A State Targeted Response to the Opioid Crisis:

A State Targeted Response to the Opioid Crisis:

A State Targeted Response to the Opioid Crisis: What Missouris Doing and Why Rachel P. Winograd, PhD Missouri Institute of Mental Health, University of Missouri-St. Louis In partnership with The Missouri Department of Mental Health, Division of Behavioral Health Total U.S. Drug Deaths

80,000 72,306 70,000 60,000 50,000 40,000 30,000 20,000

10,000 0 99 000 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 9 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Nationally, Synthetic Opioids Are Driving Up the Overdose Rate Overdose deaths in thousands in preceding 12 months Total Number of

Opioid-Related Overdose Deaths in 2016 908 Source: DHSS, 2017 35% increase from 2015

to 2016 Total Number of Opioid-Related Overdose Deaths in 2017 951 Source: DHSS, 2018

4.7% increase from 2016 to 2017 Deaths Due to Heroin Overdoses 2012-2016

High rates of mortality due to heroininvolved overdoses (a subset of opioid-involved overdoses) are strongly concentrated in the St. Louis metropolitan region and surrounding counties with a secondary cluster trailing down to the southeast corner of Missouri. This is a markedly different distribution than non-heroin

opioid-involved overdoses as will be shown in the following map. Crude rate per 100,000 population Source: MO Dept of Health and Senior Services Whats being done around the world to address the epidemic Prevention

Treatment Harm Reduction Prescription drug Expanded monitoring access to Urine drug screens medical

Mental health parity lawstreatment for Prescribing guidelines OUD Alternative pain treatments

Syringe access Safe injection sites Good Samaritan laws Increased access to overdose education and naloxone Recovery Peer support, Community, Domains

of health and wellness Take-home Harm Reduction Tips: 1. Have Narcan at all times 2. Never use alone 3. Stagger your use 4. Do a small amount to test strength 5. You will lose tolerance after 3-5 days State Targeted Response to the Opioid Crisis

Grants (Opioid STR) Missouri: $10,015,898 x 2 years = $20,031,796 ice grant; at least 76% for treatment & recovery support Missouris Plan Combined with coordinated collaboration and sophisticated

evaluation, The Opioid STR project aims to transform the system of care for OUD in Missouri. (Naltrexone) Figure 4. Clark, Robin E., et al. "Risk factors for relapse and higher costs among Medicaid members with opioid dependence or abuse: opioid agonists, comorbidities, and treatment history." Journal of substance abuse treatment 57 (2015): 75-80.

Old model Housing Readiness Individuals must address other issues that may have led to the episode of homelessness PRIOR to entering housing Housing Levels progress through until reach independence

NEW model BASICS OF HOUSING FIRST Housing is viewed as the foundation for life improvement the *most critical* piece Prioritizes permanent housing to end homelessness and serve as a platform to pursue goals

Does not mandate participation in services to obtain or retain housing Client choice is valuable in housing selection and supportive service participation Offering housing security builds trust Ketas Story Been on the street for 20+ years Mental health and substance comorbidities

Case Management Theory: Anything necessary to keep them housed. Medication First Model 1) People with OUD receive pharmacotherapy treatment as quickly as possible, prior to lengthy assessments or treatment planning sessions 2) Maintenance pharmacotherapy is delivered without arbitrary tapering or time limits

3) Individualized psychosocial services are offered but not required as a condition of pharmacotherapy 4) Do not discontinue medical treatment unless it is clearly worsening the patients condition The take-aways 1 Individuals enrolled in

STR are more likely to 4 receive medication 2

get medication sooner 3 receive fewer psychosocial services be engaged in treatment at 1 and 3 months MO-HOPE began

STR began The increase in deaths in MO was less than what would be predicted based on national and Midwest trends

Next up State Opioid Response grants So where does that leave us? How do we manage the opioid crisis? Differently than we have been In ways that benefit and include everyone who lives with addiction Using methods to keep people alive, first and foremost

Questions and Discussion Visit www.missouriopioidstr.org to learn more and sign up for our statewide listserv! Resources

MissouriOpioidSTR.org Join the Opioid STR listserv PCSS Waiver Trainings Opioid Crisis Management Trainings, Follow-Up Consultations & TA Clinic-Provider Matcher MO-HOPE naloxone training

Rx assistance programs Health Literate Patient Brochure Implementation Guide for the Medical Treatment of OUD

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