The Opiate Epidemic: What Works & What Doesn’t By Fairfield County Sheriff, Dave Phalen And Orman...
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Transcript of The Opiate Epidemic: What Works & What Doesn’t By Fairfield County Sheriff, Dave Phalen And Orman...
The Opiate Epidemic: What Works & What Doesn’t
ByFairfield County Sheriff, Dave Phalen
And
Orman Hall, Executive DirectorFairfield County Alcohol, Drug Addiction and Mental Health
Board
Core Concept
Crime slips into our community in places where we have let the fabric of our society wear thin.
Criminal Activity
Small percentage of the populationSame locations85% of theft-related crime is drug
related.
Important Dates
1979 – 1980: Crack Cocaine hits our communities
2006 – 2009: Heroin hits our communities
Key Statistics – Fairfield County Jail
127% - Increase in inmates between 2001 and 2008.
212% - Increase in drug arrests between 2003 and 2008.
375% - Increase in heroin users among new arrests between 2003 and 2008.
Fairfield County Jail
$349,064 – The estimated cost of incarcerating opiate addicts in 2003.
$2,501,786 – The estimated cost of incarcerating opiate addicts in 2008.
Causes of opiate addiction in our community
Widespread use of opiate analgesics
Increased availability of Heroin as a replacement drug
Price
Written in 1829
“The police are the public and the public are the police. The police are only members of the public who are paid to give full-time attention to the duties that are incumbent upon all citizens in the interest of community welfare and existence.”
Sir Robert Peel
U.S. Opiate Treatment Admission Trends
0%
5%
10%
15%
20%
Pe
rce
nt
of
Ad
mis
sio
ns
2000 2001 2002 2003 2004 2005 2006 2007
Year
Opiates as a Percent of Alcohol and Other Drug Treatment Admissions in the United States (Years 2000 - 2007)
Heroin Other Opiates
Figure 1. Opiates as a Percent of Alcohol and Other Drug Treatment Admissions in the United States (2000 – 2007) 1
Ohio Opiate Treatment
Admissions Trends
0%
5%
10%
15%
20%
Perc
en
t o
f
Ad
mis
sio
ns
2000 2001 2002 2003 2004 2005 2006 2007
Year
Opiate as a Percent of Alcohol and Other Drug Treatment
Admissions in the State of Ohio (2000 to 2007)
Heroin Other Opiates
Figure 2. Opiates as a Percent of Alcohol and Other Drug Treatment Admissions in the State of Ohio (2000 – 2007)2
Fairfield County, Ohio Opiate Treatment Admission Trends
4%5% 6%
8%10%
15%
31%
0%
5%
10%
15%
20%
25%
30%
35%
Perc
en
t o
f A
dm
issio
ns
2002 2003 2004 2005 2006 2007 2008
Year
Fairfield County Ohio Opiate Treatment Admission Trends (2002 - 2008)
Figure 3. Fairfield County Ohio Opiate Treatment Admission Trends (2002 – 2009*)3
0 50 100 150
Richland
Amanda
Clear Ck.
Hocking
Liberty
Walnut
Bloom
Greenfield
Rush Ck.
Berne
Violet
Pleasant
Lancaster
Admissions
Fairfield County, Ohio Opiate Treatment Admissions by Township
Figure 4. Fairfield County Ohio Opiate Treatment Admissions by township for 2008.4
Fairfield County- Jail Days
Figure 5. Opiates as a proportion of total Fairfield County jail days (2003 and 2008)5
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
1990 2003 2008
Opiate
Non Opiate
No
Opiates Opiates
Present Present
Age Group
18 - 25 40.4% 53.6%
26 - 35 38.3% 25.0%
36 - 45 11.7% 16.1%
46 - 55 7.4% 5.4%
56 -65 2.1% 0.0%
100% 100%
Fairfield County - Jail DaysBy Age and Opiate Status
Table 1. Jail Admissions by age and Opiate Status, Calendar Year 2008.6
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Non-Opiate Opiate
FEMALE MALE
Fairfield County - Jail DaysBy Age and Opiate Status
Figure 5. Opiates as a proportion of total Fairfield County jail days by gender (2003 and 2008) 7
Components of the Fairfield County Drug Court Program
Judicial intervention and oversight Frequent drug screens Intensive outpatient therapy Case management and rehabilitative
services (employment and housing). Suboxone for opiate addicted clients
Phases of Municipal Drug Court - Continued
Phase 1 – three monthsDrug court participants meet weekly with judge to
receive court orders and report on compliance. Participants must meet with probation and submit to three random drug tests weekly. Participants are not allowed to work but are required to attend intensive outpatient therapy and focus on recovery issues.
