فیلم مقدمه ای بر اپیدمی اپیودی (بخش اول از ۳)

Title:Introduction to the Opioid Epidemic (Part 1 of 3)

امسال، مرکز برنامه‌ریزی و سلامت جامعه APA و انجمن‌های سالم، میزبان مجموعه‌ای از وبینارها برای بررسی تلاقی برنامه‌ریزی و اپیدمی مواد افیونی بودند. این مجموعه که برای به اشتراک گذاشتن تجربیات محلی و منابع ملی طراحی شده است، همچنین به منظور راه اندازی شبکه ای از اعضا و متخصصان همتا است که برای درک بحران و نقش ما در آن تلاش می کنند. این اولین جلسه مقدماتی مجموعه را در چارچوب سلامت عمومی قرار می دهد که شامل اختلال مصرف مواد و متخصص پیشگیری از بیماری های مزمن، لیز بلک ول مور است. چگونه اعتیاد را درک کنیم؟ چگونه متخصصان بهداشت عمومی سایر بخش ها را برای رسیدگی به این بحران درگیر می کنند؟ این جلسه همچنین کار انجمن ملی شهرستان‌ها را به اشتراک می‌گذارد و گزارش اخیر منتشر شده در مورد همه‌گیری و همچنین همکاری بین لیگ ملی شهرها و تلاش‌های آنها برای استفاده از GIS برای درک بحران در جوامع خاص را برجسته می‌کند. قسمت دوم سریال را اینجا ببینید: https://youtu.be/Ck8buwhdEco
قسمت ۳ این سریال را اینجا ببینید: https://youtu.be/qweX8iQVHDk

درباره بحران مواد افیونی بیشتر بدانید: https://www.planning.org/blog/blogpost/9141430/

درباره کار مرکز برنامه ریزی و سلامت جامعه APA بیشتر بدانید: https://www.planning.org/nationalcenters/health/ (برچسب ترجمه )انجمن ملی شهرستان ها

قسمتی از متن فیلم: It includes more than being free gifts of disease or not feeling sick it is also includes emotional and mental health and feelings of happiness and security healthy healthy minds and healthy bodies so what factors determine our health include family health history environmental factors and behavioral and lifestyle factors so it’s important to

Remember that even as planners can have ways to address environmental factors and help people have more active lifestyles or eat healthier food there’s always going to be factors such as family and health history that are difficult for for planners to address and it the other part of healthy communities are the community design

Aspect of things so it’s important for planners to take a step back and think of community design from the view of other professions or the public at large so when talking about community design terms that we take for granted such as built environment or Complete Streets are aren’t always generally known by the

Public and to be aware of that so when talking with the general audience about a healthy community of design and the community design part of that related to schools parks grocery stores homes and employment centers where people live and work and play and also this the ways

That people get there on streets walking biking or transit and it includes both human-made structures as well as preserved natural environments such as parts and natural spaces are part of community design it’s always important to hit too on the fact that just the way a community is can change and it isn’t

Frozen in time and the community can go through a planning process to help make the community healthier for everyone so pulling that together into healthy community design the main goal is is linking the health and planning profession to create and design communities that make the healthy choice the easier

Choice for everyone in the community and I know from the planning side we have a lot of different specialties or areas we focus on but healthy communities design is a very broad broad aspect and there are a lot of different ways the work we can do affects the different aspect of

Health when we look at it through a health plans and underlying healthy communities design is a basis of social equity where everyone has the ability to meet their their needs regardless of race or income and so it’s important to remember that equality is not the same

As equity if the goal is to achieve a healthier lifestyle or a healthy community design people are coming from different places and might need different resources or different types of resources in order to reach the goal of a healthier community and with that in mind the American Planning

Association teamed up with the American Public Health Association on a multi-year effort called plan for health where they conducted a lot of site-specific air projects around the country and then worked also with 28 APA chapters around the country to help promote healthy communities a lot of these projects focused on nutrition or physical

Activity and there’s a lot of great resources both locally around the country as well as nationally that you can find through those resources that study that cigar I mentioned earlier so I helped have the privilege to help manage the healthy communities in Pennsylvania effort which was the Pennsylvania chapters plan for health

