The end goal of the Hawai‘i Opioid Initiative and its numerous partners — including medical professionals, community organizations, and key spokespeople like former UH and pro football player Chad Owens — is to coordinate a multifaceted approach to substance use prevention and treatment within the State of Hawai‘i. 2 October 25, 2020
Pūpūkahi I Holomua: Unite To Move Forward
BY KYLE GALDEIRA
The ongoing opioid epidemic represents community partners who have joined forces to Division, Department of Public Safety’s a dangerous cycle of addiction and address misuse and overdoses related to Narcotics Enforcement Division, county police destruction, which raises red flags across the opioids and other drugs. After launching three departments across the state, and an array of state as this major public health and safety years ago, HOI was organized into seven work community groups. It’s through collaboration challenge impacts thousands of people groups that meet regularly to implement the like this that such a complex and challenging throughout Hawai‘i. HOI strategic plan, which integrates substance issue of opioid addiction can be addressed and While this epidemic is less severe than what use prevention and treatment within Hawai‘i’s curtailed in Hawai‘i’s communities. is being seen throughout the continental health care system. For those seeking addiction treatment or United States, opioid misuse continues to HOI includes a multipronged action plan, recovery support services, the team at Hawai‘i needlessly kill and harm Hawai‘i’s people. which involves a comprehensive strategy CARES (Coordinated Access Resource Entry In 2018, the drug overdose death rate (age aimed at aggressively counteracting the System) is always ready and standing by to adjusted) in the 50th state was 14.3 deaths per increased abuse and misuse of opioids. Work help. A qualified treatment specialist addresses 100,000 people, compared to 20.7 deaths per groups within HOI focus on seven key areas: each case and, after evaluating the individual’s 100,000 people nationally. In 2018 alone, 213 access to treatment; prescriber education and needs, can provide information about and people in Hawai‘i died from a drug overdose, pain management; data-informed decision referrals to appropriate treatment in the area. which represents a public health challenge: making and evaluation; prevention and public For help 24 hours a day, seven days a week, call That figure is higher than the 183 people who education; pharmacy-based intervention; the 1-800-753-6879. died that same year from kidney disease. As a involvement and education of law For more information, visit hawaiiopioid.org. proactive effort to address the opioid enforcement and first responders; and “SBIRT,” epidemic, Hawai‘i Opioid Initiative (HOI) was which encompasses screening, brief The information that follows is based upon established in July 2017 in a joint effort by Gov. intervention and referral to treatment. published evidence and other generally accepted David Ige and the Hawai‘i State Department of HOI is a true partnership, as the effort is led resources available to the public. All treatment Health. by the Hawai‘i Department of Health together recommendations should ultimately be made using HOI is a collaboration of public health and with the Department of the Attorney General, professional judgment by qualified health care safety officials, health care professionals and Department of Human Services’ Med-QUEST professionals directly involved in the patient’s care. October 25, 2020 3
MESSAGE FROM MESSAGE FROM LIEUTENANT GOVERNOR THE DEPARTMENT OF HEALTH JOSH GREEN n behalf of the Department of Health, I am pleased to share the resources O available to you through the Hawai‘i Opioid Initiative. This work represents over 190 community partners across the islands that meet regularly to make hile much of our focus in 2020 has shifted to the COVID-19 substance use prevention and treatment accessible to our public through programs W pandemic, opioid use remains a growing crisis in Hawai‘i. that serve our communities and to ensure its integration into state and local priorities. Nationally, the opioid crisis has been declared a public health Substance use is a topic that many people feel is taboo, however the ability to talk emergency, and it is estimated 130 people die each day as a result of about one’s struggles openly and to not feel shame or judgment is critical for a successful opioid-related drug overdoses. Millions of individuals are affected by opioid recovery. That is why one of the goals of the Hawai‘i Opioid Initiative is to destigmatize dependency and addiction, and countless more lives have been impacted the topic so that it becomes easier for people to share and relate to others. Having spokespeople like football legend Chad Owens tell his story is integral to our efforts—it from knowing, loving or losing someone to opioid addiction. creates a safe environment where others feel they too can share their struggles, and it Opioids are highly addictive and can lead to dependency quickly. For many reminds us that it’s okay to ask for help. people, it can start with a simple health care procedure and subsequent pain Mr. Owens has appeared in PSAs promoting safe pain management and access to management regimen using opioids that leads to tolerance, dependency and substance use treatment services. “I wanted to share my story because so many of us are addiction. It can happen to anyone. struggling right now,” he explained. We would like to thank Mr. Owens for taking part In Hawai‘i, we have seen fewer opioid-related addictions and overdoses in this critical work by sharing his story with Hawai’i ’s people. His full story is available than other states, but we need to remain vigilant about the growing trend of to watch at HawaiiOpioid.org. Since the HOI launched in 2017, overdose death rates have declined and there opioid dependency and addiction in our community. Our first line of defense have been more than 200 overdose reversals from administration of Naloxone. Still, is public awareness and education, which is why I’m humbled to share a small the incidence of drug-related deaths in the state has far surpassed traffic fatalities, message in this important and special edition. with 989 drug-related deaths versus 595 traffic fatalities from 2015 to 2019. Last year, We know opioid abuse disorder touches every corner of daily life — from approximately 700,000 prescriptions for opioid or narcotic pain medication were the people suffering from dependency and addiction and their loved ones dispensed in Hawai‘i. supporting them to our health care workers, first responders, physicians and With the ongoing pandemic comes greater challenges for our people—this includes nurses who are caring for their treatment. To our public health and safety mental health and substance use challenges. We are concerned that we may see a rise in substance use and overdose as more people struggle with the emotional impact of officials, health care professionals and community partners who have banded COVID-19. together to address this immediate need in our community, thank you. Your We urge anyone who is struggling with mental health or who needs substance use efforts are seen and critically important. treatment services to call Hawai‘i CARES (Coordinated Access Resource Entry System) For those of you with loved ones — family, friends, coworkers — who are at 1(800)753-6879, available 24 hours a day, 7 days a week. Trained, caring counselors suffering from opioid abuse disorder, your love and unwavering support is also provide crisis support, as well as assistance to those in isolation and quarantine appreciated. We need you. due to COVID-19. More information about this resource is included in subsequent pages To anyone reading this and dealing with opioid dependency or addiction, and at HawaiiOpioid.org. Lastly, it’s very important right now to keep yourself and your loved ones safe and you are not alone. Reach out. Ask for help. You have an entire community avoid contracting COVID-19 by wearing a mask and practicing physical distancing. But ready to support your journey to feeling whole again. remember that being physically distant doesn’t mean you have to be socially distant— Above all, we must have hope. We can turn the tide of the opioid crisis. reach out to ohana and friends who may be struggling on a daily basis. We will do it together.
Warmly, Be well, Hawai‘i, and take care.
