Michelle L. Louisville, LCSW, CAP, ICADC Substance Abuse...

Michelle L. Louisville, LCSW, CAP, ICADCSubstance Abuse Treatment Program CoordinatorFayetteville Veterans Affairs Medical Center April 5, 2018

Objectives of today’s presentationI. Understanding the Opioid Epidemic

A. Global and National Trends

B. Active Duty and Veterans compared to civiliansC. North Carolina statistics

II. Opioid Use Disorder (OUD)A. Brief overview of criteria

B. Misuse signs & symptoms of OUD

C. How OUD affects learning and the body III. Treatment options

A. Fayetteville VA Medical Center treatment B. VA resources

C. Local community resources

IV. Questions & Comments

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Global Perspective Opioid EpidemicThe World Health Organization (WHO) estimated in 2015(UNODC Research, World Drug Report 2017 Booklet 2 & 3).

Supply of opium and heroin Ø 6,380 tons of opium plantØ 4,300 tons processed heroinØ 2,080 tons consumed as opium

Global users Ø 35 million people use opioidsØ 17.7 million people use opiates

Global drug raidsØ 587 tons opiumØ 80 tons heroin Ø 9.6 tons morphine

Approximately 2.1 million people in the United States have substance use disorder related to prescription opioids.

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Opioid Prescriptions Dispensed by US Retail Pharmacies

The total number of opiate prescriptions dispensed by retail pharmacies in the United States rose from 76 million in 1991 to 207 million in 2013. (NIDA, March 2014).

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Opioid Epidemic statistics in 2016

� 116 People died every day from opioid-related drug overdose� 11.5 million People misused prescription opioids� 42,249 People died from overdosing on opioids � 2.1 million People were diagnosed with an opioid use disorder � 948,000 People used heroin� 170,000 People used heroin for the first time� 2.1 million People misused prescription opioids for the first time � 17,087 Deaths attributed to overdosing on commonly prescribed

opioids � 19,413 Deaths attributed to overdosing on synthetic opioids other

than methadone � 15,469 Deaths attributed to overdosing on heroin � $504 billion In economic costs

Sources: 1 2016 National Survey on Drug Use and Health, 2 Mortality in the United States, 2016 NCHS Data Brief No. 293, December 2017, 3 CEA Report: The underestimated cost of the opioid crisis, 2017

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History of the Opioid Epidemic

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Trends for Active Duty According to the 2011 Department of Defense Health Related Behaviors Survey of Among Active Duty Military Personnel

� 15.2% active duty service members used prescription drugs in the past 30 days

� 24.9% active duty service members used prescription drugs in the past 12 months

� 61.2% active duty service members reported lifetime use of prescriptions drugs

� 57.7% active duty service members admitted using prescription pain relievers during military career

� 96.4% active duty service members received prescription to manage pain

� 48% of opioid users were 36-65 years of age � 19.7 % Enlisted E1-E4, 46.5% NCO, E5-E9,

23.4 % Warrant Officer, 29.1% Officer

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Trends for Active Duty cont. According to the 2011 Department of Defense Health Related Behaviors Survey of Among Active Duty Military Personnel

� Prescription drug use for male and female service members for all branches was two times more than civilian population – 9 % male, 12 % female; active duty -18.7% male, 26.9% female

� Non-medical prescription drug use doubled from 2002 (2 percent) to 2005 (4 percent) for active duty personnel

� Non-medical prescription drug use tripled from 2005 to 2008 to 11%

� Pain reliever prescriptions written by military physicians quadrupled between 2001 and 2009—to almost 3.8 million.

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Prescription Target All services Civilian

Prescribed for service member

89.6% 19.7%

Prescribed for someone else

3.7% 54%

Other source 6.8% 15.5%

North Carolina Trends � In 2015 there were more than 1,100 opioid-related deaths� NC has experience 73% spike in opioid-related deaths since 2005� Several of the counites served by Fayetteville VAMC

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County 2005 Opiate Related Deaths

2015 Opiate Related Deaths

Bladen 0 5Brunswick 14 24Catawba 9 17Harnett 7 10Johnston 8 23Moore 4 11Onslow 11 15New Hanover 26 45

Pender 1 14Robeson 5 11Sampson 0 5

Wayne 3 9

Substance Abuse Treatment Program

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Opioid Use Disorder Criteria

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DSM-V diagnosis guide definition of Substance Use Disorder is now based on a problematic pattern of substance use leading to clinically significant impairment or distress over a 12-month period, as manifested by following criteria: 1. Social or interpersonal problems 2. Failure to fulfill obligations at work, school, or home.3. Repeated use resulting in physically hazardous situations 4. Cravings or urges5. Tolerance6. Withdrawals 7. Difficulty controlling use/substance taken in larger amount and

for longer period than intended8. Desire to curt down or unsuccessful attempts to quit 9. Significant amount of time obtaining, using, or recovering10. Neglecting activities11. Continue to use despite negative consequences

Signs & symptoms of Opioid misuse

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What we doThe Substance Abuse Treatment Program is an outpatient treatment of substance use disorders (alcohol, drug and/or tobacco). We provide Veterans with an evidence-based, holistic and Veteran-centered treatment so they can move forward on the path to recovery and wellness. We also provided medication assistance for substance use disorders.

“You can’t change what’s going on around you,

until you change what’s going on within you”.

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How to get started

SATP has open access without an appointment at 2300 Ramsey Street, Bldg. 47

Monday-Fridays 8:00 am – 3:00 pm for an initial screening.

Veterans can schedule an appointment by calling Toll free: 1-800-771-6106 ext 5483/7770

Phone: 910-488-2120 ext 5483/7770The Fayetteville VAMC SATP location has Saturday

appointments available by appointment only.