Planners for health project and thinking of the way that we worked on on social equity we quick we quickly created an engagement ladder as our sort of main organizational framework we were already working on healthy community design and we were active partners and we needed certain tools to help make

That happen but we also wanted to make sure that we gave people tools to become active partners so contemplating partners are people who might have heard of healthy community design or might want to take action but don’t know quite how yet and they require different tools than potential partners who are people

Who might have never heard of the concept or don’t consider the work they do being part of a healthy community to find concept so so we’ve started by conducting a planning directors survey to all the 67 County Planning directors in Pennsylvania to get a baseline of where where municipalities were

Encounters were in Pennsylvania and that a survey came back with a large percentage of people being actively working on a healthy community design or almost active and an about equal number we’re familiar with the concept but not yet acting but there was still a large percentage maybe 17% roughly that were

Unfamiliar with the concept of healthy communities or 10 consider as part of their mission as planners so we thought to to also identify some of the priorities that we could do being a very broad topic it’s important to hone in on the most important aspects so we looked

At desired tools that the planners needed as well as what’s the most pressing needs were in communities in Pennsylvania and what strengths planners could bring to the table so this slide shows the results of that survey element showing in red what planners saw the most the greatest needs in their

Community were and in blue are what our topics where planners felt they had the ability to effect change and have the tools they need so you can see that substance abuse on opioid epidemic became a huge disparity between something where planners really felt that they that they wanted to

Effect change and it was a huge need in their community but they didn’t feel they had many tools to address it and I and we can see why when we look at when we look at drug overdose rates in the United States at this point it is those

Drug overdose rate is 19.8% our 19.8 per 100,000 population 4-h adjusted drugs overdose rates and when you compare that with motor vehicle crash rates for example those are a 10.9% population so I know motor vehicle crashes are something that that planners actively work hard to help eliminate through

Vision zero program and and the like but to to remember that you know actually almost almost double the amount of people are dying from drug overdose rates right now so here’s a map of the u.s. showing showing where drug overdose rates are statistically higher and lower

And you can see why it was so important in Pennsylvania but the Pennsylvania is not alone and then you can also see the drug overdose rates unlike motor vehicle crashes are on the rise or not motor vehicle crashes motor vehicle death rates are on the rise are motor vehicle crash rates are death

Rates are declining while drug death is increasing so we worked with through a working group concept at the healthy communities in PA to to help try to get the tools that the planners and health professionals felt they needed to promote healthy community design by going first with partner and professional organizer

With professional organizations in our network to create topic-based working groups to create those tools and so for the opioid epidemic we worked we couldn’t find a lot of great research that was being done are a lot of great ways for planners to plug in but we took this concept sort of nationally working

With the planners for health team and that sort of led to this idea of doing a webinar series to help educate people on the issue and then also hope to find some some great resources that planners can use and it’s important to remember if you want to promote healthy

Communities design in yours your state there’s a lot of resources from APA and then there are also those that the plan for health team reached quite a few states around the country so there is a network of people who are involved in healthy community design that you can

Reach out to um so I think our next speaker is we’re going to skip to Nationals I know I’m here Justin hi great okay I’ve actually just had to switch unfortunately for my phone since I’ve lost which is crazy I’d lost internet connection when turning it into the

Webinar which has never happened to me before but great well I’m finally here so human mind slide I thought that would be great okay great yeah I would do Doug Luce okay great um great so my name is Liz blacklemore and I’m a public health consultant living in Portland Maine and

I’ve been involved in substance abuse prevention and intervention for the past eight years and I’ve done the last several years working on addressing the opioid misuse problem if you could flirt to the next slide so today I’m going to orient the webinar series by talking about public a few of

The opioid misuse problem and a public health approach is one that understands people’s health is impacted by the people they are surrounded by is it organized and they’re really impacted by the organization’s they engage with and the community they live in and the policies that govern their community

People don’t make decisions or have behaviors in a bubble so you can live to the next slide so I’d like you to envision a river the ribbon always starts as a small dream but it quickly gathers water from the environment around it and it follows the path the

Land eventually leading to the ocean and if the river of staff is clean water fresh streams and no major debris advisors way into the river the path to the ocean can be fairly smooth but if a river is fed with polluted water in trash the river can turn into turbulent

