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HealthyVoicesHealthyChoices 1
PrescriptionOpioidMisuseandHeroinUseAmongYouthandYoungAdultsinAnchorage,Alaska,NeedsAssessmentHealthyVoicesHealthyChoices&AlaskaInjuryPreventionCenter
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HealthyVoicesHealthyChoices 2
HealthyVoicesHealthyChoicesPrescriptionOpioidMisuseandHeroinUseAmongYouthandYoungAdultsinAnchorage,Alaska,NeedsAssessmentApril15,2017Preparedfor
HealthyVoicesHealthyChoicescoalitionVolunteersofAmericaCharlieDanielsPhone:907-265-1912Email:[email protected]:www.voaak.org/healthy-voices-healthy-choices
Preparedby
AlaskaInjuryPreventionCenterMarciaHowell,LindseyHajdukandSylviaCraigPhone:907-929-3939Email:[email protected]:www.alaskainjurypreventioncenter.org
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HealthyVoicesHealthyChoices 3
Acknowledgements
Thisneedsassessmentwasacollaborativecommunityprocessthatwouldnotbepossiblewithouttheextensiveinvolvement,input,andinsightfromnumerouscommunitymembersimpactedbythesechallengingissues.TheHealthyVoicesHealthyChoicescoalitionwouldliketoextendaheartfeltthankstoallitscoalitionmembersandsupportersfortheoversightandfeedbackthroughouttheneedsassessmentprocess.TheHealthyVoicesHealthyChoicescoalitionwouldliketothanktoallitscoalitionmembersfortheoversightandfeedbackthroughouttheneedsassessmentprocess.Inparticular,wewouldliketothankAmandaLenhardwiththeAmericanLungAssociation,theAlaskaCounterDrugSupportProgram,MattKeithwithGenevaWoods,EydieFlygarewithTutanRecoveryServices,WillHurrwithBoysandGirlsClubsofAlaska,ChrisKosinskiwithAnchorageWaterandWaterwasteUtility,andtheAnchoragePoliceDepartment.Wewouldalsoliketothankourkeyinformantinterviewexperts.WewouldliketothankSouthRestaurant&Cafe,GenevaWoodsMedsetPharmacy,andtheAmericanLungAssociationfortheirgeneroussupportinhostingvariouscommunitymeetings.WewouldliketothankAlaskanAIDSAssistanceAssociationforthecollectionofopen-endedsurveyinformationfromtheirclients.Wewouldalsoliketothankthefollowingagenciesforprovidingprimaryandsecondarydataforthisreport,including:theStateofAlaskaDivisionofBehavioralHealth,theAnchorageSchoolDistrict,AlaskaTraumaRegistry,otherlocalagencies,andVolunteer’sofAmericaAlaska’sPRIMEForLifeprogram.WewouldliketothankAdrieneActiveforsupportontheresourceassessmentandMarnyRiveraforevaluationsupport.ThisneedsassessmentwouldnotbepossiblewithoutthegeneroussupportandinvolvementfromtheHealthyVoicesHealthyChoiceswithVolunteersofAmericaAlaskacoalition,including:CharlieDaniels,LoganDaniels,ZaraSmelcer,TamaraChilds,JayceCarlson,HarryLindsey,DavidCarey,CeylonMitchell,CooperBaldwin,JoyClark,andMorgannJensen.ThisneedsassessmentwasfundedbytheStrategicPreventionFrameworkPartnershipsforSuccessgrantthroughtheStateofAlaskaDepartmentofHealthandSocialServices,DivisionofBehavioralHealth(GrantAwardNo.602-208-1714;July1,2016–June30,2017).
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I.TABLEOFFIGURES...........................................................................................................................................6II.TABLEOFTABLES...........................................................................................................................................6III.INTRODUCTION..............................................................................................................................................8
PURPOSEOFASSESSMENT..........................................................................................................................................................8STRATEGICPREVENTIONFRAMEWORK......................................................................................................................................8STAKEHOLDERS.............................................................................................................................................................................9
HealthyVoicesHealthyChoices........................................................................................................................................9AlaskaInjuryPreventionCenter.......................................................................................................................................9
COMMUNITYDESCRIPTION.........................................................................................................................................................9Demographics.......................................................................................................................................................................10Socio-EconomicIndicators...............................................................................................................................................11HealthCareandCoverage...............................................................................................................................................13Governance............................................................................................................................................................................13LegalSystem..........................................................................................................................................................................14
IV.METHODS......................................................................................................................................................15SECONDARYDATA.....................................................................................................................................................................15
YouthRiskBehaviorSurvey.............................................................................................................................................15AlaskaTraumaRegistry....................................................................................................................................................15StateofAlaskaDepartmentofHealthandSocialServices.................................................................................15AlaskaYoungAdultSubstanceUseSurvey................................................................................................................16
PRIMARYDATACOLLECTION....................................................................................................................................................16KeyInformantInterviews.................................................................................................................................................16Open-EndedWrittenSurveys..........................................................................................................................................18VolunteersofAmericaAlaskaPRIMEforLifeData................................................................................................18TelephoneSurvey................................................................................................................................................................18
COMMUNITYREADINESS..........................................................................................................................................................19Tri-EthnicSurveysMethodology....................................................................................................................................19
V.KEYFINDINGS................................................................................................................................................20EXTENTOFTHEPROBLEMINTHECOMMUNITY......................................................................................................................20
CurrentConsumptionPatterns......................................................................................................................................20ConsequencesofOpioidMisuseandHeroinUse....................................................................................................28
COMMUNITYFACTORSASSOCIATEDWITHSOCIALAVAILABILITYOFHEROINANDPRESCRIPTIONPAINRELIEVERS............37AccesstoheroinandprescriptionsopioidsinAnchorage...................................................................................37SafeStorage..........................................................................................................................................................................37HowYouthAccessPrescriptionOpioids.....................................................................................................................39DrugTake-BackEvents......................................................................................................................................................40
COMMUNITYFACTORSTHATCONTRIBUTETORETAILAVAILABILITY....................................................................................40LackofMandatoryPrescriptionDrugMonitoringProgram..............................................................................41Hospital“SatisfactionScores”........................................................................................................................................41PainasaFifthVitalSignCulture...................................................................................................................................42AlternativeorNon-DrugTreatment.............................................................................................................................42
PERCEPTIONSFORRISKOFHARM...........................................................................................................................................43PerceptionofriskofharmamongAnchoragehighschoolstudents..............................................................43PerceptionofriskofharmamongyoungadultsinAnchorage.........................................................................45Studentperceptionofparentalattitudes..................................................................................................................46
HARMREDUCTION....................................................................................................................................................................47
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Stigma......................................................................................................................................................................................47Legislation..............................................................................................................................................................................47MedicalCommunity...........................................................................................................................................................48NeedleExchangeProgram..............................................................................................................................................48LackofMedicallyMonitoredDetoxBeds..................................................................................................................48AccesstoNaloxone.............................................................................................................................................................48
OTHERCOMMUNITYFACTORS.................................................................................................................................................49CoordinatedApoliticalAdvocacy..................................................................................................................................49InvolvementofSchools.....................................................................................................................................................50ImprovedAccesstoData..................................................................................................................................................50GrowingCommunityAwarenessThroughtheLocalMedia...............................................................................50CommunityNormsandPerceptions............................................................................................................................50InsufficientCoordinatedEffortstoAddresstheProblem....................................................................................50SyntheticOpioids.................................................................................................................................................................51
COMMUNITYREADINESSASSESSMENT...................................................................................................................................51PerceptionoftheProblemintheCommunity..........................................................................................................58KnowledgeoftheIssue.....................................................................................................................................................59ConcernofPrescriptionOpioidMisuseandHeroinUse.......................................................................................60KnowledgeofEffortstoAddressIssues......................................................................................................................61
COMMUNITYRESOURCEASSESSMENT....................................................................................................................................64Userperceptionsofavailableandneededresources............................................................................................64Resourcesavailabletoaddressinterveningvariables:.........................................................................................65
VI.PRIORITIZATION........................................................................................................................................66PRIORITIZATIONPROCESS.........................................................................................................................................................66
VII.DISCUSSIONANDRECOMMENDATIONS.............................................................................................69REDUCERETAILAVAILABILITY..................................................................................................................................................70REDUCESTIGMA.......................................................................................................................................................................70INCREASESAFEDISPOSAL.........................................................................................................................................................70REDUCEHARM..........................................................................................................................................................................71
VIII.WORKSCITED...........................................................................................................................................73IX.APPENDICES.................................................................................................................................................78
APPENDIXA–SUMMARYOFKEYINFORMANTINTERVIEWS..............................................................................................78APPENDIXB–SUMMARYOFCOMMUNITYREADINESSASSESSMENT...............................................................................97APPENDIXC–COMMUNITYPRIORITIZATIONPROCESS....................................................................................................109APPENDIXD–COMMUNITYRESOURCEASSESSMENT....................................................................................................121APPENDIXE–COMMUNITYRESOURCESASSESSMENTLIST...........................................................................................126APPENDIXF–ANCHORAGERECOVERYAGENCIES...........................................................................................................128APPENDIXG–ANCHORAGEMEDIACOVERAGE..............................................................................................................130APPENDIXH–PRIMEFORLIFESURVEY.........................................................................................................................138APPENDIXI–FOURA’SSURVEY........................................................................................................................................140
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I. TableofFiguresFigure1StrategicPreventionModel.............................................................................................8Figure2KeyInformantInterviewSectorRepresentation............................................................17Figure3IntroductiontoOpioidsforRecreationalandMedicalUse............................................20Figure4SummaryofThemesforWhenTakingPrescriptionOpioidsisRisky.............................21Figure5SummaryofThemesforReasonsPeopleBeginOverusingPrescriptionOpioids..........22Figure6AnchorageYouthPrescriptionDrugUse........................................................................23Figure7AnchorageYouthPrescriptionDrugUse........................................................................24Figure8PRIMEForLifeSummaryData.......................................................................................27Figure9SummaryofConsequencesofOpioidMisuseandHeroinUse......................................28Figure10AlaskaHeroinOverdoseDeaths,2009-2015................................................................30Figure11SummaryofAlaskaOverdoseDeathsFromPrescriptionOpioidsandHeroin,2015...30Figure12SummaryofAnchorage2015OpioidERPoisoningDischarges....................................32Figure13SummaryofAnchorage2015HeroinERPoisoningDischarges...................................32Figure14SummaryofWhatPeopledoWithExcessPrescriptionOpioids..................................38Figure15CommunityReadinessScoresforNon-MedicalPrescriptionOpioidMisuseamong12-
17Year-OldsinAnchorage(2017).......................................................................................53Figure16CommunityReadinessScoresforNon-MedicalPrescriptionOpioidMisuseandHeroin
Useamong18-25Year-OldsinAnchorage(2017)...............................................................54Figure17SummaryofthemesfromCommunityReadinessAssessmentgroupinterviews(2017)
.............................................................................................................................................56Figure18SummaryofMessagesFromPrescriberstoPatientsatTimeofPrescription.............60Figure19SummaryofPerceptionsofOpioidUseAmongYouth12-17Years-Olds....................62Figure20SummaryofPerceptionsofOpioidUseAmong18-24YearsOld.................................63Figure21SummaryofPerceptionsofHeroinUseAmongYouth18-24YearsOld......................63
II. TableofTablesTable1AnchorageYouthandYoungAdultPopulationbyAge,2010Census.............................11Table2TopTenAnchorageOccupations.....................................................................................12Table3StagesofCommunityReadinessScale(ColoradoStateUniversity,2014)......................20Table4Past30DayPrescriptionDrugUseWithoutaPrescription,YRBS2015..........................24Table5LifetimePrescriptionDrugUseWithoutaPrescription,YRBS2015................................25Table6LifetimeUseofHeroin,YRBS2015..................................................................................26Table7SubstanceUseandDependenceAmongstYouthbyAgeGroup(2010-2012)................27Table8PrescriptionOpioid-RelatedERDischarges.....................................................................31Table9PrescriptionOpioid-RelatedERDischarges.....................................................................31Table10AmountofDrugsCollectedThroughAnchorageDrugTakeBackEvents......................40Table11Perceptionofriskofharmfromprescriptiondrugmisuseasmoderateorgreater(%)44Table12Perceptionofriskofharmfromtryingtomisuseopioidsonceortwice......................45
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Table13Perceptionofriskofharmfromregularmisuseofopioidsonceortwiceaweek........45Table14Perceptionofriskofharmfromtryingheroinonceortwice........................................46Table15Perceptionofriskofharmfromregularlyusingheroinonceortwiceperweek..........46Table16Studentperceptionthatparentsconsiderprescriptiondrugmisuseaswrongorvery
wrong(%).............................................................................................................................47Table17StagesofCommunityReadinessScale..........................................................................51Table18Perceptionofprescriptionopioidmisuseproblemincommunity................................58Table19Perceptionofheroinproblemincommunity................................................................58Table20PercentageofAnchorageAdultsKnowledgeableaboutOpioidAbuseandHeroinUse
(n=382)...............................................................................................................................59Table21PercentageofAnchorageAdultsConcernedaboutOpioidAbuseandHeroinUse(n=
382)......................................................................................................................................60Table22PercentageofAnchorageAdultsKnowledgeableaboutEffortsinCommunityto
AddressOpioidAbuseandHeroinUse(n=382).................................................................61
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III. IntroductionTheStateofAlaska’sDepartmentofHealthandSocialServices,DivisionofBehavioralHealth(DBH)issuedtheStrategicPreventionFrameworkPartnershipsforSuccessGrant(SPFPFS)tocoalitionsacrossthestateofAlaskatopreventthenon-medicaluseofprescriptionopioids(NMUPO)among12-25yearoldsandheroinuseamong18-25yearolds.WithinAnchorage,theVolunteersofAmericaAlaska’sHealthyVoicesHealthyChoicescoalition(HVHC)wasawardedfunding.HVHCcontractedwithAlaskaInjuryPreventionCenter(AIPC)toconductthisassessment.
PurposeofAssessment TheDBHtaskedgranteeswithcollectingdatapertainingtoNMUPOamong12-25yearoldsandheroinuseamong18-25yearsolds.Throughtheassessment,granteesweretocollectdatapertainingtothenatureofNMUPOandheroinuseandrelatedconsequences,includinghealthdisparitiesrelatedtoNMUPOandheroinuse.Granteeswerealsoaskedtoassessinterveningandcommunityfactors.Specifically,granteeswererequiredtoassesscommunityfactorsrelatedtosocialandretailavailability,andperceivedriskforharmofNMUPOandheroinuse,andanadditionalinterveningvariablethecoalitionidentifiedinthisprocessisregardingharmreduction.PFSgranteeswereadditionallyaskedtoassessthecommunity’scapacityandreadinesstoaddressNMUPOandheroinuse.
StrategicPreventionFrameworkTheSubstanceAbuseandMentalHealthServices(SAMHSA)fundstheAlaskaSPFPFSgrant.TheDBHrequiresPFSgranteestousetheStrategicPreventionFramework(SPF)toapproachthepreventionofNMUPOandheroinuse.TheSPFisapreventionmodelusedbycommunitycoalitionstoimprovethebehavioralhealthoftheircommunities.
Figure1StrategicPreventionModel
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TheSPFtakesacomprehensiveapproachtobehavioralhealthandpreventionandisrootedinprinciplesofpublichealthandcommunityorganizing.StrategiesbasedontheSPFshouldaddressboththeindividualandtheenvironment.TheSPFoutlinesfiveprocessesforimplementation:1)Assessment,2)CapacityBuilding,3)Planning,4)Implementation,and5)Evaluation.TheSPFplacesCulturalCompetencyandSustainabilityatthecoreofthisprocess,meaningthatateachstepoftheSPF,coalitionsshouldworktoensuretheiractionsdemonstrateculturalcompetenceandthattheworkbeingdoneissustainableintothefuture.
Stakeholders
HealthyVoicesHealthyChoicesHVHCisacoalitionwithVolunteersofAmericaAlaska.HVHCbringstogethervariousstakeholderstopromotehealthychoicesthroughpubliceducation,outreach,advocacy,andyouth-ledactivities.ThevisionofHVHCistoeducateandpromotehealthylifestylechoicesrelatedtoourcommunity’syouthandyoungadult’smental,physical,andemotionalwellness.HVHCactivelyadvocatesforacommunitythat:
• Preventsaccesstoalcohol,drugs,andtobaccoproductsbyyouthandyoungadults.• Promotesabstinencefromalcohol,tobacco,andotherdrugsinyouthandyoungadults.• Supportsandpromoteseffectivelifestylechoicesthatbuildandstrengthspositive
assetsinouryouthandyoungadults.
AlaskaInjuryPreventionCenterTheAlaskaInjuryPreventionCenter(AIPC)isanon-profitlocatedinAnchorage,Alaska.AIPC’scorepurposeistopromotewellness,preventinjury,andimprovesafetyinAlaska.AIPChasahistoryofcollectingprimarydataandassessingexistingdatasets.HVHCcontractedwithAIPCtoconducttheassessment.AIPCwillalsoassistHVHCwithdevelopingthelogicmodelandstrategicplan.AIPCisamemberoftheHVHCcoalition.
CommunityDescriptionTheMunicipalityofAnchorage,AlaskaincludesthecommunitiesofAnchorage,Chugiak,EagleRiver,JointBase-ElmendorfRichardson,GirdwoodandcommunitiesalongTurnagainArm.LocatedinSouthcentralAlaska,theAnchoragemetropolitanareasitsinabowlwithCookInlettothewest,andChugachStateParktotheeast.WarmedbyPacificcurrents,thecityhasamildnorthernclimate(AnchorageConvention&VisitorsBureau).Theaveragetemperatureis37F,withanaverage
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annualhighof43.7,andaveragelowof30.3F(USClimateData).
DemographicsTheU.S.CensusBureauestimatestheJuly2016populationofAnchoragetobe299,816.Thisisa2.2%increasefrom2010populationestimates(AnchorageEconomicDevelopmentCorporation,2013).Anchorageisthelargestcommunityinthestate,withjustover40%ofAlaska’spopulation.Since2010,Anchoragehasaddedmorethan28,000residentsthroughbirths,lost9,400residentsfromdeaths,andexperiencedanetlossof12,400residentsfromout-migration.Thepopulationpeakedin2013at300,957residents,buthassincehadanetlossof1,920residentssincethattime(AnchorageEconomicDevelopmentCorporation,2017c).In-migrationintoAnchorageisoccurringamongindividualsintheirmid-20’s,oftenfromotherAlaskacommunities.Out-migrationisoccurringamongindividualsintheirlate-teens/early-20’sastheyleavethestateforschoolorwork(AnchorageEconomicDevelopmentCorporation,2017c).PopulationgrowthinAnchoragewillcontinuetobeslowedbyanagingdemographic.AlaskaDepartmentofLaborandWorkforceDevelopmentlong-termprojectionsindicatethepopulationofthoseover65yearsoldareanticipatedtoincreasemorethan30%between2017and2022.Overthatsameperiodthepopulationofresidentsbetweentheages20and64areanticipatedtodecreaseslightly(AnchorageEconomicDevelopmentCorporation,2017c).
RaceandEthnicityAccordingto2015estimatesbasedon2010datafromtheUnitedStatesCensusBureau,theracial/ethnicmakeupofAnchorageisapproximatelyasfollows:
• 65.5%White• 9.6%Asian• 9.1%HispanicorLatino• 8.3%AmericanIndianandAlaskaNative• 7.9%Twoormoreraces• 6.2%BlackorAfricanAmerican• 2.4%NativeHawaiianandOtherPacificIslander
AnchorageishometomoreAlaskaNativepeoplethananyothercityintheUnitedStates(Hunsinger&Sandberg,2013).In2010,26%ofthestate’sAlaskaNativepopulationlivedinAnchorage(Williams,2010).Today,partsofAnchoragearemorethan50%peopleofcolor.AsreportedintheAlaskaDispatchNews,Anchorage’sMountainViewcensusareawasrecentlyidentifiedasthemostraciallydiversecensustractintheentireUnitedStates(McCoy,2013).SeventeenpercentofAnchorageresidentsspeakanotherlanguagethanEnglishintheirhomes.Approximately10%ofAnchorageresidentswerenotUnitedStatescitizensatbirth.
EducationIn2016,theestimatedpopulationat25yearsorolderis192,637.Ofthispopulation,approximately5,244(2.72%)peoplehavebelowa9thgradeeducationlevel;7,482(3.88%)have
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agrade9-12educationlevel;46,448(24.11%)haveahighschoollevel;52,940(27.48%)havesomecollege;16,465(8.55%)haveanassociatedegree;41,734(21.66%)haveabachelor’sdegree;and22,324(11.59%)haveagraduatedegree(AnchorageEconomicDevelopmentCorporation,2017b).ThemunicipalityofAnchorageisalsohometotheUniversityofAlaskaAnchorage(UAA),whichisAlaska’slargestpost-secondaryinstitutionandispartoftheAlaska’sstatewideuniversitysystem.UAAservesover14,000studentsandhosts113studentclubs.UAAoffers151degreeprograms,including:associate,certificate,bachelor,masters,anddoctoralprograms(UniversityofAlaska,Anchorage,2017)
GenderIn2015,thepopulationofAnchoragewasapproximately145,703female(48.6%)and154,113male(51.4(UnitedStatesCensusBureau,2015).
AgeTable1providesabriefprofileoftheAnchorageyouthpopulationsbyage.Atthetimeofthe2010census,therewereover65,000youthbetweenages10and24livinginAnchorage.Table1AnchorageYouthandYoungAdultPopulationbyAge,2010Census
Ages NumberofYouth20-24 24,37915-19 21,18710-14 20,4435-9 20,6184andunder 21,961Note.AdaptedfromtheStateofAlaskaDepartmentofLaborandWorkforceDevelopment,ResearchandAnalysis.(2016).DemographicProfileforAnchorageMunicipality.Retrievedfrom:http://live.laborstats.alaska.gov/cen/dppdfs/dem_profile_52.pdf
MilitaryandVeteranPopulationTheAnchoragepopulationalsoincludes5,500militaryandcivilianpersonnelfromthemilitaryJointBaseElmendorf-Richardson(JointBaseElmendorf-Richardson,n.d.).Thereareapproximately29,141veteranslivingwithinAnchorage,basedon2011-2015estimates(UnitedStatesCensusBureau,2015).
Socio-EconomicIndicatorsThemedianAnchoragehouseholdincomebetween2011-2015was$78,326(UnitedStatesCensusBureau,2015).Anestimated8.7%ofpeoplewererecordedaslivingbelowpovertylevel(UnitedStatesCensusBureau,2015),with32,947people125%belowpovertylevel(StateofAlaskaDepartmentofCommerce,Community,andEconomicDevelopment,n.d.)
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BetweenOctober1,2013,andSeptember30,2014,therewere7,506peoplerecordedashomelessinAnchorage(AlaskaCoalitiononHousingandHomelessness,2014).Thisincludesfamiliesandindividualsinemergencyshelters,transitionalhousing,andpermanentsupportivehousing.Inthesametimeframe,987childrenwererepresentedunderthesamecategories.Thisdoesnotincludepeopleusing“otherprogramswhoseprimarymissionistoprovideservicestovictimsofdomesticviolence,datingviolence,sexualassault,orstalking,”suchasrapecrisiscentersorbatteredwomen’sshelters(AlaskaCoalitiononHousingandHomelessness,2014).
HousingTheaverageAnchoragehouseholdsizefrom2011-2015was2.77personsperhousehold(UnitedStatesCensusBureau,2015).Oftheestimated115,461Anchoragehouseholdsin2016,66,475wereowner-occupiedand44,830wererenter-occupied(AnchorageEconomicDevelopmentCorporation,2017).In2011,therewere40,575familyhouseholdsand9,910singlemotherhouseholdscontainingpeoplelessthan18yearsofageinAnchorage(AnchorageEconomicDevelopmentCorporation,2013).In2016,theaveragesalespriceofahomeinAnchoragewas$363,932.TherelativecostofhousinginAnchoragehasriseneveryyearsince2009,exceptfor2016witha0.23%decreasefrom2015.TheaveragerentinAnchoragedecreasedfrom$1,312in2015to$1,214in2016foratwo-bedroomapartment.Thelocalvacancyratein2016was3.79%(AnchorageEconomicDevelopmentCorporation,2017c).
EmploymentAsof2011,theAnchoragelaborforcewasestimatedat157,210persons,with147,604peopleemployed(AnchorageEconomicDevelopmentCorporation,2012).Table2showsthetoptenoccupationsinAnchorageasof2012.
Table2TopTenAnchorageOccupations
OccupationsNumberofWorkers Female Male
RetailSalespersons 5,087 2,831 2,256Cashiers 3,290 2,066 1,223OfficeandAdministrativeSupportWorkers,AllOther 2,864 2,238 626CombinedFoodPreparationandServingWorkers,IncludingFastFood
2,627 1,513 1,111
OfficeClerks,General 2,544 1,930 614PersonalCareAides 2,256 1,711 542RegisteredNurses 2,233 2,011 221JanitorsandCleaners,ExceptMaidsandHousekeepingCleaners
2,014 688 1,323
Bookkeeping,Accounting,andAuditingClerks 1,869 1,622 247
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OccupationsNumberofWorkers Female Male
GeneralandOperationsManagers 1,114 677 1,137Note. Data retrieved from the State of Alaska Department of Labor and Work Force Development,ResearchandAnalysis:AlaskaLocalandRegionalInformation,AnchorageMunicipality;accessed4/6/15;
CostofLivingAnchorage'soverallcostoflivingindexis130.2%ofthenationalaverage—or30.2%higherthanthenationalaverage—rankingtheAnchoragethe20thmostexpensivecitytoliveinintheU.S.(AnchorageEconomicDevelopmentCorporation,2017).In2013,housingwasthetopitemofexpenditureforAnchorageresidents.Averagedistributionofexpendituresincluded40.6%housing;16.9%transportation;15.5%foodandbeverages;6.6%medicalcare;6.7%recreation;5.7%educationandcommunication;5%clothing;and3.1%othergoodsandservices(Fried,2014).
HealthCareandCoverageAnchorageisrankedthethirdhighestinthenationforhealthcarecosts,precededbytwootherAlaskacities:JuneauandFairbanks.Aphysician’sofficevisitis63.7%higherthanthenationalaverage(AnchorageEconomicDevelopmentCorporation,2017).In2013,theshareofAnchorageresidentswhowereuninsuredwas18.5%.In2012,14.5%ofAnchorageresidentswerenotabletoreceivethecaretheyneededduetothecostofhealthcare.Alsoin2012,41.7%ofAnchorageresidentsreportednothavingaprimarydoctororprovider.In2012,avoidablehospitaladmissions,whicharehospitalizationsduetoconditionsthatcouldhavebeenavoidedwithpreventiveandprimarycareservices,haddecreasedto39.9per1000hospitalizations(ProvidenceMedicalCenter,2015).Anchoragehasfourmajorhospitals,andawiderangeofbehavioralandmentalhealthservicesavailable.TheNationalAllianceonMentalIllnessAnchoragelists15communitymentalhealthserviceprovidersintheAnchoragemetroarea(NAMIAnchorage).TheAnchorageNeighborhoodHealthClinicservesuninsuredandlow-incomeindividualsandfamiliesandprovided$7.8millioninservicestoalmost14,500peoplein2013(AnchorageNeighborhoodHealthCenter,2014).TheAlaskachildren’shealthinsuranceprogramDenaliKidCarepaysforhealthcareforchildrenandteensthroughage18(AlaskaDepartmentofHealthandSocialServices,2016)
GovernanceTheMunicipalityofAnchoragelists34departments,divisions,andoffices,includingtheDepartmentofHealthandHumanServices,OfficeofEmergencyManagement,FireDepartment,PoliceDepartment,ParksandRecreationDepartment,MunicipalLightandPower,
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Library,AnchorageMuseumatRasmusonCenter,SolidWasteServices,PortofAnchorage,andPublicTransportation,amongothers(MunicipalityofAnchorage,2015).Thereare38communitycouncilsrepresentingAnchorage’sneighborhoodsthatsereasadvisoriestotheAnchorageAssembly(MunicipalityofAnchorage,2015).Thecommunitycouncilsareprivate,non-profitassociationscomprisedofvolunteercitizenswithinsetgeographicalneighborhoodsdesignatedbytheAssembly(MunicipalityofAnchorage,2015).Asof2013,atotalof344policeofficerswerefulltimelawenforcementemployeesinAnchorage.TheAnchoragePoliceDepartmentisthelargestpolicedepartmentinthestateofAlaska.ItmaintainsaCrisisInterventionTeamofpoliceofficerswhoareeducatedonmentalillness,suicideandcrisisinterventions,activelistening,andde-escalationtechniquessothattheymayrespondtocallsforpersonswithmentalillnesswithempathyandrespect.Morethan90officershavebecomeAPDCrisisInterventionTeammemberssincetheprogram’sinceptionin2011(MunicipalityofAnchorage,2015).