Josh Green, M.D. Edward Mersereau, LCSW, CSAC Lieutenant Governor, State of Hawai‘i Deputy Director, Behavioral Health Administration 4 October 25, 2020
WORK GROUP 1: TREATMENT ACCESS
BY CAROLINE WRIGHT
argeting opioid misuse and ad- can help reduce deaths in the case of T diction, as well as addiction to opioid overdose. In 2019, Hawai‘i’s Al- stimulants such as methamphet- cohol and Drug Abuse Division (ADAD) amines, Hawai‘i Opioid Initiative’s Treat- purchased 1,776 naloxone kits (3,552 ment Access group works to improve doses) to distribute to partnering agen- and modernize health care strategies in cies and trainees. Kits were distributed Hawai‘i, with a special focus on treat- to syringe exchange programs run by ment and recovery services. Hawai‘i Health & Harm Reduction Cen- “We want to improve systems for ter, and in high-intensity drug traffi ck- higher quality, as well as better coor- ing areas, as well as to Kaua‘i and Maui dination,” says co-chairman Alan John- police departments, Hawai‘i Island HIV/ son, who is also president and CEO of AIDS Foundation, and others. Hina Mauka prevention and recovery Additionally, 28 training sessions on center in Kāne‘ohe. “Additionally, we medication-assisted treatment were identify procedural improvements conducted, expanding training for 448 and address challenges in barriers for providers. people to engage in treatment.” Though the group’s physical meet- The group’s achievements include ings have stopped for now, due to the advocating and providing advice for pandemic, Johnson says the energy of the state Department of Health as it its participants, which includes treat- developed a call center for the com- ment providers, insurers, government munity and providers to ask for help representatives and members of the to start treatment. Launched on Oct. community, remains high. “We quickly 1, 2019, Hawai‘i CARES (Coordinated adjusted to Zoom meetings, and our Access Resource Entry System) is the state’s multiple entry-point and co- ordinating center for substance use disorder treatment and recovery sup- port services, providing valuable con- tinuum of care. Referrals can originate from anyone. Hawai‘i CARES received 400 referrals in its fi rst month of oper- ations; 60-70 percent were new clients. “Our group also provided advice, attendance in September was the as Native Hawaiian practices that can advocacy and training to promote highest ever, with about 25 active be integrated into treatment methods. the concept that behavioral health members,” he reports. “Community engagement is very providers use medications, such as Through CARES, the group contin- welcome,” says Johnson. “We appre- Suboxone and naltrexone, to help in ues to address systems and proce- ciate stories, successes and concerns counseling,” Johnson adds. “The meds dure challenges for coordinating care about people wanting to access treat- reduce cravings and withdrawal symp- through a call center. They’re also tack- ment, and how we could improve it. We toms for people going through opioid ling systemic changes for improving are experiencing a lot of momentum as treatment.” criminal justice approaches to off end- more people come forward wanting to Access to naloxone has been iden- ers in treatment. The group will con- work together.” tifi ed as a key prevention activity that tinue to explore ideas for expanding Learn more online at hawaiiopioid. medication use in treatment, as well org/get-help. October 25, 2020 5
The professional care team at Hawaii Cancer Care recognize the special needs of patients diagnosed with cancer. Our highly trained team uses a multidisciplinary approach to cancer treatment that is specialized to each patient and precise for their disease. This means bringing the latest in medical innovation to diagnose and treat cancer. Our care philosophy includes providing supportive services in addition to medical treatment and a commitment to providing the best patient experience as possible. Call us at (808) 524-6115, send an email to We are here for you, right [email protected], here in your community, and or visit us at are fully open and operational despite the COVID-19 health www.hawaiicancercare.com pandemic. In addition to in-person services provided in our clinics, where we have put full infectious disease safety protocols in place, we offer telehealth visits, which connects you with a Provider via telephone or video conference. www.hawaiicancercare.com 6 October 25, 2020
ore than 200 people in Hawai‘i died M from an opioid drug overdose in 2018. It’s evident that time is of the es- sence when responding to an overdose. Clear signs of an opioid overdose include inability to wake up (attempt to rouse them by rubbing your knuckles hard on their sternum); slow or no breathing; pale, ashy and cool skin; and blue lips or fingernails. An opioid overdose can come on suddenly or occur over the course of a few hours, and the risk is greater when opioids are combined with alcohol or other drugs like sleeping pills, benzodiazepines, cocaine and methamphet- amine. If you think someone has overdosed on opioids, call 911, administer naloxone (if avail- able) and stay with them until help arrives. You can also perform “rescue breaths,” which the National Harm Reduction Coalition explains as getting the person on their back, tipping their head back to straighten the airway, pinching their nose, putting your mouth over theirs to form a seal, and administering one breath ev- ery five seconds. Visit hawaiiopioid.org/prevent-overdose or opirescue.com to learn more on how to respond to an opioid overdose, and other steps you can take. Testimonial What Exactly Is “ As an outreach worker, I distribute naloxone kits to the community for our participants to carry and use so no one dies from an overdose. Sometimes Naloxone? I am called on to use them myself to save a participant’s life; when someone panicking runs to the van, there is no Naloxone is a medication — there are injection and nasal administration hesitation. One time, a program partic- methods — that has been proven to stop the effects of opioid overdose and ipant down the street was laying there save lives. One of Hawai‘i Opioid Initiative’s key achievements was allowing trained pharmacists to prescribe and dispense naloxone, which is often re- blue, unresponsive and not breathing. ferred to as an “opioid antagonist.” After the easy administration of nalox- Within the state, it’s legal to carry naloxone (also known by the brand one nasal spray, in minutes that person name Narcan). It is not a psychoactive and has no potential for misuse or was breathing, coherent and, most im- abuse. In fact, side effects are rare. Naloxone is an inexpensive, FDA-approved portant of all, alive. It is rewarding and a generic drug that works to reverse an opioid overdose, including fentanyl comfort to know that I can, and truly that overdose, by restoring breath to unconscious overdose victims. anybody can, prevent a needless death To get naloxone, the public should contact their primary care provider, at any time, any place with naloxone. ” or they can get naloxone from HHHRC (hhhrc.org/overdose). Some pharma- cies are also able to dispense naloxone without a physician’s prescription. — PaijBritt Emmanuel Check with your pharmacist for more information. Visit hawaiiopioid.org/ prevent-overdose to learn more. October 25, 2020 7
WORK GROUP 2: PRESCRIBER EDUCATION & PAIN MANAGEMENT
BY CAROLINE WRIGHT
n 2016, 50 million — or 20 percent and all the changes to the way we I — of American adults were affected manage pain in general,” says Roy Goo, by chronic pain. As many as 29 per- co-chairman of the work group and cent of these adults misused their pre- associate professor/department chair scribed pain medication, and up to 12 of the Pharmacy Practice Department percent actually developed an opioid at the College of Pharmacy at Univer- use disorder. sity of Hawai‘i - Hilo. “Our work group With an overall goal of improving tries to educate providers about the prescribing practices for opioids and appropriate use of opioids, and even related drugs, the Prescriber Education more so, about appropriate manage- and Pain Management work group ad- ment of pain and how to help patients dresses several areas that are critical to manage complex pain syndromes.” Hawai‘i Opioid Initiative. The goals of a pain manage- The group’s objectives include an in- ment treatment plan include relief, creased understanding of the benefits improved mental and emotional and risks of opioids; increased aware- well-being, decreased disability, and ness of unsafe opioid use; expanded improved overall quality of life. patient use of alternative treatment “Pain, especially chronic pain, is options; and improved patient access so subjective that it’s often difficult to overdose treatment. to have conclusive evidence of effi- “There’s a lot of conflicting informa- cacy,” Goo points out. “It’s a balance tion and misinformation about opioids, to represent different perspectives
and tailor the approach to individual patients, and stress that we really need Testimonial to look at each one and take individual circumstances into account.” “ I have gotten to know many suffering from an opioid use disorder who Traditionally, Goo explains, most phy- weren’t able to access “traditional” (abstinence only) treatment since I started sicians and pharmacists receive con- working with H3RC two years ago. I used to believe that Hawai‘i wasn’t part tinuing education through in-person of the opioid epidemic because I rarely encountered those whose drug of conferences, but efforts have shifted choice were opioids in more traditional treatment settings. It turns out that to online platforms, a movement mo- Hawai‘i has many community members engaged in chaotic opioid use who tivated by economics and accelerated addressing opioid addiction in states opioid prescriptions per patient, and can’t access inpatient services due to the complexities of opioid use with- by COVID-19. like New Mexico, by increasing the an increase in prescriber confidence, drawal and the state lacking the available resources to detox. Since working “We’ve focused on collaborating number of physicians qualified to dis- knowledge and self-efficacy. in harm reduction, I have witnessed how important access to Buprenorphine with various organizations, including pense or prescribe medication-assisted Also in development: online edu- is for clients who want to manage their opioid use. Buprenorphine offers an health systems, the Department of treatment for opioid addiction. ECHO cational modules that talk about dif- extra layer of reassurance that they can balance preventing withdrawal symp- Health, JABSOM and the Pharmacy provides continuing medical education ferent aspects of opioid use and pain toms while also not abusing the opioids. I must also stress the importance School,” he reports. “We’ve brought in a grand rounds format, attended by management. “They’ll be available to of having this medication be covered by insurance, as many who need it are these entities together to provide ed- providers, social workers, pharmacists, providers, caregivers, social workers, part of our most vulnerable populations. I am grateful to see more providers ucation on a distance-based platform.” case managers and other health care medical support staff and the public,” willing to prescribe and work with people taking Buprenorphine. ” Project ECHO (Extension for Commu- workers. says Goo. “The more education every- nity Health Outcomes) is a highlight of Studies of ECHO Project’s effec- one has, the better.” — Natalia Werkoff, a certified substance abuse counselor and licensed the group’s achievements. The ECHO tiveness in other cities show an aver- For more information, visit hawaii- clinical social worker model has been proven effective in age decrease of 23 percent in annual opioid.org/manage-pain. 8 October 25, 2020
BY KYLE GALDEIRA
As a spokesperson for Hawai‘i Opioid Initiative, former UH and pro football standout Chad Owens uses his personal testimony to help those battling opioid addiction.
