Access this content and more online! Go to alcoholismdrugabuseweekly.com/createaccount and log in with your subs ref #, shown on the mailing label.

Next steps for the recovery movement: Volume 29 Number 7 Stay vocal, issue is bipartisan February 13, 2017 With the loss of some recovery lead- there’s still a lot that can be done. Print ISSN 1042-1394 ers from federal government, some First, there is a movement to get Online ISSN 1556-7591 advocates in the field are worried more people in recovery into federal that their momentum will be lost (see government. The movement, spear- ADAW, February 6). But interviews headed by Facing Addiction, already Wlast week revealed that even without has more than 100 applications, said In This Issue… a website for the Office of National Facing Addiction co-founder Greg Drug Control Policy (ONDCP) — Williams. “We don’t know yet where Our lead stories this week look at something which has rattled advo- these individuals might be placed,” next steps for the recovery cates who want everything to go Williams told ADAW. But they would movement, and at fentanyl overdose back to the way it used to be — be in top positions. “We believe this deaths in people who thought they can inform policy moving forward,” had bought cocaine. Bottom Line he said. “We have plans to represent . . . See stories, beginning on this page a top-tier list.” Until Senate confir- The recovery movement is alive and mations move forward, however, Botticelli’s optimistic advice: well and growing, but needs support nothing will happen. from everyone concerned about Partner with law enforcement “Having people in recovery in . . . See page 4 addiction as a health problem. See Recovery page 2 CADCA annual meeting: Training for youth to take back home Report details an uncommon exposure . . . See page 5 to fentanyl in regular cocaine users SAPT 20 percent set-aside essential A June 2016 incident in which 12 Morbidity and Mortality Weekly Re- to SUD prevention . . . See page 7 people in New Haven, Connecticut, port detailing the crisis in New Hav- overdosed on fentanyl, contained in en point out that typical public edu- a substance they thought was co- cation and naloxone distribution caine, underscores the need for efforts that target regular users of Amore comprehensive and multia- opioids would not have captured gency strategies to combat opioid these New Haven individuals be- overdose, a new report suggests. cause opioids generally were not Authors of an article in the Feb. their drug of choice. The June out- 3 edition of the Centers for Disease break resulted in nine hospital ad- Control and Prevention’s (CDC’s) missions and three deaths. The authors wrote that “this out- Honorable Mention 2016 Michael Q. Ford break of severe opioid intoxication Spot News 2016 Journalism Award Bottom Line… among patients who were cocaine A 2016 illicit fentanyl outbreak in FIND US ON FOLLOW US ON users, but not chronic opioid users, New Haven, Connecticut, affecting suggests that distributing naloxone individuals who thought they had and offering training to all illicit drug purchased cocaine, illustrates the need adawnewsletter ADAWnews users, their friends, and family mem- for public health and education © 2017 Wiley Periodicals,Inc. bers might prevent such opioid-as- strategies with a broad reach across View this newsletter online at wileyonlinelibrary.com sociated morbidity and mortality.” DOI: 10.1002/adaw the drug-using community. See Fentanyl page 6

A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com 2 Alcoholism & Drug Abuse Weekly February 13, 2017

