Community Responses to Heroin: Huntington, WV, and

Camden County, NJPresenters:• Jan Rader, RN, Deputy Chief, Huntington Fire Department

• William J. Lynch Jr., RPh, Clinical Staff Pharmacist, Kennedy Health System, and Member, Camden County Addiction Awareness Task Force

• Harry Earle, MA, Chief of Police, Gloucester Township (NJ) Police Department, and Member, Camden County Addiction Awareness Task Force

Heroin Track

Moderator: Jackie L. Steele, Jr., JD, Commonwealth Attorney, Kentucky 27th Judicial Circuit, and Vice Chairman, Operation UNITE Board of Directors

Disclosures

• Harry Earle, MA; Jan Rader, RN; and Jackie L. Steele, Jr., JD, have disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.

• William J. Lynch, Jr., RPh wishes to disclose he is a consultant with Pernix Therapeutics and with Iroko Pharmaceuticals.

Disclosures

• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

• The following planners/managers have the following to disclose:– John J. Dreyzehner, MD, MPH, FACOEM – Ownership interest:

Starfish Health (spouse)– Robert DuPont – Employment: Bensinger, DuPont &

Associates-Prescription Drug Research Center

Learning Objectives

1. Examine two communities’ responses to their heroin crises, emphasizing collaboration among stakeholders.

2. Describe the programs being implemented by Huntington, WV, as part of its holistic approach to heroin addiction.

3. Outline the programs developed in Camden County, NJ, to respond to its heroin epidemic.

4. Provide accurate and appropriate counsel as part of the treatment team.

Portal to Recovery

“These aren't bad people trying to get good, these are sick people trying

to get well.”

Deputy Chief Jan K. Rader, RNCity of Huntington Fire DepartmentMayor’s Office of Drug Control Policy

Huntington, WV• Located in Cabell and Wayne

Counties along the Ohio River, Huntington is the second largest city in the State of West Virginia

• Huntington population is 49,000, Cabell County population is 96,000

• Biggest employers are Marshall University, Cabell Huntington Hospital, St. Mary’s Hospital and CSX Transportation

Introduction• There is a reason why greater than 500 Detroit residents

have been arrested in Huntington over the past decade.• There is a reason why over 200 Detroit residents are

now embedded in Huntington.• In 2014 heroin was selling $200/gram in Huntington.

Due to the increase in supply, the cost is currently $75-$100/gram. This is designed to increase DEMAND.

• The reason is ADDICTION “Addiction is when you can stop you don’t want to, and when you want to stop you can’t”. – Luke Davies

Operation River to JailJune 2014

What is next?

• 50 years of fighting the “Drug War” with the same tactics and the problem has continued to worsen

• We can change what has not worked without fear of failure or condemnation

• “We can’t arrest our way out of this.”• We need to think outside the box• Begin focusing on the disease of ADDICTION• Creation of The Mayor’s Office of Drug Control

Policy

Mayor’s Office of Drug Control Policy

• Mission – To serve as a leader for improving the health and safety of individuals by promoting strategic approaches and collaboration to reduce drug trafficking and related crime while promoting prevention and treatment options for addicts.

• Vision: Decrease the Demand/Heal the Addiction

History of Area Drug Use

• 1990’s - Prescription drug abuse became popular– New synthetic opiates marketed to be non-addictive– Pain management explosion– Profit margin

• 2010-2011 - Pill Mill crackdown– Law enforcement started targeting 2010– 2011 Florida laws assisted

