report of proceedings - bernalillo county community health council

Bernalillo County

ACCOUNTABILITY SUMMIT

Turning the Curve on Opioid Abuse in Bernalillo County

September 19, 2013

UNM Rotunda - 801 University Blvd. SE - Albuquerque, NM

REPORT OF PROCEEDINGS

Drafted by William Wiese

Edited by Marsha McMurray-Avila

Accountability Summit Table of Contents

2

TABLE OF CONTENTS Summary ............................................................................................................................3 Background/Purpose/Planning .........................................................................................6 Proceedings .......................................................................................................................8 Introduction and Background Presentations ........................................................9 Welcome - Commissioner Maggie Hart Stebbins Agenda and Framework - Marsha McMurray-Avila Introduction Congressional Representation - Sam Donaldson Bernalillo County Overview - Harris Silver, MD Stepping Up to the Challenge - Bill Wiese, MD Luncheon Keynote- Sam Donaldson Panel 1: Prevention ............................................................................................14 Panel 2: Law Enforcement/Criminal Justice/Public Safety .................................18 Panel 3: Harm Reduction ....................................................................................23 Panel 4: Treatment .............................................................................................26 Next steps: Formation of implementation groups ........................................................32 Appendices A. Summit agenda

B. Planning Committee members

C. Attendees D. Panelist biographical statements E. Bernalillo County data and graphics F. Sponsors of the Summit

Accountability Summit Summary

3

SUMMARY

The first Opioid Accountability Summit convened on September 19, 2013, to review a plan to measurably reduce deaths and other consequences from use of illicit opioids and misuse of prescription opioids in Bernalillo County. Over 150 persons attended the Summit. Several recent trends and occurrences combined to make this time appropriate for launching this effort: increasing public awareness of the drug problem within the State and within Bernalillo County; concern about the escalating costs and human toll directly attributable to drug use; the opportunity afforded by expansion of funding sources for treatment; and a Federal clarification of the statutory obligation for parity in treatment for mental health and substance abuse services. The immediate objective of the Summit was to consider and attempt to augment and refine preliminary recommendations for action and measures to track outcomes that had been developed in advance by a Planning Committee. The Planning Committee had been organized and staffed by the Bernalillo County Community Health Council. To gain the desired goals, the Committee proposed using results-based planning and accountability -- projecting results based on data, developing specific plans to achieve outcomes, and tying these to accountable entities. The strategic approach was organized under the four areas (or pillars) previously used by the New Mexico Drug Policy Task Force: prevention, harm reduction, treatment, and law enforcement/criminal justice/public safety. The Summit included panels and discussion within each of these areas. This report summarizes and collates the suggestions and recommendations that evolved from the advanced planning, the panels, and the discussions. Implementation is to roll out over a 2-year period. This Summit was the first of four summits to be planned over the two years. Prevention Panel For implementation, emphasis will be on having an overall, integrated prevention plan for the County. In the immediate term there should be a focus on determining with Albuquerque Public Schools how to screen all students who are at high risk and/or initiating drug use, and how to then offer counseling and referral. Other initiatives to be considered are public and targeted drug education programs, a countywide prescription opioid take-back program, and prescribing guidelines to limit over-prescription of opioids. More long term, there should be advocacy increasing State support for services intended to prevent and mitigate the impacts of adverse childhood events that are associated with subsequent drug use. One example is assistance through home visiting programs for first-time mothers identified as being at risk. These could potentially be covered through the managed care organizations. Harm Reduction Panel With the objective of having Narcan available to all who may need it, a full implementation effort should lead to the following: all pharmacies stocking Narcan rescue kits; broad


4

participation of pharmacists having prescription authority; protocols for co-prescription of Narcan in association with opioids and training of family member as standards of care; use by all first responders; availability at all public health offices; and distribution to persons being released from incarceration and to their families. Treatment Panel For achieving effective treatment, advocacy must be effective in assuring that the statutory requirements for parity of mental health and addiction services are incorporated into health care coverage and include the full continuum of options cited by the American Society of Addiction (ASAM). Duration of coverage for specific levels of intervention should be flexible and tailored to patient needs. Co-occurring disorders should be identified and treated. Wrap-around support services should be included in coverage for treatment services. Many will need assistance in finding housing and jobs. All persons who are drug users or at risk for opioid abuse and are eligible for Medicaid should be identified and offered enrollment. Of particular importance are persons being released from incarceration. Increasing the capacity for treating persons with substance use disorders needs to be a priority. The expansion of Medicaid will draw providers into this area. Additional funding sources for health care need to be made available to assure access for low-income persons not otherwise covered. User access to medication assisted treatment (MAT) is being delayed due to lack of authorized and available providers. The barriers that constrain physicians’ motivation to participate in MAT need to be addressed, particularly the current application of requirements for prior authorization for continued use of Suboxone. Evidence-based non-pharmacologic treatment of pain should be options covered and incentivized by Medicaid. Law Enforcement/Criminal Justice/Public Safety Panel Advocacy will be needed to expand judicial capacity necessary for diversion programs such as drug courts that reduce incarceration and recidivism. Expansion of Medicaid should help with financing treatment services mandated as a requirement for diversion. Opportunities for pre-booking diversion should be reviewed including feasibility of either the Albuquerque Police Department or the Bernalillo County Sheriff’s Department piloting a Law Enforcement Assisted Diversion (LEAD) program such as that being started in Santa Fe, based on a program in Seattle. Treatment during incarceration at the Metropolitan Detention Center (MDC) should include maintaining MAT for those on it at time of incarceration. Prerelease initiation of MAT should be explored. Persons at risk for resumption of opioids should be connected with a medical provider upon release. Provision of Narcan rescue kits at release should be provided. Support and social services are essential components in the treatment planning in order to achieve successful reintegration. There are parallel considerations for persons being released from prison. The Implementation Team needs to coordinate with NM Corrections Department's Probation and Parole.


5

Overarching Themes The overall goal of a major and sustained reduction of drug use and reduction in its consequences - including death - will require significant new commitments, new partnerships, greater levels of organizational coordination and synergies, and vigorous advocacy for needed policy change. Simply doing more of the same will not deliver sustainable solutions to reach the goals articulated in this Summit. Dramatic political leadership and creative administrative follow-through will be essential. Ideas that arose across several of the Summit’s sessions included the need for budgeting incentives that align activity with outcomes, that bridge current organizational and institutional silos, and that reduce barriers. For several reasons, many of which tie back to a history of stigma, funding for mental health care in general and substance abuse services in particular have resulted in major shortcomings with respect to current infrastructure and capacity for assessment and treatment. Investment in prevention falls far short of what is needed. The judiciary that serves the County is unable to process its caseload in an expeditious manner. Addressing these will require policy solutions and commitments at the State level. The County must be creative, persistent, and effective in working with the Executive and Legislative branches of State government to balance and leverage resources and achieve supportive policies. It is particularly important at this time of the rollouts of Centennial Care and Medicaid expansion, and the changes in insurance coverage under ACA, that addiction treatment and mental health services are appropriately and fully covered, that services are promoted and supported by the managed care organizations and enrollees are actually receiving from providers the care that they need when they need it. A corollary is that people need to be actively enrolled into insurance plans. For some with substance abuse disorders, enrollment will require proactive assistance. A recurring observation in the panels and discussion was that treatment of addiction must include provision of support services and treatment of co-occurring conditions as standards of care. Parallel (and integrated) initiatives to increase opportunities for housing and jobs will be necessary. There will still be persons who are not covered and not eligible for coverage. The County and its affiliates have direct responsibilities to assure these individuals have access to needed services. Next Steps Four implementation teams will start meeting in early 2014. Participants will be drawn from those volunteering at the Summit and augmented by others needed to build the partnerships necessary to further develop and prioritize the recommendations and measures coming out of this Summit, to create timetables for implementation and schedules for reporting, and build the partnerships and commitments needed for implementation.

Accountability Summit Background/Purpose/Planning

6

BACKGROUND AND PURPOSE On September 19, 2013, at the request of Bernalillo County Commissioner Maggie Hart Stebbins, the Bernalillo County Community Health Council convened the first of four anticipated summits on opioid abuse to take place over the next two years. The meeting reviewed recommendations for improving systems and barriers to implementation to reach goals targeting a reduction in opioid abuse and overdose death rates in Bernalillo County. Planning for the Summit began two years before in the face of evidence of rising rates of drug overdose in the County (as well as the State) with certain neighborhoods heavily affected and the spread into new areas and to younger age groups. Particularly alarming was the rise in deaths for heroin and prescription opioid pain medications. It was clear that neither efforts in terms of public awareness and education nor treating persons with substance abuse disorders had been sufficient in stemming the problem. Furthermore, the courts had been buried with cases relating directly to drug use or of crimes committed in order to finance personal use of drugs. The Metropolitan Detention Center (MDC) was filled beyond capacity as a result. Related costs were rising to unacceptable levels. All of this was overlaid with the human cost and lives ruined.

PLANNING The Bernalillo County Community Health Council took on the planning, with its coordinator, Marsha McMurray-Avila, providing the facilitation. A Planning Committee involving stakeholders representing agencies involved in drug-related programs, as well as advocates and others, was formed and met approximately monthly and eventually weekly to draft a strategic plan with recommendations to be considered at the Summit. (See Appendix B for Planning Committee participants.) To gain the desired goals for the Summit, the Planning Committee proposed using results-based planning and accountability—projecting desired results based on unacceptable trends in data, developing specific plans to achieve outcomes and then tying these to accountable entities. The strategic approach was organized under the four areas (or pillars) previously used by the New Mexico Drug Policy Task Force: prevention, harm reduction, treatment, and law enforcement/criminal justice/public safety. For each area, the Committee proposed a set of potential indicators and performance measures (Figure 1) and specific recommendations for action. With the intent of gaining input from stakeholders whose participation and commitment are likely to be essential components in reaching the Summit’s goals, organizers invited representatives from government, health and social services, law enforcement, the courts, education, advocates, and community stakeholders. The Summit was not intended to be exclusive and organizers welcomed interested persons who were not on the initial contact list.

Accountability Summit Background/Purpose/Planning

7

Figure 1. Potential indicators and performance measures

HEADLINE INDICATOR: #/rate of overdose deaths

associated with opioid use in Bernalillo County

Prevention:

Rate of reported use of heroin and painkillers to get high among youth in last 30 days (YRRS)

Performance measure to track, if data are available:

# of opioid prescriptions per capita/ morphine-equivalent weight in grams

Harm Reduction Indicator:

# of heroin overdose deaths &

Naloxone reversals

Performance measures for the system to continue tracking:

# of Suboxone Rx filled in NM & BernCo

# of sites trained and using Narcan;

amount of Narcan dispensed

Treatment Indicators:

#/rate of hospitalizations for OD with any opioid involvement

# of babies with neonatal abstinence syndrome

Performance measures regarding treatment system to continue tracking

ratio of treatment capacity to need (if available)

where we stand in relation to national standard for mix of services along the continuum

Law Enforcement/Criminal Justice:

Recidivism rates at MDC (within 1 and 3 years)

Performance measures for the system to continue tracking:

# of referrals to alternative-to-incarceration programs

# of people released from incarceration going into treatment programs

Accountability Summit Proceedings

8

PROCEEDINGS OF THE SUMMIT

The pages that follow provide brief summaries of the presentations and discussions at the Summit. Specifically these include the introductory, background, and keynote presentations, the individual panelist presentations and discussions for each of the four panels. For each panel, the recommendations and indicators/performance measures originally offered by the Planning Committee are listed, followed by additional recommendations and indicators that have been extracted from the presentations and discussions in the course of generating the summaries. The final session scheduled at the Summit, “Wrap-up and Next Steps,” was markedly abbreviated due to the time previously taken for the panels and discussion. As a result, this final session served only to briefly recap some of the highlights covered during the day and did not further develop or prioritize the recommendations or substantially advance any discussions beyond what had been previously covered. The substance of this session is redundant and accordingly not reiterated in this Report. Video recordings of the presentations, panels, and discussions (partial) are available at http://www.bchealthcouncil.org/opioidinitiative. Slides associated with specific presentations are available at sites indicated following the summaries of the individual presentations in the pages that follow. For further information, contact the Bernalillo County Community Heath Council (505) 468-7025 [email protected] http://www.bernco.gov/bernalillo-county-community-health-council

http://www.bchealthcouncil.org/opioidinitiative

mailto:[email protected]

http://www.bernco.gov/bernalillo-county-community-health-council

Accountability Summit Proceedings: Introductions/Background Presentations/Keynote

9

INTRODUCTION AND BACKGROUND PRESENTATIONS

WELCOME

Maggie Hart Stebbins, Commissioner and Chair, Bernalillo County Board of Commissioners Commissioner Hart Stebbins welcomed participants to this first Summit to address the problem of opioid addiction in Bernalillo County. She recognized in particular the presence of New Mexico Corrections Department Secretary Marcantel, Metropolitan Detention Center Chief Rustin, and Attorney General Gary King. The beginnings of this Summit go back more than two years to a meeting where Jennifer Weiss and others from the Heroin Awareness Committee pointed out to Commissioner Hart Stebbins the size of the drug problem and how it was not getting the level of attention that other public health problems and threats were receiving. The Commissioner emphasized that the problem needs a coordinated effort in order to make a real difference, and doing that became the focus for this Summit. She thanked the many people and agencies that have been working on these problems, the sponsors of this Summit, and the planners for their work. The Commissioner introduced Marsha McMurray-Avila and thanked her in particular for her work in convening and shepherding the planning process to this point.

AGENDA AND FRAMEWORK Marsha McMurray-Avila, Coordinator, Bernalillo County Community Health Council Ms. McMurray-Avila thanked the Planning Committee, adding that the undertaking has gone beyond planning to include the initiation of engagement in order to build a collaborative process. The overall goal for the next two years is to launch a process that will reduce overdoses and deaths from heroin and prescription opioids in Bernalillo County. The framework for organizing the strategies to achieve this goal is built around the four “pillars” of prevention, harm reduction, treatment, and law enforcement/criminal justice/public safety. The Planning Committee has proposed specific, measurable outcomes within each of these four areas. Using available data, results-based planning and accountability, the Planning Committee has generated an initial set of ideas and recommendations intended to move toward the targeted outcomes and has proposed performance measures. Planning for the Summit drew upon the four pillars to provide the thematic basis for the respective four panels. The purpose of the panels is to broaden the input on the issues and


10

open up discussion from participants at large with the intent of generating an augmented iteration of the original recommendations and performance measures. Summit participants were encouraged to participate and contribute in this undertaking and to join implementation groups that will be responsible for further refining the planning and engage the relevant sectors and agencies within the community at large in the implementation process. This work will be reported back in about six months at the next Summit.

