TMCC Opioid Panel Discussion

TMCC Opioid Panel Discussion


I’d like to welcome everyone here on
behalf of the library club. We’ve gathered this panel of people to discuss
a pressing problem that’s we’ve been hearing about a lot lately and as opioid
abuse across the country if it’s not doctors prescribing oxycontin or it’s
China producing fentanyl or black tar heroin coming over the southern borders
from Mexico very complex problem and they’re here to discuss what’s going on
what’s available on the community level and can let us know what’s happening
here in in Reno so I think we’ll start from let’s see you’re from your right
and if you will but 15 minutes and then we’ll have five minutes of questions
after everyone is through so if you have questions for the person allow her hurt
him or her to finish what what they’re saying and then ask the question then
does that sound okay okay well I did light in introducing you and then Danny Tillman and David Meisner
Andrew servi okay so if you’ll start first if you don’t mind to give us your
presentation you know 10 15 minutes and then some questions okay there’s a mic
can you hear me if I don’t you have a voice they carry so if you want to stand
and stride or do whatever you wish do it I have given this talk more times than I
can count over the 11 years that I’ve been doing this work but I’ve actually
never done it without pointing at a set of slides a little bit of a new
experience I can show you slides if you want it but I don’t think we really have
time for that so I will just tell you a little bit about what I do what my role
in this is and what I understand to be or the the part of the problem that I
work on so my name is Carla Wagner I’m a professor at UNR in the school of
Community Health Sciences so I’m a public health professor I do
work I’m a behavioral scientist I have been working for about 15 years
specifically with injection drug use and injection drug users and interventions
to prevent negative health outcomes among people who inject drugs I started
that work working in syringe exchange programs which are programs that provide
sterile injection supplies to people who use drugs to prevent the transmission of
HIV and hepatitis C but then what we realized in the early 2000s and even
earlier than that in other parts of the country but where I was working in about
2006 was that the issue that people were worried about and the thing that was
killing people right in front of our eyes was opioid overdose and so I
started doing this work on the streets of Skid Row in Los Angeles where we
started an overdose prevention program to teach people how to recognize and
respond to opioid overdoses in their communities because what we were hearing
from people was that they were watching their friends die right in front of them
and they couldn’t do anything about it and they didn’t know what to do about it
but what we knew was that there was something that could do about it we knew
that there was a medicine that they could use that paramedics had been using
for decades to reverse opioid overdose and we knew that we could teach people
how to do it because since 1996 people in Chicago have been teaching people how
to recognize and respond to opioid overdoses how many of you have heard of
narcan or naloxone how many of you have heard of narcan or naloxone in the past
two years how many of you have known about it since 1974 when it was
available something has changed recently in our national conversation around this
issue right and I think it changed right around 2014 it changed when Philip
Seymour Hoffman died of an opioid overdose and the news articles started
saying this could have been prevented if somebody had been there with this
medicine you could have done something and maybe
he would be alive and that was the first time that I saw in the national media
that we were having a slightly different conversation about we can do something
about this problem so but what you need to know is that this isn’t new right
what you need to know is that we’ve been doing it since 1996 people in Chicago
started teaching people who use drugs to recognize what an overdose looks like
use the medicine and use the correct response technique to do something about
it and they’re saving lives so I call these overdose education and naloxone
distribution programs between 1996 when that first program started and 2010
there were a hundred and eighty-eight programs across the country as of 2014
there were 644 overdose education and lots and distribution programs across
the country those programs have given narcan to one hundred and fifty two
thousand people those 150 two thousand people have reported 26 thousand saves
that they have been abused over 26,000 times to reverse the overdose of
somebody that they saw we know from community-based studies that when you
distribute naloxone to people who are at risk of dying of an opioid overdose you
can make death rates go down they saw it in North Carolina we’ve seen it in
Massachusetts and we’ve seen it in California when we do epidemiological
studies that compare communities that have narcan to communities that don’t
have narcan you can drive death rates down if you get enough narcan into the
community so that people can use it we also do studies of those programs to see
what happens when you teach people to recognize and respond to overdoses using
the lock zone so in my research and the research of my peers we do things like
interview people before we teach them and then interview them after and then
follow them over time what’s the biggest concern all already what’s your biggest
concern with me saying I give medicine to people who use drugs to reverse
overdoses what’s the number-one thing are you encouraging people to use drugs
we’re creating a safety net the data that I have in the data that my
colleagues have show not only do drug use rates not go up sometimes they go
down in my research in Los Angeles people who came back three months after
we trained them to recognize and respond to overdoses using narcan told me they
were more frequently in drug treatment than they were before and they were
using fewer drugs than they were before and other people in other places have
also seen that in pre and post-tests evaluation service part of what we think
is happening is it’s sensitizing people to the risk when we talk about what does
an overdose really look like what’s putting you at risk for overdose how can
you prevent that happening in the first place and then your life is worth saving
and so I’m gonna teach you and your friends how to respond to start thinking
about making small changes in there for some people when they come into a
community-based organization and we say your life is worth saving and I want to
teach you how to do that and I want to teach your friends and family how to do
that and by the way if you want a referral to drug treatment we’re here
for you and we can do that sometimes that’s enough to help people make that
small step I also work with law enforcement agencies in Southern
California we’ve trained sheriff deputy sheriff’s to use narcan if they’re the
first ones on scene to respond to an overdose and when they do that they
provide a referral mechanism for that person that they responded to they give
them a handout that has a phone number of a case manager and they get their
contact information to refer that person to a case manager and in our tiny little
pilot study three of the nine people they responded to went to at least one
treatment visit as a result of that referral for the law enforcement officer
so we think that these programs not only know that these programs save lives but
we think that what they also do is create an opportunity for people to make
behavior change and create an opportunity for people to connect to
server’ to services that they wouldn’t otherwise have connected with so in
Nevada in 2014 we changed our laws have you heard of the Good Samaritan overdose
prevention law a few may so Nevada made a very
comprehensive change to our state legislation to expand access to narcan
and that one did many things but some of the things it did was create a mechanism
through which people can go to a pharmacy and buy narcan from a
pharmacist who’s now authorized to furnish it to them under State Board of
Pharmacy procedures it created a mechanism by which physicians can
prescribe the medicine to the person at risk but also the friends and family
members of that person and it created lots of protections for people it also
created protections for people when they call 9-1-1 what’s the biggest concern if
somebody’s using drugs and somebody overdoses and they’re about to call
9-1-1 but they’re gonna get busted right so we know in community-based surveys of
drug users that it’s only about 50% of people who call 9-1-1 in the event of an
overdose when somebody’s overdosing on an opioid you have minutes minutes count
because people are slowing and gradually stopping their breathing so getting
9-1-1 and getting EMS they’re fast matters so if people are delaying their
call because they’re afraid then we don’t fall and people die so there’s
also protections in the law that allow small levels of protection for people
who call anyone against things like charges for minor drug possession so
we’ve made policy level changes to try to increase access to the medicine that
we’ve been using in community-based programs for over 20 years now so let me give you that so this is
really easy and the education part is really easy so let me give you the thing
when we teach people about this we teach them through things what does an opioid
overdose look like what do I do when I see it and how do I prevent it in the
first place so when we talk about opioid overdose prevention we talk about things
like not mixing opioids with other drugs or medications mixing opioids and
benzodiazepines mixing opioids and alcohol mixing opioids and stimulants
are huge risk factors for dying of an overdose so we teach people to prevent
by not mixing drugs we teach people about not using alone because if you
overdose when you’re using alone there’s nobody there to see you go out and
there’s nobody there to save you so thinking about a safety plan we teach
people about using less after periods of abstinence if somebody gets busted and
they’re in jail for three days and then they come out their tolerance is down if
they use the same amount they’re gonna relapse they use the same amount they’re
more likely to die of an overdose when they use again we know that the couple
of weeks after coming out of jail or treatment facilities are a very very
risky time for people because their tolerance is down so we teach people
about being safer in those times and then we teach people how to recognize an
overdose so opioid overdoses killed by slowing down and eventually stopping
breathing so somebody’s gonna be non-responsive
somebody’s gonna be have slow or abnormal or stopped breathing and
they’re gonna look like they’re not breathing what are they gonna look like
if they’re not breathing blue right so that’s what we’re looking for we’re
looking for signs of respiratory depression and then we teach people how
to respond and that’s stimulate safely to see if you can wake them up call
9-1-1 to make sure that the emergency medical personnel are on their way check
the airway and breathe for that much it’s the respiratory depression that’s
killing so we provide respiratory support we breathe that I’m doing rescue
breathing and then we administer naloxone or narcan if we have it and
then you stay with them and you wait for the paramedics to show up so it’s a
small intervention it’s a small educational session and like I said 150
more now the data that I give you one hundred fifty two thousand people those
were data collected four years ago so there are many many more people that
not who have this medicine now and have had this education it’s more widely
available than ever in our history almost every state in the nation has
changed their law to make it more available and we are making those same
changes here and there’s a lot of people in this room who are working very very
hard on this in a number of different ways so I have talked with lots of folks
and some are more receptive than others you could imagine that this might be a
little bit culturally and consistent with yeah but here’s the thing even if
somebody leaves treatment and does not use again they are going home and
potentially going home to a community where other people are using
and so creating a community safety net where lots of people have this education
and have this medicine and have these skills is good for the broader public
health yeah exactly do you how many where’s so paramedics law enforcement
folks they do this sort of sternal rub knuckles on the sternum causes enough
pain to wake somebody up or on the nose the bridge of the nose here’s me of
anything I will tell you this this the safety net concern and like if people
have enough narcan then they’re gonna keep using in their use more because
it’s gonna be safe what naloxone does is bind to the
receptors in your brain that the opioid was bound to and it takes over it