LegalSystemAnchorage’scourtsystemispartoftheStateofAlaskaCourtsystemandiscomprisedoftheAnchorageDistrictCourt,AnchorageSuperiorCourts,andtheAlaskaSupremeCourt(StateofAlaska,2015).Inadditiontothetraditionalcourtsystem,theAnchorageYouthCourt“providestheopportunityforyouthingrades7through12whoareaccusedofbreakingthelawtobejudgedbytheirpeers.Itisacourtinwhichtherolesofattorneys,judges,bailiffs,clerks,andjurorsarefilledbyyouth”(AnchorageYouthCourt,2015).AnchorageYouthCourtallowsyouththeopportunitytoresolvetheirlegalissueswithoutcreatingaformalcriminalrecord.DefendantsaretypicallyfirsttimeoffendersandarereferredtotheAnchorageYouthCourtthroughMcLaughlinYouthCenter’sJuvenileProbationOffice.ThereareeightyouthfacilitiesoperatedbytheStateofAlaska’sDivisionofJuvenileJustice.Anchorage’syouthfacility,McLaughlinYouthCenter,hasthecapacitytodetainorprovidetreatmentfor135youth(StateofAlaska,2015).
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IV. MethodsHVHCandAIPCworkedincollaborationtocompletetheassessmentinaccordancewiththeguidancedocumentprovidedbyDBH.ThisassessmentcoveredfourareasofNMUPOandheroinuseincompliancewithDBH’srecommendations.First,HVHCandAIPCassessedconsumptionandrelatedconsequences.Second,thecoalitionassessedinterveningvariablesandcommunityfactorsrelatedtoNMUPOandheroinuse.Thesekeyinterveningvariablesare:socialavailabilityofprescriptionopioidsandheroin,retailavailabilityofprescriptionopioidsthroughproviders,andperceptionsofriskforharm.Third,theassessmentlookedatcommunityresourcesandcommunityreadiness.Fourthandlast,thecoalitionprioritizedcommunityfactorsrelatedtoNMUPOandheroinuse.Acombinationofprimaryandsecondarydatasourcesandtoolswereusedtocaptureandanalyzebothquantitateandqualitativedatasets.Thesevariousdatasetsandcollectionmethodsaredetailedbelow.
SecondaryDataTomeasureNMUPOandheroinconsumptionanditsconsequences,thisassessmentreliedondatafromexistingsources.ThisincludeddatafromtheYouthRiskBehaviorSurvey(YRBS),NationalSurveyonDrugUseandHealth(NSDUH),AlaskaTraumaRegistry(ATR),VolunteersofAmericaAlaska,andtheStateofAlaskaDepartmentofHealthandSocialServices(DHSS).ThesedatasourcesprovidedestimatesofNMUPOuseandheroinuseinAnchorage,aswellasinformationaboutoverdoseandfatality.HVHCandAIPCalsouseddatafromtheAlaskaYoungAdultsSubstanceUseSurvey(YASUS).
YouthRiskBehaviorSurveyTheYRBSisananonymousschool-basedsurveyofhighschoolstudentsthatcoverssixcategoriesofadolescenthealthandsocialbehaviors(AlaskaDivisionofBehavioralHealth,2012).Thesurveyisadministeredeveryotheryearandthemostrecentsurveywasconductedin2015.Inspring2015,1,418studentsfromacrossthestateofAlaskaweresurveyed.TheYRBScontainsquestionspertainingtocurrentandlifetimeprescriptiondruguse(notspecifictoopioiduse/misuse)andheroinuse.DataisavailableatthedistrictlevelfortheAnchorageSchoolDistrict.
AlaskaTraumaRegistryTheAlaskaTraumaRegistrycollectsdatafrom24ofAlaska’sacutecarehospitalsforpatientswithseriousinjuries.AlaskaInjuryPreventionCenterrequesteddatafromtheDivisionofPublicHealthpertainingtoopioidandheroinoverdosefortheappropriateagegroups.
StateofAlaskaDepartmentofHealthandSocialServicesTheDHSShasissuedseveralepidemiologybulletinscoveringtheNMUPOandheroinuseissue.InMarchof2016,theDHSSissuedabulletinwithinformationaboutdrugoverdosedeathsinAlaskafrom2009-2015.ThisbulletinreliedonmortalitydatacollectedbytheAlaskaBureauofVitalStatistics.
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AlaskaYoungAdultSubstanceUseSurveyTheCenterforBehavioralHealthResearchandServicesatUniversityofAlaskaAnchorageconductedatelephonesurveytoassessyoungadultsubstanceuseinAlaska(J.D.Barnett,personalcommunication,December23,2016).Specifically,theYASUSaimedtoestablishstate-levelestimatesofopioidandheroinconsumptionandconsequencesamong18-27yearolds.TheYASUSalsocontainedquestionspertainingtosocialavailability,retailavailability,andperceivedriskofharm.Therewereatotalof39questionswithinthesurvey.Atotalof7,130individualswereinvitedtoparticipateandatotalof1,031respondentscompletedthesurvey.Whiletheresearchteamintendedtoonlyinviteparticipantsinthe18-27agerange,someparticipantswereolderthan25.Ofthe1,031respondentstocompletethesurvey,779(75.6%)werewithinthetargetagerangeof18-27.Ofthe7,130participantsinvitedtoparticipate,2,100wereresidentsofAnchorage.Anchorageparticipantsinthe18-27yearrangecompletedatotalof212surveys.TheUAAresearchteamobtainedInstitutionalReviewBoard(IRB)approvalfromtheUniversityofAlaskaAnchorageandtheAlaskaAreaInstitutionalReviewBoardtoconducttheYASUS.PerIRBprotocoltheresearchteamcouldnotproviderawdataforfurtheranalysis,butdidprovidedataanalysisforstatewideandAnchoragedataasawhole,andbyraceandgender.
PrimaryDataCollectionBecauseofthecomplexityofopioidmisuseandheroinuse,HVHCandAIPCjointlydecidedtogatherprimarydata,bothqualitativeandquantitative.Qualitativedatacollectionmethodsallowparticipantstoprovidein-depthexplanationsandrichnarrativeonatopic.SinceNMUPOandheroinpreventionareanemergingissueintheAnchoragecommunity,HVHCandAIPCwantedtocollectasmuchinformationaspossible.GivingcommunitymembersthechancetospeakfreelyontheissueprovidedHVHCandAIPCwithamorecomprehensiveunderstandingoftheissue.HVHCandAIPCconductedinterviewsandopen-endedsurveyswithcommunitymembersandcurrentNMUPOandheroinuserstogathermoreinformationabouttheconsequencesofNMUPOandheroinuseinthecommunity.Atelephonesurvey,conductedbyHaysResearchGroup,collecteddatafromAnchorageresidentsaroundknowledgeoftheproblemofNMUPOandheroinuse,concernabouttheissuesandlevelsofknowledgeofeffortstoaddresstheproblems.
KeyInformantInterviewsTheassessmentteamfirstconsideredconductingfocusgroups.However,duetothesensitivenatureofthetopic,theassessmentteamultimatelydecidedtoconductone-on-oneinterviews.Theassessmentteamchosetoconductone-on-oneinterviewstoensurethatallparticipantsweregivenroomtospeakfreelyonthetopicandtoavoidanydiscomfortanindividualmightfeelsharinginagroup.Thekeyinformantinterviewswerequalitative,in-depthinterviewswithpeoplewhoknowwhatisgoingoninthecommunityregardingnon-medicalprescriptionopioiduseandheroinuse
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withinourtargetpopulation.ThekeyinformantsprovidednatureontheinsightofthenatureofthechallengesaroundtheissuesaswellasprovidedrecommendationsforsolutionswithinAnchorage.HVHCandAIPCworkedtogethertoidentifyindividualstointerview.Intervieweesincludedamixofexistingandnewcontacts.AIPCandHVHCchosetointerviewparents,individualsinrecoveryforopioiduse,individualsinrecoveryforheroinuse,activeusers,treatmentproviders,prescribers,militarypersonnel,corrections/law,andcommunitymembersrepresentinghealthcare,education,business,andlocalmedia.Intervieweeswereaskedtoidentifyotherstheythinkmighthavevaluableinputorbeinterestedinparticipatingincoalitionactivities.Figure2KeyInformantInterviewSectorRepresentation
HVHCandAIPCstaffandvolunteersdirectlycontactedrespondentstosolicitparticipation.Respondentswereofferedtheoptiontogothroughthequestionsasanintervieworprovidewrittenresponsestoeachofthequestions.Atotalof22keyinformantswereinterviewedforthisneedsassessment.Responsesweresynthesizedbasedonsectorrepresentation.Afullsynthesisofall22interviewsbysectorisincludedinAppendixAinthisdocument.
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Open-EndedWrittenSurveysTocollectdatafromcurrentusers,AIPCdistributedopen-endedwrittensurveystoAlaskanAIDSAssistanceAssociation(FourA’s).FourA’scoordinatesandhousesthecity’sonlysyringeexchangeprogram.AIPCinitiallyprovidedFourA’swith25surveys.Afterreceivingthecompleted25surveysbackfromFourA’sstaff,AIPCprovided25moresurveyswithafewmodificationsbasedonresponsesfromtheinitialsurveydistribution.BothsurveysareincludedintheAppendixIofthisdocument.Intotal,FourA’sstaffdistributedandcollected50surveysfromcurrentusersofeitherheroin,opioids,orboth.Inexchangeforcompletingthesurvey,respondentsreceiveda$25WalMartgiftcard.FourA’sbegandistributingsurveysonFebruary8,2017andhad50surveyscompletedbyFebruary13,2017.
VolunteersofAmericaAlaskaPRIMEforLifeDataVolunteersofAmericaAlaska,incollaborationwiththeAnchorageSchoolDistrict,theBoysandGirlsClubofSouthcentralAlaska,andtheFirstChristianMethodistEpiscopalChurchoffersPRIMEforLifetomiddleandhighschoolstudentsinthegreaterAnchoragearea(VolunteersofAmericaAlaska,2017).PRIMEforLifeisathree-day,alternativetosuspensioncourseforfirst-timedrugandalcoholoffenses.Itcanalsoserveasapreventivecourseforstudentswishingtoavoidsuspension.ThePRIMEforLifeprogramengagesstudentsinself-evaluationoftheirdecisiontousedrugsandalcohol,helpsstudentsseethelife-longconsequencesofdrugandalcoholuse,andequipsstudentswiththeskillsneededtopreventfuturesubstanceuse.VolunteersofAmericaAlaskacoordinatesthePRIMEforLifeprogramandconductssurveyswithparticipants.Thesurveyscontainquestionspertainingtodrugandalcoholuse,includingsocialavailability.AIPCandHVHCanalyzedthedatafromthesesurveysforthisassessment.
TelephoneSurveyTheAlaskaInjuryPreventionCentercontractedwithHaysResearchGroupLLCtoconductatelephonesurveyregardingattitudes,opinions,andbehaviorsrelatedtoseveralbehavioralhealthissuesinAnchorage,Alaska.Questionsaboutopioidandheroinusewereincluded.MarciaHowellofAIPCandAdamHaysofHaysResearchGroupdevelopedthesurveyinstrument.ThetelephonesurveywasconductedfromAugust4,2016toAugust9,2016.Eachsurveyaveragedapproximatelyeightminutesinlength.Atotalof382residentsfromAnchorage,Alaskawereinterviewed.Thesamplewaskeptinproportiontostatepopulationfigureswiththemarginoferrorforagegroupsandgender.HaysResearchGroupteamusedIBMSPSSsoftwaretoanalyzethedata.Theyprovidedfrequencyandcrosstabulationdata.ThoseresultsarepresentedintheKeyFindingssectionofthisreport.
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CommunityReadinessAcommunityreadinessassessmentwasconductedfollowingtheTri-EthnicCenterforPreventionResearch'smodelofCommunityReadinessforCommunityChange.(Plested,Jumper-Thurman,&Edwards,2015).Thecommunityreadinessassessmentonthenon-medicaluseofprescriptionopioidsandheroinusemeasuredattitudes,knowledge,resources,andeffortsandactivitiesofcommunitymembersandleadershipinordertoassessthecommunity'sreadinesstoaddressfivekeydimensions:1)Communityknowledgeoftheissues(howmuchdoesthecommunityknowabouttheissues?);2)Communityknowledgeofefforts(Howmuchdoesthecommunityknowaboutcurrentpreventionprogramsandactivities?);3)Communityclimate(Whatisthecommunity’sattitudetowardaddressingtheissues?);4)Leadership(Whatisheleadership’sattitudetowardaddressingtheissue?);and5)Resources(Whataretheresourcesbeingusedorthatcouldbeusedtoaddresstheissue?).
Tri-EthnicSurveysMethodologyAIPCandHVHCdevelopedagroupinterviewprotocoltoevaluatethelevelsofcommunityawareness,understanding,andreadinessofNMUPOandheroinuseinAnchorage.ThecommunityreadinessprotocolisattachedinAppendixB.AselectedgroupofHVHCcoalitionmembersandcommunitymemberswasinvitedtoattendoneortwocommunityreadinessassessmentfocusgroups.Theseparticipantswereidentifiedandselectedaskeyinformantsbasedontheirrepresentationofvarioussectorsinthecommunityaswellastheirknowledgeandexperiencearoundtheissues.Eightparticipantsjoinedthegroupfocusedonnon-medicalprescriptionopioidusefor12-17yearolds.Elevenparticipantsjoinedagroupfocusedonnon-medicalprescriptionopioidandheroinusefor18-25yearolds.Thetotalof19keyinformantsjoinedourtwogroupinterviewsrepresentingthefollowingcommunitysectors:youth-servingorganizations,military,lawenforcement,clinicalservices,medicalservices,youth,parents,NativeAmerican,peopleinrecovery,Hispanic,AlaskaNative,faith,andnon-profitcommunities.Thegroupinterviewswereconducted,captured,scored,andanalyzedbyAIPCandHVHCstaff.Theinterviewdiscussionswereanalyzedforkeythemesrelatingtoprioritycommunityfactorsrelatedtoretailavailability,socialavailability,perceptionofriskforharm,andharmreduction.AllinterviewswereindividuallyscoredonthecommunityreadinessscaleusingtheTri-EthnicCenterCommunityReadinessModel.Everykeyinformantscoredeachcommunityreadinessdimension,andthenthescoreswereaveragedforeachdimensionofreadinessforthetwoissues(non-medicalprescriptionopioidusefor12-17yearolds,andnon-medicalprescriptionopioidandheroinusefor18-25yearolds).Thescoresforeachdimensionwerethenaveragedtoarriveatan“overall”communityreadinessscoreforeachissue.
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Table3StagesofCommunityReadinessScale(ColoradoStateUniversity,2014)
StageofReadiness ScoreNoAwareness 1Denial/Resistance 2VagueAwareness 3Preplanning 4Preparation 5Initiation 6Stabilization 7Confirmation/Expansion 8HighLevelofCommunityOwnership 9
V. KeyFindingsExtentoftheProblemintheCommunity
CurrentConsumptionPatterns
Prescriptionopioidmisuse/abuseandheroinuseinAnchoragePrescriptionopioidmisuseandheroinuseareprevalentthroughoutthecommunity.Ourkeyinformantinterviewsrevealedthefarreachtheimpactsofopioidorheroinaddictionhaveonthecommunity,andthatmanypeopleareaffected.
“Mostpeopleknowopioidsaredangerous,thattheyneverwantedlovedonestodoit.Butmanypeopleknowsomeonewhodoes.[…]Manypeopleusingheroindidn’tstartthere.Thecommunityhasmoresympathyforopioidandheroinusersthanotherdrugsbecauseweallknowsomeone.”(KeyInformant,February2017)
Basedonourkeyinformantinterviewswithpeopleinrecoveryandouropen-endedsurveysfromcurrentusers,therewasaroughlyevensplitbetweenpeoplebeinginitiallyintroducedtoopioidsforbothrecreationalandmedicalpurposes.Peoplealsosharedthatiftheywereusingprescriptionopioidstheywouldoftenbothuseandsellthemtoothers.Figure3IntroductiontoOpioidsforRecreationalandMedicalUse
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Therewerevaryingopinionsofwhatconstituted“misusingprescriptionopioids.”Somethoughtitwaswhenapersonfirstbeginstousethembeyondmedicalrecommendations,othersbelieveditwaswhentheopioidswerenottreatingpain,andothersbelieveditwasassoonasadependencyisestablished.
“Ithinkitishighlylikelythatsomeonewhoismisusingopioidsrunstheriskofbecomingaddicted.Thisdrugisquicktoclaimitsnextvictim.[…]Childrendon’tunderstandhowthisdrugworksandhowquicklyitcantakeovertheirlives.Oncetheyareinthestagesofneedingit,it’shardtogothroughthewithdrawal.”(KeyInformant,February2017)
Figure4SummaryofThemesforWhenTakingPrescriptionOpioidsisRisky
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Onceapersonhasaccesstoprescriptionopioidsthereisariskatbecomingaddicted.Basedonourkeyinformantinterviews,therewerenumerousreasonsthatmayleadpeoplewithinAnchoragetobeginoverusingprescriptionopioids.Figure5SummaryofThemesforReasonsPeopleBeginOverusingPrescriptionOpioids
UseofprescriptiondrugsbyyouthDatafromtheYRBSrevealsseveraltrendsfortheuseofprescriptiondrugsbyyouth12-17yearsofage.ItisimportanttonotethatthequestionontheYRBSsurveydoesnotdifferentiatebetweendifferentkindsofprescriptionsdrugsandmaynotsolelycaptureopioiduse.Figure6showstrendsinprescriptiondrugusewithoutaprescriptionovertimebasedongenderandgradelevel.Basedongender,thereisanear-evenpercentageofmalesandfemalesthatuseprescriptiondrugsatjustunder8%forbothgenders.Basedongradelevel,useofprescriptiondrugsincreasesovergradelevelsandageofyouth.
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Figure6AnchorageYouthPrescriptionDrugUse
YouthRiskBehaviorSurveillancedataprovidedbyPFSDETAL.Manyofourkeyinformantsbelievethecommunityhasmorecompassiontowardyouthwhofallvictimtoaddiction.
“Peoplehavetounderstandthatthesekidsdon’tplanontakingthesepillstobecomeaddicts,andiftheycouldgobackandundothefirsttimetheystartedIdon’tknowofanyonewhowouldhavecontinuedtokeeptakingthesepills.”(KeyInformant,February2017)
UseofprescriptiondrugswithoutaprescriptionbyyouthDatafromtheYRBSrevealsseveraltrendsfortheuseofprescriptiondrugswithoutaprescriptionbyyouth.Itisimportanttonotethatthisquestiondoesnotdifferentiatebetweendifferentkindsofprescriptionsdrugsandmaynotsolelycaptureopioiduse.Figure#showstrendsinprescriptiondrugusewithoutaprescriptionovertime.UseofprescriptiondrugswithoutaprescriptionbystudentsinalternativehighschoolsinAlaskawasover40%,in2011,comparedto16.9%forallAlaskanhighschoolyouth(Hull-Jilly&Casto,2011).
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Figure7AnchorageYouthPrescriptionDrugUse
YouthRiskBehaviorSurveillancedataprovidedbyPFSDETAL.
30DayUseAnestimated7.5%ofAnchoragehighschoolstudentshadtakenaprescriptiondrugwithoutaprescriptionfromadoctoroneormoretimesduringthepast30days.Ratesofuseinthepast30daysrangefrom4.2%in9thgradetomorethandoublethatin12thgrade(11.0%).Therewasnodifferenceinpast30-dayuseformalesandfemales(7.5%).Forthisassessment,studentswhodidnotidentifyaswhiteorAlaskaNativewerecategorizedas“OtherRaces.”ComparedtowhiteandAlaskaNativestudents,theOtherRacesgroupsawthehighestrate(9.7%)ofprescriptiondrugusewithoutaprescription.Therewerealsodifferingratesofpast30-dayusebyacademicperformance.Approximately12%ofstudentswithprimarilygradesofC,D,orFreportedpast30-dayusecomparedto5.5%ofstudentswithgradesofprimarilyAorB.Thisdatashowsthatthereisagreaterrateofnon-prescriptiondruguseamongstudentsnotidentifyingaswhiteorAlaskaNative,studentsprimarilyreceivinggradesofC,D,andF,andupperclassmen.Table4Past30DayPrescriptionDrugUseWithoutaPrescription,YRBS2015
Estimate 95%ConfidenceIntervalAlaskaTotal 6.4 5.1 8.0AnchorageTotal 7.5 5.7 9.8Sex Male 7.5 5.1 10.8Female 7.5 5.4 10.4
0
2
4
6
8
10
12
14
16
18
2011 2013 2015
Percen
tage
TrendsinPrescrip\onDrugUseWithoutaPrescrip\onbyYear,YRBS2011-2015
30Day
Lifevme
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Race/Ethnicity White(Non-Hispanic,SingleRaceOnly) 5.9 3.9 8.8AlaskaNative 7.4 4.0 13.2OtherRaces/Refused/Missing/Unknown 9.7 6.9 12.5Grade 9thGrade 4.2 2.7 6.710thGrade 6.9 4.1 11.611thGrade 8.6 5.3 13.812thGrade 11.0 7.0 17.0AcademicGrades MostlyAsandBs 5.5 3.8 7.9MostlyCs,Ds,andFs 12.1 8.6 16.8
LifetimeUseDatafromthe2015YRBSindicatethat15.0%ofAnchorageSchoolDistrictstudentshadtakenaprescriptiondrugwithoutaprescriptionfromadoctorduringtheirlife.Accordingto2015YRBSdata,theratesforlifetimeusebyfemales(15.6%)wasnotsubstantiallydifferentcomparedtomales(14.3%).Therewaslittledifferenceinprevalenceforlifetimeusewhencomparingracial/ethnicgroups.AlaskaNativeandstudentsnotidentifyingaswhiteorAlaskaNativeeachhadapproximately16%lifetimeuseofprescriptiondrugswithoutaprescription,and13.7%ofwhitestudentsreportedlifetimeuse.Therewasagreaterrateoflifetimeuseforupperclassmencomparedtounderclassmen.Justover10%ofhighschoolfreshmanand12%ofhighschoolsophomoresreportedlifetimeuse.Highschooljuniorshadthehighestlifetimeuseratein2015at19.6%and18.9%ofhighschoolseniorsreportedlifetimeuse.Approximately21.5%ofstudentswithprimarilygradesofC,D,orFreportedlifetimeuseofanon-prescribedprescriptiondrugcomparedto12.4%ofstudentswithgradesofprimarilyAorB.Thisdatashowsthatthereislittledifferenceinlifetimeusebetweenmalesandfemales,orstudentsofdifferentracial/ethnicgroups.Thereare,however,differencesinlifetimeusebygradeyearaswellasbyacademicperformance.Table5LifetimePrescriptionDrugUseWithoutaPrescription,YRBS2015
Estimate 95%ConfidenceIntervalAlaskaTotal 14.6 12.5 17.1AnchorageTotal 15.0 12.6 17.7Sex Male 14.3 11.7 17.4Female 15.6 12.1 19.9Race/Ethnicity White(Non-Hispanic,SingleRaceOnly) 13.7 10.2 18.3AlaskaNative 16.3 11.0 23.4
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OtherRaces/Refused/Missing/Unknown 16.1 12.9 19.9Grade 9thGrade 10.3 7.6 13.810thGrade 12.3 8.6 17.111thGrade 19.6 14.6 25.912thGrade 18.9 12.8 26.9AcademicGrades MostlyAsandBs 12.4 9.9 15.5MostlyCs,Ds,andFs 21.5 17.2 26.5
UseofheroinbyAnchorageyouthTheYRBSasksstudentsaboutlifetimeheroinuse.Anestimated1.6%ofstudentsreportedeverhavingusedheroin.Table5showslifetimeuseofheroinforstudentsinAnchoragehighschoolsbysex,race/ethnicity,gradelevel,andacademicgrades.
Table6LifetimeUseofHeroin,YRBS2015
Estimate 95%ConfidenceIntervalAlaskaTotal 2.2 1.3 3.5AnchorageTotal 1.6 .9 2.9Sex Male 2.6 1.4 4.7Female 0.6 0.2 1.8Race/Ethnicity White(Non-Hispanic,SingleRaceOnly) 1.1 0.5 2.6AlaskaNative 0.8 0.2 4.3OtherRaces/Refused/Missing/Unknown 2.6 1.2 5.4Grade 9thGrade 0.8 0.2 2.810thGrade 1.7 0.6 4.711thGrade 3.1 1.3 7.212thGrade 1.1 0.3 3.7AcademicGrades MostlyAsandBs 1.0 0.4 2.1MostlyCs,Ds,andFs 2.9 1.3 6.3
Nonmedicaluseofpainrelieversinthepastyearbyyouthandyoungadults
AccordingtotheNationalSurveyonDrugUseandHealth(NSDUH),therehasbeenanincreaseinthenonmedicaluseofpainrelieversamong18-25yearoldsinAnchorage,from11.79%to
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12.35%from2006/2008to2012/2012(Heath,etal.,2015).ReportedratesofusearegreaterinAnchoragethanAlaska’sstatewiderate(11.78inthe2010/2012survey)andgreaterthantheU.S.rate(10.29inthe2010/2012survey).Theratesfor12-17yearoldswere7.2%in2010/2012inAnchorage.ThisisgreaterthattheStatewiderate(6.41)andthenationalrate(5.85)inthe2010/2012survey.Table7SubstanceUseandDependenceAmongstYouthbyAgeGroup(2010-2012)
Behavior* Anchorage Alaska UnitedStatesAges12-17 NonmedicalUseofPainRelievers 7.2% 6.41% 5.85%Ages18-25 NonmedicalUseofPainRelievers 12.53% 11.78% 10.29%Note.TablecreatedfromdataretrievedbyHeathetal.,2015,fromNSDUH.*Referstosubstanceuseordependenceintheyearprecedingsurvey.
WithadditionalinformationgatheredfromPRIMEforLifeparticipantsurveys,itisimportanttonotethatprescriptiondrugsarethethirdmost-usedsubstanceaftermarijuanaandalcohol.ManyoftheyouthparticipatinginPRIMEforLifeself-reportedthattheybeganusingprescriptiondrugsattheaverageageof14. Figure8PRIMEForLifeSummaryData
DataprovidedbyVolunteersofAmericaHealthyVoicesHealthyChoices.
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PrescriptiondrugmisuseandabuseatUniversityofAlaskaAnchorageThe2015UAADrugandAlcoholsurveyalsoshowsprescriptiondruguseontheriseoncampus.Ofthe4,000studentswhorespondedtothesurvey,6.6%reportedusingsedativesonceaweekand4.2%reportedusingsedativesthreeormoretimesaweek(Heath,etal.,2015).Lawenforcementdatashowillegaluseofpharmaceuticalsisagrowingconcern,hydrocodoneandOxyContin/oxycodoneabuse,inparticular.
ConsequencesofOpioidMisuseandHeroinUse
CommunityPerceptionsofConsequences
“Idon’tknowanyonewhohasstartedtotakethis[opioid]medicationthatbegantomisuseitbutdidn’tsuffertheconsequencesoftheirhealth,familylife,friendships,school,andfuturedestroyedbythis.”(KeyInformant,February2017)
Figure9SummaryofConsequencesofOpioidMisuseandHeroinUse
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MorbidityFrom2004-2013,40hospitalizedpatients,ages9-24,testedpositive,foropiates.Thisrepresents1.3%ofallpatientsinthisagegroupwhoweretestedfordrugs(n=2993)and4.2%(n=954)ofallpatientsinthisagegroupwhotestedpositive.AnEpidemiologyBulletinproducedbytheStateofAlaskarevealedthattherateofhospitalizationsrelatedtoheroinpoisoninginAlaskanearlydoubledfrom2008-2012(Hull-Jilly,Frasene,Gebru,&Boegli,2015).
