Media Wiki - User contributions [en]

Enhance Treatment and Recovery Support During Incarceration

2020-04-08T00:13:08Z

Dmt7109:

Expand Community Service Alternatives to Incarceration

2020-04-08T00:11:29Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output">Return to [[ZOOM_MAP_-_Prioritize_SUD_Treatment_Over_Incarceration|Zoom Map - Prioritize SUD Treatment Over Incarceration]]
----

When people are breaking laws, get arrested and convicted of a crime, having their punishment be in the form of community service can be an alternative to incarceration.  This can be less damaging to their lives moving forward than incarceration.   

= Background =

<font style="background-color:#ffffff">Alternative to incarceration is any punishment given to an individual who commits a crime that is served by means outside of confinement in a jail or prison. Alternatives to incarceration have proved to be less expensive than incarceration. Additionally, alternatives can repair harms suffered by victims, provide benefits to the community, treat individuals struggling with SUD, mental illness, or a coexistence of both; and rehabilitate offenders. It is important that before we can maximize the benefits of alternatives to incarceration, however, we must repeal mandatory minimums and give courts the power to use cost-effective, recidivism-reducing sentencing options instead. <ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref></font>

= Pros of Alternatives to Incarceration =

<u>'''<font style="background-color:#ffffff">Give Courts More Sentencing Options</font>'''</u>

<font style="background-color:#ffffff">Each offender and crime is unique, and prison or jail time may not always be the most effective response. If courts have options other than incarceration, they can better tailor a cost-effective sentence that fits the offender and the crime, protects the public, and provides rehabilitation.<ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref></font>

<br/> <font style="background-color:#ffffff"><u>'''Save Taxpayer Money'''</u></font>

<font style="background-color:#ffffff">It costs over $28,000 to keep one person in federal prison for one year (some states’ prison costs are much higher).  Alternatives to incarceration are cheaper, help prevent prison and jail overcrowding, and save taxpayers millions.</font><ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref><br/>  

<u>'''S'''</u><font style="background-color:#ffffff"><u>'''trengthen Families and Communities'''</u></font>

<font style="background-color:#ffffff">Prison or jail time separates the offender from his or her spouse and children, sometimes for decades at a time. Alternatives to incarceration keep people with their families, in their neighborhoods and jobs, and allow them to earn money, pay taxes, and contribute to their communities.</font><ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref><br/>  

'''<u>P</u>'''<font style="background-color:#ffffff">'''<u>rotect the Public by Reducing Crime</u>''' </font>

<font style="background-color:#ffffff">Over 40% of all people leaving prison will reoffend and be back in prison within three years of their release. Alternatives to prison such as drug and mental health courts are proven to confront the underlying causes of crime (i.e., drug addiction and mental illness) and help prevent offenders from committing new crimes.</font><ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref><br/>  

<font style="background-color:#ffffff"><u>'''The Public Supports Alternatives to Incarceration'''</u> </font>

<font style="background-color:#ffffff">Over ~75% of adults believe that alternatives to incarceration (probation, restitution, community service, and/or rehabilitative services) are the most appropriate sentence for nonviolent, non-serious offenders and that prison or jail are appropriate only if these alternatives fail.</font><ref>https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf</ref>

= Incarceration Alternatives =

<font style="background-color:#ffffff">Some argue that alternative to incarceration is a lesser sentence without impact. But studies have shown that the vast majority of survivors also prefer investments in education, mental health treatment, drug treatment, and job training to more spending on prisons and jails.<ref>https://www.nidirect.gov.uk/articles/non-custodial-sentences</ref></font>

== <font style="background-color:#ffffff">Various Alternative Sentences as Alternative to Incarceration</font> ==

<u>'''<font style="background-color:#ffffff">Monetary Fine</font>'''</u>

*<font style="background-color:#ffffff">A fine is the most common form of punishment given by the courts. The offender must pay a fixed sum of money. If they don't pay, they could get a prison sentence.</font>

<u>'''<font style="background-color:#ffffff">Probation Order</font>'''</u>

*W<font style="background-color:#ffffff">hen an offender is supervised by a probation officer in the community for a certain time.Sometimes the court will apply additional requirements to the probation order, including:</font>
**<font style="background-color:#ffffff">Mandatory attendance of a alcohol or drug rehabilitation center</font>
**<font style="background-color:#ffffff">Mandatory attendance of a day center</font>
**<font style="background-color:#ffffff">Mandatory attendance of any other medical treatment or counselling</font>

<u>'''<font style="background-color:#ffffff">Community Service Order</font>'''</u>

*<font style="background-color:#ffffff">When an offender gets a community service order, they must do unpaid work in the community for a derration that is decided in the discretion of the judge</font>
*<font style="background-color:#ffffff">They must work the hours as instructed. If they don't do the work, they will be returned to court, where they could receive a fine or any other sentence</font>
*<font style="background-color:#ffffff">This can be utilized in combination with a probation order</font>

<u>'''<font style="background-color:#ffffff">Conditional or Absolute Discharge</font>'''</u>

= Tools & Resources =

[[TR_-_Expand_Community_Service_Alternatives_to_Incarceration|TR - Expand Community Service Alternatives to Incarceration]]

<br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
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|  
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= Sources =

 
</div> </div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Law Enforcement Assisted Diversion and Deflection Programs

2020-04-08T00:07:46Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">''Return to [[ZOOM_MAP_-_Prioritize_SUD_Treatment_Over_Incarceration|Zoom Map - Prioritize SUD Treatment Over Incarceration]] ''
----

The most common phrase you will hear from law enforcement leadership across the country is, “We recognize we cannot arrest our way out of this problem.” We must provide our first responders and criminal justice system with the tools, resources, and support to ensure those fighting substance use disorder receive treatment and those profiting from their addiction and tragic deaths face harsh justice. Whether in the aftermath of an opioid overdose reversal or while transitioning in and out of incarceration, those battling addiction must be presented with the opportunity for treatment so they can begin their road to recovery.

= Strengths of Pre-Arrest Diversion =
<div>Pre-arrest Diversion programs  provide law enforcement with an alternative to having to make arrests. Instead, as long as a person meets certain criteria, they can avoid a police record, stay out of the criminal justice system, and modify future behavior, all the while attempting to also uncrowd U.S. correctional facilities.</div> <div class="_" style="color: rgb(51, 51, 51); font-family: sans-serif,arial,verdana,"><div class="mw-parser-output">
= Goal of Pre-Arrest Diversion =
<div>
Depending on local community needs and behavioral health capacity, police diversion programs across the country have varying designs, but their goals are consistent:

*To continue to promote and enhance public safety while also responding more effectively to substance use and mental health problems <ref>http://www2.centerforhealthan djustice.org/content/project/police-deflection</ref>
*'''<span style="font-size:10.5pt;font-family:arial;color:#323232;background-color:#ffffff;font-weight:400;font-style:normal;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap;">To low-level offenses, pre- arrest diversion helps to reverse the tide of people with nonviolent offenses entering the justice system</span>'''<ref>http://www2.centerforhealthan djustice.org/content/project/police-deflection</ref>
</div> </div>
= Pre-Arrest Diversion Frameworks =
<div>
The variety of operational characteristics of pre-arrest diversion programs creates nearly unlimited possibilities for the final program design, some common themes can be observed in deflection programs currently operating.<ref>http://www2.centerforhealthandjustice.org/sites/www2.centerforhealthandjustice.org/files/publications/DeflectionFramework-excerpt_Final.pdf</ref>

Naloxone Plus: Engagement with treatment occurs following 

'and overdose response and crisis-level treatment is readily available. Examples: opiate response teams, STEER (MD) '<ref>http://www2.centerforhealthandjustice.org/sites/www2.centerforhealthandjustice.org/files/publications/DeflectionFramework-excerpt_Final.pdf</ref>   Active Outreach: Participants are identified by law enforcement, but are engaged primarily by a treatment expert who actively contacts them and motivates them to engage in treatment. Example: Arlington Model (MA)  '<ref>http://www2.centerforhealthandjustice.org/sites/www2.centerforhealthandjustice.org/files/publications/DeflectionFramework-excerpt_Final.pdf</ref>  Self-Referral: Drug-involved individuals initiate engagement with law enforcement without fear of arrest, and an immediate treatment referral is made. Example: Angel (MA)  '<ref>http://www2.centerforhealthandjustice.org/sites/www2.centerforhealthandjustice.org/files/publications/DeflectionFramework-excerpt_Final.pdf</ref>

<u>Officer Prevention Referral</u>: Law enforcement initiates the treatment engagement, but no charges are filed. Examples: LEAD (WA), STEER (MD)''''<span style="background-color: rgb(255, 255, 255); color: rgb(50, 50, 50); font-family: arial; font-size: 10.5pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><ref>http://www2.centerforhealthandjustice.org/sites/www2.centerforhealthandjustice.org/files/publications/DeflectionFramework-excerpt_Final.pdf</ref></span>'''
<br/> <u>Officer Intervention Referral</u>: Law enforcement initiates the treatment engagement, and charges are held in abeyance or citations issued. Examples: Civil Citation (FL), STEER (MD)”'<ref>http://www2.centerforhealthandjustice.org/sites/www2.centerforhealthandjustice.org/files/publications/DeflectionFramework-excerpt_Final.pdf</ref>'</div>
= LEAD Program =
<div>LEAD is a pre-booking diversion program that allows officers to redirect low-level offenders engaged in drugs or prostitution activity to community-based services instead of jail and prosecution. LEAD participants begin working immediately with case managers to access services.</div> <div> </div> <div>According to a 2015 report by the International Centre for the Prevention of Crime (ICPC), "One of the [ONDCP] strategy's objectives for 2015 is to break the cycle of drug use, crime, delinquency, and incarceration by increasing by 5% the number of residential juvenile justice facilities offering substance abuse treatment, and increasing by 2.6% the number of treatment plans completed by individuals referred by the Criminal Justice System (ONDCP, 2012, p.18)."<ref>https://www.unodc.org/documents/ungass2016/Contributions/Civil/ICPC/Rapport_FINAL_ENG_2015.pdf</ref></div> <div class="_"> </div>
= Other Programs =

