ONE YEAR LATER: Vertava Health Asks, “Where Are They Now?”
An Update on the Progress in New England
(June 23, 2016) – Over a year ago, Vertava Health took to the streets to bring you the most up-to-the-minute, detailed accounts of our nation’s drug epidemic state by state. We spoke with the nation’s top leaders in addiction, recovery, law enforcement and state government to keep readers informed on each state’s progress in battling an epidemic that is killing 100 people a day in the United States. This week we checked in with six states in the Northeast to give you a progress report on the efforts they were initiating and enforcing when we spoke to them last.
We first talked to officials in Maine last year after the state passed a $3.7 million addiction bill. Governor Paul LePage wasted no time signing the unanimously passed legislation from the House and Senate in response the state’s growing number of overdoses and lack of treatment options, and we were thankful for that. However, Governor LePage’s recent comments regarding the opioid crisis have drawn much criticism. In a letter to the Legislature, Gov. LePage detailed his reasoning for vetoing a bill aimed at increasing access to the drug Naloxone in the state. Naloxone, a known antidote for opiate overdose, is being widely distributed by nonprofit groups, and Bill LD1547 would allow people to access it from state pharmacies without a prescription. In his letter, Governor LePage stated “Naloxone does not truly save lives, it merely extends them until the next overdose.” Aside from the debatably blunt statement, the Governor is both right and wrong. Naloxone absolutely must be coupled with treatment to prevent a cycle of overdose and revival. However, no one can be treated if they’re dead. While Vertava Health doesn’t advocate for any drug, this is one that has been proven to save lives, which is why we are working with groups to carry those addicted to opiates to the next level of a full and balanced life: through treatment. The Governor also advocated in his letter for ramping up interdiction efforts against those bringing drugs into the state, expanding education and prevention efforts and addressing opioid prescribing practices. Just recently, Governor LePage participated in the 5th Annual International Conference on Opioids at the Joseph B. Martin Conference Center at Harvard Medical School. LePage joined a Governor’s Panel featuring 6 New England governors who spoke about opioid use and actions taken by their administrations to address drug use, overdose and deaths. “The New England governors are taking this issue very seriously, and our goal is to identify ways we can work together to fight this crippling pandemic we are all facing,” said Governor LePage. “We are making progress in Maine, and as far as over prescribing, doctors are cooperating, which is the first step. Second, is to ensure we keep the illicit drug off the streets. Maine is a leader in this crisis, and by sharing information with each other we can improve many – and in some cases – save lives.” Also in attendance were Governor Baker (Massachusetts), Governor Shumlin (Vermont), Governor Raimondo (Rhode Island), Governor Hassan (New Hampshire) and Governor Malloy (Connecticut). Maine enacted a bill to prevent opioid addiction and help close the gateway to heroin use by limiting the strength and duration of opioid prescriptions while requiring prescribers to participate in the PMP (Prescription Monitoring Program), undergo addiction training and submit opioid scripts electronically. LePage signed the bill we wrote about last year to fund the uninsured and expanded access to detox facilities in the state. That $3.5 million was on top of the $72 million Maine spent on addiction treatment for the uninsured in 2015. Facing a shortage of state police and other state law enforcement personnel due to the recruitment and retention problems, Governor LePage proposed and the legislature enacted bills to increase the number of MDEA agents by 10 and to increase salaries for law enforcement officers by up to 18%. In 2014, more than 80 million opioid pills were prescribed to nearly 350,000 people in Maine. That’s ⅓ of the adult population taking a pill a day for 8 months. In MaineCare, the state cut opioid prescriptions in half in the past few years by setting limits on script sizes and encouraging alternative pain management techniques such as chiropractic procedures and physical therapy.
