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Opiate/ Heroin Working Group Final Report

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Opiate/ Heroin Working Group Final Report OPIATE/ HEROIN WORKING GROUP FINAL REPORT United States Attorney’s Offices For the Southern and Northern Districts of Mississippi February 28. 2017 HEROIN/OPIATE WORKING GROUP FINAL REPORT Law Enforcement and Data Group Recommendation No. 1: Implement a comprehensive data collection and dissemination program Recommendation No. 2: Heroin (Opiate) Involved Death Investigation Task Force Recommendation No. 3: Greater distribution and training on use of Naloxone Recommendation No. 4: Mandate greater reporting of overdoses and naloxone administration Recommendation No. 5: Expand and advertise availability of the dropbox program Medical Issues Group Recommendation No. 1: Adopt CDC Guidelines Recommendation No. 2: Continuing Medical Education Recommendation No. 3: Upgrades to the Prescription Monitoring Program Recommendation No. 4: Addiction Treatment Education Recommendation No. 5: Review Funding Issues for Alternative Treatments Recommendation No. 6: Limitations on Prescriptions Recommendation No. 7: Mandate increased use of PMP Recommendation No. 8: Change the definition of Pain Management Clinic Recommendation No. 9: IDs for Controlled Substance Prescriptions Treatment and Overdose Prevention Group Recommendation No. 1: More Funding for Treatment Recommendation No. 2: Youth/Juvenile Detention Systems Recommendation No. 3: Expand the availability and use of Vivitrol Recommendation No. 4: Drug Courts and Rentry programs Recommendation No. 5: Public Education and Awareness HEROIN/OPIATE WORKING GROUP FINAL REPORT The United States Attorney’s Offices for the Northern and Southern Districts of Mississippi convened an Opiate/Heroin Working Group in June 2016. At the initial meeting at the Mississippi Bureau of Narcotics (“MBN”) Headquarters, representatives from the medical, pharmaceutical, mental health, law enforcement, judiciary and many other specialties attended a full day symposium to begin the discussion about a comprehensive approach to the opiate and heroin crisis in the nation and in our state. Among other presenters, the group heard from the United States Attorney for the Northern District of Alabama, Joyce Vance, about the approach taken in Birmingham. That presentation was followed by a lengthy discussion of a number of initiatives being tried in other parts of the country. The Working Group followed that initial meeting with three meetings on December 13, 14 and 15 broken into a Law Enforcement Group, a Medical Issues Group and a Treatment and Overdose Prevention Group. The following are a series of recommendations that came from those three days of discussions. Prior to publication, the recommendations were disseminated to the attendees for comment, correction or dissent. Law Enforcement and Data Group Recommendation No. 1: Implement a comprehensive data collection and dissemination program The law enforcement and data group heard a presentation from an Indiana based organization (KSM Consulting) about the collection and utilization of a comprehensive data collection and dissemination program. At the June Working Group meeting, the New Jersey Drug Monitoring Initiative (DMI) was presented. Both the in house and third party models would accomplish the same goals. They would combine data in new ways to gain insights into trends; conduct studies to better understand reasons for the state’s drug abuse crisis; and visualize issues and use prediction to understand drug use over time. In doing this they would improve insight into drug abuse trends finding drug use types that were on the rise and predicting where hot spots could arise; identify trends allowing State 1 | Page employees and officials to visually see the drug abuse problem and help find ways to provide targeted help where it is most needed; and uncover other crime factors that escape notice such as a growing trend in pharmacy burglaries, for example. Through the use of data collection and analysis state and private organizations can target responses including optimizing treatment centers, Narcan dissemination and law enforcement resources. We recommend a comprehensive review of what data we have from varied sources, what data we need and a determination of how to integrate and disseminate it. Recommendation No. 2: Heroin (Opiate) Involved Death Investigation Task Force The group discussed the Cleveland, Ohio model for a Heroin Involved Death Investigation (HIDI) squad in which a group is trained to respond to any overdose situation to insure proper investigation of the scene. It is generally acknowledged that opiate overdose scenes are not, but should be, treated as crime scenes in which valuable information can be obtained that can lead to both the prosecution of individuals supplying