• Addicts turned to heroin– Cheaper– More readily available

Geography of Drug Offenses 2004

Geography of Drug Offenses 2014

Grams of Heroin Seized

Overdose Calls CC911

Cabell County Overdoses 2015

944 overdosesAverage age of an overdose 37

58% were male, 42% female

70 overdose deathsAverage age of an overdose death 38

69% male, 31% female89% Caucasian, 11% black

Overdose Deaths

IV Drug Use • Heroin is typically an injected drug

• Syringes are reused and shared among users

• IV drug use leads to major healthcare complications

Hepatitis B & C• Hepatitis B & C is an infectious (contagious) liver disease that

spreads through blood-to-blood contact with an infected person• Lives outside the body for up to 7 days, in a syringe for 63 days• Average lifetime medical cost estimated at $65,000 - $500,000

depending on need for liver transplant• West Virginia has the second highest rate of new Hepatitis C

cases in the country• West Virginia has the highest rate of new Hepatitis B cases in the

country• Infant mortality rates in Cabell County are some of the highest in

the nation, with 8.3 deaths per 1,000 live births

Hepatitis C

Hepatitis B

See a Trend?

Neonatal Abstinence Syndrome

Estimated Medical Cost of Drug Abuse in Cabell County in 2015

Short Term Strategies• “United Front” - meet with stakeholders • LEAD Program – Law Enforcement Assisted

Diversion• SAMHSA CAPE 2 Grant (Substance Abuse & Mental

Health Services Administration)• Harm Reduction Program • Centralized Information System for First

Responders and Health Care Providers• Drug Court Expansion – WEAR Program

United FrontLiaison with:• Local/regional medical facilities• Local/regional health departments• Local/regional treatment/recovery programs• Local/regional first responders• Local/regional schools• Faith based community organizations• Neighborhood associations and community groups

LEAD ProgramLaw Enforcement Assisted Diversion

• A pre-booking diversion program that allows officers to redirect low-level offenders engaged in drugs or prostitution activity to treatment services instead of jail and prosecution

• Designed for addicts to kick their habits and give those who survive by selling drugs a chance at legitimate employment and a future

• The Mayor’s Office of Drug Control Policy and the Huntington Police Department have formed a partnership with U.S. Attorney’s Office, Prestera Center and Day Report Center

• Prestera provides mental health counselors to evaluate possible clients in the program

CAPE 2 Grant

• Partnered with United Way • Grant is for research to develop early warning systems• This will allow us to develop an early warning protocol

based on community behavioral health issues• We need to be proactive, what drug will affect our

community next?• An early warning system will be a PORTAL to

RECOVERY

Harm ReductionA program that prevents people from causing irreversible damage to themselves and others. (located and run by the Cabell-Huntington Health Department)• Other harm reduction programs have lowered the rate of

Hepatitis by 50% within the first year• Harm reduction programs leads a high number of

participants to treatment (>50%)• Harm reduction programs lower the healthcare cost

associated with complications from IV drug use considerably

• Babies born with NAS (neonatal abstinence syndrome) will be lowered through planned parenthood

Harm Reduction• Cabell-Huntington Health Department, first in the state • Education, syringes, vaccinations, social services,

treatment• Recovery Coaches on site during program• Wednesdays from 10:00 am till 4:00 pm, began Sept. 2nd

– first day there were 15 participants, two asked for help• Sept. 2nd – Dec 30th : Individuals served 625, Total number

of syringe exchange visits 1266, close to 38,000 syringes given out. 50/50 male/female, 45% are known hep C +

Centralized Information System “The Call WV”

• Partnership between the U.S. Attorney’s Office, Trifecta Productions and the Mayor’s Office of Drug Control Policy

• Designed assist first responders, healthcare workers and family members in locating available services

• Will give us the ability to disseminate vital information quickly (videos)

• Will give us the ability to collect vital information

W.E.A.R. Program• Women’s Empowerment and Addiction Recovery Program• The W.E.A.R. Program will target high-risk, high-need adult,

non-violent felony offenders who are prostitutes, drug addicts, and residents of the Cabell County area

• The goals of the program are to: – To treat the drug addiction and mental health needs of prostitutes.– To offer women in prostitution a complete exit strategy from the

sex trade. – To shift the approach to drug and prostitution offenses to treat the

root cause of criminal activity through providing services rather than incarceration.

