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

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Overdose Deaths and Substance Misuse

WV SUD Associated Trends - Select Indicators

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Comprehensive Public Health Response Strategy

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

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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

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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

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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

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Incidence of Neonatal Abstinence Syndrome

8 *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

The WV incidence rate for October 2016 - May 2017 is 54.8

(NAS cases per 1,000 births. Source: WV Birth Score.)

CDC Vulnerability Report

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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

Efforts to Reduce Vulnerability

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• 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
• perating procedures
• Statewide overdose prevention initiative - Naloxone distribution
• Expansion of treatment and recovery services
• Prescription Drug Monitoring Program (PDMP) enhancements

West Virginia counties vulnerable to rapid dissemination of HIV/HCV co-infection and the location of active and planned syringe service programs.

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

Harm Reduction Program - Syringe Service Program

As of June 26, 2017

Drug Use: High School Students

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Drug Use: Middle School Students

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Drugs on School Property

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Drug Use: Adolescents and Teens

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Comprehensive School Response Strategy

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Education Overdose Prevention Curriculum Policy Resources

Public Health Partners

Roadmap Forward

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Public Health & WVDE

Healthy Schools Healthy Communities

Healthy Families (Children)

Bing Background Image: Creative Commons

Remove Barriers

Existing Policy and Opportunities

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WVBE Policy 2423 Health Promotion & Disease Prevention

Immunization, HealthCheck and Dental Exam for entry & grades 2, 7, 12 to support wellness, mental health and communicable disease spread through substance abuse

WVBE Policy 2422.8 Medication Administration

Provides for various prescribed medications to be provided during the school day including naloxone for students, staff and community members.

School Nursing/School Health School Nurse RNs (300) & LPNs (114)

Provides managed care for children with health care conditions including mental health disorders and substance abuse along with supporting substance abuse programs and education in schools while linking staff, students and family to substance abuse services, mental health services and treatment centers. They also provide staff, student and community education.

WVSB Policy 4373 Expected Behaviors to Support Safe and Supportive Schools

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 inappropriate behaviors …create, encourage, and maintain a safe, drug-free, and fear-free school environment in the classroom, on the playground, and at school-sponsored 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…

Disclaimer: Policy excerpts only; WVDE 2017.

Existing Policy and Opportunities

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WVBE Policy 2520.5 Next Generation Health Education Standards

…Teachers and policy-makers can use the health education standards to design curricula… …major focus has been given to what the Center for Disease Control recognizes as risk behaviors (tobacco use, dietary patterns contributing to disease, sedentary lifestyle, alcohol and other drug use, and behaviors that result in intentional and unintentional injuries).

YRBS/School Health Profiles, Policies, and Practices (CDC Surveys for Schools)

Supported through CDC grants funding and provides student and staff reported data on substance abuse/use and policies (Note: Some of the data in this presentation regarding drug use and schools was from this YRBS survey)

WVBE Policy 2520.19 WV College and Career Readiness Dispositions and Standards for Student Success

…describe the attitudes, knowledge, skills, and dispositions all students shall develop in relation to personal and social development… …serve as primary standards for all Pk-12 students, and are foundational standards for comprehensive school counseling programs and middle and high school teacher led, student advisory systems. …personal and Social Development and Global Competence standards include competencies related to substance abuse prevention.

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

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