== <u>The S.M.A.R.T. Approach</u> ==
SMART supports chronic misdemeanor offenders, particularly those who are otherwise resistant to intervention, with a case manager and offers individualized treatment and tailored housing placements. SMART prioritizes chronic misdemeanor offenders with acute drug addictions and complex social service needs.<br/> See fact sheet here: <div>[[File/view/SMART_Fact_Sheet.pdf/623773107/SMART_Fact_Sheet.pdf|[File:http://www.wikispaces.com/i/mime/32/application/pdf.png SMART Fact Sheet.pdf]]] <div>[[File/view/SMART_Fact_Sheet.pdf/623773107/SMART_Fact_Sheet.pdf|SMART Fact Sheet.pdf]]</div> </div>
== <u>STEER</u> ==

STEER is a police deflection initiative that incorporates prevention deflection and intervention deflection. The priority is to improve public safety by police and human services working together. It operates around the core value proposition of deflection, namely ensuring the proper placement of citizens either into the criminal justice system or away from it and towards the human services system. This results in reducing crime, building community relations, reducing drug use, and restoring the lives of citizens. STEER deflection provides a natural strategy to improve community relations by showing citizens the police know when a citizen needs help inistead of needing to be arrested. STEER makes clear that the police are indeed here to help and not just to arrest.<ref>http://www2.centerforhealthandjustice.org/sites/www2.centerforhealthandjustice.org/files/publications/STEER-FactSheet.pdf</ref>

== <u>DTAP - Drug Treatment Alternative To Prison</u> ==

This program had a high rate of success.  See this [https://www.centeronaddiction.org/addiction-research/reports/crossing-bridge-evaluation-drug-treatment-alternative-prison-dtap-program evaluation report] from 2003 for impressive statistics. 

= Tools & Resources =

[[TR_-_Expand_Law_Enforcement_Assisted_Diversion_Programs|TR - Expand Law Enforcement Assisted Diversion Programs]]

<br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----
</div> </div> </div> </div> </div> </div>
[[Category:SAFE-Law Enforcement and Criminal Justice]] [[Category:SAFE-Treatment and Recovery]]

Improve Screening for Infectious Disease among Those with SUDs

2020-04-08T00:04:54Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] <div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">__TOC__
= Current Status =

*Hep C virus (HCV) infections tripled between 2010 and 2015
*Substance abuse and infectious diseases shared common populations, risk factors, social determinants, and even contracting venues<sup class="reference">[1]</sup>
*There was little collaboration between programs that provided services to these populations<sup class="reference">[2]</sup>
*Methadone clinics would be optimal venues for service integration because these clinics serve a population that is 60% injection drug users; have medical staff performing brief health assessments for all new clients; and already have some infectious disease screenings in place, including routine tuberculosis testing and intermittent opt-in HIV testing<sup class="reference">[3]</sup>
*One study showed that 68% of opioid treatment programs nationwide had staff capacity for HCV testing, but only 33% actually offered on-site HCV testing<sup class="reference">[4]</sup>
*<span style="background-color: #ffffff; color: #333333; font-family: roboto,'helvetica neue',helvetica,arial,sans-serif; font-size: 16px">Awareness of HCV infection among this particular population may motivate them to reduce their consumption and hopefully high-risk behavior</span>

= Promising Programs =

== Texas Department of State Health Services ==

[https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html [1]]<br/>  

== Philly Website ==

[http://www.phillyhepatitis.org/support-care/ phillyhepatits.org] is an example of a resource for people seeking to identify if they have hepatitis, next steps they can take, and where they can find care or assistance.<br/>  

== TLC Awareness Campaign ==

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342624/ "Test, Listen, Cure" (TLC) Hepatitis C Community Awareness Campaign] provides information about how HCV infection is transmitted, risk factors for the disease, the importance of screening and treatment, and the availability of improved treatment for the disease.

= Tools & Resources =

[[TR_-_Improve_Screening_for_Infectious_Disease_among_Opioid_Users|TR - Improve Screening for Infectious Disease among Opioid Users]]

= <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span> =

<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html [2]]
#[https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html [3]]
#[https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html [4]]
##
##*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670662/ [5]]
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Prescriptions and Medical Response]]

Improve Screening for Infectious Disease among Those with SUDs

2020-04-08T00:04:23Z

Dmt7109: Undo revision 19901 by Dmt7109 (talk)

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] <div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">__TOC__
= Current Status =

*Hep C virus (HCV) infections tripled between 2010 and 2015
*Substance abuse and infectious diseases shared common populations, risk factors, social determinants, and even contracting venues<sup class="reference">[1]</sup>
*There was little collaboration between programs that provided services to these populations<sup class="reference">[2]</sup>
*Methadone clinics would be optimal venues for service integration because these clinics serve a population that is 60% injection drug users; have medical staff performing brief health assessments for all new clients; and already have some infectious disease screenings in place, including routine tuberculosis testing and intermittent opt-in HIV testing<sup class="reference">[3]</sup>
*One study showed that 68% of opioid treatment programs nationwide had staff capacity for HCV testing, but only 33% actually offered on-site HCV testing<sup class="reference">[4]</sup>
*<span style="background-color: #ffffff; color: #333333; font-family: roboto,'helvetica neue',helvetica,arial,sans-serif; font-size: 16px">Awareness of HCV infection among this particular population may motivate them to reduce their consumption and hopefully high-risk behavior</span><br/>  

= Barriers to Access =

 

= Promising Programs =

== Texas Department of State Health Services ==

[https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html [1]]<br/>  

== Philly Website ==

[http://www.phillyhepatitis.org/support-care/ phillyhepatits.org] is an example of a resource for people seeking to identify if they have hepatitis, next steps they can take, and where they can find care or assistance.<br/>  

== TLC Awareness Campaign ==

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342624/ "Test, Listen, Cure" (TLC) Hepatitis C Community Awareness Campaign] provides information about how HCV infection is transmitted, risk factors for the disease, the importance of screening and treatment, and the availability of improved treatment for the disease.

= Tools & Resources =

[[TR_-_Improve_Screening_for_Infectious_Disease_among_Opioid_Users|TR - Improve Screening for Infectious Disease among Opioid Users]]

= Scorecard Building =

[[PO_-_Improve_Screening_for_Infectious_Disease_among_Opioid_Users|Potential Objective Details]]<br/> [[PM_-_Improve_Screening_for_Infectious_Disease_among_Opioid_Users|Potential Measures and Data Sources]]<br/> [[PA_-_Improve_Screening_for_Infectious_Disease_among_Opioid_Users|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Improve_Screening_for_Infectious_Disease_among_Opioid_Users|More RTI ]][[RTI_-_Improve_Screening_for_Infectious_Disease_among_Opioid_Users|on]][[RTI_-_Improve_Screening_for_Infectious_Disease_among_Opioid_Users|Improve Screening for Infectious Disease among Opioid Users]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html [2]]
#[https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html [3]]
#[https://www.cdc.gov/nchhstp/programintegration/successstories-tx/inf-disease-screening.html [4]]
##
##*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670662/ [5]]
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Prescriptions and Medical Response]]

Improve Screening for Infectious Disease among Those with SUDs

2020-04-08T00:04:07Z

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Expand Number of Safe Injection Sites

2020-04-08T00:01:29Z

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Expand Number of Safe Injection Sites

2020-04-07T23:59:29Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output">Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map or]] [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]]</div> <div class="mw-parser-output"> </div>
= Background =
<div class="mw-parser-output"><div class="mw-parser-output" style="color: rgb(51, 51, 51); font-family: sans-serif,arial,verdana,"trebuchet ms"; font-size: 13px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block;">
<font style="background-color:#ffffff">Safe injection sites are supervised sites designed to provide a hygienic and safe environment for illicit intravenous drug use and reduce nuisance from public drug use. Safe Injection sites are a cornerstone of harm reduction strategies towards drug problems. Typically injection sites provide sterile injection equipment, information about drugs and basic health care, treatment referrals, and access to medical staff to drug addicts. Currently there are no legal injection sites in the United States, however many other countries have employed them with levels of success. </font>

= <font style="background-color:#ffffff">Proposed Safe injection sites in the United States</font> =

<font style="background-color:#ffffff">Currently there are thirteen proposed injection sites in the United States. They are found in:</font>

*Seattle
*<font style="background-color:#ffffff">Philadelphia</font>
*<font style="background-color:#ffffff">Vermont</font>
*<font style="background-color:#ffffff">Delaware</font>
*<font style="background-color:#ffffff">San Francisco</font>
*<font style="background-color:#ffffff">New York City</font>
*<font style="background-color:#ffffff">Colorado</font>
*<font style="background-color:#ffffff">Massachusetts</font>

= <font style="background-color:#ffffff">Positive Results from Safe Injection sites around the World</font> =

<font style="background-color:#ffffff">SISs (Supervised Injection Sites) were efficacious in attracting the most marginalized PWID (People who inject Drugs), promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes.</font>

<font style="background-color:#ffffff">Best evidence from cohort and modeling studies suggests that SISs are associated with lower overdose mortality (88 fewer overdose deaths per 100 000 person-years [PYs]), 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections.</font>

==   ==

<span style="background-color: rgb(255, 255, 255); color: rgb(34, 34, 34); font-family: arial,sans-serif; font-size: 12.8px;">'''<span style="color: rgb(77, 77, 77);">PAGE MANAGER</span>:''' </span><span style="background-color: rgb(255, 255, 255); color: rgb(255, 0, 0); font-family: arial,sans-serif; font-size: 12.8px;">[insert name here]</span><br/> <span style="background-color: rgb(255, 255, 255); color: rgb(34, 34, 34); font-family: arial,sans-serif; font-size: 12.8px;">'''<span style="color: rgb(77, 77, 77);">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: rgb(255, 255, 255); color: rgb(255, 0, 0); font-family: arial,sans-serif; font-size: 12.8px;">[fill out table below]</span>

