REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 1
REDUCING THE SUPPLY OF
ILLEGAL OPIOIDS IN WASHINGTON STATE
NOVEMBER 2017
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 1
Dear Washingtonians:
On average, two people die each day from opioid overdoses in our state. Tens of thousands of others
safe, and overwhelming our safety nets.
We partnered to convene the Summit on Reducing the Supply of Illegal Opioids in Washington, bringing together law enforcement, public health experts, prosecutors, and medical
As public safety professionals, we recognize that response to the opioid epidemic must include
Sincerely,
Bob Ferguson
Washington State Patrol
Bob Ferguson
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 2
•
GOALS & RECOMMENDATIONS
• •
•
• controlled substances.
• • •
•
•
• of overdoses.
•
•
2
1
3
5
6
7
• 4
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 3
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE
Washington —more than six out of ten— involve an opioid.
born addicted to opioids.3
To be more successful at reducing the supply of illegal opioids in our state, we
to opioids.
80 PERCENT
started by using pain medication prescribed to them or someone they know
of heroin users
Attorney General Bob Ferguson provides introductory remarks at the Summit.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 4
heroin
1.
371
694
176
446
61
281
0
100
200
300
400
500
600
700
800
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016*
Tota
l rep
orte
d dea
ths
Opioid Overdose Deaths in WashingtonAll Opioids Prescrip on Opioids Heroin
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 5REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 5REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 5
•
ADDRESS SIGNIFICANT GAPS IN PUBLIC AWARENESS ABOUT THE DANGERS OF OPIOIDS, AS WELL AS LESS RISKY ALTERNATIVES AVAILABLE
Youth hold these views, in part,
8
9
not only seen—but concentrated—among youth who have
views against illegal drug use.
1 in 4 teensbelieve there is
in using prescription pain relievers
without a prescription.
“LITTLE OR NO RISK”
1
Captain Juan Colon discusses New Jersey’s groundbreaking Drug Monitoring Initiative.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 6
federal grant funds to conduct a statewide opioid misuse
increase awareness of appropriate opioid use, storage, and disposal, as well as how to respond to an overdose.
Washington, and transit ads in Southwest Washington.
will be accessible online and will include materials that
Due to the limited budget available, the campaign will introduce target audiences to the campaign messages
campaign going forward, such as tailoring outreach to
the Use Only As Directed
acetaminophen, ibuprofen, physical therapy, and
before they interacted with their doctor. Within four
Dose of Reality. This campaign also aims
disposal methods. The campaign includes radio and television commercials, digital online ads, print ads, and
Since the campaign launch, the Wisconsin Department
Wisconsin trailed only Texas in the amount of drugs collected. The Wisconsin materials have been adapted for and adopted by several other states.one of the states that adopted the Dose of Reality
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 7
••
•
2 PREVENT ADDICTION BY ADDRESSING OVERPRESCRIBING
By
– even though research has found that,
. This points to the need to change the protocols taught to medical and dental
Prescribing less
Guideline for Prescribing Opioids for Chronic Painbegins with the treatment of acute pain.
days will rarely be needed.
of opioids medical professionals may prescribe.
Drs. Amy Cook, Christopher Frank, and Sean Dobbin provide perspectives of dental, medical, and pharmacy providers.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 8
Rates of Opioid Overdose Deaths, 2011-2015Rates Per 100,000 residents,
age-adjusted
Statewide Rate
9.7
*NR indicates data are not reliable
NR* 0 < 7
7 < 8.2 8.2 < 10.2
10.2 < 12.2 12.2 - 17
Whatcom 7.8
San Juan8.2
Island 11
Skagit 10.8
Snohomish 13.9
King 8.9
Pierce 10.2
Jefferson 8
Clallam 14.6
Thurston 8.4
Cowlitz 17
Klickitat 4.7
Skamania10.3
Yakima 5.4
Kittitas 9.3Grant 5.7
Adams 3.5 Whitman 7
Spokane 7.8Lincoln 12.4
Stevens 8.2
Chelan 11.2
Okanogan 7.8 Ferry 12.2
Douglas 10.2
Benton 8.6 Walla Walla 7.9
Garfield0
Wahkiakum 5.2Columbia 16.4
Asotin 10.7
Franklin 4.4
Clark 9.1
Lewis 10.9Pacific
6.8
GraysHarbor
10.5
PendOreille
14.3
Mason 14.1
Kitsap7.5
Rates of Opioids Prescribed, 2014
Whatcom 227
San Juan 207
Island 210
Skagit 253
Snohomish 251
King 210
Pierce 249
Jefferson 231
Clallam 261
Thurston 227
Cowlitz 273
Klickitat 136
Skamania 238
Yakima 269
Kittitas 218Grant 240
Adams 215 Whitman 210
Spokane 268Lincoln 289
Stevens 299
Chelan 252
Okanogan 252 Ferry 273
Douglas 249
Benton 272 Walla Walla 222
Garfield 302
Wahkiakum 274Columbia 284
Asotin 287
Franklin 257
Clark 237
Lewis 291Pacific
274
GraysHarbor
279
PendOreille
282
Mason 263
Kitsap226
Rates Per 1,000 residents, age & gender-adjusted
83-9874-82
60-7333-58
Statewide Rate
232
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 9
for acute pain, rather than chronic pain. Some states limit
The private sector has also imposed limits on opioid
opt out of these programs.