s a football player performing at the highest maximize output from healthy players. Essentially, do. That’s what’s helped them last so long ... it’s Owens found that he needed to use safer A level during each stop of his impressive ca- an all-world talent does nothing on the bench. what allows them to go out there and play like means of pain recovery and relief, including eating reer, Chad Owens made it a habit of playing Owens recalls seeing veteran players using Superman; let me get that.” better and cutting out intense painkillers, because through pain. medication to mask injuries so they could play It was this by-any-means-necessary mindset masking pain ended up making him feel worse After all, making the choice to remain on the through pain and perform on the fi eld during that led Owens to initially discard any concern and had more dramatic eff ects on his body. sideline to heal while dealing with injuries could games. As an up-and-coming prospect in the regarding his long-term health and well-being. “Trust me, I’ve felt it the next day, worse than have spelled an early end to his career, which took professional ranks, Owens thought that he, too, At that time, it became about living in the mo- it was prior to the game, and it’s not a good feel- him from local star at Roosevelt High School to needed to buy into this culture of masking pain in ment — about making sure he’d be on the fi eld ing,” Owens said. “When you take pain meds, you’re prodigious wide receiver and kick returner at order to have a chance of making and remaining to perform and extend his playing career. essentially putting a Band-Aid on by masking the University of Hawai‘i, and all the way to an illus- on a team. “I found that even when I didn’t have any issues, pain, and you don’t really let yourself heal. It then trious professional career in the National Football “You take it so you don’t feel any pain, so you I would still get in line (for painkillers) because that becomes a habit because even when you aren’t in League (NFL) and Canadian Football League (CFL). can go out there and play at 110 miles per hour, was part of the routine,” Owens said. “My lack of pain, you get addicted to the numbness (that the In football’s professional ranks, a lengthy injury every single play,” Owens said when discussing knowledge about it caused me to jump in line. medications cause). After learning more about the can often lead to players getting cut, as the busi- painkillers. “For a one- or two-year guy, seeing vet- But once I realized that this wasn’t healthy for me, I dangers, I decided not to go that route.” ness of the sport requires teams to trim rosters and erans doing this, you just think that’s the thing to made a decision to use alternate forms of pain relief.” Owens came to realize that it was OK to be October 25, 2020 9 injured, because that’s part of a dangerous game like foot- ball. He understood that pain should be a guide that your body should follow: If you feel so much pain that you can’t play, then you should rest and recover. It’s a simple mindset, but one that was, and to a de- gree still is, not widely accepted in professional sports. As a counter to pain medica- tion, Owens worked on strength- ening his mental toughness as a way to naturally address pain and help his body heal effi ciently. He began to trust his body’s natural instincts, and realized that miss- ing a practice or game paled in comparison to the long-term negative eff ects of using opioids to mask pain, which can often lead to more devastating and lingering injuries. “When you feel pain, that’s your body’s way of telling you to chill out. If I can manage the pain myself and endure it, then cool,” Owens said. “But, if not, then I needed to sit out. Now that I’m done playing, I’ve found other ways to decrease infl ammation by eating better and having a different mental approach. I don’t care what anyone else says. I’m doing what’s best for myself, my body, and the future of me and my family.” Owens notes that everyone
deals with pain throughout life, you need,” Owens said. “Football focus on business classes, create whether it’s physical pain via in- is here and gone in the blink of more, be artistic.’ It’s going to be jury or mental anguish and issues an eye. Even though I’ve played hard because these guys want that may not be noticeable exter- more than 20 years of football, to go to the ‘show.’ But, along the nally. He has learned that a use- more than half my life, there’s still lines of ‘Can you do it the natu- ful tool when it comes to dealing so much life ahead of sports that ral way?’ Yes, you can, you just with pain is simply talking to peo- you need to dig deep, soul search need to diversify your dreams ple, whether its family, friends or and fi gure out ‘Is it worth it?’ because sports will come to an medical professionals. “Even if you get that schol- end, but will you be capable of “Especially for youth, if I could arship or make it to the pros, doing that next thing if you’re give them a message: It’s OK to statistically the downside of addicted to pain meds? If you’re take a break and miss a prac- what can come from abusing depressed, you’re not going to tice or repetition, even a game pain medications, you can lose be able to take that next step in sometimes, because your body it all. If I could go back, I’d tell my with approaching life with men- is a machine and it tells you what younger self, ‘I want you to also tal and physical health intact.” 10 October 25, 2020
WORK GROUP 3: DATA-INFORMED DECISION MAKING & EVALUATION
BY CAROLINE WRIGHT
he earliest objective of of the data behind the Initiative T Hawai‘i Opioid Initiative’s and its initial activities, and going Data-Informed Decision forward, behind a lot of the work Making & Evaluation Group in- groups.” cluded a significant revision of The data-driven work group a law. has made progress with a pre- The change to the Uniform scription drug-monitoring pro- Controlled Substances Act, which gram (PDMP) that helps identify opened the door for limited re- patients at risk for overdose or lease of data by the Narcotics misuse of controlled substances. Enforcement Division to the De- The PDMP can reveal if a patient is partment of Health, helped the dispensed controlled substances work group move toward devel- by multiple providers and multi- oping a standardized framework ple pharmacies. The group is for the collection, analysis and also working toward innovative dissemination of data on opioid utilization strategies of the PDMP, use in Hawai‘i. such as incorporating naloxone “Our group had an early pres- prescribing and dispensing. ence in the initiative,” comments “The PDMP shows there’s less fectly legitimate consumers of from the Laulima Data Alliance. efficiency of the state’s health levels,” Galanis adds. “That’s a big co-chairman Daniel Galanis, epi- prescriptions being written for opioids have been cut off, or A nonprofit subsidiary of the care services. resource for describing epidemi- demiologist for the Department high-dose substances,” says Gal- struggle to obtain the meds they Healthcare Association of Hawai‘i, “Their small shop manages to ology of this issue.” of Health’s Emergency Medical anis. “I think we can interpret that need. It goes back to careful pre- Laulima collects, analyzes and maintain a repository of hospital Goals for the work group Services & Injury Prevention Sys- as likely that prescribing practices scribing and case management.” disseminates statewide health records from every acute care include the collection of emer- tem Branch. “We were probably are becoming more informed. Galanis says his group is grate- information in support of efforts hospital in the state, both at emer- gency department data on all sus- the main contributors in terms The downside is that some per- ful for the support it receives to improve the quality and cost gency department and inpatient pected drug, opioid, heroin and stimulant overdoses, and of drug overdose death circumstances us- ing death certificates and medical Testimonial examiner/coroner data. “Mortality has actually been “ I love him deeply (my brother). I really miss him. Even if a family tries to intervene, as decreasing related to opioid we know, this is coming from a recovering alcoholic, that doesn’t always work. That person overdoses, whereas metham- has to be ready to get sober. And I think he was just in so much physical pain, emotional phetamine mortality has gone up pain, mental pain. Sometimes families can really hide their