Massach chuset etts Healt lth Pol olic icy F Foru orum - PowerPoint PPT Presentation

Massach chuset etts Healt lth Pol olic icy F Foru orum November 17, 17, 2015 2015 1

Examin ines problem, costs and consequences of untreated substance use disorders (SUD). Desc scribes gaps in access to SUD treatment and related racial, ethnic and gender disparities. Exp xplore res benefits of expanding access to SUD treatment in the community and along criminal justice continuum. Pre Presents evidence-based and innovative practices. Acknowledge ges environment and opportunities for change. Recommends options and action steps to improve access to treatment across public health and criminal justice systems. 2

Opioid id-Re Relate ted Deaths, s, Uninte tenti tional/Undete termined Massa sachuse setts: tts: 2000-201 2014 1400 1, 1,256 256 1200 1000 1089 1089 911 911 800 600 668 668 615 615 614 614 599 599 603 603 561 561 549 549 525 525 526 526 400 468 468 456 456 429 429 338 338 200 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Confirmed Estimated 3

Uni nint ntention onal Opioi oid-Rel elated Ov Overd erdose Dea eaths vs. Motor Veh Vehicl cle-Re Relate ted D Death ths, s, MA Resi sidents, 2005-2013 2013 Unintentional Opioid-related Overdose Deaths 1000 Motor Vehicle-related Injury Deaths 800 600 400 200 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 4

 Deaths due to opioid misuse have surged.  Since 2005, deaths due to unintentional opioid overdoses exceed motor vehicle deaths.  The problem extends to 75% of municipalities (MDPH,2015) .  8.9% of MA residents 12+years misuse or are dependent on alcohol or other drugs, compared to 8.2% of the nation (SAMHSA, 2013, 2014) . 5

Treatment typically involves behavioral therapy and can include medication- assisted treatment Acute treatment services for detoxification (ATS) Clinical stabilization services, ATS step-down for those in need Transitional support services, less medically intensive step-down Residential treatment Intensive day treatment Outpatient treatment 6

• Limited access to treatment for diversionary efforts (CHIA, 2015) . • Limited access to residential beds for prisoner re-entry (CHIA, 2015) . 7

Greater engagement with the criminal justice system. Higher levels of incarceration. Disproportionate impact on Blacks, Latinos and women. Effects of incarceration. Economic impact. 8

Delayed treatment leads to continued use and more crime to support use or while under the influence (Collins and Lapsley, 2008) . Chronic drug users engage in crime 30% more than non-drug users (French et al.,2000) . Drug laws, policies and practices result in high levels of incarceration (Drug Policy Alliance, 2015) . 9

MA incarcerates 323 per US has the highest 100,000 residents- a incarceration rate in the rate lower than most world -716 people for states, but twice as high every 100,000 residents as half the world (Walmsley, 2013) . (MA DOC, 2015) . 1 in 6 DOC inmates MA recidivism- a steady incarcerated on a drug and high 41% offense (MA DOC, 2014) . (MA DOC, 2014) . 10

Massachu chusetts C Convict ctions ns b by Race/Ethni hnici city 76.9% 76. 71. 71.6% 63.9% 63. 33.0% 33. 27.1% 27. 15.4% 15. WHITE, NON-LATINO BLACK/LATINO 2011 Census 2011 Convictions 2011 Convictions for Mandatory Drug Offenses 11

MA saw females Blacks and Latinos Disparities for under jurisdiction face disadvantages women civilly of state or federal when accessing committed for authorities in treatment in MA treatment. 2012-13 increase (Cook & Alegria, by 6.3% (Carson, 2011). 2014) . 12

On the Individual • Decreases employment opportunities and lowers wages (Western, 2002) . On the Family • Adds to financial difficulties • Harms parent/child & partner relationships • Hurts childhood functioning (Clear, 2007) . On the Community • Adds to racial/ethnic wage gap (Western, 2002) • Increases child-poverty rates (DeFina & Hannon, 2010). 13

In 2010, financial costs In 2014, financial costs of prisons nationally: of prisons in MA: $48.5 billion to states $53,000 per year (Kyckelhahn,2014) . (MADOC, 2014) . 1,564 inmates convicted of drug Cost of prisons to offenses cost $83.0 taxpayers -$39 billion million per year (Henrichson & Delaney, 2012). (MA EOPPS, 2015) . 14

Cost Improved savings public that can be health. reinvested. Reduced Improved overall public recidivism safety. rates. Decreased incarcerati on for low- level drug offenders. 15

 National shift in criminal justice philosophy.  Growing bipartisan consensus.  Expansion of healthcare coverage-Affordable Care Act and earlier Massachusetts health care reform.  Massachusetts leadership’s response to opioid crisis.  Policymakers’ calls for change. 16

Criminal justice system • Commonwealth of Kentucky reforms to prioritize • Washington State access to treatment and • Brooklyn, NY alternatives to incarceration. • Bureau of Justice Assistance Federal support for • Substance Abuse and Mental improvements. Health Services Administration • Massachusetts Medication-assisted • Rhode Island treatment initiatives 17

Systems Strategies for Expansion of collaborations probation, treatment while and data parole and re- incarcerated. sharing models. entry. • Louisville, KY • California • New Hampshire, • Massachusetts Hawaii, Texas • Advocates/ Worcester County Sheriff’s Office/DOC • Harlem, NY 18

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Build MA Dept. of Mental Health’s (DMH) Jail Diversion Program to divert low-level drug offenders to treatment. Program currently runs in 24 communities, with 73% to 92% of eligible arrests diverted to treatment (MA DMH, 2014) . DMH has provided over 7,000 hours of training to 476 officers (MA DMH, 2014) . 20

MA has 34 specialty Research demonstrates courts (22 adult drug drug courts reduce courts, 6 mental health arrests, technical courts, 3 veterans’ violations and treatment courts and 3 incarceration juvenile drug courts) (Marlowe, 2010) . (Mass.gov 10/13/15) . In 2013, SAMSHA awarded Expand specialty courts MA a grant to expand SUD by diffusing model to capacity in adult, juvenile other locations and family drug courts. throughout the state. 21

MAT with psychosocial treatment produces higher abstinence rates compared to treatment with no medication (Connery, 2015). Few individuals receive MAT while incarcerated (Fox, 2015) . Offenders with opioid use at high risk for overdose upon release as tolerance has diminished (Fox, 2015) . Those who receive MAT while incarcerated are more likely to enter MAT upon release (Kinlock et al., 2007) . In Sept. 2015, U.S. Dept of Health and Human Services recommended expanding MAT (HHS, 2015) . 22

 Expand current implementation to improve access to primary care, SUD and mental health services by:  Screening offenders for eligibility.  Enrolling those not already covered by Medicaid.  Suspending Medicaid benefits for inmates on Medicaid while incarcerated.  Reactivating Medicaid benefits upon release. 23

Sy Syste tems and cultu lture Establish dat ata ex a exch change ch chan ange must involv olve a all to feed a pla plan, do, do, key agencies and the myriad study, act act cycl cycle of of law enforcement and criminal justice agencies, process improvement. departments and offices. Two alternative gov govern rning s stru tructures proposed: • A revitalized MA Interagency Council on Substance Abuse and Prevention • A reconstituted Governor’s Opioid Working Group charged with implementation and oversight. 24

Michael Doonan, Ph.D., Executive Director Massachusetts Health Policy Forum Brandeis University 415 South Street, MS 035 Waltham, MA 02454 http://masshealthpolicyforum.brandeis.edu/ publications/all.html 25