Long Term Strategies• Promote the development/expansion of services• Promote career opportunities for people recovering• Partner with union leadership to introduce

legislation to assist with employment reentry• Expand community prevention/intervention efforts• Relapse prevention through environmental design• Lower the number of babies born with NAS

Development/Expansion of Services

• Collaborate with respected healthcare facilities to provide a new all encompassing treatment program (St. Mary’s Medical Center, MU Center for Rural Health, Prestera, Health Dept.)

• This would be an Intensive Outpatient Recovery Program

– Provide MAT (medically assisted treatment) for individuals who meet the criteria

– Provide in home intensive therapy based on the nursing home health model for those who meet criteria

Career Opportunities

• Liaison with area businesses for employment opportunities

• Explore economic incentives for employers offering employment to those in recovery (Work Opportunity Tax Credit is a federal tax credit)

• Expand educational and training opportunities for those in recovery

• Liaison with area unions for employment opportunities

Relapse Prevention through Environmental Design

• Micro Level - Assist with environmental changes for individuals recovering– Housing– Friends– Family– Employment changes

• Macro Level - Removal of dilapidated abandoned houses

Summary

• Addiction is a major public health problem that impacts society on multiple levels

• We have a moral obligation to act• We must unite to decrease the demand and

heal the addiction• Dynamic strategies and tactics will lead

addicts through a PORTAL to RECOVERY

We need to prepare, big changes can come from small events.

~ The Tipping Point

Community Response to Heroin:Camden County, New Jersey

Camden County Addiction Awareness Task Force

Community Response to Heroin: Camden County, New Jersey

Camden County Addiction Awareness Task ForceWilliam J. Lynch, Jr. BS-Pharm, RPh

Clinical Staff Pharmacist-Kennedy University HospitalCore Teaching Affiliate of Rowan School of Osteopathic MedicineRutgers University, Ernest Mario School of Pharmacy Preceptor

Camden County New Jersey Addiction Awareness Task Force Member- Education & Prevention Committee Co-Chair

State of New Jersey Police Training Commission InstructorCamden County College Police Academy Instructor

National Prescription Drug Abuse & Heroin SummitMarch 30, 20163:30 to 4:45 PM

Community Response to Heroin: Camden County, New Jersey

Camden County Addiction Awareness Task Force

Chief W. Harry Earle, MAChief of Police-Gloucester Township NJ Police Department

President, Camden County NJ Police Chiefs’ AssociationCamden County Addiction Awareness Task Force Member

-Availability Reduction Committee Co-Chair FBI National Academy #234

National Prescription Drug Abuse & Heroin SummitMarch 30, 20163:30 to 4:45 PM

Disclosure Statement

William J. Lynch, Jr. BS-Pharm, RPh wishes to disclose he is a consultant with Pernix Therapeutics and with Iroko Pharmaceuticals

He will present this content in a fair and balanced manner

Disclosure Statement

Learning Objectives

• Examine two communities’ responses to their heroin crises, emphasizing collaboration among stakeholders

• Describe the programs being implemented by Huntington, WV, as part of its holistic approach to heroin addiction

• Outline the programs developed in Camden County, NJ to respond to its heroin epidemic

5,217 Number of heroin-related deaths recorded

in New Jersey 2004-2014

http://www.nj.com/news/index.ssf/2015/12/herointown_nj_the_states_heroin_crisis_in_10_graph.html

781Number of Heroin-Related Deaths in New Jersey in

2014*

*Fourth straight year New Jersey saw an increasehttp://www.nj.com/news/index.ssf/2015/12/herointown_nj_the_states_heroin_crisis_in_10_graph.html

781

8.3Heroin Deaths in New Jersey per 100,000 >3

Times National Average

20.3 Heroin deaths in Camden County New Jersey per 100,000More than 7.8 times the national average, 2.45 times NJ averagehttp://www.nj.com/news/index.ssf/2015/12/herointown_nj_the_states_heroin_crisis_in_10_graph.html

