AppalachiaHIDTAandthe

OverdoseResponseStrategy

January2021

•  AHIDTAPresenters

•  Introduc@ontoAppalachiaHIDTA

•  DrugSeizureTrends

• OverdoseTrends

• OverdoseResponseStrategy(ORS)

• ORSCornerstoneProjects

• Ques@on&AnswerSession

Agenda

AHIDTA Presenters

Edward“Joe”KuehneCurrently serves as the Deputy Manager of theAppalachia HIDTA Inves@ga@ve Support Center(ISC).Inthisrole,Mr.Kuehneisdirectlyresponsiblefordeveloping and publishing the Annual AHIDTADrug Threat Assessment while overseeing thedailyopera@onsofagroupofcriminalintelligenceanalysts who support 47 law enforcement taskforces throughout the four-state AppalachiaHIDTAregion.

GregRobertsCurrentlyservesastheOverdoseResponseStrategy(ORS)CoordinatorandTennesseeDrug IntelligenceOfficer(DIO)forAppalachiaHIDTA.In this roleMr.Roberts gathers, collates, analyzes,and facilitates the sharing of felony drug-relatedarrests and intelligence throughout Tennesseewhile supervising DIOs in Kentucky and WestVirginia.

AHIDTA Presenters

Na2onal HIDTA Program

• HighIntensityDrugTraffickingAreas(HIDTA)

• CreatedbyCongresswiththeAn@-DrugAbuseActof1988

• HIDTAisaprogramwithintheOfficeofNa@onalDrugControlPolicy(ONDCP).

• TheprogramplacesemphasisondrugtraffickingregionsthathaveharmfuleffectsonotherpartsoftheUnitedStates.

Goals of the HIDTA Program

• Disruptthemarketforillegaldrugsbydismantlinganddisrup@ngdrugtraffickingand/ormoneylaunderingorganiza@ons;and

• Improvetheefficiencyandeffec@venessofHIDTAini@a@ves.

Appalachia HIDTA Mission

To enhance and coordinate drug enforcement efforts oflocal, stateand federal lawenforcementagencieswithinareasdesignatedasHigh IntensityDrugTraffickingAreasby pursuing the disrup@on/dismantlement of DrugTraffickingOrganiza@ons, par@cularly as it relates to thespecificdrugthreatoftheAppalachianregion.

Drug Threats to Appalachian Region

• CrystalMethamphetamine(ICE)

• Cocaine

• Heroin

• MarijuanaCul@va@onandBulkMarijuana

• DivertedPharmaceu@cals

• Fentanyl

3-Year Drug Seizure Trends

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18-1 2 3 4 19-1 2 3 4 20-1 2 3

ICESeizuresinKilograms

ICE

2018 – 543 / 2019 – 563 / 2020 - 496 +

3-Year Drug Seizure Trends

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18-1 2 3 4 19-1 2 3 4 20-1 2 3

CocaineSeizuresinKilograms

Cocaine

143KG*174KG**67KG384total

2018 – 85 / 2019 – 473 / 2020 - 213 +

3-Year Drug Seizure Trends

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18-1 2 3 4 19-1 2 3 4 20-1 2 3

HeroinSeizuresinKilograms

Heroin

2018 – 56 / 2019 – 69 / 2020 - 45 +

3-Year Drug Seizure Trends

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18-2 2 3 4 19-1 2 3 4 20-1 2 3