When we last wrote about New Hampshire, there was such a lack of treatment beds for addiction that they were only able to actually treat 4-6% of the population within the state. In the last year, all regions in the state have been busy working on 2 big priorities – identifying assets and gaps in their mental health and substance use prevention, intervention, treatment and recovery resources and participating in the state’s Community Narcan Education and Distribution Initiative. “In the coming year we hope to begin addressing those gaps and reinforcing those assets that we know are most protective,” says Seacoast Public Health Network Continuum of Care Facilitator Dr. Tory Jennison, PhD, RN. “In the Seacoast Public Health region we’ve distributed over 400 doses of Narcan at community education events and I’m aware of at least 4 situations where a life was saved using one of our community distributed kits.” Seacoast is also focused on promoting provider and consumer education in their region – specifically Project Zero, an initiative started by Jim Moser, a local parent and healthcare provider who lost his son to overdose. Project Zero aims to reduce the amount of leftover narcotics patients have after treatment by encouraging patient specific prescribing and encouraging the safe disposal of unused narcotics. “We are partnering with Him to expand training and education to prescribing providers and provide education and resources for them to talk with their patients about safe disposal,” says Dr. Jennison. “We have already seen some practice change within a hospital system.” Providers are writing prescriptions for fewer opioid pills as a standard procedure, instead of encouraging patients to consider alternate pain relief options. The largest increase in heroin treatment admissions in the past year was from March-May 2016 with a 34% increase. The largest decrease was from November-December 2015 with a 14.3% decrease in heroin treatment admissions. From 2012-2015 there was a 203.7% increase in the number of incidents involving Narcan administration. May 2015 compared to May 2016, there was a 3% increase. From 2013-2015, there was a 128.6% increase in the number of all drug deaths. From 2013-2015, there was a 1472% increase in the number of Fentanyl related deaths. From 2013-2015 there was a 25.7% increase in the number of heroin related deaths.
When we last explored Vermont, the state had just launched a 3-prong attack on deadly laced drugs. Batches of Fentanyl-laced heroin were responsible for at least 2 of 3 recent overdoses near the small town of Randolph, one of them being fatal. Just this week, Governor Peter Shumlin and Health Commissioner Harry Chen, MD announced that BAART Behavioral Health Services will open a new medication-assisted treatment center – or Hub – in the St. Albans area, expanding the Care Alliance for Opioid Addiction’s Hub and Spoke system of care. “Thanks to the great work of the Howard Center/Chittenden Clinic and partners, we’ve greatly expanded access to treatment and reduced the wait list in Chittenden County, but there’s a clear need for more capacity in the northwest corner of the state,” said Gov. Shumlin. “Six months ago, about 250 residents from Franklin or Grand Isle counties were having to travel to other areas of the state for help, or were on wait lists. This new facility will serve Vermonters in need, when they need it and where they need it.” Since January 2014, the total number of people served by Hubs has nearly doubled, now serving more than 3,000 patients, with fewer than 400 on the waitlist statewide.
When we last gave you a peek inside Massachusetts, the state had over 2000 new cases of Hepatitis C in people under 30, and officials blamed the state’s heroin crisis. They warned we were on the verge of an HIV outbreak that mirrored the one 30 years ago. Since last year, not only has the Governor’s working group identified key areas in the state affected by the epidemic and put programs in place, but law enforcement agencies have saved a countless number of lives. Vertava Health partnered with the Gloucester Police Department’s Angel Initiative last year, which encourages police departments to act as a safe haven for those battling addiction. Instead of arresting someone, they help them go straight into treatment. It’s a policy that has been proven to work hundreds and hundreds of times over. Earlier this month Governor Charlie Baker and Attorney General Maura Healey unveiled a new public information campaign to encourage people to call 911 for emergency medical services at the first signs of a drug overdose. Along with Health and Human Services Secretary Marylou Sudders, Department of Public Health Commissioner Monica Bharel and members of the law enforcement community, state officials launched the $250,000 “Make the Right Call” campaign to promote the Massachusetts 9-1-1 Good Samaritan Law. This law provides protection to individuals seeking medical assistance for themselves or someone else experiencing a drug-related overdose, including opioid-related overdoses, without the risk of charges of possession of a controlled substance. “With nearly four people dying per day from opioid-related overdoses, our administration is pleased to introduce another campaign to raise awareness and help more people get access to the treatment and services they need,” said Governor Baker. “I am pleased to stand with the Attorney General and members of the law enforcement community to unveil the Make the Right Call campaign as another tool aimed