Deadly water and once those Rapids forms a team of specialists may need to be called upon to help redirect the river if the rabbets is taking hold and create a really deep river bed it may take some time and energy to redirect the river to calmer waters and you know a big river

Is a powerful force so keeping that river in the DNI’s channel is an ongoing process requiring ongoing support so like the river people really begin life as a small child for developing through the influence of the people around them and their creators in the environment and for some that I host the

Positive actions of adults in their lives and they have access to healthy communities for their developmental streams flow rather smoothly from childhood to adulthood and beyond but for others don’t come any toxic out the obstacles along the way they can lead to serious life turbulence like substance

Use disorders in order to find the land of a substance use disorder many people need to help expressional flight counselors health care practitioners and recovery coaches and the deeper the river bed or the more turbulent the waters the more support effort in time might be needed for someone to find recovery

A community of people that value and provide opportunities for wellness health people in recovery continue on a snooze like pop on a newer lifetime so today we’re going to spend some time looking up whatever looking in the rapids and down river to understand the problem will opioid misuse and defined

Our role in solving this problem because if you on the next slide so one element that really muddies the waters up river and down river is stigma and there’s been green retention paid for how language can be a part of carrying on stigma so words like substance abuse

Addicts of either clean or preserving persons can often cause people to feel shame for their actions so to get forward the slide as Brene brown a leading research on vulnerability and Shane says shame corrodes the very part of us that believes were capable of change cricket for so to reduce the

Shame and stigma we’re talking in terms of problematic substance use or substitutes disorder a person with a substance use disorder or person recovery so this language is not only impact the people who are suffering from a substance use disorder but it actually can really impact everybody and the

Peeps and all the community members are becoming a part of the solution so people oh I’m sorry if you could forward the slide people become adults through their interactions with the people around them in their environment they really don’t develop in a bubble chalo clowns brains develop over time

And through interactions the art the actual architecture of the brain is created through a mix of genetic experience and environment – before the phone so the centred on design on the developing child at Harvard University has done some amazing research on on brain architecture and the development

Of brain so if we’re looking at upriver there are many ways in which we know that in that X plays a factor in whom peoples of having a substance use disorder but we also know there are other major risk factors for opioid use disorder and we noticed through the

Samsa the substance abuse and mental health services administration had a heroin brief that they did in 2015 but really outlined some of the major risk factors associated with opioid use disorder and so if you could forward through the different obstacles sigar that so the risk sectors generally

Fell into a few categories that can be summarized really as early use of substances adverse childhood experiences and discrimination and mental health disorders and so adverse childhood experiences are often called aces and a full list of the aces can be found on the CDC website but they include things

Like abuse neglect growing up in a household as a parent who has a substance use disorder is in prison or is that there is an extensive research on how aces on aces and we know now that they put a person at increased risk for all sorts of health problems including

Substance use disorders and there’s a lot of research on the impact of early use of substances and how it puts people at much greater risk for substance use disorders later in life to take it for the side so how this works when you when you obstacles put a person at greater

Put a person at greater risk has a lot to do with how they impact brain development if we thought of the brain as a car the reward system of brain would be a lot like the gas pedal and the prefrontal cortex would be like the brakes the

Reward center is fully developed by the age of 13 and it’s stimulated by exciting and risky experiences and young people to love to put their foot all the way down on the pedal to get forward to the next slide the prefrontal cortex or the front part of the brain is really in

Charge of reasoning judgment and controlling emotion and it isn’t fully developed until about age 25 so young people often have a hard time really using those brakes so when you add in obstacles like unresolved mental health disorders early substance use and unresolved trauma they have a way of

Really rewiring the brain and they rewire the brain in a way that make it more likely that a person pushes down even more on the reward center and they can compare these different obstacles and these different toxic stress really in a person’s life can impair the development of the prefrontal cortex so

As young people seek out experiences and substances that really crank up their reward systems they may also be causing damage to their prefrontal cortex making it harder and harder for them to put on the brake and eventually they’ll have a hard time stopping even if they want to

Do even if it’s causing them and their families great harm but brains are incredibly resilient and so are people and brains and so like a car engine it can be fixed so we know that many people who are using heroin misused a prescribed opiate first so you can actually just go