New Jersey’s Heroin Epidemic: Deaths Doubled Since 2011

*Camden, Middlesex, Ocean and Monmouth had the highest number of overdose deaths in 2014

*Bergen, Camden, Cumberland, Gloucester, Middlesex, Monmouth and Warren had the percentage highest increases from 2013

http://patch.com/new-jersey/tomsriver/heroin-deaths-new-jersey-double-2011?utm_source=alert-breakingnews&utm_medium=email&utm_term=police%20%26%20fire&utm_campaign=alert

We Have a Serious Problem • New Jersey has 21 counties• Camden County is:

– 8th most populated county (n=511,038 residents)– Has 4th highest number of substance abuse

treatment admissions• 6295 in 2012, 8.3% of total NJ Admissions of 75,837• 5830 in 2013, 8% of total NJ Admissions of 72,864• 5214 in 2014, 8.1% of total NJ Admissions of 64,766

– Was 1st, for greatest number of heroin deaths in the state for 2014 with 93 of 781 in NJ (11.9%)

Heroin Pills

Photo courtesy of Pitman NJ Police website 11/17/14

www.northjersey.com/news/nj-state-news/heroin-pill-poses-potential-danger-for-new-jersey

2015 Camden Overdose Spikes, Regional Operations Intelligence Center, NJSP, Drug Monitoring Initiative Attorney General ‘s Heroin & Opiate Task Force. 1/26/16

2015 Camden Overdose Spikes, Regional Operations Intelligence Center, NJSP, Drug Monitoring Initiative Attorney General ‘s Heroin & Opiate Task Force. 1/26/16

s

AN EPIDEMIC

PEOPLE ARE DYING – AND NOT JUST FROM CRASHES

Year Deaths

2010 6

2011 9

2012 5

2013 9

2014 14

2015 20

GLOUCESTER TWP – 2014/2 2013/1

SAVE INITATIVES

THE POWER OF A GROUP

SUPPORT the creation of additional resources to treat and prevent addiction to heroin & prescription drugs

HELP to reduce the demand for and availability of heroin & prescription drugs

CREATE awareness programs to help educate residents about programs and resources available to prevent and treat addiction

Mission: To increase awareness among county residents of heroin and

prescription drug abuse and the devastating effects on our

community

THE POWER OF A GROUP

Law Enforcement

Prosecutors

Office

Religious Organizations

Education

Business

Media

Medical/

Professional

Availability Reduction

Education Prevention

Awareness Advertising

Sub-Committees

County

Government

http://addictions.camdencounty.com/

INCREASING AWARENESS

CHANGING ATTITUDES

“Shi* Bag” “Crack Head”

“Junkie”

“Skell”

“Dirt Bag”

Wife

HusbandSon

Daughter

Victim

Dad

Mom

AN EPIDEMIC

WORKING TOGETHER TO SAVING LIVES

TOTAL UNITS:

1,230

WORKING TOGETHER TO SAVE LIVES

2014517

20155,092

2016158

NJ Statewide Naloxone Deployments, Regional Operations Intelligence Center, NJSP, Drug Monitoring Initiative Attorney General ‘s Heroin & Opiate Task Force. 1/26/16

WORKING TOGETHER TO SAVE LIVES

REMEMBERING THE VICTIMS

AN EPIDEMIC

Understanding

Addiction

Genetic Pre-Disposition

It’s a Disease

Reduce the Stigma

6,000 lbs.2015

WE NEED TO PREVENT THE OVERDOSE!

SAVE ADVOCATE

47%

REMAINING 53%?

SAVE ACTIONS - SOLICIT PARTNERS

SAVED BY NARCAN – NOW WHAT?