CONGRESSIONAL REPRESENTATION Commissioner Hart Stebbins introduced Sam Donaldson, news correspondent and keynote speaker for the Summit, to recognize the persons attending on behalf of the Congressional delegation representing Bernalillo County.

Sarah Cobb, representing Senator Tom Udall. Ms. Cobb noted that Congressional staff are not allowed to speak “off the cuff.” She did note that Senator Udall has drafted a bill to reduce the abuse of prescription opioids and welcomes review and input from anyone attending this Summit.

Esther Garcia, representing Senator Martin Heinrich. Ms. Garcia stated that Senator Heinrich is concerned about the problem of drug use in Bernalillo County and she is here for ideas on how Federal support and funding might be helpful.

Deborah Armstrong, representing Representative Lujan Grisham. Ms. Armstrong affirmed the importance of the issue and her attendance being in order to listen and develop ideas that she can take back to Representative Lujan Grisham.

BERNALILLO COUNTY OVERVIEW

Harris Silver, MD, Consultant, Health Care and Drug Policy Analyst, Clinical Assistant Professor, Department of Family and Community Medicine, University of New Mexico. Dr. Silver presented data that supported the following points with respect to New Mexico and Bernalillo County:

Overdose deaths (all substances) (2000-2011) have been increasing, with New Mexico’s about double the U.S. rate. Bernalillo County’s rate is representative of the state.

Opioid overdose deaths: NM’s overall rate is about twice the US rate and perhaps leveling, while Bernalillo County’s rate averages 3-4 times the US rate.

Bernalillo County’s prescription drug overdose rates, rising since 2000, turned sharply upward 2010-2011.

Bernalillo’s drug overdoses comprise almost half of New Mexico’s total.

Rio Arriba is the county with by far the highest drug overdose rate, more than 2.5 times the overall state average and five times the national average.


11

There are five "small areas" in Bernalillo County with drug overdose rates that approach or exceed the rate in Rio Arriba County. These are designated by the following intersections: Lomas/Broadway, Central/Coors, Central/Pennsylvania, Arenal/Tapia, and Candelaria/Second. (Small areas are smaller than a zip code, but include several adjacent census tracts, and are used for in-depth data analysis by the NM Department of Health.)

The number of opioid prescriptions per 1000 population in Bernalillo County is greater than the state overall and has been rising. Data since 2012 suggest these rates may be starting to fall.

Importantly, the amount of morphine equivalents dispensed has fallen since 2010 to below the 2008 level. This means that the amount per prescription has fallen.

The number of buprenorphine (e.g., Suboxone) prescriptions (prescribed for medication assisted treatment) has steadily, but slowly been increasing.

Results from the biennial Youth Risk and Resiliency Survey (YRRS) survey for Bernalillo County show much higher rates of students self-reporting taking prescription pain medications "to get high" and using heroin than New Mexico as a whole. Additionally, the New Mexico rate runs about 2 times the national rate. The encouraging news is that the 2011 survey showed a sharp decrease in Bernalillo County students’ reports of using both heroin and prescription pain medications from the 2009 survey.

Bernalillo County’s drug courts have capacity to accept only about a third of the potentially eligible referrals coming through the Metro Courts.

Dr. Silver’s presentation slides are available at http://www.bchealthcouncil.org/Resources/Documents/BernCo%20Overview%20%20HS%209.19.13%20.pdf See Appendix E for additional data slides prepared in preparation for this Summit.

STEPPING UP TO THE CHALLENGE Bill Wiese, MD, MPH, Senior Fellow, Robert Wood Johnson Foundation for Health Policy, University of New Mexico Dr. Wiese set forth a number of issues that cut across the issues being discussed at this Summit: 1. Addiction is a chronic disease of the brain that is treatable. This basic truth needs to be

taken into account in planning for all interventions and responses to the consequences and behaviors resulting from addiction.

2. We have interventions that are known to work. We have many examples of successes, for example in clinical services. To date however, we have not applied these adequately to make a difference at the level of the population. The data presented by Dr. Silver show that

http://www.bchealthcouncil.org/Resources/Documents/BernCo%20Overview%20%20HS%209.19.13%20.pdf

http://www.bchealthcouncil.org/Resources/Documents/BernCo%20Overview%20%20HS%209.19.13%20.pdf


12

health events and social parameters have mostly worsened over the past decade. The challenge, then, is to find ways to scale up the application of strategies successful at the individual level in order to have an impact on a population level.

3. Specific challenges and barriers that need to be addressed:

Stigma underlies the social, professional, and political apathy historically given to addiction and the need to invest in prevention and treatment.

The difficulty in getting separate agencies and organizations to find common goals and coordinate their efforts.

The current costs from use of substance use disorders are enormous. Successful interventions should reduce current costs fairly quickly. We need to have a way of accounting that identifies and deploys these “savings” into incentives and enhancements that can assure sustained performance. Questions are how to do this and who should do it.

Medicaid expansion will be able to newly fund a large portion of assessment and treatment services, creating opportunities to redirect the current public funding into related but underfunded prevention and support services.

The consequences of addiction generate costs and/or reduce performance across nearly every public sector. On top of that, there is the human toll. Dealing with addiction must be seen as high on the list of public priorities.

Yet we’ve seen cutbacks in the public financing of addiction and mental health services. Insurance inadequately covers and managed care organizations systematically deny authorization of evidence-based services that are recommended by professional and federal authorities.

This Summit should consider—

Every student in middle and high school being assessed for drug dependency and offered counseling if needed;

Every person at risk for opioid overdose having access to Narcan when its needed;

Every person in need of treatment being able to access the appropriate level of treatment when it’s needed;

Reducing the volume of prescribed opioids to approximate the actual medical need and unused opioid being taken back;

Everyone being released from incarceration and at risk for resumption of opioids having coverage for health care, being on medication assisted treatment if indicated, having a prearranged medical follow-up scheduled for the first day after release, and having Narcan on hand.

Why not?


13

LUNCHEON KEYNOTE Sam Donaldson, news correspondent Mr. Donaldson squared off on the topic of money, and delivered a bottom line message for this Summit— new money will be needed in order to get anything of importance done. He drew on 70 years of U.S. history and an earlier time when this basic wisdom was accepted and when politicians could work together to solve big problems and deliver on the financing. He cited as examples raising taxes to pay the costs of World War II and to finance the highway system. That attitude, he said, has since been compromised, often with sad consequences. He offered numerous examples, many enhanced with personal anecdotes, freely tossing laurels and barbs right and left and making clear his disdain for greed and his tolerance for honest divergence of opinion. He cited Joseph Califano (former U.S. Secretary of Health, Education and Welfare) on the $0.5 trillion annually being spent on the costs for substance abuse. Most is going for the costs of jails and “cleaning up the human wreckage” and only 2% going for prevention. He then offered the following points:

You can’t stop paying for the consequences or shut down existing services; new money is needed for the prevention piece.

There are competing priorities for any new money.

In advancing the argument politically, pointing out that investments now for prevention will save more money later is not working. The same is true for appeals to logic. (There is overwhelming resistance to taxes.)

Politics is a “knife fight.” Politicians will respond to threats (ultimately at the ballot box), not cajoling.

Accountability Summit Proceedings: Panel 1 - Prevention

14

Panel 1: Prevention Prevention comprises interventions to reduce the numbers of people who become dependent or addicted to drugs. Interventions range from those that target persons in population categories that may be at some risk and where strategies are available to reduce risk (e.g., very young children, middle school students) and specific individuals identified as high risk (e.g., persons getting into difficulties in association with recreational drug use). Panelists were asked to respond to recommendations for preventing opioid addiction and overdose through solutions ranging from education and community engagement to control/disposal of prescription drugs to alternatives for controlling chronic pain

SUMMARIES OF PANELISTS’ COMMENTS Moderator: Frank Magourilos, MPS, CPS, ICPS - New Mexico Prevention Network Mr. Magourilos introduced the panel and gave an overview for prevention strategies emphasizing the need for a systems approach aiming at shared goals to achieve collective impact. He urged use of SAMHSA’s Substance Abuse Prevention Framework and emphasized that evidence-based tools are available. The sequence of steps in this model includes data-driven assessment, capacity building, planning, implementation, and evaluation. He stressed the needs for cultural competence and planning for sustainability. He particularly referenced existing planning done by the NM Public Education Department School and Family Support Bureau, “Building State Capacity to Prevent Youth Substance Abuse and Violence in the Schools - New Mexico Statewide Strategic Plan 2012.” Specific strategies need to achieve reducing risk factors and building protective factors. Mr. Magourilos’ slides are available at: http://www.bchealthcouncil.org/Resources/Documents/FINAL%20PRV%20RECOMMENDATIONS%20FOR%20REDUCING%20OPIOID%20OVERDOSE%20IN%20BERNALILLO%20COUNTY.pdf Louise Kahn, RN, MSN, PNP - Nurse Family Partnership Home Visiting Program Ms. Kahn summarized the well-documented relationship between adverse childhood experiences (ACEs) and a wide variety of adverse effects on later health, educational success, and social outcomes in adult life. Among these is a strong graded relationship with the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and injection drug use. The ACEs presumably may result in circumstances and lead to stresses managed by the individual by using drugs to self-medicate. Home visitation for first-time mothers with multiple risk factors is a program used by the Nurse Family Partnership. It is

http://www.bchealthcouncil.org/Resources/Documents/FINAL%20PRV%20RECOMMENDATIONS%20FOR%20REDUCING%20OPIOID%20OVERDOSE%20IN%20BERNALILLO%20COUNTY.pdf

http://www.bchealthcouncil.org/Resources/Documents/FINAL%20PRV%20RECOMMENDATIONS%20FOR%20REDUCING%20OPIOID%20OVERDOSE%20IN%20BERNALILLO%20COUNTY.pdf


15

an evidence-based intervention proven to mitigate these outcomes. This approach should be promoted and supported as a key component of a prevention strategy. Ms. Kahn’s presentation slides are available at http://www.bchealthcouncil.org/Resources/Documents/kahnsept192013.pdf Susan McKee, LPCC - Albuquerque Public Schools, Counseling Manager Editor’s note: There are 13 high schools and 27 middle schools in APS. According to the YRRS survey for 2011, more than 10% of high school students were current users of prescription painkillers in order to get high and 2.8% were current users of heroin. The Crossroads/Project Success/Parent Involvement Program (PIP) is the principal prevention/intervention program within APS for assisting students who have been specifically identified as having drug issues. Ms. McKee described Crossroads. This program, funded mostly by grants and with Medicaid support, has had as many as 14 licensed counselors in the high schools, but this number has been greatly decreased (currently six) as grant funding ran out. Students caught with possession or use can avoid long-term suspension when parents engage through the PIP with evening sessions. Students receive 3-day suspensions. Students receive counseling and referrals if needed. The program is valued, but reaches only a small fraction of the high school students in need and is not available in the middle school students. Julie Martinez, BA, CPS - Taos Alive Coalition, Coordinator The Taos Alive Coalition has been funded by a grant from SAMHSA as a community-based approach to substance abuse. Ms. Martinez described aspects of the Coalition’s approach and strategies that might have direct applicability for Bernalillo County. She emphasized taking a community-wide initiative bringing together people from multiple sectors and with disparate views. The process included community assessment, goal setting, strategic planning, and evaluation. Specific initiatives have included reducing availability and recreational use of prescription pain killers through prescribing guidelines, take-back programs/drop-boxes, multi-channel education programs, a naloxone pilot program, participation in Taos County DWI, a focus on recovery-oriented systems of care, and many more. Ms. Martinez’ slides are available at http://www.bchealthcouncil.org/Resources/Documents/Julie%20Martinez%20Presentation%20Turning%20the%20Curve.pdf Jolene Aguilar, MPH - Partnership for Community Action, Program Manager (Ms. Aguilar was unable to join the panel’s presentations.)

http://www.bchealthcouncil.org/Resources/Documents/kahnsept192013.pdf

http://www.bchealthcouncil.org/Resources/Documents/Julie%20Martinez%20Presentation%20Turning%20the%20Curve.pdf




16

Megan Thompson, Pharm D, UNM College of Pharmacy, Director Experiential Education Dr. Thompson described the College of Pharmacy’s Generation Rx interactive prescription drug education and prevention program for education targeting all ages: all levels in school and college (with one focus being on “pharming parties” and using skits) and adults (focusing on drug security and disposal). Subject matter includes the biology of addiction. Programs are available at no charge. Barriers include limitations of time in curriculum. Evaluation is in progress. Dr. Thompson’s presentation slides are available at http://www.bchealthcouncil.org/Resources/Documents/BernCo%20Opiate%20Summit%202013.pdf

DISCUSSION Tim Condon, retired, previously with National Institute for Drug and Alcohol Ways for prioritizing and expanding Crossroads need to be funded sufficiently to reach more broadly across the high schools and middle schools. He suggested two counselors per school. Michael Pridham, chiropractic physician Evidence-based chiropractic services for pain management should be covered under Medicaid with co-pays at levels with primary care. Such coverage would result in promoting an option for pain management without prescription. Lora Church, NM Public Education Department Health education is a requirement for high school graduation. Generation Rx might qualify toward this. Robert Rhyne, MD, UNM Family and Community Medicine faculty The several efforts described need to be done collectively rather than separately in order to have an impact. How is this being done and how can we get involved? Sally Bachofer, MD, UNM Family and Community Medicine faculty For Generation Rx, is there a self-assessment such that affected students can be directed to help? Megan Thompson, panelist, indicated that this is a component of Generation Rx. Pam Brown, RN, MPH, NM Department of Corrections Spoke in support of the early childhood intervention, especially those working with women.

http://www.bchealthcouncil.org/Resources/Documents/BernCo%20Opiate%20Summit%202013.pdf

http://www.bchealthcouncil.org/Resources/Documents/BernCo%20Opiate%20Summit%202013.pdf


17

IDEAS AND RECOMMENDATIONS Recommendations of Planning Committee to prevent opioid use and abuse by deploying proven, cost-saving strategies:

1. Implement a prevention framework in Bernalillo County with prevention tools that can be used by community coalitions, schools, faith-based institutions and workplaces.