Through all three of these animations that are thank you sure so we know that they had maybe that people use heroin misusing prescribed opiate first but we also know that people who had a previous substance use disorder were 28 times more likely to develop an opioid disorder when they were prescribed an

Opiate by their healthcare provider so most people won’t become addicted when they’re prescribed in opioid people with previous problematic substance use so they’re ones most at risk for becoming addicted to opioid so if we think if you could forward to the next slide if we think about what is our work in

Prevention prevention is really about reducing youth substance use it’s about reducing adverse childhood experiences and the impact of aces on young people increasing resilience and improving behavioral health support and so some specific examples of I think how planners can be a part of prevention isn’t having effective ways of talking

About the problem to city leaders changing the physical design of a community by reducing the density of alcohol and marijuana retailers or making sure they’re not in places there are not only in places where there’s more high poverty and improving community participation in public projects and improving transportation so

Everyone has access to mental health providers prevention essential teaching people about the harms of drug use prevention is a lot of activities across sectors of the community so now if we look in the rapid sort of where there’s really the looking into the problem of when somebody already has

A substance use disorder when people are in the rapids we are just trying to keep them afloat we just don’t want to lose them there during this time believe it or not well we seen this huge uptick in the amount of people dying we haven’t seen a huge uptick in the amount of

People with a substance use disorder it has remained relatively stable over the years and that’s currently because substance use disorders are connected to one another what people are using right now may or may not be what people are using in five or ten years so when

People are in the rapids we have to be prepared to act quickly to meet the changing needs and fortunate slide so her reduction is really right now most people are dying from opioids prescribed to opioids or heroin attention all and so communities need naloxone to reverse overdoses they need needle exchange to

Keep people from getting infectious diseases and some are considering some cities are even considering safe injection sites but to address the changing substance use disorders can use also need to beef up behavioral health support and diversion programs for people caught possessing drugs so we aren’t changing and punishing but providing accountability and support

They need to be screened in various places not just at their doctors so they can have multiple places to be referred to treatment all of these harm reduction strategies need to keep the boy alive but they also are amazing opportunities to connect people to addiction services

Get forward to the next slide well some people can get out of the rapids on their own so many it takes a team of folks to redirect the river view forward to the next line so the deeper the riverbed I’m sorry so when it comes to opiate use disorder the research is

Really clear that medication assisted treatment with counselling has the best outcome and there are a few different kinds of medications and treatment with methadone and suboxone you know most common and having the best outcome methadone is usually administered in a standalone clinic and people come a few

Times a week if not daily and suboxone can be prescribed by a health care provider and it can be weekly or monthly that somebody comes in but they both have really high success rate the deeper the riverbed the more time efforts and support may be needed to redirect the

River and there are many kinds of addiction services including medication assisted treatment but also in patient outpatient peer support groups and that’s really because there are many paths to recovery but people need access to them access includes obviously insurance but it also includes transportation to the methadone clinic

Or the counseling office and include safe places to exercise and community spaces find social connection so people in recovery may continue to support support to keep the river running smoothly and that find its way back to the rapid creating healthy communities having recovery organizations that are accessible to folks creating job

Opportunities for people who may have a criminal record or dropped out of school and having safe sober housing are important ways they can support people in recovery so the opioid misuse problem is really a complex community problem but that requires a full community response everyone has a role so I am NOT

A planner so I know there’ll be many good ideas presented by the next speakers and in the next two webinars so this is just a list of ideas that I’ve come up with from my public health lens and some of the things to highlight are related around the consideration of the

Behavioral health system when doing transportation planning using national certification standards for sober housing doing greater outreach to previously marginalized communities in the community development process and this really might entail doing a lot of upfront work to understand what are the barriers what is the community trauma that people may have experience in

Particular communities in order for that outreach to be successful and other ideas you know integrating strategies with community development funding funding so you know it’s one thing for us to know what the evidence-based strategies are but it’s another to get to communities and leaders buy-in to it too and adopt the

Evidence-based strategies and there are research-based ways of talking about the problem after years of trying to find the right messaging the right opening statements to get the public to think about substance misuse as a community problem not as a moral failing of individuals I finally stumbled upon frameworks Institute and frameworks has