MarijuanaPlantSeizures

MarijuanaPlantCount

2018 – 114,233 / 2019 – 128,338 / 2020 - 155,739 +

3-Year Drug Seizure Trends

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BulkMarijuanaSeizuresinKG

BulkMarijuana

2018 – 2,868 / 2019 – 2,883 / 2020 - 3,512 +

3-Year Drug Seizure Trends

02000400060008000

100001200014000160001800020000

18-1 2 3 4 19-1 2 3 4 20-1 2 3

DivertedPharmaceu@calsSeizuresinDU

Alprazolam Buprenorphine Hydrocodone Oxycodone Gabapen@n

2018 – 50,408 / 2019 – 49,069 / 2020 - 31,052 +

3-Year Drug Seizure Trends

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FentanylSeizuresinKilograms

Fentanyl*ToDatein2020:Over20,500Addi@onalDU

2018 – 16 / 2019 – 27 / 2020 - 33 +

Age-Adjusted Overdose Death Rates per 100,000

Opioid Prescrip2on Rates Per 100,000 Residents

Overdose Death by Type of Opioid

2017

2018

Per100,000people

WV–57.8KY–37.2TN–26.6VA–17.9

Na@onalAverage–21.7

WV–51.5KY–30.9TN–27.5VA–17.1

Na@onalAverage–20.7

•  Asaccesstolegalformsofthedrugbecamemoredifficult,thedemandforopioidscon@nuedtogrowandshimedtoillegalopioids,likeheroin,fentanylandothersynthe@csubstances.

• Whileopioidprescrip@onratesweredecreasingandthenumberofprescrip@onoverdosedeathswerelevelingoff,thenumberofoverdosedeathscausedbyheroinincreasedby211%.

• Whenfentanylandothersynthe@copioidsarrived,thenumberofoverdosedeathstheycausedroseby816%.

•  Synthe@copioidsbecametheleadingcauseofopioidoverdosedeathin2016.

ShiV from Tradi2onal Opioids to Illegal Opioids and Synthe2cs

Source:NACoAnalysisofCentersforDiseaseControlandPreven@on,Na@onalCenterforHealthSta@s@cs,Mul@pleCauseofDeath1999-2017onCDCWONDEROnlineDatabase.

INVESTING IN PARTNERSHIPS TO BUILD SAFE AND HEALTHY COMMUNITIES

Tohelpcommuni@esreducefatalandnon-fataldrugoverdosesbyconnec@ngpublichealthandpublicsafetyagencies,sharinginforma@on,andsuppor@ngevidence-basedinterven@ons.

ORS Mission Statement

TheORSallowsusto…

Collaborate across public health and public safety sectors

Share data, insights, and trends we are seeing related to drug overdose in our communities

Inform and help local communities develop local solutions to reduce overdoses and save lives

Bycrea@ngopportuni@esto…

Weusethatinforma@onto…

Collaborate across public health and public safety sectors

The ORS is implemented by state teams made up of Drug Intelligence Officers and Public Health Analysts, who work together on drug overdose issues within and across sectors and states.

TheORSallowsusto…

The ORS creates joint teams that can simultaneously promote public health and public safety efforts.

Law enforcement, first responders, public health officials, and people who use drugs intersect naturally.

The ORS is designed to increase the positive impact and outcomes of those intersections.

Share data, insights, and trends we are seeing related to drug overdose in our communities

TheORScreatesopportuni@esto…

By sharing information across sectors, the ORS is growing the body of evidence related to early warning signs and prevention strategies.

Drug Intelligence Officers have a finger on the pulse of emerging trends and threats.

Public Health Analysts can obtain, analyze and act on data more quickly than in more traditional settings.

Inform and help local communities develop local solutions to reduce overdoses and save lives

TheORSusesthatinforma@onto…

The ORS creates an infrastructure and environment to address overdose threats, utilizing the best existing strategies to help save lives.

With the information shared, and programs inspired by ORS, we are helping communities and individuals make healthier, safer choices.

Public safety agencies are already responding to overdoses.

The ORS helps equip these partners with the best available public health information to help them save lives.

1234

Sharedatasystemstoinformrapidandeffec@vecommunityoverdosepreven@onefforts.

Supportimmediate,evidence-basedresponseeffortsthatcandirectlyreduceoverdosedeaths.

Designandusepromisingstrategiesattheintersec@onofpublichealthandpublicsafety.

Useeffec@veandefficientprimarypreven@onstrategiesthatcanreducesubstanceuseandoverdoselongterm.