outcompetes that opioid and binds to that receptor which means it takes away
the respiratory depression but it also takes away the analgesic effect and it
takes away the and it puts you into withdrawal if your opioid dependent
naloxone will put you into withdrawal so it feels really bad and so people in
communities where people have been woken up with naloxone by paramedics if you
tell them you’re getting the naloxone out and they’re not totally out that
might be enough to get enough of a stimulated response because it feels
really bad the idea that people are just gonna keep using and using and using
more because they have a safe way out it doesn’t feel good to be in withdrawal if
you’re opioid dependent and people know that relaxant has a short half-life 30
to 90 minutes ish opioids can have a much longer half-life especially
long-acting opioids so things like methadone lasts for much longer
and that’s why 9-1-1 is your first call because then a lock stone will wear off
and the opioid could come back the other reason 9-1-1 is your first call is
because if that person had mixed benzodiazepines and heroin or
benzodiazepines and oxy or alcohol and oxy the naloxone is very very specific
all it does is bind to that opioid receptor so it’s not going to treat
anything else which means if you have some other weird synthetic drug on board
if you have alcohol on board if you will have other medical complications min
alaq zones not going to fix it and so you need to have paramedics on their way thank you very much Carla much
appreciated okay Melanie Flores do you have any film or any slides or anything
my name is Melanie Flores I’m actually a program coordinator at Washoe County
Health District I oversee the community health improvement plan but I’m also a
community organizer and a founding member of the Public Health Alliance for
safety access so I’m actually going to speak to you today a little bit more
about what we call Fayza did in the whole bringing this issue to the
forefront in Nevada and then I’ll give you a little bit of what Washoe County
Health District is also doing so I it’s really nice to see a lot of fresh young
student faces in the crowd because this whole project stemmed from
being a student and I’ll tell you a little bit more about that so
technically Fayza this is a very generic mission statement but we create policy
system and environmental changes to promote health and well-being in Nevada
that’s the generic term of what we do it doesn’t really tell you specifically
what we do I will tell you it actually stemmed in 2010 when Fayza was an ad hoc
policy committee to the state aids task force and at that point in time they
were looking for a comprehensive strategies to reduce HIV in Nevada and
one of the only strategies they they were not able to implement was the
syringe service programs to reduce HIV prevention among injection drug users
and as a result they pushed forth legislation in 2011 unfortunately that
legislation died and then that’s where I came in as a student and actually it’s
one of those things where because you don’t always choose your causes
sometimes your causes to choose you and that’s exactly what happened to me in
let’s say October 2009 this cause chose me when I got a phone call from a friend
telling me that somebody very very close to me had died of a drug overdose that
complete completely changed the trajectory of my entire life I was not
in Public Health that’s for sure I was doing my 12 year career in alternative
rock radio and that’s what I thought I was gonna end o Beal and that’s not what
happened as a result that changed obviously my
perspective on life and I went back to school and I got my masters in Social
Work and I ended up at Northern Nevada hopes which is an at the time was an
aide service organization and my boss at the time she put SB 335 which was the
first syringe service program bill on my on my desk and said Mel I think this is
something that you’ll be interested in and that moment had dictated pretty much
the last seven years of my life which is kind of interesting so
as a result the Public Health Alliance for syringe access later safety access
came to fruition and took life of its own and actually ended up sitting down
with Carla Wagner for eventually than along nox own access bill at some point
I’ll go into that a little bit but I have to start with the history of Fayza
because if it wasn’t for syringe service programs starting in Nevada I don’t I’m
not sure I’m sure what it came to the forefront but I think that’s where the
conversation started happening in terms of drug use substance use opioids
becoming an issue in Nevada and it wasn’t even just my ex-boyfriend dying
of an overdose but I also found being in the whole field of sex drugs and rock
and roll that a lot of my friends had heroin or pill addictions as well so
this very fast became a passionate issue for me so this was the original bill in
2011 that died and the reason why I bring it up for you guys to see is
because this started everything as a student what I did because I had the
luxury of doing all this research and having time to actually dip into this
the state AIDS task force they kind of disengaged after it lost in 2011 which
couldn’t happen when a bill doesn’t pass and so as a student I would say I was
very passionate about it and I said hey you know I really want to take this on
as my thesis project as a master student so that’s what I did so I did what I say
is policy forensics to figure out what went wrong in 2011 so that we can cure
that in 2013 so this is what we came up with the language so the original
language of the bill was very regulatory and so what happened is when you have
regulatory language immediately a fiscal note gets slapped on the bill and a
fiscal note is very bad if it’s not in the governor’s budget and can kill your
bill immediately so immediately we change the language to be more
decriminalization type language which allowed organizations who wanted to
implement a syringe service program to actually do that but it didn’t have any
severe regulatory like you didn’t have to do it
you did it if you had the money and you wanted to do it and then you just had to
abide by the the states regulations um the initial bill we had law
enforcement opposition we actually had the National Association of law
enforcement come out in opposition at the bill they said it would increase
drug use it would increase needlesticks and also they weren’t engaged at the
beginning of this bill so we thought red flag you really can’t do anything in
Nevada without the help of law enforcement so that was something that
we needed to work on and then we didn’t have any local research or data
whatsoever we had a lot of data from California from other states if you’re
from Nevada the minute you mentioned California you get shut down really fast
so it was really really important for us to have our own local data research and
then we had a lack of testimony from the injection drug using community
themselves or anybody have used a syringe service program anybody who lost
a family member as a result of drug overdose and so as a result this
actually came from Assemblywoman Theresa Benitez Thompson
who was also a social worker and she said where’s the drug using community
would they even use this and what was interesting coming from Hope’s is we
would work with that community every day the fact that we couldn’t bring somebody
to testify on behalf of the bill was almost embarrassing so as a student I
thought I thought I could help at least with the data piece of things and so I
conducted a statewide needs assessment for syringe access I won’t go into the
data because it’s horribly outdated and any of these people at the table could
give you much better data than what I had back then but in terms of painting
the picture of injection drug use in Nevada we actually had to use national
numbers to try to estimate because it’s not like we’re tagging and logging
injection drug users right so to figure out how many we would have in Nevada and
actually Stasi I had to talk to her to get data from local law enforcement Las
Vegas just to find out heroin arrests see
paraphernalia arrests and seizures went to substance abuse treatment centers
things of that nature HIV hepatitis B and C rates in Nevada just to paint that
whole picture of burden that this was an issue so people would listen to me and
then the other thing was kind of assessing readiness was Nevada truly
ready to implement something like a syringe service program and so we did
surveys to leaders politicians CEOs of organizations but also drug treatment
centers church congregations law enforcement just to assess whether our
community was ready and then we did focus group with former and current
injection drug users in both Northern Nevada and Southern Nevada and as a
result from those focus groups which were hugely i opening were that we got
to enlist people to speak on our speaker’s bureau to testify at the
legislature and to become advocates for their own healthcare in nevada and that
was probably the most impactful part of this whole process is that eventually
you know the CEO of Hope’s wasn’t the voice anymore it was somebody that was a
former injection drug user who used a syringe service program it changed their
life and they were the forefront of this whole issue in nevada so community
mobilization is definitely where i came in so i started out as a student like
you i I did the research I did my thesis and then harm reduction coalition out of
Oakland and northern Nevada hopes put together funds and hired me on as a
community mobilizer to help with some of these issues so we
had to identify key champions in the state you do need certain people to get
you through certain doors that’s just the fact of the matter so we needed
people in high political positions and then we also needed people that could
get us into drug treatment centers or that could speak to other or former
current drug users and our cops law enforcement things like that so you
needed people champion and all different sectors to talk to all
different kinds of people we had to leverage our relationships and then we
also had to defuse the opposition so as I said law enforcement was huge in terms
of opposition at the beginning but we learned really quick that it was mostly
because we didn’t engage them from the beginning and also there was a lack of
education in Nevada just in general and so we realized that we really had to get
out there and get the best practices and the data out there for people to
understand what was going on and then we built the speaker’s bureau and a group
of people that were ready to go if they had to testify if they had to do
interview on the news or if they had to go out and do a talk like this and then
we needed somebody to be ready to implement so once the law is passed
who’s actually gonna implement a syringe service program and so as a result
Northern Nevada hopes came to the table and we are so lucky at that point that
Sharon Chamberlain she came from LA and worked in syringe shovers programs down
there as well and she was the new executive director of hopes and she said
you know what I’ll figure it out but hopes will be the first organization in
Nevada to have a syringe service program and partisan service programs actually
is Anna Locke’s own distribution and a lot of states as well so you could see
how they’re very interrelated but I will go into both so our key champions here
for the first bill anyways was we are an ad hoc policy committee which means we
needed a main body or organization to be a part of and for legitimacy and it was
a state AIDS task force but since they were no longer really meeting at that
time we ended up going underneath the Northern Nevada outreach team which is a
coalition of organizations concerned about sex health and HIV prevention and
they not only took us on as ad-hoc policy committee they incorporated our
initiative into their strategic planning and all of their volunteers got backed
up everything that we were doing so it was a really beautiful partnership we
also had dr. Iser at the at the time he was the health officer and he came from
California as well in Yolo County and was very familiar with syringe service
programs and as a result he was a huge champion for
getting us in two doors that a basic grassroots organization couldn’t and he
also massaged a relationship quite a bit with law enforcement
Sharon Chamberlain as I mentioned and you know Nevada is really small and I
went to school with Stacey Shin who ended up being the lead lobbyist for the
progressive leadership Alliance for Nevada and she ended up lobbying our
bill so you know it’s all about who you know sometimes and then we had to
legitimize our presence so just building a brand website social media hosting
monthly calls actually flying down to Vegas there the majority of the
population in Nevada you can’t really move a lot of policy without them and so
we had to make sure that everybody was on the same page and we had to do quite
a bit of community education community presentations outreach developing that
speaker’s bureau we brought in harm reduction coalition for a lot of
capacity building so they would hold trainings and do technical assistance
