the opioid addiction crisis in the northern shenandoah valleyby the crisis of heroin and opiate...

The Opioid Addiction Crisis in the

Northern Shenandoah ValleyA Community Response

1

Objectives

2

• Overview of the Problem• Formation of the Northern Shenandoah Valley Substance Abuse

Coalition• Roles of key system representatives, community mental health

organizations, and outpatient treatment centers• Suggestions for sustainability

The Story We Want to Share

3

The Northern Shenandoah Valley Substance Abuse Coalition• A dynamic, multi-disciplinary collaboration of law enforcement

(prosecution and defense resources alike), health, child welfare, family courts, county and city leadership, and community members impacted by the crisis of heroin and opiate addiction

• Has brought together a diverse set of local, community partners that work collaboratively across disciplines to respond to a public health crisis in the Valley contributing time, talent and treasure

Our Community’s Reality

4

“We cannot arrest our way

out of this problem.”

5

175.0%

87.5%

39.3% 42.8%

0.0%

50.0%

100.0%

150.0%

200.0%

Clarke, Frederick,& Winchester

Loudoun Fairfax(County & City)

State of Virginia

% Change inHeroin and/or Opioid Deaths

2010-2013

3.7%

12.0%

3.3% 3.2%

0.0%

3.0%

6.0%

9.0%

12.0%

15.0%


Loudoun Fairfax(County & City)

State of Virginia

% Change in Population2010-2013

6

Copied Info

YearHeroinHeroin and Prescription OpioidOpioid UnspecifiedPrescription OpioidTOTAL DEATHS