2. Reduce the supply of prescription opioid pain medication by increasing access to and usage of the Prescription Drug Monitoring Database.

Additions and refinements of recommendations for consideration by Prevention Implementation Team:

1. Use the SAMHSA Substance Abuse Prevention Framework and NM Public Education Department School and Family Support Bureau, “Building State Capacity to Prevent Youth Substance Abuse and Violence in the Schools New Mexico Statewide Strategic Plan 2012” as starting points in developing a work plan. Assure that a community participatory process is engaged and that the prevention agenda is evidenced based and comprehensive (example of Taos Alive). Target elements include education and awareness, drug take-back, expanded availability of naloxone for both at risk persons on prescription opioids and for injection drug users, control of excessive opioid prescription, and diversion into illicit usage.

2. For pain control, promote evidence-based alternatives for prescription opioids. 3. Support policies that will enable the expansion of evidence-based early childhood

support programs including home visitation for first-time mothers with multiple risks. 4. Expand access to drug counseling services for high school and middle school students

including referrals and including how Medicaid might be utilized to support these services.

5. Prescription drug take-back/drop box. Create a plan for take-back that is available at least during weekdays in every neighborhood.

INDICATORS OF PROGRESS

Indicators and performance measures previously proposed by Planning Committee for prevention

1. Reduced rate of reported use of heroin and painkillers to get high among youth in last 30 days (YRRS)

2. Reduced number of opioid prescriptions per capita and reduced amount of opioids prescribed (expressed as morphine-equivalent weight in grams)

Additions and refinements of performance measures for consideration by Prevention Implementation Team

1. Increased number of drug counselors in APS high schools and middle schools 2. Increased number and availability of prescription drug take-back sites

Accountability Summit Proceedings: Panel 2 - Law Enforcement/Criminal Justice/Public Safety

18

Panel 2: Law Enforcement/Criminal Justice/Public Safety Panelists were asked to respond to recommendations regarding effective actions that can be taken before incarceration (diversion programs), during incarceration (treatment in the jail), and after incarceration (effective re-entry/reintegration programs that reduce recidivism). SUMMARY OF PANELISTS’ COMMENTS Moderator: William Wiese, MD, MPH - RWJF Center for Heath Policy at UNM, Senior Fellow Dr. Wiese noted that law enforcement, the criminal-justice system, and systems of incarceration (including release) constitute a nexus that is ground zero for addressing the consequences of drug abuse and addiction. A large majority of persons moving through these systems either are or have been involved with drugs and almost all of these eventually return to their communities. Reductions in deaths, crime, and costs from drugs require creating opportunities within and around this nexus for substantial improvements in drug treatment and harm reduction. Jerome Sanchez - Santa Fe Police Department, Detective Sergeant, Co-Chair of LEAD in Santa Fe Detective Sergeant Sanchez described the background and development of Santa Fe’s “Operation Full Court Press” to reduce heroin-related crime. Recently approved by the Santa Fe City Council, this is a pilot of pre-booking diversion of low-level opiate drug offenders that redirects them away from jail and prosecution and takes them immediately into treatment and social support. The program is modeled on Seattle’s pilot program, Law Enforcement Assisted Diversion (LEAD), which started in 2011 and is showing promising results. Santa Fe’s three-year pilot is scheduled to become operational in January 2014. This comes after nine months of planning by a community-based task force created by Mayor Coss. A cost-benefit analysis conducted by the Santa Fe Community Foundation presuming 100 offenders entering the program was favorable. Mike Geier - Albuquerque Police Department, Southeast Area Commander Commander Geier noted that Albuquerque has 2100 narcotics-related arrests per year (plus overdose calls). Examples include property crimes, homelessness, and prostitution as well as trafficking. He described the multi-disciplinary practices in use to address the problems that extend beyond interdiction to include intervention and rehabilitation. He stressed in particular the need for community partnerships, giving examples that included collaboration with the Bernalillo County Metropolitan Assessment and Treatment Services (MATS) using the Public Inebriate Intervention Program (PIIP) to divert people from hospital emergency rooms or jail directly to MATS; the International District Healthy Communities Coalition; Sandia Church of Nazarene; Endorphin Power Company; Media Arts Collaboration; and Family Advocates. He


19

expressed support for the LEAD approach, but noted that officers in Albuquerque are presently too stretched to take on a new initiative. Cristina Jaramillo, MBA, JD - Bernalillo County, Metropolitan Court Judge Judge Jaramillo gave a brief history of drug courts and their beginnings 23 years ago in Florida in order to address the underlying problem of drug dependency’s contribution to the revolving door of crime, arrest, and incarceration. She noted the role of adverse childhood experiences and early age onset of alcohol and drug use (age 10-11 years). The drug court model is one of diversion into outpatient treatment with supervision. The outcomes have been excellent: graduation rates of 80-85%, recidivism of 10-11% over three years, and cost of $10/person/day. Ramon Rustin - Bernalillo County Detention Center, Chief of Corrections Chief Rustin outlined a schema for classifying prisoners based on assessment of risk, violence, and needs.

o Low risk/low violence/low needs: should not be managed in jail; low risk of recidivism. o High risk/high violence/high needs: generally need to be in prison. o Medium-or-high risk/low violence/high need: constitute a majority of jail population;

they are at risk for recidivism, and need to be in jail. The last group constitutes the most appropriate target for the present effort of reducing drug-related problems in the County and reducing recidivism. According to Chief Rustin, dealing with the alcohol or substance abuse problem alone doesn’t work. To have an impact on recidivism means having to deal with basic underlying issues such as family structure, homelessness, and poor employment records. Managing these is "messy." Success lies in having a support system and finding work. Craig Sparks, MPA - Bernalillo County Youth Services Center, Director Director Sparks described the residents of the Juvenile Detention Center: average length of stay only 17 days; most are from just three zip code areas (87121, 87105, 87108), which has implications of where resources need to be placed; 70% have substance abuse issues, with an increasing proportion involving heroin. A major barrier lies in the limitations of child mental health services in the County. This challenges the ability to do assessment and planning. Children are eligible for Medicaid while in detention. Availability of funding is less of an issue than weaknesses in the processes needed for gaining services. Important partnerships come via the drug court and from CYFD. Mike Estrada - NM Corrections Department, Community Corrections Administrator Mr. Estrada noted that NM Corrections Department has 6,000 persons incarcerated and 19,000 on probation or parole. Eighty percent have drug/alcohol problems. To manage reentry, the


20

Department uses 32 vendors for treating mental health and drug and alcohol problems. It has two residential treatment centers (Los Lunas and South Valley). These capacities are over-subscribed. Inadequate funding has been a major barrier. The expansion of Medicaid in 2014 is viewed as a tremendous opportunity, certainly for accessing clinical services. The Department has depended on federal grants to help with housing and vocational education. Building effective partnerships is needed. The Behavioral Health Purchasing Collaborative should be providing a model of working together. “Criminogenic” needs must be addressed. These include drug and alcohol, lack of employment, lack of boundaries, dysfunctional homes. Hopefully the coordinated care model of Medicaid can help with drug treatment and reach at least some of these other issues. Lack of employment may be the most important issue. Sixty percent of those being released from prison are coming back into Bernalillo County. Tom Swisstack - Bernalillo County, Deputy County Manager for Public Safety Mr. Swisstack reviewed salient facts: persons going through the criminal justice system are mostly young, are disproportionately minority, and have very high rates of co-occurring mental health conditions. The median length of stay at MDC is increasing (recently reaching 126 days). Costs to the County are increasing, presently at $100 million plus $1 million in managing litigation. Yet the County has little or no direct control over the variables that are driving these costs. To get out of the present situation, managers need to look for new approaches to meet the objectives. Finding alternatives to incarceration is important. Funds will have to be redirected. Managing the parts as components of an integrated, inclusion system, rather than individually will be essential, and must be supported with appropriate reallocation of current funding.

DISCUSSION

Bruce Trigg, MD - Duke City Recovery Tool Box 300-400 prisoners entering MDC are detoxed each month. When released most recycle back. They need to be treated in MDC and after release. With Medicaid expansion, this can be done. Ramon Rustin - Panelist In the context of incarceration, treatment alone is insufficient and ineffective for most because many have no home and no job. Social service programs, at least for an interim period, must be components of planning to address this problem.


21

Craig Acorn - Attorney The present system of managing drug use through the courts and incarceration creates blockages to every aspect of successful re-integration. Diversion away from coercive approaches should be a priority. The veto of SB65, which would have assured Medicaid enrollment upon release, creates problems. Harris Silver, MD - Health care and addiction policy advocate Asked Director Sparks about juveniles needing to have a co-occurring mental health condition listed in order to have Medicaid cover drug treatment. Craig Sparks, panelist, concurred with Dr. Silver’s observation and noted that this policy can result in labeling that itself can create barriers. Steve Jenkusky, MD, Presbyterian Medical Services, addiction specialist He has had experience working in jails and notes that Assertive Community Teams (ACT) have constituted a successful approach that can be used to provide wrap-around services. He also questioned whether money saved in the system will actually go where it really needs to go, and stressed the need to break down the silos.

IDEAS AND RECOMMENDATIONS

Recommendations previously drafted by Planning Committee for law enforcement, criminal justice, and public safety To reduce the number of people with substance use disorders who are incarcerated, as well as providing effective treatment services for those who are incarcerated and upon release:

1. Increase programs offering alternatives to incarceration. 2. For persons already under medication-assisted treatment (MAT) at the time of

incarceration, continue methadone and Suboxone during incarceration. 3. Prior to or upon release, arrange for Medicaid enrollment for those eligible, arrange for

post-release social services and medical follow-up including MAT, and distribute Narcan. 4. Conduct a pilot for pre-release induction of MAT. 5. Make indicated prevention programs available for incarcerated individuals with low-

level substance abuse. Additions and refinements of recommendations for consideration by Law Enforcement/ Criminal Justice/Public Safety Implementation Team

1. Assure capacity in the community to assess and treat drug use disorders, in order to meet needs of those entering alternatives to incarceration and of those being released from incarceration.

2. Assemble stakeholders to assess feasibility of LEAD pilot by either APD or County Sheriff’s Department.

3. Collect data to assess the adequacy of presumptive eligibility for Medicaid assistance in securing Medicaid enrollment for those who are incarcerated.


22

4. Confirm the availability of financing by Medicaid for social support services. 5. Eliminate the need for a diagnosed co-occurring condition as a requirement for

Medicaid funding of treatment of alcohol or drug dependency. (Move to Panel 4, Treatment.)

6. Increase capacity of court system to expedite proceedings and reduce time waiting for verdicts and sentencing.

7. Create incentives for separate agencies and entities to collaborate in achieving overarching outcomes.

8. Coordinate with NM Corrections Department Probation and Parole on tracking outcomes of persons being released from prison into Bernalillo County.


Tracking indicators previously proposed by Planning Committee

1. Recidivism rates at MDC for drug-related issues (within 1 year and 3 years) 2. Number of referrals to alternative-to-incarceration programs 3. Number of people released from incarceration reaching treatment programs

Additions and refinements of indicators and performance measures for consideration by Law Enforcement/Criminal Justice/Public Safety Implementation Team

1. Number of property crimes in County 2. Proportion of incarcerated persons with Medicaid presumptive eligibility who become

fully approved for Medicaid enrollment 3. Number of persons referred for treatment services upon release who obtain services

measured at one month, three months 4. Number of youth receiving Medicaid covered services for substance use disorders

without a mental health diagnosis 5. Number of detox kick-kits at MDC used/month

Accountability Summit Proceedings: Panel 3 - Harm Reduction

23

Panel 3: Harm Reduction

Harm reduction refers to strategies and services for persons with ongoing drug dependency and continued use of drugs. The goal is to reduce risk for harm, including overdose deaths. A needle exchange program is an example, with the goal of reducing spread of serious infection. Medication assisted treatment (MAT) with replacement opioids, such as buprenorphine (as provided in Suboxone) or methadone, allows a person to cover the dependency requirements with relative safety and to restore a more orderly life. Because the opioid drug dependency continues, this meets the definition of harm reduction. MAT is also viewed as treatment and is discussed by Panel 4 as well as by Panel 3 Harm Reduction.

SUMMARIES OF PANELISTS’ COMMENTS

Moderator: Miriam Komaromy MD, FACP – Project Echo, Associate Director

Dr. Komaromy urged people to view harm reduction as meeting the drug user where he or she is at that moment. This patient-centered approach requires that the provider be flexible and address the person’s priorities. To address the goals of reducing the impact of opioid use in the County, the issue ultimately comes down to greatly increasing access to naloxone (Narcan) and greatly increasing access to MAT, whether buprenorphine (Suboxone and Subutex®) or methadone. There are other opportunities for harm reduction, for example testing whether safe injection facilities might confer safety and other benefits for injection drug users.

R. Dale Tinker, Executive Director, New Mexico Pharmacists Association

Mr. Tinker addressed one initiative to mitigate prescription drug overdose deaths in New Mexico, specifically steps toward implementation of authority for pharmacists to prescribe naloxone (Narcan). The prescribing protocol, developed with assistance from the Department of Health, has been approved by the New Mexico Medical Board and Board of Nursing as required by statute, and awaits a public hearing regarding specific rules. Project Echo will assist with training.

Melissa Heinz, MPH, Injury Prevention Coordinator, New Mexico Department of Health

Ms. Heinz focused on her efforts to get Narcan out so that everyone at risk for opioid overdose has opportunity for access to the drug. Specific initiatives are under way in Taos, Española, Santa Fe, Truth or Consequences, Albuquerque, and San Miguel County. Strategies involve promoting co-prescribing in conjunction with prescribed opioid pain medication, distribution and training of families of persons using opioids, of families of persons being released from incarceration, and of first responders and law enforcement.