{| class="wiki_table" style="border-bottom-color: rgb(211, 211, 211); border-bottom-style: dotted; border-bottom-width: 1px; border-image-outset: 0; border-image-repeat: stretch; border-image-slice: 100%; border-image-source: none; border-image-width: 1; border-left-color: rgb(211, 211, 211); border-left-style: dotted; border-left-width: 1px; border-right-color: rgb(211, 211, 211); border-right-style: dotted; border-right-width: 1px; border-top-color: rgb(211, 211, 211); border-top-style: dotted; border-top-width: 1px;"
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| style="border-bottom-color: rgb(211, 211, 211); border-bottom-style: dotted; border-bottom-width: 1px; border-image-outset: 0; border-image-repeat: stretch; border-image-slice: 100%; border-image-source: none; border-image-width: 1; border-left-color: rgb(211, 211, 211); border-left-style: dotted; border-left-width: 1px; border-right-color: rgb(211, 211, 211); border-right-style: dotted; border-right-width: 1px; border-top-color: rgb(211, 211, 211); border-top-style: dotted; border-top-width: 1px;" | '''Date'''
| style="border-bottom-color: rgb(211, 211, 211); border-bottom-style: dotted; border-bottom-width: 1px; border-image-outset: 0; border-image-repeat: stretch; border-image-slice: 100%; border-image-source: none; border-image-width: 1; border-left-color: rgb(211, 211, 211); border-left-style: dotted; border-left-width: 1px; border-right-color: rgb(211, 211, 211); border-right-style: dotted; border-right-width: 1px; border-top-color: rgb(211, 211, 211); border-top-style: dotted; border-top-width: 1px;" | '''Comments'''
|-
| style="border-bottom-color: rgb(211, 211, 211); border-bottom-style: dotted; border-bottom-width: 1px; border-image-outset: 0; border-image-repeat: stretch; border-image-slice: 100%; border-image-source: none; border-image-width: 1; border-left-color: rgb(211, 211, 211); border-left-style: dotted; border-left-width: 1px; border-right-color: rgb(211, 211, 211); border-right-style: dotted; border-right-width: 1px; border-top-color: rgb(211, 211, 211); border-top-style: dotted; border-top-width: 1px;" |  
| style="border-bottom-color: rgb(211, 211, 211); border-bottom-style: dotted; border-bottom-width: 1px; border-image-outset: 0; border-image-repeat: stretch; border-image-slice: 100%; border-image-source: none; border-image-width: 1; border-left-color: rgb(211, 211, 211); border-left-style: dotted; border-left-width: 1px; border-right-color: rgb(211, 211, 211); border-right-style: dotted; border-right-width: 1px; border-top-color: rgb(211, 211, 211); border-top-style: dotted; border-top-width: 1px;" |  
| style="border-bottom-color: rgb(211, 211, 211); border-bottom-style: dotted; border-bottom-width: 1px; border-image-outset: 0; border-image-repeat: stretch; border-image-slice: 100%; border-image-source: none; border-image-width: 1; border-left-color: rgb(211, 211, 211); border-left-style: dotted; border-left-width: 1px; border-right-color: rgb(211, 211, 211); border-right-style: dotted; border-right-width: 1px; border-top-color: rgb(211, 211, 211); border-top-style: dotted; border-top-width: 1px;" |  
|}

= Sources =

----
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Prescriptions and Medical Response]]
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<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
Return to[[Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_During_Opioid_Use|Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use]]<br/> Return to [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]] __TOC__<br/> <br/> (Replace this text with the information you will place here.)<br/> <br/> There is a need to [[Improve_Identification_&_Data_Collection_for_NAS|Improve Identifying and Data Collection on NAS]]<br/>  

= Tools & Resources =

[[TR_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|TR - Increase Awareness of the Risks of Opioid Use & NAS]]<br/>  

= Scorecard Building =

[[PO_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|Potential Objective Details]]<br/> [[PM_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|Potential Measures and Data Sources]]<br/> [[PA_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|More RTI on Increase Awareness of the Risks of Opioid Use & NAS]]<br/> <br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =
</div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Public Awareness]]

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Return to[[Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_During_Opioid_Use|Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use]]<br/> Return to [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]] __TOC__<br/> <br/> (Replace this text with the information you will place here.)<br/> <br/> There is a need to [[Improve_Identification_&_Data_Collection_for_NAS|Improve Identifying and Data Collection on NAS]]<br/>  

= Tools & Resources =

[[TR_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|TR - Increase Awareness of the Risks of Opioid Use & NAS]]<br/>  

= Scorecard Building =

[[PO_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|Potential Objective Details]]<br/> [[PM_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|Potential Measures and Data Sources]]<br/> [[PA_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Increase_Awareness_of_the_Risks_of_Opioid_Use_&_NAS|More RTI on Increase Awareness of the Risks of Opioid Use & NAS]]<br/> <br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =
</div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Public Awareness]]

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Enhance Collaboration among Medical, Behavioral & Social Services for Mothers with SUDs

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Return to [[Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_During_Opioid_Use|Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use ]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]

 

__TOC__ 

= Educating Providers =

<br/> see Tools & Resources for training examples

= Models of Collaboration =

<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Models of collaborative intervention vary widely in approach. They include innovative strategies such as:</font></span>

*C<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">o-location of substance abuse specialists in child welfare offices or dependency courts</font></span>
*<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Family Drug Courts or Dependency Drug Courts</font></span>
*C<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">ollaborative case management and planning</font></span>
*D<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">evelopment of collaborative structures</font></span>
*W<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">raparound services</font></span>
*I<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">mproved cross-system communication protocols</font></span>
*C<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">ross-agency training of staff</font></span>

= Promising Programs =

== Project Nurture ==

'''[http://www.healthshareoregon.org/transforming-health-together/care-innovations/maternal-child-and-family-wellness/project-nurture.html Project Nurture] - Health Share of Oregon'''<br/> ''Program Highlights (NUR)''

*Team-based approach to prenatal care that includes prenatal clinician, addictions specialist, mental health support, case management, peer support and parenting resources
*Clinic and organizational leadership with program accountability and resources
*Transparent, standardized process for screening and monitoring for substance use and for DHS involvement
*Strong commitment to a planned, coordinated approach to the inpatient maternity stay, with protocols for pain management, DHS and social work involvement and discharge planning
*Extended postpartum support lasting a full year, with pediatric care integrated with the mother’s care, ongoing addiction support, and peer support for parenting

''Outcomes Being Tracked''

*Pre-term birth rates
*Cost Savings

<br/>  

= Tools & Resources =

[[TR_-_Enhance_Collaboration_among_Medical,_Behavioral_&_Social_Services|TR - Enhance Collaboration among Medical, Behavioral & Social Services]]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =
</div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Prescriptions and Medical Response]]

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Return to [[Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_During_Opioid_Use|Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use ]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]

 

__TOC__ 

= Educating Providers =

<br/> see Tools & Resources for training examples

= Promising Programs =

== Project Nurture ==

'''[http://www.healthshareoregon.org/transforming-health-together/care-innovations/maternal-child-and-family-wellness/project-nurture.html Project Nurture] - Health Share of Oregon'''<br/> ''Program Highlights (NUR)''

*Team-based approach to prenatal care that includes prenatal clinician, addictions specialist, mental health support, case management, peer support and parenting resources
*Clinic and organizational leadership with program accountability and resources
*Transparent, standardized process for screening and monitoring for substance use and for DHS involvement
*Strong commitment to a planned, coordinated approach to the inpatient maternity stay, with protocols for pain management, DHS and social work involvement and discharge planning
*Extended postpartum support lasting a full year, with pediatric care integrated with the mother’s care, ongoing addiction support, and peer support for parenting

''Outcomes Being Tracked''

*Pre-term birth rates
*Cost Savings

<br/>  

= Tools & Resources =

[[TR_-_Enhance_Collaboration_among_Medical,_Behavioral_&_Social_Services|TR - Enhance Collaboration among Medical, Behavioral & Social Services]]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =
</div> </div> </div> </div> </div> </div> </div>
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<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to [[ZOOM_MAP_-_Increase_Early_Intervention_for_People_Misusing_Drugs|Zoom Map - Increase Early Interventions for People Misusing Drugs]]
----

One of the keys for helping people get off the road of developing dependence and OUD is to do screening to detect the risks so that people who might be more likely to misuse are not prescribed opioids at all--or if they are, with added precautions. In other cases, some types of screening or testing can help identify people who are in the early stages of misusing opioids so they can get the type of intervention that will be most helpful before they develop an addiction. Doing more screening and better screening should be an important part of a comprehsnsive strategy.

= Background =

== Screening for Risk Factors can Minimize People Misusing Opioids ==

<br/> Prescribing physicians or other medical professionals "should evaluate for mental health issues that can make patients vulnerable to addiction, says Hilary Connery, M.D., Ph.D., assistant professor of psychiatry at Harvard Medical School. “If you ignore screening for trauma, self-harm, and suicide,” she says, “you’re missing a crucial opportunity for prevention.”<ref>https://www.glamour.com/story/women-and-opioid-epidemic</ref><br/> <br/> A 2016 article in Health Psychology Open states that "Comprehensive screening and risk stratification are associated with decreased costs for patients, providers, and insurers as those prescribing are able to make increasingly well-informed decisions when treatment-planning regarding what to prescribe and how to best monitor patients for safety based on individual risk profiles."<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193264/</ref><br/> <br/> Screening tools that provide risk stratification that can aid decisions on when additional toxicology testing, such as urine drug testing (UDT) is appropriate.  