CHARLOTTESVILLE CITY20071--12

2008---22

20091--12

2010---3343435

2012---11

20132--1344349

2014---33

TOTAL4001216

CLARKE COUNTY2007---11

20111---114,023

2012-1--114,348

TOTAL11013

FAIRFAX CITY20072---2

2008---22

2009---22

2010---11

2012-1-23

20131---1

2014---22

TOTAL310913

FAIRFAX COUNTY2007101-3142

2008111-1729

200992-1728

20102--25271,081,7260.0025%

20117212535

201291-2838

201361-31381,116,8970.0034%

201476-1831

TOTAL61141192268

FREDERICK COUNTY200711-35

20084--59

200941-38

2010-1-5678,3050.008%

20114--610

20121--12

201353-91781,3190.021%

201441-813

TOTAL23704070

HARRISONBURG2007---22

2008---11

2009---22

2010---33

20111--12

2012---11

20132--24

2014---22

TOTAL3001417

LOUDOUN COUNTY2007---99

2008---66

2009---66

2010---88

20112--810

201211-68

2013421815

201441-712

TOTAL11415874

PAGE COUNTY2007---33

2008---11

2009---33

2010---11

2011---77

2012---22

20132-114

20141--23

TOTAL3012024

ROCKINGHAM COUNTY2007---22

2008---11

2009---33

2010---11

2011---55

2012---22

2013---11

TOTAL0001515

SHENANDOAH COUNTY2007---11

2008---44

20091--12

2010---33

2011---44

20122--57

20131--34

20141---1

TOTAL5002126

WARREN COUNTY2007---22

2008---22

2009---44

20101--78

20111--56

2012---77

20132--35

201411-35

TOTAL5103339

WINCHESTER CITY2008---22

20092--35

2010---22

20111--45

20123--36

20132--35

20141--12

TOTAL9001827

OUT OF STATE2007---55

20081--34

2009---22

2010--145

2011--11011

20121--56

2013--145

20141-124

TOTAL3043542

UNKNOWN20073---3

20082--24

20091--12

20101--12

20111---1

20122--13

2013---11

TOTAL1000616

TOTAL20079288381489

20088453417509

20099987390504

201043554104638,260,4050.0056%

201190105477582

2012122135401541

201317736164326618,001,0310.0083%

2014772810226341

TOTAL7841135931344090

Calculcations


CLARKE COUNTY2010014,023

20111---1

2012-1--1

2013014,348

2014020108118,5310.0000670.07

TOTAL11013201322122,8830.0001790.18

FREDERICK COUNTY2010-1-5678,305144352

20114--610175%4%

20121--12

201353-91781,319

201441-813

TOTAL23704070


20111--45

20123--36

20132--3527216

20141--12

TOTAL9001827

SHENANDOAH COUNTY2010---334199320103419930.0000710.0714404782

2011---4420134426840.0000940.0937119295

20122--571691

20131--344268433%2%

20141---1

TOTAL5002126

WARREN COUNTY20101--783757520108375750.00021290750.2129075183

20111--5620135386990.00012920230.129202305

2012---77-31124

20132--3538699-38%3%

201411-35

TOTAL5103339

LOUDOUN COUNTY2010---88312337201083123370.0000260.03

20112--8102013153496790.0000430.04

201211-68737342

201342181534967988%12%

201441-712

TOTAL11415874



2012-1-232010281,104,2680.0000250.025

20131---1239732013391,140,8700.0000340.034

2014---221136,602

TOTAL31091339%3%

FAIRFAX COUNTY20102--25271,081,726

20117212535

201291-2838

201361-31381,116,897

201476-1831

TOTAL61141192268


20081--34

2009---22

2010--145

2011--11011

20121--56

2013--145

20141-124

TOTAL3043542

UNKNOWN20073---3

20082--24

20091--12

20101--12

20111---1

20122--13

2013---11

TOTAL1000616

TOTAL201043554104638,001,031201046380010310.00005790.0578675423

20119010547758220136618,260,4050.00008000.0800202896

2012122135401541198259374

201317736164326618,260,40543%3%

2014772810226341

TOTAL7841135931344090


2008---22

20091--12

2010---33434352010343,4350.000070.07

2012---112013344,3490.000070.07

20132--13443490

2014---330.0%

TOTAL4001216


20111--12

2012---1120107100,3010.0000700.07

20132--245139520132154,0500.0000130.01

2014---22-553749

TOTAL3001417-71%54%


2011---55

2012---22

2013---1177741

TOTAL0001515

C-%Change in deaths

% Change inHeroin and/or Opioid Deaths2010-2013

% Change

Clarke, Frederick,& WinchesterLoudounFairfax(County & City)State of Virginia1.750.8750.392857142857142850.42764578833693306

C-%Change in Population


% Change

Clarke, Frederick,& WinchesterLoudounFairfax(County & City)State of Virginia3.6716133332208453E-20.119556760806436643.3145939210409064E-23.2417572185384609E-2

Data for Chart

Deaths Due to Heroin and/or Opioids

DeathsPopulationPer 10,000

Clarke, Frederick, & Winchester20108118,5310.67493

201322122,8831.79032

% Change175.0%3.7%165.3%


Shenandoah & Warren20101179,5681.38247

2013982,3831.09246

% Change-18.2%3.5%-21.0%


Loudoun20108312,3370.25613

201315349,6790.42896

% Change87.5%12.0%67.5%


Fairfax(County & City)2010281,104,2680.25356

2013391,140,8700.34184

% Change39.3%3.3%34.8%


State of Virginia20104638,001,0310.57868

20136618,260,4050.80020

% Change42.8%3.2%38.3%

20101.7%1.5%

20133.3%1.5%

% Change92.6%0.4%


Loudoun

Fairfax(County & City)