at curbing this horrific public health crisis from our communities.” The goal of the new campaign is to save lives by increasing the use of 9-1-1 in overdose situations. Make the Right Call targets active users of opioids and their friends and families with a simple message that they shouldn’t be afraid to seek help when they see an overdose. The campaign includes billboards, and advertisements on street furniture and other public environments where overdoses can take place. Viewers are directed to the website for more information on what to say when calling 9-1-1, what to do while waiting for help to arrive, and where they can access the overdose reversal tool Naloxone, more commonly called Narcan. The use of naloxone has risen quickly over the past three years. In 2015, there were over 9000 incidents during which emergency responders utilized naloxone; up from 5443 in 2013. “The Good Samaritan law removes a key barrier that prevents people from seeking help in an overdose emergency,” said Attorney General Maura Healey. “No one should die because a friend or stranger is too afraid to call 9-1-1. Our goal is to educate people about this law because nothing is more important than saving a life. We will continue to partner with law enforcement and the Administration to make sure this important message is heard.” Additionally, the Department of Public Health and the Attorney General’s Office have partnered to produce a “Roll Call video” which explains the importance of the 9-1-1 Good Samaritan Law to members of the law enforcement community, who play such a key role in responding to overdose situations and saving lives. The 5-minute video features public safety officials who have seen the positive impact of the Massachusetts 9-1-1 Good Samaritan Law, and also includes the compelling testimony of one Massachusetts resident whose life was saved because of a 9-1-1 call – and who is now in long-term recovery. The Roll Call Video will be shared with public safety partners in every police department in Massachusetts. “Opioid use is a medical disease, and an epidemic,” said Health and Human Services Secretary Marylou Sudders. “As such, we must treat it like an illness with prevention, intervention, treatment and recovery options for everyone. The Good Samaritan law plays a critical role in allowing people to treat an overdose as they would another sudden medical illness – by calling for medical help when it is needed most.” Make the Right Call also includes a grass-roots component to spread the word. Posters which feature the campaign messaging can be ordered at no charge by municipal agencies, community organizations, churches, businesses and others by visiting the Massachusetts Health Promotion Clearinghouse. “The opioid epidemic continues to impact families, friends and neighbors in every corner of Massachusetts,” said Department of Public Health Commissioner Dr. Monica Bharel. “We must continue to do everything in our power to save lives, and stem the rate of opioid deaths.” Campaign advertising will run through the end of June. More information about Make the Right Call can be found at the Make the Right Call website. In addition to the strides made by Governor Baker, the Attorney General and the Department of Health and Human Services, Vertava Health has announced a 500-acre, 12 building campus in Cummington, Massachusetts.
When we looked in on the state of Rhode Island a year ago, the state had made headlines for 22 overdose deaths in less than 2 weeks. The powerful drug Fentanyl was present in 13 of those deaths. Since then, Governor Raimondo has included $4 million in her proposed budget this year to support medication-assisted treatment at the Department of Corrections, and to expand access to peer recovery services. A number of other important bills have been proposed, including bills to support comprehensive hospital discharge planning for patients treated with substance use disorders, and to expand the use of the Prescription Drug Monitoring Program. This past Saturday, 8 bills were sent to Governor Raimondo’s desk for her signature after a 10 month collaboration between state health officials, prescribers, insurers, health advocates and family members of overdose victims. For the first time, physicians and health advocates are supporting legislation in the state to limit initial prescriptions such as Vicodin and Oxycontin. About 30,000 people (3.4% of the population) were dependent on or used illicit drugs in the past year. Of the small percentage that actually sought out help for addiction, less than 50% actually received help.
In Connecticut, we checked in with a Doctor at Yale who conducted a study on the importance of medically-assisted treatment, and found it was very effective in the state. Since then lawmakers have been determined to find ways to limit access to prescription painkillers and increase naloxone availability. Now, there’s a new legislative push to expand access to treatment and end the stigma and shame associated with addiction. A new bill just signed into law and praised by the Association of Addiction Specialists enables a treatment process where primary care physicians can tap into a network of counselors and help develop treatment plans. It would increase accessibility and communication between the client’s medical care giver and their therapists. The bill treats addiction like a chronic medical condition. It couldn’t come at a better time. Last year in the state, about 206,000 people (6.8% of the population) were dependent on or used alcohol.