== Risk Factor Screening Tools ==

There are a variety of risk factor screening tools that are appropriate for different scenarios.<br/> '''[http://interasolutions.com OARS]'''<br/> '''Opioid Abuse Risk Screener (OARS)''' was developed as a comprehensive self-administered measure of potential risk that includes a wide range of critical elements noted in the literature to be relevant to opioid risk.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193264/</ref> This 43-question assessment is administered using an iPad (tablet) and takes about 10 - 12 minutes to complete. It is HIPAA compliant, EMR supported, and has high reliability, validity and preditablity scores. The assessment is instantly scored and a report is available to the prescribing physician that provides a summary opioid risk profile and a multidimensional assessment of risk factors. The OARS also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits, including scores for the PHQ-9 and the GAD-7. All information is provided in a compressive easy to read report which clearly identifies aberrant behavior and risk factors for followup by the provider with the patient during the visit.<br/>   The OARS is reimbursable with an average rate of $40/screening. Providers can get reimbursed in most cases with the CPT Code 96103 or the SBIRT codes while taking important steps to identify individuals that may be at risk for opioid misuse or abuse.

  InteraSolutions, the company that developed OARS, received a 2018 recipient of the State of Ohio's [https://www.usnews.com/news/best-states/ohio/articles/2018-09-12/ohio-set-to-award-latest-prizes-in-opioid-science-challenge Opioid Science Challenge] that seeks to identify and support scientific breakthroughs that help to address the opioid crisis. The OARS screening tool was recognized as one of those important breakthroughs. 

 [[More_information_on_the_Opioid_Abuse_Risk_Screener|More information on the Opioid Abuse Risk Screener]] (OARS)<br/>  

'''WellScreen'''

[http://wellscreen.health/ WellScreen] integrates technology-based screening tools with the SBIRT model.

== Key Benefits of Toxicology Testing for Misuse ==

When done well, toxicology testing for misuse can contribute to addressing the opioid crisis in several ways:

#It provides prescribing physicians with insights to reduce or eliminate prescriptions of opioids in situations where the risk of misuse is high.
#It quickly detects if opioids are being overused so steps to stop misuse can begin earlier.
#It detects if opioids are being underused and potentially diverted to illegal use (being sold or given away) or left around for possible theft.
#It enhances accountability and discourages people from misusing or diverting opioids because such behavior will be detected

== Recommended Testing for People on Chronic Opioid Therapy ==

Researchers estimate that 9.6–11.5 million adults, or approximately 3%–4% of the adult U.S. population, were prescribed long-term opioid therapy in 2005. <ref>https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm (See Citation 15)</ref><br/>   These people on chronic opioid therapy are at significant risk for developing Opioid Use Disorder, with one review of studies showing that an average of between 3% and 19% of people on chronic opioid therapy develop an addiction<ref>https://www.ncbi.nlm.nih.gov/pubmed/25785523</ref> .<br/>   A review of 26 studies by Cochrane in 2010 concluded that well-screened patients receiving long-term opioid treatment were at very low risk of developing an addiction (< 1%)<ref>http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain</ref> , but it should be considered that the studies they were reviewing may have been the ones funded by pharma companies trying to prove that long-term opioid treatment was safe, and the screening they used may have contributed to fewer instances of people becoming addicted--which itself could support the benefits of effective screening in reducing the risks of people becoming addicted.

  Prescriptions for this category of patients is a major contributor to the amount of opioids in the U.S. (statistics and citation needed). The following are recommended practices when people are on chronic opioid therapy:

 

#All patients should be assessed for risk factors, and then classified and stratified to optimize the testing protocols used.
#All patients on chronic opioid therapy should have a detailed treatment agreement in the form of a contract signed by both the patient and physician that clearly identifies risks and the terms under which opioids may be prescribed.
#Physicians must review PDMP data before prescribing opioids to identify possible risks or evidence of misuse or redirection.
#Drug screening (or preferably, toxicology testing) prior to the initiation of opioid therapy.
#Pill counts
#Screening to potentially make referrals to mental health providers or social service providers.

<br/>  

<div class="mw-parser-output">
= Current Status of Testing and Following Recommended Protocols =

*Very few (statistics and source needed) physicians follow the recommended guidelines when giving prescriptions for people on chronic opioid therapy.
*Only 11 states make it mandatory for physicians to randomly test patients if they are writing multiple controlled substances prescriptions.
*Carol Falkowski, CEO of Drug Abuse Dialogs emphasized the need to expand testing and screening in doctors’ offices at the 2016 Saving Lives Opioid Conference in Minneapolis.
*Falkowski said that less then 5% of the referrals to treatment come from doctors’ offices, but they should be a huge source of referrals.

 
</div>

= Types of Urine Drug Testing =

There are two categories of urine drug testing: screening and confirmatory.<br/> [[File:Testing comparison smaller.PNG|testing_comparison_smaller.PNG]]<br/>   BB: Use the new cheek swab testing method as a key to changing that.<br/>  

 

= Promising Programs =

== SBIRT ==

Screening is the first step to recognizing whether a person may have a substance use disorder. It is important to take clinical care a step further and get everyone the help they need. See the [[Expand_SBIRT_Program|SBIRT Program]] wiki page for more information. More information on [[Expand_SBIRT_Program|Expanding SBIRT Programs]]

<div class="mw-parser-output">
== Other Programs and Services ==

 

'''[https://guidemed.com/ GuideMed]''' - This organization utilizes a software program to develop network standards of care for people receiving long-term opioid therapy for pain management, including:

*Monitoring protocols
*Treatment recommendations
*Risk assessments
See this fact sheet for benefits and services offered <div class="objectEmbed">[[File/view/GuideMed_Intro.pdf/615990097/GuideMed_Intro.pdf|[File:http://www.wikispaces.com/i/mime/32/application/pdf.png GuideMed_Intro.pdf]]] <div>[[File/view/GuideMed_Intro.pdf/615990097/GuideMed_Intro.pdf|GuideMed_Intro.pdf]]
*[[File/detail/GuideMed_Intro.pdf|Details]]
*[[File/view/GuideMed_Intro.pdf/615990097/GuideMed_Intro.pdf|Download]]
*463 KB
</div> </div> <br/> <br/> '''<span style="background-color: #ffffff">Saliva Drug Screening</span>'''<span style="background-color: #ffffff">– For multiple reasons, a saliva sample should be chosen over the more common urine sample to test for drugs present in the system. Unlike urine, saliva tests cannot be adulterated, it can be administered rapidly, it has the ability to test for many things, it shows the metabolite drug and is cost-effective in the long run. Some healthcare systems may consider cost an issue, but saliva tests are billed to the same code. </span><br/> ''<span style="background-color: #ffffff">Contact</span>''<span style="background-color: #ffffff">: John Cribbs (john@nodrugsneeded.com)</span><br/> <br/> '''<span style="background-color: #ffffff">Biobot Labs</span>'''<span style="background-color: #ffffff">- [http://biobot.io/ Biobot Labs] has built a robot which analyzes human waste to determine where drugs are being abused most in a particular city or town. They analyze human waste flowing through the sewers at various points throughout the system, testing for metabolized traces of various substances to pinpoint where the highest concentrations of opioid users -- or cocaine users, alcohol userse -- are located. The goal is to shift data collection and response away from overdose and death, and move it in the direction of early detection and overdose prevention.</span> <div class="mw-parser-output"> </div> </div>

= Tools & Resources =

[[TR_-_Improve_&_Expand_Screening_for_Risk_Factors_&_Testing_For_Misuse|TR - Improve & Expand Screening & Testing For Misuse]]
</div>
<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| border="1" class="wiki_table"
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| '''Date'''
| '''Comments'''
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= Sources =

----
</div> </div> </div> </div> </div> </div> </div>
</div> </div>
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[[Category:Pages with broken file links]]

Improve & Expand Screening and Testing for Misuse and Dependency

2020-04-07T22:12:27Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to [[ZOOM_MAP_-_Increase_Early_Intervention_for_People_Misusing_Drugs|Zoom Map - Increase Early Interventions for People Misusing Drugs]]
----

One of the keys for helping people get off the road of developing dependence and OUD is to do screening to detect the risks so that people who might be more likely to misuse are not prescribed opioids at all--or if they are, with added precautions. In other cases, some types of screening or testing can help identify people who are in the early stages of misusing opioids so they can get the type of intervention that will be most helpful before they develop an addiction. Doing more screening and better screening should be an important part of a comprehsnsive strategy.

= Background =

== Screening for Risk Factors can Minimize People Misusing Opioids ==

<br/> Prescribing physicians or other medical professionals "should evaluate for mental health issues that can make patients vulnerable to addiction, says Hilary Connery, M.D., Ph.D., assistant professor of psychiatry at Harvard Medical School. “If you ignore screening for trauma, self-harm, and suicide,” she says, “you’re missing a crucial opportunity for prevention.”<ref>https://www.glamour.com/story/women-and-opioid-epidemic</ref><br/> <br/> A 2016 article in Health Psychology Open states that "Comprehensive screening and risk stratification are associated with decreased costs for patients, providers, and insurers as those prescribing are able to make increasingly well-informed decisions when treatment-planning regarding what to prescribe and how to best monitor patients for safety based on individual risk profiles."<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193264/</ref><br/> <br/> Screening tools that provide risk stratification that can aid decisions on when additional toxicology testing, such as urine drug testing (UDT) is appropriate.  

== Risk Factor Screening Tools ==

There are a variety of risk factor screening tools that are appropriate for different scenarios.<br/> '''[http://interasolutions.com OARS]'''<br/> '''Opioid Abuse Risk Screener (OARS)''' was developed as a comprehensive self-administered measure of potential risk that includes a wide range of critical elements noted in the literature to be relevant to opioid risk.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193264/</ref> This 43-question assessment is administered using an iPad (tablet) and takes about 10 - 12 minutes to complete. It is HIPAA compliant, EMR supported, and has high reliability, validity and preditablity scores. The assessment is instantly scored and a report is available to the prescribing physician that provides a summary opioid risk profile and a multidimensional assessment of risk factors. The OARS also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits, including scores for the PHQ-9 and the GAD-7. All information is provided in a compressive easy to read report which clearly identifies aberrant behavior and risk factors for followup by the provider with the patient during the visit.<br/>   The OARS is reimbursable with an average rate of $40/screening. Providers can get reimbursed in most cases with the CPT Code 96103 or the SBIRT codes while taking important steps to identify individuals that may be at risk for opioid misuse or abuse.