MortalityDatacollectedfromtheAlaskaBureauofVitalStatisticsmortalitydatabase,showsthatfrom2009-2015,therewere774drugoverdosedeaths.400ofthesedeathswerefromopioidpainrelieversand128wereheroinrelated.Ofthe311thenumberofaccidentalpoisoningdeathsdoubledfrom66in2005to133in2012(Strayer,Craig,Asay,Haakenson,&Provost,2014).Poisoningdeathsinclude,butarenotlimitedto,unintentionaloverdosesfromdrugs.ThenumberofheroinoverdosedeathsinAlaskaincreasedbyafactoroffourfrom2008-2013(Hull-Jilly,Frasene,Gebru,&Boegli,2015).Seventy-fivepercentofallheroin-associateddeathinAlaskafrom2008-2013occurredinAnchorageandtheMatanuskaSusitnaregions(Hull-Jilly,Frasene,Gebru,&Boegli,2015).From2007-2011,Anchoragehad257unintentionallydruginduceddeaths,whichwas49%ofallsuchdeathsintheState.Thisisarateof17.1per100,000andwas25percenthigherthanthenationalaverageof12.9per100,000(Hull-Jilly,Frasene,Gebru,&Boegli,2015).PoisoningwastheleadingcauseofunintentionalinjurydeathsforAlaskaNatives/AmericanIndiansintheAnchorageMat-Suareafrom1992-2011at21%.ThesecondleadingcauseofinjurydeathforAlaskaNatives/AmericanIndiansduringthistimeperiodweremotorvehiclecrashes,meaningthattherewere20%morepoisoningdeathsthanmotorvehicledeathsduringthistimeperiod(Strayer,Craig,Asay,Haakenson,&Provost,2014).
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Figure10AlaskaHeroinOverdoseDeaths,2009-2015
http://www.epi.alaska.gov/bulletins/docs/b2016_06.pdfFigure11SummaryofAlaskaOverdoseDeathsFromPrescriptionOpioidsandHeroin,2015
http://www.epi.alaska.gov/bulletins/docs/b2016_06.pdf
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RatesofHospitalizationsrelatedtoprescriptionopioidsTable8PrescriptionOpioid-RelatedERDischarges
N %TotalERDischarges 121,232 100.0% PrescriptionOpioid-RelatedERDischarges 568 0.5%Poisonings 29 5.1%OtherERDischarges 539 94.9%Gender Male 271 80.4%Female 297 19.6%Age 12-17YearsOld 7 0.0%18-25YearsOld 101 33.9%OtherAge 460 66.1%Race White 400 70.4%AKNative 100 17.6%AllOtherRaces 55 9.7%Other 13 4.8%Note.AnchorageMunicipalityhealthfacilitiesdischargedataprovidedbyDETAL
Table9PrescriptionOpioid-RelatedERDischarges
N %PharmaceuticalERPoisoningDischarges 458 100.0% PrescriptionOpioidERPoisoningDischarges 29 6.3%Gender Male 10 34.5%Female 19 65.5%Age 12-25YearsOld 8 27.6%OtherAge 21 72.4%Race White 17 58.6%AllOtherRaces 12 41.4%Note.AnchorageMunicipalityhealthfacilitiesdischargedataprovidedbyDETAL
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Figure12SummaryofAnchorage2015OpioidERPoisoningDischarges
HospitalfacilitydischargedataprovidedbyPFSDETAL.Figure13SummaryofAnchorage2015HeroinERPoisoningDischarges
HospitalfacilitydischargedataprovidedbyPFSDETAL.
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HepatitisCVirusTheHepatitisCvirusinfection(HCV)isthemostcommonchronicbloodborneinfectionintheUnitedStates.HepatitisCisacontagiousliverdiseasethatresultsfrominfectionwiththeHCVandcanrangeinseverityfromamildillnesslastingafewweekstoaserious,lifelongillness.HepatitisCusuallyspreadswhenbloodfromapersoninfectedwiththeHCVentersthebodyofsomeonenotinfected,oftenthroughtheuseofsharingneedlesorotherequipmenttoinjectdrugslikeheroin.ThereisnovaccineforHepatitisCsopreventionisthebestavenuetoavoiditsspread,likeabstainingfrominjectingdrugs(AlaskaDepartmentofHealthandSocialServices,2016).TheStateofAlaska’sSectionofEpidemiology(SOE)reportedatotalof5,888HCVcasesduring2011-2015.ThenumberofHCVcasesroseconsiderablyforallagegroupsinthatperiod,butmostsignificantlyforpeoplebetweentheages18-29(from228to459,a100%increase).Mostcases(55%)weremale,butamongtheagerangeof18-29years,mostcases(53%)werefemale(AlaskaDepartmentofHealthandSocialServices,2016).WithinAnchorage,theoverallrateofpeoplehavingtheHCVis161per100,000people;therateamong18-29year-oldsis221per100,000people,whichisa100%increase(AlaskaDepartmentofHealthandSocialServices,2016).
CostsTheaveragecostforahospitalizedheroinpoisoningwasapproximately$30,000.IncreasesinHepatitisCinfectionsareassociatedwiththesharingofsyringesforheroinorotherintravenousdruguse.ThetreatmentofHepatitisCforonepersoncosts$81,000throughMedicaid(FourA's,2017).
MotorVehicleImpairedDrivingIn2009,justover10%ofDUIcitationsinwhichnon-alcoholrelatedtoxicologytestswereconductedwereissuedduetoopiateuse(AlaskaHighwaySafetyOffice,2009).DrugRecognitionExpert(DRE)evaluationsrevealedthat52driversoutof299impaireddriversin2008wereundertheinfluenceofnarcoticssuchasheroin,oxycontin,orotheropioids(AlaskaHighwaySafetyOffice,2008).TheDREprogramisbeingrevitalized.Itwillbevaluabletogetupdatedinformationwhenitbecomesavailable.
JuvenileDrugOffensesThenumberofjuvenilesarrestedforadrugoffenseincreasedfrom272in2007to353in2011;thismarkeda29%increaseinjuveniledrugoffensearrestsinAlaskaduringthistime(Hull-Jilly,Frasene,Gebru,&Boegli,2015).Keyinformantinterviewsfoundthattherearespecificchallengeswithyouthinthejusticesystemandlinkstodruguse.Someyouthwithinthejuvenilejusticesystemexperiencecognitivedelays,whichthenchallengesthemtounderstandthelong-termconsequencesoftheircurrentactions.Forexample,itmaybechallengingtoconnectthataddictionanditsconsequencescanresultfromtakinganopioidpillforshort-termreliefnow.Thismakesit
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challengingforyouthtomakethebestdecisionsforthemselvesspecificallywithinthispopulation.
StatewideSeizures,Charges,andArrestsandCrimeFrom2009to2011arrestsandchargesinAlaskarelatedtoheroinnearlydoubledfrom64to118respectively.Statewide,thepoundsofheroinseizedalsonearlydoubledfrom3.3poundsin2009to6.4poundsin2011(Hull-Jilly,Frasene,Gebru,&Boegli,2015).In2014,theAlaskaStateTroopersreport209arrests/chargesand22.4poundsofheroinseized(AlaskaStateTroopers,2015)In2015therewere233heroinrelatedarrestsinAlaska.In2012,141Hydrocodoneand609OxyContin/Oxycodonedoseswereseized.Thesenumberssawlargeincreasesto796and1183respectivelyin2014(AlaskaStateTroopers,2015).Locally,theAnchoragePoliceDepartmentseized2.78kilosofheroinin2011.Thatnumberincreasedto2.92in2012,5.67in2013and6.9in2014.The2014seizurehadastreetvalueof$3,441,785dollars.In20154.2kilosofheroinwereconfiscatedwithastreetvalueof$1,054,997.APDseized1050Oxycodone,Oxycontin,andhydrocodonedosesinAnchorage,withastreetvalueof$196,900.(AlaskaStateTroopers,2015)Anchoragehasseenanincreaseinallkindsoftheftfrom2014-2015,asreportedbyAnchoragePoliceDepartment.In2014therewere496reportedrobberies,1375burglaries,2768theftsand939reportsofstolenvehicles.In2015,thosenumbersincreasedto621reportsofrobberies,1885burglaries,8962theftsand1154vehiclesreportedstolen.Arrestsforpossessionofnarcoticsrosefrom97in2014to132in2015.(McClure&Monfreda,CrimeinAlaska2015,2015)(McClure&Monfreda,UniformCrimeReportingProgram,2014).
ImpactstoFamiliesBasedonourkeyinformantinterviews,therearemanypersonalchallengesnotonlytoapersonmisusingopioidsorheroin,butalsototheirfamilyandclosefriends.Ourkeyinformantinterviewssharedthemesthatafteraddictionpeoplemaybecomehomeless,jobless,losefamilyandfriendconnections,mayleadtojail,sexualexploitation,ordeath.Onechallengekeyinformantssharedwasthatapersonmaynotknowthefullextentoftheconsequencesuntilitistooclose,includinglosingtheirchildrentotheOfficeofChildren’sServicesorbecominghomeless.Arecentanalysisof2004-2015datafoundthattheincidenceofNeonatalAbstinenceSyndrome(NAS)isincreasingbothnationallyandinAlaska(AlaskaDepartmentofHealthandSocialServices,2016).NASisprimarilyassociatedwithprenatalexposuretoopiates.Prenataluseofopioids,whichincludeheroinandotherprescriptiondrugs,isincreasingnationally,resultinginanassociatedincreaseinNAS.InAlaska,healthcareprovidersareresponsibleforreportingNASinfantstoOCStoassessthesafetyofthehomeenvironmentandpossiblyintervene(AlaskaDepartmentofhealthandSocialServices,2017).
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RealConsequencesofNMUPOasdescribedbyactiveusersParticipantswereaskedtoidentifyconsequencesthattheyhadseenfromindividualsusingopioidsbeyondmedicalrecommendations.Consequenceswerevaried,oftenserious,andincluded:addiction,overdose,poorhealth,losingfamilyandfriends,losingjobs,homelessness,lossofnormallife,jail,anddeath.Didyouknowabouttheseconsequencesbeforeyoustartedusing?Afterbeingaskedtoidentifyconsequencestheyhadseenfromprescriptionopioidmisuse,participantsfromthefirstroundofsurveyswereaskediftheyhadbeenawareoftheseconsequencesbeforetheystartedusing.Overhalfofthoseaskedindicatedthattheydidnotknowabouttheconsequences.Ofthosethatsaidyes,theydidknowoftheconsequencesbeforetheystartedusing,severalindicatedthattheydidnotfullyunderstandthedepthandimpactoftheconsequences.Participantsfromthesecondroundofsurveyswereaskedtoidentifywhichconsequencestheyknewaboutbeforetheystartedusing.Justoverhalfofrespondentsknewthatjailandpoorhealthwereconsequencesofusingprescriptionopioidsbeyondmedicalrecommendations.Underahalfofrespondentsknewthatlossofnormallife,losingajob,homelessness,andlosingfriendswerepotentialconsequences.Approximatelyonethirdofrespondentsknewthatlosingfamilycouldbeaconsequenceofmisusingprescriptionopioids.Howlikelydoyouthinkitisthatpeoplewhouseopioidsbeyondrecommendationwillfacetheseconsequences?Almostallrespondentsindicatedthatitisverylikelyorguaranteedthatapersonwhomisusesprescriptionopioidswillfaceconsequences.Whichconsequencesmighthavepersuadedyoutonotstartusing?Themajorityofrespondentsindicatedthatlossoffamilymighthavepersuadedthemfromnotusing.Lossoffriends,jail,andhomelessnesswerealsocommonresponses.Afewsurveyparticipantsmentionedthathavingaccesstomorecommunityevents,parks,andactivitiesandabettercommunityenvironmentmighthavehelpedpreventopioidmisuse.Afewrespondentsalsoindicatedthatbeingmoreeducatedabouttheeffectsofprescriptionopioidsmighthavepreventedthemfrommisusingthem.Somerespondentsindicatedthatnoneoftheconsequencescouldhavepersuadedthemfromnotusing.
RealConsequencesofheroinuseasdescribedbyactiveusersWhatconsequenceshaveyouseenfromheroinuse?
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Theconsequencesofheroinuseasdescribedbycurrentuserswereserious.Consequencesincludedlossoffamilyandfriends;loseofjob,homelessness,poorhealth,lossofnormallife,dependency,overdose,anddeath.Whichoftheseconsequencesdidyouknowaboutbeforeyoustartedusing?Theoriginalsurveycontainedaquestionaboutwhichconsequencestheyknewofbeforebeginningtouseheroin.Responsesincludedlossoffamily,lossoffriends,poorhealth,overdose,physicaldependency,abscess,jail,andlossofpossessionsandhome.Themodifiedsurveyprovidedrespondentswithoptionstoselectfrom.Theseoptionsincludedlosingfamily,losingfriends,losingjobs,homelessness,poorhealth,lossofnormallife,andjail.Themajorityofrespondentswereawareofatleastsomeoftheconsequencesofheroinusebeforeinitiatinguse.Roughlyone-fifthofrespondentsfromall50surveyswerenotawareoftheconsequencesofheroinusebeforetheybeganusingheroin.Severalrespondentsindicatedthatwhiletheyhadbeenawarethattherewereconsequencesofheroinuse,theydidnotfullyrealizetheextentoftheconsequencesuntiltheyhadexperiencedthemthemselves.Howlikelydoyouthinkitisthatpeoplewhouseheroinwillfacetheseconsequences?Almostallrespondentsindicatedthatitisverylikelythatapersonwhousesheroinwillfaceconsequencesliketheonesreferencedinthepreviousquestions.Whichconsequencesmighthavepersuadedyoutonotstartusing?Whenaskedwhichconsequencesmighthavepersuadedthemfromnotusingheroin,lossoffamilywasthemostcommonresponse,followedbyjail.Lossoffriends,death,homelessness,andexperiencingwithdrawalwerealsofrequentresponses.Afewrespondentsindicatedthatlossofnormallifemighthavepersuadedthemfromnotusing.Somerespondentsindicatedthatnoneoftheconsequencescouldhavepersuadedthemfromnotusing.Whatotherthingsthatcouldhavepreventedyourheroinuse?Heroinuserswereaskedwhatotherthingsmighthavepreventedthemfromusingheroin.Commonresponsesincludedhavingfamilyandfriendsprovidesupportandoutreachmay
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havepreventedthemfromusingheroin.Severalrespondentsalsopointedtopasttrauma,familyinstability,ormentalhealthissuesasleadingthemtoheroinuse.Tworespondentsindicatedthattheytransitionedfromopioidusetoheroinuse.Oneoftheseparticipantsrespondedthatbeingcutoffcoldturkeyfromprescriptionopioidsmadethemseekoutheroin.
CommunityFactorsassociatedwithSocialAvailabilityofheroinandprescriptionpainrelievers
AccesstoheroinandprescriptionsopioidsinAnchorageObtainingPrescriptionOpioidsForcurrentusers,thetwomostfrequentlymentionedmeansforobtainingprescriptionopioidswerethroughthestreetorthroughaprescriptionfromdoctors.Obtainingdrugsfromthestreetwasoftenmentionedasnetworking,orthroughword-of-mouth.Afewrespondentsindicatedfakingscripts.Dealers,friends,andstealingfromfamilyandstrangerswerealsocommonresponses.ObtainingHeroinWhenaskedhowcurrentusersorpeopletheyknewobtainedheroininAnchorage,themajorityrespondedwitheitheradealerorthestreet.Otherresponsesincludedfromfriends,strangers,and,inafewinstances,familymembers.
SafeStorageAthemeemergedfrominterviewswithkeyinformantsthatmanypeopledonotthrowawayunusedprescriptionmedication.Stockpilingofunuseddrugs“foranotherday”isacommonpracticethroughoutAnchorage.Fromacitywidesurvey,nearlyhalf(47%)ofallcommunitymembersreportedthattheystillhavetheirunusedprescriptionopioids.Aquarterofrespondentsreportedthattheydidnothaveanymedicationremainingsodidnothavetodisposeofthem.However,thatleavesaremaining29%ofrespondentsthatdisposedofthemeitherbythrowingtheminthetrash(8%),flushingthemdownatoilet(11%),bringingthemtoa“takeback”(2%),andtheremaindergavethemaway(8%).
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Figure14SummaryofWhatPeopledoWithExcessPrescriptionOpioids
DataprovidedbyPFSDETAL.Surveyof212Anchorageresidentsaged18-27.Currentmisusersofprescriptionopioidswhoparticipatedinthesurveysat4’s,discussedwhatsafestoragemeanstothem.Themajorityofrespondentsindicatedthattheyneededtobeinasafeorlockbox.Afewindividualsalsoindicatedthattheyshouldnottellanyonethattheyhaveaprescriptionforopioids.Whenaskedwhattheywoulddoifprescriptionopioidswereunavailable,mostrespondentssaidtheywouldmovetoheroin,anotherdrug,orcontinuetosearchforopioidsuntiltheycouldfindthem.Asmallnumberofsurveyrespondentsindicatedthattheywouldenterdetoxortrytostopusingprescriptionopioidsalltogether.Manyactiveheroinusersarealsomisusersofprescriptionopioids.Whenaskedwhattheywoulddoifprescriptionopioidsweresecurelystored,mostsaidtheywouldseekother
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drugs.Severalpointedoutthattheywoulddoanythingtoavoidexperiencingwithdrawal.Asmallnumbersaidtheywoulddetoxandgetclean.Interviewswithkeyinformantsfoundthatadultswerealsonotlikelytobedeterredifopioidsweresimplyunavailable.Many,includingpeopleinopioidrecovery,saidthatiftheywereaddictedandopioidswerenotavailabletheywouldsimply“findsomethingelsetouse”(KeyInformant,January2017).Open-endedsurveyswithactiveusersreinforcedthismessage,thatsomeonewithanaddictionwilldo“whateverittakestonotbesick.”IntheAdultPerceptionsofAnchorageYouth(APAY)asurveyinitiatedbyHVHCandwithDr.MarnyRiveraattheUniversityofAlaskaAnchorageastheprincipalinvestigator,adultsinAnchoragewereaskedquestionsaboutprescriptiondrugsintheirhomeandyouthaccesstotheirprescriptiondrugs.Seventy-fourpercentofadultsinAnchorageindicatedthattheyhaveprescriptiondrugsinthehome.WhilemostAnchorageadultshaveprescriptiondrugsinthehomefifty-fivepercentindicatedthatchildreninthehomedonotknowprescriptiondrugsareinthehomeandanothersixpercentdidnotknowwhetherchildreninthehomeknewtherewereprescriptiondrugs.Themajorityofadults(87%)agreedthatitisnecessaryforparentsorguardianstotakestepstokeepchildrenandyouthfromhavingaccesstoprescriptiondrugsinthehome.AdultsinAnchoragewerealsoaskedaboutseveralstepsthatcouldbetakentoreduceyouthaccesstoprescriptiondrugsinthehome.Lessthanhalfoftheadultsengagedinanyofthefouractivitiestheywereaskedabout.ThemostcommontechniquesusedbyadultsinAnchorageforreducingyouthaccesstoprescriptiondrugsincludedhidingthepills(49%)andkeepingtrackofthenumberofpills(48%).Theleastcommontechniquesusedbyadultsforreducingyouthaccesstoprescriptiondrugsincludedkeepingthepillswiththemwhentheyleavehome(21%)andlockingthepillsup(35%).“Other”methodsforpreventingyouthaccesstoprescriptiondrugssuggestedbysurveyrespondentsincludededucatingyouthaboutprescriptiondruguse,makingprescriptiondrugsinaccessibletoyouth,anddiscardingprescriptiondrugsassoonastheprescriptionhasexpired.Across-tabulationanalysisofAdultPerceptionsofAnchorageYouthsurveydatashowedthatparents(of12-24yearolds)weresignificantlylesslikelythanotheradultsinAnchoragetotakevariousstepstoreduceyouthaccesstoprescriptiondrugsinthehome.Fifty-twopercentofadultshideprescriptionmedicationswhileonly40%ofparentsdid.Whereas35.6%ofadultsreportedthattheylockuptheirpills,only26.2%ofparentsdid.Twenty-threepercentofadultsreportedthattheykepttheirprescriptionmedicationswiththemwhileonly14%ofparentsdid(HVHCdata).
HowYouthAccessPrescriptionOpioidsYouthwhoparticipatedinthePrimeForLifeevaluationsurveyreportaccessingprescriptionopioidsfromafriend,takingthemfromafamilymemberandpayingsomeoneforthem.
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Severalmentionedgettingthematschool.Thetwomostcommonresponsesweretakingthemfromafamilymemberandgivingsomeonemoneyforthem.Communityperceptionwasgatheredondruguseandmisuse.HVHC’smemberssurveyed100communitymembersin2015byaskingopenedendedquestions.Questionsaskedincluded“Howdoyouthinkyoungpeopleareaccessingprescriptiondrugsinourcommunity?"Thesurveyfoundthatanswerstothequestion,confirmourassumptionthatyouthareobtainingthemfromsomeonetheyknow,especiallyfriendsandfamilymembers.Themostfrequentlyrecordedanswerwasparents’homefollowedbyfriends,thenfollowedbyparents,siblings,family,andacquaintancesingeneral.
DrugTake-BackEventsPrescriptionDrugTake-BackeffortshaveoccurredinAnchoragewithleadershipprovidedbyHVHC.TheAnchorageDEAisanactiveparticipantintheHVHC’sDrugTakeBackcommittee.TheprescriptiontakebackeffortsthroughoutAlaskahaveresultedinasignificantamountofsafedisposalofdrugs.HVHCandAIPCstaffrecentlymetwithDEAstaffandHVHC'sTakeBackworkgroup.ThereisrenewedinterestandcommitmenttoconductingTakeBackevents.ThenextonewillbeinlateApril,followedbyafallevent.TakeBackeffortsareapowerfulawarenessraisingtool,andwillhelpelevatecommunityrecognitionoftheproblemaswellasreadinesstoplanandimplementpreventionstrategies.Table10AmountofDrugsCollectedThroughAnchorageDrugTakeBackEvents
Eventdate AmountofdrugscollectedinpoundsSeptember25,2010 1336.00April30,2011 1603.60October29,2011 1877.66April28,2012 2722.41September29,2012 1838.00April2013 3931.00Fall2013 2763.00
CommunityFactorsthatContributetoRetailAvailabilityOpioidUseInitiationHalfoftheadultsurveyparticipantswhoareactivelymisusingprescriptionsopioidsindicatedthattheybeganusingprescriptionopioidstogethigh.Theotherhalfrespondedthatusebeganafterreceivingaprescriptionfromadoctorforpost-surgerypain,asportsinjuryoranemergencyroomvisitorfromadentist.
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Howdidyoustarttakingopioids?
nRecreationalUse 24Surgery 12SportsInjury 6MedicalCare 4EmergencyRoom 4Dentist 3
FromUsetoMisuseResponsestothequestion“Atwhatpointdoyouthinkusingprescriptionopioids,beyondmedicalrecommendations,becomesdangerous?”werevaried.Manysurveyrespondentsindicatedthattakingprescriptionopioidsatanypointbeyondmedicalrecommendationsisdangerous.Otherrespondentsreferenceddependencyasthepointatwhichitbecomesdangerous.Takingprescriptionopioidswhennotinpainorusingthemrecreationallywerealsoindicatedasdangerous.MisusingPrescriptionCommonresponsesforreasonsformisusingprescriptionopioidswereenjoyingorwantingtoexperiencethehigh,increasedtolerancetoprescriptionopioids,prescribeddosagenotbeingadequateforpain,experiencingpersistentpain,andtheexperienceofphysicalwithdrawalsymptoms.Afewrespondentsalsoindicatedatraumaticexperienceascatalystorunderlyingreasonforabusingprescriptionopioids.
LackofMandatoryPrescriptionDrugMonitoringProgramVoluntaryPDMPparticipationallowsunsupervisedoverprescribing.Inarecentconversation,itwasreportedthatdoctorsaresometimespersuadedtoprescribemorethanthestandardofcareamounttohelpapatientavoidpayingtheco-paytwiceiftheyneedarefill.Keyinformantsstressedthatprescribersmaybeinthechallengingpositionofnotknowinghowmuchprescriptionopioidsapatientistaking,especiallyiftheyareseekingmultipleprescriptionsfromdifferentdoctors.
Hospital“SatisfactionScores”Keyinformantinterviewsalsorevealedthat“hospitalsatisfactionscores”drivemanyprescribers.TheHospitalConsumerAssessmentofHealthcareProvidersandSystemssurvey,orHCAHPS,wasthefirstnational,standardized,andpublicallyreportedsurveyofpatients’perspectivesonhospitalcare.Thesescoreswerefirstusedin2006bytheCentersforMedicareandMedicaidServices(Adams,Bledsoe,&Armstrong,2016).
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TheHCAHPSscoresaredesignedtomeasurepatientperceptionsofhospitalexperienceasonesurrogateforhospitalquality.Basedonpatientsatisfaction,manyhavespeculatedthathigherscoresoccurwithpatientsthataremoresatisfiedwiththehospital’streatmentoftheirlevelsofpain.Focuscentersaround:
HCAHPSQuestion14:“Howoftendidthehospitalorproviderdoeverythingintheirpowertocontrolyourpain?”(CentersforMedicareandMedicaidServices,2016).
Manyphysiciansseetheirpatientsatisfactionscoresinpatientsurveysdecreaseasaresultofchangesintheirprescribingpractices,whichaffectcompensationandpromotions.Thequickestsolutiontotreatpainiswithprescriptionopioids.Somefeelthisculturehascontributedtotoday’schallengeswithopioidaddiction,andthatprescribersmayover-prescribetopatientsbydosageandduration.
PainasaFifthVitalSignCultureKeyinformantinterviewswithpharmacistsandprescriberslinkedtoday’sepidemicwithwhattheycall,“painasafifthvitalsign”culture.TheJointCommissionandAgencyforHealthcareResearchandQualitypromotedthemedicalpracticethatnopatientshouldexperiencepain.(Adams,Bledsoe,&Armstrong,2016).Prescribershavetotrusttheirpatientsandprescribeaccordingtothepain;howevertheymaynotknowwhenapatientisaddictedorbreakstrust,puttingtheprescriberintheunwittingpositionofsupportingdangerousbehaviors.
“Weliveinasocietyofinstantfixes,andnobodythink’sit’sOKtoexperiencepainanddiscomfortfromtimetotime,andthat’snottrue.It’sOKtohavethesefeelingsandtofeelthem.I’mjustnotsurewhattheansweris,butwehavetostartdoingsomethingdifferentthanwhatwehavebeendoing.”(KeyInformant,February2017)
AlternativeorNon-DrugTreatmentKeyinformantinterviewswithpharmacistsandprescribersstressedthattherearealternativestoprescribingopioidmedicationthatpotentialpatientshavetherighttobeeducatedonbeforereceivingprescriptionopioids.Variousothertreatmentswereraised,includingmassagetherapy,physicaltherapyoreasternmedicines,suchasacupuncture.Somekeyinformantsalsopointedtotheuseofnon-steroidalanti-inflammatorydrugs(NSAIDs)ratherthanprescriptionopioids.TheseNSAIDsareaclassofdrugsthatprovidesanalgesicandantipyreticeffects,andinhigherdosesalsoprovideanti-inflammatoryeffects.ThesemayincludeIbuprofen,aspirin,andmore.Manycommunitymembersagreetheywouldliketoseeprescriberslookatotheralternativesbeforeprescribingdrugsathigh-riskforaddiction.
“Iwouldliketoseemorenaturalmethodsoftreatment,physicaltherapy,iceorheattreatment,dietandexercisetherapy,andeducationforpeople.[…]Focusontheyoungergenerationtogrowandbuildahealthiergenerationofpeoplewhounderstandthebodyandhowimportantwhatyouputinaffectswhatyougetout.”(KeyInformant,January2017)
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PerceptionsforRiskofHarmBasedonopen-endedsurveysofcurrentusers,approximately60%ofyoungadultsviewtryingprescriptionopioidsonceortwiceasrisky.Eighty-sevenpercentofthosesurveyedalsoperceiveregularlymisusingopioidsasphysicallyorotherwiseharmful.Roughly85%ofyoungadultsviewtryingheroinasrisky.Approximately90%ofthosesurveyedalsoviewusingheroinonceortwiceaweekasposingagreatphysicalharmtoanindividual.
