From the Field: West Virginia Experience Rahul Gupta, MD, MPH, - PowerPoint PPT Presentation

From the Field: West Virginia Experience Rahul Gupta, MD, MPH, MBA, FACP Commissioner and State Health Officer ASTHO Annual Meeting September 20, 2017

Overdose Deaths and Substance Misuse 1

WV SUD Associated Trends - Select Indicators 2

Comprehensive Public Health Response Strategy 3

Policy Strategies Enacted in WV Making naloxone available without a prescription or third-party prescribing Overdose response training for professionals, laypersons and community-based naloxone education and distribution programs Good Samaritan laws and Criminal Justice System Reform PDMP and CME requirements for prescribers MAT and Pain Clinics Harm Reduction Programs at community level Office of Drug Control Policy 4

State Office of Drug Control Policy • Moving Upstream - Strategic plan to reduce the prevalence of drug, alcohol and tobacco abuse among youth and adult populations • Primary prevention initiatives: 1. LARCs 2. Overdose follow up & prevention 3. K-12 education and community integration 4. Early childhood interventions 5. Systems accountability • A coordinated and comprehensive approach to substance use disorder as a complex, multifaceted, social, and contemporary challenge using a public health approach to combat the epidemic 5

Intrauterine Substance Exposure • From October 1, 2016 to May 31, 2107: • 14.2% of all infants born at West Virginia birthing facilities were exposed to drugs prenatally • 14.6% of West Virginia infants born at in-state birthing facilities were exposed to drugs prenatally 6

Neonatal Abstinence Syndrome • From October 1, 2016 to May 31, 2107: • 5.3% of all infants born at West Virginia birthing facilities were exposed to drugs prenatally • 5.6% of West Virginia infants born at in-state birthing facilities were exposed to drugs prenatally 7

Incidence of Neonatal Abstinence Syndrome The WV incidence rate for October 2016 - May 2017 is 54.8 (NAS cases per 1,000 births. Source: WV Birth Score.) *NAS Cases per 1,000 Hospital Births Source: Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999 – 2013. MMWR Morb Mortal Wkly Rep 2016;65:799 – 802. DOI: http://dx.doi.org/10.15585/mmwr.mm6531a2 8

CDC Vulnerability Report Source: Van Handel et al. J Acquir Immune Defic Syndr. 2016 Nov 1;73(3):323-331 Vulnerability to Rapid Dissemination of HIC/HCV Infections Among Persons Who Inject Drugs 9

Efforts to Reduce Vulnerability • Enhanced surveillance for HIV and Hepatitis C • Concurrent outreach to corrections, health care providers, regional jails and juvenile facilities • Expansion of Hepatitis B and C testing and vaccinations • Statewide 24/7 substance use helpline: 844-HELP-4-WV • Syringe Service Program expansion • Overdose outbreak investigations and the development of standard operating procedures • Statewide overdose prevention initiative - Naloxone distribution • Expansion of treatment and recovery services • Prescription Drug Monitoring Program (PDMP) enhancements 10

Harm Reduction Program - Syringe Service Program Additional outreach testing for HIV/HCV; Indicates high risk populations targeted WV Adult Hepatitis Vaccine Project* STD Clinics, Drug Treatment Facilities, Correctional Facilities, HIV Clinics, and Family Planning Clinics * Distributed 12,094 doses *75% (9,000) administered *Cost $317,645 As of June 26, 2017 West Virginia counties vulnerable to rapid dissemination of HIV/HCV co-infection and the location of active and planned syringe service programs.

Drug Use: High School Students 12

Drug Use: Middle School Students 13

Drugs on School Property 14

Drug Use: Adolescents and Teens 15

Comprehensive School Response Strategy Overdose Education Curriculum Policy Resources Prevention Public Health Partners 16

Roadmap Forward Healthy Public Health Schools & WVDE Healthy Families (Children) Healthy Communities Remove Barriers 17 Bing Background Image: Creative Commons

Existing Policy and Opportunities WVBE Policy 2423 Immunization, HealthCheck and Dental Exam for entry Health Promotion & grades 2, 7, 12 to support wellness, mental health and communicable disease spread through substance abuse & Disease Prevention WVBE Policy 2422.8 Provides for various prescribed medications to be provided during the school day including naloxone for students, staff and community members. Medication Administration Provides managed care for children with health care conditions including School Nursing/School Health mental health disorders and substance abuse along with supporting substance abuse programs and education in schools while linking staff, School Nurse RNs (300) students and family to substance abuse services, mental health services & LPNs (114) and treatment centers. They also provide staff, student and community education. Requires county board of education policies to include safeguards to protect the safe and supportive environment of the schools. …meaningful interventions and consequences for substance abuse and WVSB Policy 4373 inappropriate behaviors Expected Behaviors to Support …create, encourage, and maintain a safe, drug -free, and fear-free school environment in the classroom, on the playground, and at school-sponsored Safe and Supportive Schools activities Procedures regarding possession of, be under the influence of, distribute or sale any substance containing alcohol, over-the-counter drugs, prescription drugs marijuana, narcotics… 18 Disclaimer: Policy excerpts only; WVDE 2017.

Existing Policy and Opportunities …Teachers and policy -makers can use the health education standards to WVBE Policy 2520.5 design curricula… … major focus has been given to what the Center for Disease Control Next Generation Health recognizes as risk behaviors (tobacco use, dietary patterns contributing to Education Standards disease, sedentary lifestyle, alcohol and other drug use, and behaviors that result in intentional and unintentional injuries). …describe the attitudes, knowledge, skills, and dispositions all students WVBE Policy 2520.19 shall develop in relation to personal and social development… …serve as primary standards for all Pk -12 students, and are foundational WV College and Career standards for comprehensive school counseling programs and middle and Readiness Dispositions and high school teacher led, student advisory systems. …personal and Social Development and Global Competence standards Standards for Student Success include competencies related to substance abuse prevention. YRBS/School Health Profiles, Supported through CDC grants funding and provides student and staff reported data on substance abuse/use and policies Policies, and Practices (Note: Some of the data in this presentation regarding drug use and (CDC Surveys for Schools) schools was from this YRBS survey) 19 Disclaimer: Policy excerpts only; WVDE 2017.

Contact Information Rahul Gupta, MD, MPH, MBA, FACP Commissioner, Bureau for Public Health State Health Officer West Virginia Department of Health and Human Resources 350 Capitol Street, Room 702 Charleston, WV 25301 (304) 558-2971 Rahul.Gupta@wv.gov 20