Recovery from page 1 she said. Specific tools federal government should not be Still, everyone in the recovery When the Comprehensive Ad- something that happens by acci- field thinks that the gains made over diction and Recovery Act (CARA) dent,” said Michael Botticelli, former the past eight years are at risk, said was enacted last July (see ADAW July director of the Office of National McDaid,“You’d have to be naïve if you 18, 2016), it authorized a small Drug Control Policy, in recovery and didn’t think about that strategically.” amount of grant funding for “build- openly gay. “Having people in re- The long-time grassroots recov- ing communities of recovery.” This covery throughout the federal gov- ery group, which has been known could be used for recovery schools, ernment should happen by design,” for celebrating recovery, decreasing recovery supports, and other recov- he told us last week. “Under the stigma and implementing real recov- ery-related issued. “One of our jobs Obama administration there were ery support services across the coun- will be to make sure that the funding similar projects — on LGBT, on peo- try, is Faces and Voices of Recovery. from that and from the rest of CARA ple of color.” Patty McCarthy Metcalf, executive gets appropriated,” said McDaid. The focus should not be restrict- director, said that Botticelli, Coderre, CARA’s allocation of $37 million ed to addiction work, said Botticelli. and Hill helped create a “culture of gave $20 million to the Department “The recovery community needs to recovery” at ONDCP and SAMHSA. of Justice, to focus on recovery sup- demand that they be involved in “We do have a lot of people in re- port services in the criminal justice these positions and these discus- covery at SAMHSA and at ONDCP,” system, said Metcalf. “We’re advocat- sions,” said Botticelli. The recovery she told ADAW. “They may not be ing that SAMHSA and Congress nominations project will give people vocal or have leadership positions, come to a resolution” on the other in recovery a chance to step forward but they understand how far we’ve $17 million, to use money to fund “and be open not only about their come and that we can’t go back- recovery support services, she said. individual competences but their wards. They know it’s a health crisis The $1 billion in Cures money recovery.” and not a criminal justice issue.” going out to the states can be used The loss of Botticelli, as well as The national advisory council of for recovery supports, but only to Tom Coderre and Tom Hill from the SAMHSA’s Center for Substance the extent that the state wants to use Substance Abuse and Mental Health Abuse Treatment (CSAT) consists of it for that. “We have 127 recovery Services Administration (SAMHSA), many people in recovery, who are community organizations across the hurt the field, advocates agree. in leadership positions throughout country,” said Metcalf. “We gave “They are irreplaceable,” said Carol the country, said Metcalf. “Structur- them specific strategies to work with McDaid, principal at lobbying firm ally, CSAT is where the money the SSAs to become apart of that Capitol Decisions. But the recovery comes from. Any decisions around funding.” In some states, RCOs are appointment project can help, she funding for Community Support Ser- not even being invited to the table. said. “This is when the recovery ad- vices comes from CSAT, not from When the applications are in Febru- vocates are going to have to step up, CSAP [Center for Substance Abuse ary 17, more will be known about the grass roots is going to have to Prevention] or CMHS [Center for how that Cures money will be used. step up, getting good candidates,” Mental Health Services].” The Surgeon General’s report

$7056 (institutional, Can./Mex.), $7110 (institutional, rest of world); Print & elec- tronic: $765 (individual, U.S.), $788 (individual, Can./Mex.), $937 (individual, rest of world), $7805 (institutional, U.S.), $8468 (institutional, Can./Mex.), $8532 (institu- tional, rest of world); Electronic only: $555 (individual, U.S.), $572 (individual, rest of world), $6504 (institutional, U.S.), $6895 Institutional, rest of world). Alcoholism & Drug Abuse Weekly accepts no advertising and is supported solely by its readers. For address changes or new subscriptions, contact Customer Service at (800) 835- Editor Alison Knopf 6770; email: [email protected]. © 2017 Wiley Periodicals, Inc., a Wiley Com- Contributing Editor Gary Enos pany. All rights reserved. Reproduction in any form without the consent of the publisher is strictly forbidden. Copy Editor James Sigman Alcoholism & Drug Abuse Weekly is indexed in: Academic Search (EBSCO), Aca- Production Editor Douglas Devaux demic Search Elite (EBSCO), Academic Search Premier (EBSCO), Current Abstracts Managing Editor Donna Petrozzello (EBSCO), EBSCO Masterfile Elite (EBSCO), EBSCO MasterFILE Select (EBSCO), Expanded Academic ASAP (Thomson Gale), Health Source Nursing/Academic, Publisher Lisa Dionne InfoTrac, Proquest 5000 (ProQuest), Proquest Discovery (ProQuest), ProQuest Health & Medical, Complete (ProQuest), Proquest Platinum (ProQuest), Proquest Research Alcoholism & Drug Abuse Weekly (Print ISSN 1042-1394; Online ISSN 1556-7591) Library (ProQuest), Student Resource Center College, Student Resource Center Gold is an independent newsletter meeting the information needs of all alcoholism and and Student Resource Center Silver. drug abuse professionals, providing timely reports on national trends and develop- ments in funding, policy, prevention, treatment and research in alcohol and drug Business/Editorial Offices: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ abuse, and also covering issues on certification, reimbursement and other news of 07030-5774; Alison Knopf, email: [email protected]; (845) 418-3961. importance to public, private nonprofit and for-profit treatment agencies. Pub- To renew your subscription, contact Customer Service at (800) 835-6770; email: lished every week except for the third Monday in April, the first Monday in Septem- [email protected]. ber and the last Mondays in November and December. The yearly subscription rates for Alcoholism & Drug Abuse Weekly are: Print only: $695 (individual, U.S.), $716 (individual, Can./Mex.), $865 (individual, rest of world), $6504 (institutional, U.S.),