  InteraSolutions, the company that developed OARS, received a 2018 recipient of the State of Ohio's [https://www.usnews.com/news/best-states/ohio/articles/2018-09-12/ohio-set-to-award-latest-prizes-in-opioid-science-challenge Opioid Science Challenge] that seeks to identify and support scientific breakthroughs that help to address the opioid crisis. The OARS screening tool was recognized as one of those important breakthroughs. 

 [[More_information_on_the_Opioid_Abuse_Risk_Screener|More information on the Opioid Abuse Risk Screener]] (OARS)<br/>  

'''WellScreen'''

[http://wellscreen.health/ WellScreen] integrates technology-based screening tools with the SBIRT model.

== Key Benefits of Toxicology Testing for Misuse ==

When done well, toxicology testing for misuse can contribute to addressing the opioid crisis in several ways:

#It provides prescribing physicians with insights to reduce or eliminate prescriptions of opioids in situations where the risk of misuse is high.
#It quickly detects if opioids are being overused so steps to stop misuse can begin earlier.
#It detects if opioids are being underused and potentially diverted to illegal use (being sold or given away) or left around for possible theft.
#It enhances accountability and discourages people from misusing or diverting opioids because such behavior will be detected

== Recommended Testing for People on Chronic Opioid Therapy ==

Researchers estimate that 9.6–11.5 million adults, or approximately 3%–4% of the adult U.S. population, were prescribed long-term opioid therapy in 2005. <ref>https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm (See Citation 15)</ref><br/>   These people on chronic opioid therapy are at significant risk for developing Opioid Use Disorder, with one review of studies showing that an average of between 3% and 19% of people on chronic opioid therapy develop an addiction<ref>https://www.ncbi.nlm.nih.gov/pubmed/25785523</ref> .<br/>   A review of 26 studies by Cochrane in 2010 concluded that well-screened patients receiving long-term opioid treatment were at very low risk of developing an addiction (< 1%)<ref>http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain</ref> , but it should be considered that the studies they were reviewing may have been the ones funded by pharma companies trying to prove that long-term opioid treatment was safe, and the screening they used may have contributed to fewer instances of people becoming addicted--which itself could support the benefits of effective screening in reducing the risks of people becoming addicted.

  Prescriptions for this category of patients is a major contributor to the amount of opioids in the U.S. (statistics and citation needed). The following are recommended practices when people are on chronic opioid therapy:

 

#All patients should be assessed for risk factors, and then classified and stratified to optimize the testing protocols used.
#All patients on chronic opioid therapy should have a detailed treatment agreement in the form of a contract signed by both the patient and physician that clearly identifies risks and the terms under which opioids may be prescribed.
#Physicians must review PDMP data before prescribing opioids to identify possible risks or evidence of misuse or redirection.
#Drug screening (or preferably, toxicology testing) prior to the initiation of opioid therapy.
#Pill counts
#Screening to potentially make referrals to mental health providers or social service providers.

<br/>  

<div class="mw-parser-output">
= Current Status of Testing and Following Recommended Protocols =

*Very few (statistics and source needed) physicians follow the recommended guidelines when giving prescriptions for people on chronic opioid therapy.
*Only 11 states make it mandatory for physicians to randomly test patients if they are writing multiple controlled substances prescriptions.
*Carol Falkowski, CEO of Drug Abuse Dialogs emphasized the need to expand testing and screening in doctors’ offices at the 2016 Saving Lives Opioid Conference in Minneapolis.
*Falkowski said that less then 5% of the referrals to treatment come from doctors’ offices, but they should be a huge source of referrals.

 
</div>

= Types of Urine Drug Testing =

There are two categories of urine drug testing: screening and confirmatory.<br/> [[File:Testing comparison smaller.PNG|testing_comparison_smaller.PNG]]<br/>   BB: Use the new cheek swab testing method as a key to changing that.<br/>  

 

= Promising Programs =

== SBIRT ==

Screening is the first step to recognizing whether a person may have a substance use disorder. It is important to take clinical care a step further and get everyone the help they need. See the [[Expand_SBIRT_Program|SBIRT Program]] wiki page for more information. More information on [[Expand_SBIRT_Program|Expanding SBIRT Programs]]

== Other Programs and Services ==

 

'''[https://guidemed.com/ GuideMed]''' - This organization utilizes a software program to develop network standards of care for people receiving long-term opioid therapy for pain management, including:

*Monitoring protocols
*Treatment recommendations
*Risk assessments
See this fact sheet for benefits and services offered <div class="objectEmbed">[[File/view/GuideMed_Intro.pdf/615990097/GuideMed_Intro.pdf|[File:http://www.wikispaces.com/i/mime/32/application/pdf.png GuideMed_Intro.pdf]]] <div>[[File/view/GuideMed_Intro.pdf/615990097/GuideMed_Intro.pdf|GuideMed_Intro.pdf]]
*[[File/detail/GuideMed_Intro.pdf|Details]]
*[[File/view/GuideMed_Intro.pdf/615990097/GuideMed_Intro.pdf|Download]]
*463 KB
</div> </div> <br/> <br/> '''<span style="background-color: #ffffff">Saliva Drug Screening</span>'''<span style="background-color: #ffffff">– For multiple reasons, a saliva sample should be chosen over the more common urine sample to test for drugs present in the system. Unlike urine, saliva tests cannot be adulterated, it can be administered rapidly, it has the ability to test for many things, it shows the metabolite drug and is cost-effective in the long run. Some healthcare systems may consider cost an issue, but saliva tests are billed to the same code. </span><span style="background-color: #ffffff; color: #ff0000">[citation needed] Review this to learn more: </span>[https://vimeo.com/160404196 [1]] <span style="color: #f40b2c">and then delete the link to the discussion</span>.<br/> ''<span style="background-color: #ffffff">Contact</span>''<span style="background-color: #ffffff">: John Cribbs (john@nodrugsneeded.com)</span><br/> <br/> '''<span style="background-color: #ffffff">Biobot Labs</span>'''<span style="background-color: #ffffff">- [http://biobot.io/ Biobot Labs] has built a robot which analyzes human waste to determine where drugs are being abused most in a particular city or town. They analyze human waste flowing through the sewers at various points throughout the system, testing for metabolized traces of various substances to pinpoint where the highest concentrations of opioid users -- or cocaine users, alcohol userse -- are located. The goal is to shift data collection and response away from overdose and death, and move it in the direction of early detection and overdose prevention.</span> <div class="mw-parser-output">
= Tools & Resources =

[[TR_-_Improve_&_Expand_Screening_for_Risk_Factors_&_Testing_For_Misuse|TR - Improve & Expand Screening & Testing For Misuse]]
</div>
<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| border="1" class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

----
</div> </div> </div> </div> </div> </div> </div>
</div> </div>
</div>
[[Category:Pages with broken file links]]

Disrupt the Supply of Illegal Drugs

2020-04-07T22:09:06Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] <span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]]
 

Add a intro paragraph here.  
<div class="mw-parser-output"><div class="mw-parser-output">
= Background =

Key to any strategy to reduce opioid misuse is preventing illicit opioids, including heroin and synthetic opioids, from ever reaching communities. This role is almost exclusively the role and responsiblity of law enforcement at both the federal and state level, and requires cooperation between jurisdictions and federal partners to ensure success.

<font style="background-color:#ffffff">In the United States, fentanyl is classified as a Schedule II controlled substance, meaning there is a potential for misuse and dependence, but it does have an accepted medical use and can be prescribed for restricted use. Although prescribed synthetic opioids are sometimes diverted to the illicit market, the main reason for the surge in high purity synthetic opioids are from the increase in manufacturing from clandestine labs, which are either pressed into pills or left in powder form and mixed with heroin. <ref name="Drug Policy">https://drugpolicy.org/drug-facts/are-synthetic-opioids-legal</ref></font>

== <font style="background-color:#ffffff">Law Enforcement, State, and Federal Response</font> ==

<font style="background-color:#ffffff">Increasing seizures of synthetic opioid-laced heroin by law enforcement, calls from politicians to increase punishment for possession and/or sale of illicit fentanyl included escalating mandatory minimum sentencing, and even capital punishment for sale of heroin.There is no evidence that escalating criminal punishment will have any effect on reducing risk of overdose or use in general. Research has suggested that these policies will fail to address the issues involving fentanyl and will continue the harmful trend of mass incarceration in the US. </font><ref name="Drug Policy">https://drugpolicy.org/drug-facts/are-synthetic-opioids-legal</ref>

<br/> <font style="background-color:#ffffff">Individual states and the federal government’s efforts are centered around placing individual synthetic opioids and opiate-like NPS into Schedule I of the Controlled Substances Act (CSA). </font><ref name="Drug Policy">https://drugpolicy.org/drug-facts/are-synthetic-opioids-legal</ref>
<div class="mw-parser-output">
== Perceived Dangers of Accidental Overdoses ==

With the distribution of [[Additional_Info_on_Fentanyl|fentanyl]], a powerful opioid that can be lethal in small amounts, overdoses have been reported by law enforment personnel as having occured through inhalation or absorption through the skin during routine encounters.<ref>http://www.cnn.com/2017/05/16/health/police-fentanyl-overdose-trnd/?iid=ob_article_footer_expansion]</ref> These instances, however, are more myth than reality,<ref>_</ref> and can lead to misplaced fear when law enforement and emergency responders come upon a suspected overdose. Any delay in responding to an overdose could cause brain damage and even death.
See page on [[Support_Strategies_to_Address_Fentanyl|Support Strategies to Address Fentanyl]]</div> </div> </div>
= National Programs =