and consulting such as working with law enforcement or they even brought in a
chief of police from Washington to talk to our law enforcement so that way it
was more a peer-to-peer based education and it wasn’t me who has no idea about
law enforcement um telling them what they should be doing instead it was
somebody in their pure telling them how they implemented it in their County and
could address their comments questions and concerns so we definitely took
approach of community activism if you will and very grassroots so you can see
these are some of our advocates actually the girl used to be a drug dealer and
the gentleman on the left was a former injection drug user and they were
together at the table and for this cause which I thought was pretty amazing we
okay okay I’ll go ahead and so the strengths of this campaign was that we
utilized focus groups consumer advisories we enlisted the speaker’s
bureau we had a year to prepare for the first bill which made it so much
year for the second bill because we already had a well-oiled machine in
terms of advocates that came to the table so when Carla came to the table
and said hey are you interested in getting involved with the naloxone
access bill which is SB 459 we were able to engage in a two-month time period
which is like unrealistic but for most people to help so that that was amazing
some of our challenges well after I worked at the state for four years as
well so now I know the state comes out it neutral on everything but the time we
really were like what we thought they were gonna support and they ended up
coming out neutral and I kind of already addressed some of the others like Nevada
hates California there was a lot of massaging we had to do we had to do a
lot of education to legislators some legislators thought we were taking
needles and actually cleaning them in the back in a kitchen and redistributed
redistributing them so a lot of Education so we had success and I say
rinse repeat on the knocks on access bill because we did a lot of the same
activities to push forth this this was a lot easier though because Cathleen sound
of all was a champion the first lady and we had a bill and they had a bill we
ended up merging the bills because they were pretty much the exact same and so
that made it a lot easier to push forth than naloxone naloxone bill there are
slight differences as I said the time difference in terms of turnaround
merging the bills of course advocates changed Karla being one of our big ones
judge Dorothy Nash homes another one and the branding changed the public health
public health what did I say Public Health Alliance for safety access rather
than syringe so I’ll go ahead and just end it there and take questions no I have no idea but I can tell you
that people have done cost effectiveness studies for 30 years and it is much much
cheaper to find syringe exchange programs than it is to fund HIV and Hep
C meds other questions No then we’ll continue
on with our panel Stacy do you have some this microphone on yes no I was
listening tonight was having this thought that after hearing what I just
said and after hearing it might be possible to walk out of here and think
this is not my problem because this is the problem that drug users have and I
am NOT like those people right and this is the social process of stigma and
social distancing when we create an other and you say that this thing is
somebody else’s problem we know please this is not somebody else’s problem this
is our problem right I am NOT talking exclusively about people who live on say
irrelevant heroin I talk a lot about them because that’s a community I work
with but we have so many opioids in circulation right now
opioids through prescription opioids that are getting diverted my mom has
opioids on her kitchen counter right it is all of our jobs to increase access to
the information at the medicine that can prevent people from dying and it doesn’t
matter if these are legally or illegally obtained opioids well there’s a program
similar to Northern Nevada hopes but not change point which change point is a
syringe service program at Northern Nevada hopes there are individuals that
are trying to create something right now but as of now there’s nothing similar so
right now change point is the very first one and only syringe service program in
Nevada I mean not to say there aren’t backpack efforts and people kind of just
doing grassroots type of stuff because there are and there was before the law
even happened but yeah something formalized now is there a panel like you
or people like you down there working on these problems Southern Nevada Health
District I know are a little bit it’s just a larger monster come down there
okay okay I’m Stacy with the Reno Police Department so I’m a civilian with Reno
PD and my job there is the drug prevention coordinator so it’s my entire
focus to do these types of things outreach with the community educating
the community stuff like that so what I’m going to talk about is just what
Reno Police Department has done at the local level to respond to the opioid
crisis it’s been the opioid problem came on to our radar in about the middle of
2009 and so since then Reno PD has been focusing efforts on this and then I’ll
just kind of go through what all that has entailed so the first major project
that we undertook was called the smart policing initiative it looks like you
can pretty much see all of the text on this
so that’s good um so the way this came about in the spring of 2009 there was a
local couple that came forward to join together Northern Nevada the
organization that Jennifer represents they came forward and they said our son
Austin who was 15 years old just died of it of a methadone overdose he was out at
a party he came home said goodnight kissed his mom and dad
goodnight went up to bed and then in the morning his mom went into his bedroom
and found him dead in his bed so they came forward he wasn’t a he wasn’t
really a drug user he hadn’t really been in trouble or anything like that
he was an it was a shockingly small amount of methadone that he took
but for him in combination with something he was legally prescribed it
turned out to be fatal for him so his parents came forward and said we don’t
want anybody else to have to go through what we were going through we don’t want
this to happen to other families so what could we do that could maybe prevent
this in the future so join together Northern Nevada reached out to the Reno
Police Department we were fortunate to already have a very good relationship
with them based on working on some other substance abuse issues the meth problem
in particular anybody heard of a meth problem in Nevada yeah that hasn’t gone
away by the way this is where the focus is right now but we still have an
enormous meth problem but because of that we already had some partnerships in
place so what we did is we all met together with those parents and we just
kind of brainstormed what could we do one of the first things we did also is
to look at our internal data so my supervisor at the time said I don’t
think we even really have a prescription drug problem but can you take a look and
see we don’t have a whole lot of data at the law enforcement level about
prescription drug abuse because there’s obviously a legal realm for using those
drugs right it’s not inherently illegal like heroin is what we did look at was
our heroin data heroin is an opioid just the same as prescription narcotics our
and we had a thirty eight hundred percent increase in our heroin seizures
over the last few years to that point so we said wow obviously we do have a big
opioid problem so we designed a prevention plan and then we applied for
the smart policing initiative funding which is a national grant from
the Bureau of Justice Assistance we were fortunate to receive that funding and so
it was initially a two-year grant and then we were refunded for an additional
two years so it ended up being with an extension about a four and a half year
project and the objectives of the project kind of broke down into three
areas so one of them was education this included educating health care
professionals so we put together several continuing ed classes for prescribers as
well as pharmacists and pharmacy techs so there are a lot of and Carla kind of
talked about this there are a lot of different pieces right to the opioid
problem there’s no one sector that you can target and hit it all
so with prescribers we talked to them about a lot of different things
identifying kind of red flag behaviors when a patient is in your office and
they’re just trying to scam you for drugs basically they they told us in
some survey data that they had had no training on that whatsoever but they did
simultaneously report that they encountered drug seeking patients what
they identified as drug seeking patients regularly at least weekly
so we educated them and then as well about just some alternatives to opioids
depending on what the problem is that the patient’s presenting with and then
within the pharmacy side of things it’s a lot of fraud prevention so if you’re
going to obtain narcotics prescription narcotics you have to go to a pharmacy
pretty much right unless you steal them off of a truck or from the manufacturer
and so we educated the pharmacy community about identifying fraudulent
prescriptions you know people that are calling in prescriptions for themselves
that are not even originating from a doctor things like that and we also on
that first point educated just the general public about prescription drug
abuse – and Jennifer’s going to talk more about those – so I won’t really
linger on that increased enforcement of prescription fraud and diversion laws so
what this looked like was prior to 2010 Reno police and pretty much all law
enforcement in Northern Nevada had nobody dedicated to working prescription
fraud at all so we have people dedicated to working drug crimes and we have
people dedicated to working fraud but description frogs stealing prescription
pills was was getting missed it was a gap so we dedicated people to that and
primarily what this looked like is we have had rings of people come into the
area often from California that’s just where they happen to be from come into
the area it’s a very organized setup they’ll steal prescription pads they’ll
print their own prescriptions and their goal is just to obtain as many pills as
possible and flood the community with them sell them so this was our target
our target was not a soccer mom who inadvertently got addicted to her pills
we have no interest in seeing her go to jail in those cases actually we’ve had
our detectives testify on behalf of some of those individuals and lobby for them
to try to get into drug court so that they can go to treatment instead of jail
so we understand that there’s a very important distinction there and then
reducing the availability of prescription drugs is probably what the
bulk of our kind of day-to-day activities had been under that program
and so this I talked about on the prescriber education we did some surveys
and we were able to see through a couple of different means whether the education
was effective so that we would know is this worth spending your time on in the
future we saw that for the doctors who attended a training event that we put on
they subsequently decrease the amount of controlled substances they prescribed by
you can see they’re almost 18% and then similarly they wrote 117 fewer
prescriptions per month which was about a 16% reduction so that told us that you
know they do they do listen in these trainings most by and large the majority
of doctors in my experience are well-meaning they became a doctor
because they want to help people when a patient comes to them and says I’m in
excruciating pain then they want to help and they they often don’t know what else
to do besides give that person pills so a lot of it was just educating them
about alternatives and having an exit strategy if you’re starting somebody on
opioid therapy things like that there are outliers of course there have been
doctors you all may have heard of a doctor in the area who is arrest
recently but that’s the minority by far as far as reducing availability the main
thing that that has looked like from the Arena Police Department is the
prescription drug roundup so has anybody heard of this event okay so what we’ve
done is the first event that we held in Washoe County was in October of 2009 we
didn’t invent the idea but I looked and saw that some other states in the
country had been doing similar things the idea is that if you have extra pills
lying around in your house that you don’t need and you don’t really know
what to do with them you don’t want to flush them down the toilet you don’t
want to just leave them in your medicine cabinet you can bring them here and just
dump them and we’ll destroy them for you so we’ve repeated that twice a year ever
since that time as of right now we’ve had 16 events since – since October 2009
and we’ve been logging what comes in we’ve collected about 2.1 million pills
at those events so this is just a photo from one of the early events in that
photo is probably only maybe fifty thousand pills but I will tell you we