feelings, and they have the same in recent years,” observes Galanis. story that plays out year after year, generation after generation. I really think we need to “That’s not to say we’re done with get rid of stigma so people can talk freely about these things so there’s not so much guilt one and we can move on to the around it, so people can move on and heal. We have to get rid of this stigma so people don’t feel ashamed and they’re more apt to get help. If you can’t talk about it in the family, next. Though the HOI was funded if you can’t talk about it in the community, that’s not a good thing. I feel so honored to be around opioids specifically, this able to share my brother’s story, as sad as it is, in hopes that I can save somebody’s life. initiative was constructed to be This has been heartbreaking to me. If I can reach somebody, a family member that has a able to pivot to other substances, loved one, that’s addicted, or the person that’s struggling themselves just to get rid of that with the basic underlying philos- stigma and go, yeah, I need help. Sometimes you feel so helpless because you’ve got to hit ophy that the issue of addiction your bottom, whatever that looks like. Unfortunately, he hit a bottom that took him out. ” can take different forms.” For more information, visit — Catherine Cooper hawaiiopioid.org/learn-the-facts. October 25, 2020 11 Reliable Resources For The Community
ne of the best ways to spread aware- mation on everything from videos detailing O ness is by supplying the public with how drugs affect the body to lessons about ample information. That’s why Hawai‘i drug facts. In addition, there are links for in- Opioid Initiative offers resources on its website formation covering drug abuse outside of for the public to peruse. Find a link to con- opioids, as well as HIV and hepatitis testing, versation starters to refer to when sparking a and needle exchange sites. critical discussion with children about medi- Whether you are a patient, parent, teen, cine abuse. doctor, pharmacist or first responder, check Teens and teachers, meanwhile, can check out resources tailored for you at hawaiiopioid. out a website that offers science-based infor- org/resources.
Testimonial
“ I want people to know that life can be so much better. If you de- cide to change, there’s so much help. There are people willing to lis- ten and to help you. You don’t have to live that way. You can live the life you always wanted. You can be what you always wanted to be. Have your own money. Have your own things. Don’t have to steal. Life is too precious. And, you know, your life is too precious. Love yourself. ”
— Candie Spencer
2015-2020 6-YEAR LEGACY AWARD Whether you have been Medicare affected by Covid-19, turning 65, retiring, or already have Medicare, Returning the patient to Annual Enrollment I would be glad to assist health on ke ala pono: you. My promise to you is Oct. 15 - Dec. 7 is to provide honest the right path and unbiased guidance for recovery. with all aspects of your Medicare benefi ts. As “It made it easier for me to get help, it took away IF YOU an independent agent the fear and embarrassment to be online.” that represents most The McKenna Recovery Center is a patients say: “It was easier for me to NEED HELP Medicare plans available private intensive outpatient treatment get help, it took away the stigma and CALL ME. in Hawaii, my goal is to program for substance use disorders embarrassment by being seen online” serving the State of Hawaii via We are grateful to be among very Vance Kobayashi guide you to a plan that Telehealth. few programs with a full time medical fi ts your needs. Best of We are grateful to serve you for director dually certifi ed in Psychiatry over 30 years from Ke Ala Pono - Kauai and Addiction Medicine, who has been all, there is never a fee and additional clinics: the Honolulu dedicated to providing evaluation, 808-780-7989 for my services. Professionals Program and the detoxifi cation and treatment with a or, email [email protected] Manager’s Recovery Program. multi-disciplinary behavioral health team Virtual services allow us to see you to support you in your recovery from Mahalo and let’s get in the comfort of your home, where addiction. through these diffi cult Call for an appointment (808) 246-0663 or times extending the email [email protected] aloha spirit to each other! Gerald J. McKenna, M.D., FASAM, DLFAPA 1585 Kapiolani Blvd., Suite 1020, Honolulu 96814 Board Certifi ed in Psychiatry and Addiction Medicine 12 October 25, 2020 October 25, 2020 13 “I’m glad I reached out. The best form of recovery is talking to someone.”
Chad Owens Hawai‘i Football Legend Pro Football Player
To connect to substance use treatment services, call Hawai‘i CARES at 1-800-753-6879 14 October 25, 2020
WORK GROUP 4: PREVENTION & PUBLIC EDUCATION
BY CAROLINE WRIGHT
awai‘i Opioid Initiative’s fourth H work group, which focuses on Prevention & Public Education, is assigned the task of improving com- munity-based programs and public ed- ucation to prevent opioid misuse and related harms. “Basically, we focus on building re- siliency and innovations within com- munities, families and people with lived experiences in Hawai‘i,” explains co-chairman Thaddeus Pham, who also serves as the Viral Hepatitis Prevention Coordinator for the Hawai‘i Department of Health. Early goals for this work group in- cluded the development of a multi- level public awareness campaign that included a website, social media and collateral material, all designed to in- crease awareness of opioid issues, risks and centralized resources. The web- site, hawaiiopioid.org, is packed with resources for the general public and specific community segments (e.g., pharmacists, parents and teens). “Tied in with the website, our work in August 2019. By November 2019, ty-driven approaches to opioid preven- group has developed broadcast and website traffic increased by 286 percent tion and education. “We know that our digital campaigns to promote risk as- and averaged 70 visits a day. work must continue, since COVID-19 sessments and pain management op- “Our group has also helped im- has not only health but also social im- tions,” says Pham. plement year-round drug ‘take-back’ pacts, such as depression, isolation and Patients can use the website to ob- boxes in all counties across the state,” suicidality, that can contribute to opi- tain more info about Hawai‘i CARES says Pham. oid misuse and related harms, like HIV, (Hawai‘i Coordinated Access Resource In survey responses, representa- hepatitis C and overdose,” says Pham. Entry System, the state’s new multiple tives from many community organi- As the end of 2020 draws near, the entry-point and coordinating center zations said they benefited greatly group’s objectives include ongoing for behavioral health services including from high-impact initiatives like those promotion of the HOI website as the substance use disorder, mental health, “take-back” boxes. HOI’s website even one-stop shop for local resources Pham. “We’ll also be taking a broader Visit hawaiiopioid.org/learn-the-facts and crisis intervention services). includes Google mapping of the year- around opioid prevention and educa- look at how our local communities for a brief anonymous quiz to see if you The site also includes tips on pain round drug “take-back” boxes on each tion. are already doing things to keep our might be at risk for opioid dependence. management, preventing overdose, island. “We’ll continue, as needed, to de- families healthy and resilient. That way, To learn more about how you can get safe storage and disposal of medica- During the COVID-19 pandemic, the velop local media campaigns that we can promote local innovations that involved with HOI, visit hawaiiopioid. tions, and more. An awareness cam- work group has continued to meet, drive people to the website to learn truly come from — and are made for org or send an email to hawaiiopioid@ paign for the new resource launched working toward more communi- more and get linked to services,” adds — our ‘ohana.” gmail.com. October 25, 2020 15
ccording to the state Legislature, opioid-related over- Thanks to the vigilance of community groups and orga- substance abuse, health care and drug treatment. A doses resulted in upward of $9.8 million in hospital costs nizations like Hawai‘i Opioid Initiative, there are a number of For more information and status updates on the bills listed back in 2016. bills going through the state Legislature regarding opioids, below, visit capitol.hawaii.gov.