== DEA 360 Strategy ==

'''Target Drug Trafficking Organizations'''<br/> In the past, the DEA has targeted low-level, first time non-violent offenders who usually are selling to get high themselves.<sup class="reference">[6]</sup> This new strategy will target all drug deals, but start from the top down.<sup class="reference">[7]</sup><br/> <br/> "''These drug trafficking organizations are predators. There's no other way to describe it. They look for the vulnerable, they exploit them by finding them while they are trying to get treatment; that's how severe, how bad these drug trafficking organizations are to find their customer and peddle their poison. We're going to put together a task force and this task force is going to put together building federal cases based on these overdoses, and there is significant sentencing around and this is a way to impact straight into the organization and take out upper level members of an organization that directly impact the flow of drugs''.”<sup class="reference">[8]</sup><br/> <br/> -Thomas Gorman, Assistant Special Agent in Charge, DEA

== Organized Crime Drug Enforcement Task Force ==

'''Organized Crime Drug Enforcement Task Force (OCTDEF) National Heroin/Fentanyl and Opioid Initiative'''<br/> Since its inception in December of 2014, the ultimate goal of this initiative has been to develop multi-agency, multi-jurisdictional cases against criminal organizations. The Initiative leverages the national structure, resources and information sharing capabilities to identify the local street level distributors who are responsible for overdose deaths, as well as their network of suppliers at the local and regional level. In the last several years, OCDETF investigators and prosecutors attacked the opioid epidemic by prosecuting rogue physicians, pharmacists, internet sales, and pill mill operations. Their traditional diversion investigations involved overwriting of oxycodone by doctors, and misuse of fentanyl patches by users who clipped the edges to consume the gel inside. Today, OCTDEF funds 60 Heroin/Fentanyl and Opioid Initiatives across the country. <sup class="reference">[9]</sup><br/> <br/> '''Working With China to Stop Export of Controlled Substances'''

*A large number of synthetic opioids, specifically fentanyl, come to the US from China. <sup class="reference">[10]</sup>
*China has agreed to crack down on the exports of substances that are controlled in the US, but not in China.<sup class="reference">[11]</sup>
*The US and China will work together to exchange more law enforcement and scientific information to coordinate actions.<sup class="reference">[12]</sup>
*Cooperation between the U.S. Drug Enforcement Agency (DEA) and the China Ministry of Public Security (MPS) and recognized China’s actions toward combating global synthetic drug trafficking.<sup class="reference">[13]</sup>
*On October 1, 2015, China took an important step in international coordination by controlling a list of 116 synthetic drugs that were widely abused in the U.S.<sup class="reference">[14]</sup>
*When evaluating a substance for control, the new provision also allows China to consider harm to the public in countries other than China.<sup class="reference">[15]</sup>
*DEA continues to share information with Chinese officials to secure scheduling of additional fentanyl-class substances in China due to the wave of recent deaths in the United States from these synthetic opioids. <sup class="reference">[16]</sup>
*At a time of massive growth in postal shipments from China due to e-commerce, the investigators found that the postal system received the electronic data on just over a third of all international packages, making more than 300 million packages in 2017 much harder to screen. Data in the Senate report shows no significant improvement during 2017 despite the urgency. <sup class="reference">[17]</sup>
*The U.S. Postal Service said it has made dramatic progress in the last year in total packages with opioids seized by U.S. Customs and Border Protection... implementing the use of electronic data is slowed by the need to negotiate with international partners, but the service is making progress. <sup class="reference">[18]</sup>

= General Strategies =

== <font style="background-color:#ffffff">Better Addiction Prevention, Treatment, and Recovery Services</font> ==

<font style="background-color:#ffffff">Improve access to prevention, treatment, and recovery support services to prevent the health, social, and economic consequences associated with opioid misuse and addiction, and to enable individuals to achieve long-term recovery.<ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref></font>

== <br/> <font style="background-color:#ffffff">Better Data</font> ==

<font style="background-color:#ffffff">Strengthen public health data reporting and collection to improve the timeliness and specificity of data, and to inform a real-time public health response as the epidemic evolves.</font><ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

== <br/> <font style="background-color:#ffffff">Better Pain Management</font> ==

<font style="background-color:#ffffff">Advance the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.</font><ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

== <font style="background-color:#ffffff">Better Targeting of Overdose Reversing Drugs</font> ==

<font style="background-color:#ffffff">Target the availability and distribution of overdose-reversing medications to ensure the broad provision of these drugs to people likely to experience or respond to an overdose, with a particular focus on targeting high-risk populations.</font><ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

== <font style="background-color:#ffffff">Better Research</font> ==

<font style="background-color:#ffffff">Support cutting-edge research that advances our understanding of pain, overdose and addiction, leads to the development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms.</font><ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

= Tools & Resources =

[[TR_-_Expand_Efforts_to_Disrupt_the_Supply_of_Heroin_&_Synthetic_Opioids_to_the_Community|TR - Expand Efforts to Disrupt the Supply of Heroin & Synthetic Opioids to the Community]]

<br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
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| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
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<div class="mw-parser-output">
= Sources =

----

#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [https://www.dea.gov/press-releases/2016/06/10/dea-warning-police-and-public-fentanyl-exposure-kills]]
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [2]]
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [3]]
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [4]]
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [5]]
#[http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse [6]]
#[http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse [7]]
#[http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse [8]]
#[https://www.justice.gov/usao/file/895091/download [9]]
#[https://www.statnews.com/2016/09/03/us-china-fentanyl/ [10]]
#[https://www.statnews.com/2016/09/03/us-china-fentanyl/ [11]]
#[https://www.statnews.com/2016/09/03/us-china-fentanyl/ [12]]
#[https://www.dea.gov/divisions/hq/2017/hq011317.shtml [13]]
#[https://www.dea.gov/divisions/hq/2017/hq011317.shtml [14]]
#[https://www.dea.gov/divisions/hq/2017/hq011317.shtml [15]]
#[https://www.dea.gov/divisions/hq/2017/hq011317.shtml [16]]
##
##*
##**
##***
##****
##*****
##******
##*******[http://time.com/5117820/china-opioids-postal-service-drugs/ [17]]
##*******[http://time.com/5117820/china-opioids-postal-service-drugs/ [18]]
</div> </div> </div> </div> </div> </div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Reduce Non-Medical Access to Prescription Drugs

2020-04-07T22:03:05Z

Dmt7109:

Expand Prescription Drug Take-back & Disposal Program

2020-04-07T22:01:26Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">
''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

= Background =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<sup class="reference">[2]</sup>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but were used by others who were not prescribed those drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<sup class="reference">[1]</sup> Throwing drugs in the garbage also is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however medications flushed into the waste stream can end up in water supplies.<sup class="reference">[3]</sup>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]
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== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<sup class="reference">[5]</sup> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Others experts strongly recommend <u>'''not'''</u> flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around. <br/>  
</div>
= Special Populations =

== Senior Citizens ==

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reachng people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

 

== Nursing Homes ==

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<sup class="reference">[6]   </sup>

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

== Hospice Programs or Funeral Home Programs ==

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<sup class="reference">[7]</sup>

Funeral Homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes)

= Take-back Events =

== DEA National Drug Take-Back Day Initiative ==

<span style="background-color: #ffffff">The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days and they continue to collect more and more drugs each time. <sup class="reference">[8]</sup><br/> <br/> <span style="background-color: #ffffff">'''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''</span></span>

*<span style="background-color: #ffffff">Over 4,200 law enforcement and community partners and 5,500 sites across the country.</span>
*<span style="background-color: #ffffff">Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.</span>
*<span style="background-color: #ffffff">The last National Take-back Day collected more than 900,386 pounds (450 tons).</span>

<span style="background-color: #ffffff"><span style="background-color: #ffffff">To promote your local Rx Take Back Day, the DEA provides a [https://www.dea.gov/take-back/takeback-day_2016_oct.html partnership toolkit] featuring promotional materials for associated partners.<sup class="reference">[9]</sup><br/> <br/> <span style="background-color: #ffffff">'''<span style="font-size: 15.6px">See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.</span>'''</span></span></span>

== <span style="background-color: #ffffff"><span style="background-color: #ffffff">State Level Drug Take Back Programs</span></span> ==

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">See below for inspiration and ideas to replicate from current state efforts:</span></span></span>

*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.in.gov/bitterpill/ Indiana]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.artakeback.org/index.html Arkansas]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.takebackyourmeds.org/ Washington]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://stoprxabuseinga.org/ Georgia]</span></span>

= <span style="background-color: #ffffff"><span style="background-color: #ffffff">Local Disposal Drop Boxes</span></span> =
<div class="mw-parser-output">
== <span style="background-color: #ffffff"><span style="background-color: #ffffff">Finding Disposal Locations</span></span> ==

=== <span style="background-color: #ffffff"><span style="background-color: #ffffff">Medication Disposal Locators</span></span> ===

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Use the following links to find drug disposal locations</span></span></span>

*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<sup class="reference">[10]</sup></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://rxdrugdropbox.org/ Rx Drop Box]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://disposemymeds.org/ Dispose My Meds]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]</span></span>
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== <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Increasing the Number of Drug Drop-Boxes in your Community</span></span></span> ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

Ths [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back] , created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.</span></span></span>
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<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">With the help of the of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities to be safer, and reduce the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley<sup class="reference">[11]</sup> , they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.</span></span></span>
</div>
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">In-Home Disposal</span></span></span> =

== <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Medication Mail-back Envelopes</span></span></span></span> ==

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Stericycle Prescription Drug Seal&Send Pouches</span></span></span></span>'''

Stericyle provides an option for unsed prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Learn more at: </span></span></span></span>[https://www.stericycleenvironmental.com/service/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/service/pharmaceutical-takeback/]

 

== In-home disposal pouches & powders ==

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Deterra Drug Disposal System </span></span></span></span>'''

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Minneapolis based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs.</span><br/> <br/> <span style="background-color: #ffffff">Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches and liquids, allowing them to be adsorbed by the carbon, rendering them inert and non-retrievable.</span><br/> <br/> <span style="background-color: #ffffff">For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]</span></span></span></span></span><br/>  

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Current Efforts to Promote In-Home Disposal</span></span></span></span>'''
<div class="objectEmbed"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Case Studies</span></span></span></span></div>
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.</span></span></span></span></span>
<div class="objectEmbed"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties[5]</span></span></span></span></span></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network.</span><br/> <span style="background-color: #ffffff">[http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study]</span></span></span></span></span> These pouches render opioids ineffective for misuse and safe for disposal and the environment, are another cost-efficient way to safely dispose of opioids.