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission. Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw February 13, 2017 Alcoholism & Drug Abuse Weekly 3 on Alcohol, Drugs, and Health, re- is why we wanted to build an over- Facing Addiction, Jim Hood, lost his leased last year (see ADAW, Novem- arching movement,” he said. son to an overdose four years ago. ber 21, 2016) is being used “mas- “He never experienced recovery,” sively” in the field, said McDaid. Family loss movement said Williams of Hood’s son, Austin. There are also real possibilities The family loss movement in- “There’s a level of urgency from for the Affordable Care Act (ACA), cludes some people who are in fa- the families of loss movement that said McDaid. The bill introduced last vor of the war on drugs, who do not the recovery movement never had,” month by Senators Bill Cassidy (R- fit easily into the recovery move- he said. “If there’s anything the re- Louisiana) and Susan Collins (R- ment, which is anti-stigma. But, said covery movement can learn from Maine) would protect addiction and Williams, they do fit, in their own the families of loss, it’s that sense of mental health coverage in each of its way. “Something that Pam Hyde urgency. It’s what the AIDS move- three options for how states can “re- (former SAMHSA administrator) said ment had, and what the breast can- implement” the ACA, she said. On the often and should get credit for is cer movement had in the 1960s. We House side, there is a strategy mov- that people fight over the 10 to 15 need to fire people up.” ing forward that instead of one big percent they don’t agree with and replacement will include a series of forget about the 85 percent they do Some advocates small incremental reforms. “A num- agree on,” he said. “That’s where we ‘getting a little lost’ ber of hearings in the House Energy try to push the agenda, which for us Williams also pointed out that the and Commerce Committee appear to includes recovery, prevention, crimi- opioid crisis didn’t start last year, yet it be laying the groundwork for that,” wasn’t until last year that the Obama said McDaid. “I don’t think it’s a done administration started its push for the deal that we will lose coverage.” $1 billion that was finally realized in ‘A lot of the dust Cures. “So we have to remain optimis- Not just recovery tic going forward,” he said. Very little federal funding has bowl states who “A lot of the dust bowl states gone directly to national recovery elected Trump have who elected Trump have alcohol organizations, said Williams of Fac- and opioid problems,” said Williams. ing Addiction. Aside from some alcohol and opioid “He has the base to tackle this issue.” technical assistance, the vast majori- Williams thinks the advocates ty of the funds go out to states and problems. He has are “getting a little lost” in terms of local entities, he said. “The missing the base to tackle the ONDCP, calling for the website to gap in moving the recovery move- be put back up. “It’s not an office that ment forward is to understand that this issue.’ has much power when it comes there are local resources that want down to dollars.” Actual funding de- to support the growth of recovery Greg Williams cisions and money flowing to the support services,” he said. It’s up to states happen on Capitol Hill, he said foundations, individual families, and “That’s where we’re really excited — the federal government to help fund nal justice reform, and more that is the willingness of individuals and these resources, he said. bubbling up through the grass families to call their senators, to ask “The challenge is investment,” roots.” Unifying disparate voices is Ben Carson what he thinks about said Williams. “We need states to be an important tactic, said Williams, ecovery housing.” The ONDCP is writing grants, not just about detox, especially “when you’re trying to get “more about rhetoric,” he said. not just three weeks in an inpatient $1 billion in the Cures bill and you Still, the institutional memory at program, but about a five-year re- need everybody in every corner to ONDCP has fallen off the radar covery management plan” for each be pushing for this.” screen, said one administration offi- patient. The recovery movement histori- cial on background. “Most large- Facing Addiction doesn’t con- cally has been about “celebration of scale change happens from the sider itself a recovery organization. recovery," said Williams, while the ground up.” And from a fiscal per- “We wouldn’t take the place of the families with loss movement “has a spective, it makes more sense to po- great work Young People in Recov- lot of anger.” The recovery move- sition addiction as a public safety ery and Faces and Voices of recov- ment is “getting more angry as the issue, saying that treatment reduces ery are doing,” he said. The large death toll continues to rise,” he said. criminal behavior and saves public family loss movement — people “There’s much to learn from each health and other dollars," said this who have lost loved ones to over- other. From a recovery perspective, official. “Reach out to the new ad- doses — is a big part of Facing Ad- families of loss never get to experi- ministration and do your work lo- diction’s constituency, he said. “This ence recovery.” The co-founder of Continues on next page