PREPARING FOR RE-ENTRY

Food Bank

Clothing Bank

SAVE Advocate

GTPD Family Resource Center

GT Library

Community Re-Entry Specialist

SAVE - DRUG DISPOSAL

How has the taskforce and epidemic affected the county alcohol and addiction operations?• Creation of an after-hours warm line• Targeted prevention / education efforts• Hosted Naloxone (Narcan®) trainings• Increased visibility in the community via

presentations county-wide• Partnered with other prevention / education groups

to work on shared goals

Creation of an after-hours warm line

• First, we needed an after hours warm line• To accomplish this we partnered with an ‘ongoing

crisis line’ (called Contact Community Helplines)• We ensured they were familiar with & understood

how the unit operates• Understand where individuals and families who were

insured & not insured could seek out services• Provide information, refer & keep statistics on callers

The Campaign addictions.camdencounty.com

“Awareness Van”

Targeted Audiences• Schools• Teachers• Athletic Directors • Peer to Peer Youth Groups • Physician Associations • Parent Teacher Associations • Faith Based Groups • Business Community Chambers,

Rotaries• Community Colleges • Municipal Alliances • Youth Service Organizations

• Community at Large– Parents– Teens– Pre-teens– Seniors/Grandparents

• Law Enforcement• Health Care Professionals• Anyone as it effects

Everyone

Methods of Communicating the Message• Presentations• Awareness and Prevention Events • PSA’s & Videos • Billboards• Digital Marketing• Awareness Tool-Kit

Outreach Initiatives

• Promotion of Rx Return Boxes • Promotion of NJ Good Samaritan Law • Physician Awareness Programs • Promotion of Naloxone Availability & Training for

Residents

Brought to you by the Camden County Board of Freeholders’ Addiction Awareness Task Force & Camden County Health Department

Camden County Addiction Awareness Task Force Naloxone (Narcan®) Initiatives

• Naloxone (Narcan®) Training for Police/First Responders• Naloxone (Narcan®) Training for General Public• Naloxone (Narcan®) Over-the Counter Prescription with CVS in New Jersey

– Over-the-Counter = Behind the Counter– Universal Prescriber

• No need to have a prescription• Prescription is provided for you• Prescribed to the insured

– Available in:• Injectable form (vial)• Auto-injectable form: Evzio®• Nasal naloxone• Narcan® Nasal Spray (Adapt Pharma)

Camden County Addiction Awareness Task Force Presentations

• Camden County College Police Academy• Camden County Police Chiefs Best Practices Summit• Camden County School Superintendent Meeting• Camden Diocesan School Superintendent/Principal Meeting• Municipal Alliances Meeting• Regional Substance Abuse Counselor (SAC) Meeting• CME accredited for Nurses in NJ • CME accredited programs for physicians • Grand Rounds at Kennedy Health System• South Jersey Pediatric Networking Group• New Jersey Prevention Network (NJPN)• New Jersey Association of County Governments• Association of Student Assistance Professionals-NJ (ASAP-NJ)

American Medicine Chest Phone Application-Location to Dispose Meds

http://www.safecoalition.org/2013-05-30-american-medicine-chest-challenge-mobile-app_mxzsy

Bridging the Gap: Law Enforcement & Medical Personnel• Naloxone Purchasing Program

– Collaborative Agreement• Candlelight Vigil

– Police & Medical Personnel in Uniform• Law Enforcement Life Saving Award Ceremony

– 300+ naloxone saves• New Jersey State Police Drug Monitoring Initiative• CCPCA Drug Monitoring Initiative/Notification System• Identification of Rx Drugs for Law Enforcement

– “M” and Codeine Phosphate from Argentina– Diltiazem information for DMI monograph– Reverse opiate overdose-naloxone/treat CCB overdose-glucagon

• Speakers Bureau-Tag Teams– Law Enforcement & Medical Personnel

• Operating silos now robustly connected

Naloxone Purchasing Program• Collaborative Agreement between:

– Kennedy Health System (KHS)– Camden County Police Chiefs’ Association (CCPCA)– Expanded to Gloucester County Prosecutor’s Office