HB 35, HD1 HB 933, HD2 SB 2592 SB 2505 SB 2773 Testimonial Relating to Mental Relating to Crisis Relating to Health Opioids Health Drug Treatment Intervention (Non-forensic Stabi- Requires providers “ (When I was addicted), my Authorizes expenditures Appropriates funding Creates a crisis inter- lization Crisis Resi- authorized to prescribe mind was always churning. I from the mental health and for the implementation vention and diversion pro- dential Beds) opioids to discuss with couldn’t stay still. Not being substance abuse special and development of the gram in the department Requires and appropri- patients certain risks as- present. You know, I think fund to be used for capital Hawaii coordinated ac- of health to divert those ates funds for the Depart- sociated with controlled that’s the biggest red flag is improvement projects. Ef- cess recovery entry sys- in need to appropriate ment of Health to establish substances that are opi- when you’re spending time fective July 1, 2050. (HD1) tem to increase access to health care and away from oids prior to issuing initial with your family, and they’re treatment for all individ- a continuum of stabiliza- the criminal justice sys- opioid prescriptions for just all over the place versus uals who suffer any form tion beds statewide for tem. Appropriates funds. the treatment of acute just being present with you HB 2022 of substance abuse and non-forensic patients with Sunsets on June 30, 2023. substance abuse or mental pain. Requires providers face-to-face. mental illness. Requires I would wake up in the Relating to the Mental Effective July 1, 2050. (HD2) health disorders, or both, to include a note acknowl- the DOH to pursue all morning and take three pills by repurposing unused edging the discussion of Health and Substance known funding sources just to get out of bed, like state facilities. (SD1) the risks associated with Abuse Special Fund for drug treatment pro- someone drinking coffee. I HB 2522, HD1 opioids in the patient’s Authorizes expendi- grams prior to expending needed those pills just to get medical record. tures from the mental general revenue funds ap- me out of bed. health and substance Relating to Health propriated. Requires DOH HB 2237, HD1 At the end, when I realized abuse special fund to be Requires DOH to estab- to exhaust all public and what I was putting into my Relating to Drug used for certain capital im- lish a continuum of stabi- private insurance options Noteworthy Measures from body, when I was detoxing, I provement projects. Limits lization beds statewide for reimbursement for Disposal the Past was up to about 20 to 23 pills the expenditures for capital by repurposing unused individual treatment pro- Establishes the Drug SB2247 SD1 HD2 CD1 a day. So I got to the point improvement projects to state facilities for short- vided before expending Disposal Program, admin- (2018), Act 154 where I had to take a pill or istered by the Department an unspecified percentage term residential use by appropriated funds. Relating to Opioid Antag- two, sometimes three every of the Attorney General, to of total expenditures from non-forensic patients with onists hour just to get through my dispose of prescription and the special fund and an substance abuse or men- Authorizes pharmacists day. over-the-counter drugs in unspecified percentage of tal health conditions, and to prescribe, dispense, and What I learned is that when SB 2506 a safe, secure, and environ- the total surplus of the spe- accessing and triaging provide related education I was an active user, active pill mentally friendly manner. cial fund. Excludes projects the patients to a clinically on opioid antagonists to taker, basically it allowed me Establishes the Drug Dis- that would expand inpa- appropriate level of care Mental Health and individuals at risk of opi- to not be present. And it just posal Special Fund and ap- tient forensic capacity at through the Hawai‘i coor- Substance Abuse oid overdose and to family allowed me to escape from propriates funds. Effective things. And later on in life, I the Hawai‘i State Hospital dinated access resources Special Fund members and caregivers of July 1, 2050. (HD1) found I found out that it just from permissible capital entry system. Appropri- Authorizes the men- individuals at risk of opioid numbs you from the world. improvement projects ates funds. Takes effect on tal health and substance overdose without the need You know, it robs you from funded from the mental Dec. 31, 2059. (HD1) abuse special fund to be for a written, approved col- being present in people’s health and substance used for certain capital HB 668, HD1; SB 534 laborative agreement; sub- lives. It robs you of your life. abuse special fund. Effec- improvements. Requires ject to certain conditions. I haven’t taken any prescrip- tive Dec. 31, 2059. (HD2) HB 1807; SB 2225 the Department of Health Relating to Health Care (CD1) tions. I haven’t taken any- to identify, among other Requires DHS to obtain thing stronger than Tylenol The Physical Therapy things, capital improve- legislative approval prior Senate Concurrent Reso- or Advil. HCR 65; HR 50 ment projects that should to reducing the number lution 103 (2019) Practice Act And in all honesty, I actu- Clarifies the scope be made with moneys of medicaid plans available Urging the inclusion of Recognizing and sup- ally had my chart flagged, my of practice for licensed from the mental health in any part of the State. Re- Native Hawaiian cultural porting ongoing collab- medical records say do not physical therapists to in- and substance abuse spe- quires an audit and legis- intervention treatment pro- orative efforts between prescribe me any narcotics, clude the practice of dry cial fund to improve the lative task force to review grams, wellness plans, and the Department of Health, patient is highly addictive. needling. Expands other continuum of care for be- DHS’ request for informa- holistic living systems of HEP Free Hawai‘i, and oth- Because it’s easier. It’s easy to competence-related ac- havioral health and submit tion and request for pro- care in the state of Hawai‘i’s ers to produce a statewide get it again. ” tivities to include certain a report to the Legislature. posals processes regarding response to the rise of mis- plan to eliminate viral hep- dry needling specific Repeals on June 30, 2025. RFP-MQD-2019-002. Effec- use and abuse of opioid or — Alberta Silva atitis in Hawai‘i. knowledge. (SD1) tive July 1, 2050. (HD1) illicit substances in Hawai‘i. 16 October 25, 2020
WORK GROUP 5: PHARMACY- BASED INTERVENTION
BY CAROLINE WRIGHT
hen Patrick Uyemoto ity is the biggest piece. If people W first got involved with can just get naloxone from their Hawai‘i Opioid Initiative pharmacy, it’s a lot easier than a few years ago, the effort to ad- having to schedule an appoint- dress opioid addiction in Hawai‘i ment, go to the doctor’s office, was in its nascent stages. get a prescription, and then find “The state put all these peo- a pharmacy that will fill it.” ple, all these resources, together Access to naloxone is a nation- in one room to think about how ally and universally recommended we could respond to the opioid practice, proven to reduce the pandemic,” recalls Uyemoto, who incidence of opioid deaths due is director of pharmacy for Times to overdose. Many states have in- Pharmacy, the pharmaceutical stituted a standing order that al- department at Times Supermar- lows pharmacists to dispense the ket. “We got perspectives and lifesaving medication. Thanks to buy-ins from multiple organi- Hawai‘i Opioid Initiative, the Aloha zations and departments. They really tackled this issue in a very good way.” As co-chairman of the Phar- macy-Based Intervention work group, Uyemoto helped his team State passed a similar law during by University of Hawai‘i at Hilo Moving forward, the Phar- establish objectives that would the 2019 Legislative session. - The Daniel K. Inouye College macy-Based Intervention group prove to be deeply impactful. SB535 authorized pharmacists, of Pharmacy, was presented to is developing resources for ha- “Working with various partners acting in good faith and exercis- pharmacists across the state. The waiiopioid.org, including a list of in the Department of Health and ing reasonable care, to prescribe response has been overwhelm- pharmacies that participate in the their relationships in the Legisla- and dispense opioid antagonists ingly positive. naloxone program. The group will ture, we were actually able to pass like naloxone to patients at risk “I think the DOH recognized continue to provide training for a bill that allows pharmacists to of overdose, and/or to their the accessibility of community pharmacists on naloxone access prescribe and dispense naloxone,” family members and caregivers. pharmacies,” says Uyemoto. “The to patients, along with continuing he