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. View this newsletter online at wileyonlinelibrary.com 4 Alcoholism & Drug Abuse Weekly February 13, 2017

Continued from previous page background.” to have more federal employees who cally.” And keep in mind this one Having an ONDCP director in re- are in recovery, expanding the tent to fact: nobody is opposing recovery. covery, like Botticelli, may not hap- include other voices, and the under- The addiction issue is a bipartisan pen. Even having someone with a standing that Trump supporters want one. “Just try to have someone lead- public health background may not recovery support services too will go ing ONDCP who has a public health happen. But taken together, the move far in making voices heard. •

Botticelli’s optimistic advice: Partner with law enforcement Michael Botticelli, who as direc- talked to the sheriffs about the role forcement and supply reduction to tor of the Office of National Drug that drugs play in driving crime in one focusing more on public health.” Control Policy (ONDCP) under Presi- the streets, said Botticelli. “This is an Part of the answer was the support dent Obama championed the recov- issue that President Trump is at- of law enforcement itself, he said. ery movement, shared advice for tuned to,” he said. “The current epi- “It’s always helpful when you get un- advocates in a 30-minute phone con- demic is the worst we’ve ever seen. expected messengers who can help versation with us last week. His main It’s incumbent on the advocates to carry your message.” advice: don’t wait for something to make sure they’re putting them- “Whether it’s the new adminis- happen — make it happen first. selves in place, to say ‘We’ve known tration or Congress, they need to “It’s important for key leaders in about this for a long time, and we hear not just from the addiction field the field to not to wait for the admin- have the solutions to these prob- but from public safety and law en- istration to define what its policies lems,’” said Botticelli. forcement,” he said. “It’s really im- will be,” he said. For example, Presi- dent Trump promised to repeal the Affordable Care Act (ACA), some- thing that Republicans in Congress ‘When you get law enforcement saying had been talking about doing throughout the Obama years. “There that the biggest crime prevention tool is already significant concern about is increasing access to treatment, changes to the ACA and what that means to people with addiction,” said that’s impactful.’ Botticelli. Advocates need to “under- score the important role that insur- Michael Botticelli ance plays around getting people treatment in general,” he said. With- out coverage for treatment, crime and We still ‘can’t arrest portant for the addiction treatment mortality will go up, he said. our way out of the problem’ community to partner with law en- Botticelli had been listening to a The message that addiction is a forcement.” The National Sheriffs’ broadcast of President Trump talk- public health problem and not a Association and the National District ing to the National Sheriff’s Associa- criminal one is key. That message — Attorneys Association are among the tion before our interview. “It’s inter- embodied in former ONDCP director groups that can help. “When you get esting that he focused a considerable Gil Kerlikowske’s oft-repeated state- law enforcement saying that the big- amount of his remarks on the rav- ment that “we can’t arrest our way gest crime prevention tool is increas- ages that drugs are having on com- out of this problem” — took hold in ing access to treatment, that’s im- munities,” said Botticelli. “He talks in the Obama administration. “It’s im- pactful,” he said. “It’s one thing for a number of ways that are important portant now that the addiction field the treatment field to promote it, to the field.” But building a wall to talk about how we partner with pub- one thing for the ONDCP to do it, prevent drugs from entering the lic safety and law enforcement to but when you have the sheriffs say- country is “an oversimplification,” send the same message,” said Botti- ing it, that has an impact.” Botticelli said. “Clearly reducing the celli. “It was incredibly impactful “Sheriffs operate many of the availability of drugs is part of the so- when [Botticelli’s predecessor under jails across the country,” said Botti- lution, given the magnitude of the Obama] Gil Kerlikowske, as a former celli. “We were trying not just to heroin and fentanyl problem, but it’s police chief, said ‘We can’t arrest our work with them on supporting in- overly simplistic to say we’re going way out of this,’” he said. “People of- creased access to treatment, but to reduce drug use solely by build- ten ask me what the process was at working with them about imple- ing a wall.” President Trump also ONDCP in pivoting from law en- menting evidence-based treatment

