Partnership for Change: Decreasing prescription drug diversion in Kennebec County

1. Partnership for Change: Decreasing prescription drug diversion in Kennebec County Nancy Findlan Charles J. Rumsey IV Alison Jones Webb 2008 International Symposium on Pharmaceuticals in the Home and Environment: Catalysts for Change November 10, 2008

2. Partnership for Change: Decreasing prescription drug diversion in Kennebec County Presentation overview • Prevention Framework • Community • Law Enforcement • Health Care Providers • Q&A

3. Substance Abuse Prevention: Why bother? Maine Office of Substance Abuse Treatment Data System: https://portalx.bisoex.state.me.us/jav/osa_tdsreports/home.do accessed July 24, 2008

4. Substance Abuse Prevention: Why Bother? Maine Health Information Center

5. Substance Abuse Prevention: Why bother? • Access to treatment • Nationwide, 15.2% of individuals with past-year opioid use disorder received some form of formal treatment or counseling in the past year. • If 437 individuals received treatment for opioid use disorder in Kennebec County in 2006, then 2,875 did not receive treatment. William C. Becker et al Opioid use disorder in the United States: Insurance status and treatment access. Drug and Alcohol Dependence 94 (2008) 207-213.

6. Universal, Selective and Indicated Substance Abuse Prevention Target: individuals with identified precursors of alcohol or drug abuse. The targeted individualsexhibit early signs of substance abuse and other problem behaviors, such as falling grades among students, known problem consumption or conduct disorders, alienation from parents, etc. Indicated Prevention Target: high risk groups. The targeted groups may be distinguished by characteristics such as age, gender, family history, or economic status (e.g. children of substance abusers). Selective Prevention Target: the entire population. Interventions target an entire population (local community, school district, etc.). Universal Prevention Karol L. Kumpfer, “Prevention of Alcohol and Drug Abuse: What Works?” in Strategic Plan for Interdisciplinary Faculty Development, Association for Medical Education and Research in Substance Abuse, 2002.

7. Environmental Substance Abuse Prevention • Reduce Access (server trainings, enforcement of laws, etc.) • Reduce Demand (health education, warning labels, etc.) • Change community environment (media campaigns, counter-advertising, etc.) Environmental Prevention: Regulatory or community level interventions to deter drug consumption Indicated Selective Universal Karol L. Kumpfer, “Prevention of Alcohol and Drug Abuse: What Works?” in Strategic Plan for Interdisciplinary Faculty Development, Association for Medical Education and Research in Substance Abuse, 2002.

8. Evidence-based interventions • Office of Substance Abuse SPF-SIG Strategy Approval Guide http://www.maine.gov/dhhs/osa/prevention/community/spfsig/documents/StrategyApprovalPacket_RevisedFinal_11-13-07.doc • National Registry of Evidence-based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration http://nrepp.samhsa.gov/ • National Institute of Drug Abuse www.nida.nih.gov/Prevention/Prevopen.html • The Community Guide http://www.thecommunityguide.org/

9. Community Greater Waterville Area Communities for Children and Youth Prevention Coalition Community of Promise with the America's Promise Network Recipient of Office of National Drug Control Policy’s Drug Free Communities Grant Recipient of Maine Office of Substance Abuse Essential Services Grant and Strategic Prevention Framework State Incentive Grant Prevention Strategies Targeting Youth

10. Youth Prescription Drug Use in Kennebec County In 2006, nearly 20% of high school seniors reported having “ever used” prescription drugs (Kennebec County 19.2%; Maine 19.7%). Maine Youth Drug and Alcohol Survey, 2002, 2004 and 2006

11. Prescription Drug Use Students in grades 6 –12 Smaller % of students reported misusing prescription drugs in 2006 compared to 2002 and 2004. 5% of students reported they have misused prescription drugs 10 or more times in their lifetime Youth Prescription Drug Use in Greater Waterville Area Maine Youth Drug and Alcohol Survey, 2004 and 2006. Schools included Messalonskee Middle and High School, Waterville junior high and high school, Winslow junior high and high school, Lawrence junior high and high school.