says. “That prescription author- Naloxone training, developed pharmacies are very dedicated to education on the pharmacist’s role their communities and their pa- in screening patients for opioid de- tients, so wherever they can help, pendency and addiction risk. Testimonial especially on the neighbor islands “The state really did a good where resources are limited, job when it created this initiative,” they’re happy to do new things Uyemoto remarks. “We’re just one My theory was, as long as I wasn’t picking out something that was in a baggie, it wasn’t as bad. I thought because I was “ to support their communities and getting these pills from a doctor, I convinced myself that this was fine. Each paycheck, I would spend about $500 just to make of seven groups, just one arm of myself feel better. I did a lot of it to numb myself. When there’s nothing to numb yourself with, those feelings are going to protect their patients.” this effort. We’re all collaborating to come back and they come back harder. If you are able to gather a big group of friends and a group of people you can call As the primary points of con- help protect Hawai‘i and prevent family like I did, you’ll make it through. There are people that are going to be there for you to lean on. It was crazy because, tact for patients with opioid and the opioid epidemic from taking you know, when you’re a kid, you never expect that that’s where your life’s going to be. And when you get to that point and other narcotic prescriptions, hold here, and I think it’s been you’re looking back and you’re like, was that worth it? I think that was the hardest part for me. When I looked at everything pharmacists can provide key successful.” and I was like, I did all this for nothing, to end up in a shed with random people that don’t even know my first name. ” screening and education. They’re More information for pharma- also well-positioned to support cists is available at hawaiiopioid. — Gabe Bautista public awareness efforts. org/resources. October 25, 2020 17 Tips for Appropriate Medication Storage
awai‘i Opioid Initiative encourages the Testimonial •Store medications as recommended by the manufac- community to be vigilant about keep- H turer and your doctor or pharmacist. “ My younger son has a severe substance use disorder, and his drugs of choice are ing their medications safe and secure. opiates, which include prescription painkillers and heroin. He knows how important it Best practices for storing prescription painkill- • Don’t leave medications in checked is that he stop. One evening, he looked at me, near tears, and said, ‘A woman at my AA ers and other medications include a lockbox, bags when flying. Put them in your car- ry-on luggage. meeting told me I would die. And I will, if I don’t beat this.’ I’ve heard a heroin addict safe or locked medicine cabinet to prevent relapses an average of nine times. This is not a treatment failure; the physiological any of the aforementioned uses or misuses. • Don’t put medications in the trunk while driving. changes that have taken place in the brain take months, sometimes years, to return However, if locking up medications is not a Rather, keep them in the car when driving and take to normal. Relapse is part of the disease. viable option, the next best thing would be them with you when you park your vehicle. Getting useful information was so difficult for our family that I wrote a book titled to keep them out of sight and out of reach. • Choose overnight shipping for mail-order medications. Feathers in the Soul: A Guide for Families Struggling with a Child’s Addiction, which tells To safely get rid of unneeded or expired pre- If you work during the day, have the medication shipped of our own struggle and offers the advice of addiction specialists, treatment profes- scriptions, it’s best to visit a medication drop to your office. An FDA study from 1995 found that the sionals, and the sage words of young people who have succeeded in gaining sobriety. box near you. Check out the full list of available interior temperature of a black mailbox can reach as high as 136 degrees when the ambient air temperature Feathers in the Soul is a story of hope and recovery. Treatment specialists are beginning Hawai‘i Medication Drop Box locations later in was 101 degrees. to acknowledge the powerful role that families play in a loved one’s recovery. The this publication. Hawai‘i Opioid Initiative Prevention & Public Education work group is establishing a These guidelines can go a long way in pre- • Take extra care of injectable medications, as these may call-in system for families facing a loved one’s substance use. Family members will be venting the abuse of prescription medications be more vulnerable to extreme temperatures. connected to trained coaches who have faced the same crisis. and ensuring someone else in your household • If you see a change in color or texture in your medica- Let’s beat addiction and its stigma. This disease should be as shame-free as diabetes doesn’t accidentally take the wrong medica- tion, do not consume it. or myopia. And in the meantime, take action. Lock up all addictive medications. Reach tions. Check out the sidebar (at right) to find out for advice and guidance. It takes a village, and you are a powerful influence. ” easy ways to keep your medications safe, and • Most importantly, if you have any doubts or questions learn more online at hawaiiopioid.org/safe- about the medications you’re taking, consult your doc- tor or pharmacist. — Debby Atkinson med-storage.
“I thought I would never see my family again.”
Spent 3 weeks in a coma due to COVID-19. ad blocker 2044732 ad blocker 2044733
Watch real patient stories at hawaiicovid19.com/survivors
Wear a mask. Avoid social gatherings. 18 October 25, 2020
WORK GROUP 6: LAW ENFORCEMENT & FIRST RESPONDERS
BY KYLE GALDEIRA
aw enforcement officers Opioid Initiative (HOI) is geared when encountering opioid over- lated incidents and emergencies. mapping system to help with dis- The law enforcement and fi rst L and first responders are toward helping the dedicated dose victims; training at least 30 Throughout 2019, this work seminating real-time data refl ect- responder work group continues trained to use their unique law enforcement offi cers and fi rst percent of the law enforcement group took positive steps toward ing the reporting of substance to tackle new objectives through- skillsets when addressing an array responders learn about and im- members and fi rst responders in addressing the opioid epidemic use disorders or crisis incidents to out the complex process involved of potentially disastrous situations plement policies and procedures all four counties on the program in the state. It collaborated with allow for a coordinated response with decreasing Hawai‘i’s depen- affecting residents in commu- that will help when treating opioid implemented by the work group; the work group focused on pre- by available community resources. dence on opioids. Some of the nities across the state. However, overdose victims and suggesting coordinating with other work vention and public education when it comes to dealing with the treatment options. groups within the HOI and like- to develop a resource card/info- rapidly evolving opioid epidemic Early in the process, which minded stakeholders to create a graphic explaining the availability in Hawai‘i, these everyday heroes began more than two years ago, list of diversion programs to use and effectiveness of treatment are now being provided with the initial goals for this specific as a reference when referring options for both opioid users and specialized training to help with work group included developing overdose victims; and creating a their families in health care set- treating opioid overdose victims. a standardized course of action mechanism for real-time reporting tings. Additionally, the Maui Police The sixth focus area of Hawai‘i and clearly defined protocols and data collection for opioid-re- Department piloted an overdose
projects the work group aims to fi nish by the end of 2020 include collecting, analyzing and sharing quarterly data from hospital emer- gency departments on inpatient and outpatient discharges on sus- pected all-drug, all-opioid, heroin and all-stimulant overdoses (orga- nized by month, county, sex and age group to be shared with the HOI work groups). It also plans to develop a plan to distribute per- sonal protective equipment for Hawai‘i law enforcement offi cers to protect them from fentanyl when responding to overdose cases; and provide coordination and leadership for community stakeholders and resources for implementing “Law Enforcement Assisted Diversion” activities. More information for first re- sponders is available at hawaii- opioid.org/resources. October 25, 2020 19 “With COVID-19, you’re not the only Husband was hospitalized for 7 weeks.
