The Overdose Epidemic in RI: The Scope of the Crisis and the State’s Response Tom Coderre, Senior Advisor, Governor’s Office Rhode Island Quality Institute TCPi Learning Series, September 20, 2018

Rhode Island’s Overdose Epidemic DRAFT: NOT FOR DISTRIBUTION Rhode Island’s Overdose Epidemic Year Overdose deaths Fentanyl-related overdose deaths 2011 94 7 2012 183 Fewer than 5 (2% of total) 2013 232 26 2014 240 84 2015 290 136 2016 336 195 2017 323 205 (63% of total) Between 2017 and 2016, Rhode Island has seen a roughly 4% decrease in overdose deaths, though we saw an increase in the number of fentanyl-related overdose deaths during this time.

Impact of the Overdose Crisis on Economy & Business The crisis has had a huge impact on the economy and Rhode Island businesses. Total cost on RI economy is hard to determine, but here are estimates: Employers spent $2.6 billion in 2016 alone on opioid treatment. Annual treatment costs to the state government are about $90 million in RI, though total could be much higher. (Boston Fed, 2018) Crisis has cost the US economy over $1 trillion since 2001, and could cost another $500 billion between 2018-21. (Altarum, 2018)

Impact of the Overdose Crisis on Economy & Business Source: Altarum Institute, 2018

DRAFT: NOT FOR DISTRIBUTION Overdose Task Force In 2015, Governor Raimondo convened an Overdose Prevention and Intervention Task Force in response to Rhode Island’s overdose crisis. The Task Force developed an Overdose Action Plan focusing on: Prevention, Rescue, Treatment, and Recovery. Initial efforts focused on infrastructure building. The Task Force is now in an implementation phase.

DRAFT: NOT FOR DISTRIBUTION Overdose Task Force Sample of representation: State & Local Governments The RI General Assembly Insurers Health Equity Zones Pharmacists Law enforcement Prevention community Treatment Providers Healthcare providers Recovery community Educators Academics and researchers EMS personnel Healthcare facility administrators Family members of people who are struggling or have passed

DRAFT: NOT FOR DISTRIBUTION Prevention Strategy The best way to avoid the costly consequences of opioid misuse and addiction is to invest in effective prevention and early intervention to reduce its incidence. Major initiatives: Instituting limitations on most initial opioid prescriptions for acute Pain. Developing Levels of Care for Treating Overdose and Opioid Use Disorder in Hospitals and Emergency Departments. Primary Prevention, community based & TRUTH Initiative

DRAFT: NOT FOR DISTRIBUTION Rescue Strategy A sustainable source of naloxone for community and first responder distribution is key, as well as broad coverage of naloxone among patients at high risk of overdose. Major initiatives: Expanding access to naloxone throughout Rhode Island. Targeting naloxone to individuals who are at highest risk (as well as their family and friends).

DRAFT: NOT FOR DISTRIBUTION Treatment Strategy The combination of psychological/behavioral therapy and FDA- approved medications (i.e., methadone, buprenorphine, naltrexone) is the most effective means of treating opioid use disorders and preventing opioid overdose. Major initiatives: Launching Centers of Excellence. Providing medication-assisted treatment at the Department of Corrections. Expanding access to medication-assisted treatment throughout Rhode Island.

DRAFT: NOT FOR DISTRIBUTION Recovery Strategy Recovery support services play an important role in any management of chronic disease. Recovery housing, recovery-friendly employment, transportation, GED/life skills classes, mutual aid meetings, and recovery community centers are crucial to building recovery capital. Major initiatives: Training peer recovery specialists and placing them in strategic areas around the state (Emergency Depts, AnchorMore, etc.) Launching an “Addiction is a Disease, Recovery is Possible” media campaign.

DRAFT: NOT FOR DISTRIBUTION Treatment & Recovery Providence Safe Stations Available 24 hours a day, seven days a week, you can visit any of Providence’s 12 fire stations, speak with the trained staff on duty, and immediately get connected to treatment support and services. (401) 942-STOP (7867) Rhode Island’s 24/7 Hope & Recovery hotline with English and Spanish-speaking counselors licensed in chemical dependency. PreventOverdoseRI.org A public dashboard offering resources for people who may be at risk of overdose, healthcare professionals who would like to learn more about treating addiction, as well as concerned family members and friends.

The Task Force’s 2018 Theme “Communities Coming Together” This theme will help us: Equip Rhode Island’s diverse communities to draw upon their resources to enhance prevention efforts; Challenge community members to reach out to families and neighbors affected by the opioid crisis helping them save lives; Engage first responders and providers to screen for substance use disorder and connect patients to treatment; and Support recovery and build individual capital through a trauma- informed, strength-based approach.

Looking ahead… RNP / BH Link / crisis services Governor’s Executive Order Harm Reduction Workgroup Focus on Prevention: TRUTH Initiative Recovery housing grants / coaching waiver Opioid manufacturer / distributor lawsuits NGA-NAS learning lab (paired with Ohio) Recovery Friendly Workplaces, job training HOPE Initiative / engaging Law Enforcement

Contact information Tom Coderre, Senior Advisor Office of Governor Gina Raimondo Tom.Coderre@governor.ri.gov 401-222-2367 Thank You!