were all shocked at the quantities of medications that people are bringing in
we have people in the community largely elderly people in many cases they’ve had
a spouse or a parent pass away and so there’s just a stockpile of medications
sitting there the problem with that is if anybody in your life whether it’s
your grandchild your grandchild’s friends a plumber who comes to your
house if anybody wants to divert some prescription pills and they’re just
gonna walk into your medicine cabinet and take them so that’s what we were
trying to get at and the prescription drug roundup affords an opportunity to
educate the public about why should you care if you have prescription
painkillers sitting in your house why should you be extra careful to lock
those up if there are any children in your house or anybody really things like
that so that’s how the prescription drug roundups have gone they’ve been hugely
successful and the number of pills that we collect has gone up and up and up
with every event so unfortunately it’s not tapering off there’s still a huge
need for that to give you an idea I said we’ve collected about 2.1 million pills
over the last years we also looked at how many
prescriptions are prescribed in Nevada so this is just controlled substances
this doesn’t include things like antibiotics heart medicine just
controlled substances over forty four months in this study period we had 14
million eight hundred and sixty one thousand prescriptions filled in the
state of Nevada for a total of 1.1 billion
pills an average of 25 million pills per month three hundred and thirty seven
thousand prescriptions per month and Nevada’s population is 2.8 million
people so unfortunately the amount of pills that we’ve recovered from the drug
roundup is actually a drop in the bucket in comparison to how many prescription
controlled substances are in the state of Nevada of course a lot of those we
hope were prescribed for a legitimate need and so the patient took them and
they’re not going to show back up at the roundup um but we know since we’ve seen
the numbers go up and up and up at the roundups every year that a lot of those
pills are not actually ever used and they’re just sitting out there floating
out there in the community and then this is what the Reno Police Department is
doing now so the smart policing initiative ended in the middle of 2014
we knew that the problem we hadn’t fixed the problem by any means by that point
so we’ve initiated a new project and obtained some new funding this one is
primarily research-based so it’s called the Harold Rodgers
prescription drug monitoring program grant the Reno Police Department has
that grant and then we also actually have a grant at the state level to from
that program so this is a partnership between Reno PD UNR we have an evaluator
that we contract with at UNR and then the State Board of Pharmacy as well and
primarily what we’re doing is analyzing the PMP data anybody know what the PMP
is nobody I know a couple of people in here know it
so the PMP is the prescription monitoring program so every controlled
substance that is prescribed in the state of Nevada goes into a database and
that’s the prescription monitoring program and
so the purpose of that was for physicians to be able to go in and check
it so if you show up at a doctor’s office and you say I need some vicodin
the doctor can look and make sure you didn’t already just get vicodin
yesterday that you’re not already taking a benzodiazepine which presents a huge
overdose risk if he gives you narcotics things like that what it also allows is
for some aggregate data analysis so there’s a lot of data just sitting in
there if we’re able to de-identify it take away people’s names we can get a
lot of information out of it so that’s what we’re working on now the focus
areas are identifying populations that are at high risk of abuse and overdose
we’ve identified I think eight or nine metrics that we’re looking at including
things like a combination of a narcotic and a benzodiazepine a combination of
those two and a muscle relaxer and then several other different things that
indicate somebody’s at high risk we’re educating prescribers again like we saw
that that was effective and then we’re analyzing the link between prescription
drugs and heroin so we’ve we knew anecdotally a long time
ago that people do in some cases graduate to using heroin after using
prescription narcotics they work in your body essentially the same way and the
withdrawal is the same and so either one can be substituted for the other to stop
withdrawal to prevent withdrawal and so what we’re looking at now is is are
there any common factors that exist in people who do make that jump a lot of
people don’t a lot of people only ever use prescription opioids but some people
do graduate to heroin use and that’s really the worst case scenario as far as
we’re concerned we don’t want them to end up there and so this research
project were only about halfway through it we don’t have any findings to publish
at this point but we’re hoping to identify if there are any risk factors
for somebody to make that jump to heroin that’s where we want to intervene that’s
where we want to educate them that’s where we want to educate their doctor
whatever it is we can do to keep people from ending up in that spot where they
ever even need naloxone at all so that’s kind of an overview of that I think
those are all of my slides yep so questions for me
Thank You Stacy the VA operates differently so because it’s a federal
entity the VA is not required to report their data into the prescription
monitoring program which is an issue there are a lot of controlled substances
prescribed at the VA and so we’re kind of missing that
however the VA is interested in voluntarily reporting into the
prescription monitoring program which is good and if they would like the
prescribers at the VA can also obtain an account and they can query the PMP so
they can log in and look and see but it’s just because they’re not required
to input the data there may be some that we’re missing but we are the Board of
Pharmacy is working with the VA and trying to get all of that ironed out
it’s a problem nationally too because the VA is a national entity and every
state’s prescription monitoring program is a little different every state law is
a little different so there’s just some red tape that we’re working through I
say we because I also work at the State Board of Pharmacy as an aside their rate of accessing it know we can
obtain that data um it’s a little bit difficult to fish
out its that have used it or that have long that have obtained an account yeah
so in Senate bill 459 which was mentioned it became mandatory for
prescribers to check the PMP in certain situations so in effect all prescribers
are required to have an account in the PMP so now we’re we’re nearing a hundred
percent compliance with that the next step is going to be making sure they
actually use it that’s having an account the next step is do they actually use
their account and there’s there’s not a whole lot of available data on that to
be honest with you but it’s something we could go and we
can we can log can see exactly yeah it’s and so one of the issues has been the
software vendor has changed a couple of times and so previous systems were not
as easy to use but I can tell you since I work there in one of my functions is
to get people signed up it’s very easy to use it’s an online setup it takes
about 10 minutes to sign up for an account and then to log in and check
somebody’s history takes you know two minutes so it’s pretty simple great so
any other questions here so we’ll move on to our next board member
Jennifer delet snyder executive director of joined together northern nevada okay
I’m Jennifer I’m the executive director of joined together Northern Nevada we
are a substance abuse prevention coalition here in Washoe County we are
one of will see if we can get this events we are one of twelve coalition’s
in the state that make up the Nevada state Way coalition partnership do you
all know what a coalition is I mean I’ve got it on the screen but we all coalesce
we get together over certain topics and ours of course is substance abuse
prevention so we may coalesce over marijuana or prescription drugs or
whatever the topic is maybe it like Stacey was saying
the family who had come to us back in 2009 when they were trying to figure out
something to do so that their their child’s death wouldn’t be in vain that’s
something that we you know we went met with law enforcement and others just to
determine what we could do about it so that’s what we do on daily basis we’re a
pretty small agency but we have a lot of partners in the community and that’s how
we get our work done so we engage the community in a myriad of ways we have
committees we have partnerships and we also have a comprehensive community
prevention plan in 2009 when this family came to us and we went to Reno Police
Department we created the community prescription roundup committee so CC
named our roundups and then we named the committee after the roundup so but so we
started meeting in 2009 and this committee among other things plans the
roundup activities that we do twice a year and this was I think CC said this
even before the DEA had created the national take back days we were doing
this here locally and so we were very organized since I have to give CC a lot
of credit because she’s the one who got volunteers initially but we have so many
people involved in this event now we have we have people who count the pills
as she said these are volunteer pharmacists we have people from the
retail Association just there are so many people it takes about 50 people at
least before you have law enforcement involved every time we do one of these
events and it’s a very fun time if anyone ever wants to volunteer
feel free to see either of us because it is interesting like CC said to see the
people with their bags over their shoulders like they’re coming down the
chimney but waits with pills and not presents so this committee also has a
subcommittee and that looks at physician education I think Stacy and I are the
only ones on it right now but we have had others involved in the past and we
created a senior roundup that is not to round up seniors that is surround up
their pills and so we do this at various senior sites in Sparks in Reno and
during the roundup it’s usually a couple of days prior to the main event and then
we also started a roundup over the Reno Sparks Indian colony so we’ve done that
twice we’re gonna do it again here in the spring okay so in 2009 like CeeCee
said we noticed a problem too we were hearing about it we started I I’m my job
at the time was helping create physician education
not just physician education education in the community and so I brought in a
couple of physicians and they were talking about a drug called suboxone
that we all have heard about now maybe but nobody had really heard about it in
2009 and so then I started thinking wait a second maybe we need to back up
because we need to figure out how do we even get to the suboxone piece maybe
that we’re over prescribing so in 2010 we started partnering with the School of
Medicine at UNR to develop prescriber trainings like Stacey talked about and
we’ve partnered with our PD and others in the community to deliver those those
trainings since 2010 we’ve developed promotional items and there’s some items
back there that you’ll see we’ve got a rack card feel free to take that we have
Anna lock down brochure that we just did and some other things up there too we’ve
done billboards we’ve done public service announcements any way we can get
information out to the public we’ve done funny ones we’ve done serious ones it’s
really just kind of engaging people on either about the round up events safe
storage just kind of risky prescribing that type of thing and we also
established permanent drop boxes across the state so Stacy and Reno PD purchased
the drop boxes for Washoe County including Sparks yeah and then okay so
Reno and Washoe County Sheriff’s Office and a grant with the coalition’s or
twelve partners we were able to purchase those drop boxes in the rest of the
counties so each county has one out of law enforcement office so no matter
where you are in the state if you have drugs that you want to get rid of you
can get rid of them through the lobby of the sheriff’s office or you know Reno
Police Department wherever that is we also I think I forgot to mention this
with the prescription drugs and it may be on another slide so Washoe County was
the first in the state to have an official prescription drug roundup every
county in the state now has one we all do them at the same time so we shared
that information with our coalition partners we all do it at the same time
now here we go here’s the plug April 29th if you have pills bring them to
you’ll have to look at our websites I didn’t put them on there but @j tienen
org we have and I think there was a sheet back there too for you we have six
locations here in Washoe County Las Vegas will have someone don’t think
any of you are from Las Vegas but if you have friends let them know you can also