12. Youth Prescription Drug Use in Greater Waterville Area Maine Youth Drug and Alcohol Survey, 2004 and 2006. Messalonskee Middle and High School

13. Environmental Prevention Strategies • Educate parents about their responsibilities with regards to limiting access of prescription drugs, proper use of prescription drugs and proper disposal • Parent Media Campaign • Social Hosting

14. Indicated Prevention Strategies • Educate youth about the dangers of misusing prescription drugs and the risks associated with misuse or abuse • Boomerang • Diversion to Assets Program

15. Environmental PreventionStrategies Law Enforcement Forging Partnerships to Reduce Access/ Abuse of Pharmaceuticals

16. Working Together • Waterville Police Department: • 31 sworn officers • 2 officers assigned exclusively to drug investigations • Networking with numerous law enforcement/ community health organizations • Education about current trends in street level abuse • Serve as source of information to medical community • Foster relationships to improve open communication

17. Working Together • Kennebec Valley Drug Task Force: • Includes members from 5 municipal/county law enforcement agencies • Share intelligence, manpower, equipment • Mainly target prescription and “hard” drugs • Northern Kennebec Underage Drinking Task Force: • Numerous agencies and community partners • Conduct enforcement/compliance • Education around underage drinking • Encounter/enforce various drug violations

18. Working Together • Maine Chiefs of Police Association • This fall, MCOPA endorsed the efforts of the Maine e-Prescribing Interest Group to advocate for Maine’s doctors to be able to prescribe controlled substances in a paperless environment: • Reduces/eliminates use of paper prescriptions • May reduce opportunity for theft, forgery and/or diversion

19. Innovative Programs • Waterville Police Department’s Crime Tip Information Form: • Allows area citizens to report illegal drug activity anonymously • Information is forwarded to on-duty supervisors for review and action • Can be accessed through: • www.waterville-me.gov

20. Innovative Programs • Waterville Police Department’s Prescription Drug Diversion Program: • Monthly mailing/email • Maintains up-to-date list of offenders charged in northern Kennebec County for prescription or “hard” drug crimes or diversion crimes • Mailing includes picture and other public information • Made available to doctors, emergency department staff, pharmacists

21. Prescription Drug Diversion Program • A tool for healthcare professionals to consider when determining whether/how to prescribe pharmaceuticals • Partnership with local law enforcement, District Attorney’s Office, healthcare professionals • Enthusiastically received by community • The program is being replicated by numerous law enforcement agencies across the state

22. Prescription Drug Diversion Program

23. Moving Forward • Key for law enforcement is continued investigation and enforcement to disrupt supply • Waterville Police Department will continue to seek ways to engage our healthcare partners in dialogue to affect the problem • We will continue to cooperate with community efforts such as “take back” programs • Please contact us for more information!

24. Environmental Prevention Strategies Health Care Providers MaineGeneral Medical Center’s Prevention Center • Recipient of Strategic Prevention Framework State Incentive Grant • Reduce Access: Prescription Monitoring Program • Reduce demand: Alcohol/drug screening [brief intervention, referral, treatment]

25. Maine’s Prescription Monitoring Program • Legislation passed in 2003 • Scheduled drugs (II, III, and IV) • All transactions saved in centralized, relational database • Data collection began in July of 2004 • Data is submitted twice a month from over 300 pharmacies (both in and out of state)

26. Maine’s Prescription Monitoring Program • Free service for registered prescribers • Online access to database for background check (patient history report) on prescriptions of Schedule II, III, and IV drugs for current and new patients • red flags of potential addiction and/or diversion (e.g., “doctor-shopping”) • Automatically generated Threshold Reports • Coordinate care with other prescribers • Sub-accounts for use by non-prescribers

27. How do Prescribers use PMP in Kennebec County? 2008 survey of MaineGeneral Medical Staff

28. How do Prescribers use PMP in Kennebec County? Most common “other” responses: • Suspicious patient behavior • New patients requesting narcotics 2008 survey of MaineGeneral Medical Staff

29. Alcohol/drug Screening • Promote evidence-based screening tools • Educate health care providers about substance abuse treatment options • Promote substance abuse treatment services • Promote treatment access lines

30. Alcohol/drug Screening

31. Alcohol/drug Screening • Promote on-line self-assessment at worksites, schools, in the community, etc. www.alcoholscreening.org www.drugscreening.org

32. Contact Information • Nancy Findlan, Project Director, Greater Waterville Area Communities for Children and Youth Prevention Coalition nancy@gwc4cy.org • Charles J. Rumsey IV, Deputy Chief of Police, Waterville Police Department crumsey@waterville-me.gov • Alison Jones Webb, Public Health Specialist, MaineGeneral Prevention Center alison.webb@mainegeneral.org