Done a great session great research into how to frame social problems remove the public’s understanding closer to that of experts on the topic so we’re presenting new strategies like a new location for a needle exchange or changing a police policy to divert more people to treatment rather than jail talking about

Brain development and the root causes of substance use disorders is an important part of helping the public understand the problem so using the metaphor helps move the river metaphor help move people away from blaming individuals and having a fatalistic view of the problem to understanding the whole picture and

Seeing their part in the solution so as you come up with new strategies to implement in your communities I suggest working with your partners in public health and city government and policing to create some consistent talking points that include some of these ways of talking about the problem the center on

The developing child at Harvard University has incredible short videos that can explain brain development and aces and resilience and the framework Institute a short videos on the river metaphor and I can tell you from experience that this framing of the problem will help build public support for your efforts people who may have

Seemed like adversaries may suddenly become your biggest champions because they now see the problem differently so I’ve included a list of resources and links that I’ve mentioned throughout the presentation in this stage is mostly about communication and prevention resources and then the last slide so far

If you get forward to this page mostly addiction services and recovery resources so I just want to thank you all for attending the webinar not just for attending it but really for having the vision to see that you are also a part of the solutions of this

Problem to give them more sectors that we engage in thinking about the problem the more success we will have in solving the problem so thank you very much thank you Justin yes I think we’re on to tip Brian and honey great thank you so much Justin and Liz for that for that great

Overview again my name is Brian Bowden with the National Association of County I cover our health policy and advocacy portfolio here and I’m going to be joined by my colleague hottie siddhaye who does the same for justice in public safety and has been leading a lot of the

Work we’ve been doing with our sister organization on this tradition so a quick overview of Meiko and counties so the National Association of counties or nako is we will say for short since 1935 has really represented over 3,000 counties parishes and boroughs across the country it’s really advocated around the

Collects ways to be the voice in Washington for county government our vision actually is creating a health healthy vibrant and safe counties across the United States so directly in line with some of the work that we’ve been talking about here most people you know around the country have heard of

Counties but we often find as County government is not understood very well and counties themselves when we think about counties we we like to point out that half of the country’s population lives in 120 of the largest counties LA County San Diego County Dallas County so your large counties was over but

Population is over 500,000 the other half of the population lives in much smaller counties about two-thirds of all counties have populations below 50,000 so various science counties and and as many of you know who work in city or county government all local governments are slightly different but there’s some

Commonalities so I’m going to quickly walk through lists set me up nicely because counties are really involved in in many of those sectors that the Liz mentioned everything from transportation to Community Economic Development but for the purposes of this webinar I’m going to focus on Health Human Services

And justice and in kind of highlight county’s role so counties invest about over 80 billion annually and community health systems Kennedy’s were the original safety net they still support over 900 hospitals across the country with hospitals like Parkland Hospital in Dallas Grady Hospital Atlanta being the most well known County Colonels Casso

And a lot of our rural counties across the country about half the state behavioral health so mental health juice is still county based and then about to church or local public health departments are still based through our county and I I put it on this fight to the importance of Medicaid again

Counties even before the Medicaid program was came to be a little over fifty years ago counties were that original safety net they’re actually used to be a lot more county hospitals than there are now Medicaid has been really crucial in helping counties meet their obligations

A lot of states hundred Clark I need to provide some for some sort of health care to uninsured or underinsured so they actually have state statute that require county to provide care Medicaid certainly helps with that and for those that don’t know you know twenty one percent of all health care spending on

Substance use disorders is through Medicaid so a vital source of coverage for this issue especially in states that have expanded Medicaid with what people often don’t know as much about or forget about especially in relation to the opiate epidemic for those come from a health background in

The role of both justice and Public Safety and Human Services and the impact that is having on those other those sectors you know I said counties invest over 80 billion in health the figure for justice and public safety is it’s pretty similar about over 90 billion most people think

About they’re either mainly sheriff’s but also some police departments in our counties besides against your County’s fair most people in the associate with the county jail there there are approximately 2800 local County jells that’s the majority or county operated and they annually admit eleven point four million individuals so for those

You know we often talk about prisons and jails of prisons being right run by the state being for longer sequences of time but jail being for more minor offenses with an average length of stay at 23 days so you have folks paying for shorter times and unfortunately many