Watch real patient stories at hawaiicovid19.com/survivors
Wear a mask. Avoid social gatherings. 20 October 25, 2020
O‘AHU n assemblage of people from the Office of the Lieutenant Governor, A Department of the Attorney General, Department of Health, Depart- State Narcotics Enforcement Longs Drugs Pearl City Joint Base Pearl Harbor-Hickam ment of Public Safety and county police departments have joined Division Honolulu 850 Kamehameha Hwy. #107 Naval Health Clinic Makalapa forces to offer a safe and secure way to dispose of unused medication. 3375 Koapaka St.#D-100 The Hawai‘i Medication Drop Box and Disposal Program was initially of- Longs Drugs Wahiawā Kalaeloa Airport fered at select police stations. However, thanks to a partnership with Longs Longs Drugs Hau‘ula 925 California Ave. Warrior ‘Ohana Medical Home Drugs, the project expanded last July and now features several more secured 54-316 Kamehameha Hwy. collection receptacles on O‘ahu, three on Hawai‘i Island, three on Maui and Marine Corps Base Hawai‘i two on Kaua‘i. The driving force behind this initiative is to provide residents Longs Drugs Wai‘anae Naval Health Clinic Kāne‘ohe Bay Longs Drugs Honolulu with a viable option to rid of medication — especially narcotics like opioids 86-120 Farrington Hwy. 2470 S. King St. — and prevent the drugs from potentially ending up in the wrong hands. Naval Computer & Telecommu- Studies show that the majority of opioid misuse begins with individuals Longs Drugs Waipahu nications Area Master Station taking medication that was not prescribed to them. Longs Drugs Honolulu 94-060 Farrington Hwy. #6 Naval Health Clinic Wahiawā The most common opioids include oxycodone, hydrocodone, morphine, 1620 N. School St. Military Locations Schofield Barracks methadone, codeine and fentanyl, a lot of which, if left sitting in a bathroom Longs Drugs Kāne‘ohe (military ID required) Desmond T. Doss Health Clinic cabinet unused or disposed of improperly, could contribute to abuse. Items 46-047 Kamehameha Hwy. #C not accepted are infectious waste, aerosol cans, syringes, thermometers, Joint Base Pearl Harbor-Hickam Tripler Army Medical Center inhalers and illegal drugs (e.g. heroin). 15th Medical Group Hickam Clinic Mountainside Main Entrance, Longs Drugs Kapolei 4th floor For more information, visit hawaiiopioid.org/drug-take-back. 590 Farrington Hwy. #300
KAUA‘I MAUI HAWAI‘I COUNTY
Kaua‘i Police Maui Police Department Hāna Maui Police Department Wailuku Hawai‘i Police Hawai‘i Police Department Līhu‘e 4611 Hāna Hwy. 55 Mahalani St. Department Hilo Department Nā‘ālehu 3990 Kā‘ana St. 349 Kapiolani St. 95-5355 Māmalahoa Hwy. Longs Drugs Kahului Maui Police Department Kīhei Hawai‘i Police 70 E. Ka‘ahumanu Ave. Hawai‘i Police Longs Drugs Kapa‘a 2201 Pi‘ilani Hwy. Department Laupāhoehoe Department Pāhoa 845 ‘Aleka Loop Pu‘u‘alaea Homestead Maui Police Department Lahaina Longs Drugs Kīhei 15-2615 Kea‘au-Pāhoa Road 1850 Honoapi‘ilani Hwy. 1215 S. Kīhei Road #B Hwy. Longs Drugs Līhu‘e Maui Police Department Lāna‘i 3-2600 Kaumuali‘i Hwy. Hawai‘i Police Hawai‘i Police 855 Fraser Ave. Longs Drugs Lahaina #1100 Department Honoka‘a Department Waimea 1221 Honoapi‘ilani Hwy. 45-3400 Māmane St. Maui Police Department Moloka‘i 67-5185 Kamāmalu St.
110 Ainoa St. Hawai‘i Police Longs Drugs Hilo Department Kapa‘au Testimonial 555 Kīlauea Ave. 54-3900 Akoni Pule Hwy.
“ I have worked in public health for over 25 years and found the Hawai‘i Opioid Initiative to be one of the most effective col- Hawai‘i Police Longs Drugs Kona laborations I have ever participated in. Focusing on a balance of public health and public safety provided an unprecedented Department Kona 75-5595 Palani Road opportunity for evidence-based innovations such as our police and first responders carrying naloxone and saving lives by using 74-611 Hale Māka‘i Place it during opioid overdose. Hawai‘i pharmacists can now prescribe naloxone, and treatments for opioid use disorder such as Longs Drugs Pāhoa suboxone are more accessible than ever thanks to the efforts of the Hawai‘i Opioid Initiative. Visit hawaiiopioid.org and hhhrc. 15-1454 Kahakai Blvd. org/overdose. ”— Heather Lusk (MSW HHHRC), Hawai‘i Opioid Initiative founding member October 25, 2020 21
WORK GROUP 7: SCREENING, BRIEF INTERVENTION, REFERRAL TO TREATMENT (SBIRT)
BY KYLE GALDEIRA
he seventh focus area of Collaborative to expand the Ha- via clear links to the referral sys- T the Hawai‘i Opioid Initia- wai‘i Prenatal SBIRT efforts state- tem, and coupling those efforts tive (HOI) targets screening, wide; this effort sets a foundation with subsequent tracking of the brief intervention and referral to for healthier keiki and ‘ohana that SBIRT approach throughout the treatment (SBIRT). The screening will make a lasting impact for gen- state. model involves implementing a erations to come. The goal of the Additional critical pieces nec- widespread screening and early Hawai‘i Maternal and Infant Health essary to advancing the objective detection system for individuals Collaborative is to improve birth are collaborating with federally at risk for substance use disorder outcomes and decrease pre-term qualified health centers to incen- (SUD). The goal of this approach births in Hawai‘i by reducing risk tivize SBIRT-related performance is to utilize brief interventions, factors stemming from tobacco, measures and promoting inclu- whenever possible, to reduce alcohol and illicit drug use during sion of Native Hawaiian cultural the demand for and stress on the pregnancy. Improvement in this intervention treatment programs, treatment care system, as well area is made possible through im- wellness plans and holistic living as to support coordinated entry plementation of a universal state- systems of care. points and referrals for individuals wide system that is dedicated to More information about this who need more specialized care. increasing the delivery of prenatal work group’s efforts — as well as The initiative is working with SBIRT services, which will promote the full Hawai‘i Opioid Initiative the state to provide statewide the cessation of substance use by with facts, prevention strategies SBIRT training for hospitals and pregnant women. and resources — can be found at primary care settings for specific The next steps in bolstering this hawaiiopioid.org/resources. populations like mothers and initiative, and enhancing its sus- newborns. tainability in the future, include The work group responsible for increasing collaboration with like- this focus area collaborated with minded stakeholders, developing Hawai‘i Maternal & Infant Health plans and standardized training
Testimonial
“ I would say to those struggling, there are people that are here for you, people with no motives other than to just try to help you find another way to live. I know there are people that care about you that don’t even know you, because I care about you. And you have value. You are somebody’s child, daughter, mother, son, grandson, grandpa. Whatever you are, you are somebody. And however you may feel, it’s not the end all be all. There is something else out there and it’s good. I used to hear in treatment that I would never trade my worst day sober for my best day high. And I was like, yeah, OK, whatever. I get that today. I couldn’t even imagine going back now. I couldn’t imagine living without drugs and now I couldn’t imagine living with drugs again. ”
— Farah Aquino 22 October 25, 2020
hose in need of sub- wai‘i CARES has merged with It’s all thanks to a collabora- Social Work. The group is re- center for behavioral health are available to take your call 24 T stance use treatment or the former Crisis Line of Hawai‘i, tive effort between the state sponsible for the development services. hours a day, seven days a week. recovery support ser- now providing a one-stop ho- Department of Health’s Behav- of Hawai‘i CARES, as well as its Individuals and their loved Local specialists will offer a vices can rely on Hawai‘i CARES tline for Hawaii residents for cri- ioral Health Administration and overall planning and imple- ones can call or text Hawai‘i listening ear and provide infor- (Coordinated Access Resource sis support, mental health and University of Hawai‘i at Mānoa’s mentation to serve as a multiple CARES at 1-800-753-8679 or text mation and referrals to treat- Entry System) to get help. Ha- substance use treatment. Myron B. Thompson School of entry-point and coordinating ALOHA to 741741 for crisis sup- ment options in your area, if port, substance use treatment needed. services, and mental health re- Hawai‘i CARES also offers as- sources. sistance to those in isolation or Trained, caring professionals quarantine due to COVID-19.