go to the DEA gov website and that lists every location in the entire country for
where you can drop off your drugs on April 29th and every time they have a
take-back event those are listed on the DEA website this is what one of the
permanent boxes looks like this is the one in Sparks PD they’re located in Reno
PDS Lobby Washoe County Sheriff’s Office is back toward the back going into a
booking area this one is like right when you walk in the door I think this one’s
probably the most easily accessible depending on where you live these are
permanent they’re open during lobby hours the other coalition’s have them
like I said in theirs their communities as well we are lucky enough to have one
Walgreens the one over the freeway and on Virginia that is now a 24 hour drop
box so there’s no excuse that people say they can’t find a place to drop off
their pills and they want to flush them down the toilet there’s no excuse we
have a 24 hour drop box here it’s the only one we have in the north and there
are five down in the South at Walgreens okay so let’s say you cannot get to a
prescription drug take-back event you can’t get to a permanent disposal site
we have these doTERRA bags we have our state was lucky enough to be the
recipient of 80,000 of them from Malin Crowe who is the distributor and
manufacturer so if anybody in this room would like something like this please
let me know we can we have a couple hundred at our office but there will be
about forty thousand for the northern part of the state it’s very easy this
one takes 90 pills and you just tear off the top you put your pills in you fill
it up with water seal it it kind of bubbles up it’s got these like charcoal
packets in here and then you just toss it in the trash if you don’t have that
you can still do the same type of Emma it’s not going to bubble and look fun
and all that but you can still put it in your pills in with used kitty litter or
coffee grounds put it in a plastic bag and throw it in the trash okay safe
storage I also had another flyer up there for you if anyone wants a a free
box we have some they look like that we have a couple of different sizes this is
for people who have not Erick’s anxiety medications
benzodiazepines other addictive prescription sedatives if you have these
in your home and you are trying to keep them out of reach of younger people or
other people which you should we encourage you to not lock them up if you
bring that flyer to my office we will get one for free if you don’t have the
flier or you don’t want to use that lockbox anything with a lock will work
as far as you know toolbox file cabinet a safe anything like that but please if
you do have narcotics in your home it’s a great idea to keep them away from the
hands of others okay this is a this is a terrible slide to show everybody on I
didn’t realize how small I was gonna look so back in 2013 I apologize for
that I’ll just I’ll briefly tell you what it is
back in 2013 the state applied for partnerships for success grant and the
coalition’s we helped write that application and then the coalition’s
administer that grant to some degree and what we looked at is we were looking at
strategies that have been used best practices through the rest of the
country and we I might have to turn around to look at this okay so reducing
inappropriate prescription use that is back to the training of physicians and
the public cc’s talked about that we’ve talked about that reduce access to drugs
that is the prescription drug take-back everything I just talked about improve
overdose intervention this is making sure people understand about naloxone
and the Good Samaritan Law as has been said about the SB 459 the Board of
Pharmacy regulations weren’t permanent the M everything wasn’t in law I guess
until the end of last year and so now that everything is is in law and people
can there’s a standing order they can go to pharmacies and get in a lock stone we
are doing trainings now on naloxone and the Good Samaritan Law
we’ve got substance abuse prevention that’s um trainings for physicians
I’m sorry trainings for parents and youth the middle one is working with
mental health we have a program called first mental health first aid and then
this one over here is really making sure that we work with our treatment and
recovery friends so we really looked at this as
all of these strategies in order for us to make a difference in the community as
a coalition we have to work with our partners and we have to hit all of these
different aspects of prescription drug abuse okay so our partners again tiny
it’s very hard to see but hopefully you can see on this one I’ve got a couple of
websites for you these are resources the first one is healthier envy org and
that is a website that the Nevada statewide coalition partners created a
couple of years ago right before the last legislative session and there are
resources on there whether you live here or in Vegas that you can find a place to
go for detox you can find treatment you can find someplace to do an assessment
you can also find other information on there there’s also information for
physicians as well we Stacy talked about the prescription
monitoring program we did some trainings for physicians on the PNP we had a cute
little flyer that we would go to their offices and we would create trainings
usually with the hospitals at maybe 12 to 15 people at a time and you were
asking about the PNP it was so quick first of all I was really fast to get
them set up and then for them to use it they were surprised at how quick it was
of course they did not want to use it but you know we were charged with
helping them understand how to use it and then we also collaborated recently
with the licensing medical boards in our state they came up with a new website
called know your pain meds calm it just debuted a couple of weeks ago go to the
site there’s a lot of good information if you suspect somebody is over
prescribing whether it’s the nurse practitioner or a do physician or you
suspect some funny business going on if you go to the site you can put
information in and it will go to that specific board but they are going to be
coming out with a media campaign soon too and then we like it just mentioned
we are working with REM so to deliver some naloxone and get some errands and
presentations and our comprehensive community prevention plan we just really
set today that’s a plan that we do every two years so we look at the community
look at the data and we do focus groups as well as surveys to to gather
information and and make sure that we are focusing on what the data tells us
that website you cannot see it but if you go to J TNN org you can get to our
community and plan there just a couple of things
from that data in the focus groups prescription drugs came to the they were
in the top three in every single focus group that we we met we talked to youth
we talked to adults of different shapes sizes colors ethnicities everything
everybody said prescription drugs were at the forefront and we’re dangerous in
our community we have almost one in five high school students who have said that
they used a prescription drug without the need of it for non-medical use the
computer-aided dispatch calls for heroin rose five hundred fifty percent in just
one year that’s 2014 to 2015 so these are the calls that you’re making to
9-1-1 they started tracking those and in Washoe County Hospital admissions that
data 2010 to 2015 the number of opiate admissions doubled in that year I’m
sorry in those five years so that’s that’s all I have thank you very much
are there any questions for her I have a question was the five hundred
fifty percent increase because you bought a new a new way of getting at the
material I mean that the computer-aided no it was just they were what they were
doing is any call that came in if they if the person used the word heroin in
the call or opiate they were started they tracked it they have been tracking
it since I think 2010 and there were only maybe thirty a year until 2014 that
2014 to 2015 jump then so there was a severe spike over that year okay very
good well we’ll move on then to Andrew sir be
I’m sorry I’m getting my to I’ll just do it in in the order that we’re going down
there David Meisner is this thing on check-check good alright hi I’m uh I’m
David Meisner I work here at TMCC as a student worker in the Disability
Resource Center and I’m a senator of Liberal Arts in our Student Government
Association I think the reason I’m here today though is because I’m alive I
think that’s pretty much the only reason so I got started really early on with
drug abuse I didn’t even know it was drug abuse the first time I started
doing drugs I took a vicodin something clicked in my head and I thought this is
great I like this I think I’ll go after more of this I was like another year or
two before I even figured out what that pill was I don’t know if if I was a
traditional drug addict or if I just didn’t have any coping mechanisms with
my everyday life but either way I quickly started choosing substances any
substance I could get ahold of and and most of the time those were prescription
drugs anything from xanax to muscle relaxers anyth anything I could get to
make me feel less me was great that’s what I wanted I didn’t want to feel like
me so I think that’s why I got got started
I never really delved too deep into that until I think three or four years into
my addiction when when I turned to heroin because oxy cotton was too
expensive and I got to a point where I was paying about a dollar a milligram
for that stuff and that was just ridiculous a neighbor of mine said here
here’s some heroin it’ll probably do good for you and it did it did a little
too good for a while I think about five or six years into my drug addiction was
when it really got to its worst I was about a hundred and five pounds standing
at six feet tall my skin was like tinted kind of green just from toxicity my hair
was always frizzy from lack of nutrients I I couldn’t think straight I had
drug-induced schizophrenia people avoided me when I walked down the road
they would I mean even had 110 pounds hundred and five pounds wherever I was
they would they would get to the other side of the road is to not look at me or
have to encounter me and I just felt like that’s where I was going with life
I used to tell people that I was going to die on stage as a musician at 24 26
now not dead so that’s good so that’s I don’t want to spend too much time into
the end of the addiction a lot of us know what that looks like and if we
don’t know personal and we know somebody who’s going through it for me though the
redeeming light was was actually my rock bottom I was with this this girl at the
time and she was a she was hooked on multiple drugs and we were trying our
best to raise her daughter and one day I was in the bathroom shooting up and she
opened the door on me and she saw me there and even with the drugs even with
the numbness even with that lack of humanity as soon as as soon as she left
I just told her quickly you know I’m sick I need this shot she was four years
old so she you know she kind of just dismissed it and and she walked away I
just I collapsed and I fell on the ground and I knew I was I was done I
couldn’t do it anymore I couldn’t spread my sickness and I was
given an amazing childhood and look at where I was you know 110 pounds shooting
up in a bathroom and this little girl didn’t have a choice she was there
looking at me right there she didn’t have a chance at all and so I went and I
I went to rehab after that I went to a christ-centered rehab clinic known as a
New Hope recovery ranch they’ve recently closed down they were out in Silver
Springs and I it was there I was 20 20 or 21 years old when I got there again
110 pounds and within six months I gained about 50 60 pounds and my
humanity back I could think straight and I didn’t need drugs to be me I was able
to look in the mirror and I was able to be happy with myself I was able to to
feel that hope again that I had just given up before I even knew I had a
chance so that Christ based rehab was really it opened up my eyes spiritually
and it showed me that there was coping mechanisms that I was I was lacking and
I hadn’t I had nothing and so naturally I would turn to what I had and those
were drugs well in rehab I learned how to turn to those who are close to me how
to ask for help how to how to love I learned how to love that was pretty good
and yeah if it wasn’t for them I wouldn’t be here today and to bounce off
of what they were saying earlier is that this isn’t just a fight for those who
are addicted this is a fight for everyone out there because if somebody
didn’t fight for me I wouldn’t be here my wife wouldn’t be sitting here I
wouldn’t have a kid on the way I wouldn’t be taking classes and I
wouldn’t be happy I might not even be here at all so I’m gonna share a poem
real quick and then all if I have time I’ll go into a little bit more to turn
back time just a little and see what I look like
in the middle of my weakness weekends spent chasing waiting wasting everything
on frequent visits to my own man-made gods isn’t it funny how much you can fit