Basedonourkeyinformantinterviews,thereisavaryingrangeofwhenpeoplebelievedangerexistsintakingprescriptionopioids.Amongpeopleinrecoveryfromopioidaddiction,somefeltriskexistsassoonasanopioidprescriptioniswritten,whileothersfeelitisonlydangerouswhenapersonusestheprescriptionbeyondthedoctor’sorders.
“Thefirsttimeapersontakesmedicationnotasdirectedtheycrossalineandbecometheirowndoctor,asiftheyknowhowmuchtotake,whichisdangerousbecausetheydon't.”(KeyInformant,January2017)
Interviewswithpeopleinrecoveryforopioidandheroinaddictionsharedsimilarstoriesthatthoughtherisksaregreat,manyfeelknowingtheriskswouldnotdeteruse.Manyfeltthatthedrugusewastreatingasymptomoftrauma,despair,orotherlifechallenges.Manyalsofeltthat,“Peoplethinkitwon’thappentothem”(KeyInformant,January2017).
PerceptionofriskofharmamongAnchoragehighschoolstudentsTheYRBSasksstudentsabouttheirperceptionofriskofharmfromuseofprescriptiondrugswithoutaprescription.Over80%ofstudentsinAnchoragethinkthereisamoderateorgreaterriskofharmfromuseofprescriptiondrugswithoutaprescription.Whenassessedbysex,agreaterpercentageoffemalestudents(85.5%)believethereisamoderateorgreaterriskof
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harmascomparedtomales(79.2%).ComparedtoAlaskaNativestudentsandstudentsofOtherRaces,agreaterpercentageofwhitestudentsperceiveamoderateorgreaterriskofharmfromprescriptiondrugmisuse.Between82%and84%of10th,11th,and12thgradestudentsperceivetheriskofharmfromprescriptiondrugmisuseasmoderateorgreat.Incomparison,79.5%of9thgradestudentsperceiveamoderateorgreaterriskofharm.Agreaterpercentage(85.4%)ofstudentswithmostlyA’sandB’sperceivetheriskofharmfromprescriptiondrugmisuseasmoderateorgreatthanstudentswithmostlyC’s,D’s,andF’s(74.6%).Lowgradesshouldnotautomaticallybeassumedtomeanthattheyoutharelessintelligentorhavealwaysbeenlowachievingstudents.Trendsinperceptionmatchtrendsinlifetimeand30-dayprescriptiondrugmisuse.Table11Perceptionofriskofharmfromprescriptiondrugmisuseasmoderateorgreater(%)
PerceptionofRisk Moderateor
GreaterGreat
AlaskaTotal 78.7 54.4AnchorageTotal 82.2 55.8Sex Male 79.2 53.5Female 85.5 58.2Race/Ethnicity White(Non-Hispanic,SingleRaceOnly) 88.9 61.2AlaskaNative 77.8 50.2OtherRaces/Refused/Missing/Unknown 75.2 50.9Grade 9thGrade 79.5 52.310thGrade 83.2 58.411thGrade 84.0 54.212thGrade 82.6 58.4AcademicGrades MostlyAsandBs 85.4 59.0MostlyCs,Ds,andFs 74.6 48.1Ourkeyinformantinterviewsrevealedathemethatpeoplethinkdoctor’sprescriptionsaresafe,especiallyyouthwhomaynothavetheeducationaroundaddictionbrainchemistryandaremisinformed.Youthbelieveinstereotypesthat“addicts”or“heroinusers”arejunkiesandnotsomeonetheyknow.Sinceopioidsarenotillegalbutprescribedbyadoctorthatlendstothemisperceptionthatprescriptionopioidsarenotdangerous.
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“Thereisaperceptionthatthosewhoabuseopioidprescriptionsarelosers,ill-educated,unhygienic,cannotholdajob,overallbadpersonratherthan‘regularpersonjustlikeyouandI.’”(KeyInformant,February2017)
Manykeyinformantsalsocitedyoungerpeoplebecomingintroducedtoopioidsthroughsportsinjuriesinmiddletohighschool.Manyalsocitedthatyouthmaybeintroducedtoopioidsas“partydrugs”andmaynotknowwhatpillstheyareexposedto.
PerceptionofriskofharmamongyoungadultsinAnchorageTheYASUScontainedseveralquestionstotheperceptionofriskofharmofopioidandheroinuse.Table13andTable14containdatapertainingtoperceptionofriskfrommisusingopioidsonceortwiceandperceptionofriskofharmfromregularmisuseofopioids.Respondentsrankedthelevelofriskonascalewhere1=noriskand6=greatrisk.Table13showsthatthemajorityofsurveyparticipantsindicatedtherebeingsomelevelofrisktomisusingopioidsonceortwice.Table12Perceptionofriskofharmfromtryingtomisuseopioidsonceortwice
Total AlaskaNative White AllOtherRaces N % N % N % N %1NoRisk 13 6.1 3 10.0 4 3.1 6 11.82 25 11.8 2 6.7 18 13.7 5 9.83 43 20.3 9 30.0 27 20.6 7 13.74 30 14.2 4 13.3 22 16.8 4 7.85 40 18.9 4 13.3 27 20.6 9 17.66GreatRisk 60 28.3 8 26.7 33 25.2 19 37.3Note.TablecreatedusingdatafromHanson,B.L.&Barnett,J.D.(2016)
Table12showsthatjustoverhalf(54.7%)ofyoungadultsaged18-27thatweresurveyedfoundthattheregularmisuseofopioidsonceortwiceariskposedagreatrisk.Table13Perceptionofriskofharmfromregularmisuseofopioidsonceortwiceaweek
Total AlaskaNative White AllOtherRaces N % N % N % N %1NoRisk 10 4.7 4 13.3 1 0.8 5 9.82 4 1.9 0 0.0 3 2.3 1 2.03 12 5.7 2 6.7 5 3.8 5 9.84 22 10.4 3 10.0 12 9.2 7 13.75 47 22.2 4 13.3 30 22.9 13 25.56GreatRisk 116 54.7 17 56.7 80 61.1 19 37.3Note.TablecreatedusingdatafromHanson,B.L.&Barnett,J.D.(2016)
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Table14andTable15showdatafromtheYASUSonyoungadultsinAnchorageperceptionofriskfromtryingheroinonceortwiceandfromregularlyusingheroin.Whencomparedtodataformisusingopioidsonceortwice,amuchgreaterpercentageofadultsidentifyusingheroinonceortwiceasposingagreatrisk.Similarly,ahigherpercentageofyoungadultsidentifyregularlyusingheroinonceortwiceaweekasposingagreatriskcomparedtothesamequestionforopioidmisuse.Table14Perceptionofriskofharmfromtryingheroinonceortwice
Total AlaskaNative White AllOtherRaces N % N % N % N %1NoRisk 9 4.2 3 10.0 4 3.1 6 11.82 8 3.8 2 6.7 18 13.7 5 9.83 10 4.7 9 30.0 27 20.6 7 13.74 22 10.4 4 13.3 22 16.8 4 7.85 31 14.6 4 13.3 27 20.6 9 17.66GreatRisk 131 61.8 8 26.7 33 25.2 19 37.3Note.TablecreatedusingdatafromHanson,B.L.&Barnett,J.D.(2016)
Table15Perceptionofriskofharmfromregularlyusingheroinonceortwiceperweek
Total AlaskaNative White AllOtherRaces N % N % N % N %1NoRisk 7 3.3 3 10.0 1 0.8 3 5.92 5 2.4 1 3.3 2 1.5 2 3.93 5 2.4 0 0.0 3 2.3 2 3.94 10 4.7 1 3.3 4 3.1 5 9.85 24 11.3 3 10. 15 11.5 6 11.86GreatRisk 160 75.5 22 73.3 106 80.9 32 62.7Note.TablecreatedusingdatafromHanson,B.L.&Barnett,J.D.(2016)
StudentperceptionofparentalattitudesAcrossallstudentgroups,between86%and92%ofstudentsfeltthattheirparentsconsiderprescriptiondrugmisuseaswrongorverywrong.
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Table16Studentperceptionthatparentsconsiderprescriptiondrugmisuseaswrongorverywrong(%)
PerceptionofParentalAttitudes Estimate 95%ConfidenceIntervalAlaskaTotal 91.1% 88.9 92.9AnchorageTotal 90.3 88.0 92.2Sex Male 89.5 86.4 92.0Female 91.1 88.0 93.4Race/Ethnicity White(Non-Hispanic,SingleRaceOnly) 94.6 92.4 96.2AlaskaNative 86.0 79.1 90.9OtherRaces/Refused/Missing/Unknown 86.3 81.5 90.0Grade 9thGrade 89.2 84.2 92.810thGrade 89.9 84.0 93.711thGrade 90.6 86.6 93.512thGrade 91.6 87.0 94.7AcademicGrades MostlyAsandBs 91.9 89.6 93.7MostlyCs,Ds,andFs 87.0 81.9 90.8
HarmReduction
StigmaTherearemisperceptionsaboutwhousesheroin,andthiscreatesastigma.Stigmamaycauseindividualstonottoseekhelpforthemselves,andforotherstonotrecognizetheneedforhelpinfriendsandfamilymembers.However,heroinaddictioncrossesallethnicandraciallines.
LegislationTheOpioidODDrugsDispensing;ImmunityActbecamelawinAlaskaonMarch15,2016.Opioid/heroinuseandoverdosehascaughttheattentionoflocalpoliticians.In2015,AlaskaStateSenatorJohnnyEllis,representingDowntownAnchorage,Fairview,MountainView,andAirportHeights,introducedSenateBill23tomakeNarcanmorewidelyavailable.ThiswillbeaninvaluabletoolfordecreasingoverdosedeathsbyincreasingaccesstoNaloxoneandimmunityforprescribing,providing,oradministeringopioidoverdosedrugs.Raisingawarenessofthenewlaw,andreducingstigmathatsomemayfeelaskingforaprescriptionforNaloxoneareripeopportunitiesfortheAnchoragecoalitions.
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MedicalCommunityTherewere28physiciansinAnchoragecertifiedtotreatopioiddependencewithbuprenorphineasofJanuary6,2016.Buprenorphineisanopioidpartialagonist.Itrelievesopioidwithdrawalsymptoms.Initially,certifiedbuprenorphinephysicianscanonlyhave30activepatientsatatime.After1year,theycanapplyforanincreaseto100patients.ThereisanincreasingnumberoftrainingsbeingprovidedinAnchorageforprescriberstobecomecertifiedtoprescribebuprenorphine.
NeedleExchangeProgramAnchoragehasoneneedleexchangeprogramatFourA’s.Needleexchangeprogramsareaneffectivewaytoreduceconsequencesofneedlesharing,suchasHepatitisCandHIV.Duringthe2016calendaryear,participantscametotheneedleexchangeprogram21,316times.FourA’sdistributed438,578syringesandcollectedandincinerated523,245syringes.GiventheincreaseincasesofpeopleinfectedwiththeHepatitisCvirusbothnationallyandlocallyinAnchorage,manynationaleffortsincludeexpandingsyringeexchangeprogramsaswellasexpandingeffortstoallowaccesstosterilesyringesupplies.
LackofMedicallyMonitoredDetoxBedsAnchoragehasonly13medicallymonitoreddetoxbedsatErnieTurner.Generally,drugtreatmentprogramsrequirethatapersonhasdetoxedpriortoadmission.Medicallymonitoreddetoxisthesafestwaytostopusingheroin.Peoplewithaddictionscanhitanextremelow,generatingadesiretoquitusingandseektreatment.Itiscriticalthatthisoptionbeavailableimmediately.InAnchorage,thewaitisoften30ormoredaysuntilabedisavailable.Thiscreatesasituationwheresomeoneseekingrecoveryservicesmaycontinueusing,andwhentheirnamepopsuponalistforanavailablebed,themomentofdesiringhelphaspassed.Onechallengeourkeyinformantinterviewsrevealedwasthatapersonneedstobesoberinordertoenteradetoxortreatmentprogram.Thatcanbeamajorbarrierforpeopletoreceivethetreatmenttheyneed.Manystressedthatimmediateactionneedstobetakenassoonasapersoniswillingtoseekhelp.Otherwise,thewindowofopportunitymayquicklyclose,especiallyifapersonisdeniedfromaprogram,insurancechallengesthecoverage,orchildcarecannotbesecured.Manykeyinformantsraisedtheneedformorecommunityresourcestosupportacomprehensivetreatmentcenter,includingdetoxbeds,ahospital,in-patientrecoveryservices,jobandlifeskillscoaching,andcoursestoteachindependence.Unfortunately,therewasalsoanacknowledgementatthelackofresourcesandleadershiptomovethisforward.
AccesstoNaloxoneKeyinformantsspokehighlyoftheneedformoreaccesstoNaloxone,sometimesknownasNarcan.Manyrecommendeddistributingthemthroughoutthecommunity.InterviewswithkeyinformantsalsouncoveredthatthereismisinformationabouttheuseofNaloxone.Manypeopledidnotknowthatmedicalcareafteritsusemustbesought.
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SomealsofeltthatNaloxoneisgood,butitdoesnottreattherootoftheproblem.SomekeyinformantsalsohadwarningsregardingNaloxone.SomefeltthatofferingNaloxonemayenableuserstoignoreconsequencesofoverdosingandcontinueusing.Withoutadequatedetoxortreatmentfacilities,apersoninrecoveryafteroverdosingandusingNaloxonemayendupinthesamesituation.Onekeyinformantcalledita“veryviciouscycle.”Outofthe504A’ssurveyparticipantswhoarecurrentusersofopioids,justoverhalf(n=29)hadsomeknowledgeaboutNaloxoneorhadheardofit.Fromthe25participantsthatwereaskedabouthowlongNaloxoneremainseffectiveafterbeingadministered,noneoftheparticipantscorrectlyidentifiedthatitlastsroughly30minutes.Responsesvariedfromafewminutestooveramonth.Manyrespondentsdidnotanswerthequestionorwrote“Don’tKnow.”
WhenaskedwhereNaloxoneshouldbedistributed,manyrespondentsindicatedthatitshouldbeavailableattheneedleexchanges.Othersuggestionsincludedinvendingmachines,atlowcostoverthecounter,forfreeatclinics,atalldoctor’soffices,andinEmergencyRooms.
OtherCommunityFactors
CoordinatedApoliticalAdvocacyAnchoragehasastronganddedicatedfieldofpeopleinterestedinreducingdruguseandconsequences.Whiletherearemultiplefactorsthatencourageuseandabuse,thereareevengreateropportunitiestodiscouragethem.Whathasbeenlackingisacentralized,apoliticaland
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staffedforcetogatherthestakeholders.ThiswasechoedattheAlaskaHealthSummitduringthesessiondiscussingtheheroinandopioidissuesinFebruary2016.
InvolvementofSchoolsInDecember2015,SouthAnchorageHighSchoolPrincipalDr.KerstenJohnson-Struemplerwrotealettertoparentstitled"PrescriptionDrugs:Pleasetalktoyourstudent."Intheletter,Dr.Johnson-StruemplershedlightonthegrowingissueofillegalprescriptiondruguseatSouthAnchorageHighSchoolandurgedparentstospeakwiththeirchildrenaboutprescriptiondruguseandmonitortheirownmedications.
ImprovedAccesstoDataThereisaneedtoimprovedatacollectionregardingprescriptionopioidandheroinuse.Thisshouldincludeincreasingthenumberoftoxicologytestsdoneforviolentdeathvictims,inmotorvehiclecrashesandtoreinstatesurveillanceofpoisoninginthetraumaregistry.Thiswillprovidemorethoroughdatatofullyunderstandtheseverityoftheheroinandopioidproblemsandassistwithdefiningbaselinesfromwhichtomeasurechange.
GrowingCommunityAwarenessThroughtheLocalMediaInrecentyears,therehasbeenagrowingnationaldiscussionaroundtheincreaseofopioidandheroinoverdosesandrelateddeathsintheUnitedStates.TheAlaskaDispatchNewshasbeencoveringtheriseinopioidandheroinoverdosesanddeathsandtheonlineconversationsonthesearticlesreflectthecommunity'sconcern,levelofawareness,andpersonalconnectionstotheissue.Severalhighprofilefatalitiesrelatedtoopioid/heroinusehavecapturedthelocalmediaandpublic'sattention.AlistoflocalnewsstoriesisdetailedinAppendixG.
CommunityNormsandPerceptionsCommunitynormsareafactorthatdiscouragesriskbehaviors.Alaska’sStrategiestoPreventUnderageDrinkingstatesthat“Individualsandcommunitiesmustmodelpositivebehaviorsinordertopreventfuturegenerationsfromdevelopingsubstanceusedisorders.Thingsassimpleasdiningtogetherasafamilycreatepositivenormsforyouth."HVHCandAYDC/AIPCactivelypartnerpromotinghealthynormsinAnchorage.Researchlocallyandnationallysupportstheconceptthatfamilysupport,monitoringandcommunicationhaveanimpactonyouthalcoholbehaviors.AnchorageSchoolDistrictYRBSanalysisshowedyouthtalkingtotheirparentsnearlyeverydayaboutschoolisasignificantprotectivefactorfor30-dayuseandbingeuseofalcohol.OtherfactorsthatarecorrelatedwithdecreasedsubstanceabusebyAnchorageyouthinclude:Parentandrolemodelbehaviorandcommunitynormsthatdiscouragesubstanceuse,School,home,andcommunityenvironmentsthatdiscouragebothsubstanceuseandalcoholadvertising,Individualsandcommunitiesthatmodelpositivebehaviors,familysupport,monitoringandcommunicationandstrongculturalidentityandsupport.
InsufficientCoordinatedEffortstoAddresstheProblemTherearequiteafeworganizationsinAnchoragewithaninterestintheopioidandheroinproblem.However,theylacktheleadershipincollaborativeinvolvement.ThenewlyformedAnchorageOpioidTaskforcewillalsobeastrongpartnerinthecommunity.
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SyntheticOpioidsOurkeyinformantsalsonotednationaltrendsarebeingfeltwithinAnchorage,notingthreewaves:1)opioidpainkillers,2)heroinuse,and3)syntheticopioids.Syntheticopioidsaremorepotent,suchasfentanyl,whichis50-100timesmorepotentthanmorphine.Astheprevalenceofsyntheticopioidsbecomesmoremainstream,theremaybemoreoverdosesanddeaths.
CommunityReadinessAssessmentHVHCandAIPCheldtwogroupkeyinformantinterviewstodeterminethecommunityreadinessinAnchoragetoaddressnon-medicaluseofprescriptionopioidsfor12-17yearolds,andthenon-medicaluseofprescriptionopioidsandheroinusein18-25yearolds.GroupinterviewsfollowedtheTri-EthnicCommunityReadinessAssessmentmodel,developedbyColoradoStateUniversity.Atotalof8individualswereinterviewedinthegroupregarding12-17yearolds,and11individualswereinterviewedinthegroupregardingthe18-25yearolds.Thetotalof19keyinformantsjoinedourtwogroupinterviewsrepresentingthefollowingcommunitysectors:youth-servingorganizations,military,lawenforcement,clinicalservices,medicalservices,youth,parents,NativeAmerican,peopleinrecovery,Hispanic,AlaskaNative,faith,andnon-profitcommunities.TheTri-EthnicCenterforPreventionResearch'smodelofCommunityReadinessforCommunityChangemeasuresfivekeydimensions:1)Communityknowledgeoftheissues(howmuchdoesthecommunityknowabouttheissues?);2)Communityknowledgeofefforts(Howmuchdoesthecommunityknowaboutcurrentpreventionprogramsandactivities?);3)Communityclimate(Whatisthecommunity’sattitudetowardaddressingtheissues?);4)Leadership(Whatisheleadership’sattitudetowardaddressingtheissue?);and5)Resources(Whataretheresourcesbeingusedorthatcouldbeusedtoaddresstheissue?).Everykeyinformantscoredeachcommunityreadinessdimension,andthenthescoreswereaveragedforeachdimensionofreadinessforthetwoissues(non-medicalprescriptionopioidusefor12-17yearolds,andnon-medicalprescriptionopioidandheroinusefor18-25yearolds).Thescoresforeachdimensionwerethenaveragedtoarriveatan“overall”communityreadinessscoreforeachissue.Table17StagesofCommunityReadinessScale
StageofReadiness ScoreNoAwareness 1Denial/Resistance 2VagueAwareness 3Preplanning 4Preparation 5Initiation 6
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Stabilization 7Confirmation/Expansion 8HighLevelofCommunityOwnership 9
BasedontheTri-EthnicCommunityReadinessAssessmentmodel,theoverallcommunityreadinessscoreforprescriptionopioidmisusepreventionforages12-17was4.6(onascaleof1to9).Thisindicatesalevelofcommunityreadinessthatisabove"Stage4:Preplanning,"meaningthereissomeconcernandacknowledgementofconcernoftheproblemandstigmaaroundtheissue,butlittleknownoftheissueoroflocalefforts,andthattherearelimitedresourcestofurthertheefforts.Theoverallcommunityreadinessscoreforprescriptionopioidmisuseandheroinusepreventionforages18-25was4.7.Thisalsoindicatesalevelofcommunityreadinessthatisabove"Stage4:Preplanning,"meaningthereissomeconcernandacknowledgementofconcernbutlittleknownoftheissueoroflocalefforts,andthattherearelimitedresourcestofurthertheefforts.
BothcommunityreadinessscoresforbothagegroupsareonthehigherendoftheStage4scale,nearing“Stage5:Preparation,”whichwouldindicatethatmostcommunitymembershaveheardoflocalefforts,leadershipactivelysupportscontinuingandimprovingcurrentefforts,thereisbasicknowledgeabouttheissues,andtherearesomeresourcesidentifiedtofurtherefforts.Theoverallcommunityreadinessscoresareillustratedinthefollowingfigures,aswellasabriefnarrativedescribingsomeofthefindingsbasedoncommunitysectors.
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Figure15CommunityReadinessScoresforNon-MedicalPrescriptionOpioidMisuseamong12-17Year-OldsinAnchorage(2017)
CommunityReadinessScoresvariedbasedonsector.Forthekeyinformantsdiscussingnon-medicalprescriptionopioidusefor12-17year-olds,overallcommunityreadinessscoresrangedfrom3.3to5.4acrosssectors.Themilitaryandnon-profitcommunityhadsomeofthelowestreadinessscoresoverallat3.6and3.3respectively.Theclinicalandmedicalservicesectorshadthehighestreadinessscoresforleadershipat7.5and7respectively.TheNativeAmericanyouthrepresentative’sleadershipreadinessscorewas9;however,theremaybelimitationsbasedonhavingonlyonerepresentativefromthisandothersectors.
“Idoseeadvocatesonthisissue,buthavingadvocatesandcommunitymemberleadershiparetwodifferentthings.Folkswouldsaytheysupportexpandedefforts,butwhetheryouhavethepeopletomakethemovementtowardsasolutionisalsotwodifferentthings.”(KeyInformant,April6,2017)
Additionalpolicyrelatedquestionswereaskedregardingpreventioneffortsaroundalternativetreatmenttoprescriptionopioids,safestorageanddisposalofprescriptionopioids,andsocialstigma.Thesectorswiththelowestcommunityreadinessscoresforthesepolicyproposalsweretheclinicalandyouth-servingorganizationswithscoresof2.7and3.7respectively.Both
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themilitaryandmedicalsectorshadthehighestcommunityreadinessscoresforthesepoliciesatscoresof6and5.7respectively.
“Ifsomethinghappensclosetoyou,youwanttoworkonsolvingit,butyougetburnedoutwhenyourealizehowbigtheissuesarebeforeyougettothesolution.Alotoftimescommunitymembersknowthereisaproblem,butthere’sstillthatsocialstigmanotonlyonusersbutalsoonfamilyandfriends.”(KeyInformant,April6,2017)
Figure16CommunityReadinessScoresforNon-MedicalPrescriptionOpioidMisuseandHeroinUseamong18-25Year-OldsinAnchorage(2017)
CommunityReadinessScoresvariedbasedonsector.Forthekeyinformantsdiscussingnon-medicalprescriptionopioiduseandheroinusefor18-25year-olds,overallcommunityreadinessscoresrangedfrom3to5.8acrosssectors.TheAlaskaNativeandHispanicrecoveryserviceprovidercommunitieshadsomeofthelowestreadinessscoresoverallat3and3.4respectively.Thelawenforcement(score5.8),clinical(score5.4),andNativeAmericanYouth(score5.4)hadthehighestoverallcommunityreadinessscores.
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“InAnchoragethepopulationisinalotofsurvivalmodebecauseofdrinkinganddrugs.Theseissuesimpactfamiliessomuch,butknowingaboutresourcesisdifficult.It’shardtoevenadmitthereisaproblem,especiallyforgrandparentsthatareraisingthegrandkids.Lotsoffamilieshavesecretiveproblems.Thereislotsofhealingtodo.[…]Therearelotsofprograms,buttoknowyoualreadyneedtobelookingforhelpsoyougenerallyhavetobeinalotoftroubletobeginwith.Ifyou’renotintroublepeopledon’ttendtoknowaboutit.”(KeyInformant,April6,2017)
Additionalpolicyrelatedquestionswereaskedregardingpreventioneffortsaroundalternativetreatmenttoprescriptionopioids,safestorageanddisposalofprescriptionopioids,socialstigmaforopioidandheroinuse,andneedleexchanges.ThesectorswiththelowestcommunityreadinessscoresforthesepolicyproposalswerethemedicalandAlaskaNativecommunitieswithscoresof4.4and4.2respectively.Theclinical(score8.8),NativeAmericanYouth(score8.6),andlawenforcement(score8)hadthehighestcommunityreadinessscoresforthesepolicies.Theseoverallscoresareratherhighforthecommunityandmaybeduetotheselectionofkeyinformantswhohaveextensiveexperienceandnetworkingintopreventionefforts.
“Themilitaryisveryreactiveandnotproactive.It’sallcommander-dependent.Thereareafewcommandersthatarevocalaboutthis,andwehavealotofresourcesareavailable,butthey’renotusedunlessthereisaproblem.[…]Ifyouhaveaprescription,noonewillthinktwiceaboutitormakethatbigofadealaboutit.Butuntilsomeonegetsintrouble,that’swhenitbecomesanissue.”(KeyInformant,April6,2017)
Throughthegroupkeyinformantinterviews,themesarosearoundleadershipandcommunitymembers,includingvariousorganizations,understandingandtakingactiononopioidandheroinuse.However,alackofresourcesandenoughfundingtoexpandexistingresourceswasraisedasacommonbarrier.Throughthegroupkeyinformantinterviews,therewerethemesthatarosearoundculturalresponsiveness.Generally,theAlaskaNativeandHispanicpopulationsscoredlowercommunityreadinessscores.Manyofthesechallengescenteredonsocialstigmaholdingfamiliesbackfromseekingsupportservices.Thereisalsoalanguagebarrierthatmayexistineducationeffortsonthedangersofprescriptionopioidaddiction,especiallyfromthemedicalfieldtotheHispaniccommunity.Manyofthethemesfromthegroupkeyinformantinterviewsreinforcedtheprioritycommunityfactorsprioritizedfromcommunitymembers.Thesethemesfromthegroupinterviewsaresummarizedbelow.
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Figure17SummaryofthemesfromCommunityReadinessAssessmentgroupinterviews(2017)
IntermediateVariable
PriorityCommunityFactors
CommentsfromCommunityReadinessAssessmentmeetings
"Youth"Group(n=8)
Percent
"YoungAdult"Group(n=11)
Percent
RetailAvailability
Alternativepainmanagementnotcommonlydiscussedwithpatient 6 75 4 36
Alternativeformsofpaincontrolmaycostmorethanopioidsduetoinsurers.
Notmanypeopleknowwhatalternativepaincontrolis,especiallyyouth.
Maybealternativeornon-drugopioidsshouldbepreferencesintreatment.
Doctorstendtoofferprescriptionopioidsasthefirstlineofpaintreatment.