Anita Cordova, MA, Director of Development Planning and Evaluation, Albuquerque Health Care for the Homeless

Ms. Cordova described her experience with the Re-Entry Collaborative designed to assist persons who are opiate addicted, homeless, and recently released from incarceration. She


24

stressed that MAT in this population works and that wrap-around services are essential (help with jobs, housing, psychological support, motivation). Results show 74% are still on the replacement at six months with 80% of those testing negative for drug use. Key elements include being non-judgmental and relapse tolerant. Sally Bachofer, MD, Associate Professor, Family and Community Medicine at UNM

Dr. Bachofer has extensive experience with MAT and concurred with the need for supportive services. Her work with Milagro, a program for pregnant women who are addicted, has brought home the multigenerational aspects of the addiction cycle. Barriers are bias against the patient and ignorance about what it takes to maintain a patient in care when they are leading a difficult life and dealing with a relapsing disease. She proposed using the rate of GED completion as an outcome measure. Andru Zeller, MD, Executive Director, Casa de Salud Family Medical Office

Dr. Zeller emphasized the need to see people as people and the importance of humanizing the interaction. He stressed the need to maintain flexibility when using Suboxone as patients’ experiences and needs differ. He views Suboxone as not the answer; rather it offers opportunity to fix other things. He would like to become involved in participating with a re-entry program. Bruce Trigg, MD, Physician, Duke City Recovery Toolbox and Santa Fe Recovery Center

Dr. Trigg emphasized the dismal prognosis faced by heroin users. He cited a study with a 33-year follow-up that registered half as dead and most of the remainder either still on heroin or incarcerated. Stigma still casts its shadow over the MAT experience. Patients feel shame. While persons on MAT remain dependent on the opioid, they are no longer “addicted” in so far as they have otherwise regained control over their lives. There is urgency to promote the use of MAT. Addiction carries stigma, and stigma follows even when on MAT.

DISCUSSION

Melissa Heinz, Panelist, Department of Health Needing to have Narcan on hand also carries stigma. She’s trying to combat this by universalizing the distribution of Narcan.

Christian Shaw, MD, University of New Mexico, Department of Medicine He asked the panel about options to replace the pleasure of drug use. Anita Cordova (panelist) acknowledged the importance of positive activities, citing as examples ArtStreet (HCH's community art studio) and encouraging volunteerism.

An unidentified questioner asked about using MAT in juveniles and the risk of manipulation or diversion. Bruce Trigg (panelist) said that directly observed therapy (DOT) was a reasonable option for Suboxone.


25

IDEAS AND RECOMMENDATIONS: Recommendations previously drafted by Planning Committee for harm reduction

1. Increase distribution and availability of Narcan for all who can benefit, especially in situations where there is risk for opioid overdose.

2. Make medication-assisted treatment (MAT) more widely available for those who can benefit from it.

Additions and refinements of recommendations for consideration by Harm Reduction Implementation Team

1. Narcan. Create a plan for universalizing the distribution and appropriate use of Narcan rescue kits and coordinate implementation. This will involve availability of rescue kits and training for persons/families/associates – a. Persons being released from incarceration b. All first responders c. Public health offices as walk-in sites d. Agencies with outreach programs for injection drug users e. Persons receiving chronic opioid pain prescriptions f. All pharmacies to stock Narcan rescue kits g. Prescribers of opioid pain medications for chronic use to co-prescribe Narcan as

standard of care 2. Move MAT issues from Harm Reduction to Treatment. Both Panel 3 (Harm Reduction)

and Panel 4 (Treatment) addressed MAT. Moving into implementation, there should be a single group (Treatment) that deals with the barriers for increasing use of MAT and the integration of MAT into the levels of treatment and management of opioid dependency and addiction.

3. Consider feasibility of a pilot for a medically supervised safe injection facility for intravenous drug users.


Indicators and performance measures previously proposed by Planning Committee for harm reduction

1. Numbers of heroin overdose deaths and naloxone reversals 2. Number of sites trained and using Narcan 3. Amount of Narcan dispensed for (a) intravenous drug users and (b) persons being

prescribed opioids for chronic pain 4. Number of Suboxone prescriptions filled in NM and Bernalillo County 5. Number of people on methadone

Additions and refinements of indicators for consideration by Harm Reduction Implementation Team

1. Rate of GED completion for drug-related target groups 2. Transfer indicators #3(b) and 4 (above) to Treatment Implementation Team

Accountability Summit Proceedings: Panel 4 - Treatment

Panel 4: Treatment

SUMMARIES OF PANELISTS’ COMMENTS Moderator: Harris Silver, MD - UNM School of Medicine, Clinical Assistant Professor, Health Care and Drug Policy Analyst Dr. Silver made several introductory remarks regarding the status of substance abuse treatment.

According to SAMHSA, public investment in treatment for substance abuse results in public saving of dollars at 12:1.

The American Society of Addiction Medicine (ASAM) has patient placement criteria covering a continuum of evidence-based treatment options, many of which have not been covered by available insurance.

That treatment doesn’t work is frequently alleged, but this can be attributed to inadequate length or intensity of treatment, lack of social supports and wrap-around services and failure to recognize and manage co-occurring mental disorders.

In terms of covered services, there should be parity of care for mental health and substance use disorders with medical/surgical care as required by the Mental Health Parity and Addiction Equity Act. This is not happening.

Requirements by insurers for providers to demonstrate “failure” of lower cost/lower intensity services before authorizing other levels of needed treatment can result in delay of needed treatment. These policies ignore the ASAM placement criteria and constitute a lack of parity.

Preauthorization protocols are disproportionately onerous in addiction treatment compared to other areas of medical care and constitute another example of lack of parity.

Dr. Silver proposed the following as examples of what might be done.

Determine whether current County Department of Substance Abuse Programs (DSAP) could become the nucleus for a much-expanded comprehensive treatment system.

Prepare a comprehensive inventory of treatment services in the County and identification of gaps in service.

Assure the viability of a full ASAM continuum of services to meet treatment needs.

Cover the full continuum to be available through Medicaid and the Health Insurance Exchange.

Track indices for (a) overdose, (b) hospitalizations for overdose with opioid involvement, (c) emergency room visits for overdose with opioid involvement, (d) recidivism rates, (e) slots available for each level of treatment, (f) treatment admissions for each level of treatment, and (g) births with neonatal abstinence syndrome.


27

Dr. Silver’s presentation slides are available at: http://www.bchealthcouncil.org/Resources/Documents/Treatment%20panel%20presentation%20HS%209.19.13%20.pdf Anne Foster, MD, MPH, FACOG - NM Human Services Department, Medicaid Chief Medical Officer Dr. Foster described the initiation of Centennial Care and its goal of intensive care coordination for those with the highest levels of needed care. The expansion of Medicaid is projected to increase enrollment from current 550,000 to as many as 720,000. This will add an estimated 20-30,000 persons with active substance abuse disorders. She stressed Medicaid’s focus on integrating/coordinating the treatment of mental illness and medical illness. Substance abuse treatment and prevention are high priorities. She noted specifically Medicaid’s coverage of MAT including both Suboxone and methadone and of the Narcan rescue kits when co-prescribed with opioids with the intent of making this a standard of care. Editor’s note. Following the conference, Medicaid announced it would support presumptive eligibility for Medicaid enrollment in various settings, including hospitals, IHS facilities, and prisons and county jails. Moriah MacCleod, LPCC - Molina Healthcare, Behavioral Health Administrator Drawing upon her years of clinical experience, Ms. MacCleod emphasized the importance of recognizing and dealing with the association of addiction and co-occurring mental health and personality disorders. She offered the following. At a methadone clinic, 70-80% had depression, anxiety, or PTSD. Of patients being treated for chronic pain, 27% had a lifetime prevalence of depression and/or suicidality. Of those who have both heroin and alcohol addictions, 60% have anti-social personality disorders. Julie Bohan, MD - UNM Addiction and Substance Abuse Program (ASAP), Attending Physician Dr. Bohan gave a brief history of the 30 years of ASAP at UNM, itemized its services including MAT, counseling, dual diagnosis clinic, teaching clinic, Milagro Program, adolescent treatment, and working with the Department of Health on Narcan availability. She acknowledged the wait-list at ASAP for services. As a clinician doing MAT, she commented on the barriers created by limitations on drug coverage and current requirements for prior reauthorization. Paul Tucker, MS, LADAC - Turning Point Recovery Center, CEO Mr. Tucker described the services offered by Turning Point Recovery Center and how intensive outpatient (IOP) services work. He stressed that IOP should not be viewed in isolation. Some patients require the offerings of the full continuum of care. He specifically mentioned as problematic the limited number of days Medicaid will pay for care, Medicaid’s failure to cover residential treatment, and limitations on coverage of certain drugs, notably extended release

http://www.bchealthcouncil.org/Resources/Documents/Treatment%20panel%20presentation%20HS%209.19.13%20.pdf

http://www.bchealthcouncil.org/Resources/Documents/Treatment%20panel%20presentation%20HS%209.19.13%20.pdf


28

naltrexone which can be the optimal drug for selected patients with addiction. He urged that the relevant agencies come together to work through a plan for improving treatment options. Yolanda Briscoe, MEd, PsyD - Santa Fe Recovery Center, Chief Executive Director Dr. Briscoe noted that there are only four CARF accredited treatment centers in NM. Treatment does work, but patients need to be properly assessed and offered the appropriate level of care. Residential treatment is one element, among others. Wrap-around services are essential. Services at all levels need to be flexible to accommodate patients’ specific situations and clinical needs. Treatment needs to be person-centered. Miriam Komaromy, MD, FACP - Project ECHO, Associate Director In line with the magnitude of the public health problem of drug addiction and the lack of deployment of evidence-based treatments, Dr. Komaromy stressed the importance of primary care providers taking an active role in the treatment of addiction. The model should include participation with counselors and community health workers (CHWs), and she alluded to Project ECHO’s Community Addiction Recovery Support (CARS). She stressed the need for greatly expanding the use of MAT. Evidence strongly supports the benefits in terms of recovery, reduced injection drug use, reduced crime, and reduced deaths. Data from France indicate 85% reduction of property crimes and illicit drug selling and 90% reduction of deaths. Only around a quarter of physicians certified to prescribe Suboxone in NM actually do so. She emphasized the barriers that prescribers face with respect to Suboxone, in particular the problem of meeting requirements for prior reauthorization that place administrative burdens on the physician and clinical performance requirements that are inappropriate for the realities of addiction as a chronic relapsing disease. She contrasted the requirements for reauthorization with the lack of authorizing controls on Percocet as an example of the opioid pain drugs that create vastly more diversion and mortality than Suboxone. With respect to Suboxone, she feels that there is a misplaced singular concern regarding diversion. Katrina Hotrum, MA - Bernalillo County Director, Department of Substance Abuse Programs (DSAP), Director DSAP functions as the County’s safety net provider for persons with substance abuse disorders. Ms. Hotrum’s presentation covered in detail DSAP’s organization, scope of services, funding, and relationships with multiple public and community partners, notably MDC, APD, the courts, UNMH, and community providers. DSAP’s direct services and partnerships cover much of the range of ASAM’s continuum of care, although sometimes with only limited capacity, reflecting the limits of funding. DSAP has recently opened a new adolescent transitional living center and has a provider, but no specific funding source.


29

DSAP plays a direct role in diversions from emergency room care and in enabling and managing referrals into alternatives to incarceration. Ms. Hotrum stressed that assessments for getting persons into the proper level of care can be cost saving in that the care will be more likely to be effective. Sometimes assessment can appropriately assign a lower and less costly level of service. Ms. Hotrum’s presentation slides are available at http://www.bchealthcouncil.org/Resources/Documents/BERNALILLO%20COUNTY%20DSAP%20LFC%20(6).pdf .

DISCUSSION Michael Pridham - NM Chiropractic Association Chiropractic care can be effective in pain management. Would like to obtain parity in terms of Medicaid coverage. (Dr. Foster indicated she would look into this.) Pam Brown - NM Corrections Department Having eligible persons being released from Corrections enrolled in Medicaid upon release will be an absolutely essential component in the Department’s efforts to achieve successful re-integration. Anne Foster - Panelist Dr. Foster would like to see the issues raised about prior authorization of Suboxone addressed. She has received complaints about policies of MCOs from prescribers and is particularly concerned if denial or delay of authorization results in a person who has been controlled going off their medication and back into illicit drug use. This has relevance for persons whose medication is interrupted during incarceration. She is seeking a collaborative solution. Because diversion is an issue, DEA should be represented in these discussions. Cost is also a factor that underpins the reauthorization issue. Simply taking away the requirement for prior authorization is a possibility. Moriah MacCleod - Panelist Presently, methadone is authorized as a pass through, unlike Suboxone. The issues with Suboxone are diversion and cost. The process needs to be simplified. Miriam Komaromy - Panelist The reauthorization form is difficult and seems to be used punitively. Marcello Maviglia, MD – Molina Healthcare, Medical Director Dr. Maviglia urged finding a collaborative solution as soon as possible. Interruption of treatment is unconscionable. Unidentified physician The prior authorization form required for Suboxone renewals is onerous.

http://www.bchealthcouncil.org/Resources/Documents/BERNALILLO%20COUNTY%20DSAP%20LFC%20(6).pdf

http://www.bchealthcouncil.org/Resources/Documents/BERNALILLO%20COUNTY%20DSAP%20LFC%20(6).pdf


30

Editor’s note: On October 23, Dr. Foster hosted a meeting at Medicaid in Santa Fe for MCO representatives and Suboxone prescribers to address the issue of prior authorization of Suboxone and related topics raised at the Summit. Subsequently, a Medicaid Letter of Direction to MCOs removed the prior authorization for Suboxone and directed MCOs to develop tracking/oversight/review mechanisms for utilization/prescribing both Suboxone and prescription opioids, to be effective in January 2014. Yolanda Briscoe - Panelist There is an increasing problem of benzodiazepine abuse, especially in conjunction with heroin. This combination complicates detoxification and often requires access to residential treatment, which is not covered by Medicaid. Bruce Trigg, MD The detoxification system needs fixing. Many cycle through detoxification repeatedly without getting onto treatment. Currently, there is a barrier in reimbursing authorizing physicians who are not psychiatrists from prescribing Suboxone to patients transitioning from detox into outpatient treatment. Representative from DEA The audits of authorized physicians confirm that a large proportion are not actively prescribing Suboxone. Katrina Hotrum - Panelist Responding to a question from Harris Silver about possible expansion of DSAP’s role in creating a system of care in Bernalillo County, the County is interested in continuing to build an integrated system of care with the full continuum of services. The plan includes engaging community partners. Funding will be needed.

