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
0
50
100
150
200
250
300
350
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
0
20
40
60
80
100
120
140
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
0
5
10
15
20
25
30
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
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
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
0
200
400
600
800
1000
1200
1400
1600
1800
2000
18-2 2 3 4 19-1 2 3 4 20-1 2 3
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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2
4
6
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10
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14
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18
20
18-1 2 3 4 19-1 2 3 4 20-1 2 3
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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0 10 20 30 40 50 60 70 80 90 100 110 120
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