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Community Referral

� Is the Veteran eligible for services?� Register with VA in person at 2300 Ramsey Street location

or verify by calling Health Benefits at 1-910-488-2120 ext 6016

� Medical records of current medication dosage, UDS results� Current psychotropic medication � Treatment records – talk therapy, groups

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� July 2012 FVAMC SATP began providing Suboxone to Veterans diagnosed with Opioid Use Disorder.

� Fayetteville VAMC currently has 450 Veterans diagnosed with an Opioid Use Disorder.

� Average Veterans served per month in SATP are 665 for individual appointments, 855 for groups.

� 20% of Veterans in Cumberland County have SUD and treated at FVAMC.

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• SATP has physical locations in Fayetteville VAMC, Wilmington HCC, and Jacksonville Community Based Outpatient Clinics (CBOCs).

• SATP provides substance abuse treatment at Hamlet, Goldsboro, Robeson (Pembroke), and Sanford through tele-health services.

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4/4/18

PCP MH Provider

Self Referred

ThreesourcesofSATPreferrals

Substance Use Screening Opioid MAT:-Screening -Agreement-ROI

“Yes” Opioid Use Disorder

“NO” Screening is complete

SATP Intake:-Consent-BAM/AUDIT/DAST-Sched. Nurse Prac.-Sched. Psychiatrist-Sched. Tx Plan

SATP TX Services

Opioid Replacement

Tx Team

SATP Services Flow sheet

“Yes”Ambulatory

Detox

Smoking Cessation

Ambulatory Detox


� Screening does not mean enrollment in services.

� The program is voluntary.

� FVAMC SATP does not offer inpatient detox nor residential treatment services.

� SATP staff has the capability to make referrals to an inpatient substance use disorder facility within the VAMC.

� SATP clinic has over 1200 visits per month by Veterans for groups and individual sessions in FY18.

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Interdisciplinary Team

• Program Coordinator• Psychiatrist• Psychologist • Nurse Practitioner• Nurse• Social Worker• Addiction Therapist

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Substance Abuse Treatment Program Outpatient services offered are : 1. Motivation for Change groups 2. Intensive Outpatient program – IOP, Aftercare, and

Recovery Management groups3. Opioid Replacement Treatment program4. Tele-health groups for CBOCs5. Smoking Cessation program6. Seeking Safety – PTSD/SUD 7. Evidence Based-Practices > Behavioral Couples Therapy,

Cognitive Processing Co-Occurring and Prolonged Exposure, Motivational Interviewing, Chronic Pain/SUD

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Outpatient services offered (continued):8. Ambulatory Detoxification (outpatient for

alcohol withdrawals)9. Co-occurring group topics – depression, anxiety,

bi-polar, etc. . .10. Emotional Regulation/DBT Informed group 11. NC licensed facility for DWI 12. Inpatient psychiatrist group & screenings, medical

unit screenings 13. Medication assistance treatment for SUD

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Substance Abuse Treatment ProgramMedication Assistance for substance use disorders

Alcohol � Naltrexone/Vivitrol� Acamprosate/Campral� Disulfiram/Antabuse

Smoking Cessation� Wellbutrin/Bupropion� Lozenges� Gum/Parasympathomimetic alkaloid� Patch/NicoDerm� Chantix/Varenicline

Opioids � Naloxone/Narcan Training Kit� Buprenorphine/Suboxone

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Substance Abuse Treatment ProgramPrimary locations point of contact

Fayetteville VAMC SATP:2300 Ramsey Street , Building 47

Fayetteville, NC 28301Toll free: 1-800-771-6106 ext 5483/7770

Phone: 910-488-2120 ext 5483/7770

Jacksonville VA CBOC4 Josh Court

Jacksonville, NC 28546910-353-6406 ext 2058

Wilmington HCC1705 Gardner Road

Wilmington, NC 28405910-343-5300 ext 3584

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Resources available online 1. Substance Abuse Treatment Program 2. Primary Care Mental Health Integration3. Suicide Prevention brochure 4. Whole Health Program – coming May 2015 5. Recovery Resource Guide

(Cumberland & surrounding counties)

6. Veteran friendly applications for smartphones7. DOD Caregiver Resource Directory 20178. Cape Fear Valley - Cohen Network information9. Support groups for substance use:

ØAA/NA meeting linkØSMART Recovery linkØCelebrate Recovery link

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References� 24 Shocking Opiate Addiction Recovery Statistics (October 27, 2014). Health Research

Funding. Retrieved from https://healthresearchfunding.org/24-opiate-addiction-recovery-statistics/

� County-by-County Figures: The Opioid Crisis in North Carolina. (May 2017). North Carolina Office of the Governor. Retrieved from https://governor.nc.gov/news/county-county-figures-opioid-crisis-north-carolina

� Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel, 2011. Available online https://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-508947957a0f/final-2011-hrb-active-duty-survey-report.pdf

� North Carolina Health News (July 27, 2017). Four North Carolina Cities Make Top 25 List for Opioid Abuse. Retrieved from https://www.northcarolinahealthnews.org/2017/07/27/four-north-carolina-cities-make-top-25-list-opioid-abuse/

� Opioid Overdose. (August 30, 2017). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/drugoverdose/index.html

� Universal Health Coverage, World Health Organization, World Drug Report 2017. Retrieved from https://www.unodc.org/wdr2017/index.html

� Veterans and Military Families (September 15, 2017). Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/veterans-military-families

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Questions and comments

Michelle L. Louisville, LCSW, CAPSATP CoordinatorFayetteville VAMC Bldg. 47, Rm. 111Fayetteville, NC 28301Phone: (910) 488-2120 ext. 5475Fax: (910) 482-5091 Email: [email protected]

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