Barbara Cimaglio, Deputy CommissionerVermont Department of Health, Division of Alcohol and Drug Abuse Programs

May 2017

Opioid Coordinating Council

Thomas Anderson, CommissionerVermont Department of Public Safety

The Opioid Crisis

February 2017

• Scope of the problem

• Effect on Vermonters

• Some Positive News

Extent of the Opioid Crisis a.k.a., the “Bad News!”

Pictured Above: Rolling Stone feature story in April of 2014

Pictured Right: National Geographic Feature Story

on the most “Drug infested State”

2015 Deaths

22,000

13,000

FENTANYL• 100 Times More Potent than

morphine

• 77 percent increase in Fentanyl cases -- 2014 to 2015

• 175 percent increase in Fentanyl cases --2015 to 2016

Pictured Right: 2mg potentially fatal dose of

fentanyl

Vermont is one of the top 5 states for heroin use

(by percentage of adult population)

Effect on Vermont Families• The number of children in DCF custody increased from 982 to 1,323 in federal FY

2016.

• During 2016, 53% of children under the age of 6 in DCF care were in DCF care due to opioid use issues.

• Termination for parental rights petitions increased 93% between 2011 and 2016

• Petitions for ‘children in need of supervision’, increased from 553 to 1,070 cases between 2011 and 2016.

Law Enforcement • Seizure Data -- 2016

– 31,722 bags of heroin

– 1,932 grams of bulk heroin

– The street value is approximately $1,395,830

• Interdiction Efforts– Vermont State Police drug investigations have increased 70% for 2016

– Expansion of the drug task force

– Close cooperation with U.S. Attorney’s Office and DEA

• Drug Monitoring Initiative – Better tracking opioid data

– Better OD tracking

Large parts of the state do not have wait lists for treatment

Deaths from prescription opioids appear to be flattening

Naloxone is getting into the hands of those who need it most

Youth use is trending downward over time

IT’S NOT ALL BAD!

Vermont is in the bottom 5 states for non-medical use of pain relievers

Non Medical Use of Prescription Pain Relievers Age 12+ (NSDUH 2013/2014)

Vermont Department of Health

New England Drug Overdose Deaths

5

10

15

20

25

30

35

40

2010 2011 2012 2013 2014 2015

Dea

ths

per

100,

000

Drug Overdose Deaths per 100,000 by State

ConnecticutMaineMassachusettsNew HampshireRhode IslandVermont

Vermont Department of Health

Source: CDC/NCHS, National Vital Statistics System, mortality data. Includes opioids and other drugs

21

The number of Vermonters treated for opioid addiction continues to increase

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Number of people treated in ADAP Preferred Providers by substance

Alcohol Marijuana/Hashish Heroin/Other Opioids All Others

Source: Alcohol and Drug Abuse Treatment Programs

Vermont Department of Health

Opioid Use Disorder Treatment Hubs

0

500

1000

1500

2000

2500

3000

3500

Jan-

14Fe

b-14

Mar

-14

Apr

-14

May

-14

Jun-

14Ju

l-14

Aug

-14

Sep-

14O

ct-1

4N

ov-1

4D

ec-1

4Ja

n-15

Feb-

15M

ar-1

5A

pr-1

5M

ay-1

5Ju

n-15

Jul-1

5A

ug-1

5Se

p-15

Oct

-15

Nov

-15

Dec

-15

Jan-

16Fe

b-16

Mar

-16

Apr

-16

May

-16

Jun-

16Ju

l-16

Aug

-16

Sep-

16O

ct-1

6N

ov-1

6D

ec-1

6Ja

n-17

Feb-

17M

ar-1

7

Number of People in Hubs and Waiting for Hub Services Over Time

In Treatment Waiting

Vermont Department of Health

Source: Alcohol and Drug Abuse Treatment Programs

The statewide number of people waiting for opioid use disorder treatment in hubs has trended downward over time; the number of people served in hubs has increased

23

Treatment access and rate of treatment varies by county

Vermont Department of Health

Rate of opioid-related ED visits by State – VT had the smallest increase in rate and is lower than other NE states