Inadequatepatient/parenteducationattimeofinitialprescription 2 25 6 55
Familiesoftenseekinformationorprogramsaftertheyareseverelyimpactedbyaddictionanditsconsequences.
Thereisnostandardwarningtogivetopatients.
Veryfewprescribersorpharmacieshavepainagreementswithpatientsexplicitlystatingpropermedicationuse.
Themilitarycommunityandculturetendstoacceptuseofprescriptionopioidswithoutquestion.
Languagemayalsobeabarrierincommunicatinginformationaboutprescriptionopioids.
LackofPrescriptionDrugMonitoring(PDMP)participation
6 75 9 82
TheAlaskaNativeMedicalHospitalandSouthcentralFoundationledcommunityonprescriptiondrugmonitoringandpaincontracts.
Therearetoofeweffortstocombatprescriptionopioidmisuse.
TheGovernorisleadingeffortsandhasofferedbillstoaddressprescriptiondrugmonitoringefforts.
SocialAvailability Securestorageandsafedisposal 4 50 7 64
Thereareoveralltoofeweffortstocombatopioidandheroinuse,andtoofewresourcestosupportexistingefforts.
Pharmaciesorprovidersseemtobeunwillingtotakebackallprescriptiondrugs.
Familieswanttoplaytheirparttomakeadifference,buttheymaynotknowthebestpracticesforsafestorage.
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Communitymembers,includingthemilitary,donottendtothrowawayprescriptiondrugs.
Socialcircle 2 25 2 18
Grandparentsraisinggrandchildrendonothaveaccurateinformationonopioids,andmaynotuseproperstorageorteachbestbehaviors.
Militarystructureoffersreactive,ratherthanproactive,punishmentofbehavior.
PerceptionofRisk
Lackofunderstandingofwhatopioidsdotothebrainandbodyandhowquicklydependencecanoccur
8 100 11 100
Thereisvastmisinformationaboutopioidaddictioninyouth.
Thereisalackofunderstandingthatmisuseofprescriptionopioidsmayleadtoheroinuse.
Thereisamisconceptionthatdoctorscantellwhowillbeatriskformisuseandabuse.
Peoplebelieveinstereotypesoffamiliessobelieveyouthmayormaynottendtomisuseprescriptionopioids.
Opioidsareprescribedfromadoctorandpresumedtobesafe.Thereislessstigmasurroundingopioidusethanotherdrugssuchasheroin
4 50 2 18
Peoplebelievetherearefewerrisksinprescribedmedication.
Treatingpainasavitalsignhasledtoover-prescribing,andpatientsnowrequestit.
Thereismorepotentialforconversationsaroundstigmafor12-17year-olds,butmaybeharderfor18-25year-olds.
Notunderstandingthevastconsequencesofusingandmisusing 8 100 10 91
Mostyouth-serviceworkersdonotknowhowtoaddressopioidaddictioninyouth.
Thereismisinformationaboutwhocanbecomeaddictedtomisusingprescriptionopioids.
Leadershipinthecommunityarenotactivatedunlesstheconsequencesofaddictionimpacttheirlivesdirectly.
HarmReduction Accesstoneedleexchange N/A 1 9
Thereisalackofunderstandingofhowaneedleexchangeaddressesheroinaddiction.
De-stigmatizeaddiction 4 50 3 27
Familiesarestillsecretivewhenaddictionisimpactingthem.Stigmacanholdthembackfromseekingsupportservices.
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Thereisaracialissuethatsomepeopleofcolormightbeatadisadvantageorreceivingtreatment.
Stigmaisprevalentanddifferentinvariouscultures.
Lackofcopingskills 1 13 0 0
Alternativetreatmentcouldinvolvediscussingotherpainmanagementskillswithpatients.
PerceptionoftheProblemintheCommunityTheYASUSaskedsurveyrespondentsabouttheirperceptionoftheproblemofprescriptionopioidmisuseandheroinuseinthecommunity.ThefollowingtwotablesaretheresultsfortheseperceptionsoftheproblemquestionsforAnchorageresidents.Thequestionwasaskedasascalewithonereflectingthattheindividualfoundittobeanotaproblematall,andsixtobeaverylargeproblem.ThetablesshowresultsofthescoresforallAnchorageresidents,AlaskaNativerespondentsonly,Whiterespondents,andrespondentsofallotherraces.Table18Perceptionofprescriptionopioidmisuseproblemincommunity
Total AlaskaNative White AllOtherRaces N % N % N % N %1Notaproblematall 26 12.3% 3 10.0 13 9.9 10 19.62 26 12.3% 4 13.3 18 13.7 4 7.83 51 24.1% 11 36.7 29 22.1 11 21.64 37 17.5% 4 13.3 25 19.1 8 15.75 28 13.2% 4 13.3 18 13.7 6 11.86Averylargeproblem 41 19.3% 3 3.3 27 20.6 11 21.6Table19Perceptionofheroinproblemincommunity
Total AlaskaNative White AllOtherRaces N % N % N % N %1Notaproblematall 31 14.6 3 10.0 18 13.7 10 19.62 28 13.2 7 23.3 17 13.0 4 7.83 42 19.8 6 20.0 25 19.1 11 21.64 25 11.8 1 3.3 18 13.7 6 11.85 30 14.2 7 23.3 19 14.5 4 7.86Averylargeproblem 53 25.0 5 16.7 33 25.2 15 29.4
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KnowledgeoftheIssueTheAdultTelephoneSurveyofopioidmisuse/abuseandheroinuseinAnchorageaskedadultsabouttheirknowledgeofopioiduseamongyouthage12-17,youngadultsage18-25,andheroinuseamongyoungadultsage18-25.Theresultsforthosethreequestionsfromthesurveycanbeseeninthetablebelow.Table20PercentageofAnchorageAdultsKnowledgeableaboutOpioidAbuseandHeroinUse(n=382)
Knowledgeaboutopioidabuseamongkids12-17Veryknowledgeable 10%Knowledgeable 10%Somewhatknowledgeable 31%Notknowledgeable 46%Don’tknow 3%Refused 0%Knowledgeaboutopioidabuseamongyoungadults18-25Veryknowledgeable 17%Knowledgeable 13%Somewhatknowledgeable 36%Notknowledgeable 32%Don’tknow 2%Refused 0%Knowledgeaboutheroinuseamongyoungadults18-25Veryknowledgeable 18%Knowledgeable 11%Somewhatknowledgeable 31%Notknowledgeable 39%Don’tknow 1%Refused 0%
Itisalsoclearthatpeoplearenotgivenadequateinformationatthetimeofreceivinganopioidprescription,includingcreatingaplantostop,alternatives,andriskofaddiction.BasedonasurveyofAnchorageresidents,thesummaryisdisplayedinFigure18.
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Figure18SummaryofMessagesFromPrescriberstoPatientsatTimeofPrescription
DataprovidedbyPFSDETAL.Surveyof212Anchorageresidentsaged18-27.
ConcernofPrescriptionOpioidMisuseandHeroinUseTheAdultTelephoneSurveyofopioidmisuse/abuseandheroinuseinAnchorageaskedadultsabouttheirlevelofconcernofopioiduseamongkidsage12-17,youngadultsage18-25,andheroinuseamongyoungadultsage18-25.Theresultsforthesethreequestionsareshowninthetablebelow.Table21PercentageofAnchorageAdultsConcernedaboutOpioidAbuseandHeroinUse(n=382)
Concernaboutopioidabuseamongkids12-17VeryConcerned 63%Concerned 15%Somewhatconcerned 15%Notconcerned 4%Don’tknow 1%Refused 0%Concernaboutopioidabuseamongyoungadults18-25VeryConcerned 57%Concerned 16%
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Somewhatconcerned 18%Notconcerned 7%Don’tknow 1%Refused 0%Concernaboutheroinuseamongyoungadults18-25VeryConcerned 63%Concerned 16%Somewhatconcerned 13%Notconcerned 6%Don’tknow 1%Refused 0%
KnowledgeofEffortstoAddressIssuesTheAdultTelephoneSurveyofopioidmisuse/abuseandheroinuseinAnchorageaskedadultsabouttheirknowledgeofeffortsinthecommunitytoaddressopioiduseamongkidsage12-17,youngadultsage18-25,andheroinuseamongyoungadultsage18-25.Table22PercentageofAnchorageAdultsKnowledgeableaboutEffortsinCommunitytoAddressOpioidAbuseandHeroinUse(n=382)
Effortsincommunitytoaddressopioiduseamongkids12-17Alot 15%Some 37%Alittle 19%Nothing 11%Don’tknow 16%Refused 1%Effortsincommunitytoaddressopioiduseamongyoungadults18-25Alot 16%Some 35%Alittle 24%Nothing 10%Don’tknow 15%Refused 0%Effortsincommunitytoaddressopioiduseamongyoungadults18-25Alot 19%Some 32%Alittle 21%Nothing 14%Don’tknow 15%Refused 0%
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Overall,communitymemberswhowereconcernedorveryconcernedregardingyouthages12-17misuseofprescriptionopioidswas78%.However,theirknowledgeofcommunityeffortsandtheissuewerelower.Peoplewhofelttheyhad“alot”or“some”knowledgeofeffortswas52%ofrespondents.Theirknowledgeoftheissueitselfwaslowerstillat20%.Figure19SummaryofPerceptionsofOpioidUseAmongYouth12-17Years-Olds
DatacollectedbyHaysResearchGroupLLCforAIPC.N-382.Overall,communitymemberswhowereconcernedorveryconcernedforyoungadultsages18-25misuseofprescriptionopioidswas73%.However,theirknowledgeofcommunityeffortsandtheissuewerelower.Peoplewhofelttheyhad“alot”or“some”knowledgeofeffortswas51%ofrespondents.Theirknowledgeoftheissueitselfwasat30%.Overall,communitymemberswhowereconcernedorveryconcernedregardingyoungadultsages18-25forheroinusewasat79%.However,theirknowledgeofcommunityeffortsandtheissuewerelower.Peoplewhofelttheyhad“alot”or“some”knowledgeofeffortswas51%ofrespondents.Theirknowledgeoftheissueitselfwaslowerstillat29%.
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Figure20SummaryofPerceptionsofOpioidUseAmong18-24YearsOld
Figure21SummaryofPerceptionsofHeroinUseAmongYouth18-24YearsOld
Figure20and21datacollectedbyHaysResearchGroupLLCforAIPC.N-382.
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Thecombinationofhighlevelsofconcern,butlowerlevelsofknowledgeofeffortsandknowledgeofissuewerethemesthroughoutallprimarydatacollection,includinginkeyinformantinterviews.
“Whenwewentdownthispathwedidn’tknowwheretogoorwhototurntoforhelp.[…]Onceyourkidisincrisisit’sassumedit’sbecauseyouareabadparentandthat’sjustnotthecase.Thiscanhappentoanyone.Parentsneedtoknowthewarningsignsbecausetheycanbesoeasilyhiddenandexplainedaway.”(KeyInformant,February2017)
CommunityResourceAssessmentAthree-tieredresourceassessmentwasconducted.First,currentNMUPOandheroinuserswereaskedwhatresourcesareavailableinAnchorageaddressingbothpreventionandtreatment.Treatmentquestionswereincludedknowingthatsuccessfultreatmentwillleadtofewerusers,overdosesandotherharmfulconsequences.Userswerealsoaskedwhatresourcestheywishwereavailable.Secondly,anassessmentwasconductedofresourcesthatcouldprovideassistancewiththeinterveningvariablesprovidedbytheState.ThelistofpotentialpartnersisprovidedasAppendixDandE.AppendixFlinesoutwhichresourcesareavailabletoaddresseachoftheproscribedinterveningvariables.Finally,anassessmentofavailabletreatmentresourcesinAnchoragewasprovided.
UserperceptionsofavailableandneededresourcesSurveyparticipantswhoareactivelymisusingopioidsand/orusingheroinwereaskedabouttheresourcesavailableforthosewhowanthelpwithopioidaddiction.Responsesincludedbothgeneralandspecificresources.Generalresourcesincludedtreatment,detox,counseling,hotlines,rehab,clinics,hospitals,familyandfriends,andchurches.MorespecificresourcesnamedincludedtheErnieTurnerCenter,themethadoneclinic,Suboxone,Vivitrol,NarcoticsAnonymousandAlcoholicsAnonymous,andtheSalvationArmyClitheroeCenter.SeveralrespondentspointedoutinadequacieswiththeresourceoptionsinAnchorage.Criticismsincludedthattherearen’tenoughresources,thatresourcescanbeexpensive,thatthereareoftenwaitlists,andthatthereisalackofempathyforthoseexperiencingopioidaddiction.Afterbeingaskedaboutresourcescurrentlyavailable,surveyparticipantswereaskedaboutresourcesthattheywishedwereavailable.SomeofthemorefrequentresponsesincludedgreateraccesstomethadoneandSuboxone.Therewerealsopleasformoredetoxcentersandrehabswithshorterwaitlists.Afewrespondentsalsowishedforharmreductionresourcessuchasmoreneedleexchangeslocationsandsupervisedinjectionsites.
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Resourcesavailabletoaddressinterveningvariables:
OpioidAvailabilitySocialandRetailAvailabilityofPrescriptionOpioidsareinextricablylinked.Areductioninretailavailabilitywillnecessarilyreducesocialaccess.Anchoragehasanumberofagenciesandindividualswhoarewellpoisedtohelpreduceretailavailabilitythrougheducationtopatientsseekingpainrelief,physiciansaboutalternativestoopioidstoreducepainaswellasimprovementstotheAKPDMD.Thelistofresourcesincludespeoplewhoworkorvolunteerinopioidmisusepreventionaswellasprescribersandpharmacists.SeeAppendicesD,E,andF.CurrentlyparticipationintheAlaskanPrescriptionDrugMonitoringProgramisvoluntary.Keyinformantsdescribedthebroadrangeoflevelsinwhichprescribersandpharmacistsareparticipating.Currently,only22%ofstatewidepotentialprofessionalsareregistered.However,implementationofSB74willresultinpositivechanges.TheBillisscheduledtorolloutwithaseriesofmandatesoverthenextfewyears.Ascomponentsbecomecompulsory,retailaccesstoprescriptionopioidswilldecrease.Onceopioidsareprescribedtheyhavethepotentialtobecomesociallyavailable.Anchoragehastwoyear-roundmedicationdroplocationsatProvidencePharmacyandAlaskaNativeTribalHealthConsortium.Additionally,HVHCinconjunctionwithmultiplepartnersincludingtheDEAhosttwoNationalPrescriptionDrugTake-BackDaysinAprilandOctober.Thisisanopportunityforpeopletosafelydisposeofprescriptionmedication.InadditiontoTake-Backevents,safestorageisanothermethodofreducingsocialavailability.HVHCisdistributing“pillpods”toraiseawarenessofsafestorageofallmedication.
HeroinAvailabilityReducingheroinavailabilityisprimarilyalawenforcementfunction.LawenforcementinAnchoragehascontinuallyincreasedtheamountofheroinconfiscatedeachyearandisfullyonboardtocontinuetodoso.However,reducingavailabilityofheroinisnotacure-allfortheultimategoalsofreducingmorbidityandmortalityassociatedwithheroin.Mostactiveheroinuserssaidthatifheroinwerenotavailabletheywouldswitchtoanotherdrug.Simplyreducingaccessisnotaviablestand-aloneoption.Acomplementarycommunitylevelapproachisthereductionofthedesireforheroin.Halfofcurrentheroinuserssaidtheybeganusingopioidswithalegitimateprescriptionforpain.Theythenprogressedtousingheroinwhenprescriptionopioidsbecameunaffordableorinaccessible.Reducingthedesireforheroincanstartwithreducinginitialretailavailabilityofprescriptionopioids.
PerceptionofRiskandHarmReductionResourcesforincreasingtheperceptionoftheriskofbothprescriptionopioidsandheroinandreducingharmfromusecomefrommanyofthesameplaces.AppendicesD,E,andFdescribemultipleorganizationsandindividualswhoareresourcesfortheseissues.Theyfitintotwocategories.Thefirstfallsintotheprimarypreventionscope.Theseareprescriberswhocaneducatepotentialusersaboutthetruerisksofmusingopioidsforpain,aswellasprovidingimprovedinformationaboutwhatconstitutesappropriateuseandhowtotaperoff.The
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secondcategoryisthoseorganizationsandindividualswhocanhelpwithharmreduction.ThisincludesprovidingaccesstoandinformationregardingNarcan,cleanneedlesandreferralsandinformationabouttreatmentoptionsandresources.Reducingstigmaregardingaddictionandincreasingwillingnesstoseekhelparetwomoreeffortstheabove-listedresourcescanassistwithproviding.Additionalresourcesfortheseendeavorsincludethenewsmedia,whohavecoveredtheopioidissueswithseveralarticlesamonthforthepasttwoyears.
Communitystrengths,gaps,assets,andweaknessesPartnersinAnchoragehavealonghistoryofworkingtogetheronsubstanceabuseissues.Thisincludestreatmentproviders,membersofmultiplecoalitions,youthservingorganizations,andtheAnchorageSchoolDistrict.Somerelationshipsthatareinthedevelopmentphaseincludemedicalprofessionalsnotinvolvedintreatmentservicesandlawenforcement.Mostcollaborativesubstanceabuseeffortshavebeengearedtowardsunderagedrinking.Inunderagedrinkingpreventionefforts,lawenforcementwasakeypartner.Thenewdirectionofopioidmisuseandheroinusepreventioncanworktore-invigoraterelationshipsfrompriorcollaborativeefforts.Aswithallcollaborativework,relationshipsarethekeystartingpoint.Anchorageisarelativelysmallcommunity,andmanyofthenecessaryrelationshipsarewellformed.Afinalstrength,thatisalsoaweakness,isthatAnchoragenowhasseveralgroupsworkingonthisissue.Worktowardsplanninganddevelopingstrategieswillprovideanopportunityforthevariouspartnersandcoalitionstocometogetherandstrategicallyusetheirstrengthsmovingforward.
VI. PrioritizationPrioritizationProcess
AIPCandHVHCcoordinatedtwoprioritizationmeetingswithmembersoftheHVHCleadershipteam,aswellasmembersoftheHVHCcoalitionasawholeandgeneralcommunitymembers.OnMarch8,2017,theHVHCleadershipteammetfortwohourstonameandprioritizecommunityfactorsrelatedtoNMUPOandheroinusebasedonlocalprimaryandsecondarydatasharedwiththem.Tostarttheprocess,AIPCstaffpresenteddatarelatedtoNMUPOandheroinusetotheleadershipteam.Theleadershipteamthenbrokeoutintogroupsbasedontheirinterestinfourinterveningvariables:retailavailability,socialavailability,perceptionofrisk,andharmreduction.TheDBHrequiredcoalitionstoconsiderretailavailability,socialavailability,andperceptionofrisk.HVHCandAIPCincludedharmreductionasaninterveningvariablebasedonthecommunity’seffortsaroundNarcandistributionandfeedbackfromNMUPOandheroinusers.Throughsmallgroupdiscussions,thegroupsbrainstormedalistofcommunityfactorscontributingtoeachofthefourinterveningvariables.AIPCusedtheCommunityFactor
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PrioritizationworksheetprovidedbytheDBHtoguideandframethisprocess.Afterbrainstormingcommunityfactors,thegroupswereaskedtoplacefactorsonachartbasedonwhetherornottherewasthepotentialforchangeonthatfactor,andtheimportanceofthatfactor.AIPCstafffacilitatedeachgroupthroughtheprocessandwasavailabletotakenotesandanswerquestions.Adetailedprotocolfortheprioritizationprocess,worksheets,andsummariesareavailableinAppendixC.Attheconclusionofthefirstprioritizationmeeting,AIPCstaffsummarizedthegroup’swork.AIPCthenmetwithHVHCtofurtherinterpretandorganizethefactorsbrainstormedanddevelopalistofcommunityfactorsforeachinterveningvariable.Belowisthelistofcommunityfactorsdevelopedatthefirstmeeting.
RetailAvailabilityCommunityFactors
• LackofknowledgeofnewpainmanagementrecommendationsfromtheCDC• LackofPrescriptionDrugMonitoringProgram(PDMP)participation• Inadequatepatient/parenteducationattimeofinitialprescription• Alternativepainmanagementnotcommonlydiscussedwithpatient• Needforongoingtrainingforprescribers• Inadequatepatientscreeningforpaincontractsoraddictionrisk• Pharmaceuticalpainmanagementischeaperthanphysicaltherapy
SocialAvailabilityCommunityFactors
• Prescriptiondrugstockpiles• Givingaway,trading,stealing,sellingexcess• Socialstatusofhavingpills• Socialcircle• Inadequatepolicingcapacityandlackofenforcementconsequences• Drugsaren’tstoredsecurely• Socialhost/parent/caregiverenabling
PerceivedRiskCommunityFactors
• Opioidsareprescribedfromadoctorandpresumedtobesafe(evenismisused)• Lessstigmaaroundusingopioidsthanheroin• Trustthatheroinisheroinandnotcutwithfentanyl,etc.• Lackofunderstandingofwhatopioidsdotothebrainandbodyandhowquickly
dependencecanoccur• Notunderstandingvastconsequencesofusingandmisusing• Itwon’thappentome• Riskofmixingsubstancesismisunderstood
HarmReduction
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CommunityFactors• AccesstoandknowledgeofNarcan/Naloxone• Accesstoneedleexchange• Lackofcommunityconnectednessandbystanderinvolvement• Interventionavailableatthemomentpeopledecidetheywanttoquitusing• Needtoincreasecopingskills:Reduceneedforquickfixofanyailments,andseeing
opioidsascureall• Needforongoingposttreatment/recoveryservicesandopportunities• De-stigmatizeaddiction
• Perceptionthataddictionisamoralissue• Perceptionthatthedruguseisonlyanissuefor“them”not“us”• Increasehelp-seeking
ThesecondprioritizationmeetingwasopentoallmembersoftheHVHCcoalitionandstakeholdersthroughoutthecommunity.ThatmeetingtookplaceonMarch28,2017.Atthesecondprioritizationmeeting,AIPCstaffagainpresenteddatarelatedtoNMUPOandheroinuse.AIPCstaffthenledthegroupthroughaprioritizationprocessusingthecommunityfactorsbrainstormedbytheHVHCleadershipteamatthefirstprioritizationmeeting.AIPCaskedattendeestoprioritizethevariablesbasedontheirimportanceandchangeability.AIPCplacedseverallargegraphsonthewallsaroundtheroomforeachoftheinterveningvariables.Thegraphsweredrawnwithchangeabilityonthex-axisandimportanceonthey-axis.Participantsweregivenasetofcoloredandnumberedpost-itnotesthatcorrespondedwithacommunityfactorrelatedtotheinterveningvariables.Participantswereaskedtochartthecommunityfactorsaccordingtotheirlevelofimportanceandchangeabilityusingtheircoloredandnumberedpost-itnotes.Attheconclusionofthemeeting,AIPCcollectedthegraphstoassessthegroup’sinputtofurthernarrowthecommunityfactors.SeeAppendixC.Toassessthegraphsanddeterminethefactorsofhighestprioritytothecoalition,AIPCdevelopedamethodtoassignnumericalvaluetoeachfactor’splacementonthegraphs.AIPCtookphotosofeachgraphandprintedthegraphonlinedgraphpaper.AIPCthenassignednumericvaluestoeachhashmarkofthegraphbothonthex-axisandy-axis.Ascorewascalculatedandgiventoeachfactor.Thecommunityfactorswererankedforeachofthefourinterveningvariables.Oncethefactorswereranked,HVHCandAIPCmettoselectahighestprioritycommunityfactorsoffocusforeachoftheinterveningvariables.Basedonthedataandthecoalition’sinput,thefollowingcommunityfactorswereprioritizedforeachinterveningvariable:
RetailAvailabilityPriorityCommunityFactors
• Alternativepainmanagementnotcommonlydiscussedwithpatient• Inadequatepatient/parenteducationattimeofinitialprescription• LackofPrescriptionDrugMonitoring(PDMP)participation
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SocialAvailabilityPriorityCommunityFactors
• Securestorageandsafedisposal• Changesinsocialcircle• SafeDisposal
PerceivedRiskPriorityCommunityFactors
• Lackofunderstandingofwhatopioidsdotothebrainandbodyandhowquicklydependencecanoccur
• Opioidsareprescribedfromadoctorandpresumedtobesafe.Thereislessstigmasurroundingopioidusethanotherdrugssuchasheroin.
• NotunderstandingthevastconsequencesofusingandmisusingHarmReductionPriorityCommunityFactors
• Accesstoneedleexchange• De-stigmatizeaddiction• Lackofcopingskills
VII. DiscussionandRecommendationsThroughthedatacollectionandprioritizationprocesses,pathsformakingchangehavebecomeclear.Thishowever,doesnotmeanitwillbeeasy.Thegoodnewsistherearemanyoverlappingissuesandpotentialsolutionsthatwillallowfuturepreventioneffortstomakegreaterimpact.Fourkeyfindingswillassistwithstrategicallymovingforward.
• First,atleasthalfofthecurrentheroinuserswhorespondedtothesurveysstartedusingprescriptionopioidsforpain.Ofthem,manywerenotawareofalternativestoprescriptionopioids,therisksofusingopioids,northeimportanceoftaperinguse.
• Second,misperceptionsandstigmaaroundaddictionresultinmisuseleadingtodependence,adisinclinationtorecognizewhensomeonedevelopsaproblemandanunwillingnesstoseekhelp.
• Third,manypeopleinAnchorageareunwillingtodiscardopioidsandotherunusedmedications.
• Andfinally,onceapersondevelopsanopioiddependence,therearemethodstoreducerisksthatwillreducetheconsequencesofuse.
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ReduceRetailAvailabilityReducingretailavailabilityofprescriptionopioidsisoneofthefirststepstotaketopreventbothopioidandheroinaddiction.Thisactionwillreducethenumberofpeoplewhostartusingopioidsnotasprescribed,andwholatermaydevelopdependence.Thedatashowthecommunityisreadytoembarkonmultiplemethodsto
makethishappen.Themedicalprofession,throughnewPDMPmandates,willreceivemoretrainingregardingpainmanagementandengageinmoreconservativeprescribingpractices.Increasingprospectivepatientawarenessofboththerisksofandalternativestoopioiduseforpainmanagementwasrecommendedbythecommunitytodecreaseinitialdemandforopioidprescriptions.Bothoftheseactionswilldecreaseprevalenceofopioiddependenceandhavewidecommunitysupport.
ReduceStigmaInAnchoragetherearestigmasandmisperceptionsregardingopioidaddiction.Theseincludeperceptionsthatopioidaddicts(bothprescriptionandillicitopioids)areprimarilyhomeless,liveinpoverty,andthatitisanAlaskaNativecommunityproblem.Thedatashowthatnoneofthesearethecase.
Opioidaddictionreachesacrossculturesandsocioeconomiclevels.Addictsarealsothoughttobebadpeoplewhorobandstealtoaccessdrugs.Whilethiscanbetrue,whatisoftenmisunderstoodisthatmanypeopleaddictedtoopioidsdonotwanttobeaddictedanddowanthelp.Thestigmasandmisperceptionsresultinfamiliesnotwantingtoadmitthatamemberhasanaddictionissue,andthesubjectishushedandhidden.Membersofthecommunityshowedreadinesstobeginconfrontingthestigmassurroundingaddiction,andbelieveitisanimportantsteptowardsreducingtheharmsofNUMPOandheroinuse.
IncreaseSafeDisposalManypeopleinAnchorageexpressedanunwillingnesstodiscardprescriptiondrugs,includingopioidswhenacourseoftreatmenthasended.Forthosewhoarewillingtodoso,theDrugTake-Backeventsareavaluableservice.Theeventscanalsoserveasanopportunitytoraiseawarenessoftherisksofstockpilingdrugs.
Forthoseunwillingtodiscarddrugs,safestorageiscritical.Usersrecommendedseveraloptions.First,don'tletanyoneknowabouthavingtheprescriptioninthefirstplace.Second,lockthedrugsinasafe,justlikeyouwouldagun.