how much time you can fit into such a little bag a little mad twisted a little
man wishing I had more so I could feel less like the dirt under my nails
memories never fail to evoke the sixth sense
of smoke floating down my throat like a river of thirst this my personal curse
that I chose over family and friends alike not unlike many of you who still
wander in the dark looking for that spark of life in the land of the
lifeless if only it was as easy as a light switch like suddenly I could
forget how good it feels to feel good and maybe maybe just be okay with
feeling okay sometime I’ll spend a little bit of time going over what I do
to stay sober for me that’s very different than than many other people um
for me the 12 steps it was great I have a lot of friends who are alive today
because of them but it just was too many steps for me I take a very spiritual
approach and I try and take one step in the right direction every day I make
sure that there’s a lot that I have to lose in front of me I have an amazing
wife I have friends who care about me I make sure that I keep those in in my
focus point because it’s one needle away and I can I could say goodbye to every
single one of them to everything I’ve built so thoroughly throughout the last
six years again for me it’s not that 12 steps it’s that one step every day and
and I think that uh I think that people need to know that there are more options
out there than just the abstinence program the one way fits all type thing
again I’m not trying to shame that program at all I have many friends who
are still here today because of it but there’s there are other ways there’s a
there’s more of a spiritual approach you can take you can be more mindful I’m
very mindful nowadays I spend a lot of time meditating practicing just
controlling my thoughts because if I don’t control my thoughts then I know
where they go and my actions will soon follow
so I think that’s pretty much all I have to say just if you know somebody that’s
struggling with this please fight for them they might be worth it
well thank you David do we have any questions for him any questions from the
audience well it sounds like a brave journey that you undertook when you give
that up and we’ll move on to Danny Tillman it is wonderful thank you for
sharing that story I hear stories like that every day my name is Danny Tillman
I am the specialty Services Director for the life change center here and while
it’s in Sparks I always say here and here in Sparks I’m also a counselor over
there and I get to hear stories like this every day and it never ceases to
amaze me that people that are addicted to substances whether it be alcohol
prescription pills marijuana it doesn’t matter what it has cigarettes caffeine
strongest individuals I know and and that’s no joke strongest people I know
so um I wasn’t always with the life change center I wanted to share a piece
of my background so that you understand why my journey took me to the life
change center well I guess first let me tell you what the life change center is
life change center is a medically assisted treatment programs we provide
medically assisted treatment for individuals who are living with opiate
addiction or dependence our primary vehicle for this treatment is methadone
although we do offer some of the alternatives so it’s a very specialized
treatment program and we currently have a client census of about 700 patients we
do have two clinics we have one in Sparks and we have one down in Carson
City that we opened up about a year ago so like I said my journey though it
didn’t start at the life change Center my journey actually began with another
treatment program I was employed by another treatment program that
ironically is 12-step apps abstinence based treatment program that provided
residential treatment as well as individual and group counseling to
individuals in the community living with all types of addictions not just heroin
and it was my job to provide kind of ancillary services I did a lot of
Workforce Services I was surrounded by clinicians and I was
kind of knee deep in this in this world of substance use treatment here in this
community when my my then 21 year old daughter called me from Seattle
Washington in the end of 2011 and said mom I’m shooting heroin and cocaine and
and I’m really sick and I need help so I immediately went to my boss who you know
called probably JT NN and a couple of other places and and we pulled some
strings and we got a replace in a treatment program and I set out to
Seattle to go round up my daughter and bring her here and fix her so I get to
Seattle it’s the middle of the night and my daughter’s not where she said she was
you know big surprise and and I’m standing in the middle of the street and
I’m in tears and I’m thinking to myself what am I gonna do and I look up and I
see this figure walking down the road towards me moving from side to side like
I wasn’t even sure if it was real okay I was a little tired it was a long drive I
drove straight through I was worried and I’m like am I seeing
things and I hear mom and I look up and there is my beautiful beautiful daughter
who was about 84 pounds her skin was ghostly white and she just collapsed in
my arms so I picked this kid up I load her in the truck and I watch her inject
heroin multiple times on the trip down here just to get her here so that she
was okay enough to get here hardest thing I ever had to see in my life I put
her in a treatment program in and uh if anybody’s ever you know been engaged in
treatment or known people that have gone to treatment it doesn’t always work the
first time and that’s okay that’s the good message here it’s okay if it
doesn’t work the first time but don’t give up so it didn’t work the first time
for my daughter she ran from that treatment treatment program and she
continued to live on the streets for a while using whatever she could get her
hands on I’d see her periodically here and there she called me for Christmas by
now we’re you know we’re just coming into the new
year of 2012 and and uh you know my mom or my mom I’m sorry my my daughter calls
me and she says mom I’m ready to quit again can I come live with you I said
absolutely but you know let’s let’s sit down let’s talk about this and remember
I worked for this treatment program that was very strict in its abstinence based
philosophy and so you know yes you can come live with me but you can’t use
under my roof and you have to get into a program I don’t care what program it is
na GA is I don’t care just do something mom can I get on suboxone no because
remember that was what I was surrounded by the conversation hadn’t entered my
treatment program yet for me to hear it okay so no you can’t no you can’t but
you’ve got to stop using and you’ve got to do something but you can’t do that on May 10th 2012 at 5:30 in the morning the
coroner knocked on my door to tell me that my 22 year old daughter had died
alone in a bathroom as a result of a heroin overdose that was the moment that
my trajectory was changed I decided at that moment that we could no longer have
the conversation of one treatment program fits all we could no longer have
the conversation that a person has to get clean and sober on the first try or
they were in denial we couldn’t continue those conversations because we were in
the in what we now know was the beginning of the biggest opioid epidemic
that we have ever seen in this state and we were losing people by the dozens
people are dying our neighbors are dying our children our
parents our loved ones they’re dying and we had to do something I’m very proud to
say that as a result of my daughter’s death that first treatment program that
I work for well first of all I decided at that moment I was going to become a
counselor I couldn’t sit by idly and watch others
do the work that I then figured out that I was destined to be doing and so I
began my education to become a substance abuse counselor and I had many many long
conversations with the executive director of that agency and I’m very
very proud to report today that that agency is medication assisted treatment
friendly they have houses that are dedicated to our youth who are addicted
to opioid addiction and they are fighting the fight for our children but
that wasn’t enough for me that wasn’t enough I needed to get in on
the front lines of the m80 world I needed to be able to truly understand
the options that that people with opiate addiction have the treatment options
that are available the barriers to to gaining access to treatment and I needed
to do something so I made a move and I joined the team over at the life change
Center and I and I could not be more excited to to tell you that we we have a
program that supports not just the medication component of treatment but we
have a phenomenal staff of 35 including this wonderful guy to my right that
continued to promote a sober lifestyle so the individuals that will come into
our doors not everybody by the way that comes into our doors is seeking
medication assisted treatment we do have a population of folks that come in for
the other services and those other services are group and individual
counseling one-on-one counseling we have ancillary programs I’m I’m very proud to
report that we were recently given the opportunity to fund a women’s services
program that’s going to target women who are the most underserved of our addicted
population for a multitude of reasons but women with children under the age of
18 who are living with opiate addiction I’m so excited that we get to roll this
program out next month and and start changing the cycle
start having these conversations where people can empower okay people can be
empowered to take control of their own lives to change their destinies and to
change the destinies of our children because it’s a really scary thought when
I think about how many people are out there dying and to know that those
people are the ones that are supposed to be caring for me when I get old I need
the generations that come after me to be healthy to be happy and to never ever
have to experience the loss of a child or a family member or a loved one
because of opiate addiction so I’m very very happy to be here today and I’m very
very happy to share with you that there are options everyone at this table has
taken a huge stand and a huge fight against this epidemic problem and we all
have our flag to wave and we all have a piece and a we all have an investment
here you know and like everyone before me has said this isn’t just my fight
this isn’t just Brittany’s fight this is your fight this is your fight we’ve got
to do this we’ve got to do this we’ve got to save our community and preserve
it for our children and for our grandchildren and I’m just I’m so
grateful to all of the ladies that have spoken before me here today some of whom
I’ve had the the pleasure of working with although they don’t recognize that
because it was always by phone and some of whom I do get to sit in in community
action meetings with and I’m just very very proud that the Northern Nevada is
the community that we are and that we are determined to care for our community well thank you very much do we have any
questions for Danny any questions from anyone please yes we do we write our
primary vehicle is methadone but we actually utilize subutex as well which
is very similar to suboxone it does not have the naloxone in it so if you have
more questions about the specifics of the medications I encourage you to
certainly talk to to Karla but you can absolutely call any of us or you can
call the life-change center you can just google the number we are like I said we
do focus primarily on methadone but our primary focus is a complete bio
psychosocial interview with the patient to determine which medication is the
most appropriate because there are indications that for certain patients
methadone is the more appropriate medication than suboxone or subutex and
vice versa and we really don’t know that until we get in and we do a complete bio
psychosocial history and figure out exactly you know how old you are how
long you’ve been using how you’ve been using are you injecting or smoking what
you’ve been using what your genetic family history is I mean there’s just so
many components to it that it’s really not a black and white answer of suboxone
versus methadone and so I’m really excited to see everybody here kind of
getting this information because there is multiple multiple options out there
and just take the time to figure out which one’s best talk to the
professionals they are happy to help you and you know if we don’t have the answer
for you that’s okay I’ve got an entire I want to say rolodex but it’s on the
computer now it’s a rolodex on the computer I have an entire pie of a
plethora of referrals that I can provide if we aren’t the program for you but you
know walk through the door and ask the question if you know anyone that is
struggling with opiate addiction you can pick up the phone
just make the call perhaps you could discuss very briefly what suboxone is
it’s a very relatively recent phenomenon I’d say within the last two years or so
perhaps three this has become it’s a version of opiates I know that it is a
