from 2012 to 2015
18Georgia Department of Behavioral Health and Developmental Disabilities
GEN Rx Challenges
Lack of data, especially for the 20-25 year old/college-aged population
Identifying and addressing health disparate populations
Lack of evidence-based strategies to address Rx drugs
PDMP Improvements Needed
19Georgia Department of Behavioral Health and Developmental Disabilities
TRAVIS FRETWELL
DIRECTOROFFICE OF BEHAVIORAL HEALTH PREVENTION
Medication Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) Grant
The Iowa MAT Project
Clarification
To clarify, our presentation today is on Iowa…• We’re not known for potatoes (Idaho)• We’re not the buckeye state (Ohio)• We’re here to talk about Iowa (Corn)
– State of approximately 3.1 million people– Generally rural state with several larger metro areas
Substance Use Facts
• Each year our SUD provider network serves over 48,000 individuals in various levels of treatment
• We have 21 catchment areas that encompass all 99 counties, offering subsidized treatment services through use of SAPT Block Grant and State Appropriations
• Substances used– Alcohol (46.6%)– Marijuana (24.5%)– Methamphetamine (18.4%)– Heroin/Other Opioids/Synthetics (4.8%)– Cocaine/Crack (1.4%)
Heroin/Opioid Treatment AdmissionsDrug Classification Number of admissions in
2005Number of admissions in
2014
Heroin: 186 636
Other Opioids: 422 1,363
Heroin/Opioid Overdose DeathsDrug Classification Number of overdose
deaths in 2005Number of overdose
deaths in 2014
Heroin: 2 19
Other Opioids: 10 33
Heroin/Opioids in Iowa
• In the last decade, Treatment Admissions in Iowa for individuals indicating Heroin/Other Opioids as their drug of choice has tripled
• In the last decade, Overdose Deaths in Iowa due to Heroin/Other Opioids have quadrupled
MAT in Iowa
• Iowa currently has 4 opioid treatment programs (OTP’s) in 7 locations, and contracted with 2 additional in IL and NE
• According to SAMHSA’s Buprenorphine treatment locator, Iowa has 31 qualified physicians that can prescribe/dispense Buprenorphine
• For the past 20 years, the Iowa Department of Public Health (IDPH) has funded 3 selected OTP’s to provide medication assisted treatment (methadone)
MAT in Iowa
• As approaches to MAT continued to evolve, through our Access to Recovery (ATR) grant, in 2007 Iowa began funding additional medications such as Naltrexone and Buprenorphine
• Despite these efforts, less than 20% of individuals receiving treatment in Iowa for Heroin/Opioids are being provided MAT
MAT-PDOA Grant
• In early 2015, SAMHSA released the Medication Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) grant to further support State efforts in addressing opioid misuse
• Applications for the grant were due May 8, 2015• We “assumed” that there would be a grant start
date of October 1, 2015• Iowa applied, proposing a simple application
Iowa’s Proposal
• Release a presumptive RFP to the established SAPT block grant funded substance abuse treatment providers in the 10 counties designated as highest need
• Upon notice of award from SAMHSA, the four highest scoring proposals (counties) would be awarded a MAT grant by IDPH
Iowa’s Proposal
• Funding awarded to providers would be used as follows:– 85% of award goes to treatment provision to all eligible Iowans
• Medication • Medical Services• Care Coordination
– 15% of award goes to provider infrastructure• Workforce development • Integrated care coordination • Prescriber recruitment • Outreach to underserved populations• Improved access
Grant Collaboration
• Didn’t budget for Recovery Support Services (RSS), instead making it an eligibility requirement that providers need to also be an ATR provider or have an MOU with one.
• To maximize funding for MAT, clients would be enrolled in ATR for any RSS needs
• Because we chose SAPT Block Grant providers/partners, we again maximized funding for client MAT treatment services
Proposal Goals
1. Coordinate expansion and enhancement of MAT services
2. Increase the number of individuals receiving MAT services
3. Decrease illicit drug use and improve client outcomes
Award Notification
• We received our Notice of Award on July 29th
• It stated that the grant starts on August 1st • Brief moment of panic, then started with
implementing our “modified” plan
Implementation
• In just over a month (September 10th) we released our RFP
• We released a NOA, identifying 4 awarded providers on October 29th
• Entered our first client on December 3rd• As of March 1st, we’ve admitted 29 clients into
our MAT project
Our MAT Grant Sites
• Area Substance Abuse Council (East)• Jackson Recovery Centers (West)• Mercy Turning Point (Northeast)• United Community Services (Central)
Area Substance Abuse Council
• Treatment provider since 1962, provides multiple levels of care, mother/child-specific as well as some culturally-specific services
• East central Iowa region, 4 hours from Chicago seeing high concentration of opioid overdoses
• Very new and cautious to starting MAT. Part-time medical director is the ONLY waivered doctor in the city. Two OTPs operate separately
Jackson Recovery Centers
• Treatment provider in Northwest Iowa since 1976 with focus on adolescent services. Also provides women/children –specific and culturally specific services
• Traditional 12-step focus remains, new to MAT• Local OTP operating separately
Mercy Turning Point
• Treatment center within larger medical system, has 3 prescribers
• North east Iowa, 4 hours from Chicago seeing high concentration of opioid cases
• Partners with local block-grant/ATR service provider, but no OTPs within 60miles
• Started preparing for MAT a year prior to grant
United Community Services
• Treatment provider since 1997. Also one of two local OTPs in Central Iowa. Adult focus with special outreach to LGBT population and a co-located physician’s practice
• Extensive experience in methadone and MAT with staff pharmacists, nurses, and doctors in addition to treatment counselors
Lessons Learned
• Don’t try to outsmart SAMHSA• Be specific with providers regarding expectations
and timelines (Rx)• Keep an open mind: Theory versus Practice
Contact UsMonica Wilke-BrownSBIRT Project Director
Kevin GabbertATR Project Director
DeAnn Decker Bureau Chief of Substance Abuse
Rx Drug Use and Misuse:Prevention and Treatment Programs
at the State/Community LevelPresenters:• Travis Fretwell, MAC, NCAC II, CCS, Director, Georgia Department of
Behavioral Health and Developmental Disabilities
• Kevin Gabbert, MSW, LISW, IAADC, Access to Recovery Project Director, Iowa Department of Public Health
• Monica Wilke-Brown, LMSW, Director, Screening, Brief Intervention and Referral to Treatment Project, Iowa Department of Public Health
Federal Track
Moderator: Mitra Ahadpour, MD, DABAM, Medical Officer, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration
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