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission. Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw February 13, 2017 Alcoholism & Drug Abuse Weekly 5 behind the walls, and on good re- tion ONDCP director was a clear conservative lawmakers of this artic- entry and early release programs.” sign of the broad bipartisan support ulate, openly gay man in long-term There were numerous meetings for the public health approach to recovery. There’s no reason for that at the White House with corrections addiction. “There’s significant con- momentum to stop just because he is officials who were shown examples sensus in an overall approach to no longer there, he said. “Continue to of what sheriffs were doing in their drug policy," said Botticelli. work with Congress on this, because jails, said Botticelli. “We brought But he is modest about his own there’s a significant consensus in an Sheriff Peter Koutoujian from Mid- personal appeal. “I don’t think I was overall approach to drug policy.” dlesex County (Massachusetts) nu- confirmed unanimously because of Botticelli was still exploring op- merous times.” who I was.” In fact, his clear-eyed tions for his next steps. “My main and honest responses to questions goal is to be sure whatever I do Not just personal before Congress disarmed any pos- makes significant contributions to Botticelli's unanimous confirma- sible criticism from even the most the field.” •

CADCA annual meeting: Training for youth to take back home The first major conference for Dean, adding that each coalition CADCA national leadership the substance use field since the works with more than 100 volun- awards went to Botticelli and Sen. presidential election took place last teers. The coalitions have federal Sheldon Whitehouse (D-R.I.). week in National Harbor, Maryland, Drug-Free Communities (DFC) grants. where more than 3,000 community- Under the terms of the grants, the Hill Day based prevention workers and training academy is required. “It’s Last Wednesday, CADCA attend- young volunteers gathered for the like getting a master’s degree in com- ees met with legislators and staff on annual leadership forum of CADCA munity-based substance use preven- Capitol Hill. “This helps our repre- (Community Anti-Drug Coalitions of tion,” said Sue R. Thau, public policy sentatives understand the importance America). Starting with Prevention consultant for CADCA, who partici- of the work done at the local level,” Day, sponsored by the Substance pated in the interview with Dean. said Dean. It helps keep funders Abuse and Mental Health Services “It’s very intense.” aware of the DFC program and of Administration, the conference had The training last week included other legislation that supports pre- more than 75 workshops on topics “hot issues” such as underage drink- vention in local communities. “We’re ranging from marijuana legislation ing, misuse and abuse of medicine also asking them to thank people,” and tobacco cessation to the opioid (prescription or over-the-counter), said Thau, noting that the funding epidemic and underage drinking. and tobacco, said Dean. “How do from the Cures Act and the Compre- “This is the largest gathering you manage your work in a state that hensive Addiction and Recovery Act, we’ve had in recent years,” Gen. Ar- has legalized marijuana?” is a key which came last year, is important. thur T. Dean, CADCA chairman and question for the coalitions, he said. “We’re shoring up the relationships, CEO, told ADAW last week. More There were almost 400 youth in and then making the case that the $1 than a training event for youth, the training at the forum last week, said billion over two years is fantastic, but forum brings together federal and Dean. “They are learning about all only a small amount is going to pre- state officials from across the coun- they need to carry out this work at vention,” she said. “We do need more try, said Dean. the local level,” he said. “We have emphasis on the front end.” At the forum, 171 coalitions re- found that coalitions who incorpo- Administration officials told ceived recognition for their gradua- rated this training are the most effec- ADAW last month that the ONDCP tion from the yearlong training in tive at convincing local and state of- drug strategy, which funds the DFC effective coalition-building. “They ficials,” he said. “Young leaders can grant program, would favor treat- take this back to their hometowns,” carry a substantial message to lead- ment, primary prevention, and stop- said Dean. ers in the community.” ping drugs from coming in at the A typical coalition has three to Speakers included Robert Du- border (see ADAW, January 30), cre- seven full-time staff members work- Pont, M.D., former director of the ating some hope that prevention ing in a not-for-profit, explained National Institute on Drug Abuse; would get more attention from the and Michael Botticelli, former direc- Trump administration. “We under- tor of the Office of National Drug stand that a new administration is in Renew your subscription today. Control Policy (ONDCP). (For an in- town, and from what we know of 800-835-6770 terview with Botticelli, see the previ- their priorities we think they will ous story on page 4.) Continues on next page