State of Virginia

Copied Info



2008---22

20091--12

2010---3343435

2012---11

20132--1344349

2014---33

TOTAL4001216

CLARKE COUNTY2007---11

20111---114,023

2012-1--114,348

TOTAL11013


2008---22

2009---22

2010---11

2012-1-23

20131---1

2014---22

TOTAL310913

FAIRFAX COUNTY2007101-3142

2008111-1729

200992-1728

20102--25271,081,7260.0025%

20117212535

201291-2838

201361-31381,116,8970.0034%

201476-1831

TOTAL61141192268

FREDERICK COUNTY200711-35

20084--59

200941-38

2010-1-5678,3050.008%

20114--610

20121--12

201353-91781,3190.021%

201441-813

TOTAL23704070


2008---11

2009---22

2010---33

20111--12

2012---11

20132--24

2014---22

TOTAL3001417

LOUDOUN COUNTY2007---99

2008---66

2009---66

2010---88

20112--810

201211-68

2013421815

201441-712

TOTAL11415874

PAGE COUNTY2007---33

2008---11

2009---33

2010---11

2011---77

2012---22

20132-114

20141--23

TOTAL3012024


2008---11

2009---33

2010---11

2011---55

2012---22

2013---11

TOTAL0001515

SHENANDOAH COUNTY2007---11

2008---44

20091--12

2010---33

2011---44

20122--57

20131--34

20141---1

TOTAL5002126

WARREN COUNTY2007---22

2008---22

2009---44

20101--78

20111--56

2012---77

20132--35

201411-35

TOTAL5103339


20092--35

2010---22

20111--45

20123--36

20132--35

20141--12

TOTAL9001827


20081--34

2009---22

2010--145

2011--11011

20121--56

2013--145

20141-124

TOTAL3043542

UNKNOWN20073---3

20082--24

20091--12

20101--12

20111---1

20122--13

2013---11

TOTAL1000616

TOTAL20079288381489

20088453417509

20099987390504

201043554104638,260,4050.0056%

201190105477582

2012122135401541

201317736164326618,001,0310.0083%

2014772810226341

TOTAL7841135931344090

Calculcations


CLARKE COUNTY2010014,023

20111---1

2012-1--1

2013014,348

2014020108118,5310.0000670.07

TOTAL11013201322122,8830.0001790.18

FREDERICK COUNTY2010-1-5678,305144352

20114--610175%4%

20121--12

201353-91781,319

201441-813

TOTAL23704070


20111--45

20123--36

20132--3527216

20141--12

TOTAL9001827

SHENANDOAH COUNTY2010---334199320103419930.0000710.0714404782

2011---4420134426840.0000940.0937119295

20122--571691

20131--344268433%2%

20141---1

TOTAL5002126

WARREN COUNTY20101--783757520108375750.00021290750.2129075183

20111--5620135386990.00012920230.129202305

2012---77-31124

20132--3538699-38%3%

201411-35

TOTAL5103339

LOUDOUN COUNTY2010---88312337201083123370.0000260.03

20112--8102013153496790.0000430.04

201211-68737342

201342181534967988%12%

201441-712

TOTAL11415874



2012-1-232010281,104,2680.0000250.025

20131---1239732013391,140,8700.0000340.034

2014---221136,602

TOTAL31091339%3%

FAIRFAX COUNTY20102--25271,081,726

20117212535

201291-2838

201361-31381,116,897

201476-1831

TOTAL61141192268


20081--34

2009---22

2010--145

2011--11011

20121--56

2013--145

20141-124

TOTAL3043542

UNKNOWN20073---3

20082--24

20091--12

20101--12

20111---1

20122--13

2013---11

TOTAL1000616

TOTAL201043554104638,001,031201046380010310.00005790.0578675423

20119010547758220136618,260,4050.00008000.0800202896

2012122135401541198259374

201317736164326618,260,40543%3%

2014772810226341

TOTAL7841135931344090


2008---22

20091--12

2010---33434352010343,4350.000070.07

2012---112013344,3490.000070.07

20132--13443490

2014---330.0%

TOTAL4001216


20111--12

2012---1120107100,3010.0000700.07

20132--245139520132154,0500.0000130.01

2014---22-553749

TOTAL3001417-71%54%


2011---55

2012---22

2013---1177741

TOTAL0001515

C-%Change in deaths

% Change inHeroin and/or Opioid Deaths2010-2013

% Change

Clarke, Frederick,& WinchesterLoudounFairfax(County & City)State of Virginia1.750.8750.392857142857142850.42764578833693306

