Department of Behavioral Health Team Meeting February 10, 2016

Department of Behavioral Health Team Meeting February 10, 2016

Response to Opioids in the District One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Objectives Develop a better understanding of opioids and potential risks Learn about what the Department of Behavioral Health is doing in response to the opioid issue Discover available supports: Prevention Treatment - Crisis Intervention Recovery

One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Department of Behavioral Health Mission The Mission of the Department of Behavioral Health (DBH) is to support prevention, resiliency and recovery for District residents in need of public mental health services. One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health 3 Department of Behavioral Health

Vision The District of Columbia is a thriving community where prevention is possible and recovery from mental health and substance use disorders is the expectation. One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health 4 Prescription Opioids A number of opioids are prescribed by doctors to relieve pain. These include hydrocodone, oxycodone, morphine, and codeine. While many people benefit from using these medications to manage pain, prescription drugs are frequently diverted for improper use. In the 2013 and 2014.

National Survey on Drug Use and Health (NSDUH), 50.5% of people who misused prescription painkillers got them from a friend or relative for free, and 22.1% got them from a doctor. As people use opioids repeatedly, their tolerance increases and they may not be able to maintain the source for the drugs. This can cause them to turn to the black market for these drugs and even switch from prescription drugs to cheaper and more risky substitutes like heroin. One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Prescription Opioids Continued According to the National Survey on Drug Use and Health (NSDUH) 2014 (PDF | 3.4 MB): 4.3 million Americans engaged in non-medical use of prescription painkillers in the last month.

Approximately 1.9 million Americans met criteria for prescription painkillers use disorder based on their use of prescription painkillers in the past year. 1.4 million people used prescription painkillers non-medically for the first time in the past year. The average age for prescription painkiller first-time use was 21.2 in the past year. One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health

List of Prescription Opioids Codeine (only available in generic form) Buprenorphine Fentanyl (Actiq, Duragesic, Fentora) Hydrocodone (Hysingla ER, Zohydro ER)

Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin) Hydromorphone (Dilaudid, Exalgo) Morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR) Oxycodone (OxyContin, Oxecta, Roxicodone)

Oxycodone and acetaminophen (Percocet, Endocet, Roxicet) Oxycodone and naloxone (Targiniq ER) Opioid (Narcotic) Pain Medications Pentazocine

Levorphanol Meperidine (Demerol) Methadone (Dolophine, Propoxyphene

Methadose) Tapentadol Tramadol One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Taking it to Scale One Agency. One Mission. One Voice.

District of Columbia Department of Behavioral Health Illicit Opioids Fentanyl (can also be Rx) Fentanyl analogs Heroin Illicit synthetic opioids One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Opioids Continued How to recognize opioid use/abuse : A thorough pain assessment is vital to the initial evaluation of a patient and must be performed to guide treatment decisions.

Dosing may be done incrementally and titrated to analgesic effect. Particularly in those without prior analgesic use, effects are variable and overdosing in these patients can result in adverse events. Individualize doses based on risk for adverse outcomes, prior effective doses, comorbidities, concomitant medications, and response to therapy. One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Opioids Continued Immediate-release opioids are recommended for breakthrough pain.

When possible, use the same class of opioid analgesic for long-acting (ie, 24-hour scheduled doses) and short-acting (ie, PRN doses for breakthrough pain) pain relief One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health . HEROIN Heroin is a powerful opiate drug. Heroin looks like a white or brownish powder, or as the black sticky substance known on the streets as black tar heroin. It is diluted with other drugs or with sugar, starch, powdered milk, or quinine before injecting, smoking, or snorting. Some of the physical symptoms of heroin are euphoria, drowsiness, respiratory depression, constricted pupils, nausea, and dry mouth. A heroin overdose causes slow and shallow breathing, blue lips and fingernails, clammy skin, convulsions, coma, and can be fatal.

Many young people who inject heroin report misuse of prescription opioids before starting to use heroin. In addition to increasing the risk of overdose, the intravenous use of heroin places individuals at higher risk of diseases like HIV and hepatitis C. According to SAMHSAs 2014 NSDUH (PDF | 3.4 MB): 4.8 million people have used heroin at some point in their lives. Among people between the ages of 12 and 49, the average age of first use was 28. 212,000 people aged 12 or older used heroin for the first time within the past 12 months. Approximately 435,000 people were regular (past-month) users of heroin. For more information about the treatment of opioid use disorders, visit the topics Behavioral Health Treatments and Services, Mental and Substance Use Disorders, and Prescription Drug Misuse and Abuse One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health

In The Event of an OVERDOSE Naloxone - is a medication approved by the Food and Drug Administration (FDA) to prevent overdose by opioids such as heroin, morphine, and oxycodone. It blocks opioid receptor sites, reversing the toxic effects of the overdose. Naloxone is administered when a patient is showing signs of opioid overdose. The medication can be given by intranasal spray, intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection. Good Samaritan Law (a) Any person who in good faith renders emergency medical care or assistance to an injured person at the scene of an accident or other emergency in the District of Columbia outside of a hospital, without the expectation of receiving or intending to seek compensation from such injured person for such service, shall not be liable in civil damages for any act or omission, not constituting gross negligence, in the course of rendering such care or assistance. (1) Good faith under subsection (a) of this section does not include the seeking of health care as a result of using drugs or alcohol in connection with the execution of an arrest warrant or search warrant or a lawful arrest or search.