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. View this newsletter online at wileyonlinelibrary.com 6 Alcoholism & Drug Abuse Weekly February 13, 2017

Continued from previous page stay away from substances of all recently, the coalition placed seven support us in our work and helping types,” he said. “But the vibes here boxes throughout Putnam County to communities,” said Dean. “People are enthusiasm and excitement — help keep prescription medication are very concerned about the opioid these community leaders are very out of the hands of teens. epidemic, and about helping young interested in making sure parents We asked him how the confer- people stay away from substances of and young people can lead produc- ence was going, and on Wednesday all types,” he said. “The vibes here tive lives without having to endure he reported back that the organiza- are enthusiasm and excitement — the ravages of drugs.” tion’s three main goals — network- these community leaders are very ing, finding creative ways to get interested in making sure parents The local angle youth involved, and increasing and young people can lead produc- Bruce Kelly, coalition coordina- knowledge about underage drinking tive lives without having to endure tor for the Putnam Communities that and marijuana use specifically focus- the ravages of drugs.” Care Coalition, went to CADCA from ing on brain research — were met. ONDCP Acting Director Kemp Carmel, New York. “We are so ex- “We will weave the information Chester was also at CADCA. cited to be able to spend several into our meetings to apprise mem- “We understand that a new ad- days with other similar organizations bers and use it in our campaigns,” ministration is in town, and from from across the country, learning said Kelly. “Our needs are just as im- what we know of their priorities we and honing our prevention skills so portant as they were with the last think they will support us in our our community can be a better administration,” he said. “It’s crucial work and helping communities,” place, one that doesn’t suffer from for youth engagement that you in- said Dean. “People are very con- the harms of drug and alcohol volve them in the process and ac- cerned about the opioid epidemic, abuse,” said Kelly in a statement re- knowledge their importance in the and about helping young people leased prior to the conference. Most work the coalition does.” •

Fentanyl from page 1 sal drug proceeded to develop re- cocaine users who do not use opi- The report’s authors, led by An- spiratory failure. oids have received similar warnings. thony J. Tomassoni, M.D., of the De- Two of the individuals were partment of Emergency Medicine at pronounced dead on arrival at the Community response the Yale School of Medicine, credit- hospital, and a third died from mul- The report states that within a ed a multiagency response that in- tisystem organ failure three days af- few hours of recognition of the out- cluded two government depart- ter having taken the powdery sub- break, a multiagency response was ments of public health with stance adulterated with fentanyl launched. Participating agencies in- mitigating the effects of the fentanyl (there were trace amounts of co- cluded the public health departments substitution last June. “The rapid caine in the powder). On-site toxi- for New Haven and the state of Con- medical, law enforcement, and pub- cology screens found that in almost necticut, the New Haven Office of lic health actions likely limited the all cases, the hospitalized patients Emergency Management, the Con- extent and impact of this outbreak,” tested positive for cocaine. Blood necticut Poison Control Center, the the authors wrote. Leaders from de- testing found that only one patient New Haven Mayor’s Office, and the partments of laboratory medicine at tested positive for an opioid (hydro- Drug Enforcement Administration. Yale and the University of California, codone), and authors of the report Some of the initial actions of San Francisco also were co-authors stated that this “was consistent with these agencies included advising of the report. reports by the patients that most emergency medical services (EMS) were not habitual opioid users.” crews to increase naloxone doses in Onset of crisis The authors added that “this treating suspected cases of fentanyl In a period of less than 8 hours outbreak was unique in representa- overdose, and issuing public alerts last June 23, 12 individuals who had tion of fentanyl as cocaine to an specifically citing sales of the high- bought and used a white powder opioid-naïve population, which re- potency opioid being marketed as that was sold as cocaine were trans- sulted in an outbreak of fatal and cocaine. ported to Yale New Haven Hospital nonfatal overdoses.” On the day after the crisis facilities with symptoms consistent While a growing number of opi- emerged, 700 naloxone kits were with opioid overdose. Some of the oid users are likely to have been transferred from the state Depart- patients required naloxone doses far made aware of the risk of their pre- ment of Public Health to hospitals in excess of the typical initial dose ferred substance being substituted and EMS personnel in New Haven. of 0.1 to 0.2 mg, and some patients by or adulterated with fentanyl, it is On the law enforcement side, three who responded at first to the rever- considerably less likely that regular individuals allegedly responsible for