ORS Program Goals

ORS Strategic Direc2ons

LawEnforcement Response

TreatmentandRecovery Preven@on

Drug Intelligence Officers (DIO)

•  Partnerwithpublichealthagenciesandpublichealthanalyststobridgecommunica@ongapwithlawenforcement

•  DIOsfillacri@calgapinintelligencesharingby:•  repor@ngcross-jurisdic@onallinks•  communica@nginterstateintelligence•  relayingcasereferralsbetweenagencies•  developing@melyintelligencereportsforlawenforcementaudiences

•  FelonyArrestNo@fica@ons(FANs):•  Trackandrelaydrug-relatedfelonyarrestsofout-of-stateresidentsandreportthisinforma@ontotheindividual’shomelawenforcementagencyandotherlawenforcementagencieswithavestedinterest

Public Health Analysts (PHA)

• Workwithkeypublichealthagencies,non-governmental(e.g.treatmentandpreven@on)organiza@ons,andlawenforcementtoincreaseinteragencydatasharing

•  Majorityofworksupportsorcollaborateswithlawenforcementagencies

•  PHAGoals:•  Createandcoordinateshareddataregimesthatallowpublichealth,lawenforcement,andotherstorespondquicklyandeffec@velytoemergingoverdosecrises

•  Developandsupportstrategic,evidence-basedresponsestogenerateimmediatereduc@onsinthenumberofoverdose-relatedfatali@es

•  Promoteandsupportpreven@oneffortstopreventorreduceopioidmisuse•  Promotetheac@veengagementoflocalcommuni@esinthediscussion,planning,andimplementa@onofORSgoalsandac@vi@es

DIO DIO&PHA

ORS Program Scope & Reach

DIO and PHA Partnership

•  TheORSbuildsuponexis@ngpublichealthandpublicsafetyinfrastructurestocreatestrong,las@nginforma@onsharingsystems,responseini@a@ves,andotherinnova@onstocombattheopioidepidemic.

•  AreasofCollabora@on:•  FANAnalysis• NaloxoneDistribu@on• OverdoseSpikeResponses• Others

Cornerstone Projects

•  EnhancedandpurposefulPHA/DIOcollabora@on

• Mobilizetheen@reORStoexploreevidence-basedresponsestooverdose

•  Topicsselectedjointlybymul@pleHIDTAsandtheCDC

•  PublicHealthandPublicSafetycollabora@onbetweenDIOsandPHAsisfounda@onaltotheORS’smission

•  TopicselectedbytheHIDTADirectorsandORSpartnersattheCDC

•  CornerstoneProjectsarebuiltuponevidence-basedprac@cestoreduceoverdose

2016:FentanylReport2017:911GoodSamaritanLaws2018:PublicSafety-ledLinkagestoCare2019:OverdosePreven@oninJails

Cornerstone Projects

Correla2on Reports

•  Analyzed Felony Drug Arrests (FANs) andiden@fiedan individualsstateofresidencewithillicitdrugtypeandfirearms.

•  ComparedFANdatawithoverdosedeathsby county through a Pearson Correla@onCoefficient.

West Virginia - Correla2on Reports

Revealedasignificant.900value.Degreesoffreedom=53,pvaluesignificantatthe.05levelat.322,infimy-fiveWestVirginiacoun@esformthex-axis.

Kentucky - Correla2on Reports

Revealedasignificant.855value.Degreesof freedom=118,p value significant at the .05 levelat.195,in120Kentuckycoun@esformthex-axis.

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Correla@onBetweenFelonyDrugArrestsandOverdoseDeathsbyCounty,2019

FAN OD

Correla2on Conclusion

•  Determinedthatfelonydrugarrestsanddrugseizuredatamayprovideapredic@vemodeltoassistinthedecreaseofdrugoverdosedeathsinWestVirginiaandKentucky.

•  Sincethecorrela@onheldtruein2AHIDTAstates,couldthistrendholdtruethroughoutthecountry?

•  Similar methodology is currently being studied by the Na@onalEmerging Threat Ini@a@ve (NETI) and it is our hope that it may beimplemented on a na@onal scale as part of the ORS - PHA and DIOrela@onshiptoreducethenumberofoverdoses.

Closing Remarks

• Na@onalandAppalachiaHIDTAPrograms

•  Illicit drug trends andoverdose rates that arenega@vely effec@ng theAppalachianregion

• How the rela@onship between PHAs and DIOs can assist both publichealth and law enforcement sectors in reducing the number ofoverdosedeathswhiledirectlydeterringdrugtraffickingac@vity

Ques2ons?

Edward“Joe”Kuehne&GregRoberts

AppalachiaHIDTAHeadquarters-London,KY(606)877-2100

kuehnej@ahidta.org

robertsg@ahidta.org