• Purchased by KHS Hospital Pharmacy – Leverage group/bulk purchasing power– CCPCA Vice President Chief Chris Winters requests– KHS Director of Pharmacy Services orders– Pass along savings/purchase outright– 625 naloxone units supplied/cost $12,500 ($20/unit)

• All 36 municipalities in Camden County have police officers carrying 2 units nasal naloxone/officer

CCAATF Speakers Bureau• Speakers Identified to address this addiction issue

– Law Enforcement– Medical Personnel– Parents who have lost a child– People in recovery

• Present at different events throughout the county• Tag Teams

– At Police Academy: Rx Abuse & Naloxone Training• Chief Earle/Chief Winters-Law Enforcement Perspective• Patty DiRenzo-Parent of a child lost to this disease• Bill Lynch-Pharmacist-addressing Rx abuse/disease of addiction

CCPCA Drug Monitoring Initiative/Notification System

• Run of overdoses in hospital ER• Notify NJSP ROIC DMI• Notify CCPCA President and Vice President• Notify Camden County Dispatch

– Notify all Chiefs of Police in Camden County– Notify all officers on the street

• Two overdose deaths in same hospital ER within hours of each other– Notify officers – Have backup respond

• May need more than 2 doses of nasal naloxone to reverse– Overdose substance retrieved if available

• Sent to crime lab for evaluation/identification

Community Presentations for 2015• Presentations: 128• Attendees : 5935 (range: 10-750)

– Average 46 attendees/presentation • Locations

– Schools (assemblies/health classes)– Boy Scout/Girl Scout troops– Churches– Senior Citizen Community Center-BINGO! Brigade– Sports Teams– Hospitals/Treatment Centers– Conferences– Libraries– Colleges/Universities– Police Academies– Police Chief Association Meetings– School Superintendent Meetings (County & Diocesan)

• Post Presentation Survey

OPERATION SAL (Save-A-Life)

Brought to you by the:Camden County Addiction Awareness Task Force &

Camden County Health Department

Operation SAL-Save A Life!Offer evidence based treatment to clients who:• Have overdosed

• Were administered Narcan® (naloxone) by municipal police department/first responders

• Are medically cleared

• Actively seeking treatment services

Acknowledgements: Thank You!Rachel M. Lynch• Doctor of Pharmacy Candidate 2016• Rutgers University, Ernest Mario School of PharmacyBrian V. Blazovic• Doctor of Medicine Candidate 2018• Jefferson Medical College, Thomas Jefferson UniversityDavid Z. Yang• Pharmacy Intern-Doctor of Pharmacy Candidate 2016• Rutgers University, Ernest Mario School of PharmacyKurt D. Meakim, Pharm D• Pharmacy Intern-Rutgers University, Ernest Mario School of PharmacyEric W. Lynch• Doctor of Pharmacy Candidate 2020• Rutgers University, Ernest Mario School of PharmacyGregory E. Cabanas• Pharmacy Intern, Doctor of Pharmacy Candidate 2016• Rutgers University, Ernest Mario School of Pharmacy

We thank all of the members of our Camden County Addiction Awareness Task Force who engage in battling this epidemic in our community every day. Together we ARE making a positive difference!

Community Responses to Heroin: Huntington, WV, and

Camden County, NJPresenters:• Jan Rader, RN, Deputy Chief, Huntington Fire Department

• William J. Lynch Jr., RPh, Clinical Staff Pharmacist, Kennedy Health System, and Member, Camden County Addiction Awareness Task Force

• Harry Earle, MA, Chief of Police, Gloucester Township (NJ) Police Department, and Member, Camden County Addiction Awareness Task Force

Heroin Track

Moderator: Jackie L. Steele, Jr., JD, Commonwealth Attorney, Kentucky 27th Judicial Circuit, and Vice Chairman, Operation UNITE Board of Directors