SUD SUMMIT | NOVEMBER 7TH, 2017 SUBSTANCE USE IN MONTANA Overview: Scope of the Problem and Current State Actions presented by : KATIE LOVELAND MPH, MSW Loveland Consulting LLC
Reference Documents STATE PERSPECTIVES
Reference Documents NATIONAL PERSEPCTIVE
What we do (and do not) know about addiction in Montana 9
Substance Use Disorders are common in our state
66,500 dependent on or abusing alcohol 18,000 Adults 18+ dependent on or abusing illicit drugs Source: National Survey on Drug Use and Health, 2012-2014
One in ten Montana adults is dependent on or abusing alcohol or illicit drugs. Source: National Survey on Drug Use and Health, 2012-2014
One in four young adults used illicit drugs in the last month Source: National Survey on Drug Use and Health, 2012-2014
Alcohol misuse and abuse is the most common SUD
CURRENT USE Montana’s rates 58% of alcohol use, 54% binge drinking, BINGE DRINKING and heavy 20% drinking are all 16% higher than CHRONIC DRINKING those in the US 8% 6% Source: Behavioral Risk Factor Surveillance System 2015
One in three 61% of students high school who report students reports drinking also engage in binge alcohol use in drinking the last month behavior. Source: Youth Risk Behavior Survey, 2015
Percent of traffic fatalities that are alcohol related Alcohol is a key driver of 34% Montana’s 29% traffic fatality rate which is almost twice that of the US Source: National Highway Traffic Safety Administration
More than 13% of all deaths among individuals aged 20-64 in Montana are due to excessive drinking.
Marijuana is the most commonly used illicit drug.
One in five high school students used marijuana in the last month. Source: Youth Risk Behavior Survey, 2015
The number for young adults is one in four. Source: National Survey of Drug Use and Health, 2012-2014
10 Year Trends in Substance Use YOUTH ADULTS All other All other Marijuana illicit drugs, alcohol Marijuana illicit drugs and cigarettes Source: YRBS 2007-2017, National Survey on Drug Use and Health, 2012-2014
1748 of 2539 violations Marijuana Year 2015 constitutes 69% the majority of criminal 57% drug violations in Year 2005 Montana 2256 of 3959 violations
Opioids are the most deadly illicit drug used in Montana.
Montana has 70 opioid prescriptions for every 100 residents Source: Centers for Disease Control and Prevention. US State Prescribing Rates, 2016.
138 people died from drug overdose More than half died of in Montana opioid overdose . in 2015. Source: Montana DPHHS Vital Statistics.
Unlike national trends, Montana’s death rate for opioid overdose has trended down in the past few years Peak in 2008-2009 7.7 Age-adjusted death rate per 100,000 6.2 5.2 5.3 4.2 4.1 3.2 1.4 Source: Montana DPHHS Vital Statistics.
Montana’s justice system is increasingly driven by substance use-related crimes.
Total Annual Drug Offenses, 1980-2018 559% 8110 increase 6119 5425 5011 from 3633 1980 to 2015 1414 1163 917 1980 1985 1990 1995 2000 2005 2010 2015 216 Source: Montana Board of Crime Control
101% Felony and misdeameanor arrest for increase drug offenses, 2009-2015 in felony 1834 1717 1419 drug 1245 1045 911 1046 arrests 3735 3503 3137 2929 2534 2483 2398 from 2009- 2009 2010 2011 2012 2013 2014 2015 Misdemeanor drug arrests Felony drug arrests 2015 Source: Justice Reinvestment Project, Montana Department of Justice data
Top 5 Adult Felony Conviction Offenses Possession of drugs Possession of drugs Criminal endangerment Criminal endangerment Felony DUI Theft Distribution Theft of drugs Burglary Felony DUI Source: Montana Department of Corrections, 2012-2016
A justice Probation 98% and system Parole driven by Violations 189% SUD Failures to appear related from crimes 109% Bail & 2009- experiences bond revocations 2015 more Source: Justice Reinvestment. 2009-2015
SUD cases are overloading Montana’s justice system PUBLIC PRISONS DEFENDER CASES At capacity-female Criminal case duration has population has grown increased to 1.5 years 30% since 2012 JAILS COURTS District court case filings have 67% increase in MT’s jail increased 21% since 2009 population from 2011-2013 Source: Justice Reinvestment, Department of Corrections, Office of the Court Administrator and Office of the Public Defender
Methamphetamine is a key driver of justice system involvement and is trending sharply up.