IDEAS AND RECOMMENDATIONS: Recommendations previously drafted by Planning Committee for treatment

1. Develop a comprehensive inventory and mapping of current treatment centers to determine gaps in capacity and levels of care as basis for an effective, coordinated system.

2. Expand the number and/or capacity of the full range of treatment services, including hospital and residential treatment centers and long-term care programs.

3. Work with Medicaid, private insurance companies and Centennial Care MCOs to allow reimbursement for effective treatment for opiate addicts, aligned with ASAM patient placement criteria and compliance with the Mental Health Parity and Addiction Equity Act.


31

Additions and refinements of recommendations for consideration by Treatment Implementation Team

1. Explore feasibility and appropriately plan for expansion of County DSAP as nucleus of a much-expanded integrated treatment system.

2. Assure the viability of a full ASAM continuum of services to meet treatment needs. 3. Work with the New Mexico Health Insurance Exchange and State Office of the

Superintendent of Insurance to assure coverage and reimbursement. 4. Eliminate the need for a diagnosed co-occurring condition as a requirement for

Medicaid funding of treatment of alcohol or drug dependency. (From Panel 2.)


Indicators previously proposed by Planning Committee

1. Number and rate of hospitalizations for overdoses with any opioid involvement 2. Number and rate of babies with neo-natal abstinence syndrome 3. Ratio of treatment capacity to need 4. Where Bernalillo County stands in relation to national standard for mix of services along

the continuum (assuming such standards or norms exist, e.g., ratio of outpatient to inpatient treatment capacity necessary to provide full range of services).

Additions and refinements of indicators and performance measures for consideration by Treatment Implementation Team

1. Number of Suboxone prescriptions filled in NM and Bernalillo County 2. Number of people on methadone 3. Number of emergency room visits for overdose with opioid involvement 4. Recidivism rate 5. Burglary/property crime rates 6. Slots/waiting times for each level of treatment 7. Treatment admissions for each level of treatment 8. GED completion rates

32

NEXT STEPS

FORMATION OF IMPLEMENTATION TEAMS Four implementation teams representing (1) prevention, (2) harm reduction, (3) treatment, and (4) law enforcement/criminal justice/public safety will be activated at the start of 2014. Participants will include those who indicated interest on forms distributed at the Summit as well as others to be invited or otherwise stepping up. The teams will further refine the target indicators and refine the recommendations into prioritized objectives and plans. The teams will identify and work with partners (agencies, institutions, policy makers) to advance the plans, and establish needed commitments and accountability, hopefully creating needed collaborations and synergies. A coordinating group will maintain liaison with County government and assist with specific projects, recognizing that some activities will in practice organize differently than the four strategic categories listed above. For example, in dealing with the needs of persons in incarceration, there will be issues around harm reduction and treatment and management of release. Specific task groups will be created as needed.

NEXT SUMMIT The first follow-up Summit will likely be in late spring of 2014 to report progress and recalibrate the structure and operations of the overall initiative.

Accountability Summit Appendix A - Agenda

APPENDIX A: SUMMIT AGENDA

ACCOUNTABILITY SUMMIT “Turning the Curve on Opioid Abuse in Bernalillo County”

Thursday, September 19, 2013 UNM Rotunda - 801 University Blvd. SE - Albuquerque, NM

PURPOSE: In this first of four Accountability Summits over the next two years we will begin working toward consensus on a blueprint for action, clarifying our roles and individual/institutional accountability for positive change to "turn the curve" on the alarming trends in overdose deaths, as well as costs of medical care, crime and incarceration resulting from opioid dependency – both to prescription drugs and to heroin – in Bernalillo County.

AGENDA 8:00 am Registration & Networking

8:30 am Welcome - Commissioner Maggie Hart Stebbins Introductions - Master of Ceremonies, Sam Donaldson

8:45 am Overview of the problem and role of the 4 “pillars” – William Wiese, MD and Harris Silver, MD Prevention, Law enforcement/Criminal Justice/Public Safety, Harm Reduction and Treatment

9:15 am PANEL – PREVENTION Panelists will respond to recommendations for preventing opioid addiction and overdose through solutions ranging from education and community engagement to control/disposal of prescription drugs to alternatives for controlling chronic pain.

MODERATOR: Frank Magourilos, MPS, CPS, ICPS – NM Prevention Network PANELISTS: Louise Kahn, RN, MSN, PNP – UNM/CDD, Nurse Family Partnership Program, Pediatric Nurse Practitioner Susan McKee, LPCC – Albuquerque Public Schools, Counseling Prevention/Intervention Manager Julie Martinez, BA, CPS - Taos Alive Coalition Coordinator Jolene Aguilar, MPH - Partnership for Community Action, Program Manager Megan Thompson, PharmD – UNM School of Pharmacy, Director for Experiential Educations

10:30 am BREAK

10:45 am PANEL – LAW ENFORCEMENT/CRIMINAL JUUSTICE/PUBLIC SAFETY Panelists will respond to recommendations regarding effective actions that can be taken before

incarceration (diversion programs), during incarceration (treatment in the jail), and after incarceration (effective re-entry/reintegration programs that reduce recidivism).

MODERATOR: William Wiese, MD, MPH – RWJD Center for Health Policy at UNM, Senior Fellow PANELISTS: Jerome Sanchez - Santa Fe Police Department, Detective Sergeant, Co-Chair, LEAD Mike Geier – Albuquerque Police Department, Southeast Area Commander Cristina Jaramillo, MBA, JD – Bernalillo County Metropolitan Court, DWI/Drug Court, Chief Judge Ramon Rustin - Metropolitan Detention Center, Chief of Corrections Craig Sparks, MPA - Youth Services Center, Director Mike Estrada – NM Corrections Department, Community Corrections Administrator Tom Swisstack – Bernalillo county, Deputy Manager for Public Safety

Accountability Summit Appendix A - Agenda

12:00 pm LUNCH

Sponsored by Presbyterian Healthcare Foundation, RWJF Center for Health Policy at UNM, and Molina Healthcare

12:30 pm LUNCHEON SPEAKER – Sam Donaldson, veteran news anchor, was born and raised in New Mexico and

has moved back to live in Albuquerque after an exemplary lifelong career in TV journalism. 1:00 pm BREAK 1:15 pm PANEL – HARM REDUCTION

Panelists will respond to recommendations for reducing the harm of opioid addiction and preventing overdose deaths.

MODERATOR: Miriam Komaromy, MD, FACP - Project ECHO PANELISTS: Dale Tinker, BA - Pharmacists Association, Executive Director Melissa Heinz, MPH – New Mexico Department of Health, Injury Prevention Coordinator Sally Bachofer, MD - UNM Family & Community Medicine, Associate Professor Anita Cordova, MA – Albuquerque Health Care for the Homeless, Director of Development & Eval Andru Zeller, MD - Casa de Salud, Healing Oasis Recovery Program, Executive Director Bruce Trigg, MD – Duke City Recovery Tool Box/Santa Fe Recovery Center, Clinician

2:30 pm BREAK 2:45 pm PANEL – TREATMENT

Panelists will respond to recommendations for expanding capacity and access to a full continuum of services for opioid addiction as part of a comprehensive treatment system for Bernalillo County.

MODERATOR: Harris Silver, MD – Drug Policy Analyst PANELISTS: Anne Foster, MD, MPH, FACOG – NM Human Services Dept, Medicaid, Chief Medical Office Moriah MacLeod, LPCC – Molina Healthcare, Behavioral Health Administrator Julie Bohan, MD – UNM Addiction and Substance Abuse Program (ASAP), Attending Physician Paul Tucker, MS, LADAC – Turning Point Recovery Center, CEO Yolanda Briscoe, Med, PsyD – Santa Fe Recovery Center, Chief Executive officer Miriam Komaromy, MD, FACP - Project ECHO Katrina Hotrum, MA – Bernalillo County, Department of Substance Abuse Programs, Director

4:00 pm Wrap-up and next steps

4:30 pm ADJOURN

Accountability Summit Appendix B - Planning Committee

APPENDIX B: SUMMIT PLANNING COMMITTEE

OPIOID SUMMIT PLANNING COMMITTEE

September 19, 2013

Staff: Marsha McMurray-Avila, Tracy McDaniel (Bernalillo County Community Health Council) Special thanks to Dr. Bill Wiese and Dr. Harris Silver for making all the right connections for us.

Thanks to the following people for attending meetings and/or providing valued feedback:

Laura Allen, Turquoise Lodge David Broudy, Social Vision Leigh Caswell, Presbyterian Healthcare Enrique Cardiel, Bernalillo County Adán Carriaga, Molina Healthcare Mark Clark, NM Dept of Health Theresa Cruz, UNM Prevention Research Center Ivette Cuzmar, UNM Urban Health Partners Alex Dominguez, Bernalillo County MATS Richard Guay, Commissioner Stebbins' Office Melissa Heinz, NM Dept of Health Katrina Hotrum, Bernalillo County DSAP Miriam Komaromy, Project ECHO Tim Lopez, NM Dept of Health Frank Magourilos, NM Prevention Network

Marcello Maviglia, Molina Healthcare Jerry Montoya, NM Dept of Health Mary Murphy, NM Dept of Health Hanh Nguyen, Community Member Mandy Owens, UNM - CASAA Mike Robertson, City of Albuquerque Carmela Roybal, UNM RWJF Center for Health Policy Art Salazar, NM Dept of Health Christian Shaw, UNM Preventive Medicine Harris Silver, Health & Drug Policy Analyst Daryl Smith, UNM Urban Health Partners Bruce Trigg, Physician Kevin Vlahovich, UNM Preventive Medicine Jennifer Weiss, Heroin Awareness Committee Bill Wiese, UNM RWJF Center for Health Policy

Accountability Summit Appendix C - Attendees

APPENDIX C: SUMMIT ATTENDEES

Last name First name Organization Acorn Craig Center on Law & Poverty Allen Laura DOH - Turquoise Lodge Armstrong Deborah Rep. Michelle Lujan Grisham's Office Ault Monica NM Drug Policy Alliance Bachofer Sally UNM HSC Bohan Julie UNM - ASAP Bradford Kelly Bernalillo County - Public Safety Breeden Charlotte Duke City Recovery Toolbox Briscoe Yolanda Santa Fe Recovery Center Broach Carl Bernalillo County - DSAP Broudy David Social Vision Brown Pam New Mexico Corrections Department Buser Robert Optum Health Cadena Micaela Young Women United Callan Danelle UNM - Family & Community Medicine Cardiel Enrique BernCo - Urban Health Extension Cardinali Gina UNM Family & Community Medicine

Carriaga Adan Molina Health Care

Carver Adrian NM Forum for Youth in Community Caswell Leigh Presbyterian Health Services Chavez Virginia Bernalillo County MDC Church Lora NM Public Education Dept Clark Mark NMDOH - Health Promotion Cobb Sarah Senator Tom Udall's Office Condon Tim UNM - CASAA Cordova Anita Albuquerque Health Care for the Homeless Cross-Guillen Matt BernCo Office of Health & Social Services

Cunico Louanne Presbyterian Healthcare Services Dominguez Alex Bernalillo County - MATS Donaldson Sam Luncheon Speaker Estrada Mike NM Probation & Parole Ferguson Sheena UNMH Fields Diane US Department of Veterans Affairs Flansbaum Carl NM Board of Pharmacy Foster Anne NM HSD - Medicaid Gans Andrew NM Department of Health Garcia Esther Senator Heinrich's Office Garcia Jacque Bernalillo County Place Matters Geier Mike Albuquerque Police Department Gelber Rinaldo Suzanne The Avisa Group George-Lucero Dayana Presbyterian Healthcare Services Gonzales Jessica City of Albuquerque Goode Eileen NM Primary Care Association Guerin Paul UNM - Institute of Social Research Harris Marcia UNMH ASAP Hart Stebbins Maggie Bernalillo County Commission Heinz Melissa DOH/ERD - Office of Injury Prevention Hise Blanca Attorney General's Office Hotrum Katrina Bernalillo County - DSAP


Last name First name Organization Howell Cindy Molina HealthCare Isselhard Karl Albuquerque Fire Department Jacobsohn Vanessa First Choice Community Healthcare Jaramillo Cristina Bernalillo County Metropolitan Court Jenkusky Steve Presbyterian Health Services Johnson Marvin 2nd Judicial District Attorney Office Kahn Louise UNM/CDD - Nurse Family Partnership Kashinski Barbara Albuquerque Treatment Services Katzman Joanna UNM HSC Kesler Denece UNM - School of Medicine King Gary NM Attorney General's Office Knight Lauris Presbyterian Healthcare Services Komaromy Miriam UNM Project ECHO Kuehn Nandini First Choice Community Healthcare Lahoff John Lopez Tim NMDOH - Infectious Disease Bureau Lopez Ron USAO Law Enforcement Lopez Camila US Department of Veterans Affairs LoPorto Joanne UNMH ASAP Loring Larry NM Board of Pharmacy Lucero Lindsey Juvenile Drug Court Luick Marti City of Albuquerque Lynn Tony NM Department of Public Safety MacCleod Moriah Molina Health Care

Macias Santiago First Choice Community Health Care Magourilos Frank NM Prevention Network Manlove Melissa First Choice Community Healthcare Mann-Lev Shelley Santa Fe Prevention Alliance Marcantel Gregg NM Department of Corrections Martinez Julie Taos Alive Martinez-Romero Fran Bernalillo County - DSAP Maviglia Marcello Molina Health Care

Maxwell Sandy Community member McDaniel Tracy BernCo Community Health Council McKee Susan APS - Counseling Department McKeen Patricia A New Awakening McLish Ralph NM Osteopathic Medical Association McMurray-Avila Marsha BernCo Community Health Council Metzler Jenny Albuquerque Health Care for the Homeless Montoya Jerry NMDOH - Health Promotion Moonan Catherine NMDOH/CDC Moxey Michael NM Dental Association Muche Julie Physician Nguyen Hanh Community member Ortega Fermin NM Veterans Integration Center Otten Robin CABQ - Family & Community Services Owens Mandy UNM Paisano Michael Ryan Pueblo of Sandia

Parada Ricardo Senator Tom Udall's Office Parish Brooke Blue Cross Blue Shield Penn Janice Guidance Foundation