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Benefits</span></span></span></span>'''

*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Inexpensive - Costs $7 per pouch</span></span></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from station and dispose of them at home and save any potential embarrassment</span></span></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage</span></span></span></span>

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">DisposeRx</span></span></span></span>'''

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.</span></span></span></span></span>

*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])</span></span></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Packets can attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)</span></span></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Well-suited to campaigns with community partners (like clinics, churches, barbershops or hair salons) to increase distribution to diverse populations.</span></span></span></span>

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.</span></span></span></span></span>

 
</div>
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Funding for Drug Takeback & Disposal</span></span></span></span> =

== <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Legislation & Drug Companies</span></span></span></span></span> ==

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Currently several West Coast counties, the city of San Francisco and the state of Massachusetts have issued legislature that require drug companies to fund drug take-back programs.<sup class="reference">[13]</sup> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <sup class="reference">[14]</sup> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <sup class="reference">[15]</sup><br/> <br/> <span style="background-color: #ffffff">The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties.</span><br/> <br/> <span style="background-color: #ffffff">In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<sup class="reference">[16]</sup></span></span></span></span></span></span>

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state passing such a bill.<sup class="reference">[4]  </sup>[http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Tools & Resources</span></span></span></span></span></span> =

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]</span></span></span></span></span></span></span>
<div class="mw-parser-output">
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Actions to Take</span></span></span></span></span></span></span> =

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link:<br/> <span style="background-color: #ffffff">[[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]</span></span></span></span></span></span></span>

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Potential Actions for Individuals</span></span></span></span></span></span></span>]]
</div>
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span></span><br/> <span style="background-color: #ffffff"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></span></span></span></span></span></span></span>

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| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Reviewer'''</span></span></span></span></span></span>
| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Date'''</span></span></span></span></span></span>
| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Comments'''</span></span></span></span></span></span>
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= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Sources</span></span></span></span></span></span> =

 

----

 

#[http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm [1]]</span></span></span></span></span></span>
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [2]]</span></span></span></span></span></span>
#[http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/ http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts [3]]</span></span></span></span></span></span>
#<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://disposerx.com/dl/Kentucky_Press_3-15_final.pdf [4]]</span></span></span></span></span></span>
#[https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm [5]]</span></span></span></span></span></span>
#[http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.XXVl6ehKhPZ http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.XXVl6ehKhPZ] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.WmEKDd-nGUk [6]]</span></span></span></span></span></span>
#[https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://www.dea.gov/divisions/hq/2017/hq050817a.shtml [7]</span></span></span></span></span>
#[https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://www.dea.gov/divisions/hq/2015/hq100115.shtml [8]]</span></span></span></span>
#[https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm [9]]</span></span></span></span>
#[https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html]  <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://focus.mnsun.com/2013/02/19/drop-off-prescription-drugs-anonymously-at-fridley-pd/ [10]]</span></span></span>
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] <span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [11]]</span></span>
#[https://fortune.com/2016/04/30/big-pharma-drug-take-back/ https://fortune.com/2016/04/30/big-pharma-drug-take-back/] <span style="background-color: #ffffff">[http://fortune.com/2016/04/30/big-pharma-drug-take-back/ [12]]</span>
#[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/] <span style="background-color: #ffffff">[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/?utm_term=.e9ccd1f56650 [13]]</span>
#[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/]<span style="background-color: #ffffff">[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/?utm_term=.e9ccd1f56650 [14]]</span>
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] [http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [15]]
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div>
  </div> </div> </div> </div> </div> </div> </div> </div>
</div>
[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Reduce the Diversion of Prescription Drugs

2020-04-07T21:59:24Z

Dmt7109:

Reduce the Diversion of Prescription Drugs

2020-04-07T21:47:07Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">
Return to [[Opioid_Top-Level_Strategy_Map|Top-Level Strategy Map]]     or    Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Zoom Map - Reduce Diversion of Prescription Drugs]]

Most misuse of prescription drugs is not being done by the peopte who were prescribed the drugs by the doctors.  Therefore a core strategy for responding to the opioid crisis must include multiple ways to reduce the diversion of prescription drugs to people who are misusing them.  The details for the strategies to address this are in the supporting objectives rather than at this objective. 

= Background =

== Statistics on Diversion ==

Add statistics here

== Main Pathways for Prescription Drug Diversion ==

Major ways that prescription drugs are diverted to uses other than the intended use of the prescription include: 

*People giving pills to a friend or relative
*People stealing pills (from friends/relatives or strangers)
*People buying pills from someone who was prescribed the pills or from someone who stole them.
*People stealing pills from a pharmacy or healthcare provider

 

= Tools and Resources =

Details for Tools and Resources are on the more detailed objectives on Zoom Strategy Map for this topic.

 

= Sources =
</div> </div> </div> </div> </div>

Expand Community Service Alternatives to Incarceration

2020-04-06T18:56:47Z

Dmt7109:

<div class="mw-parser-output">Return to [[ZOOM_MAP_-_Prioritize_SUD_Treatment_Over_Incarceration|Zoom Map - Prioritize SUD Treatment Over Incarceration]]
----

When people are breaking laws, get arrested and convicted of a crime, having their punishment be in the form of community service can be an alternative to incarceration.  This can be less damaging to their lives moving forward than incarceration.   

= Background =

<font style="background-color:#ffffff">Alternative to incarceration is any punishment given to an individual who commits a crime that is served by means outside of confinement in a jail or prison. Alternatives to incarceration have proved to be less expensive than incarceration. Additionally, alternatives can repair harms suffered by victims, provide benefits to the community, treat individuals struggling with SUD, mental illness, or a coexistence of both; and rehabilitate offenders. It is important that before we can maximize the benefits of alternatives to incarceration, however, we must repeal mandatory minimums and give courts the power to use cost-effective, recidivism-reducing sentencing options instead. <ref name="https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf" /></font>

= Pros of Alternatives to Incarceration =

<u>'''<font style="background-color:#ffffff">Give Courts More Sentencing Options</font>'''</u>

<font style="background-color:#ffffff">Each offender and crime is unique, and prison or jail time may not always be the most effective response. If courts have options other than incarceration, they can better tailor a cost-effective sentence that fits the offender and the crime, protects the public, and provides rehabilitation.<ref name="https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf" /></font>

<br/> <font style="background-color:#ffffff"><u>'''Save Taxpayer Money'''</u></font>

<font style="background-color:#ffffff">It costs over $28,000 to keep one person in federal prison for one year (some states’ prison costs are much higher).  Alternatives to incarceration are cheaper, help prevent prison and jail overcrowding, and save taxpayers millions.</font><ref name="https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf" /><br/>  

<u>'''S'''</u><font style="background-color:#ffffff"><u>'''trengthen Families and Communities'''</u></font>

<font style="background-color:#ffffff">Prison or jail time separates the offender from his or her spouse and children, sometimes for decades at a time. Alternatives to incarceration keep people with their families, in their neighborhoods and jobs, and allow them to earn money, pay taxes, and contribute to their communities.</font><ref name="https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf" /><br/>  

'''<u>P</u>'''<font style="background-color:#ffffff">'''<u>rotect the Public by Reducing Crime</u>''' </font>

<font style="background-color:#ffffff">Over 40% of all people leaving prison will reoffend and be back in prison within three years of their release. Alternatives to prison such as drug and mental health courts are proven to confront the underlying causes of crime (i.e., drug addiction and mental illness) and help prevent offenders from committing new crimes.</font><ref name="https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf" /><br/>  

<font style="background-color:#ffffff"><u>'''The Public Supports Alternatives to Incarceration'''</u> </font>

<font style="background-color:#ffffff">Over ~75% of adults believe that alternatives to incarceration (probation, restitution, community service, and/or rehabilitative services) are the most appropriate sentence for nonviolent, non-serious offenders and that prison or jail are appropriate only if these alternatives fail.</font><ref name="https://famm.org/wp-content/uploads/FS-Alternatives-in-a-Nutshell.pdf" />

= Incarceration Alternatives =

<font style="background-color:#ffffff">Some argue that alternative to incarceration is a lesser sentence without impact. But studies have shown that the vast majority of survivors also prefer investments in education, mental health treatment, drug treatment, and job training to more spending on prisons and jails.<ref name="https://www.nidirect.gov.uk/articles/non-custodial-sentences" /></font>

== <font style="background-color:#ffffff">Various Alternative Sentences as Alternative to Incarceration</font> ==

<u>'''<font style="background-color:#ffffff">Monetary Fine</font>'''</u>

*<font style="background-color:#ffffff">A fine is the most common form of punishment given by the courts. The offender must pay a fixed sum of money. If they don't pay, they could get a prison sentence.</font>

<u>'''<font style="background-color:#ffffff">Probation Order</font>'''</u>

*W<font style="background-color:#ffffff">hen an offender is supervised by a probation officer in the community for a certain time.Sometimes the court will apply additional requirements to the probation order, including:</font>
**<font style="background-color:#ffffff">Mandatory attendance of a alcohol or drug rehabilitation center</font>
**<font style="background-color:#ffffff">Mandatory attendance of a day center</font>
**<font style="background-color:#ffffff">Mandatory attendance of any other medical treatment or counselling</font>