People following through the cracks and ending up in in jail that happened to have a substance use disorder or a co-occurring mental health disorder also counties employ first responders and importantly operate court systems including drug courts so prosecutors excetera that whole infrastructure there that counties are involved with that are

Directly impacted by this epidemic also I want to highlight Human Services and County’s role footprint there because that’s what we’re hearing a lot from from from our folks on this epidemic and over 12 states counties administered child welfare services who are really being impacted in most counties operate

Child protective services in foster care and just to give an example in Ohio a strong County state you know they’re there’s their foster care system costs are expected to increase by more than two-thirds just in this next year so we’re really hearing that you know you have grandparents raising kids when

When parents are taken away so this this epidemic and this this issue while it may at first impact kind of our what we think of as our typical public health or or health system it’s it’s definitely having impacts across sectors at the county level and so we’re looking at it

From kind of a holistic viewpoint and and I guess you know there’s there’s the human toll that that we all know about and that our county officials hear about but clearly there’s also an economic consequence of the epidemic that that we hear about from our counties counties

Are really limited and how they raise new revenue typically that’s through property taxes and most states limit how how either how fast or how much counties can raise new revenue and again across the health just as human services their budgets are really being impacted with with not a lot of federal funding right

Now for this we we learned early on and those that have been involved with this issue given the complexity of this issue is both Liz and Justin mentioned he really it really requires coordination across multiple agencies at the at the city and county level at the local level

And very clear leadership and we’ve seen those champions at the local level look a little bit different across the country many times you know it is our county commissioner or an elected county supervisor it’s also a County Sheriff or someone else who’s really respected or trusted in a community so you know right

When this epidemic started to to take off over the past five years at the National Association of counties we were hearing about this issue from our members and realize that we needed a different approach where we’re kind of structures internally by issue area but because this

Cuts across areas and it’s not just a County issue it really involves like a coordinated local issue we took a slightly different approach on this issue than we do many other issues and to talk about that process and what’s come out of out of that and where

We’re going from here I’m going to turn it over to my colleague hottie today thank you Brian thank you to the Planning Association for hosting this great conversation and we certainly hope that this is the beginning of a greater partnership in our work and the work that you all are doing in your

Communities as Brian mentioned we have taken a somewhat atypical approach to dealing with this issue within our organizational work and I’m going to lay that out for you all a little bit and hopefully it’s helpful as you formulate your local efforts as well in 2016 the

Picture that you see there is as the taskforce that we put together we called it the National City County Task Force on the opioid epidemic and we brought together 10 city officials mayor City Councilmembers police chiefs firefighters etc and 10 County officials and our task was to comprehensively

Study an issue that had come to the forefront for both of our organizations through our members reached out to us in telling us you know this is really straining our communities on our governments and in every conceivable way so our task was to assess the opioid epidemic how it was impacting local

Communities and to come up with a set of recommendations mostly aimed at local officials but also for Satan federal partners to inform their response to this epidemic and ultimately the report that you see there which is available at opioid Action org was the culmination and final

Product of our work and in order to arrive at these recommendations we spent pretty much all of 2016 in conversation not only among the task force members but also with other city and county officials with state officials with federal officials and also with local officials of all different stripes with

Prosecutors and public health directors and county managers and our the the reason we made that conversation so broad was that we really wanted to understand what parts of the community the opioid epidemic was impacting and it pretty quickly became apparent that there were very few parts of many of the

Most impacted communities that were not being altered in some way by this epidemic so to kind of give shape to our work we focused on four buckets of recommendations the first is leadership which we thought was a was a sort of a unique part of the task of local

Officials in this epidemic we talked about how local officials had both the authority that came with public elected office but also the familiarity with their communities that came from being at the local level rather than at the state or federal level and we called on them to kind of use that unique position

To to really set the tone on these conversations and then the other three buckets that you see there numbers two through four are sort of the traditional categorization of the response to this epidemic prevention and education sort of jamming they’re rolling door to make sure that further individuals are not

Becoming addicted as you work to provide treatment for the individuals who are struggling with addiction treatment obviously and then Public Safety and law enforcement to ensure that you are fighting against the list forces and sometimes the over-prescription that are driving factors of this epidemic so on the on the first bucket

