SUBSTANCE USE IN MONTANA - Overview: Scope of the Problem and Current State Actions - Montana Healthcare ...
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SUD SUMMIT | NOVEMBER 7TH, 2017
SUBSTANCE USE IN MONTANA
Overview: Scope of the Problem and Current State Actions
presented by :
KATIE LOVELAND MPH, MSW
Loveland Consulting LLC
Reference Documents STATE PERSPECTIVES
Reference Documents NATIONAL PERSEPCTIVE
What we do (and do not) know
about addiction in Montana
9
Substance Use Disorders are common in our state
66,500
dependent on or
abusing alcohol
Adults 18+
18,000
dependent on or
abusing illicit drugs
Source: National Survey on Drug Use and Health, 2012-2014One in ten Montana adults is dependent on or abusing alcohol or illicit drugs. Source: National Survey on Drug Use and Health, 2012-2014
One in four young adults used illicit drugs in the last month Source: National Survey on Drug Use and Health, 2012-2014
Alcohol misuse and abuse is the most common SUD
CURRENT USE
Montana’s rates 58%
of alcohol use, 54%
binge drinking, BINGE DRINKING
and heavy 20%
drinking are all 16%
higher than CHRONIC DRINKING
those in the US 8%
6%
Source: Behavioral Risk Factor Surveillance System 2015One in three 61% of students
high school who report
students reports drinking also
alcohol use in engage in binge
drinking
the last month behavior.
Source: Youth Risk Behavior Survey, 2015Percent of traffic fatalities
that are alcohol related Alcohol is a key
34%
driver of
29%
Montana’s
traffic fatality
rate which is
almost twice
that of the US
Source: National Highway Traffic Safety AdministrationMore than 13% of all deaths among individuals aged 20-64 in Montana are due to excessive drinking.
Marijuana is the most commonly used illicit drug.
One in five
high school
students used
marijuana in
the last month.
Source: Youth Risk Behavior Survey, 2015The number
for young
adults is one
in four.
Source: National Survey of Drug Use and Health, 2012-201410 Year Trends in Substance Use
YOUTH ADULTS
All other
Marijuana illicit drugs, alcohol All other
Marijuana illicit drugs
and cigarettes
Source: YRBS 2007-2017, National Survey on Drug Use and Health, 2012-20141748 of 2539 violations
Marijuana Year 2015
constitutes 69%
the majority
of criminal
57%
drug
violations in Year 2005
Montana
2256 of 3959 violationsOpioids are the most deadly illicit drug used in Montana.
Montana has
70 opioid
prescriptions
for every
100
residents
Source: Centers for Disease Control and Prevention. US State Prescribing Rates, 2016.138
people
died from
drug
overdose
More than half died of in
opioid overdose. Montana
in 2015.
Source: Montana DPHHS Vital Statistics.Unlike national trends, Montana’s death rate for opioid
overdose has trended down in the past few years
Peak in 2008-2009
7.7
Age-adjusted death
rate per 100,000
5.2 6.2 5.3
4.1 4.2
3.2
1.4
Source: Montana DPHHS Vital Statistics.Montana’s justice system is increasingly driven by substance use-related crimes.
Total Annual Drug Offenses, 1980-2018
8110
559%
5425
6119
5011
increase
3633
from
1980 to
917
1163
1414
2015
1980 1985 1990 1995 2000 2005 2010 2015
216
Source: Montana Board of Crime Control101% Felony and misdeameanor arrest for
increase drug offenses, 2009-2015
in
felony 1245
1419
1717
1834
drug 911 1045 1046
arrests 2534 2483 2398
2929 3137 3503 3735
from 2009 2010 2011 2012 2013 2014 2015
2009- Misdemeanor drug arrests Felony drug arrests
2015 Source: Justice Reinvestment Project, Montana Department of Justice dataTop 5 Adult Felony Conviction Offenses
Possession of drugs Possession of drugs
Criminal endangerment Criminal endangerment
Felony DUI Theft
Theft Distribution
of drugs
Burglary Felony DUI
Source: Montana Department of Corrections, 2012-2016A justice 98% Probation
and
system Parole
driven by 189%
Violations
SUD Failures
to appear
related
crimes 109% Bail & from
experiences bond
revocations
2009-
more 2015
Source: Justice Reinvestment. 2009-2015SUD cases are overloading
Montana’s justice system
PRISONS PUBLIC
DEFENDER CASES
At capacity-female
population has grown Criminal case duration has
30% since 2012 increased to 1.5 years
JAILS COURTS
67% increase in MT’s jail District court case filings have
population from 2011-2013 increased 21% since 2009
Source: Justice Reinvestment, Department of Corrections, Office of the Court Administrator and Office of the Public DefenderMethamphetamine is a key driver of justice system involvement and is trending sharply up.