<u>'''<font style="background-color:#ffffff">Community Service Order</font>'''</u>

*<font style="background-color:#ffffff">When an offender gets a community service order, they must do unpaid work in the community for a derration that is decided in the discretion of the judge</font>
*<font style="background-color:#ffffff">They must work the hours as instructed. If they don't do the work, they will be returned to court, where they could receive a fine or any other sentence</font>
*<font style="background-color:#ffffff">This can be utilized in combination with a probation order</font>

<u>'''<font style="background-color:#ffffff">Conditional or Absolute Discharge</font>'''</u>

= Tools & Resources =

[[TR_-_Expand_Community_Service_Alternatives_to_Incarceration|TR - Expand Community Service Alternatives to Incarceration]]

<br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

 
</div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Enhance Treatment and Recovery Support During Incarceration

2020-04-06T18:39:28Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|Zoom Map - (Shift from Punishment to Treatment Approach for Opioid Users)]]<br/>  

= Overview =

<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Research has shown that a vast amount of the inmate population, on both the state and federal level, suffer from substance use disorder, a psychological disorder, or a combination of the two. Studies have shown that proper treatment during incarceration that is followed through to post release, significantly lowers their risk for relapse, criminality, inmate misconduct, and recidivism.</font></span>

 

= Prison Treatment Programs =

The Criminal Justice System has supported treatment during incarceration by offering <span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">psychotherapy sessions, religious ministry meetings and 12-step programs such as Alcoholics Anonymous to inmates with substance use problems. <ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" /></font></span>

While there is significant need for more availability, federal prisons offer a number of programs designed to assist inmates in overcominig a substance use disorder such as:

*'''<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Drug Abuse Education</font></span>'''
**E<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">ntails a series of classes that educate inmates on substance use disorder and the effects it has on your body and mind <ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" /></font></span>
*'''<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Nonresidential Drug Abuse Treatment</font></span>'''
**A<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">12 week CBT (cognitive-behavioral therapy) program that is organized in group sessions</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">This program addresses criminal lifestyles while also giving inmates the opportunity to increase skills in the areas of rational thinking, communication, and institution to community adjustment</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Inmates that are enrolled in this program normally have short sentences, do not meet the Residential Drug Abuse Program, are waiting to be enrolled in RDAP, are in transition back into the community or have a positive urinalysis test </font></span><ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" />
*'''<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Residential Drug Abuse Program (RDAP)</font></span>'''
**T<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">he most intensive program that the Bureau provides</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Inmates in this program live in their own separate community from the rest of the population. Inmates take part in daily half-day programming and half-day of work, school, or vocational activities; this program is normally nine months in length</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Research shows inmates that take part in RDAP are less likely to recidivate and relapse to drug use by significant amounts compared to those inmates who do not take part in RDAP </font></span><ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" />
*'''<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Community Treatment Services (CTS)</font></span>'''
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Provides continued care to inmates who have been released and put into Residential Reentry Centers or on Home Confinement</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Evidence shows that the period after being released is the most vulnerable time for inmates to relapse back to drug use or criminal activity; continued treatment after release is vital to the success of the offender completing their treatment </font></span><ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" />

= Benefits of Successful Prison Treatment Programs =
<div><span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Well-designed prison treatment programs reduce relapse, criminality, inmate misconduct and recidivism — the likelihood that a convicted criminal will reoffend. They also increase levels of education, mend relationships, boost employment opportunities upon release and improve overall health. <ref name="https://doi.org/10.1007/s11920-013-0414-z" /></font></span></div> <div> </div> <div><span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Research shows that residential prison treatment is cost-effective if prisoners continue treatment after their release. The cost of treatment pales in comparison to the cost of incarceration. Rehab helps prisoners overcome drug use and reduces the economic burden of recidivism. </font></span><ref name="https://doi.org/10.1007/s11920-013-0414-z" /></div>
= Issues Affecting the Availability of Effective Treatment =

== Overcrowding of Jails and Prisons ==

O<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">vercrowding of jails and prisons is a leading factor as to why inmates with drug dependency problems are not enrolled in these programs. The overcrowding of jails leads to an increase in the length of the waiting lists to enter drug treatment programs. In addition to overcrowding, staff shortages and limited resources are part of the issue of low enrollment in drug treatment programs.<ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" /></font></span>

== Need for Trauma-Informed Care ==

<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Incarcerated prisoners are marked by considerable diversity, yet they share a common experience of incarceration. Prisons can be violent, harsh, psychologically damaging environments; incarcerated people live in an environment that is both depersonalizing and dehumanizing. Moreover, the social stigma associated with incarceration, combined with the depersonalizing effects of imprisonment, may result in a sense of hopelessness and powerlessness, as well as deeply internalized shame and guilt. Thus, in addition to treating substance abuse and other mental disorders, the consensus panel recommends that in-prison treatment also address the trauma of the incarceration itself as well as a prison culture that conflicts with treatment goals.<ref name="https://www.ncbi.nlm.nih.gov/books/NBK64123/" /></font></span>

 

= Training =

Residential Substance Abuse Training RSAT training and technical assistance tool

= Tools & Resources =

[[TR_-_Enhance_Treatment_During_Incarceration|TR - Enhance Treatment During Incarceration]]

<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =
</div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Enhance Treatment and Recovery Support During Incarceration

2020-04-06T18:38:28Z

Dmt7109:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|Zoom Map - (Shift from Punishment to Treatment Approach for Opioid Users)]]<br/>  

= Overview =

<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Research has shown that a vast amount of the inmate population, on both the state and federal level, suffer from substance use disorder, a psychological disorder, or a combination of the two. Studies have shown that proper treatment during incarceration that is followed through to post release, significantly lowers their risk for relapse, criminality, inmate misconduct, and recidivism.</font></span>

 

= Prison Treatment Programs =

The Criminal Justice System has supported treatment during incarceration by offering <span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">psychotherapy sessions, religious ministry meetings and 12-step programs such as Alcoholics Anonymous to inmates with substance use problems. <ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" /></font></span>

While there is significant need for more availability, federal prisons offer a number of programs designed to assist inmates in overcominig a substance use disorder such as:

*'''<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Drug Abuse Education</font></span>'''
**E<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">ntails a series of classes that educate inmates on substance use disorder and the effects it has on your body and mind <ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" /></font></span>
*'''<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Nonresidential Drug Abuse Treatment</font></span>'''
**A<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">12 week CBT (cognitive-behavioral therapy) program that is organized in group sessions</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">This program addresses criminal lifestyles while also giving inmates the opportunity to increase skills in the areas of rational thinking, communication, and institution to community adjustment</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Inmates that are enrolled in this program normally have short sentences, do not meet the Residential Drug Abuse Program, are waiting to be enrolled in RDAP, are in transition back into the community or have a positive urinalysis test </font></span><ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" />
*'''<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Residential Drug Abuse Program (RDAP)</font></span>'''
**T<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">he most intensive program that the Bureau provides</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Inmates in this program live in their own separate community from the rest of the population. Inmates take part in daily half-day programming and half-day of work, school, or vocational activities; this program is normally nine months in length</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Research shows inmates that take part in RDAP are less likely to recidivate and relapse to drug use by significant amounts compared to those inmates who do not take part in RDAP </font></span><ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" />
*'''<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Community Treatment Services (CTS)</font></span>'''
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Provides continued care to inmates who have been released and put into Residential Reentry Centers or on Home Confinement</font></span>
**<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Evidence shows that the period after being released is the most vulnerable time for inmates to relapse back to drug use or criminal activity; continued treatment after release is vital to the success of the offender completing their treatment </font></span><ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" />

= Benefits of Successful Prison Treatment Programs =
<div><span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Well-designed prison treatment programs reduce relapse, criminality, inmate misconduct and recidivism — the likelihood that a convicted criminal will reoffend. They also increase levels of education, mend relationships, boost employment opportunities upon release and improve overall health. <ref name="https://doi.org/10.1007/s11920-013-0414-z" /></font></span></div> <div> </div> <div><span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Research shows that residential prison treatment is cost-effective if prisoners continue treatment after their release. The cost of treatment pales in comparison to the cost of incarceration. Rehab helps prisoners overcome drug use and reduces the economic burden of recidivism. </font></span><ref name="https://doi.org/10.1007/s11920-013-0414-z" /></div>
= Issues Affecting the Availability of Effective Treatment =

== Overcrowding of Jails and Prisons ==

O<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">vercrowding of jails and prisons is a leading factor as to why inmates with drug dependency problems are not enrolled in these programs. The overcrowding of jails leads to an increase in the length of the waiting lists to enter drug treatment programs. In addition to overcrowding, staff shortages and limited resources are part of the issue of low enrollment in drug treatment programs.<ref name="https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/" /></font></span>

== Need for Trauma-Informed Care ==

<span style="font-size:small;"><font style="background-color: rgb(255, 255, 255);">Incarcerated prisoners are marked by considerable diversity, yet they share a common experience of incarceration. Prisons can be violent, harsh, psychologically damaging environments; incarcerated people live in an environment that is both depersonalizing and dehumanizing. Moreover, the social stigma associated with incarceration, combined with the depersonalizing effects of imprisonment, may result in a sense of hopelessness and powerlessness, as well as deeply internalized shame and guilt. Thus, in addition to treating substance abuse and other mental disorders, the consensus panel recommends that in-prison treatment also address the trauma of the incarceration itself as well as a prison culture that conflicts with treatment goals.<ref name="https://www.ncbi.nlm.nih.gov/books/NBK64123/" /></font></span>

 

= Training =

Residential Substance Abuse Training RSAT training and technical assistance tool

= Tools & Resources =

[[TR_-_Enhance_Treatment_During_Incarceration|TR - Enhance Treatment During Incarceration]]

<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

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= Sources =
</div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]