version of opiate I actually sitting here looking at this panel I don’t know
if I’m I’m the expert on this I can provide it would you like to do okay
okay well I’ll go ahead and give my spiel and I’m and please jump in so
methadone everybody’s heard about methadone methadone it has been around
forever it was primarily used in the beginning it was primarily used as a
pain reliever and in small doses methadone is very very effective for a
pain reliever it is an opiate analgesics so it is a synthetic opiate and it has a
very very long half-life you’ve heard us talking a little bit about half-life
short life short half-life long half-life heroin has a very very short
half-life which is why folks get that euphoria heroin if you if you can
imagine in your mind here kind of a really steep bell curve that’s kind of
how heroin works in your system so it takes you up really high really fast but
it doesn’t last very long and it drops you really really hard really quickly
methadone on the other hand has a very low bell curve to it and the general
half-life for methadone is 24 to 40 hours so it’s going to stay in your
system for 24 to 40 hours to help suppress the cravings for heroin
addiction that is what makes this particular drug so effective is that it
doesn’t give the huge high and it stays in your system for a very very long time
now you know as we heard earlier there are risks you know anytime you use an
opioid analgesic there are risks long-term opioid exposure of any sort
has risk and there is absolutely a risk of overdose on heroin and sometimes it
is that combination of heroin and benzodiazepine or heroin and alcohol we
actually monitored for that very very closely with drug
tests urine analysis we also monitor the PMP so that we can ensure that you know
someone’s not not reporting a benzodiazepine prescription when they
come in and get meth in and by the way methadone is a prescribed and monitored
substance so then we switch over to suboxone which really came out and hit
the hit the conversation somewhere around 2013-14 it really just kind of
went hey here we are we are the Cure and for some that is absolutely true
suboxone is another opioid analgesic it is its brand name alright it’s a generic
it’s buprenorphine is what it is and suboxone you heard us talking about
nalaxone the reversal agent that is in suboxone
so subbox a methadone is a full agonist so it attaches to the opiate receptor
and it just kind of hangs out there suboxone is a partial agonist because of
the knockin the locks on and at the buprenorphine so what it does is it
attaches to the opioid receptor much like methadone does but what also occurs
is that if other opiates are ingested into the system and try to attach the
buprenorphine will kick the opiate off of the receptor so there’s there’s some
things that come into play when you start talking about which drug is most
appropriate for which kind of person and you know there’s there’s some statistics
that would tell us that people that are long-term IV drug users with a
significant history of relapse are probably better suited to be treated
with methadone there are there is other data that tells us that people with a
very short short addiction history who have not reached the point of iv
injection use are better suited for suboxone but one thing that’s important
about suboxone is that there’s a ceiling on it you can reach a point with
suboxone where no matter how much you take it’s not going to
work and that’s why it’s not as effective with people that have
long-term IV drug use because more often and not that tolerance level is above
the ceiling of suboxone and that’s why it’s so important when we have these
conversations that we include all of the different options the suboxone the
subutex subutex is the same thing as suboxone but it doesn’t have that narcan
piece in it or the naloxone piece and it’s important to have the conversation
including methadone because all three of these medications do very very specific
things have very very specific outcomes and are really good options thank you
very much for that right naloxone suboxone and the other word you might
have heard the other medicine you might have heard about is now trekked zone and
we tend to get them like really complain it because they all sort of sound
similar so so methadone and buprenorphine are drugs that are used in
medication assisted treatment buprenorphine can be suboxone if it
hasn’t a lock zone added to it right the reason we have naloxone to the people
nor theme in suboxone is as an abuse deterrent so that people can’t use it in
other ways to try to get high on it so some of these things act as agonists
they turn on a receptor whose worth of like ecology people we’re sure where’s
our biology folks right yep opioid receptors in your brain and some of
these things act as agonists they turn them on and some of these things act as
partial agonist they partially turn them on and some of these things work as
antagonists and block the receptor so when you’re talking about medication
assisted treatment you’re talking about things like methadone buprenorphine
which is the brand name is subutex or suboxone which is the beep of narcan
plus non-op zone treatment if you’re talking about treatment for alcohol
addiction and some other things you might be talking about naltrexone
different or if you’re talking about reversing opioid overdoses you’re
talking about naloxone brand name for no locks on is narcan they all sort of
sounds similar and I don’t know why we did this to ourselves right yeah sure
it’s very confusing trust me vivitrol is now trapped vivitrol brand
name for nail tracks vivitrol is amazing but it has there’s some challenges right
now with vivitrol the first is that it’s really expensive it’s really expensive
vivitrol isn’t is a once a month injection that can be given to folks
with opiate addictions and it it’s naltrexone see I get them all confused
but pardon me it’s the extended release now trucks don’t work so it is super
effective but it’s super expensive and there are I believe the Washoe County
Sheriff’s Department just received funding to begin
I am I correct here a pilot program for injecting opiate addicts pre-release in
my ticket speaking out of school but Northern Nevada hopes does administer a
vivitrol so if anybody is interested in vivitrol and it and the data I went to
in Alchemy’s that’s a manufacturer of a Patrol presentation not too long ago the
data is really good you don’t have to stay on it forever but the idea is to
clear the mind enough so that the person is not thinking about their drug all the
time to help them you know get coping skills etc to to be off the drug so I
think in the alchemy studies they were on the drug maybe I think it’s 3 to 6
months and our Medicaid does pay for it now so it’s um I mean it’s on
formularies right now in our state what are the other important distinctions
between methadone and buprenorphine and one of the changes that happen which is
why we talk about it more methadone is federally regulated and federally
controlled and you have to go to a federally controlled clinic I’m looking
for my cassette people here you burn or Fein can be used in office based
outpatient treatment so physicians who have a DEA license can prescribe
buprenorphine out of their offices and so that was designed to increase
availability and very recently in the past couple of years federal legislation
changed to expand the caps there was a cap on how many patients each doctor
could have and they raised that cap so that doctors can be
anymore and so that gives people more options to go to a methadone clinic or
go to an outpatient office based program did you have a question I saw your hand
in I mean I can tell you that hey I can tell I’m in it absolutely you have a bet
probably a better answer on the legal side of it but it is the number one
reason why women aren’t entering treatment programs that’s the data that
we’ve collected and that’s the data that we’ve collected specifically from the
women in our program as to the timing of their entry to treatment I didn’t come
sooner because I was afraid I was gonna lose my kids
we serve a lot of women that are pregnant you know and opiate use during
pregnancy I mean that we could do a whole nother panel on that right but the
the real fear here is that I’m going to lose my child and we can tell you that
we’ve had a lot of conversations with law enforcement in the community and
these ladies here have done such phenomenal work that the the the
perception by our patients is changing and they’re beginning to enter treatment
sooner now from the legal perspective like I would have to hand that off I
would like to just we have a limited time here and I would like to hear from
anniversary and perhaps some of the other notions will come up that are
circulating year with this nice response we’re getting I just like to say with
the panel you guys have here you guys are extremely lucky and we’re also
extremely lucky to have you guys here listening because what you’re gonna be
able to do is spread this out there and I think that’s one of the hardest things
about substance abuse it’s never talked about and oh hey Jerr about that great
substance abuse story and it’s never that you know what’s it’s – world so I
feel incredibly lucky to be here with this group you have no idea so please if
you guys have questions while I’m talking just raise your hand cuz
information you can get from these experts get it now put it out there to
the community the reason I work at with Danny at the life change Center real
quick about me I was born here in 1971 right there at st. Mary’s this is where
I love and where I’ll always stay the only time I’ve left Nevada on
purpose was when I joined the army and I was stationed at Fort Stewart for ten
years just under ten years and as a combat medic you see a lot of different
things when it comes to prescription drugs alcohol everything so when I came
back to Reno after getting out of the military I wanted to do something for my
community initially I tried massage therapy went to massage therapy school
cuz I wanted to work with vets with PTSD so you can you know go like that and
touch them without them trying to punch you and that’s just the straight-up
facts about it that’s what I wanted to do got in a car accident lady rear-ended
me ruined my wrist I can’t do that anymore so being a medic I wanted to
help my community wanted to help where I was born and heard about the life chain
Center now I’m extremely new to the substance abuse community I’m blown away
by the amount of time and energy that people like Danny and these ladies here
and there’s somebody here put into their community that needs their help whether
they want it or not whether they get rewards or not whether they get
thank-you letters or not these people go out there and I I’ve seen Danny do it
multiple times she’s not getting paid for it but she’s
sitting there stressing about how can I make this class better I got this group
coming up how can I make this class better she could go in there and give a
group sit there and talk to people have a group okay great
check the box she doesn’t these people don’t do that they I’ve seen the way
these people act about this they put a whole entire heart mind and soul into
this and wide days got a really good reason you know she’s lost someone to
addiction I’m sure every single buddy in here knows somebody who’s lost someone
to addiction if you have in yourself I know I have it’s it’s too common for you
not to be touched by this problem so what this community is doing to me makes
me proud someone who is from Nevada lives in Nevada loves Nevada will never
leave and I’m not licensed into any way I’ll just be straight up with you
besides being a combat medic which doesn’t transfer into the civilian world
I work the front desk I see these people every day they come in they talk to me
for about this long but what I do see from them is this since I’ve been there
you can see the change happen in people when they come out of a group but when
something good happens to him when they do get their kid back when they do get
to go up to their family and say hey I’m clean for the last couple days because
of this but I didn’t get this disease because of a needle I turned in and got
a fresh one stuff like that that is what this community needs and like I said I
was born here my mom was born here we need this use these programs and
these people because they want to help you guys help people you know use them I
have a question we’ve been talking about opioid you know the prescription based
opioid abuse what about black tar heroin I you know I’ve heard in the in general
conversations and reading in magazines that that that’s a that’s fairly common
– and there’s a fair distribution of that throughout the the country and so
that if people aren’t taking icky cotton they may be taking black tar
heroin and then of course there’s the Chinese thing with fentanyl which is
very deadly I don’t know if you can address that in short any of you yeah so
depending on where you are in the country different forms of heroin will
be predominant and so here in Nevada we’re close to Mexico the majority of