Last name First name Organization Petroff Christopher Bernalillo County Fire & Rescue Powdrell Nataura C. Bernalillo County Price Mink Crossroads for Women Pridham Michael NM Podiatric Medical Association Priloutskaya Galina HealthInsight Rael Patricia D.U.D.E. Rhyne Robert UNM Health Sciences Center Richards Kitty BernCo Office of Health & Social Services

Rios Javier NMDOH - Office of Health Equity Robertson Mike CABQ - Health & Human Services Rodriguez Lorena DEA Rodriguez Monica District Court Romero John Juvenile Court Roybal Carmela UNM Rustin Ramon Bernalillo County - MDC Sagarin Mark Presbyterian Healthcare Services Salazar Arthur NMDOH Sanchez Jerome LEAD - Santa Fe Sanchez Ramona Bernalillo County Sandoval Heather NM Attorney General's Office Sauer Noell Bernalillo County Schroeder George BernCo Office of Health & Social Services

Shafer Darren Presbyterian Healthcare Services Shaw Christian UNM - Preventive Medicine Sheppard Reed Juvenile Justice Silver Harris Health Policy Advocate Sloan Olivia NM Drug Policy Alliance Smith Daryl UNM/HSC - Urban Health Partners Soto Frank City of Albuquerque Sparks Craig Bernalillo County Youth Service Center Stark Rich US Department of Justice Steimel Leah Community member Stoltzfus Winona NM DOH - Office of School Health Swatek Josh New Mexico AIDS Services Sweet Forrest Albuquerque Health Care for the Homeless Swisstack Tom Bernalillo County Thayer Terry US Department of Veterans Affairs Thompson Megan UNM - School of Pharmacy Tinker Dale NM Pharmacists Association Trigg Bruce Duke City Recovery Toolbox Tucker Paul Turning Point Treatment Center Vall-Spinosa Leigh First Choice Community Healthcare Vlahovich Kevin UNM - Preventive Medicine Walker Martin Albuquerque Health Care for the Homeless Weiss Jennifer Heroin Awareness Committee Westenberg Verne Consultant Widner James Duke City Recovery Toolbox Wiese Bill UNM/RWJF Health Policy Center Zeller Andru Casa de Salud

Accountability Summit Appendix D - Panelist Bios

APPENDIX D: PANELIST BIOGRAPHICAL STATEMENTS

ACCOUNTABILITY SUMMIT

“Turning the Curve on Opioid Abuse in Bernalillo County”

Thursday, September 19, 2013 UNM Rotunda - 801 University Blvd. SE - Albuquerque, NM

PANELIST BIOS & PROGRAM INFORMATION

SAM DONALDSON - Master of Ceremonies Sam Donaldson is a native of New Mexico having been raised on a farm in Dona Ana County. He is a High School graduate of New Mexico Military Institute and received a BA from Texas Western College (now UTEP). He served two and a half years on active duty in the U. S. Army and achieved the rank of Captain in the USAR. Donaldson has been a news reporter based in Washington since 1961, and has been employed by ABC News since 1967 to the present. He has covered every presidential election beginning in 1964, with the campaign of Barry Gold-water. Donaldson covered the war in Vietnam and the First Gulf War, he was ABC’s Watergate Correspondent, was twice Chief White House Correspondent covering presidents Carter, Reagan and Clinton, co-anchored the ABC magazine program Prime Time Live with Diane Sawyer, co-anchored the Sunday program This Week with Sam Donaldson and Cokie Roberts and was the founding anchor of Politics Live, the first regularly scheduled Monday through Friday news program in the United States on the Internet. Donaldson has ranching interests in New Mexico and now lives in Albuquerque.

PREVENTION PANEL

FRANK MAGOURILOS, MPS, CPS, ICPS (Moderator) New Mexico Prevention Network [email protected] Frank G. Magourilos is a Sr. Certified Prevention Specialist with a Master’s Degree in Prevention Science from Oklahoma University and Bachelor’s Degrees in Cognitive Behavioral Psychology and Intercultural Communica-tion from the University of New Mexico. He is a Consultant for the Bernalillo County Department of Substance Abuse Programs. Mr. Magourilos is also the Executive Director of the New Mexico Credentialing Board for Behavioral Health Professionals, www.NMCBBHP.org and the founder of the New Mexico Prevention Network, www.nmpreventionnetwork.org. ************************************************************************************* LOUISE KAHN, RN, MSN, PNP UNM/CDD - Nurse Family Partnership Program [email protected] Louise Kahn is a pediatric nurse practitioner who has worked with marginalized children, women and families in Bernalillo County for the past 25 years, and with families experiencing substance abuse with the Los Pasos Program (now known as FOCUS), Healthcare for the Homeless, and PB&J Family Services. She recently left her faculty position at UNM College of Nursing to be a nurse home visitor with the Nurse Family Partnership.

http://www.nmcbbhp.org/

http://www.nmpreventionnetwork.org/


The Nurse Family Partnership has over 35 years of evidence and three large randomized controlled trials that have demonstrated that relationship-based home visits between nurses and low-income women from pregnancy with their first child to the age of two, can significantly impact long-term health and life outcomes for both the women and their children. Federal dollars from the Affordable Care Act have created the opportunity for Bernalillo County to implement the first NFP Program in New Mexico. For more information about NFP, go to www.nursefamilypartnership.org. ************************************************************************************* SUSAN MCKEE, MA, LPCC Counseling Prevention / Intervention Manager Albuquerque Public Schools [email protected] Susan McKee, LPCC, has worked in the counseling field in Albuquerque for 25 years. Susan was employed as the drug and alcohol specialist at the UNM Student Health Center immediately following graduation. She then served as the Interim Director for the Employee Assistance Program at UNM. Following her work for the University, Ms. McKee opened a private practice, specializing in substance abuse and recovery. She worked at Cottonwood Treatment Center in Los Lunas, New Mexico, conducting aftercare groups for families. Today, Ms. McKee is the Counseling Manager for Albuquerque Public Schools. In her role, she manages several prevention/intervention counseling groups. In particular, the Crossroads Counseling program. The Crossroads program has been in APS for over 15 years and the counselors are specialists placed in various schools to address the substance use among students in those schools. It is Ms. McKee’s sincere desire to expand the Crossroads Program in the Albuquerque Public Schools. She has a deep commitment to helping those in need of recovery from substance abuse and their families/communities. ************************************************************************************* JULIE MARTINEZ, BA, CPS

Taos Alive Coalition

[email protected]

Julie Martinez is a lifelong resident of Taos New Mexico, where she currently works as the Coalition Coordinator

for the Taos Alive Coalition since its current inception. Julie began her work in substance abuse prevention in

2002, working in many different capacities since. Her passion for Substance Abuse Prevention grew out of the

love for her community, family & friends whom she witnessed their struggles and some, death from this illness.

Julie holds a Bachelor’s Degree in Health Education as well as Certification as Prevention Specialist.

Taos Alive Coalition is a community based coalition, whose goal is to reduce substance abuse in Taos County

while increasing community collaboration in this effort. Taos Alive grew from a smaller more focused group that

worked solely on underage drinking and from the larger group Taos Cares Health Council to its current

inception. Taos Alive received Drug Free Communities funding from SAMHSA in October of 2010 and quickly

began mobilizing the Taos community to address the issue of substance abuse. Taos Alive has several sub-

committees that work on more focused initiatives including; Prescription Drug Abuse Initiatives, School Wellness

Committee, Media Advisory Council & Naloxone Pilot Program. We also collaborate with Taos County DWI,

Juvenile Justice Board, Northern New Mexico Implementation Team, Recovery Friendly Taos and Taos Crisis

Systems of Care, just to name a few.

*************************************************************************************


JOLENE AGUILAR, MPH Program Manager Partnership for Community Action [email protected] Ms. Aguilar received her Master’s of Public Health Degree and Bachelor’s of Criminology from the University of New Mexico . Currently she is the Program Manager for the Partnership for Community Action, where she oversees a Department of Health Strategic Prevention Framework grant. In that capacity, Ms. Aguilar works on key preventative strategies to reduce substance abuse amoung youth in Bernalililo County. Ms. Aguilar has over 15 years experience in Public Health and Health Policy and has worked in both the federal and state governments, with the US Department of Health and Human Services, Indian Health Services and NM Department of Health. ************************************************************************************* MEGAN E. THOMPSON, PharmD Director for Experiential Education / Assoc Professor of Pharmacy Practice & Administrative Sciences UNM College of Pharmacy [email protected] Dr. Megan Thompson is the Director for Experiential Education and Associate Professor of Pharmacy Practice and Administrative Sciences at the UNM College of Pharmacy. Dr. Thompson recently received the “Generation Rx Award of Excellence”, an award that is given annually to recognize a pharmacist who has demonstrated a commitment to the mission of substance abuse education. The “Generation Rx” program is designed to increase awareness about the issue of prescription drug misuse, abuse and overdose. Under her leadership, the UNM student pharmacists involved with this project also received the “National Generation Rx Student Award” in March of 2013. Brief Description of the Generation Rx Initiative The Generation Rx Initiative is a nationwide program designed to educate the general public on the dangers of prescription drug misuse and abuse. The UNM College of Pharmacy, in collaboration with Cardinal Health and the Ohio State University, has developed interactive programs for all ages that provide education on the science behind prescription misuse and abuse. The interactive programs have been tailored to specific audiences, and include presentations for elementary school, middle school, high school, and college students, in addition to parents, teachers, healthcare providers, elderly and the general public. Through these live presentations, over 20,000 New Mexicans, including 15,000 youth, reaching 21 counties statewide and covering over 75,000 square miles, have learned about the science and dangers of prescription drug misuse and abuse. The UNM College of Pharmacy Generation Rx Initiative has received numerous awards nationwide for the development, implemen-tation, collaboration with community partners and efforts in combating prescription drug misuse and abuse. More information can be found at http://www.cardinal.com/us/en/generationrx or you can contact the UNM College of Pharmacy at (505) 272‐3241 to arrange for a presentation in your area. *************************************************************************************

LAW ENFORCEMENT / CRIMINAL JUSTICE / PUBLIC SAFETY PANEL

WILLIAM WIESE, MD, MPH (Moderator ) Senior Fellow RWJF Center for Health Policy at UNM

[email protected]


Dr. Wiese is Senior Fellow at the Robert Wood Johnson Foundation Center for Health Policy at the UNM. Over the past four years he has chaired the New Mexico Drug Policy Task Force, which has made policy recommenda-tions related to prevention, treatment, harm reduction, criminal justice. He is a former chair of the Department of Family and Community Medicine at UNM and was instrumental in establishing programs in family medicine and emergency medicine, the Master of Public Health Program, and the University’s Employee Occupational Health and Employee Wellness programs. From 1996-2000 he took positions with New Mexico state government including three years as director of the Public Health Division in the NM Department of Health. He returned to UNM Health Sciences Center in 2002 to become the founding director of the Institute for Public Health. Nationally, he served on the U.S. Preventive Services Task Force, the Council on Linkages Between Academia and Public Health Practice, and as president of the Association of Teachers of Preventive Medicine. ************************************************************************************* JEROME SANCHEZ

Detective Sergeant

Santa Fe Police Department

msan he i santa-fe nm us

Detective Sergeant Jerome Sanchez is Co-Chair of the Law Enforcement Assisted Diversion (LEAD) community

planning committee in Santa Fe, NM.

The Santa Fe City Council recently approved a program that is designed to break the cycle of arrest and addiction

by diverting some drug offenders into treatment. The city will implement a pre-booking diversion pilot program,

otherwise known as Law Enforcement Assisted Diversion (LEAD), by early 2014. The move came as a result of

recommendations from the Santa Fe LEAD Task Force, which has been working for more than nine-months on the

issue.

LEAD identifies low-level opiate (pills and heroin) drug offenders for whom probable cause exists for an arrest

and redirects them from jail and prosecution by immediately providing linkages to treatment and social supports

including harm reduction and intensive case management. When the program is implemented, the city of Santa

Fe will become second in the nation to implement this new model; Seattle was the first to implement in 2011.

************************************************************************************* MICHAEL GEIER Southeast Area Commander Albuquerque Police Department [email protected]

Commander Michael Geier has been with the Albuquerque Police Department for almost 20 years. He is currently in charge of the Southeast Area Command, one of the busiest and most challenging communities in the city. He has 40 years of law enforcement experience, having retired as a Lieutenant from a police department in north suburban Chicago prior to starting with APD. He has served in several assignments during his career, including patrol, criminal investigations and gang suppression; with recognized expertise in crisis intervention/negotiations and drug recognition evaluations. Program Model: As a representative for the law enforcement/criminal justice component, Commander Geier will discuss strategies that law enforcement agencies currently use to address the drug problem in the metropolitan area. He will provide an overview of current practices in the field that include a multi-disciplinary approach to the “war on drugs.” These initiatives involve partnerships and “place-based” policing strategies that address identified


problems throughout the area. These goes beyond traditional education, enforcement and interdiction practices to now include intervention and rehabilitation. Bernalillo County is particularly vulnerable to drug issues due to its proximity to Mexico and the lucrative profits that attract organized networks of traffickers to the area. With two major interstate highways intersecting in the hub of the city, along with an international airport and railway within the region, the problem is further enhanced within our community. The availability of narcotic drugs has affected not only the individual users, but also impacts their families and all the residents of this area. Property and violent crime, along with other quality of life issues are related to drug abuse and the police are tasked with trying to resolve these concerns with less personnel and resources. The time has come for a collaborative model that addresses the problem on many levels, using all available community services, to assist law enforcement battle this on-going dilemma.

****************************************************************************** CRISTINA JARAMILLO, MBA, JD Bernalillo County Metropolitan Court Judge [email protected]

Graduated from University of New Mexico School of Law in 1990 and University of New Mexico Anderson School of Management – Masters in Business Administration – 1990. She went to work in the New Mexico Public Defender Department – Albuquerque, New Mexico – doing felony and misdemeanor criminal defense for indigent clients from 1991 to 2002. She was appointed to the bench in 2002 in the Bernalillo County Metropolitan Court. Judge Jaramillo has been involved with drug court since 1997, as one of the original members of Metropolitan Court DWI Drug Court team. Judge Jaramillo was also a member of the Metropolitan Court Drug Court Advisory Board in 1997. After being appointed to the Bench, Judge Jaramillo became a DWI Drug Court Judge in February, 2003. She began a drug court track for mental health DWI offenders beginning in 2005. Judge Jaramillo became the Chief DWI Drug Court Judge for the Bernalillo County Metropolitan Court in July, 2006. She was also the Drug Court Judge for Urban Native American Track since Spring of 2006. Judge Jaramillo has been a board member of the New Mexico Association Drug Court Professionals since 2005. She was elected President of the New Mexico Association Drug Court Professionals, October, 2006 and still holds that position. She is the Chairwoman for the New Mexico Drug Court Advisory Committee since being appointed by the New Mexico Supreme Court in 2009.

