The Opiate Epidemic: What Works & What Doesn’t

1. The Opiate Epidemic: What Works & What Doesn’t By Fairfield County Sheriff, Dave Phalen And Orman Hall, Executive Director Fairfield County Alcohol, Drug Addiction and Mental Health Board

2. Fairfield County, Ohio

3. Core Concept Crime slips into our community in places where we have let the fabric of our society wear thin.

4. Criminal Activity • Small percentage of the population • Same locations • 85% of theft-related crime is drug related.

5. Important Dates • 1979 – 1980: Crack Cocaine hits our communities • 2006 – 2009: Heroin hits our communities

6. 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.

7. Fairfield County Jail • $349,064 – The estimated cost of incarcerating opiate addicts in 2003.

8. 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.

9. Causes of opiate addiction in our community • Widespread use of opiate analgesics • Increased availability of Heroin as a replacement drug • Price

10. 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

12. What works • Law enforcement • Treatment • Education • Drug Court • Non-conventional: Grace Haven

13. Police • Enforcement • Knock and Talk • Landlord Training

14. U.S. Opiate Treatment Admission Trends Figure 1. Opiates as a Percent of Alcohol and Other Drug Treatment Admissions in the United States (2000 – 2007)1

15. Ohio Opiate Treatment Admissions Trends Figure 2. Opiates as a Percent of Alcohol and Other Drug Treatment Admissions in the State of Ohio (2000 – 2007)2

16. Fairfield County, Ohio Opiate Treatment Admission Trends Figure 3. Fairfield County Ohio Opiate Treatment Admission Trends (2002 – 2009*)3

17. Fairfield County, Ohio Opiate Treatment Admissions by Township Figure 4. Fairfield County Ohio Opiate Treatment Admissions by township for 2008.4

18. Fairfield County- Jail Days Figure 5. Opiates as a proportion of total Fairfield County jail days (2003 and 2008)5

19. Fairfield County - Jail Days By Age and Opiate Status Table 1. Jail Admissions by age and Opiate Status, Calendar Year 2008.6

20. Fairfield County - Jail Days By Age and Opiate Status Figure 5. Opiates as a proportion of total Fairfield County jail days by gender (2003 and 2008)7

21. 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

22. Phases of Municipal Drug Court - Continued Phase 1 – three months Drug 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.

23. 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.

24. 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.

25. 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.

26. 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 Philosophy To 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 RecoveryWith 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.

27. 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%.

28. 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.

29. Bibliography • 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. • 2007 • http://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 • 2004 • http://oas.samhsa.gov/TEDS/2k4TEDS/TEDSHi2k4Tbl6a.htm • http://oas.samhsa.gov/TEDS/2k4TEDS/TEDSHi2k4Tbl6b.htm • 1993-2003http://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 • 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

30. Bibliography - Continued • 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. • Ibid. • Phalen, Dave and Orman Hall. (May 2009) Unpublished Utilization Review Study of Fairfield County Jail Admissions. Lancaster, Ohio 43130. • Ibid. • Ibid.