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission. Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw February 13, 2017 Alcoholism & Drug Abuse Weekly 7 the fentanyl sales were arrested less licit drug–using community. “I am quite concerned that drug than a week after the outbreak sur- They also concluded about the control policy is not paying close at- faced. lessons of the New Haven episode, tention to what appears to be a re- On a longer-term level, “This “The swift coordinated multi-agency surgence in cocaine,” Carnevale told episode resulted in the formation of response likely limited the impact of ADAW. He added, “Drug prevention a partnership between the Connecti- this outbreak, and the resultant has a major role to play at the onset cut Department of Public Health strengthening of community part- of a new wave of drug use.” and Yale New Haven Hospital that nerships has the potential to further The data that are available leave facilitated implementation of a pilot limit the morbidity and mortality re- some room for uncertainty about program to provide overdose educa- lated to opioids in communities.” the magnitude of this trend so far, tion and take-home naloxone kits to but Carnevale has suggested that a ED patients at risk for overdose. In Concern about major problem lies in a diminishing addition, community opioid treat- cocaine trend ability for the nation to identify ment programs and providers col- Details of a phenomenon that emerging drug trends. Among his laborated with the EDs to provide affected cocaine users also reinforce recommendations in last year’s poli- rapid access to treatment for patients concerns that cocaine use might be cy brief is for the CDC to develop a with opioid use disorders,” report experiencing a resurgence across surveillance program for emerging authors wrote. the nation. John Carnevale of Car- drugs, resembling its system for But the comments of the au- nevale Associates, a public policy tracking infectious diseases. thors also convey that public health and strategic planning consultant, “The new administration should efforts need to be broad-based, as it last August issued a policy brief stat- invest, or reinvest, in real-time sur- is apparently not only opioid users ing that a combination of sharply veillance systems,” Carnevale said. • who face risk from illicit fentanyl’s higher coca cultivation in Colombia entry into a drug-using community. and increasing cocaine initiation The full Morbidity and Mortality For this reason, they suggest that rates in the National Survey on Drug Weekly Report on the Connecticut public distribution of naloxone kits Use and Health offer significant rea- crisis can be found at https://www. and the accompanying training be son for concern (see ADAW, Sept. cdc.gov/mmwr/volumes/66/wr/ applied more widely across the il- 26, 2016). mm6604a4.htm?s_cid=mm6604a4_w.

SAPT 20 percent set-aside essential to SUD prevention Under federal law, states must di- of substance use before it starts. In States have the flexibility to use data rect at least 20 percent of the Sub- most states, the SAPT Block Grant to decide how to spend funds based stance Abuse Prevention and Treat- prevention set-aside constitutes most on their local needs. The average ex- ment (SAPT) Block Grant toward of the SUD prevention funding in penditure percentages below reflect primary prevention. This amounts to the state. the numbers reported by states in $371 million in FY 2017. The total • In four states, the set-aside 2015. Categories include: SAPT Block Grant for FY 2016 was makes up 100 percent of the • Information dissemination: in- $1.858 billion. The set-aside consti- primary prevention funding. crease knowledge and aware- tutes the majority of funding for sub- • In 14 states, the set-aside makes ness of the dangers associated stance use disorder (SUD) prevention. up 75–99 percent. with drug use and abuse (14.8 Last week, the National Associa- • In 19 states, the set-aside makes percent). tion of State Alcohol and Drug up 50–74 percent. • Education: build skills to pre- Abuse Directors (NASADAD), whose • In 11 states, the set-aside makes vent illicit drug use, including members constitute the single state up 25–49 percent. decision-making, peer resis- authorities (SSAs) responsible for • In three states, the set-aside tance, stress management and administering the SAPT Block Grant, makes up 24 percent or less. interpersonal communication issued an overview of the preven- (25.7 percent). tion set-aside, noting that it makes How set-aside funds • Alternatives: organize healthy up 65 percent of the primary pre- are used activities that exclude alcohol vention funding across the United By statute, the SAPT Block Grant and illicit drugs (8.6 percent). States. In some states, the set-aside prevention set-aside must be spent • Problem identification: identi- is the only funding at all used for on primary prevention services or fy individuals abusing alcohol primary prevention. services for individuals who have not and illicit drugs and assess Primary prevention is prevention been identified as needing treatment. Continues on next page