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NMUPOandheroinusersdescribedthedegreestowhichtheywillgotoaccesstheirnexthigh.Theseincludestealingdrugsfromfamilyandfriends.Thepowerofaddictionandthehorrorsofwithdrawalleadtheseactions.Safestoragewillreducesocialavailabilityofprescriptionopioids.Forsome,thiswillhelpreducenonprescriptionuseofprescriptionopioids.Thisisnotacure-all.Itisimportanttonotethatpeoplethatuseheroinandmisuseprescriptionopioidshaveastrongproclivitytoswitchtoadifferentdrugifonebecomesunavailable.
ReduceHarmFinally,anoftenmentionedandmuchneededresourceisincreasedaccesstoin-andout-patientdetoxandtreatmentoptions.Becausethisgrantwillnotsolvethoseissues,harmreductionforuserswasrecognizedasimportant.Harmreductioncomesinvariousflavors.
OneformofharmreductionistheincreasedaccesstoandknowledgeaboutNaloxone(Narcan).MostcurrentheroinuserswerenotfamiliarwithNaloxone.Ofthosewhowerefamiliarwithit,manydidnothaveaccurateunderstandingsabouthowlongitworksforandtheneedformedicalattentionafteronereceivesit.TherewerealsoconcernsthatNaloxonecanleadtopushingthelimitsforahigh.Theseareimportantconsiderationsfortheplanningphase.AnotherharmreductioneffortincludesaccesstotheAlaskanAIDSAssistanceAssociation’s(FourA’s)syringeexchange.Somepeoplewereconfusedbyhowthishelps.Syringeexchangesserveseveralfunctions.One,cleanneedlesprotectagainstmanybloodbornediseasesandinfections,likeHepatitisC.Second,andatleastasimportant,theneedleexchangeisatrustedplacewheremanyusersgotogetinformationabouttreatment,Narcan,HIV/AIDSandmore.Afinalharmreductionideaistoimprovecopingskills,socialandemotionalskills,andlifeskills.Thesearelonger-termrecommendationsbutwilleventuallyhelptoreducetheneedforimmediatereliefofbothphysicalandemotionalpainthroughdrugs.
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FourA's.(2017).FrequentlyAskedQuestions(FAQs)AboputtheFourA'sSyringeAccessProgram(FASAP).RetrievedApril7,2017,fromhttp://www.alaskanaids.org/index.php/prevention/faqs
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IX. AppendicesAPPENDIXA–SummaryofKeyInformantInterviews
SummaryofKeyInformantInterviewsbasedonsectorresponses.KeyInformant-OpioidRecoveryCommunity
1.Whatdrugsdoyouthinkofwhenyouhearaboutprescriptionopioids?
Bothindividualsidentifiedhigherpotentpainmedicationsasprescriptionopioids.
2.Atwhatpointdoyouthinktheusingopioidsbeyondthemedicalrecommendationisdangerous?
Theindividualsdifferedintheirresponses.Oneindividualfeltanytimeanopioidprescriptioniswrittentheriskexists,whiletheotherindividualfeltitisatthepointwhenthepersonbegintousetheprescribeddrugoutsidethedoctor'sorders
3.Howdidyoustarttakingprescriptionopioids?Whatledtoyourusebeyondrecommendations?Thinkingaboutotherpeopleyouknow,howdidtheystartandwhatledtotheirusebeyondrecommendations?
Bothindividualsreferencedhowthedrugsmadethemfeelasthereasonforusingthembeyondwhatthedoctorprescribed,suchastherelieffromchronicpain.
4.Howdo(did)you,orpeopleyouknowobtainprescriptionopioids?
Mostgetopioidsfromdoctor,someforgedprescriptions,stole,orborrowed/boughtfromafriend.
5.Whatconsequenceshaveyouseenfromopioidusebeyondrecommendations?Didyouknowabouttheseconsequencesbeforeyoustartedusing? Bothreferenceddeath."Becominglostinlifeaddicted."
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6.Howlikelydoyouthinkitisthatpeoplewhouseopioidsbeyondrecommendationwillfacetheseconsequences?Andwhichonesmighthavepersuadedyoutonotstartusing?
Itdependswithopioidsbecausethereareothernon-lethalusesforthem.Peoplethinkitwon'thappentothem.
7.Whatotherthingsthatcouldhavepreventedorintervened?
Bothareunsure.Onethought"maybe"amotherorfatherfigure.
8.Whataresafewaystostoreopioidsandhowlikelywouldyoubetousethem? Lockedup.Usethemasdirected.
9.Whatwouldyouhavedoneifopioidsweren'treadilyavailable?
Ifusingforpain,usealternativesliketramadoloribuprofen.Ifaddicted,likelyfindsomethingelsetouse.
10.Whatresourcesarethereforpeoplewhowanthelpwithopioidaddiction?
Bothsaidtreatmentcenters,butoneacknowledgedyouhavetobesobertoenterbutthatdoesn'tmakesense.
11.Whatresourcesdoyouwishwereavailable?TellmewhatyouknowaboutNaloxone,sometimesknowasNarcan?Howdoyouthinkitcouldbedistributedtomakeitmorereadilyavailable?
DistributeNarcanthroughsoupkitchensorhomelessshelters.Comprehensivetreatmentcenterwithdetox,hospital,recovery,job/lifeskills,tobeindependentagain.
12.Isthereanythingyou’dliketoadd?
Narcanmayenableuserstocontinueusing.OnceNarcansavesyou,there'snodetoxortreatment,sothe"veryviciouscycle"continues.
KeyInformant-HeroinRecoveryCommunity
1.Tellmeabouthowyoustartedusingheroin?Thinkingaboutotherpeopleyouknow,howdidtheystart?
Onewasalreadyusingopioids.Onestartedsmokingheroin,thenIV,thenwithotherdrugs(cocaine).
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2.Howdo(did)you,orpeopleyouknowobtainheroin? Fromotherpeople,includingdrugdealers.
3.Whatconsequenceshaveyouseenfromheroinuse?Didyouknowabouttheseconsequencesbeforeyoustartedusing?
Afteraddiction,becomehomeless,jobless,losefamily,andmayincludejail,sexualexploitation,ordeath.Didnotknowconsequencesbeforehand.
4.Howlikelydoyouthinkitisthatpeoplewhouseheroinwillfacetheseconsequences?Andwhichonesmighthavepersuadedyoutonotstartusing?
It'sjustamatteroftime.Knowingtheconsequencesmaynotdeteruse,"itwon'tbeme"orwilluseotherdrugs.
5.Whatotherthingsthatcouldhavepreventedorintervened?
Doctorsnotprescribeopioids.Peoplehavetomakeadecisiontoquit;havetotreattheirillness(maybelifechallenges)inahealthywayinsteadofdrugs.
6.Whatwouldyouhavedoneifheroinwasn'treadilyavailable? Useanotherdrug.
7.Whatresourcesarethereforpeoplewhowanthelpwithheroinuse?
NarcoticsAnonymousorAlcoholicsAnonymous(12stepprogram)
8.Whatresourcesdoyouwishwereavailable?
Comprehensivedetox,hospital,treatment(drug-free)centerthatteacheslifeskills.
9.TellmewhatyouknowaboutNaloxone,sometimesknowasNarcan?Howdoyouthinkitcouldbedistributedtomakeitmorereadilyavailable?
Naloxonesavelivesbutmakesuremedicalcareissought.Distributefromneedleexchangeandhomelessshelters.
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10.Doyouknowofcommunityprogramsthatofferdetoxortreatmentprograms? Few,mustbesobertoenter.
11.Wheredoyougetinformationaboutheroinuseorrecovery? AlcoholicsAnonymousorVolunteersofAmerica.
12.Isthereanythingyou’dliketoadd? (noresponse)
KeyInformant-Parents
1.Atwhatpointdoyouthinkthemisuseofprescriptionopioidsisdangerous?
Prescriptionmedicinethatisnotprescribedtothem,orifitisthey'renotfollowingdoctor'sorders.
2.Whataresomeoftherisksorconsequencesofassociatedwithmisusingopioidsthatyouhaveseen?Howlikelyisitthatsomeonemisusingopioidswillsuffertheseconsequences?
Family,health,andfutureallimpactedfromaddiction.Consequencesarehighlylikelytooccur.
3.HoworwhatcausespeopleinAnchoragetobegintakingprescriptionopioids?Whathappensthatendsupleadingtoaddiction?
Foryouth,sportsinjuries,peerpressure,andgetdrugsfromfamilies.Kidswithmentalhealthissuesmayuseopioidstoself-medicate(anxiety),thenbuildtolerance,andmaybecomeaddicted.Parentsmaybenaiveandnotlockupdrugs.Kidsoftendonotknowthelong-termconsequencesoftakingprescriptionopioids.
4.Hadyourdoctororpharmacistdiscussedtherisksofaddictionwithyou?
Doctorsdidnotsharetherisksofprescriptionopioidaddiction,andwhentheyouthwasincrisisoveritthedoctor'sofficedidnothelp.Doctorsneedtoknowwheretosendpeoplefortreatment.
5.Forpeoplewhoaremisusingopioids,howdoyouthinktheyobtainthem?Whatdoyouthinkcouldbedonetolimitthisaccess?
Demographicsmayleadtomoreopioidprescriptions.Thisperson'sexperienceiswithwhitemiddle-classfamilieswheredoctorsmaymorefreelyprescribeopioidstoprivateinsurance.
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6.Whataresafewaystostoreopioids?
Countpillsandlockthemoutofreachofchildren.Educateparentsandchildrenonalternativewaystomanagepainandproperuseofprescriptiondrugs.
7.Whatwouldyoubewillingtodotolimitaccesstoprescriptionopioids?(storage,dropoff,pillpod) Lockopioidsup,havemoredrugtake-backevents.
8.Didyouknowwheretofindsupportandservicesforyourchild?Whatsupportsdoyouwishwereavailabletoyou,andtoyourchild?
No,wedidnotknow.Commercialstoadvertiselocalhelp.Eliminatethestigmaofdruguse,don'tbeafraidtotalktoyourkidsaboutdrugs.Parentsshouldlearnwarningsigns.
9.TellmewhatyouknowaboutNaloxone,sometimesknowasNarcan?Howdoyouthinkitcouldbedistributedtomakeitmorereadilyavailable? (noresponses)
10.Whatthoughtsormessageswouldyouliketosharewithotherparents?
Shareyourstorytobecomepartofthesolution.Worktogethertoeducateourcommunityandourkidstolearntoacceptdifferentwaystodealwithpainmanagementorwaystofeelbetter.
KeyInformantTreatmentProviders
1.Whatdoesitmean,tothemedicalprofession,tomisuseprescriptionopioids?
Togethigh,leadstoaddictionandoverdose,repeatedERvisits.Somedoctorsgetitandofferalternativetreatment,othersjustkeepprescribing.
2.HowconcernedareyouaboutopioidmisuseinAnchorage?Whataboutheroin?Whatisitaboutopioidmisuseandheroinusethatconcernsyou?
Allareveryconcerned.Opioidusemayleadtoheroinuse,whichischeaper,oranotherdrug.Needmoreenforcementtopolicestreetdealers.
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3.Tellmeaboutstoriesyouhearabouthowpeoplestartedusingopioidsmisusingopioids,andstartedusingheroin.(sportsinjuries,starttogethigh…)
Sportsinjuries.Workinjurythatleadstoprescription,thenheroinischeaper.Paindoctor.ClosingPalmerCorrectionalFacilitymeantpeoplecouldnotreceivetreatment,thendealerstargetedthemagain.
4.Whatrisksdoyourclientsperceivewithmisusingopioids?Whataboutheroin?(addiction,death,losingkids,jobs,homelessness…)
Youthclientsdon'tcareaboutrisks,justaboutgettingahigh.Clientsdon'tseetherisksuntilit'stoolate.ItcanbelosingkidstoOCSorhomelessness.Hospitalsreceivehigherfundingbasedon"satisfactionscores"ifprescribingopioidsoverprolongedperiods.
5.Withyourpatients,whatdoyouthinkcouldhavebeendonetopreventtheirinitialuseandeventualaddiction?Whatinformationmighthavecausedthemtohesitatebeforestarting?
Preventioneducationhelps,includinghighschools.Peerinterventionwouldbekey.Hospitaldatabasethatflagsrepeatvisits,sotheycanbeeducated.
6.Whatwouldhelpaftertreatmenttokeepthemfromusingagain?
ContinuingCaregroups,structuredsobersupportgroups.Buildupresiliency.Learningbasiclifeskills(job),healthierhabitsandhobbies.
7.Whoarethepeoplemostaffectedbyopioidmisuse?Heroin?
Teens,youngadultsandmiddleageadults.Especially18-25or20-30yearolds.
8.WhattrendsareyouseeingwithprescriptionopioidandheroinuseinAnchorage?
Bothopioidandheroinuserising.Doctorshoppingforpills.Heroinischeaper.Peoplemaskingtheiraddictions.
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9.WhatcanyourecommendtoaddresstheopioidmisuseprobleminAnchorage?Heroin?
Trainteenstointervenewithpeers.Getridof"patientsatisfactionscore"paincontracts.Bettereducation,affordableandaccessibledetoxandrehab.
10.Isthereanythingelseyou’dliketoadd?
Educationandsupportsysteminplace.ER'streataddictionandhavefacilitytotransportpatienttoimmediately.
KeyInformant-PharmacistsandPrescribers
1.Whatdoesitmean,tothemedicalprofession,tomisuseprescriptionopioids?
Prescriberhastotrusttheirpatientandprescribeaccordingtothepain.Usebeyondmedicalrecommendations.Orprovidingopioidstosomeonewhomtheywerenotprescribed.
2.HowconcernedareyouaboutopioidmisuseinAnchorage?Whataboutheroin?Whatisitaboutopioidmisuseandheroinusethatconcernsyou?
Yes,concerned.Prescribersmaynotknowhowmuchapatientistaking.Ifprescriberhastohelppatientusingheroin,theyhavetogotothemofteninadangerousenvironment.Publicsafety.Negativeeffectsonfamily.
3.HowdoyouthinkmostpeopleinAnchorageobtainprescriptionopioidsthataremisusingthem?
Fromsomeoneelse.Falseprescriptions,overprescribing,pharmacyrobberies,orpurchasingfromsomeonewhoobtainedtheminthatway.
4.Fromwhatyou’veseen,whatdoyouthinkcausespeopletostartmisusingprescriptionopioids?HowaboutusingHeroin?
Teenslackknowledgeandthinkofitaspartydrug.Misuseofopioidsmayleadtoheroinuse.Recreationaluse.self-medication,overusewithpooroversightofpractitioner,unrealisticexpectationofpaincontrol,poorawarenessofalternatives,notfollowingaftercareplan(physicaltherapy).
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5.Whatrisksdoyourclientsperceivewithmisusingopioids?Whataboutheroin?
Heroinusersmaymarkwhichveinformedicalprofessionalstouse.Patientsdon'tsharesenseofrisk.Eitherunconcerned,unaware,orbenefitoutweighsrisks.Patientsunderappreciaterisk.
6.Whatwasthelikelihoodyouthinkpeoplethinktheyareatriskofbecomingaddictedtoopioids?Heroin? Notsure.Lowforopiates,highforheroin.
7.Whoarethepeoplemostaffectedbyopioidmisuse?Heroin?
Communitysuffersmostthrougheconomicsandperceptionofsafety.Userismostaffected,thenimmediatefamilyandfriends,thencommunity.
8.WhattrendsareyouseeingwithprescriptionopioidandheroinuseinAnchorage?
Shootingupmorphine,takingDilaudid.Hospitalsadvertisewhenthey'reoutofDilaudidtominimizeseekers.Heroinandopioiduseontheriseinoverdose/deaths.Increasedproviderawareness,butnochangeinprescribingorprescriptionvolume.Possiblegreatersenseofpatientdemandforopioids.
9.WhatcanyourecommendtoaddresstheopioidmisuseprobleminAnchorage?Heroin?
Trackingsystemforprescribers.UseNSAID'sbeforeopioids.(non-steroidalanti-inflammatorydrugs)
10.Isthereanythingelseyou’dliketoadd? Educationforkids.
KeyInformantLawEnforcement
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1.Inyourexperience,howarepeopleobtainingprescriptionopioids?Whataboutheroin?
Peoplegetopioidsfromlegitimateprescriptions,maybebuyingorstealingfromfriends/family.Thenaddictionandheroinusemightfollow.YouthtendtousemoremarijuanaandsmokewithXanax,thanopioidsorheroin.Forheroin,fromadrugdealer,afriend,familymember,orusing/sharingheroin.
2.WhataresomeoftheconsequencesyouareseeingfromopioidmisuseinAnchorage?Whataboutheroin?
Higherpropertycrime,overdosedeaths,dysfunctionalfamilies,jailtime,lossofjob,divorce/separation,lossoftrust,financialburden,lossofchildcustody,poorjudgment,violentcrimes,stealing,domesticviolence.Forboth.Heroinandfentanylleadtomoreoverdoses.Youthdon'tknowlong-termconsequences.
3.Whatareyouhearingabouthowpeoplestartmisusingprescriptionopioids?Heroin?
Doctorsover-prescribedbydosageorduration.Keepexcessmedicationforfutureusetoselfmedicate,thinkingit's"safe."Opioidaddictsmayturntoheroinsinceit'scheaperandeasiertofind.Kidsinsingleparent,low-incomefamilies,withmentalhealthortraumaissuestendtomorelikelyleadtofullhabitoraddiction.Startbymanagingpain,thenbuildatolerance,andnotrealizethey'readdicteduntilit'stoolate.
4.WhattrendsareyouseeingwithprescriptionopioidmisuseinAnchorage?Heroinuse?
Prescriptionpadtheftandthediversionofpharmaceuticalopioids.Useofthemailservicetoorderopioidsandheroin.Youtharegettinglessprescriptionswrittenforthemselvesnow,sotendtotakefromothers.Parentsnaivethatchildwouldusepills.Higherpotencyheroinisavailablesopeopleareoverdosingmoreeasily.Fentanylmixedwithheroin.
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5.Whatarepeopleinyourprofessiondoingtocombattheheroin/opioidprobleminAnchorage?Whatwouldyouliketoseechange?
DEA’s360strategy:1. LawEnforcementactionagainstherointraffickers.2. DiversionControla) EnforcementactionsagainstDEAregistrantswhichincludedoctors,pharmacists,veterinariansandnursesoperatingoutsidethelaw.b) Long-termengagementwithpharmaceuticaldrugmanufacturers,wholesalers,pharmaciesandpractitionerstocomeupwithreasonablesafeguardsagainstthedangersofopioidtreatmentandaddiction.3. CommunityOutreachSupportyouthon"front-end"inprobation(notinstitutionalized)todo"SevenChallenges"substanceabuseprogram,andPrimeforLife.Joburinalysis,awareness,prevention&treatment,education.
6.WhatotherrecommendsdoyouhaveonhowtoaddresstheopioidmisuseprobleminAnchorage?Heroin?
Treatopioiduseasanepidemic.Stateputintopracticereasonablemeasurestocurtailtheusebyproviders. Educatethepublic,includinginschools. Retaineffectivepenaltiesforthosethatpossessanddistributeheroin.
7.Whatchallengesdoyouseetomakingthosethingshappen?
ChallengesincludeStaterulessurroundingSB91inrelationtoheroinoropioiddistributionandpenalties.Statedatabaseinthelimitingofopioidprescriptionsinquantityandduration.Youthwithcognitivedelayshavetroubleunderstandingthelong-termconsequencesofopioiduseandcannotmakethebestdecisionsforthemselves.Parentsusingdrugsmodelsthatbehavior,andifOCSgetsinvolvedthecyclecontinues.Fundingfortreatment,lawenforcement,prevention,coalitions,socialworkers,therapists,publichealth,etc.Communitybuy-intosupportpeopleinrecovery.
KeyInformant-KeyCommunityMembers
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1.HowdomostpeopleinAnchorageviewusingprescriptionsopioidstogethigh?Whataboutheroin?
Pillformorinjecting.Thereisaperceptionthatthosewhoabuseopioidprescriptionsarelosers,ill-educated,unhygienic,cannotholdajob,overallbadpersonratherthan"regularpersonjustlikeyouandI."Increasescrimeandsafetyconcerns.Althoughbotharebad,opioidabuseismore"forgivable/overlooked"thanheroin.Prescriptiondrugsareaddictiveespeciallywhenusedinamannernotconsistentwiththelabelingorusedsomeoneotherthanthepatient.Basedonthenews,heroinuseseemstobeontherise.
2.Howdoyouthinkmostpeopleobtainprescriptionopioids?Whataboutheroin?
Multiplevisitstomedicalfacilitieslikethedoctorsoffice&ERtoobtainopioidprescription.Giveitawayorsellto/fromfamily/friendsBuyingfromdrugdealers."Blackmarket"foropioidsandheroin.Canbebroughtinfromotherstates.Youthgetfrompeersinschool,parent'smedicinecabinets,stealingotherpeople'sprescriptions.
3.WhataresomeoftheconsequencesyouareseeingfromopioidmisuseinAnchorage?Whataboutheroin?
HigherCrimeratesandsafetyconcerns.OverdosesTakingresourcesawayfromAPDandAFD.Addiction&dependency.Quick-payingjobs,likeservingtoprostitution,tobuymoredrugs.Increaseofdeceptivebehaviorlikelyingandstealing.Unhealthyweightlossinheroinusers.Openedsyringesinpublicparksandparkinglots.
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4.Whatcausespeopletostartmisusingprescriptionopioids?Heroin?
Painmanagement.Lackofknowledgeofaddictionwhenbeginningopioiduse.Depression.OtherDruguse.Economic/Financialimpactssuchaslosingajoborhouse.Curiosity-learningfromusers/dealersinhigh-riskareas,ratherthansafereducation.Compulsivedrugseekingforheroin.Heroincanbecut/mixedwithotherdrugs/poisonsorwhitesubstancessuchassugar,starchorpoweredmilk,causingmoredanger.
5.WhattrendsareyouseeingwithprescriptionopioidmisuseandheroinuseinAnchorage?
Epidemicisregularlyinthenews.It's"notinthedark"anymore.Usedsyringesleftinpublicareas.Ifeelthatuseisincreasing.Opioidmisuseiscommonamongstteensandyoungadults.AccordingtonewsstoriesmanyHeroinaddictsstartedwithOpioidmisuse.
6.Whatarepeopleinyourprofessiondoingtocombattheheroin/opioidprobleminAnchorage?Whatwouldyouliketoseechange?
Comingtogethertobrainstormsolutions&strategies.Makingthecommunityawareofthelevelofseriousness,andthateveryonehasthepotentialtobecomeanaddict.Myprofessiondoesnotcombatthisproblem.Wetieinfactsaboutdrugstonicotinewhilepromotingdrug-freesociety.Iwouldliketoseemoreeducationfromschools&parentstokidsontheimportanceoffollowingdoctorsorderswithprescriptionmeds.Offeringpreventativemeasures/services,treatmentservicesandtransitiontoindependenceservicesamongotherservicestoadolescentsandadults.
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7.WhatdoyourecommendtoaddresstheopioidmisuseprobleminAnchorage?Heroin?
Communityawarenessandeducation,inthegeneralcommunityandtheschooldistrict.Moreandbetterresourcesforthoseinneedofhelp.Education/awareness,talkingaboutitopenly,addressthatthereisaproblem,nottostereotypeitaslowSESpeopleonly.Reducestigma.Sharingknowledgewiththoseclosesttous.Helpingothersdealwiththepressuresoflifewithalternativepositive,healthyways,likeexercisingandvolunteering.Medicalhelpforthosesufferingwithmentalillnessandsubstanceabusesuchasanxiety,depression&post-traumaticstressdisorder.Peopleusewhenlifeisnotworkingout.Helpintervenebyhelpingsethealthypriorities,includingbalanceddiets.
8.Whatarechallengestowhatyou’dliketoseehappening?
Peoplewillseekahigh,andaddictshavetowanttoquit.Educationmaynotbeenough.Loworlackofcity/statebudget.Notenoughprofessionalsinthefield.Druglordsaredangerouspeopleandmaykillwhenpeopleinterferewiththeirbusiness.(Somethingcanbedoneaboutthisifwealljoinefforts)Parentusingwhiletheirchildrenareinrecoveryandareusingaroundthem.(Childrenwithpoorsupportsystem.)
KeyInformant-Media
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1.HowdomostpeopleinAnchorageviewusingprescriptionsopioidstogethigh?Whataboutheroin?
Generallypeopleviewusingopioidsinanegativewayorasdangerous.Maystartwithopioidprescriptionorrecreationallyleadingtoaddiction;thenmaybeintoheroinuse.Needtoseeabuseasanillnessratherthanjudging.Mostpeopleknowopioidsaredangerous.Parentsknowmorenow,butwedon'tknowwhoisnewlygettingaddicted.InJuneau,thewholeclassof2007hadrampantaddiction.Kenaihashighheroinuse.Communityhasmoresympathyforheroinusersthanotherdrugsbecauseweallknowsomeone.Heroinispublichealthcrisisnow,whichhasracialundertones.
2.Howdoyouthinkmostpeopleobtainprescriptionopioids?Whataboutheroin?
DoctorsTheStreet,orblackmarket,andeasilyinTownSquarePark.Drugsareeasytogetinhalfwayhousesorcorrectionssystem.Pillmills-howmanyinAnc?Peoplegetheroinfromanetworkoflow-leveldealersconnectedtoCAandWAStates.Evenmomswithkidsinwithdrawalwillsometimesgobuyherointohelplessentheirkids'withdrawalsymptoms.
3.WhataresomeoftheconsequencesyouareseeingfromopioidmisuseinAnchorage?Whataboutheroin?
LosecustodyofkidstoOCS.Ifparentstryingtogetclean,dealingwithOCSmakesthatharder.Babiesbornaddicted,thenOCS.DeathLossofJob.It'snotaproblemofawareness.Peopleknowtherisks.
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4.Whatcausespeopletostartmisusingprescriptionopioids?Heroin?
Heroinischeaper,andthereisacommunitybuiltarounddruguse.Peopleareself-medicatingaroundtraumasintheirlives.Peopleareself-treatingothertrauma,aimlessness,depression,etc.,thatleadstoheroinandopioiduse.Givepeoplemoreoptions,likejobcorps.
5.WhattrendsareyouseeingwithprescriptionopioidmisuseandheroinuseinAnchorage?
JayButlersaidtherearethreewaves:1.Prescriptionpainkillers,2.Heroin,3.Syntheticdrugs(likeFentanyl)."Weneedmoredetox"istoosimplistic.Replacementtherapyismoreeffective(vivitrol,methadone,soboxone).Methadonehasworkedforsomepeople,butthereisastigma.
6.Whatarepeopleinyourprofessiondoingtocombattheheroin/opioidprobleminAnchorage?Whatwouldyouliketoseechange?
Inthemediawe'renotdoingenoughsolutionsreporting.Reportingpersonalstoriescanreducestigma.TheAnchoragePresshasdonesomegoodin-depthreporting.Nowit'srecognizedasanationalproblembecauseofraceandeconomics.Thisisatopicofinteresttoeditors.Thingsthatwork,notwhatisbrokenistheangleweprefer.But,ourreaderstendtolikethetragediesthatpeoplecanrelateto,morethanthesolutionsstories.
7.WhatdoyourecommendtoaddresstheopioidmisuseprobleminAnchorage?Heroin?
Moreneedleexchanges,likeFourA's.Treatingthisproblemlikeapublichealthcrisis.CriminalJusticeReformforthelong-termimpact.Moreresourcesfortreatment.Likeanimmediatehelp/actioncenteroranemergencymentalhealthcenterorcrisisnumber.Changeinpublicperceptionofthoseusingasbadpeople;it'snotamoralissue.Preventionmeasures,suchasgiving17-25yearoldsalternativestomaketheirlivesbetter,tocareforthemandbuildtheirself-worth’s.Haverealpeoplesharetheirstory.
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8.Whatarechallengestowhatyou’dliketoseehappening?
Notenoughtreatmentoptionsthatwork,likePartnersReentrySystem.Supportforaddictsthatareinjails,moretrainingforguardsandmoreresourcestowithdrawals.Treatwithdrawalslikeemergency,opportunitytointervene.RestrictavailabilityofdrugstothoseinHalfwayHousesbyincreasingthequalityofguards.Naloxone.Goodbutdoesn'tgetattheroot.Awareness.Peopleknowdrugsarebad.Ads,radios,etc.don'twork.Youngpeopleconsumemediabetterandaresavvierthanthoseads.
