Thursday's meeting with U.S. Senator Amy Klobuchar’s staff members was only an hour long, but a lot of ground was covered in that time frame. Assembled in the room were state and local health representatives, first responders, health care providers, treatment professionals and community partners. The topic was the opioid and meth crisis and the impact of substance use disorders across the state.
Dr. Deb Dittberner is a family physician and the Chief Medical Officer for Alomere Health. She told Klobuchar's staff about the start for the local community health drug task force. Dittberner says it began as a way to address the high number of opioid prescriptions in the area. The task force's findings led to procedural changes that have made a dramatic difference. In an earlier report Dittberner pointed to the statistics that have been kept since 2017 as proof of what kind of change has been made. In pill counts alone, Douglas County issued 8,312,231 opioid pills in the 12 months prior to October of 2017. The latest 12-month numbers show that number has dropped to 3,957,595. (Opioid pill count based on an equivalent to 1mg of Morphine) The more than 52% reduction in pills has dropped Alexandria well out of the top 10. Dittberner says it may, in fact, make them now one of the lowest in the state.
Other changes include the number of patients who had a "care plans" regarding their opioid prescriptions. Care plans are mutual agreements between the patient and provider that they will adhere to certain guidelines. Prior to addressing the issue head-on Alomere Health only showed 7% of their patients had a plan. As of the latest statistics 73% of their patients have a care plan. Dittberner says the solution, however, is not just about addressing prescriptions. It is about making connections within the community and approaching it from all phases; the emergency medical system, law enforcement, medication and treatment, and most of all prevention.
Amy Reineke is a Community Health Strategist with Horizon Public Health. She focused on youth and public awareness. Reineke says that a recent survey shows that 11% of 11th grade males were using prescription drugs, not prescribed to them. She also questioned whether the general public really even knows what an opioid is. She says prescriptions don't have the word opioid on the side of the bottle. Administrator at Horizon Public Health Ann Stehn says we need to look into what's leading up to addictions such as the system, the environment. She hopes the Senator can address that on the federal level.
Doug Paulson works on treating people with addictions. He says the biggest barrier is funding. He says that insurance companies are regulating what is needed to help with treatment and often what's needed and what's allowed, under insurance, do not come close to meeting. He also challenged Douglas County to get a drug court. He offered his help in establishing one, but says it requires a progressive judge and many people committed to its success.
Tam Bukowski is a Safety Coordinator at Alexandria Technical and Community College. She says two of their students died this year as a result of opioid addiction. She says they work with a lot of students with high ACEs scores (Adverse Childhood Experiences) and therefore the solution needs to address that.
Mental Health professionals mentioned that housing is a real problem for their clients. They said there is a need for not just housing, but sober housing. Stephanie from the Region 4 Mental Health Office asked what other programs or events, besides AA, are more family centered and alcohol free. The topic of mental health parody was brought up for people who have to pay for everything out of pocket. The high cost of care causes them to drop out. There is also the challenge of treatment. If people come in with addictions they may not fit into a mental health category and cannot receive services.
Alexandria Police Captain Scott Kent says that the Alexandria task force is taking an out of the box approach. "Putting money into silos will not work", says Kent. He added that just providing funding for the problems will not fix it. He says you have to have groups (like the one on Alexandria) that are collectively working to solve a community problem.
As a whole the opioid epidemic is something many in the the group agreed needs a holistic approach with more resiliency work. Dittberner responded to the recent @$20 million Governor Walz approved to address the opioid epidemic, with a portion going for grants to fund prevention strategies to reduce opioid deaths and overdoses. She says it's good that its being addressed, however, she worries about the effectiveness of the funds without a solid plan. The communities that receive the money need to be ready to address the problem as a community.
The conversation also highlighted Senator Klobuchar’s legislation to reduce opioid distribution, fund treatment, and improve prescribing. Most Americans know someone with a substance use disorder and one in seven people in the U.S. is expected to develop a substance use disorder at some point in their lives. Members of the public are encouraged to join these discussions and share how people’s substance abuse disorders have impacted their lives. Prior to the discussion, staffers played a video from the senator.
As a former Hennepin County Attorney, Klobuchar has long led local and national efforts to curb drug abuse and help people overcome addiction. In February 2018, Klobuchar and Senators Rob Portman (R-OH), Maggie Hassan (D-NH), Sheldon Whitehouse (D-RI), Shelley Moore Capito (R-WV), Dan Sullivan (R-AK), Bill Cassidy (R-LA), and Maria Cantwell (D-WA) introduced the bipartisan Comprehensive Addiction and Recovery Act (CARA) 2.0 Act. The bill would increase the funding authorization levels for the CARA programs enacted in 2016, and put in place additional policy reforms to help combat the opioid epidemic—including provisions from Klobuchar and Portman’s Prescription Drug Monitoring Act.
In October 2018, three of Klobuchar’s bipartisan bills to combat the opioid epidemic were signed into law as part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. The Synthetic Abuse and Labeling of Toxic Substances (SALTS) Act, which Klobuchar introduced with Senator Lindsey Graham (R-SC), will make it easier to prosecute the sale and distribution of “analogue” drugs, which are synthetic substances that are substantially similar to illegal drugs. The Synthetics Trafficking & Overdose Prevention (STOP) Act, which Klobuchar introduced with Portman, will help stop dangerous synthetic drugs like fentanyl and carfentanil from being shipped through U.S. borders and into our communities. The Eliminating Kickbacks in Recovery Act, which Klobuchar introduced with Senator Marco Rubio (R-FL), will help crack down on health care facilities or providers that try to game the system to take advantage of vulnerable patients.
In February, Klobuchar and Portman reintroduced legislation to require that all states receiving certain federal funding to combat opioid abuse have prescription drug monitoring programs (PDMPs) using best practices, and also require states to make their PDMP data available to other states. PDMPs can identify and prevent unsafe prescribing practices and doctor shopping, helping to prevent addiction before it starts. Klobuchar also joined Senator Joe Manchin (D-WV) and other senators to reintroduce the Budgeting for Opioid Addiction Treatment (LifeBOAT) Act, which would establish a permanent funding stream to provide and expand access to treatment for addiction.