C-%Change in Population


% Change

Clarke, Frederick,& WinchesterLoudounFairfax(County & City)State of Virginia3.6716133332208453E-20.119556760806436643.3145939210409064E-23.2417572185384609E-2

Data for Chart

Deaths Due to Heroin and/or Opioids


Clarke, Frederick, & Winchester20108118,5310.67493

201322122,8831.79032

% Change175.0%3.7%165.3%


Shenandoah & Warren20101179,5681.38247

2013982,3831.09246

% Change-18.2%3.5%-21.0%


Loudoun20108312,3370.25613

201315349,6790.42896

% Change87.5%12.0%67.5%


Fairfax(County & City)2010281,104,2680.25356

2013391,140,8700.34184

% Change39.3%3.3%34.8%


State of Virginia20104638,001,0310.57868

20136618,260,4050.80020

% Change42.8%3.2%38.3%

20101.7%1.5%

20133.3%1.5%

% Change92.6%0.4%


Loudoun

Fairfax(County & City)

State of Virginia

Opiate Overdose Deaths

2 1

21

3330 30

10*

05

101520253035

2011 2012 2013 2014 2015 2016 2017

* 2017 as of 3/1/17

NW Virginia

7

* Compared to 4 deaths as of 3/1/17

Clarke/Frederick/Winchester ArrestsVirginia State Police

8

0100200300400500600700800900

1000

201220132014

Northwestern Regional Adult Detention Center

90 Day Treatment Program

9

From July 2011 through March 2016:

724 inmate graduates $5.2 Million

expended

10

Increase in Drug Related Foster Care – Frederick County

$1,021,882

$702,335

$0.00

$200,000.00

$400,000.00

$600,000.00

$800,000.00

$1,000,000.00

$1,200,000.00

2012 2013 2014

Total Foster Care Expenditures by Year

Foster Care Expenditures - Drug Related

* YTD

26

39

62

16

28

48

0

10

20

30

40

50

60

70

2012 2013 2014Total Number of Frederick County Children in Foster Care at any Time During Calendar Year

Total Number of Frederick County Children in Foster Care at any Time During Calendar Year -Drug Related

11

1.6

23.318.0

22.3

23.2

$-

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

Nursery-7,850 20 37 43 65

2012-2015 2012 2013 2014 2015

Non-Drug Exposed Babies

NAS Babies

Winchester Medical Center2012-2015

The data in the bars is the average length of stay.

14

The Community Responds

15

Substance AbuseSelect Initiatives

April 2014• Summit at Shenandoah University attended by approximately 200

people representing the U.S. Attorney’s Office, Drug Enforcement Agency, Valley Health, local law enforcement, and concerned community members

June 2014• Implemented a system wide program to ensure proper prescriptive

practices in all Valley Health Hospital Emergency Departments and Urgent Care Centers• Appropriate dispensing• PMP utilization by prescribers• Patient Education program

• Partnered to develop informational resources, access, and visibility for community organizations and programs relating to addiction, rehab and crisis referral.

• Increased data sharing to support regional grant applications• Continuing local and state level advocacy for drug exposed newborns

16


July 2014• Partnered with Casey Family Programs bringing subject matter

expertise to the community• Community outreach on substance abuse and addiction initiatives

launched: • VHS magazine article (115,000 households) educating our

community on safe medication management • Health & safety fairs• VHS social media

17


September 2014• Valley Health sponsored an educational forum for 200 local medical

providers featuring presentations from local law enforcement, the DEA, and others about the opioid and heroin crisis in our community

• Monthly Addiction Awareness program for Valley Health employees launched educating staff and medical staff on best practices

• Promotion of the use of Virginia Prescription Monitoring Program to screen prescribed controlled substances.