METHAMPHETAMINE AND HEROIN VIOLATIONS
1200
427% increase
in meth 1243
violations and
900
1557% increase
in heroin
violations from
600
2010-2015
561
300
236 116
4 7
0
2005 2010 2015
Methamphetamine Heroin
214
Source: Montana Board of Crime ControlDIVISION OF CRIMINAL INVESTIGATION CASES
250
219 232
200
54% of
150 143 151 all cases
103 involve
100 meth
68
50
0
2010 2011 2012 2013 2014 2015
Marijuana Methamphetamine Drug Diversion (pills) Cocaine Heroin Ectasy
Source: Montana Department of Justice, DCI administrative dataSUDs are also a key contributor to child welfare concerns in our state.
THE MAJORITY OF CHILD AND FAMILY SERVICES
PLACEMENTS HAVE SUD INDICATED
Substance use not indicated
BUYER 01 BUYER 01
35%
65%
BUYER 01 BUYER 01
Substance indicated
Source: DPHHS Child and Family Services Administrative Data, April 2016THE MOST COMMON SUBSTANCE INDICATED IN CFSD
PLACEMENTS IS METHAMPHETAMINE
Prescription drugs
BUYER 01
or unknown BUYER 01
20%
46%
Marijuana 17%
Methamphetamine
BUYER 01 BUYER 01
18%
Alcohol
Source: DPHHS Child and Family Services Administrative Data, April 2016CFSD District Court Filings are up sharply
2500
130% 2321
increase
from
2000
2009-2015
1500
1006
1000
Source: Office of the Court AdministratorSUD treatment and payment systems are undergoing a massive shift nationally and in Montana.
Shift in Understanding of SUD
“Addiction is a
“Addiction is a chronic,
moral failure” relapsing brain
disease”MAJOR SHIFTS IN SUD TREATMENT
Treatment not covered by
Coverage mandated
insurance, funded by federal
Medicaid expansion
block grants + state dollars
Treatment limited to SUD Routine screening, treatment in
providers team-based primary care settings
Chronic disease management
Abstinence model including medication assisted
treatment
Building a continuum of care,
Focus on inpatient beds emphasis on community-based
treatment
Informal recovery support Professional peer support and
recoveryMontana’s Model Historically: New Model
SUD treatment provided by 33 state
approved providers
More state approved
( Max=1 per county) providers
INTEGRATING
SUD treatment being
AND integrated into
EXPANDING primary care,
CARE hospitals and
mental health-
shifting focus to
community based
careCovered comprehensive SUD treatment for
expansion adults
90%+ of cost covered by federal dollars
Medicaid
Expansion Practices can now be reimbursed for SUD care for
adults who qualify for Medicaid-not capitated
Allowed Montana to re-allocate federal block grant
dollars traditionally used to treatment in new waysRemaining Challenges: Access
Most current
Only 7% of Only 6% of state providers don’t
Montanans with approved treat co-occurring
an SUD are providers care for mental illness or
receiving pregnant women medical illnesses
treatment and children that can interfere
with recovery
Source: Manatt Health, 2017SUD Patients receiving Medicaid
Assisted Treatment in Outpatient Care
Remaining 50%
Only 16
physicians in
Montana are
challenges: certified to
prescribe
MAT 25% buprenorphine
56
27%
access 1
8%
23
6
0
Source: Manatt Health, 2017To learn more
LIVED EXPERIENCE OF SUBTANCE USER IN MT
ACCESS TO
NOT OFTEN PRESENT TREATMENT IS
IN THE OFFICIAL LIMITED, ESPECIALLY
SYSTEM IN RURAL AREAS
90% of those with SUD
not receiving treatment.
PRIMARY ENTRY INTO
TREATMENT IS
THROUGH THE
JUSTICE SYSTEM
TRAUMA HISTORY,
EARLY ONSET OF
SUBSTANCE USE SUD IS ONE CONCERN
OF MANY HEALTH
AND FINANCIAL
WORRIESTo learn
more
See maps in the Substance Use in Montana ReportWHAT INDIVIDUALS WITH LIVED SUD
EXPERIENCE IN MONTANA WANT YOU TO KNOW
“ Talk to more addicts and people in recovery.
Understand our perspective.
Addiction is a disease, not just bad choices.
We face a lot of stigma.
“
Accessing treatment, housing and jobs is a challenge.
Source: Focus group themes, Montana Healthcare Foundation, June 2017WHAT INDIVIDUALS WITH LIVED SUD
EXPERIENCE IN MONTANA WANT YOU TO KNOW
“ We want to be treated with compassion but the
system is based on punishment and fear.
We worry that our criminal history will define us forever.
“
We need to make it easier for children and parents to get help.
Caring professionals make a big difference.
Source: Focus group themes, Montana Healthcare Foundation, June 2017Health and justice partners in Montana are working together in new ways to address SUD.
INNOVATIONS IN SUD IN MONTANA
DRUG MAT HUB
TREAMENT AND SPOKE
COURTS MODEL
24/7 PROGRAM
JUSTICE MORE STATE
AND OTHER
REINVESTMENT APPROVED
MONITORING
PROVIDERS
INITIATIVESTo learn
more
Stay tuned for today’s speakers &
learn from other summit participantsThank
you
QUESTIONS?
Katie Loveland
406-431-9260
lovelandk@gmail.comYou can also read