Of recommendations as I as I mentioned we really found that stigma was a was a huge part of this this epidemic and we found that at stigma was preventing individuals struggling with addiction from seeking help so one way to look at it is you might be struggling with the

Prescription painkiller addiction and if you feel that you are going to stigmatize yourself in some way by seeking help that painkiller addiction might turn into heroin addiction which now has a new set of risks for not only the individual in the family but also for the local government when it comes

To hepatitis C outbreaks and that sort of thing and we found that stigma was with also affecting and I think this is relevant to you all was also affecting the ability of communities to establish physical locations that would help to address the opioid epidemic whether that

Would be a methadone clinic or a queen syringe exchange program or what have you we found that there was a lot of pushback at the local level on that sort of thing and that local leaders could play a huge role in in addressing that stigma and then I think the other big

Piece of the leadership puzzle for us was the role of local elected officials as conveners of bringing to the table all of those individuals that I mentioned from public health to law enforcement to planners and county managers to prosecutors and educators and literally anyone who works with a

Population that is impacted by this epidemic bring them to the table and start all of your conversations there so I think that is kind of a fundamental underlying recommendation that we had throughout this report was that to understand what the epidemic looks like in your community and what response is

Is your best bet of getting out of it you need to bring together local leaders and start all those conversations there the next bucket of recommendations that we had while we work on loading this next slide was related to prevention and education and that certainly I think

Splits into a couple of different areas that are a huge part of this conversation and one part of it is the education piece just assuring that this this sort of culture of painkillers being perceived as sort of a fun thing to dive into after you have a root canal

You know I certainly remember as a kid having some sort of small medical procedure and then joking with my friends about receiving oxycodone prescription or hydrocodone or whatever it might be and that sort of culture of not treating prescription painkillers and opioids as products that could very

Rapidly lead to a heroin addiction you know not making that connection of how deadly serious this these products can be is something that we have we have worked with our members on on kind of reversing so public education awareness of the dangers of opioids awareness of proper proper disposal was certainly one

Side of it and and on that note kind of working with counties helped them understand that you need to help diminish the supply of drugs that are in your County and helping to feed this epidemic so one one part of it as I mentioned is obviously on the law

Enforcement side that I’ll get to in a moment but also just in people’s homes like are you aware of the proper way to dispose of medications are you aware that it is a risk to your family your kids your kids friends and their families to have you know oxycodone just

Sitting in your bathroom accessible to anyone that might drop in and counties obviously play a big role in that sort of supply decrease through take-back days and safe disposal sites and and there are a lot of interesting questions of where those safe disposal boxes should be located should it be in

A County Building should it be in a sheriff’s office should it be in a CVS or Walgreens where is it most effective and how do we work to limit the risks that come along with having a box that has a bunch of opioids in it during the

During the opioid epidemic so those are some of the prevention points that we hit on and again one of the things that we sometimes struggle but always work to address with our members is even in the in the heat of the escalating opioid epidemic even as individuals are

Tragically dying if you take your eye off the prevention and education side of things we’re never going to be able to get out of this because you need to stop the new dependence from developing before you can truly solve this epidemic and then working through these next

Items a bit more quickly because I think these are some of the more traditional solutions to the opioid epidemic that you have doubtlessly seen in your work naloxone I think is in a odd way one of the success stories of the view and epidemic getting naloxone into into more

Hands local governments and counties working to ensure that not only individuals struggling with addiction not just first responders but all who come into contact with with individuals who might be experiencing an opioid overdose have access to naloxone in some places that’s public libraries and the librarians having access to naloxone in

Other places that’s jail staff in other places it’s families of individuals Baltimore is a is a model sort of example of this sort of work of making sure that this this naloxone which is in its own small way can can help to prevent overdose of the fatalities is in

As many hands as possible and enhance that or aware of how that drug should be administered and then the other items medication assisted treatment it is difficult to overstate the importance of that the medically proven the scientifically supported treatment to to opiate addiction so we certainly worked with with our members

To make sure that they understood why these are the scientifically backed treatments this epidemic and how they can help facilitate them within their communities and then lastly we talked about law enforcement solutions one of the core convictions of our work was that we cannot arrest our way or