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. View this newsletter online at wileyonlinelibrary.com 8 Alcoholism & Drug Abuse Weekly February 13, 2017

Continued from previous page whether they can be helped by educational services (6.9 Coming up… percent). The annual meeting of the National Association of Psychiatric Health Systems • Community-based process: will be held March 20–22 in Washington, D.C. Go to www.naphs.org/home for provide networking activities more information. and technical assistance to community groups and agen- The National Council for Behavioral Health will hold its NatCon Conference April cies (26.3 percent). 3–5 in Seattle. Go to www.thenationalcouncil.org/events-and-training/ • Environmental: establish strat- conference for more information. egies for changing community The American Society of Addiction Medicine will hold its annual medical- standards, codes and attitudes scientific conference April 6–9 in New Orleans. For more information, go to www. toward alcohol and illicit drug asam.org/education/live-online-cme/the-asam-annual-conference. use (10.1 percent). In addition to using the money The National Rx Drug Abuse & Heroin Summit will be held April 17–20 in for general primary prevention ef- Atlanta. Go to https://vendome.swoogo.com/2017-rx-summit for more forts, states can use SAPT Block information. Grant prevention set-aside funds to The National Association of Addiction Treatment Providers National Addiction target specific populations that may Leadership Conference will be held May 21–23 in Austin, Texas. For more be at increased risk for developing a information, go to https://www.naatp.org/training/national-addiction- substance use disorder. In 2015, the leadership-conference. following populations were targeted: • Rural communities (60.0 per- cent of states). the largest source of funding for pre- Recovery Act, among other efforts.” • College students (58.3 percent). vention programs managed by state Prevention activities that are ful- • Underserved racial and ethnic alcohol and drug authorities. In re- ly funded reduce access to alcohol, minorities (50.0 percent). cent history, both state and federal tobacco and drugs; change social at- • Military families (41.7 percent). funding for substance use disorder titudes; raise awareness about the • African-American (40.0 percent). prevention and treatment have re- consequences of substance use dis- • Hispanic (38.3 percent). mained stagnant. “Despite stagger- orders; and build communities’ ca- • LGBTQ (35.0 percent). ing increases in opioid overdose pacities to effectively deal with ad- • American Indian/Alaska Native deaths, total primary prevention ex- diction, concludes the NASADAD (33.3 percent). penditures managed by state alco- fact sheet. • • Asian (30.0 percent). hol and drug authorities dropped • Native Hawaiian/Other Pacific from $583 million in 2008 to $577 For the fact sheet, go to http:// Islanders (26.7 percent). million in 2015,” noted NASADAD. nasadad.org/wp-content/uploads/ • Homeless (18.3 percent) “However, in 2016 Congress worked 2017/02/SAPTBG-Prevention-Set- with the Administration to reverse Aside-2017-2.pdf. Role of the SSAs this trend by allocating $1 billion to The National Prevention Net- States for opioid-related services in work, a component organization of the 21st Century Cures Act, and by For more addiction information, visit NASADAD, consists of state preven- approving and funding programs in www.wiley.com tion coordinators who work with the Comprehensive Addiction and SSAs to provide high-quality alco- hol, tobacco and illicit drug use pre- vention services. States work with local communities to ensure that in case you haven't heard… public dollars are dedicated to effec- Only seven weeks of binge drinking may result in alcohol liver damage, tive programs using tools such as: researchers reported last month. Just 21 binge drinking sessions in mice caused providing data for data-driven deci- symptoms of early-stage liver disease, according to work published by sion-making, workforce develop- researchers at the University of California-San Francisco in Alcoholism: Clinical ment through training and creden- and Experimental Research in the January 19 online addition. Binge drinking, tialing, performance data manage- defined as five or more drinks within two hours for a man, four or more for ment and reporting, and technical woman, frequently leads to alcohol use disorder and associated risks. Excessive assistance to community coalitions. alcohol use results in about 88,000 preventable deaths a year in the United The SAPT Block Grant remains States.

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals, Inc. publication. View this newsletter online at wileyonlinelibrary.com