To date, Washington has not imposed daily or dosage limits
Days’ supply of first opioid prescription
Prob
abili
ty o
f con
tinui
ng u
se (%
) Using opioids 1 year later
Using opioids 3 years later504540353025201510
50
0 5 10 15 20 25 30 35 40 45
Risk of prolonged opioid use increases with
each day of prescription after just 3 days
Chief John Batiste highlights Washington State Patrol’s role in
combatting the opioid epidemic.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 10
has directed the various boards and commissions that regulate
number of people who become addicted.
opioid pain treatments, such as physical therapy and acupuncture.
means that though they are covered, they may remain out of reach
The audience engaged in a robust discussion with members of the Public Health and Medical Community Perspectives panel, moderated by Dr. Kathy Lofy.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 11REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 11REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 11
REDUCE ILLICIT USE OF PRESCRIPTION OPIOIDS
• controlled substances.
• • •
3
for illicit purposes. One way that people obtain increasing
to treatment. In Washington, dispensers—generally
54%36%
5%5%
Source of Opioids Used
Non-Medically
Friend/Family Doctor Drug dealer/Stranger Other
Snohomish County panelists Commander Patric Slack, Sheriff Ty Trenary, and Mr. Hil Kaman discuss innovative approaches underway in their community.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 12
name and dosage, and the prescribing and dispensing dates.
been accessible to many Washington providers through one of the most commonly used electronic health record
the convenience this adds for providers and the fact that
no cost, beyond the emergency departments described below, only one health system has fully implemented
F.
convenience, this eliminates bias, as providers do not
is suspicious. Based on the results demonstrated in
implement this capability to enable their providers to
30%Only about
of Washington’s
MEDICAL & DENTAL PROVIDERSwho prescribe controlled substances have registered for the
Prescription Monitoring Program
Emergency Departments Prescribers in
Other Medical Settings
2014 26,546 522,872
2015 2,222,446 958,246
2016 2,722,172 802,104
PMP Queries
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 13
other licensed health care providers, such as medical assistants.
Accordingly,
and other controlled substances.33
In both
electronically from medical providers to pharmacists. Rx Fraud Alert Report,
38
incidents may have also occurred.
39 According
community pharmacies across the country are enabled
an electronic health records system.
for other household members, guests, or criminals to
Impact of Prescription Monitoring Program Mandate
in New York
Num
ber o
f PM
P re
port
requ
ests
by
med
ical
pro
vide
rs
Num
er o
f pat
ient
s ex
hibi
ting
sign
s of
doc
tor s
hopp
ing
PMP reportrequests
Patients visting 5 or more prescribers and pharmacieswithin the month
1,800,000
1,600,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
450
400
350
300
250
200
150
100
50
Oct‘11
Jan‘12
Apr‘12
July‘12
Oct‘12
Jan‘13
Apr‘13
July‘13
Oct‘13
Jan‘14
Apr‘14
July‘14
Oct‘14
Jan‘15
Apr‘15
July‘15
Oct‘15
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 14
cabinets. A study exploring why parents of teens do not
and did not believe that they could be used to get high.
opioids securely. These conclusions support the need
unusable.
were collected at these events in Washington. A study
opioids originally dispensed were unused.
0
2,000
4,000
6,000
8,000
10,000
12,000
Po
un
ds
Me
dic
ine
Snohomish County Law Enforcement
Medicine Collection (pounds)
2010 2011 2012 2013 2014 2015 2016
Since passing a pharmaceutical stewardship ordinance,
the number of secure medicine drop boxes in
has increased from
KING COUNTY
10 to 99with 80%
now located at pharmacies.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 15
medicine return systems, including a minimum number of secure drop boxes in each city or town, prepaid mailers for those who are homebound, and public
claims.
million annually.
pouches may be helpful.
pharmacies.
the vehicle. They contacted the Pharmacy Board and
revealed that a pharmacy technician used his access to
names, obtaining access to opioids with a high street value paid for by the government.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 16REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 16REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 16
DISRUPT AND DISMANTLE DRUG TRAFFICKING ORGANIZATIONS RESPONSIBLE FOR BRINGING NARCOTICS INTO OUR STATE
•
4
Seizure by Grant County Taskforce - Oct. 2017
De
served on homes and storage units throughout the
Department, Ephrata Police Department, and WSP.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 17
$1,626,421
$624,602
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
$1,600,000
$1,800,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
State Funding for
Washington's Drug-Gang Task Forces
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 18
$5,838,974(1990)
$5,478,148(2004)
$6,600,000(2010)
$3,144,091(2017)
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Federal JAG Funding for
Washington's Drug-Gang Task Forces
-
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 19REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 19REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 19
PREVENT FURTHER INCREASES IN OVERDOSE DEATHS FROM FENTANYL5
overdose deaths in our state.