the drugs and information about lethal substances (e.g. fentanyl laced heroin) that are available in a certain locale. After reviewing the Cleveland model for a HIDI squad, the general consensus was that there were two obstacles to effective implementation in Mississippi. First, unlike Cleveland, the geographic area to be covered in Mississippi would make implementation of a specific squad difficult. Second, as discussed below in Recommendation No. 4, reporting by coroners and other first responders that a scene is an overdose scene has not been optimal. In order to overcome these two obstacles, we recommend that sheriff’s deputies in each sheriff’s office, and police officers in each police department, be trained in overdose response investigations. We recommend at least two such HIDI certified officers for each office (see attachment 1 and 2). Recommendation No. 3: Greater distribution and training on use of Naloxone The Gulf Coast HIDTA is currently providing overdose and reversal training which includes use of naloxone. The Mississippi National Guard Counterdrug Program is encouraged to begin offering similar training to first responders. 2 | Page The state of Mississippi has a statute permitting the liberal prescribing and dispensing of naloxone (Miss. Code Ann. §41-29-319). We recommend actions that would educate the public, prescribers and pharmacists about this legislation. Recommendation No. 4: Mandate greater reporting of overdoses and naloxone administration The state of Mississippi currently requires coroners to report overdose deaths within 24 hours. There is no penalty attached to a coroner’s failure to comply. We recommend amending the requirement to make reporting of suspected overdoses mandatory that would include a penalty provision and that reporting should include not only statistical data to MBN but also reporting to the local police department and sheriff’s office for HIDI response immediately. We also recommend a reporting requirement for naloxone administration by first responders and medical personnel through an online form similar to the one used by New Jersey’s DMI program (see attachment 3). Recommendation No. 5: Expand and advertise availability of the dropbox program In some areas of the state, dropboxes are readily available. But even in those areas it is generally agreed that the availability of dropboxes for excess controlled substance medications is not well known by the general public. We recommend that the dropbox program be expanded and that a public service campaign be initiated to inform the public. Medical Issues Group Recommendation No. 1: Adopt CDC Guidelines In March 2016, the Centers for Disease Control and Prevention (“CDC”) issued a set of guidelines for prescribing opioids for chronic pain (see attachments 4 and 5). The Working Group consensus was to recommend that the Medical Board adopt the CDC guidelines. 3 | Page The American Dental Association also adopted a multi-tiered approach to the use of opioids and we recommend involving the Mississippi State Board of Dental Examiners in creating solutions for their members. Recommendation No. 2: Continuing Medical Education The Medical Licensure Board now requires its licensees to take continuing medical education on prescribing opioids. Compliance with this requirement has not been complete. We recommend enforcing this requirement. We also recommend making it a requirement for nurses, dentists, veterinarians and pharmacists. Recommendation No. 3: Upgrades to the Prescription Monitoring Program (“PMP”) It was generally agreed that the PMP is an extremely useful tool and that its ease of use has increased tremendously over the last several years. Working Group members suggested some upgrades. Specific recommendations include an ability to segregate data based on prescriber rather than facility for institutions such as UMMC and the ability to link e-records and the PMP. We recommend a task force to explore potential upgrades to the PMP that would improve access and useability while safeguarding privacy concerns. We also recommend continuing to improve links to other states’ PMPs. Recommendation No. 4: Addiction Treatment Education One of the concerns addressed was inadequate addiction treatment training and personnel. We recommend that addiction training be part of the medical school curriculum. Recommendation No. 5: Review Funding Issues for Alternative Treatments New, alternative approaches to chronic pain issues are being explored on a national level. There is some concern that these alternative approaches are not accepted by public and private insurers. We recommend a review of alternative methods and funding of the same. Recommendation No. 6: Limitations on Prescriptions 4 | Page During the course of discussions, the Group discussed New York’s recent law limiting acute pain prescriptions
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