************************************************************************************* RAMON C. RUSTIN Chief of Corrections Bernalillo County - Metropolitan Detention Center [email protected] Ramon C. Rustin is Chief of Corrections at the Bernalillo County Metropolitan Detention Center. Chief Rustin is a 33 year veteran in Corrections and has served in a supervisory capacity for 30 years. Chief Rustin is currently responsible for the care and custody of 2900 inmates, 530 staff personnel, and an annual budget of approximately $65 million dollars. His unique skill sets involve the development and progressive implementation of correctional concepts including, but are not limited to: policy and procedure development, operations management, treatment program development, effective communication and records management, while influencing positive culture, progressive change, and leadership. Prior to his selection as Chief at MDC in January of 2011, Rustin served as Warden of the Allegheny County Jail located in Pittsburgh, Pennsylvania. In October of 2004 an intensive national search for Warden of the Allegheny County Jail was underwritten by Pittsburgh Foundations. As a result of this, Warden Rustin began his career as Director of Allegheny County Bureau of Corrections and Warden of Allegheny County Jail. The Jail is part of a


collaborative that partners with the 5th Judicial District Court of Common Pleas, the Allegheny County Departments of Human Services and Health to provide programs for successful re-entry of inmates back to society where Warden Rustin was the Chairperson. The collaborative initiative is responsible for reducing recidivism of program participants by 50 percent throughout Allegheny County. Bernalillo County Metropolitan Detention Center The Detention Center is the largest county facility in the state. Its purpose is to protect the citizens of Bernalillo County from criminal offenders through a collaborative system of incarceration which segregates offenders from society, assures offenders of their constitutional rights, and maintains diagnostic rehabilitative treatment programs to enhance the success of offenders’ reintegration into society. Today the Jail houses about 2000 inmates. A few months ago, the population was over 2,500 inmates. Part of the operation includes the Community Custody Program (CCP), a program where inmates are supervised in the community by GPS electronic monitoring. There are 300 inmates in this program. We are also housing 570 inmates in other facilities due to the facilities’ overcrowding. This costs $35,000 a day. On any given day there are 800 inmates with a mental health diagnosis, including 60% of our female population. In our most recent risk and needs assessment, 80% of the population admitted to regularly using drugs and alcohol. ****************************************************************************** CRAIG SPARKS, MPA Director, Youth Services Center Bernalillo County [email protected] Craig Sparks has a Bachelor’s Degree from UNM in Criminal Justice, Master’s Degree in Public Administration from UNM. 21 years of work experience in criminal justice field, 17 of those years in juvenile justice. Has held positions at CYFD as Chief Juvenile Probation Officer in Bernalillo County, and Director of Community Outreach and Behavioral Health Services. Currently Mr. Sparks is the Director of the Bernalillo County Youth Services Center (juvenile detention). Bernalillo County is recognized as one of only five National Model Sites for the Juvenile Detention Alternatives Initiative (JDAI) which focuses on reducing the use of secure detention for kids except in cases of true public safety risk. ****************************************************************************** MICHAEL ESTRADA Community Corrections Administrator NM Corrections Department [email protected] Mike Estrada has worked in Corrections since 1991. He was first employed as a social worker in the Philadelphia Prisons System in Philadelphia, PA. He came to New Mexico in 1997 and began work with the New Mexico Corrections Department. He has worked as an Officer, Supervisor, Program Manager, and currently is the Department's Community Corrections Administrator. He oversees statewide treatment funding and the operation of two residential rehabilitation programs. Mr. Estrada is especially interested in working with consumers with chemical dependency and mental health diagnoses. Community Corrections works with consumers who are simultaneously high risk and high need. That is, they present a risk of reoffending if their community treatment needs are not met. Community Corrections is considered a special program within the Probation and Parole Division of the New Mexico Corrections Department. ************************************************************************************


THOMAS E. SWISSTACK, BA Deputy County Manager for Public Safety Bernalillo County [email protected]

Thomas E. Swisstack has been in the Juvenile and Adult Justice System for over 30 years. He has served as an Executive Director of a Drug Abuse Center, the Assistant Chief of Juvenile Probation and Parole, and Director of the Bernalillo County Youth Services Center. He is presently the Deputy County Manager for Public Safety. The Youth Services Center is currently ranked the 4th National Model Site in the country by the Annie E. Casey Foundation. His objective is providing proactive leadership both in public relations and in the juvenile and adult justice system, combining operations management, strategic planning and financial expertise with vision, leadership and business insight. Thomas in partnership with others has been successful in identifying and capitalizing upon opportunities to achieve organizational aims by empowering team players to achieve goals set forth. As past Director of the Bernalillo County Youth Services Center and the current Deputy County Manager of Public

Safety, Tom has collaboratively worked on Detention Systems Reform in both juvenile and adult systems. He

believes that successful systemic changes should include some of the following:

Eliminate inappropriate or unnecessary use of secure detention in the hopes of reducing detention rates and

facility crowding.

Improve court appearance rates and minimize or reduce the incidence of deviant behavior through

implementation of strong and effective community based alternatives.

To re-direct public finances that are provided to juvenile and adult detention facilities into community based

programming.

To enhance, strengthen and support the current community custody programs that have proven to be

successful.

March 2008 – Present, Mayor of Rio Rancho; 2002-2008, Elected to the House of Representatives; 1994-1998 Tom was the Mayor of Rio Rancho, NM; 1987-1994 he was a Sandoval County Commissioner. Tom has also served on the Board of New Mexico Correctional Association, the Executive Board of United Way of New Mexico, Who's Who, American Colleges, American Law Enforcement and Public Administration.

*************************************************************************************

HARM REDUCTION PANEL

MIRIAM KOMAROMY, MD, FACP (Moderator) Associate Director of the ECHO Institute Project ECHO [email protected]

Dr. Komaromy is board-certified in internal medicine and addiction medicine. Her medical training was at the University of California, San Francisco (UCSF), and she was a Robert Wood Johnson Clinical Scholar in the UCSF/Stanford program. In addition to work in academia and community health centers, she was medical director of the state-funded addiction treatment hospital, Turquoise Lodge Hospital, for 5 years and created the Medical Observation and Treatment Unit in collaboration with Bernalillo County. She has worked with Project ECHO since 2005, and started the Integrated Addictions and Psychiatry teleECHO clinic in 2006. She came to UNM full time in 12/2012 as associate director of the ECHO Institute, where she leads two large clinical programs that both involve addiction treatment


delivered by new clinical teams in a total of 18 community health centers in NM and 10 in Washington state. Dr. Komaromy also chairs the board of directors of the non-profit "Healing Addiction in our Communities" (HAC, formerly Heroin Awareness Committee).

Project ECHO - Program Description Project ECHO is a model to diffuse knowledge from academia and medical specialists to primary care providers and patients in rural and traditionally-underserved areas. PCPs from around the state join specialists in a particular disease area via video conference on a weekly basis, and present challenging clinical cases for co-management with specialists. Over time PCPs develop clinical expertise in that disease area that allows them to deliver care that is as good as that delivered by a specialist, but is accessible to patients in their own communities. ECHO is being widely replicated nationally and internationally. The Integrated Addictions and Psychiatry (IAP) teleECHO clinic has operated weekly videoconferences since 2006, involving clinicians in hundreds of NM communities. In addition to treatment of common mental health problems and all types of addiction, the program has also focused on training physicians and other health care team members to treat opioid addiction with buprenorphine, and has provided buprenorphine certification to hundreds of NM physicians. The program also offers the Community Addiction Recovery Support (CARS) program, which trains community health workers to support addiction recovery and assist with addiction treatment. ************************************************************************************* R. DALE TINKER, BA Executive Director New Mexico Pharmacists Association [email protected]

Dale Tinker is the Association Manager for community pharmacists and pharmacies in New Mexico. He graduated

from the UNM School of Architecture in 1976 and has been working for associations for 36 years, starting with

construction related associations in 1976. He has been the Executive Director of the Pharmacists Association

more than 24 years.

Dale represents the profession and business of community pharmacy at the New Mexico Legislature and at

regulatory hearings of various government agencies, primarily at the state level. He supports member efforts in

providing quality patient care through Pharmacist Prescribing (vaccines, tobacco cessation products, emergency

contraception and in providing TB testing in New Mexico). The association provides continuing education for

pharmacists and technicians.

The Association's most recent prescribing protocol, Pharmacists Prescribing of Naloxone (Narcan), has been approved by the New Mexico Medical Board, the Board of Nursing and the Board of Pharmacy as required by statute. The next step before offering the service to the community will be a public hearing about implementation rules (in October) with full pharmacist training and full implementation coming in the next few months. They worked with Project ECHO and the NM Department of Health in development of this protocol. ************************************************************************************* MELISSA HEINZ, MPH Injury Prevention Coordinator, Office of Injury Prevention NM Department of Health/Injury & Behavioral Epidemiology Bureau/Epidemiology & Response Div [email protected]

Graduate of the University of North Carolina at Chapel Hill School of Public Health – Worked as research associate


with the Center for Drug and Social Research at the University of Texas at San Antonio from 1998 through 2001 when she joined the New Mexico Department of Health in the Infectious Disease Bureau. From 2004 through mid-2012, Melissa managed the Hepatitis Program within the ID Bureau, during which time the Program established Suboxone clinics in public health offices and expanded harm reduction and disease prevention services on outreach in county jails across the state. Melissa currently works with the Office of Injury Prevention for the Department of Health, responsible for prescription opioid misuse and overdose prevention and policy development and coordinates community based planning efforts to expand access to Naloxone. ************************************************************************************* SALLY BACHOFER, MD Associate Professor UNM Family & Community Medicine [email protected] Dr. Sally Bachofer is a graduate of the University of Michigan Medical School and is Board Certified in Family Medicine. She is an Associate Professor in Family & Community Medicine at UNM. A significant component of her clinical and educational effort has been focused on developing an appreciation for and incorporation of the social determinants of health into the daily practice of medicine. She is a founding faculty member of the Family Medical Home model for the FOCUS Early Intervention Program. This program works with families of children under the age of 3 year who are struggling with adverse social situations such as chronic mental illness, substance use, violence, poverty & incarceration. ************************************************************************************* ANITA CÓRDOVA, MA Director of Development, Planning and Evaluation Albuquerque Health Care for the Homeless anita ordova ab h h org Anita Córdova, Director of Development, Planning and Evaluation, began work at Albuquerque Health Care for the Homeless more than seven years ago. She holds her AA in Liberal Arts from Central New Mexico Community College (formerly Albuquerque Technical-Vocational Institute); BA with honors in Psychology & Spanish from the University of New Mexico; and MA in Forensic Psychology from Castleton State College in Vermont. Ms. Córdova has more than a decade of experience working for community-based health, civil legal services, domestic violence, and community corrections programs located both in community-based private organizations and in public institutions. In positions from independent consultant, to resource development and planning directorships, policy analyst, and part-time academic faculty, she is adept at grant-writing, fund-raising, best practices research, psychological assessment, and program evaluation and development. Ms. Córdova is a native New Mexican who returned to the state in 2004 to live and work. She performed the role of external evaluator and was closely involved with the design, implementation and ongoing performance improvement of the Re-Entry Collaborative. Established in 2009, the Re-Entry Collaborative (REC) is designed to assist Bernalillo County NM residents who are opiate addicted, homeless, and recently released from incarceration. The REC is a Medication-Assisted Addiction Treatment Program delivered in an integrated primary care setting with wrap-around case management and an emphasis on accessing housing, overdose prevention, and recovery support. Project outcomes include: improved ability for target population to access and remain engaged in treatment services; sustained recovery from opiate addiction following release from incarceration; improved housing status and quality of life of participants; and for participants who completed 12 months of buprenorphine treatment, the number of arrests for new charges during these 12 months decreased by at least 25% compared with the one year prior to their most recent incarceration. *************************************************************************************


ANDRU ZELLER, MD Executive Director Casa de Salud Family Medical Office - Healing Oasis Recovery Program [email protected] ************************************************************************************* BRUCE G. TRIGG, MD Physician, Duke City Recovery Toolbox and Santa Fe Recovery Center [email protected] Dr. Trigg is a pediatrician who retired in 2011 after working at the New Mexico Department of Health (DOH) for 23 years where he was medical director of the Sexually Transmitted Disease Program and of the Public Health Program at the Bernalillo County Metropolitan Detention Center (MDC) . He was also instrumental in starting the methadone treatment program at MDC and a buprenorphine treatment program at the DOH. Since retiring from the DOH Dr. Trigg has worked at several methadone maintenance programs in Albuquerque and as medical director for the MDC methadone program. He is currently a clinician at the Duke City Recovery Toolbox in Albuquerque and the Santa Fe Recovery Center. He consults on clinical and policy issues relating to drug addiction and sexual and reproductive health locally, nationally and internationally. Dr. Trigg recently returned from living and working in India and Southeast Asia for nine months. He worked as a consultant to methadone treatment programs in Cambodia and Indonesia. Dr. Trigg is Clinical Assistant Professor, Department of Pediatrics and Associate Professor of Nursing at the University of New Mexico Health Sciences Center. He graduated from George Washington University School of Medicine in 1981 and did his residency training at Albert Einstein College of Medicine in NYC and the University of New Mexico Health Sciences Center. From 1983 to 1986 he worked with the Indian Health Service of the US Public Health Service on Native American reservations in New Mexico and Arizona. He is past national board member of Physicians for a National Health Program (PNHP) that advocates for a universal, single-payer, Medicare for All health system for the US. *************************************************************************************

TREATMENT PANEL

HARRIS SILVER, MD (Moderator) Drug Policy Analyst & Advocate [email protected] Harris Silver, MD is a retired Ear, Nose & Throat / Head & Neck Surgeon due to previous health issues who now works as a health care and drug policy analyst and advocate. He is an expert in matters dealing with prescription and illicit opioids, including safer pain management and methods to reduce the chance of opioid addiction and overdose. He also works on health care and drug policy legislation, and works as an adviser to legislators at the state and national level. He served as the policy analyst for the New Mexico Senate Memorial 18 Drug Policy Task Force and was also a policy analyst on the Senate Memorial 45 Harm Reduction Workgroup. He is a frequent lecturer to professional groups on the substance abuse crisis and opioid overdose epidemic, and Harris has also been one of the chief organizers of this Opioid Accountability Summit. He is also a Clinical Associate Professor at the UNM Health Sciences Center in the Department of Family and Community Medicine where he teaches medical students and in the Masters of Public Health Program, and does health care and drug policy research.