In contrast,
fentanyl at all. This can result in an overdose when they use the same amount they normally would.
fentanyl for amounts greater than ten grams. Those convicted of this crime now face up to twenty years in state
substances. The lethality of fentanyl and fentanyl analogues
enhanced penalty when those substances are involved. This can
standard range. Such a provision may prevent Washington from experiencing the explosion of fentanyl deaths experienced by states in other parts of the country.
•
Amount of fentanyl that
can be deadly
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 20REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 20REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 20
IMPROVE OVERDOSE REPORTING AND INFORMATION SHARING
• • •
6
deaths in that brief period. Furthermore, many of the overdoses occurred in a single day, which could be due to
expedites the chemical analysis of any drug evidence gathered whenever heroin is suspected in an overdose.
seized throughout the region and the impact on public health outcomes.
Dr. Richard Harruff underscores the importance of creating a real-time drug overdose monitoring system.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 21
statewide system. The Washington State Toxicology
impaired driving cases—has increased by more than
overdose cases can help the state recognize and respond to emerging threats.
and enhance response to public health threats, it does not capture overdoses not treated in the emergency department. Emergency medical service providers
emergency medical services. However, DOH recently
these funds will be used, in part, to build the capacity of emergency medical service providers to report these data, including care provided to people who have overdosed. DOH will also use the grant funds to improve
to prevent and respond to opioid overdoses. In contrast, the State does not have an electronic system for law
responders to report their response to an overdose in
geographic area.
8,000
9,000
10,000
11,000
12,000
13,000
14,000
15,000
16,000
17,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017*
*2017 projected based on actual January - June 2017 submissions.
WSP Toxicology Lab
Number of case submissions per year
9,575
15,710
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 22
nonfatal.
also allows the public health department to perform analyses and issue community opioid report cards to monitor
Clallam County Community
Opioid Report Card - 2016
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 23REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 23REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 23
EXPAND ACCESS TO TREATMENT7
with similar felonies, who demonstrated a need for substance abuse treatment and were otherwise considered
•
King County Prosecuting Attorney Dan Satterberg remarks on the changing role of a prosecutor’s office in responding to the opioid epidemic.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 24
the program.
this tax. The federal government has also recognized the
it serves.
into treatment and support services, rather than the
such as medical needs, housing, and mental health
Department of Human Services have partnered to hire
the community. The purpose is to connect people on the streets—those facing chronic homelessness and mental illness—to treatment providers, housing, and
individuals were connected to treatment. The limited availability of treatment has presented a barrier to
possession cases have been treated as misdemeanors
criteria, including possessing seven grams or less of a controlled substance and showing no signs of dealing, are eligible to have their charges reduced to
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 25REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 25REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 25
NOTES
Opioid-related Deaths in Washington State, 2006-2016. Retrieved from .
opioid. See:
Morbidity and Mortality Weekly Report .
3
Morbidity and Mortality Weekly Report .
. Retrieved from .
. Retrieved from tanyl.html.
Fentanyl Overdose Deaths in Washington State. Washington State Department of Health. Retrieved from .
trieved from: .
8 . Retrieved from .
9 Pediatrics, 136
Ibid.
Dose of Reality campaign.
.
Morbidity and Mortality Weekly Report
linical Journal of Pain, 30
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 26
Pain Medicine
Morbidity and Mortality Weekly Re-port;60
Medscape. Retrieved from
NPR. Retrieved from
DOI: .
Interagency Guideline on Prescribing Opioids for Pain. Retrieved from .
Morbidity and Mortality Weekly Report, 66 .
prescribe an opioid to a minor is available at:
.
Opioid Clinical Policy—Medicaid. Retrieved from
.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 27
. Retrieved from .
Washington.
33
ing, , is available at: .
Retrieved from .
. Retrieved from .
Ibid.
38 The latest Rx Fraud Alert report is available online: .
39
enforcement mechanism.
ONC Data Brief, no.18
.
REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 28
Journal of .
Pediatrics, 139.
.
. For Walgreens store count by state, see .
-. Retrieved from
King
are not yet available.
. Retrieved from .
-. Retrieved from
.
Beshear, Partners Launch Kentucky Opioid Disposal . Retrieved from .
Ibid.
Washington. Retrieved from