INSPIRING THE NEXT GENERATION
Our youth are facing unprecedented challenges with COVID-19. Hawai‘i Opioid Initiative and the Department of Health are reaching youth through a campaign developed by students from the University of Hawai’i at Mānoa College of Social Sciences, Mānoa Now, and UH Productions. These students are helping to spread the word about Hawai‘i CARES, through a social media campaign funded by the Hawai‘i State Department of Health. “A Surfboard Apart” focuses on keeping physical distance during the pandemic, but urges youngsters to reach out to friends or family members if you are struggling, and to call Hawai‘i CARES if you need extra support. The students plan, develop, and film the ads themselves, with guidance from the Department of Health Communications Office. Follow Mānoa Now on Instagram and check out their website manoanow.org/ covid19 for fun quarantine activities and more helpful resources for young adults. Hawai‘i Opioid Initiative and the Department of Health are also sponsoring a category in next year’s ‘Ōlelo Youth Xchange Student Video Com- petition, dedicated to substance use and dependency. Kids and teens are encouraged to create a short, 5-minute film to share how alcohol and drugs have directly impacted their lives or the lives of their loved ones, focusing on questions like “What have you learned from the experience? How has it made you a stronger person? What plans do you have for the future as a result of your experience?” For more information on the Sub- stance Use Prevention category visit olelo.org/yxc2021. October 25, 2020 23 Are You At Risk For Opioid Dependency?
t’s possible that someone can be at risk for opioid dependence and not even know it. To help oxycodone, oxycontin, hydrocodone (like Vicodin or Norco), buprenorphine, fentanyl, morphine I determine your reliance, Hawai‘i Opioid Initiative provides a self-reported screening tool to and codeine. help assess one’s risk for opioid abuse. To use this guide, circle your answer for each question and tally your “yes” answers, or take the Opioid or narcotic prescription pain medications include (but are not limited to) things like quiz online at hawaiiopioid.org/are-you-at-risk.
1. I am currently taking one or 6. I have made unsuccessful at- 10. I have continued to use de- 14. I need a higher dose of pre- more of the aforementioned pain tempts to cut down my use of spite negative consequences. scription pain medication than medications. prescription pain medication. YES NO before to achieve the same result. YES NO YES NO YES NO 11. I have concealed how much I 2. I have chronic pain or have re- 7. I spend a signifi cant amount of use or people have commented 15. I have experienced any of cently had an accident or injury. time using or recovering from my on my use. the following symptoms after
YES NO use of prescription pain YES NO stopping use of prescription pain medication. medication: diarrhea, nausea, 3. I have misused drugs or alco- YES NO 12. I have procrastinated or vomiting, crying/tears, runny hol in the past. neglected to do things because nose, sweating, yawning, chicken YES NO 8. My use of prescription pain of my prescription pain skin, anxiety/worrying, trouble medication has had negative medication use. sleeping or fever. 4. I have been taking prescription consequences on my home life, YES NO YES NO pain medication for longer than school or work. one week. YES NO 13. I have experienced strong 16. My prescription pain YES NO cravings for prescription pain medication use caused me to put 9. My use of prescription pain medication. myself or someone else in a 5. I have diffi culty controlling how medication has had negative dangerous situation. YES NO much I use or for how long I use consequences on my relation- YES NO prescription pain medication. ships or social life. YES NO YES NO Your Score:
If you answered “yes” to two to three ques- If you answered “yes” to four to fi ve questions, you If you answered “yes” to six or more ques- tions, you are at low risk for dependence may be dependent on opioids or narcotic pain tions, it is very likely that you are dependent on opioids or narcotic pain medication. medication. Discuss your results with your doctor on opioids or narcotic pain medication. It is Resources that HOI provides include: or health care provider, and check out: important that you keep naloxone on-hand to • Complementary and integrative ap- • The signs of dependence and withdrawal symp- prevent an overdose. If you are experiencing proaches to pain management toms a crisis, call 911 or the CARES line available • How to dispose of unused medications • How to identify risk factors for opioid overdose on O‘ahu (832-3100) and neighbor islands (1- properly to keep your friends and family • Treatment options available 800-753-6879). Discuss your results with your safe • Complementary and integrative approaches to doctor or health care provider, and check out: • The signs of dependence and withdrawal pain management • Treatment options available symptoms • Complementary and integrative approaches • How to prevent an overdose to pain management • How to identify risk factors for opioid over- dose For more information, visit hawaiiopioid.org/learn-the-facts 24 October 25, 2020 Safe Medication Disposal Units
Longs Drugs® and CVS Health® are dedicated to helping the communities we serve address and prevent prescription drug misuse and diversion through our commitment to safe medication disposal.
Customers can now dispose of expired or unused prescription medications, over-the-counter medications and liquid medication bottles promptly, safely and securely by accessing medication disposal bins at any of the following Longs Drugs locations throughout Hawaii:
O’AHU HAWAI’I ISLAND • 54-316 Kamehameha Highway, Hauula • 555 Kilauea Avenue, Hilo • 1620 North School Street, Honolulu • 75-5595 Palani Road, Kailua Kona • 2470 South King Street, Honolulu • 15-1454 Kahakai Boulevard, Pahoa • 46-047 Kamehameha Highway, Suite C, Kaneohe MAUI • 590 Farrington Highway, Unit 300, Kapolei • 1215 South Kihei Road, Suite B, Kihei • 70 East Kaahumanu Avenue, Kahului • 850 Kamehameha Highway, Suite 107, Pearl City • 1221 Honoapiilani Highway, Lahaina • 925 California Avenue, Wahiawa KAUA’I • 86-120 Farrington Highway, Waianae • • 94-060 Farrington Highway #6, Waipahu 645 Aleka Loop, Kappa • 3-2600 Kaumualii Highway, Suite 1100, Lihue
For more information, call your neighborhood Longs Drugs Store.