Chautauqua County's HRSA Rural Commuity Opioid Response Program

John Lloyd of the Program Committee and Steve Kilburn, speaker
John Lloyd with Steve Kilburn, Grant Director for the HRSA Rural Community Opioid Response Program.
 
John Lloyd introduced today’s speaker, Steve Kilburn, who is the Grant Director for the Chautauqua County Rural Community Opioid Response Program (RCORP) grant from the U.S. Health Resources and Services Administration (HRSA). Steve is a native of northwestern PA, resident of Busti, a Cornell graduate, and the Board Chair of UPMC WCA. He has a Doctorate of Divinity degree and is pastor at the Sherman Community Church.
 
Mr. Kilburn was presenting to us on behalf of the Grant. As the Grant Director, he works for the CC Dept. of Mental Hygiene.
 
The County received a three year, $1,000,000 grant to address the opioid crisis. This is an issue fraught with emotion, attitudes and opinions both from the legal and the treatment point of view. Notwithstanding the areas of controversy, it needs to be directly and strongly addressed.
 
First, there are some basic things that we as Rotarians and community leaders should know about addiction. It afflicts our population without regard to socio-economic status, or any other demographic. It is in all our interest to address this problem.
 
Mr. Kilburn addressed the actual term we use. Addiction is more accurately a “Substance Use Disorder” in the medical terminology. The grant specifically works to address Opioid Use Disorder (OUD). Opioids include:
     Pain medication- oxycodone, hydrocodone
     Fentanyl, morphine, opium and other street drugs.
 
There are no statistics about the extent of OUD in the county, but the estimate is that there are about 1,500 people dealing with it.
 
There are so many consequences just from a public health point of view. Lives are impacted in so many ways, but the most quantifiable is the deaths by overdose. There has been a steady increase in deaths. The number peaked in 2017 with 30 known deaths. In 2018, the most recent year with available statistics, there were 20 deaths. This is great news. Unfortunately, it is not because the rate of OUD is decreasing. In all likelihood, the major reason is growing awareness of and availability of Narcan (Naloxone) nasal spray. It is definitely saving lives.
 
There are numbers that can be useful when developing a plan to address the crisis. 24 overdoses a month are reported in the County. Unfortunately, this is known to be a significant under-reporting of actual overdoses. If someone requests another Narcan kit to replace one that they have used, they are asked to fill out a form explaining why they used their kit. Most people report that they used it to treat an overdose, but did not report the overdose to the authorities (for example, by calling 911.)
 
Opioid use is a very significant problem in our county. Financial, legal, health and employment implications make it significant.
 
The federal grant is available nationwide for local consortiums to initiate and/or expand programs addressing the issue in 4 ways. Chautauqua County is working to strengthen each.
  1. Prevention. Strengthen “Prevention Works”, formerly CASAC. Working with young people to develop a host of skills, using evidence-based programs that are shown to cause reduction in drug use. Chautauqua County students use drugs at a higher level than nationally and underrate the seriousness of drug use. Prevention Works is addressing this.
  2. Treatment. There is a notable array of treatment options including out-patient counseling, inpatient treatment, long term housing during recovery, and medication (most effective). One setback is losing beds at Lakeshore hospital which is closing.
    1. Methadone. Can only be distributed in a Federally approved clinic. There is no clinic in Chautauqua County. Only in Erie County, which isn’t realistic for the local population.
    2.  Buprenorphine. Physician must have training to prescribe. This is available in Chautauqua County. It controls cravings.
    3. Vivitrol (Naltrexone) blocks the receptors in the brain.
  3. Recovery. This requires long term “reorganizing” of life and life style. There is one group doing this in the County, the Mental Health Association.
  4. Harm Reduction. This addresses the side effects of drug use, reducing the consequences of active drug use. One major way to do this is to provide those who are using with sterile needles. This reduces cases of hepatitis C and HIV. Evergreen Health provides these services.
In the big picture, Mr. Kilburn noted that Chautauqua County needs to improve the systems of care and improve the access to and awareness of these services.
 
Preparing for the future is difficult because the nature of substance use disorder is constantly morphing. Fentanyl use is increasing. It is more potent than heroin. Multi-drug overdoses are increasing, often with amphetamine as an ingredient.
 
Another very significant issue is the lack of professionals to address the crisis. The County needs to plan for training and attracting professionals to deal with the issues. Currently, there are positions that cannot be filled because there is not a large enough work force. So, the grant is working on this, as well as the following:
  1. Expand Distribution of Narcan. It is easy to apply and there is no downside if it is administered to someone whose problem turns out to be non-opioid related.
  2. Expand Peer Program of the Mental Health Dept. Ideally, whenever an overdose is reported through 911 a peer should be available from the MHD to reach out to the individual within 24 hours.
  3. Improve referrals from doctors’ offices to clinics. Especially in pediatric offices-have someone in the office trained to identify people with SUD and to counsel the patient on assistance that is available.  
  4. Expand use of the treatment medications, including in emergency rooms. The chance of successfully getting people onto a treatment regimen is much higher if done immediately rather than after a day or two.
  5. Job skill preparation. The Mental Health Association is working on this, funded by a separate grant.
  6. Improved services in the county jail. This is a very susceptible population.
  7. Workforce improvement.
  8. Increase awareness throughout the County of the crisis and of resources available.  
Question: First I’d like to commend the Office of Mental Hygiene. It has been doing amazing work. My question is about the proposed legalizing of marijuana. How will this impact our substance abuse issues? There are concerns, of course. People should carefully consider whether the sanctioned use of recreational drugs sends the right message.
 
Question: What will you be talking about 25 years from today? We have trouble anticipating even what will be happening in two years. The morphing of substance abuse issues, for example the increased presence of meth-amphetimine. Opioid use disorder should see continued improvement because of the resources being directed to it. Will there be the political will in the future when there is a “tolerable” level of substance abuse to keep the pressure on?
 
Question: Of all the addictive substances-are opioids most addictive? What has greatest negative impact? The greatest negative impact is tobacco.  The most lethal is alcohol. Opioids are the most highly addictive. Mr. Kilburn emphasized this anecdotally, citing a doctor who was in treatment who said he knew “what his life had been missing” when he took his first dose of an opioid for treatment of a knee injury and was immediately dependent.