KeyInformant-AdditionalKeyCommunityMembers
1.HowdomostpeopleinAnchorageviewusingprescriptionsopioidstogethigh?Whataboutheroin?
Peoplethinkdoctor'sprescriptionsaresafe.Mayleadtochronicaddiction,andpossiblygoingtothestreetforheroin.Peoplethinkheroinusersarejunkiesorrockstarsandnotsomeonetheyknow,butnowthey'relearningneighborsorhousewifedownthestreetare"pillpopping"togethigh.Theyviewopioidsaseasytogetsincethey'renotillegalandareprescribedbyadoctor.Heroinisillegalbecausethegovernmentsaysso.
2.Howdoyouthinkmostpeopleobtainprescriptionopioids?Whataboutheroin?
“Doctorhop”togetopioidprescriptions.(Thereneedstobesomemechanismtostopprescriptionabuse.)Peoplestartwithprescriptionsforlegitimatepain.Buyorstealfrompeopletheyknowhaveprescriptions.HurtthemselvespurposelyinordertogototheERandgetacoupleday'ssupply.Peoplearebuyingheroinonthestreetsfromdrugdealers.
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3.WhataresomeoftheconsequencesyouareseeingfromopioidmisuseinAnchorage?Whataboutheroin?
DomesticviolenceChildreninneedofaidduetoabuseorneglect.Pettycrimestosupporttheirhabit.Overcrowdedjails. OveruseofandfullERs/Hospitals.Lackofenoughtreatmentfacilities.Poorhealthofthoseaddicted.Death.Heartbreak.Averagemiddleclasspeoplewithopioidaddictions.It'scheapertogetheroin,somoreuseit.
4.Whatcausespeopletostartmisusingprescriptionopioids?Heroin?
Painfromworkers’compensationinjuries,caraccidentinjuries,etc. Prescriptionopioidsmightleadpeopletoturntothestreetforillegalheroin.Itfeelsgood/likethefeeling.Itbecomesawaytocopewiththingslikedepression,frustration,anger,trauma,etc.Over-prescribedopioidmedication.Heroin-becauseitischeaperandeasiertoobtainthanaprescriptionmed.
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5.WhattrendsareyouseeingwithprescriptionopioidmisuseandheroinuseinAnchorage?
Thepeopleusingsenttojail,somorepeopleinprisons.Over-useofERandPolice.Increaseofoverdoses.Increaseofchildabuse&neglect.Youngerpeopleusingandgettinghooked;likeathletes,goodstudents,&middleschool-ers.Ruralcommunitiesexposedatanearlierage.Usingisconsideredcoolbyperformers&entertainers,theycallit"lean"or"sizzurp"whichiscodeineIthinkmixedwithjuiceorpop.Influencesyoungerpeople.Heroinnotaspopularwithmainstreamentertainers.IncreasedintransferofSTDHIV/AIDSthroughunprotectedsexandneedlesharing.
6.Whatarepeopleinyourprofessiondoingtocombattheheroin/opioidprobleminAnchorage?Whatwouldyouliketoseechange?
Mostpreferaddictstobeputbackoutonthe street(fromjail)becausetheyperceivenothingwrongisbeingdone. Promotelongerjailsentenceswithmandatorydrugrehabilitationprogramswhileinjail.Peoplearemoreawareofwarningsignsofdrugabuse.Prescribersaren'tsoquicktogiveopioidprescriptions.Discussedopeningatreatmentcenterbutlogisticallyitisnotpossibleduetolackoffunding.Considernaturalmethodsoftreatment;physicaltherapy,iceorheattreatment,dietandexercisetherapy,andeducationforpeople.Focusontheyoungergenerationtogrowandbuildahealthiergeneration.Limitthenumberofpillsprescribedatatime.Medsshouldbedistributedbydosethroughathirdparty.Peoplebeingprescribedshouldbeheldaccountableandtoldofconsequences.Theyshouldalsobetestedtohavepillsintheirsystemtoensuretheyare
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7.WhatdoyourecommendtoaddresstheopioidmisuseprobleminAnchorage?Heroin?
Morepoliceonthestreet.Stifferpenaltiesforrepeatoffenders;2ndoffenseforselling/usinganyopioidorheroin,senttojailfortherestofyourlife.Gettotherootofwhypeopleusethroughtherapy&treatmentthatisaffordableandeasytoaccess.Moredetoxbedsandtreatment.Considerotherpaintreatmentsbeforeopioiduse.Limitamountprescribed.Educationontreatingthebodybetteratanearlyagetoavoidpainlaterinlife."Takecareoftheoldpersonyouaregoingtobecome."
8.Whatarechallengestowhatyou’dliketoseehappening?
Shutdownthecourtsystem's“revolvingdoor”problemwiththesamepeopleinandoutofthejailsystemforthesamecrimes.Money/ResourcesAnchoragemunicipalityleadershiptobeactiveinfindingsolution.Gettinglocalagenciestocampaignforfunds;suchasAlaskaNativeCorporationsinvillages.Doctorstostopover-prescribingHoldpatientsaccountabletousingmedicationresponsibly,andusingsafestorage,likelockingthemupandnotsellingthem.Parentsandfamiliesmodelbetter,healthier,andsubstance-freelifestylestoyouth,especiallyAlaskaNativeyouth.
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APPENDIXB–SummaryofCommunityReadinessAssessment
HealthyVoicesHealthyChoicesCommunityReadinessAssessmentPartnershipsforSuccess:OpioidandHeroinPrevention
Non-medicalprescriptionopioidandheroinusefor18-25year-olds
Purpose(forinterviewertoread)
ThankyouforjoiningtheHealthyVoicesHealthyChoicescoalitiontodayforourcommunityreadinessassessmentinterviews.WeareconductinganeedsassessmentforAnchoragetopreventandreducethenon-medicaluseofprescriptionopioidsandheroinfor18-25year-olds,aswellasthenon-medicaluseofprescriptionopioidsfor12-17year-olds.Thepurposefortoday'ssurveyistobetterunderstandthelevelofcommunityreadinessinpreventingnon-medicaluseofprescriptionopioidsandheroininAnchorage.Thismodelofassessmentuseskeyinformantinterviewswithstakeholderswhoareknowledgeableandrepresentvarioussectorsinthecommunity.Youhavebeeninvitedtoparticipatebecauseyourepresentanimportantcommunitysectorandarealsoknowledgeableabouttheissue,community,andresources.Iwillaskaseriesofquestionsonfiveareas:1)communityknowledge,2)leadership,3)communityclimate,4)knowledgeabouttheissue,and5)resourcesforefforts.Today,whenIreferto"theissue,"Iamreferringto:
Today's"Issue:"thenon-medicaluseofprescriptionopioidsandheroinfor18-25year-oldsinAnchorage.
Let'sgetstarted!Introductions
Inclusionactivity:talktoapartnerandshareyourstoryofhowyou’vegottentowhereyouarenow(2minutes)whileyourpartnerlistens.Thenyourpartnerwillgiveyoufeedbackonwhatyoulearnedaboutthem.Repeatandswitchsotheotherpartnerforsharingandlistening.
CommunityReadinessInterviewQuestionsCommunityKnowledge
1. Everyonescorethecommunitylevelofcommunityconcernfortheirsector.2. ArethereeffortsinAnchoragethataddressissue?3. Canyoubrieflydescribeeachofthese?4. Abouthowmanycommunitymembersareawareofeachofthefollowingaspectsofthe
efforts?(None,afew,some,many,ormost)a. Haveheardofefforts?
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b. Cannameefforts?c. Knowthepurposeofefforts?d. Knowwhotheeffortsarefor?e. Knowhowtheeffortswork(e.g.activitiesorhowthey'reimplemented)?f. Knowtheeffectivenessoftheefforts?
5. Basedonthat,whydoyouthinkyourcommunitymembershavethisamountofknowledge?
6. Aretheremisconceptionsorincorrectinformationamongcommunitymembersaboutthecurrentefforts.
7. Isanyoneinthecommunitytryingtogetsomethingstartedtoaddresstheissues?Canyoutellmeaboutthat?
Leadership1. Everyonescorethecommunitylevelofcommunityconcernfortheirsector.Explain.2. Howmuchofapriorityisaddressingthisissuetoleadership?Canyouexplainwhyyou
saythis?3. I’mgoingtoreadalistofwaysthatleadershipmightshowitssupportorlackofsupport
foreffortstoaddressissue.Canyoupleasetellmewhethernone,afew,some,manyormostleaderswouldordoshowsupportinthisway?Also,feelfreetoexplainyourresponsesaswemovethroughthelist.Howmanyleaders…
a. Atleastpassivelysupporteffortswithoutnecessarilybeingactiveinthatsupport?
b. Participateindeveloping,improvingorimplementingefforts,forexamplebybeingamemberofagroupthatisworkingtowardtheseefforts?
c. Supportallocatingresourcestofundcommunityefforts?d. Playakeyroleasaleaderordrivingforceinplanning,developingor
implementingefforts?(prompt:Howdotheydothat?)e. Playakeyroleinensuringthelong-termviabilityofcommunityefforts,for
examplebyallocatinglong-termfunding?4. Doestheleadershipsupportexpandedeffortsinthecommunitytoaddressissue?5. Howmuchofapriorityisaddressingthisissuetoleadership?Canyouexplainwhyyou
saythis?
CommunityClimate1. Everyonescorethecommunitylevelofcommunityconcernfortheirsector.Explain.2. Howmuchofapriorityisaddressingthisissuetocommunitymembers?Canyouexplain
youranswer?3. I’mgoingtoreadalistofwaysthatcommunitymembersmightshowtheirsupportor
theirlackofsupportforcommunityeffortstoaddressissue.Canyoupleasetellmewhethernone,afew,some,manyormostcommunitymemberswouldordoshowtheirsupportinthisway?Also,feelfreetoexplainyourresponsesaswemovethroughthelist.Howmanycommunitymembers…
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a. Atleastpassivelysupportcommunityeffortswithoutbeingactiveinthatsupport?
b. Participateindeveloping,improvingorimplementingefforts,forexamplebyattendinggroupmeetingsthatareworkingtowardtheseefforts?
c. Playakeyroleasaleaderordrivingforceinplanning,developingorimplementingefforts?(prompt:Howdotheydothat?)
d. Arewillingtopaymore(forexample,intaxes)tohelpfundcommunityefforts?4. Abouthowmanycommunitymemberswouldsupportexpandingeffortsinthe
communitytoaddressissue?Wouldyousaynone,afew,some,manyormost?Ifmorehowmighttheyshowthissupport?
KnowledgeAbouttheIssue
1. Everyonescorethecommunitylevelofknowledgefortheirsector.Explain.2. Wouldyousaythatcommunitymembersknownothing,alittle,someoralotabout
eachofthefollowingastheypertaintotheissue?(Nothing,alittle,someoralot)a. issue,ingeneralb. thesignsandsymptomsc. thecausesd. theconsequencese. howmuchissueoccurslocallyf. whatcanbedonetopreventortreatissueg. theeffectsofissueonfamilyandfriends?
3. Whatarethemisconceptionsamongcommunitymembersabouttheissue?
ResourcesforEfforts1. Everyonescorethecommunitylevelofknowledgefortheirsector.Explain.2. Howarecurrenteffortsfunded?Isthisfundinglikelytocontinueintothefuture?3. I’mnowgoingtoreadyoualistofresourcesthatcouldbeusedtoaddressissueinyour
community.Foreachofthese,pleaseindicatewhetherthereisnone,alittle,someoralotofthatresourceavailableinyourcommunitythatcouldbeusedtoaddressissue?
a. Volunteers?b. Financialdonationsfromorganizationsand/orbusinesses?c. Grantfunding?d. Experts?e. Space?
4. Wouldcommunitymembersandleadershipsupportusingtheseresourcestoaddressissue?Pleaseexplain.
5. Onascaleof1to5,where1isnoeffortand5isagreateffort,howmucheffortarecommunitymembersand/orleadershipputtingintodoingeachofthefollowingthingstoincreasetheresourcesgoingtowardaddressingissueinyourcommunity?
a. Seekingvolunteersforcurrentorfutureeffortstoaddressissueinthecommunity.
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b. Solicitingdonationsfrombusinessesorotherorganizationstofundcurrentorexpandedcommunityefforts.
c. Writinggrantproposalstoobtainfundingtoaddressissueinthecommunity.d. Trainingcommunitymemberstobecomeexperts.e. Recruitingexpertstothecommunity.
6. Areyouawareofanyproposalsoractionplansthathavebeensubmittedforfundingtoaddressissueincommunity?
AdditionalPolicy-RelatedQuestions:
Foryoursector…1. Howreadyisyourcommunitywithpromotingalternativestoopioiduse?2. HowreadydoyouthinkAnchorageistostartstoringproperlyinasafeanddiscarding
oncethey’reexpiredornolongerneeded?3. Whatdoyouthinkthelevelofreadinessarepeoplereadytostarttalkingaboutstigma
foropioids?4. Whatdoyouthinkthelevelofreadinessarepeoplereadytostarttalkingaboutstigma
forheroin?5. Howwillingdoyouthinkyoursectoristothinkingtheneedleexchangeisagoodidea?
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HealthyVoicesHealthyChoicesCommunityReadinessAssessmentPartnershipsforSuccess:OpioidandHeroinPrevention
Non-medicalprescriptionopioidusefor12-17year-olds
Purpose(forinterviewertoread)
ThankyouforjoiningtheHealthyVoicesHealthyChoicescoalitiontodayforourcommunityreadinessassessmentinterviews.WeareconductinganeedsassessmentforAnchoragetopreventandreducethenon-medicaluseofprescriptionopioidsfor12-17year-olds,aswellasthenon-medicaluseofprescriptionopioidsandheroinfor18-25year-olds.Thepurposefortoday'ssurveyistobetterunderstandthelevelofcommunityreadinessinpreventingnon-medicaluseofprescriptionopioidsandheroininAnchorage.Thismodelofassessmentuseskeyinformantinterviewswithstakeholderswhoareknowledgeableandrepresentvarioussectorsinthecommunity.Youhavebeeninvitedtoparticipatebecauseyourepresentanimportantcommunitysectorandarealsoknowledgeableabouttheissue,community,andresources.Iwillaskaseriesofquestionsonfiveareas:1)communityknowledge,2)leadership,3)communityclimate,4)knowledgeabouttheissue,and5)resourcesforefforts.Today,whenIreferto"theissue,"Iamreferringto:
Today's"Issue:"thenon-medicaluseofprescriptionopioidsfor12-17year-oldsinAnchorage.
Let'sgetstarted!Introductions
Inclusionactivity:talktoapartnerandshareyourstoryofhowyou’vegottentowhereyouarenow(2minutes)whileyourpartnerlistens.Thenyourpartnerwillgiveyoufeedbackonwhatyoulearnedaboutthem.Switchsotheother
CommunityReadinessInterviewQuestionsCommunityKnowledge
1. Everyonescorethecommunitylevelofcommunityconcernfortheirsector.2. ArethereeffortsinAnchoragethataddressissue?3. Canyoubrieflydescribeeachofthese?4. Abouthowmanycommunitymembersareawareofeachofthefollowingaspectsofthe
efforts?(None,afew,some,many,ormost)a. Haveheardofefforts?b. Cannameefforts?
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c. Knowthepurposeofefforts?d. Knowwhotheeffortsarefor?e. Knowhowtheeffortswork(e.g.activitiesorhowthey'reimplemented)?f. Knowtheeffectivenessoftheefforts?
5. Basedonthat,whydoyouthinkyourcommunitymembershavethisamountofknowledge?
6. Aretheremisconceptionsorincorrectinformationamongcommunitymembersaboutthecurrentefforts.
7. Isanyoneinthecommunitytryingtogetsomethingstartedtoaddresstheissues?Canyoutellmeaboutthat?
Leadership1. Everyonescorethecommunitylevelofcommunityconcernfortheirsector.Explain.2. Howmuchofapriorityisaddressingthisissuetoleadership?Canyouexplainwhyyou
saythis?3. I’mgoingtoreadalistofwaysthatleadershipmightshowitssupportorlackofsupport
foreffortstoaddressissue.Canyoupleasetellmewhethernone,afew,some,manyormostleaderswouldordoshowsupportinthisway?Also,feelfreetoexplainyourresponsesaswemovethroughthelist.Howmanyleaders…
a. Atleastpassivelysupporteffortswithoutnecessarilybeingactiveinthatsupport?
b. Participateindeveloping,improvingorimplementingefforts,forexamplebybeingamemberofagroupthatisworkingtowardtheseefforts?
c. Supportallocatingresourcestofundcommunityefforts?d. Playakeyroleasaleaderordrivingforceinplanning,developingor
implementingefforts?(prompt:Howdotheydothat?)e. Playakeyroleinensuringthelong-termviabilityofcommunityefforts,for
examplebyallocatinglong-termfunding?4. Doestheleadershipsupportexpandedeffortsinthecommunitytoaddressissue?5. Howmuchofapriorityisaddressingthisissuetoleadership?Canyouexplainwhyyou
saythis?
CommunityClimate1. Everyonescorethecommunitylevelofcommunityconcernfortheirsector.Explain.2. Howmuchofapriorityisaddressingthisissuetocommunitymembers?Canyouexplain
youranswer?3. I’mgoingtoreadalistofwaysthatcommunitymembersmightshowtheirsupportor
theirlackofsupportforcommunityeffortstoaddressissue.Canyoupleasetellmewhethernone,afew,some,manyormostcommunitymemberswouldordoshowtheirsupportinthisway?Also,feelfreetoexplainyourresponsesaswemovethroughthelist.Howmanycommunitymembers…
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a. Atleastpassivelysupportcommunityeffortswithoutbeingactiveinthatsupport?
b. Participateindeveloping,improvingorimplementingefforts,forexamplebyattendinggroupmeetingsthatareworkingtowardtheseefforts?
c. Playakeyroleasaleaderordrivingforceinplanning,developingorimplementingefforts?(prompt:Howdotheydothat?)
d. Arewillingtopaymore(forexample,intaxes)tohelpfundcommunityefforts?4. Abouthowmanycommunitymemberswouldsupportexpandingeffortsinthe
communitytoaddressissue?Wouldyousaynone,afew,some,manyormost?IfmoreHowmighttheyshowthissupport?
KnowledgeAbouttheIssue
1. Everyonescorethecommunitylevelofknowledgefortheirsector.Explain.2. Wouldyousaythatcommunitymembersknownothing,alittle,someoralotabout
eachofthefollowingastheypertaintotheissue?(Nothing,alittle,someoralot)a. issue,ingeneralb. thesignsandsymptomsc. thecausesd. theconsequencese. howmuchissueoccurslocallyf. whatcanbedonetopreventortreatissueg. theeffectsofissueonfamilyandfriends?
3. Whatarethemisconceptionsamongcommunitymembersabouttheissue?
ResourcesforEfforts1. Everyonescorethecommunitylevelofknowledgefortheirsector.Explain.2. Howarecurrenteffortsfunded?Isthisfundinglikelytocontinueintothefuture?3. I’mnowgoingtoreadyoualistofresourcesthatcouldbeusedtoaddressissueinyour
community.Foreachofthese,pleaseindicatewhetherthereisnone,alittle,someoralotofthatresourceavailableinyourcommunitythatcouldbeusedtoaddressissue?
a. Volunteers?b. Financialdonationsfromorganizationsand/orbusinesses?c. Grantfunding?d. Experts?e. Space?
4. Wouldcommunitymembersandleadershipsupportusingtheseresourcestoaddressissue?Pleaseexplain.
5. Onascaleof1to5,where1isnoeffortand5isagreateffort,howmucheffortarecommunitymembersand/orleadershipputtingintodoingeachofthefollowingthingstoincreasetheresourcesgoingtowardaddressingissueinyourcommunity?
a. Seekingvolunteersforcurrentorfutureeffortstoaddressissueinthecommunity.
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b. Solicitingdonationsfrombusinessesorotherorganizationstofundcurrentorexpandedcommunityefforts.
c. Writinggrantproposalstoobtainfundingtoaddressissueinthecommunity.d. Trainingcommunitymemberstobecomeexperts.e. Recruitingexpertstothecommunity.
6. Areyouawareofanyproposalsoractionplansthathavebeensubmittedforfundingtoaddressissueincommunity?
AdditionalPolicy-RelatedQuestions:
Foryoursector…1. HowreadyisAnchoragetohearaboutalternativestopainmedication?Changingthe
perceptionofinstantgratification.2. HowreadydoyouthinkAnchorageistostartstoringproperlyinasafeordiscarding
oncethey’reexpiredornolongerneeded?3. Whatdoyouthinkthelevelofreadinessarepeoplereadytostarttalkingaboutstigma?
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SummaryofCommunityReadinessAssessmentScores
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SummaryofthemesfromCommunityReadinessAssessmentgroupinterviews
IntermediateVariable
PriorityCommunityFactors
CommentsfromCommunityReadinessAssessmentmeetings
"Youth"Group(n=8)
Percent
"YoungAdult"Group(n=11)
Percent
RetailAvailability
Alternativepainmanagementnotcommonlydiscussedwithpatient 6 75 4 36
Alternativeformsofpaincontrolmaycostmorethanopioidsduetoinsurers.
Notmanypeopleknowwhatalternativepaincontrolis,especiallyyouth.
Maybealternativeornon-drugopioidsshouldbepreferencesintreatment.
Doctorstendtoofferprescriptionopioidsasthefirstlineofpaintreatment.
Inadequatepatient/parenteducationattimeofinitialprescription 2 25 6 55
Familiesoftenseekinformationorprogramsaftertheyareseverelyimpactedbyaddictionanditsconsequences.
Thereisnostandardwarningtogivetopatients.
Veryfewprescribersorpharmacieshavepainagreementswithpatientsexplicitlystatingpropermedicationuse.
Themilitarycommunityandculturetendstoacceptuseofprescriptionopioidswithoutquestion.
Languagemayalsobeabarrierincommunicatinginformationaboutprescriptionopioids.
LackofPrescriptionDrugMonitoring(PDMP)participation
6 75 9 82
TheAlaskaNativeMedicalHospitalandSouthcentralFoundationledcommunityonprescriptiondrugmonitoringandpaincontracts.
Therearetoofeweffortstocombatprescriptionopioidmisuse.
TheGovernorisleadingeffortsandhasofferedbillstoaddressprescriptiondrugmonitoringefforts.
SocialAvailability
Securestorageandsafedisposal 4 50 7 64
Thereareoveralltoofeweffortstocombatopioidandheroinuse,andtoofewresourcestosupportexistingefforts.
Pharmaciesorprovidersseemtobeunwillingtotakebackallprescriptiondrugs.
Familieswanttoplaytheirparttomakeadifference,buttheymaynotknowthebestpracticesforsafestorage.
Communitymembers,includingthemilitary,donottendtothrowawayprescriptiondrugs.
Socialcircle 2 25 2 18
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Grandparentsraisinggrandchildrendonothaveaccurateinformationonopioids,andmaynotuseproperstorageorteachbestbehaviors.
Militarystructureoffersreactive,ratherthanproactive,punishmentofbehavior.
PerceptionofRisk
Lackofunderstandingofwhatopioidsdotothebrainandbodyandhowquicklydependencecanoccur
8 100 11 100
Thereisvastmisinformationaboutopioidaddictioninyouth.
Thereisalackofunderstandingthatmisuseofprescriptionopioidsmayleadtoheroinuse.
Thereisamisconceptionthatdoctorscantellwhowillbeatriskformisuseandabuse.
Peoplebelieveinstereotypesoffamiliessobelieveyouthmayormaynottendtomisuseprescriptionopioids.
Opioidsareprescribedfromadoctorandpresumedtobesafe.Thereislessstigmasurroundingopioidusethanotherdrugssuchasheroin
4 50 2 18
Peoplebelievetherearefewerrisksinprescribedmedication.
Treatingpainasavitalsignhasledtoover-prescribing,andpatientsnowrequestit.
Thereismorepotentialforconversationsaroundstigmafor12-17year-olds,butmaybeharderfor18-25year-olds.
Notunderstandingthevastconsequencesofusingandmisusing 8 100 10 91
Mostyouth-serviceworkersdonotknowhowtoaddressopioidaddictioninyouth.
Thereismisinformationaboutwhocanbecomeaddictedtomisusingprescriptionopioids.
Leadershipinthecommunityarenotactivatedunlesstheconsequencesofaddictionimpacttheirlivesdirectly.
HarmReduction
Accesstoneedleexchange N/A 1 9
Thereisalackofunderstandingofhowaneedleexchangeaddressesheroinaddiction.
De-stigmatizeaddiction 4 50 3 27
Familiesarestillsecretivewhenaddictionisimpactingthem.Stigmacanholdthembackfromseekingsupportservices.
Thereisaracialissuethatsomepeopleofcolormightbeatadisadvantageorreceivingtreatment.
Stigmaisprevalentanddifferentinvariouscultures.
Lackofcopingskills 1 13 0 0
Alternativetreatmentcouldinvolvediscussingotherpainmanagementskillswithpatients.
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APPENDIXC–CommunityPrioritizationProcessCommunityPrioritizationMeetingProtocolPartnershipsforSuccess–OpioidandHeroinPreventionHealthyVoicesHealthyChoicesCOMMUNITYFACTORSWe'relookingtofindwhatfactorsinourcommunityleadtotrendsaroundopioidandheroinuse.Forexample,iftherearefewdisposalsitesforprescriptionopioids,itcanmakeiteasierforsomeonetogettheirhandsonthemwhowasnotprescribedtousethem.We'lldiscusssomeofthetrendswe'veseeninAnchoragebasedonlocaldata,surveys,interviews,andlocalmedia,andwe'llidentifywhatfactorsmayleadtothosetrends.Thenwewillseewhatcommunityfactorswecomeupwithandprioritizetheminhowimportanttheyareandhowmuchwecouldchangethemwithnewprogramsgoingforward.PRIORITIZATIONCriteriatoprioritizeothercommunityfactors:NowthatwehaveanideaofcommunityfactorsthatleadtotrendsofopioidandheroinuseinAnchorage,weneedtoprioritizewhatfactorswewanttoaddressgoingforward.Weshouldprioritizeandselectcommunityfactorsthatarehighinbothimportanceandchangeability:
• Importanceo Ifthefactorchanged,howmuchofadifferencewillitmakeontheproblem?
§ Example:Ifdoctorschangethewaytheyprescribe(vs)Storageo Doesthecommunityfactorimpactotherbehavioralhealthissuesorother
identifiedproblemsforopioidandheroinuse?• Changeability
o Doesthecommunityhavethecapacity—thereadiness,resources,andfunding—tochangeaparticularcommunityfactor?
o Canchangeoccurinareasonabletimeframe?(withinnexttwoyears?)o Canthechangebesustainedovertime?
WORKSHEETDIRECTIONSCommunityFactors-Step1Directions:Inasmallgroup,brainstormsomeofcommunityfactorsthatinfluenceprescriptionopioidandheroinuseandconsequencesinthefollowingareas.WewillthendiscussthisasalargegroupbeforemovingtoStep2.Prioritization-Step2Directions:FillinthischartplacingcommunityfactorsfromStep1basedonthecriteriaofchangeabilityandimportance,andtakingotherconsiderationsintoaccount.Factorsthatlandinthe“highimportanceandhighchangeability”quadrantwilllikelyhavemostpriorityforourworkgoingforward.