our heroin comes up from Mexico and that’s why it’s referred to as Mexican
black tar heroin it’s called black tar because it looks like black tar looks
like little tiny chunks of tar we occasionally encounter more of a
powdered heroin that’s brown here on the west coast but the what you might have
heard of is China white heroin like was in pulp fiction is more East Coast we
rarely if ever see that form of heroin here we kind of have the opposite going
on with fentanyl nowadays we have encountered some fentanyl here but if
you hear about what’s going on in the East Coast they’re getting hammered and
people are dying left and right a fentanyl overdose it’s much more common
over on the East Coast a part of that may be because their heroin tends to be
powdered and fentanyl tends to be powdered so it’s easier to mix it’s
difficult to mix something in with black tar heroin so there’s just regional
differences heroin is still heroin it at the end of the day what it does to your
body will be the same but black tar is primarily the form of heroin that we see
here is that there are multiple things going on and it’s a very complicated
relationship between prescription opioids and heroin we’ve seen increases
in prescribing so there’s lots more prescription opioids which leads in some
cases to diversion leads in some cases to addiction and then when we see a
restriction on that prescribing and people can’t get it or it gets too
expensive because all of a sudden it’s $80 a pill right and I’m addicted and I
can’t get into effective treatment then I need something and so I can so some
people switch from prescription opioids to heroin but what we also know is that
we’ve seen changes in trafficking of heroin and the heroin market has change
just such that and my date are a little old so you can print me because I’m sure
you have newer stuff purity has increased quantity has increased
availability has increased so there so there are two things and they’re sort of
operating simultaneously and a little bit differently but we see these
transitions um but we also see we’re seeing dramatic increases in heroin
related deaths we might be seeing a little bit of tapering in terms of
prescription opioid related deaths that we’re seeing big increases in heroin
related deaths and in places where they’re seeing fentanyl fentanyl is so
potent and it’s killing people very very fast so here we know you are seeing this
shift over to the black tar heroin deaths seemingly yeah I mean it’s hard
to say that’s that’s why one of the focuses of this new research project is
to look at is it a linear progression that I use vicodin and then oxycontin
and then heroin and I never go back and forth or what we’re starting to see as
we get early findings is that using both in the same period of time is more
common than we would have thought so it may be that on certain days I get lucky
and I’m able to get some oxycontin pills and I use those and on another day I
can’t get any or they’re too expensive on the street so I use heroin because
like I said either one will prevent withdrawal for the other so it’s hard to
say and then nationally they’ve been looking at that – some studies have have
suggested that it may not be the increase in heroin use may not be
because we’re cracking down on prescription drug use but it may just be
the natural progression of addiction that you know eventually this drug isn’t
isn’t doing it for me anymore and I need something else so they maybe go – yeah I
mean heroin is it’s very effective so thank you sir I have a question I got a
preface my question is it’s not rooted in callousness or ignorance because my
wife was a cop for ten years and my father is a substance abuse counselor my
father or some of my siblings are addicts my question is this aren’t
programs and legislation and all these things just attempting to fix symptoms
and not cures because we have programs for people who are already addicted and
recovery programs for people who are already addicted but the addiction is
stemming from something else now that’s a big question whatever it’s something
else is there like how how do you deal with instead of just the symptoms can I
respond see that’s why I represent prevention
here because a coalition and say CTO and and realistically when you look at
prevention dollars like in our state eighty percent of the dollars for the
block rat goes to treatment I get it but 20 percent goes to the prevention
piece so if we put more effort on the prevention and to begin with and we do
as a coalition and other coalition’s do the same thing we fund evidence-based
programs in the schools with families you know around the community they’re so
limited though we have such few dollars and I agree the federal government needs
to look at that too when they’re looking at at all of these programs if you start
in the beginning and you make sure that kids have coping skills and they know
how to make good not just good choices but you know behaviorally that’s that’s
where I come in on the prevention piece so I mean other there might be other
answers here but I I really feel passionately about prevention to begin
with right so we do what we do a lot of things yeah we have we have teenagers we
have a youth program where we have 11 youth and they they pair up and they go
out and they talk to younger youth about drugs right now they’re focusing on
marijuana prescription drugs and alcohol and they have lessons or evidence-based
lessons but we also have individual different programs in the schools we
have a parenting wisely where we talk with parents of young kids see
help them before the kids you know progress in anything and we have
specific programs and we work with the children’s cabinet Boys and Girls Club
Big Brothers Big Sisters except quest so we work with a lot of agencies reducing
drug diversion controlling pills in a home drug take-back days checking the
prescription drug monitoring program and working with prescribers around opioid
stewardship and alternate considering alternative pain medication regimen
that’s Alperin that’s prevention a lot of this stuff that people have talked
about today is prevention and then you have the clinical aspect of
it that kind of comes in at the tail end of this and.and you’re right you know
the drug use itself is is just a symptom of a much deeper much lower seeded issue
and so we spend a lot of time using cognitive behavioral therapies
existential therapies different person-centered therapies we use an
integrated therapy approach to get to what the root of the problem is because
you’ve got to change the thinking you’ve got to change the thinking if you change
the way you think about the drug if you change the way you think about what the
drug does for you the behavior is gonna follow but we’ve got to get you stable
you know we’ve got to provide we’ve got to get prevention out there telling our
kids that they don’t have to use you know and we’ve got to have the people
that are doing the research to figure out what is the best approach we’ve got
to have every single person that’s sitting up at this table today we’ve got
to have law enforcement at the table we’ve got to have social services at the
table and we’ve got to have you guys at the table it seems like what he was
saying also is it’s an ongoing battle I mean people like to get high and they
will experiment with it and it will escalate and they will find it like you
said were close to a border and so it’s an ongoing battle and there perhaps are
not enough resources but there’s also favorable laws and norms
so if youth like in our community when we did our focus groups unfortunately
there were a lot of risk factors for our youth not a lot of protective factors we
live in a community that’s 24 hours everything is going 24 hours
is access to drugs and alcohol all the time and never stops being sold we have
issues in our state that are different than other states and that’s I mean
that’s something that we have to look at as a community and we’ve just legalized
another drug marijuana so our kids already right now 50% of them only 50
I’m sorry 50 a little more than 50% feel like it’s they perceive harm for using
an illegal drug marijuana okay in the analyzed data now it’s legalized we have
one in four teenagers who say they’re using it right now
so until we have some sort of perception of risk or that there is going to be
maybe something that happens to you use alcohol or one or whatever it is when we
talk about addictive drugs kids have to perceive that there is something
first of all else for them so like other options and maybe if you use this option
alcohol marijuana whatever it is it doesn’t it doesn’t mean that that’s the
only drug you’re ever going to use in your life okay go lead on to something
else but they have to understand they have other options in our community I’m
just telling you they don’t always perceive that there are other options if
that made sense Sharon could you speak up what of it could you speak up my feeling is that the media and
Hollywood that we starting in their 50 glamorize the use of recreational use of
drugs and that we need to really start thinking about
message done substantial research in opiate use on the Comstock among
prostitutes so as you say what or just general usage thank you they’re really chose agender they’re not
that different than they are now the only thing that’s different is that
portrayal of drug addictions very different as far as just think somehow
we could change that tone trying to use that dialogue to some extent yes I was doing orientations and the
concept came up about heroin epidemic and I had in one class and then another
class a week later to substance abuse counselors they told me that to buy
heroin on the street I would say I know that there is a
predominant philosophy to be honest I mean people initiate substance use for
any number of reasons they’re as unique as the person heroin is very cheap those
prices are about right drugs do tend to have a quantity discount associated with
them just like Costco so if you were to buy a pound of heroin you’ll pay less
per two tenths of a gram which is what’s considered one dose so it’s a
combination of factors I guess would be my answer to that question it depends on the substance for opioids
I don’t know off the top of my head right hard to get that one oh please
please if she’s pregnant I would tell her pregnant women are given priority in
entering treatment so because it’s such a need and there’s such a great risk as
far as kids I don’t know that I could say whether the children are
automatically taken away I know the overarching goal of Social Services is
reunification of the family whenever possible I have a friend who just
entered treatment and has a small child and he you know he still is able to see
his kid so I don’t know that I could say if there’s a blanket right that would
help your case I would think yeah right yeah I mean there’s that’s what I was
thinking there’s also a risk of having your children removed for being in a
drug-using environment cuz that’s a great risk for the kids so so I don’t
know for pregnancy I would say yeah for sure let them know that they have
priority and receiving treatment and then I don’t know that I could say
what’s what’s the common stance from social services standpoint so that’s
kind of their call rather than law enforcement doesn’t doesn’t make those
calls in step two does take women with children you know that probably right there’s if we’re talking specifically
about opiate addiction there’s some risks with a mother that’s using opiates
while pregnant the last thing that we want to do is put a mother who is using
opiates while pregnancy into withdrawal because that does increase the risk for
miscarriage so this is where some of that understanding between suboxone and
methadone come in methadone is is an opiate agonist that you don’t have to go
into withdrawal to start the treatment which is why we typically we are one of
the agencies that does offer priority service to women who are pregnant but we
offer primarily methadone for this because we can’t send a woman into
withdrawal what we have done is we’ve fostered very good relationships with
some of the Obie’s in town as well as we continually try to educate the hospitals
and what we find is that you know kids that are born addicted to methadone you
know may or may not there’s no there’s no checkbox that you can answer that
question of whether or not CPS is going to be involved what I can tell you is
that the sooner they get into treatment and they stop testing positive for
illicit substances the better their chances are at reunification faster if
not complete unification from the beginning but it’s so it’s a
coordination effort you know you got to coordinate with your doctors you’ve got
to coordinate with the treatment providers and you’ve got to encourage
these women to talk to both be open with the treat the the OB because if the baby
test positive for methadone at birth now we’ve gotten if another issue okay what
our time is up thank you so much for for coming in if there’s any last questions
here before they leave do you have any No then it’s for up there for thank you
very much

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