METHAMPHETAMINE AND HEROIN VIOLATIONS 427% increase 1200 in meth 1243 violations and 1557% increase 900 in heroin violations from 2010-2015 600 561 300 116 236 4 7 0 2015 2005 2010 Methamphetamine Heroin 214 Source: Montana Board of Crime Control
DIVISION OF CRIMINAL INVESTIGATION CASES 250 232 219 200 54% of all cases 143 151 150 involve 103 meth 100 68 50 0 2010 2011 2012 2013 2014 2015 Marijuana Methamphetamine Drug Diversion (pills) Cocaine Heroin Ectasy Source: Montana Department of Justice, DCI administrative data
SUDs are also a key contributor to child welfare concerns in our state.
THE MAJORITY OF CHILD AND FAMILY SERVICES PLACEMENTS HAVE SUD INDICATED Substance use not indicated BUYER 01 BUYER 01 35% 65% BUYER 01 BUYER 01 Substance indicated Source: DPHHS Child and Family Services Administrative Data, April 2016
THE MOST COMMON SUBSTANCE INDICATED IN CFSD PLACEMENTS IS METHAMPHETAMINE Prescription drugs or unknown BUYER 01 BUYER 01 20% 46% 17% Marijuana Methamphetamine BUYER 01 BUYER 01 18% Alcohol Source: DPHHS Child and Family Services Administrative Data, April 2016
CFSD District Court Filings are up sharply 130% 2321 2500 increase from 2009-2015 2000 1500 1006 1000 Source: Office of the Court Administrator
SUD treatment and payment systems are undergoing a massive shift nationally and in Montana.
Shift in Understanding of SUD “Addiction is a chronic, “Addiction is a relapsing brain moral failure” disease”
MAJOR SHIFTS IN SUD TREATMENT Treatment not covered by Coverage mandated insurance, funded by federal Medicaid expansion block grants + state dollars Routine screening, treatment in Treatment limited to SUD team-based primary care settings providers Chronic disease management including medication assisted Abstinence model treatment Building a continuum of care, Focus on inpatient beds emphasis on community-based treatment Professional peer support and Informal recovery support recovery
Montana’s Model Historically: New Model SUD treatment provided by 33 state approved providers More state approved ( Max=1 per county) providers SUD treatment being INTEGRATING integrated into AND primary care, EXPANDING hospitals and CARE mental health- shifting focus to community based care
Covered comprehensive SUD treatment for expansion adults 90%+ of cost covered by federal dollars Medicaid Expansion Practices can now be reimbursed for SUD care for adults who qualify for Medicaid-not capitated Allowed Montana to re-allocate federal block grant dollars traditionally used to treatment in new ways
Remaining Challenges: Access Most current Only 7% of Only 6% of state providers don’t Montanans with approved treat co-occurring an SUD are providers care for mental illness or receiving pregnant women medical illnesses treatment and children that can interfere with recovery Source: Manatt Health, 2017
SUD Patients receiving Medicaid Assisted Treatment in Outpatient Care Remaining 50% Only 16 physicians in challenges: Montana are certified to prescribe MAT buprenorphine 25% 27% access 56 1 8% 23 6 0 Source: Manatt Health, 2017
To learn more
LIVED EXPERIENCE OF SUBTANCE USER IN MT ACCESS TO NOT OFTEN PRESENT TREATMENT IS IN THE OFFICIAL LIMITED, ESPECIALLY SYSTEM IN RURAL AREAS 90% of those with SUD not receiving treatment. PRIMARY ENTRY INTO TREATMENT IS THROUGH THE JUSTICE SYSTEM TRAUMA HISTORY, EARLY ONSET OF SUD IS ONE CONCERN SUBSTANCE USE OF MANY HEALTH AND FINANCIAL WORRIES
To learn more See maps in the Substance Use in Montana Report
WHAT INDIVIDUALS WITH LIVED SUD EXPERIENCE IN MONTANA WANT YOU TO KNOW “ Talk to more addicts and people in recovery. Understand our perspective. Addiction is a disease, not just bad choices. “ We face a lot of stigma. Accessing treatment, housing and jobs is a challenge. Source: Focus group themes, Montana Healthcare Foundation, June 2017
WHAT INDIVIDUALS WITH LIVED SUD EXPERIENCE IN MONTANA WANT YOU TO KNOW “ We want to be treated with compassion but the system is based on punishment and fear. We worry that our criminal history will define us forever. “ We need to make it easier for children and parents to get help. Caring professionals make a big difference. Source: Focus group themes, Montana Healthcare Foundation, June 2017
Health and justice partners in Montana are working together in new ways to address SUD.
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