0

50

100

150

200

250

300

350

400

450

500

CT RI MA VT US

Opioid Related ED Visits Per 100,000 in 2014

CT RI MA VT US

Note: NH did not report

0

10

20

30

40

50

60

70

80

CT RI MA VT US

Cumulative % Change in Rate/100,000 - 2009 to 2014

CT RI MA VT US

Source: HCUP Statistical Brief #219. December 2016. Agency for Healthcare Research and Quality

Vermont Department of Health

25

Naloxone

333566 471

600 589815

680 746951

74151

184

264426 436

622

938 1046 11741408

836

514

1881

1131

Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016

Number of doses dispensed to clients by client type, quarter and year

New - 1 Dose Returning - 1 Dose New - 2 Dose Returning - 2 Dose

832 31

5171

85

145

102119 123

96 85

Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016

Reports of naloxone use in response to a perceived overdose incident

Source: Vermont Department of Health Naloxone Pilot Program

In July of 2016, VDH slowly began to incrementally switch to distributing naloxone in new packaging -clients began receiving one dose instead of two. Because of the change in standard number of doses being distributed, doses distributed before and after July 2016 cannot be compared.

Vermont Department of Health

Slide 26Vermont Department of Health

2002 2017

Today

2002 2004 2006 2008 2010 2012 2014 2016

First Methadone Clinic Opens (Chittenden Center)2002

Buprenorphine Induction Hub Opened (CVSAS) 2004

Methadone in SE (Habit Opco)2006

Patient Limits for Bup prescribers: 30 Year 1, then a max of 1002006 PDMP (VPMS) data

collection begins2009

Hub and Spoke Model (Care Alliance)2013

Safe Disposal of Unused Medication Rule2013

Methadone in Rutland (West Ridge)2013

Naloxone Pilot Begins2014

Opioids for Chronic Pain Rule2015

Acute Pain Prescribing Rules2017

Buprenorphine Approved for MAT by FDA2002

VT Prescribers use Buprenorphine2003

Methadone in NEK (BAART)2005

VT PDMP legislation passed

2006

Methadone in Central VT (BAART)2008

MAT for Opioid Dependence Rules Enacted

2012

Opioids overtake alcohol as primary substance in treatment

2013

Good Samaritan Law Passed

2013

Mandatory PDMP/VPMS Registration2013

VPMS Rule Updated2015

MAT for Opioid Dependence Rules Updated

2016

Standing order for Naloxone at VT Pharmacies

2016

Timeline: Addressing Opioid Misuse and Addiction in Vermont

Vermont Department of Health

What are we doing to address the problem?

Increased Supply Side Reduction

Public Information and Messaging

Pain Management and Prescribing Prevention

Community Mobilization Drug Disposal

Early Intervention

Vermont Prescription Monitoring System

Expanding Access to Treatment

Narcan

Increase Recovery

Vermont Department of Health

Gaps

Coordinated Statewide Prevention/Messaging Strategy

Timely Data Collection (ODs, ED, Arrests)

Improved Prosecution Coordination

Prescribing Practices

Workforce Shortage

Waits for Service

Vermont Department of Health

Goals for 2017

St. Albans hub opening summer 2017 New pain rules in place July 1, 2017 Implementation of peer recovery support services in

three Vermont hospital emergency departments Public information, social marketing, and messaging

about use of opioids Awareness about the responsible use of prescription pain relievers

Encourage patients to talk with their doctor about the risks of opioids

Address expectations of zero pain

Increase the perception of risk associated with prescription pain reliever misuse and transitioning to other opioids such as heroin.

Outreach to prescribers with support tools and resources

Vermont Department of Health

Goals for 2017 – “State Targeted Response to Opioid Crisis” Grant - $2M

Training for NPs/PAs to prescribe buprenorphine Drug disposal system implementation & evaluation Community/parent education & prevention grants Telephone recovery support Improve treatment system capacity management Workforce development Recovery Coach Academy Counselor competencies

Vermont Department of Health