Incarcerate our way out of out of this epidemic but at the same time we knew that local law enforcement and state and federal law enforcement was a huge part of this and that we would never be able to turn the tide without their help so what is the proper balance in helping

Divert individuals out of the justice system and making sure that the justice system still has that that deterrent quality of enforcing law in ways that will limit supply of opioids and there’s a lot of cross state and cross county and city collaboration that plays into

That as well so our last slide here and and we’re certainly happy to address any questions that you all might have it’s just about our work going forward we are in pretty much constant communication with Senate and House offices and are working on different pieces of legislation that addressed this issue we

Have convenings on this issue at pretty much all of our events and I think that the last thing I’ll say on this is before passing it momentarily back to Bryan is that we are always happy to partner with you all whether that be individual conversations about your community or with the Planning

Association as a whole about how counties and planners can can partner moving forward so I’ll pass it back to Bryan quickly before we wrap up our part sure that’s work okay we’re short on time I’m happy just to turn it back over to you and maybe we can do everything else through

Question and answer thousand great so I’m going to moderate the question-and-answer period is I’m a good stand-in for planners looking to get involved in the academic and sure what to do so submit your questions through the the box we have a couple already in and also want to point out on this slide

That this is an emerging topic and if you are doing any work related please let us know so there are a couple questions related to rural communities and how how some of these suggestions relate to rural communities that have minimal services limited public transportation and treatment centers

Being fair fairly far away and and if there’s any specific funding sources for rural yeah so I have some thoughts on that because I live in Maine which is obviously it has lots of rural parts in it and you know one of the things ways I’ve seen other rural communities deal

With this is suboxone is an incredibly it’s a credible medic treatment for people with opioid use disorders that is prescribed through a physician’s office so most rural communities have some physicians offices and so I’ve seen different people having different solutions to the problem where people have used in Vermont they’ve used this

Hub-and-spoke model where there’s a hub where people go to seek treatment for their initial getting on to suboxone and doing some of the initial work and then they can end they can continue their treatment through a their primary care provider and so getting the primary care providers to get connected with a

Behavioral health person is kind of a different problem you know some of them you need to have kind of ongoing counseling often to be doing suboxone treatment and so I’ve seen here in Maine they’ve been using GIS mapping actually to find people who are primary health care providers and match them with

Behavioral health providers so that people can get both of their needs met to be able to use suboxone as a treatment great another question relates to and I think this is before for the NATO reps the idea of this being declared a public health emergency which might open

Federal dollars are you aware of as status on that or are any background information on that sure that this is Brian and yet so some President Trump declared this epidemic of public health and actually just extended that declaration that I think it was for 90 days originally I just pretty much

Allows the Department of Health and Human Services to to move around kind of staff and internal funding that the funding is very very small so there’s really not been new additional federal dollars for this epidemic could the task force evicted the Commission White House Commission really kind of put that in

Congress’s hands and we we do hope that you know when they they have to kind of do an appropriations package to keep the federal government open that potentially there will be some additional resources for the open epidemic but given the scale of the problem it’s likely to not

To not be enough yeah and I think another legal question just quickly was addressing silver living facilities and and how that relates to the Fair Housing Act how we can license and encourage responsible sober living facility is without superseding the Fair Housing Act anyone have any thoughts on that

Brian one of our colleagues on the webinar is a little more into housing issues I mean I would highlight for for this audience I mean there the key issue that we’ve heard of and we’ve also heard from County specifically and in Florida and some of some of the western states that there

Are some bad actors in this space so this is a hot issue right now about what constitutes an appropriate sober home and how you zone for that in communities etc so some of you may be facing that those issues great and if anyone listening has experiences a cactus cigar

And I’ll turn it over to him for wrapping things up Thank You Justin and again please feel free to contact any of the speakers if you have any follow-up questions that email addresses are on the slide and I would like to thank all our speakers for the wonderful

Presentation and I’m sure we have better understanding of the opioid crisis now than before thanks again and thank you Justin for moderating the Q&A I would like to again remind everyone that you will receive a link to the recorded webinar in your email soon and with that

I would awfully and they’re ready now have a good rest of the day Thanks

ID: IoCL2r81VgQ
Time: 1518033449
Date: 2018-02-07 23:27:29
Duration: 00:54:12

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