Every Life is Worth Saving

1. Every Life is Worth Saving Combined Overdose Working Group Meeting September 3, 2008

2. Agenda • 1-1:15pm - Introduction and Welcome • 1:15-2pm - Reporting of Working Group Activities • Implementation, Capacity, Evaluation • 2-2:55pm - Where Do We Go From Here • 2:55-3pm - Next Steps and Next Meeting

3. Meetings • At this point, we believe that it is important that all three sub-working groups begin to meet collectively. Thus, future combined working group meetings will be scheduled and include implementation, capacity and evaluation sub-working group members. • If the sub-working groups would still like to meet individually, please schedule as needed. However, the combined working group will continue to meet to maintain our progress towards the goal of reducing overdoses in our community.

4. New Initiative Website http://www.peru.pitt.edu/overdose/index.html • The website will soon include a blog page and include specific pages for each of the sub-working groups and the at-large working group. Meeting minutes, meeting announcements, documents and related information will be posted on a regular basis. • An email will be sent to everyone on the listserve when new information or materials are posted along with a link to the new post.

5. Implementation Working Group • Development of an overarching blue print. • The blue print is the beginning of the formal strategic plan that will outline and identify the prevention, intervention and treatment efforts that will be implemented in Allegheny County – December 2008. • Please note, what is presented today is a draft or work in progress. We encourage your feedback and suggestions!

6. Low Risk of Overdose (All Risk Levels) Prevention/Interventions Strategies Applied at Multiple Community Service Points (e.g., Schools, Community Screening Opportunities, Churches, etc.) Prevention/Intervention: Overdose Prevention Strategies, Application of SBIRT) Elevated Risk of Overdose Interventions at Service Points Where These Cases Present (e.g., Primary Care Offices, Pharmacies, Pain Clinics, Detox/Methadone Clinics, Magistrate Offices, Schools and EDs (for presentation not related to overdose)) Intervention: Application of SBIRT and Naloxone Application High (but nonlethal) Overdoses Interventions at Service Points Where These Cases Present (e.g., EDs and Poison Center) Intervention: Application of SBIRT, Naloxone Application, and Specialized Discharge Strategies Highest Risk of Overdose or Overdose Death Interventions at Last Community Service/ Access Point (e.g., D&A, MH and Jail) Intervention: Education Regarding Individual Behavior Changes and Community Resources, Potential Follow Up (?) Application of Good Samaritan-like Approaches by Law Enforcement

7. Strategies for Implementation: Example • Name/title of program, policy, practice - SBIRT applied as an Overdose Intervention Program • Rationale/justification/establishing need for the program, policy or practice via local/national data, literature and other sources. • The Epi Profile indicates many persons who have overdosed are at risk for overdoses or death from overdoses and others have been part of the medical–social system. Thus SBIRT associated strategies can be applied across all risk bands to reduce overdose risk. - Utilize evidence-based research and literature on effectiveness of SBIRT. Utilize PA SBIRT state and local Allegheny County data to support implementation of this program.

8. Strategies for Implementation: Example • Resources/capacity required to implement - Provide training to social and/or medical staff on the application of SBIRT. University of Pittsburgh School of Pharmacy and Prevention Point Pittsburgh can provide appropriate training in collaboration with local physicians and others who have previously implemented and participated in SBIRT in Allegheny County.

9. Strategies for Implementation: Example • Lead individuals and other to be involved and what their respective roles will be in the program, policy, or practice. - Coordinator - Trainer(s) - Evaluator(s)

10. Strategies for Implementation: Example • Implementation plan or strategy - Determine sites interested in participating. - Conduct site visits to determine best method (least disruptive) manner for implementation of SBIRT component. - Conduct training with appropriate staff who will conduct SBIRT interventions.

11. Strategies for Implementation: Example • Evaluation plan or strategy - Collect basic demographics - Number of patients who participate in SBIRT intervention and screening results - Conduct pre/post evaluation on patients to determine changes in alcohol/drug use, risky behaviors, and other identified data measures - Collect claims data

12. Strategies for Implementation: Example • Timeline for implementation and activities - Develop feasible timeline for implementation that is shared with all participating sites, staff, trainers and evaluators • Document progress of implementation and program on a regular basis, such as quarterly reports

13. Strategies for Implementation: Example • Development of final report containing: - Introduction/Description of program, policy or practice - Implementation (processes and activities, including training) - Who participated (sites, types of sites, staff, patient population) - Evaluation plan and results

14. Capacity • Informational brochures on the risk of overdose and resources for assistance. • Developed for various audiences including • Naive audiences or audiences that are not educated on overdose and risk of overdose • Family members • Elderly • Jail, Treatment (D&A and MH) and other institutionalized populations • Focus Group with pharmacists (in collaboration with University of Pittsburgh and Duquesne University)

15. Evaluation Working Group September 3, 2008

16. Problem Statement/Baseline – ‘Epidemiological Profile Of Overdose Data’ • Medical Examiner’s Data • Trends in Fatal OD – 1998-2006 • Age, Race/Ethnicity, Gender, Drug(s) • City/County, Neighborhood • County EMS Data (2006) • 2,608 emergency responses in 2006 • Neighborhood (Oakland, Downtown, Middle Hill, South Side . . .) • Pennsylvania Youth Survey (PAYS) Data / Monitoring the Future • UPMC Emergency Room Data – Accidental Poisoning Incidents, Trends 1999-2007 • Uniform Crime Reports – Arrests for Drug Abuse Violations, County and State, Trends 2001-2006

17. Service Data (2000-2007) • Medical Examiner’s Data > Allegheny County Data Warehouse (CCBH / County Funding) • 2000-2006 – Total of 1453 OD fatalities in Allegheny County (Medical Examiner) • 2000-2006 – Service Data for 846 of Total County Overdoses (58%; U 66%; L 40%) • Breakdown/Analyses – Year, Type of Service, Age, Race/Ethnicity, Gender, Days Since Last Service

18. Service Data (2000-2006)

19. Service Data - Services Received (MH and DA Only) and Date of Death (1997-2006)

20. Working - Data and Analyses • Death by Residence / ZIP Code / Municipality (Medical Examiner) • Death by Location • EMS Response by ZIP Code / Municipality • Work on Real-Time Mapping of OD Data with Pittsburgh Poison Control Center

23. Working Data / Analyses • Purity - DEA - Heroin Domestic Monitor Program (Price, Purity, Source) • Treatment • Jail History • Develop Evaluation Tools based on Programs and Policies Designed by Working Groups

24. Evaluation - Who Benefits? • Participants – Did they learn anything? • Program – Is there a decrease in deaths? • Fundors – Is the program working? • Clinicians – Are they gaining useful skills?

25. Evaluation Working Group Alex Bennett, Mario Brown, Neil Capretto, Lois Edmondston, Kim Falk, Shari Holland, Jan Pringle