1. Serving our community by improving health The Addiction Crisis November 2014

2. The Disease of Addiction – Primary Chronic Disease of Brain Reward, Motivation, Memory and Related Circuitry. – A neurobiological disease that changes how brain cells organize to process information and mediate behavior.

3. Valley Health Data Overview 5-10x increase in heroin ODs in Valley Health EDs since 2010 3x increase in substance exposed newborns at WMC since 2010 VHS heroin poisoning patients: – 91.1% Caucasian – 75.2 % male – 48.3 % <25 YO

4. Opiate Overdose Deaths NW Virginia * Without the use of NARCAN (A drug used to immediately counteract the effects of Opiates) the death toll would be much higher.

5. Commonly Abused Medications OPIOIDS: Derived from the opium poppy, or synthetic versions of it, and used for pain relief. BENEZODIAZEPINES: Central nervous system depressants used as sedatives, to induce sleep, prevent seizures, and relieve anxiety. AMPHETAMINE LIKE DRUGS: Central nervous system stimulants used to treat Attention Deficit Hyperactivity Disorder (ADHD).

6. Quick Facts Prescription Drug Abuse has always been around: “Grand Daddy Of All Drug Abuse”. Is the Nation’s fastest growing drug problem and has been classified as an epidemic. In 2011, 41,340 unintentional drug overdose deaths occurred in the United States, increase for 12 th consecutive year; one person dies every 12.45 minutes 1. 22,810 (55%) were prescription drug overdose deaths, of which opioid pain relievers were involved in 16,917 deaths (74.165 %) 1. Opioid pain relievers were involved in more overdose deaths than cocaine and heroin combined 1. Enough prescription pain relievers were prescribed in 2012 to provide every American adult with a bottle of pills 1. 6 1 SOURCE: CDC National Center for Health Statistics/National Vital Statistics Report; June 2014 CDC Vital Signs: Opioid Painkiller Prescribing; July 2014

7. Circle of Addiction 7 Hydrocodone (Vicodin®, Lortab,® Lorcet®) Oxycodone (Percocet®, Percodan®, Roxicodone®) OxyContin® OPANA® Zohydro TM ER Heroin

8. Drug Poisoning Deaths Involving Opioid Analgesics, Cocaine, and Heroin: United States, 1999-2011 Note: Not all drug poisoning deaths specify the drug(s) involved, and a death may involve more than one specific substance. The rise in 2005-2006 in opioid deaths is related to non-pharmaceutical fentanyl (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a.htm). *Heroin includes opium. Source: National Center for Heath Statistics/CDC/ National Vital Statistics Report, Final death data for each calendar year (June 2014). % CHANGE 2006-11 + 23% - 37% + 110% Number of Deaths

9. Addiction Select Initiatives Launched a system-wide Emergency Department Pain Treatment Guidelines June 2014 Enhancing our philosophy around pain management Educating our staff and medical staff on best practices Educating our patients and clients on safe medication management CME Dinner “Prescription Drug Abuse Crisis” attended by >200 providers VH Wide monthly Employee Education- Addiction Awareness

10. Addiction Select Initiatives Educational outreach on substance abuse and addiction Successfully partnered to expand/market prescription drug “take back” programs Increased data sharing to support regional grant applications

11. Addiction Select Initiatives Collaborating with community partners to: develop a comprehensive, sustainable and effective addiction treatment model to address this growing public health issue through prevention, education and treatment

12. Serving our community by improving health The Addiction Crisis November, 2014