Phases of Municipal Drug Court - Continued
Phase 2 – three months
Participants report to the court bi-weekly. Focus on employment and other rehabilitative issues begins.
Phases of Municipal Drug Court - Continued
Phase 3 – six months
Participants report monthly to judge. Maintaining employment and abstinence are major priorities. Upon successful completion of phase three, participants graduate and are released from probation.
Phases of Municipal Drug Court - Continued
After Care – four months
This phase is voluntary. Participant checks in with probation and voluntarily submits to drug screens twice a month. The focal points of this phase are maintaining sobriety, maintaining employment, and avoiding new charges.
Use of Suboxone in Opioid Addiction Treatment in Fairfield County
What Is Suboxone?Suboxone® is a combination of buprenorphine and naloxone. To be taken only under the supervision of a qualified physician.
How Does Suboxone Work? Suboxone provides the patient with a mild opiate effect, ideally just enough to reduce or eliminate opiate cravings. More importantly, It also blocks the effects of all other opiates.
Fairfield County PhilosophyTo use the smallest amount of Suboxone required to eliminate opiate cravings and block the effect of other opiates. The goal of public AOD (alcohol and other drug) treatment in Fairfield County is complete recovery and eventual abstinence from the use of harmful drugs.
Patient Recovery With cravings eliminated and withdrawal fears calmed, Suboxone® permits a person to focus on recovery and treatment. Underlying treatment issues can be more effectively addressed once the effects of the opioid are no longer present.
Important Fairfield County Statistics
75% of all Adult Drug court clients in Fairfield County have an opiate addiction.
In 2008 there were an estimated 44,725 jail days accounted for by opiate addicts in the Fairfield County Jail.
Over two years, 14,000 days of jail for drug court were participants suspended for a total cost savings of $910,000.
Medication costs at the jail for drug court participants have decreased by 66%.
Important Fairfield County Statistics - Continued
Among opiate addicted clients receiving Suboxone - 62% successful treatment and discharge rate.
Among opiate addicted clients not receiving Suboxone, 87% relapse and are terminated unsuccessfully.
Successful Opiate Discharges With Suboxone
Successful62%
Not Successful
38%
Successful Opiate Discharges Without Suboxone
Suc c es s f ul
13%
Not Suc c es s f ul
87%
1. Myers, Rhonda. (June, 2009). Unpublished presentation from the National Association of Drug Court Professionals Annual Meeting. Anneheim, CA. The Treatment Episode Data Set (TEDS), Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). United States Department of Heath and Human Services.
2007http://oas.samhsa.gov/teds2k7highlights/TEDSHighl2k7Tbl6a.htm http://oas.samhsa.gov/teds2k7highlights/TEDSHighl2k7Tbl6b.htm 2006
http://oas.samhsa.gov/teds2k6highlights/Tbl6a.htm http://oas.samhsa.gov/teds2k6highlights/Tbl6b.htm 2005
http://oas.samhsa.gov/teds2k5/TEDSHi2k5Tbl6a.htm http://oas.samhsa.gov/teds2k5/TEDSHi2k5Tbl6b.htm 2004http://oas.samhsa.gov/TEDS/2k4TEDS/TEDSHi2k4Tbl6a.htm http://oas.samhsa.gov/TEDS/2k4TEDS/TEDSHi2k4Tbl6b.htm 1993-2003
http://oas.samhsa.gov/2k5TEDS/teds_03_tbl2.1a.htm http://oas.samhsa.gov/2k5TEDS/teds_03_tbl2.1b.htm http://oas.samhsa.gov/2k5TEDS/teds_03_tbl4.2a.htm
2. The Treatment Episode Data Set (TEDS), Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). United States Department of Heath and Human Services.
http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_web_table?t_state=OH
Bibliography
3. Public-Private Solutions. 108 W. Main Street – Suite A. Lancaster, Ohio 43130. Jim Averill, PPS Director. Robert Peare, Programmer/Analyst. c/o http://www.fair-mh.org (740) 654-0929.
4. Ibid.5. Phalen, Dave and Orman Hall. (May 2009) Unpublished Utilization Review Study of Fairfield County Jail Admissions.
Lancaster, Ohio 43130.6. Ibid.7. Ibid.
Bibliography - Continued