******************************************************************************


ANNE FOSTER, MD, MPH, FACOG (OB-GYN) Chief Medical Officer, Medical Assistance Division NM Department of Human Services [email protected] Dr. Foster is Chief Medical Officer for Medicaid for the Department of Human Services, State of New Mexico. She provides clinical direction and medical leadership for the NM Medicaid program, including quality assurance, program redesign, the development of innovative service delivery models, and the implementation of the Affordable Care Act in New Mexico. She is originally from Taos, NM. Prior to serving in her current role, Dr. Foster was CMO for a multi-county community health system in the in the San Francisco Bay area. Prior to this, Dr. Foster was full-time ob/gyn faculty at the University of California San Francisco, where in addition to teaching, patient care and research, she focused on international women’s health and health policy reform in Latin America, with emphasis on maternal mortality prevention and family planning. She developed and directed the Spanish language course for the International Family Planning Leadership Program while at UCSF. She has published widely on contraceptive research and women’s health. She received her MD from the Univ. of New Mexico, MPH Health Policy and Management and AB Linguistics from the University of California, Berkeley. Dr. Foster is a past Chair of the ACOG International Affairs Committee and co-directed the FIGO/ACOG Save the Mothers’ Project on Maternal Mortality Prevention in Central America. She was an ACOG Women’s Health Policy Fellow and a Kellogg Scholar in Social Disparities in Health, as well as a recipient of the Jacob’s Institute Excellence in Women’s Health Award. In her spare time she works in film/television/theater, along with her children Dulcie and Julian, as a producer/actor/writer. ************************************************************************************* MORIAH MacCLEOD, LPCC Behavioral Health Administrator Molina Healthcare [email protected] Moriah MacCleod, LPCC, has worked with adults and adolescents in New Mexico who have co-occurring disorders for the last 22 years in a variety of capacities. Her clinical specialties are trauma, personality disorders, and addictions, with an emphasis in the last few years on opioid addictions and Medication Assisted Treatment. She practices using EMDR, hypnosis, and EFT, as well as CBT, ACT, and creative expressive therapies including art, movement, journaling. Moriah has worked in a number of treatment settings and levels of care including adult residential treatment for co-occurring disorders at Cottonwood de Albuquerque; treatment of co-occurring disorders, trauma and personality disorders at Lovelace Behavioral Health; adolescent outpatient, RTC, Day Treatment, IOP, and group home, and independent living at Desert Hills and Hogares. In addition she served as the Family Program Supervisor for Hogares’ residential substance abuse programs. She has served as a member of the Adolescent Transition Group for BHSD, a group of NM state staff and providers who planned transition of severely mentally ill adolescents into the adult mental health system. She has worked in both Quality and Utilization Management for ValueOptions as well as Region II RCC in Santa Fe. Currently, she serves as Director of Behavioral Health for Healthcare Services/Utilization Management at Molina Healthcare of New Mexico. Prior to moving to New Mexico, she worked in healthcare in St. Louis for the American Red Cross, Washington University Dental School, Barnes Hospital at Washington University Medical School. During her time in St. Louis, she served on the board of Directors for The St. Louis Holistic Health Center.


************************************************************************************* JULIE BOHAN, MD Professor, UNM Department of Psychiatry Attending Physician, UNM Addiction and Substance Abuse Program (ASAP) Clinic [email protected] Dr. Bohan has been on the UNM faculty for 25 years and created a Primary Care Clinic at the UNM Addiction and Substance Abuse Program. She has had extensive involvement in teaching medical students-in the classroom as well as in the clinical arena and is head of the UNM School of Medicine’s undergraduate mentoring program. She is actively involved in teaching many topics on addiction throughout the Health Sciences Center. Description of ASAP The UNM Addiction and Substance Abuse Program serves over 700 patients. It is an Opiate Replacement Treatment center with approximately 450 patients on Methadone and 100 on Suboxone. We also treat alcohol, benzodiazepine and stimulant dependence. It includes individual and group therapy, detox, a mandatory Narcan program for new patients, a co-located primary care clinic and psychiatric services. We are a teaching facility and have medical students, residents, pharmacy and PA students rotating with us. ************************************************************************************* PAUL TUCKER, MS, LADAC CEO Turning Point Recovery Center and Focused Recovery [email protected] Paul Tucker has a Masters of Science degree from Wisconsin and is a Licensed Alcohol and Drug Abuse Counselor (LADAC) in NM. For the past 18 years, Paul has owned and operated successful evidence based Intensive Outpatient substance abuse treatment programs (Turning Point Recovery Center www.turningpointrc.com and previously Focused Recovery) in Albuquerque. The Mission of these programs includes a philosophy of abstinence yet is flexible to best meet the needs of the clients. Turning Point receives referrals from Insurance Companies, EAP programs, SAP and professional monitoring boards, LADACs, Social Workers, MDs and treatment centers as well as internet and public referrals. Turning Point includes outpatient alcohol and opiate detox services, working closely with NPs, MDs and Psychiatrists (both in-house and with providers in the community). For his opiate dependent clients, he has successfully utilized a Suboxone taper with Behavioral therapy and Naltrexone (with extended release) to establish a successful separation from opiate use/maintenance. Turning Point’s treatment modalities are varied, but include an awareness of the role trauma plays in the treatment and recovery process. ************************************************************************************* YOLANDA BASOCO BRISCOE, MEd, PsyD Chief Executive Director Santa Fe Recovery Center [email protected] Yolanda Basoco Briscoe, M.Ed., PsyD is a licensed psychologist in the State of New Mexico and California. She is responsible for the development and implementation of a CARF accredited evidence-based residential and outpatient treatment center for adults who struggle with substance abuse in Santa Fe and Espanola. Prior to her position as the Chief Executive Director at the Santa Fe Recovery Center, Dr. Briscoe worked as a clinical psychologist on a behavioral unit at the largest facility in the country for adults who are developmentally

https://legacy.bernco.gov/OWA/redir.aspx?C=VthTw3HdxUGOcPZaKQiFsa3kn2OLhNBIPehGZpFJbJacIw4EICov_1Noydp9P9QrgTEsI8h2vW4.&URL=http%3a%2f%2fwww.turningpointrc.com%2f


disabled. She also served as Program Director and Counselor at a residential treatment facility where she implemented an 18-month biopsychosocial model for the treatment of substance abuse for women and their children. She has also taught at several colleges, and provides her services to Native American Pueblos including Santo Domingo for the past 7 years, and most recently, Five Sandoval Pueblos. She is currently serving on a two-year federally appointed Substance Abuse and Mental Health Services Administration (SAMHSA) Women’s Advisory Committee. In addition, Dr. Briscoe serves on Santa Fe Mayor David Coss’s Law Enforcement and Diversion (LEAD) advisory committee and, the State of New Mexico Department of Behavioral Health Recovery Oriented Systems of Care (ROSC) advisory committee. Dr. Briscoe has also reviewed and edited books on grief support and professional ethics. For more information call 505-471-4985 or visit our website at www.sfrecovery.org. ************************************************************************************* MIRIAM KOMAROMY, MD, FACP Associate Director of the ECHO Institute Project ECHO [email protected] Dr. Komaromy is board-certified in internal medicine and addiction medicine. Her medical training was at the University of California, San Francisco (UCSF), and she was a Robert Wood Johnson Clinical Scholar in the UCSF/Stanford program. In addition to work in academia and community health centers, she was medical director of the state-funded addiction treatment hospital, Turquoise Lodge Hospital, for 5 years and created the Medical Observation and Treatment Unit in collaboration with Bernalillo County. She has worked with Project ECHO since 2005, and started the Integrated Addictions and Psychiatry teleECHO clinic in 2006. She came to UNM full time in 12/2012 as associate director of the ECHO Institute, where she leads two large clinical programs that both involve addiction treatment delivered by new clinical teams in a total of 18 community health centers in NM and 10 in Washington state. Project ECHO is a model to diffuse knowledge from academia and medical specialists to primary care providers and patients in rural and traditionally-underserved areas. PCPs from around the state join specialists in a particular disease area via video conference on a weekly basis, and present challenging clinical cases for co-management with specialists. Over time PCPs develop clinical expertise in that disease area that allows them to deliver care that is as good as that delivered by a specialist, but is accessible to patients in their own communities. ECHO is being widely replicated nationally and internationally. The Integrated Addictions and Psychiatry (IAP) teleECHO clinic has operated weekly videoconferences since 2006, involving clinicians in hundreds of NM communities. In addition to treatment of common mental health problems and all types of addiction, the program has also focused on training physicians and other health care team members to treat opioid addiction with buprenorphine, and has provided buprenorphine certification to hundreds of NM physicians. The program also offers the Community Addiction Recovery Support (CARS) program, which trains community health workers to support addiction recovery and assist with addiction treatment. ************************************************************************************* KATRINA HOTRUM, MA Director, Department of Substance Abuse Programs (DSAP) Bernalillo County [email protected] Katrina Hotrum has been the Director of the Substance Abuse Programs (DSAP) for Bernalillo County since 2011. There she is responsible for oversight of:

MDC Jail-Based Addiction Treatment Program

The Community Addiction Treatment Program

http://www.sfrecovery.org/


HUD’s – Renee’s Project that assist women with children that are in recovery

The Milagro Residential Program

Metropolitan Assessment and Treatment Services (MATS) Detox

Supportive Aftercare

Public Inebriate Intervention Program (PIIP) with oversight to DWI

ADE Tracking

Assessment Center

Prior to working at Bernalillo County, Ms. Hotrum worked for the State of New Mexico’s Department of Health as the Deputy Secretary of Facilities. While with the State, she managed:

Turquoise Lodge Hospital

Sequoyah Adolescent Treatment Center

Roswell Rehabilitation

New Mexico Behavior Health Hospital

Fort Bayard Medical Center and Yucca Lodge

New Mexico Veterans Home

Los Lunas Community Program - for individuals with developmental disabilities.

During this time, Katrina also managed the state's developmentally Disabled Waiver Program. Katrina earned her Master of Arts Degree in 1995 from the University of New Mexico. ******************************************************************************

Accountability Summit Appendix E - Data

APPENDIX E - DATA

NOTE: Death rates for specific drugs and drug categories are not mutually exclusive. SOURCE: Total rate from Bureau of Vital Records and Health Statistics, NMDOH; All others from the New Mexico Office of the Medical Investigator. Population estimates for rate calculation from Bureau of Business and Economic Research, University of New Mexico.

SOURCE: CDC Wonder Compressed Mortality, 1999-2010. http://wonder.cdc.gov/mortSQL.html

20.7 20.6

23.824.9

19.6

26.2 26.727.4

34

25.826.7

29.6

6.4 6.88.3

9.5 7.8 9.2

12.7

14.3

15.914.7

8.29.1

10.77.8

11.2

8.5

6.6

9.39.9

10.6

12.8

9.1

65.4

01.2 1.5 1.3

3.7

1.3 1.2 1.8 1.5 1.2 6.3

10.9

0

5

10

15

20

25

30

35

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Age-adjusteddeathratesper100,000persons

YEAR

BernalilloCountyDrugOverdoseDeathRatesforDrugCategories,2000-2011

TotalOD RxOpioids Heroin Unspecifieddrug

0

5

10

15

20

25

30

35

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

AgeAd

justed

deathra

teper100

,000

person

YEAR

OverdoseDeathRates,USandNM,1999-2010

PoisoningUS PoisoningNM OpiatePoisoningUS OpiatePoisoningNM

http://wonder.cdc.gov/mortSQL.html


All maps from NM Community Data Collaborative - Drug Overdose Deaths, 2005-2009. SOURCE: Deaths: NM IBIS - http://ibis.health.state.nm.us/query/selection/mort/MortSelection.html - New Mexico Death Certificate Database, Office of Vital Records and Statistics, New Mexico Department of Health; Population Estimates: University of New Mexico, Bureau of Business and Economic Research, http://www.unm.edu/~bber/

NewMexicoDrugOverdoseDeaths,2005-2009

RioArribaCountyDrugOverdoseDeaths,averageperyear,2005-09Rateper100,000=64

RateinadjacentSantaFeCounty=39

BernalilloCountyDrugOverdoseDeaths,2005-2009


Albuquerque/BernalilloCountyDrugOverdoseDeaths2005-2009

CentralAlbuquerqueDrugOverdoseDeaths2005-2009


Drug Use Indicators by Year for Current Use of Heroin and Painkillers

Bernalillo County - Grades 9-12 (YRRS 2011)

Percent (%) 2003 2005 2007 2009 2011

Current use of painkillers to get high

12.8 15.2 10.2

Current heroin use 4.4 4.2 4.6 4.9 2.8

0

2

4

6

8

10

12

14

16

2003 2005 2007 2009 2011

Current use of painkillers to get high

Current heroin use

PER

CEN

T %

Accountability Summit Appendix F - Sponsors

APPENDIX F – SUMMIT SPONSORS

The Accountability Summit – Turning the Curve on Opioid Abuse in Bernalillo County was organized and convened by the Bernalillo County Community Health Council with funding support from Bernalillo County. Special recognition goes to Marsha McMurray-Avila, Health Council Coordinator, for Chairing the Planning Committee and overseeing all aspects of the Summit, to Tracy McDaniel for administrative support, and to Matt Cross-Guillén and Enrique Cardiel for technical support on the day of the Summit. Thanks go to the sponsors who covered additional expenses including the luncheon:

Presbyterian Health Care Foundation

Robert Wood Johnson Foundation Center for Health Policy at UNM

Molina Healthcare