(3) Overdose means an acute condition of physical illness, coma, mania, hysteria, seizure, cardiac arrest, cessation of breathing, or death, which is or reasonably appears to be the result of consumption or use of drugs or alcohol and relates to an adverse reaction to or the quantity ingested of the drugs or alcohol, or to a substance with which the drugs or alcohol was combined. One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Campaigns Adult Ages 30-60; Harm/Risk Reduction From January 1, 2014 to November 30, 2016, the D.C. Office of the Chief Medical Examiner investigated a total of 3,952 deaths due to use of opioids including 83 deaths in 2014, 114 in 2015 and 198 deaths in 2016, respectively.

83% of overdoses were African American and 51 was the average age for an overdose. Youth Ages 12-17, Young adults ages 18-25 891,000 youth between the ages 12 and 17 misused opioids and 239,000 misused pain relievers according to the 2016 National Survey on Drug Use and Health. Tackle the common misperceptions that 1) prescription drugs are safer than other drugs, 2) use of opioids and prescriptions are not as glamorous as some media has made them seem Educates teens and parents about the risks of physical and mental harm, One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Times Have Changed One Agency. One Mission. One Voice.

District of Columbia Department of Behavioral Health More Harmful Than You Think One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health More Harmful Than You Think One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Treatment Services Assessment and referrals for appropriate levels of care and maintenance of a comprehensive continuum of substance

abuse treatment services including: Outpatient Intensive outpatient Residential Detoxification Stabilization Medication Assisted Therapy (MAT) One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health Treatment Service Access DBH Access Helpline 1 (888) 7WE-HELP Individuals up to the age of 21 can visit an ASTEP provider for assistance Individuals 21 and over can visit the ARC

One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health ASTEP Providers Adolescent Substance Abuse Treatment Expansion Program (ASTEP) Federal City Recovery Services Address: 316 F Street NE, Suite 118, Washington, DC 20002 Phone Number: (202) 710-1850 Hours: Mon to Fri, 9:00 AM 5:00 PM Hillcrest Children and Family Center Address: 915 Rhode Island Avenue NW, Washington, DC 20001 Phone Number: (202) 232-6100 Hours: Mon and Fri, 8:30 AM 6:00 PM Tues, Wed, and Thurs, 8:30 AM 8:00 PM

Latin American Youth Center Address: 1419 Columbia Road NW, Washington, DC 20009 Phone Number: (202) 319-2225 Contact: Roco Rosa, Admissions Coordinator, (202) 319-2257 Hours: 9:00 AM 7:00 PM Riverside Treatment Center Address: 2041 MLK Jr. Avenue SE, Suite 301, Washington, DC 20020 Phone Number: (202) 889-3182 Hours: Mon to Fri, 4:30 PM 8:00 PM One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health

Assessment and Referral Center (ARC) Assessment and referral is available to District residents ages 21 and older The ARC is a walk-in clinic with no appointment necessary between the hours of 7am 6pm Monday thru Friday Clients are required to show valid identification to receive services (required under Title 29 Chap. 24 of DCMR) Accessible by Metrorail One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health ARC Assessment Process Every client is assessed by a nurse The Nursing Assessment is designed to identify clients

with urgent needs: Substance Intoxication Substance withdrawal Acute psychiatric symptoms Medical issues requiring immediate attention One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health ARC Referral Process If there are no issues requiring immediate attention, the client will be seen by a counselor. An assessment is completed to determine the level of care most appropriate for the clients needs. The level of care is determined by using the Patient Placement Criteria published by the American Society of Addiction Medicine (ASAM).

Once level of care has been determined, the client is offered a choice of treatment providers within that level of care. One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health ARC Referral Process The ARC staff works to ensure that all clients have a placement before leaving the facility. If a client is recommended to residential treatment or inpatient detoxification, transportation is available to the facility. Clients recommended for residential treatment, the ARC staff works to ensure the client goes directly to the facility to avoid the client from slipping through the cracks. One Agency. One Mission. One Voice.

District of Columbia Department of Behavioral Health Recovery Support Recovery support services include wrap-around services, such as mentoring services, education skills building and job readiness training, to ensure a full continuum of care. DBH ensures the quality of these services through its regulation and certification authority as the Single State Authority for substance abuse treatment services. One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health How to Reach Us DBH Substance Use Disorder Services 64 New York Avenue, NE, Washington, DC 20002

(202) 727-8857 www.dmh.dc.gov Assessment and Referral Center (ARC) 75 P. Street, NE, Washington, DC 20002 (202) 727-8473 7:00am 6:00pm Walk-in (no appointment needed) Access HelpLine 1(888)7WE-HELP or 1-888-793-4357 One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health QUESTIONS & ANSWERS One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health

CONTACT INFORMATION Michael Pryor Department of Behavioral Health Substance Use Disorders, Prevention Division (202) 727-2541 michael.pryor @dc.gov One Agency. One Mission. One Voice. District of Columbia Department of Behavioral Health

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