18


October and November 2014• Installation of Drug Take Back Boxes at the Winchester Police

Department, Clarke County Sheriff’s Department, and Frederick County Sheriff’s Department through grants awarded by CVS pharmacy

• Partnering to advertise area:• Prescription drug “take-back” programs• Community “Drop Box” program• RX123 program launched in partnership CLEAN, Inc.

19

ActionNovember 18, 2014

www.roadtorecovery.info

20

Mission and Vision Statements

City of Winchester: To provide a safe, vibrant, sustainable community while striving to constantly improve the quality of life for our citizens

Frederick County: Insuring the quality of life of all Frederick County citizens preserving the past and planning for the future

Valley Health: Serving our Community by Improving Health

Shenandoah University: SU educates and inspires individuals to be compassionate citizens who are committed to making responsible contributions within a community

Northwestern Community Services: To help people through life’s challenges with quality behavior health services guided by principles of respect, recovery and self-determination.

21

Substance AbuseNovember 2014 Summit

• With critical support and expertise from Casey Family Programs, we pulled together 100 local decision-makers and stakeholders in the community to address this public health crisis:– Law enforcement, Health Care, Judiciary, Government, Community

Service Board, Educators, Social Services, recovery community, private substance abuse and mental health providers, non-profit organizations, and concerned citizens

22


• The participants were presented with key data highlighting the community-wide effects of opioid and heroin addiction in our community

• Launched The Road to Recovery website with information and links to community resources for treatment and help (www.roadtorecovery.info)

23


Adopted Desired Future State: By January 1, 2017 the Winchester, Frederick, and Clarke community will have a comprehensive coordinated approach to the prevention, treatment and adverse societal impact of addiction, as evidenced by:• A decrease in mortality from overdoses• A decrease in the incidence of substance exposed infants• A decrease in the incidence of children needing social services

intervention due to parental/caregiver addiction• A decrease in the incidence of crimes attributable to addiction

24

Substance AbuseCommunity Timeline- Select Initiatives

January 2015• Northern Shenandoah Valley Substance Abuse Coalition (NSVSAC)

Charter written and process initiated which has resulted in becoming a Virginia non-profit corporation with 501(c)(3) status from the IRS

February and March 2015• NSVSAC leadership meetings with federal state and local

representatives

25


March 2015 • Community forum

– Attended by approximately 125 people– Content

• Message of hope from a recovering addict• Data from the November 2014 summit• Member of the Northwest Virginia Regional Drug Task Force.• An hour-long Q&A session that provided excellent community

feedback

26


March 2015 • Jointly funded CSB/Valley Health Prenatal Early

Intervention Service for substance addicted pregnant women: OB referrals to CSB Counselor on-site– OB offices obtain urine drug screen (UDS) at 1st Prenatal visit.– Universal UDS on 1st labor and delivery outpatient visit & on

admission for labor.– Universal umbilical cord collection (lab stores for up to 3 weeks).– Cord tissue toxicology screening for known substance exposed

infants and high risk families.– Finnegan’s neonatal abstinence scoring assessment.– Adoption of AAP guidelines for increased length of stay of

substance exposed newborns to monitor for NAS (4-5 days).

27

April 2015 • Community educational forum “Your Kids Know More Than You Do.”

– Attended by approximately 150 people – Dr. Will Rushton, an emergency room physician and poison

control expert. • Convened the organizational meeting of the Winchester-Frederick-

Clarke Drug Treatment Court Advisory Committee with 22 participants in attendance, plus one member of the press.


28


May and June 2015• Members of the Winchester-Frederick-Clarke Drug Treatment Court

Advisory Committee visit 4 Drug Treatment Courts in the Commonwealth

• The Northern Shenandoah Valley Substance Abuse Coalition is incorporated as a Virginia non-profit corporation; receives 501(c)(3) status from the IRS

29


July 2015• $60,000 each from the City of Winchester, Frederick County and Valley

Health, plus $15,000 from Clarke County to enable the NSVSAC to hire an Executive Director

• Primary duties will be the planning and implementation of a Drug Treatment Court for Winchester, Frederick and Clarke

30


September 2015• Educational Forum for 160 physicians on pain management• Community program on Addiction treatment optionsOctober 2015• Peer-to-Peer Recovery Coach Training funded by Casey Family

Programs and conducted by the McShin Foundation• Visit to Philadelphia Drug Treatment Court

31


November 2015 – Hire Executive Director for the NSVSACJanuary 2016 – Executive Director officially begins workMarch 2016• Submit Application to Virginia Supreme Court for approval of Drug

Treatment Court• Strategic Planning RetreatApril 2016 – Attend training conducted by the National Drug Court InstituteAugust 2016 – First Drug Treatment Court docket

32

Strategic Planning Retreat March 2016

MissionThe Northern Shenandoah Valley Substance Abuse Coalition will collaborate with community partners to take the lead in identifying and developing effective resources to ensure that the necessary continuum of care for substance abuse and addiction services are available to all members of the community.

33

Vision

34

Working together to overcome the grip of substance abuse and addiction.

Areas of Strategic Focus• Prevention

– Creating a new community norm– Age-appropriate and situationally-appropriate education offered to

all longitudinally• Treatment

– Treatment that is financially and geographically accessible in a timely manner

– Client-focused individualized treatment with family/supports• Recovery

– Resources are available to anyone with a substance use disorder who reaches out to NSVSAC members

– Robust Peer Recovery Coach program

Desired Future State

35

36

Executive Committee

Community Outreach

Best Practices Finance

Original Organizational StructureAddiction Action Committee

37

Revised Organizational StructureNSVSAC

Executive Committee

Prevention

Community Outreach Re-Entry

Treatment Recovery

Implementation Team

38

Drug Treatment Court• Promote public safety by treating addiction and substance

abuse among non-violent offenders• High Accountability Court• Comprehensive Substance Abuse Treatment• Fee = $900 payable at the rate of $75 per month• Work, education, or community service required

39

• In 2013, Virginia’s re-arrest rates were (24.5%), better than national average of (27.5%)

• Up to two years of completing Drug Treatment Court, 75.5% of graduates are NOT re-arrested, compared to the national average of 72.5%

*According to the Office of National Drug Control Policy

Drug Treatment Court

SBIRTScreening

Brief InterventionReferral to Treatment

http://chhs.gmu.edu/sbirt/index.cfm

http://chhs.gmu.edu/sbirt/index.cfmhttp://chhs.gmu.edu/sbirt/index.cfmhttp://chhs.gmu.edu/sbirt/index.cfm

41

Grants Awarded

• $25,000 – United Way Grant to support the Drug Treatment Court• $18,200 – Rotary Club Grant to support the Peer Program• $350,000 – BJA Drug Court Implementation Grant• $100,000 – HIDTA Funding for Treatment

42

Key Drivers of Early Success/ Lessons Learned

Strategies to consider

43

• Engage and educate the Community/Leaders• Collect and share the data• Put a face on the crisis• Shine a light on the hope of recovery

• Education Strategy• Providers of Healthcare• Elected Leaders• Public



44

• Addiction is a disease. This is a public health crisis.• Establish a multi-disciplinary, cross-systems approach• Establish realistic and concrete goals• Share the issue through the media whenever the

opportunity arises• Include the Recovery and Faith based communities early



45

Stakeholders can…• Contribute time, talent and treasure to the community effort• Champion the community’s understanding of the disease

of Addiction• Educate providers and the community about the

appropriate use of opioid analgesics• Champion the community Drug take back programs• Facilitate education and community access to Naloxone• Help assess and address unmet needs in the continuum of

care in the community

The work has just begun, but imagine what we can do by working together.

46

Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Slide Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Slide Number 37Slide Number 38Slide Number 39SBIRT�Screening�Brief Intervention�Referral to TreatmentSlide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46

the opioid addiction crisis in the northern shenandoah valleyby the crisis of heroin and opiate...

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