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CommunityFactorPrioritization–GroupWorksheet
Organization/Member:_______________________________________________Step1:Step2:RETAILAVAILABILITY
HighChangeability
LowChangeability
HighImportance
LowImportance
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CommunityFactorPrioritization–GroupWorksheet
Organization/Member:_______________________________________________Step1:Step2:RETAILAVAILABILITY
HighChangeability
LowChangeability
HighImportance
LowImportance
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CommunityFactorPrioritization–GroupWorksheet
Organization/Member:_______________________________________________Step1:Step2:PerceivedHarmRisk
HighChangeability
LowChangeability
HighImportance
LowImportance
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CommunityFactorPrioritization–GroupWorksheet
Organization/Member:_______________________________________________Step1:Step2:HarmReduction
HighChangeability
LowChangeability
HighImportance
LowImportance
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Communityfactorsfromround1ofHVHCcommunityprioritizationmeetingsTheHVHCcoalitionheldaseriesoftwocommunityprioritizationmeetings.Belowaretheresultsofthefirstcommunityprioritizationmeetingofpossiblecommunityfactors.Thesecommunityfactorswererefinedfurtheratthesecondcommunityprioritizationmeeting.IntermediateVariable PriorityCommunityFactors
RetailAvailability
1.LackofknowledgeofnewpainmanagementrecommendationsfromtheCDC
2.LackofPrescriptionDrugMonitoringProgram(PDMP)participation
3.Inadequatepatient/parenteducationattimeofinitialprescription
4.Alternativepainmanagementnotcommonlydiscussedwithpatient
5.Needforongoingtrainingforprescribers 6.Inadequatepatientscreeningforpaincontractsoraddictionrisk
7.Pharmaceuticalpainmanagementischeaperthanphysicaltherapy
SocialAvailability 1.Prescriptiondrugstockpiles 2.Givingaway,trading,stealing,sellingexcess 3.Socialstatusofhavingpills 4.Socialcircle
5.Inadequatepolicingcapacityandlackofenforcementconsequences
6.Drugsaren’tstoredsecurely 7.Socialhost/parent/caregiverenablingPerceptionofRisk
1.Opioidsareprescribedfromadoctorandpresumedtobesafe(evenismisused)
2.Lessstigmaaroundusingopioidsthanheroin 3.Trustthatheroinisheroinandnotcutwithfentanyl,etc.
4.Lackofunderstandingofwhatopioidsdotothebrainandbodyandhowquicklydependencecanoccur
5.Notunderstandingvastconsequencesofusingandmisusing 6.Itwon’thappentome 7.RiskofmixingsubstancesismisunderstoodHarmReduction
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1.AccesstoandknowledgeofNarcan/Naloxone 2.Accesstoneedleexchange 3.Lackofcommunityconnectednessandbystanderinvolvement
4.Interventionavailableatthemomentpeopledecidetheywanttoquitusing
5.Needtoincreasecopingskills:Reduceneedforquickfixofanyailments,andseeingopioidsascureall
6.Needforongoingposttreatment/recoveryservicesandopportunities 7.De-stigmatizeaddiction oPerceptionthataddictionisamoralissue
oPerceptionthatthedruguseisonlyanissuefor“them”not“us” oIncreasehelp-seeking
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FinalprioritycommunityfactorsTheHVHCcoalitionheldaseriesoftwocommunityprioritizationmeetings.Belowarethefinaldeterminationsoftheprioritycommunityfactors.IntermediateVariable
PriorityCommunityFactors
RetailAvailability Alternativepainmanagementnotcommonlydiscussedwithpatient Inadequatepatient/parenteducationattimeofinitialprescription LackofPrescriptionDrugMonitoring(PDMP)participationSocialAvailability Securestorageandsafedisposal SocialcirclePerceptionofRisk Lackofunderstandingofwhatopioidsdotothebrainandbodyandhow
quicklydependencecanoccur Opioidsareprescribedfromadoctorandpresumedtobesafe.Thereisless
stigmasurroundingopioidusethanotherdrugssuchasheroin NotunderstandingthevastconsequencesofusingandmisusingHarmReduction Accesstoneedleexchange De-stigmatizeaddiction Lackofcopingskills
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APPENDIXD–CommunityResourceAssessment
InterveningVariable:
Decreasesocialandretailavailabilityofprescriptionopioids
CommunityFactor:LackofActivePrescriptionDrugMonitoringProgram
CommunityFactor:Over-prescriptionofopioidsfromlocalproviders
CommunityFactor:MedicationDisposalProgramLocation
Resources:Routinescreeningatprimarycarevisitstoidentifyat-riskchildren&adults.Specializedprogramstodiscourageusebypregnantwomen.Carecoordination&patientnavigationservicesforpeoplewhoreceivepainkillers.Townhallmeetingstoraiseawareness.Databaseofprescriptionsformedicalproviders&pharmacists(SouthcentralFoundation&GenevaWoodsClinic)MethadoneClinic
Resources:AdultsandPrescribingDoctorstrainedtoidentify&referindividualsatrisk.Fundingdedicatedtosupportopioidpreventionefforts.PeoplewhoworkorvolunteerinopioidpreventionPreventiontraining&educationofferedSpecializedprogramstodiscourageusebypregnantwomen.Townhallmeetingstoraiseawareness.
Resources:MedicationDisposalProgramM-F8:30–6p.m.Sat9am–5p.m.3300ProvidenceDr.,Suite101(BTower–Entrance#4)NationalPrescriptionDrugTake-BackDay,April29,2017–10am–2pmFindlocationathttps://www.deadiversion.usdoj.gov/drug_disposal/takeback/
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CommunityFactor:Lackofcommunityunderstandingofthescopeofheroinabuseproblem
CommunityFactor:Continuouscareforrecovery
CommunityFactor:Experimentationwithheroinuse
Resources:SocialandlifeskillstreatmentMedicallyassistedtreatmentDetoxTreatmentforco-occurringdisorders,i.e.mentalhealthandaddictionDrugCourt(s)AA,NA,andAlanonFaithbased(non-AA/NA)treatmentprograms
Resources:TownhallmeetingstoraiseawarenessComprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsAwarenessofavailableresourcesforfamilies,employees,religiousorg,lawenforcement,andlawmakers
Resources:Preventionprogramsregardingsubstanceabuse.Lowlevelsofparentalapprovalofheroinuse.Educationorproperinformation-effectsofdruguse.Awarenessofavailableresourcesforfamilies,employees,religiousorg,lawenforcement,andlawmakersPrograms&policiesimplemented,withincommunity,toaddressopioidprevention.
InterveningVariable:
Decreasesocialavailabilityofheroin
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CommunityFactor:Susceptibilitytomisuseofopioid
CommunityFactor:Lowperceptionofriskofdoingheroin&usingopioidsbeyondadoctor’srecommendation
CommunityFactor:Experimentationwithuseofopioids
Resources:TownhallmeetingstoraiseawarenessComprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsandheroinAwarenessofavailableresourcesforfamilies,employees,religiousorg,lawenforcement,andlawmakers
Resources:Comprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsandheroin
Resource:Comprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsandheroinSupportsforfamilymemberofaddicts.Engagesocialnetworks:positivecommunitynormsorpositivecommunityframeworkmodelsTrainingforlawenforcementtodetectillegalsubstancetransactions.
InterveningVariable:
Increaseperceptionofriskofdoingheroin&usingopioidsbeyondadoctor’srecommendations
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CommunityFactor:Lackofknowledge
CommunityFactor:Trustindoctorsandmedicalfield
CommunityFactor:Normalizingdruguse
Resources:TownhallmeetingstoraiseawarenessComprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsandheroinAwarenessofavailableresourcesforfamilies,employees,religiousorg,lawenforcement,andlawmakers
Resources:Comprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsandheroin
Resource:Comprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsandheroinSupportsforfamilymemberofaddicts.Engagesocialnetworks:positivecommunitynormsorpositivecommunityframeworkmodelsTrainingforlawenforcementtodetectillegalsubstancetransactions.
InterveningVariable:
Increaseperceptionofriskofdoingheroin&usingopioidsbeyondadoctor’srecommendations
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CommunityFactor:Familymemberorfriends–give,stealorsellexcessopioidprescriptionthattheyrefillbutdon’tuse
CommunityFactor:Susceptibilityofopioidmisuseleadingtoillicitdruguse(i.e.,Heroin)
Resources:Comprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsandheroinSupportsforfamilymemberofaddicts.Trainingforlawenforcementtodetectillegalsubstancetransactions.Engagesocialnetworks:positivecommunitynormsorpositivecommunityframeworkmodels
Resource:Comprehensiveprev&educationofpotentialharmofopioidprescriptiondrugsandheroinSupportsforfamilymemberofaddicts.Engagesocialnetworks:positivecommunitynormsorpositivecommunityframeworkmodelsTrainingforlawenforcementtodetectillegalsubstancetransactions.
InterveningVariable:
Increaseperceptionofriskofdoingheroin&usingopioidsbeyondadoctor’srecommendations
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APPENDIXE–CommunityResourcesAssessmentList1. AAofAlaska 272-2312 615E82ndave,B-82. AEON 562-4606 4325LaurelSt,Suite297A3. Akeela 565-1200 360WBensonBlvd4. AlaskaNativeTribal
HealthConsortium729-354 4000AmbassadorDr
5. AlaskaWisdomRecoveryAKAWisdomTraditions
562-4540 401WInternationalRoad,Suite127
6. AnchorageMethadoneClinic
866-369-5535
7. Blais,Peggy 317-6704 [email protected]. Charles,Tyrone 562-4606 [email protected]. CookInletCouncilon
AlcoholandDrugAbuse
771-9950 401ENorthernLght
10. CookInletTribalCouncil
793-3200 3600SanJeronimoDr
11. DenaliCoveCounselingCenter
222-2436 1565BragawSt.Suite201
12. DiscoveryCoveRecovery&WellnessCenter
694-5550 16600CenterfieldDr,#203
13. Durtschi,ShirleyDr. 317-6306 [email protected]. GenesisRecovery
Svcs243-5130 2825W42ndAve
15. Igwacho,PeterDr. 727-1324 [email protected]. InsightTherapy 677-8942 600CordovaSt,Suite617. JettMorgan
TreatmentSvcs677-7709
18. NarcoticDrugTreatmentCenter
276-6430 520E4thAve,Suite102
19. NauskaCounseling 277-1166 2509EideSt,Suite520. Nelson,DonLPC 229-5155 21. NorthStar
BehavioralHealth258-7575 2530DeBarrRd
22. ProvidenceBreakthrough
212-6970 3760PiperSt,Suite1108
23. RADACT 563-9202 3901OldSewardHwy,Suite8
24. RationalRecovery 351-8249 308GSt,Suite212
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25. RecoveryAlaska 333-6535 6401ENorthernLights,BoulevardRoom207
26. RenewYourMind 222-5464 123EFireweedLn,Suit21227. ResolutionSvcs 770-7769 401ENorthernLights28. SalvationArmy 770-8821 1015E6thAve&8000West
EndRoad29. Southcentral
Foundation729-5190
30. Stephens,Kimberly 982-4040 [email protected]. TheDeltaIntegrative
Therapy928-373-8488 239W4thAvenue
32. TutanRecoveryServices
563-0555 3001PorcupineDrive
33. VetCenter 563-6966 34. VeteransAdmin. 257-4729 3001CSt35. Volunteersof
America,Alaska279-9646 509W3rdAve
36. Wright,Kelly 980-6648 www.kellywrightlcsw.com37.
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APPENDIXF–AnchorageRecoveryAgencies
• AkeelaHouseRecoveryCenterisalong-term,co-ed,adultresidentialprogram.Outpatient,AssessmentCenter,TransitionalHousingandMedicationassistedtreatment
Akeela,Inc.
• AssessmentandOutpatientAlaskaFamilyServices
• Outpatient,IntensiveOutpatientProgram,ContinuingCare,andaContinuumofCare
AlaskaWisdomTraditionsCounselingSvcs.,LLC
• Medicationassistedtreatment;Methadone,Suboxone,andBuprenorphine(Subutex)
AnchorageTreatmentSolutions
• Chanlyut-2yearresidentialwork-trainingandeducationformenfacingaddiction,homelessness,and/orreenteringsocietyafterincarceration.Outpatient;IntensiveOutpatient;MedicalandSocialDetox;ResidentialandMedicationassistedtreatment
CookInletTribalCouncil
• Clinicalcounseling:assessment,outpatienttreatment,substanceabuse,andco-ocurringdisorders
DenaliCoveCounselingCenter
• Outpatienttreatment,substanceabuseassessmentandMedicationassistedtreatmentDiscoveryCove
• Residential,IntensiveOutpatient,Outpatient,AftercareandTransitionalHousingGenesisRecoverySvcs
• AssessmentandOutpatientJettMorganTreatmentSvcs
• AssessmentandResidentialNorthStarBehavioralHealth
• Assessment,Outpatient,IntensiveOutpatient,AdolescentResidentialandMedicationassistedtreatmentProvidenceHealth&Svcs
• Assessment,Outpatient,IntensiveOutpatient,andMedicationassistedtreatmentResolutionSvcs
• Assessment,Residential,Outpatient,IntensiveOutpatient,Aftercare,andMedicationassistedtreatmentSalvationArmy,Alaska
• Assessment,Residential,Outpatient,IntensiveOutpatient,Aftercare,andMedicationasssitedtreatmentSouthcentralFoundation
• AssessmentandOutpatientStartingPoint,Inc.
• Assessment,Outpatient,andIntensiveOutpatientTutanRecoverySvcs
• Assessment,Residential,Outpatient,andMedicationassistedtreatmentU.S.DeptofVeteransAffairs
• AdolescentResidential,Assessment,OutpatientandIntensiveOutpatient
VolunteersofAmericaAlaska
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APPENDIXG–AnchorageMediaCoverage
Date SourceSearchTerm Title Author Link
16-Dec-16
AlaskaDispatchNews
Itcanhappentoanyone':DirectorofBean'sCafeconfrontsson'ssuspectedoverdosedeath DevinKelly
https://www.adn.com/alaska-news/anchorage/2016/12/16/it-can-happen-to-anyone-director-of-beans-cafe-confronts-sons-suspected-overdose-death/
13-Nov-16
AlaskaDispatchNews
Overdosedeathssuggestemergenceofdeadlysyntheticopioid'pink'inAlaska
MichelleTheriaultBoots
https://www.adn.com/alaska-news/2016/11/13/overdose-deaths-suggest-emergence-of-new-deadly-synthetic-opioid-pink-in-alaska/
26-Oct-16
AlaskaDispatchNews
DrugthatcanhaltheroinoverdoseswillsoonbeavailableinAlaskastores
MichelleTheriaultBoots
https://www.adn.com/alaska-news/health/2016/10/25/why-you-cant-buy-the-anti-overdose-drug-narcan-without-a-prescription-yet-despite-alaskas-change-in-law/
24-Sep-16
AlaskaDispatchNews
IsmethadoneananswertoAlaska'sheroincrisis?
MichelleTheriaultBoots
http://www.adn.com/alaska-news/health/2016/09/24/wednesday-morning-at-the-methadone-clinic/
7-Sep-16 KTUU Heroin
Anchoragemanwantedforrobbery,probationviolationsarrestednearDillingham KTUUStaff
http://www.ktuu.com/content/news/Anchorage-man-wanted-for-robbery-probation-violation-arrested-near-Dillingham-392640011.html
6-Sep-16 KTUU Heroin
Days-longmanhuntcontinuesforsuspectedheroindealerinDillingham
CameronMackintosh
http://www.ktuu.com/content/news/Days-long-manhunt-continues-for-suspected-heroin-dealer-in-Dillingham-392452411.html
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4-Sep-16
AlaskaDispatchNews Opioid
Couldasoon-to-be-closedAlaskaprisonbecomeamuch-neededdetoxcenter?
ZazHollander
http://www.adn.com/alaska-news/mat-su/2016/09/04/could-a-soon-to-be-closed-alaska-prison-become-a-much-needed-detox-center/
1-Sep-16 KTUU Heroin
Nearly$3millioninfederalfundsheadedtoAlaskatocombatopioidcrisis
PaulaDobbyn
http://www.ktuu.com/content/news/Nearly-3-million-in-federal-funds-headed-to-Alaska-to-combat-opioid-crisis-392048921.html
1-Sep-16
AlaskaDispatchNews
RatesofhepatitisCamongyoungpeopleincreaseacrossAlaska
TeganHanlon
https://www.adn.com/alaska-news/health/2016/09/01/rates-of-hepatitis-c-among-young-people-increase-across-alaska/
5-Aug-16
AlaskaPublicMedia Heroin
SurgeonGeneralvisitsPalmertodiscussopioidepidemic
EllenLockyer
http://www.alaskapublic.org/2016/08/05/surgeon-general-visits-palmer-to-discuss-opioid-epidemic/
5-Aug-16
AlaskaPublicMedia Heroin
HealthofficialsaddressopioidabuseatWellnessSummit
EllenLockyer
http://www.alaskapublic.org/2016/08/05/health-officials-address-opioid-abust-at-wellness-summit/
4-Aug-16
AlaskaDispatchNews Heroin
AlaskansbattlingopioidepidemicgetaudiencewithU.S.surgeongeneral
ZazHollander
http://www.adn.com/alaska-news/2016/08/04/summit-gives-surgeon-general-alaskan-perspective-on-heroin-addiction/
4-Aug-16
AlaskaDispatchNews Opioid
Medicalboardrejectsofferfrompilldoctor,reaffirmssuspension
AlexDeMarban
http://www.adn.com/alaska-news/health/2016/08/04/medical-board-rejects-offer-from-pill-doctor-continues-license-suspension/
2-Aug-16
AlaskaDispatchNews Opioid
High-poweredMat-SusummittakesonAlaska'sopioidepidemic
ZazHollander
http://www.adn.com/alaska-news/health/2016/08/02/high-powered-mat-su-summit-takes-on-alaskas-opioid-epidemic/
30-Jul-16
AlaskaDispatchNews Opioid
SummitgathersforcestofightaddictioninAlaska
Sen.DanSullivan
http://www.adn.com/opinions/2016/07/30/summit-gathers-forces-to-fight-addiction-in-alaska/
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29-Jul-16
AlaskaPublicMedia Heroin OpioidsinAlaska
LoriTownsend
http://www.alaskapublic.org/2016/07/29/opioids-in-alaska/
3-Jul-16
AlaskaDispatchNews Opioid
Witnessanoverdose?Call911.Itmaysavealife. JillBurke
http://www.adn.com/alaska-news/health/2016/07/03/witness-an-overdose-call-911-it-may-save-a-life/
27-Jun-16
AlaskaDispatchNews Heroin
APD:WomanfounddeadinHillsidemayhavebeenmovedafterheroinoverdose ChrisKlint
http://www.adn.com/alaska-news/2016/06/27/apd-woman-found-dead-on-hillside-may-have-been-moved-after-heroin-overdose/
7-Jun-16
AlaskaDispatchNews Overdose
InmateatAnchoragejaildiedofdrugoverdose,DOCsays
MichelleTheriaultBoots
http://www.adn.com/alaska-news/2016/06/07/inmate-at-anchorage-jail-died-of-drug-overdose-doc-says/
28-May-16
AlaskaDispatchNews Opioid
MassivefailureatmanylevelscausedAlaskaopioiddetoxshutdowns JohnC.Laux
http://www.adn.com/voices/commentary/2016/05/28/massive-failure-at-many-levels-caused-alaska-opioid-detox-shutdowns/
26-May-16
AlaskaDispatchNews Opioid
Angryparentsprotestanesthesiologistaccusedofover-prescribingopiates
AlaxDeMarban
http://www.adn.com/alaska-news/health/2016/05/26/angry-parents-protest-anesthesiologist-accused-of-over-prescribing-opiates/
23-May-16
AlaskaDispatchNews Opioid
Medicalboardsuspendslicenseofdoctoraccusedofrunningpainkiller'pillmill'clinicinAnchorage
MichelleTheriaultBoots
http://www.adn.com/alaska-news/2016/05/23/medical-board-suspends-license-of-doctor-accused-of-running-painkiller-pill-mill-clinic-in-anchorage/
17-May-16
AlaskaDispatchNews Heroin
ShediedintheAnchoragejaildetoxingfromheroin.Herfamilywantsanswers
ZazHollander
http://www.adn.com/alaska-news/article/father-sues-doc-over-wasilla-womans-death-anchorage-jail-while-detoxing-1/2016/04/09/
17-May-16
AlaskaDispatchNews Heroin
Anchoragemangets7yearsforhisroleincocaine,herointrafficking ChrisKlint
http://www.adn.com/crime-justice/article/anchorage-heroin-cocaine-dealer-gets-7-years-federal-plea-deal/2016/04/18/
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17-May-16
AlaskaDispatchNews Heroin
Troopers:Manarrestedinairportdrugbustbrought$1MinheroinintoAlaska ChrisKlint
http://www.adn.com/crime-justice/article/man-airport-drug-bust-allegedly-brought-1m-heroin-alaska/2016/04/19/
17-May-16
AlaskaDispatchNews Heroin
AwaveoffederalfundingforaddictiontreatmentisheadingtoAlaska
EricaMartinson
http://www.adn.com/health/article/new-help-arrives-alaskan-addiction-problems/2016/04/03/
17-May-16
AlaskaDispatchNews Opioid
NewstatewidetaskforcewilltakeonAlaska'sopioidepidemic
MichelleTheriaultBoots
http://www.adn.com/alaska-news/article/new-statewide-task-force-will-take-alaskas-opioid-epidemic/2016/04/26/
17-May-16
AlaskaDispatchNews Opioid
Arepost-accidentpainkillerscausingastaremployeetomakeerrors? LynneCurry
http://www.adn.com/business/article/are-post-accident-painkillers-causing-star-employee-make-errors/2016/04/05/
1-May-16
AlaskaDispatchNews Opioid
Alaska'stwoinpatientopiatedetoxcenterssuspendnewadmissions
MichelleTheriaultBoots
http://www.adn.com/alaska-news/article/states-two-inpatient-detox-centers-suspend-new-admissions/2016/05/02/
25-Mar-16
AlaskaDispatchNews Heroin
Alaska'sheroindeathratespikes,butprescriptionopioidstakemorelives
ZazHollander
http://www.adn.com/health/article/alaskas-heroin-associated-death-rate-spikes-still-dwarfed-fatal-pain-med-ods/2016/03/25/
9-Mar-16
AlaskaDispatchNews Opioid
Legislaturepassesbillexpandingaccesstooverdoseantidote
RashahMcChesney
http://www.adn.com/health/article/legislature-passes-bill-expanding-access-overdose-drug/2016/03/09/
7-Mar-16
AlaskaDispatchNews Heroin
Housepassesbilleasingaccesstoheroinoverdosemeds
NathanielHerz
http://www.adn.com/politics/article/house-passes-bill-easing-access-heroin-overdose-meds/2016/03/07/
20-Jan-16
AlaskaDispatchNews Heroin
Texasmangets7yearsforbringingmeth,herointoAlaska AlaskaNews
http://www.adn.com/crime-justice/article/texas-man-sentenced-7-years-drug-conspiracy-brougt-pounds-meth-heroin-
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alaska/2016/01/21/
5-Jan-16
AlaskaDispatchNews Overdose
AlaskaFredMeyerstorescouldstartsellinganti-overdosedrugifLegislatureacts
TheAssociatedPress
http://www.adn.com/health/article/alaska-fred-meyer-stores-could-start-selling-anti-overdose-drug-if-legislature-acts/2016/01/05/
23-Dec-15
AlaskaDispatchNews Heroin
Packageofheroin,pillsfoundinsideAnchoragejailinmate AlaskaNews
http://www.adn.com/crime-justice/article/package-heroin-pills-found-inside-anchorage-jail-inmate/2015/12/23/
20-Nov-15
AlaskaPublicMedia Heroin
CombatingheroininAlaska
ZachariahHughes
http://www.alaskapublic.org/2015/11/20/combating-heroin-in-alaska/
18-Nov-15
AlaskaDispatchNews Heroin
FixingAlaska'sheroinproblemcouldstartbygivingarrestedaddictsbetterchanceatrecovery
MikeDingman
http://www.adn.com/commentary/article/alaska-should-give-drug-addicts-better-chance-recovery-not-just-jail/2015/11/19/
17-Nov-15
AlaskaDispatchNews Heroin
AlaskaneedsNarcantofightbacktheriseofheroinaddiction
ElisePatkotak
http://www.adn.com/commentary/article/narcan-necessary-tool-alaska-fight-back-rise-heroin-addiction/2015/11/18/
14-Nov-15
AlaskaDispatchNews Heroin
Withheroinoverdosesrising,acallforwideraccesstothedrugthatcanhaltthem
MichelleTheriaultBoots
http://www.adn.com/health/article/heroin-overdoses-rise-alaska-call-broader-access-drug-can-halt-them/2015/11/15/
10-Nov-15
AlaskaDispatchNews Heroin
HeroinstoryunderscoresneedforAlaskatotreataddicts,notimprisonthem
MikeDingman
http://www.adn.com/commentary/article/heroin-story-underscores-need-alaska-treat-addicts-not-imprison-them/2015/11/11/
17-Oct-15
AlaskaDispatchNews Heroin
EffortstostampoutheroinandotherdrugsdominateAFNresolutions
AlexDeMarban
http://www.adn.com/afn-coverage/article/efforts-stamp-out-heroine-and-other-drugs-dominate-afn-resolutions/2015/10/18/
14-Oct-15
AlaskaPublicMedia Heroin
Newdrugreducesheroincravings,mayreduce
AnneHillman
http://www.alaskapublic.org/2015/10/14/new-drug-reduces-heroin-cravings-may-reduce-recidivism/
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recidivism
11-Oct-15
AlaskaDispatchNews Opioid
Afteryearsinaprescriptionpainkillerfog,Alaskapatientfightsfornewlaws
MichelleTheriaultBoots
http://www.adn.com/alaska-news/article/after-years-prescription-painkiller-fog-one-patient-fights-new-laws-regulating/2015/10/12/
9-Oct-15
AlaskaPublicMedia Heroin
HeroinaddictioninAlaska
EvanErickson
http://www.alaskapublic.org/2015/10/09/heroin-addiction-in-alaska/
26-Jul-15
AlaskaDispatchNews Heroin
SimplechangecansaveAlaskanlives,reducealarmingtollofheroin Sen.Ellis
http://www.adn.com/commentary/article/bill-would-save-alaskan-lives-cut-opiate-overdose-deaths/2015/07/27/
20-Jul-15
AlaskaDispatchNews Heroin
Anchoragecouplesentencedforcrimestiedtolocalmethandheroinsales
JerzyShedlock
http://www.adn.com/crime-justice/article/anchorage-couple-sentences-gun-drug-charges-tied-local-meth-and-heroin-sales/2015/07/21/
14-Jul-15
AlaskaDispatchNews Heroin
PublichealthofficialsfindsteepriseinAlaskaheroindeaths,overdoses
MichelleTheriaultBoots
http://www.adn.com/health/article/public-health-officials-find-steep-rise-alaska-heroin-deaths-hospitalizations/2015/07/15/
14-Jul-15
AlaskaPublicMedia Heroin
Report:AlaskaHeroinUseisSkyrocketing AnnieFeidt
http://www.alaskapublic.org/2015/07/14/report-heroin-use-is-skyrocketing-in-alaska/
9-May-15
AlaskaDispatchNews Opioid
Recoveringaddictfindsafriendinpharmacistwhobustedher MarcLester
http://www.adn.com/health/article/deb-and-cat/2015/05/10/
1-May-15
AlaskaPublicMedia Heroin HeroininAlaska
LoriTownsend
http://www.alaskapublic.org/2015/05/01/heroin-in-alaska/
14-Mar-15
AlaskaDispatchNews Heroin
Video:abeautifulmindlosttoheroinaddiction Nonegiven
http://www.adn.com/multimedia/video/video-beautiful-mind-lost-heroin-addiction/2015/03/15/
12-Jan-15
AlaskaDispatchNews Heroin
Anchoragemangets21yearsfordrugchargestiedtoheroinoverdose
JerzyShedlock
http://www.adn.com/crime-justice/article/anchorage-man-gets-21-years-drug-charges-tied-heroin-overdose/2015/01/12/
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136
17-Nov-14
AlaskaPublicMedia Heroin
EastAnchorageDrugBustPartofState-WideRiseinHeroin,Cocaine,Meth
ZachariahHughes
http://www.alaskapublic.org/2014/11/17/east-anchorage-drug-bust-part-of-state-wide-rise-in-heroin-cocaine-meth/
3-Nov-14
AlaskaDispatchNews Heroin
Anchorageman,7otherschargedwithconspiringtodistributecocaine,methandheroin
JerzyShedlock
http://www.adn.com/crime-justice/article/anchorage-man-7-others-charged-conspiring-distribute-nearly-100-pounds-cocaine-meth/2014/11/03/
30-Jul-14
AlaskaDispatchNews Opioid
State:Anchoragephysicianbilledmorethan$1.1millioninfraudulentMedicaidpayments
LaurelAndrews
http://www.adn.com/crime-justice/article/state-anchorage-physician-billed-more-11-million-fraudulent-medicaid-payments/2014/07/31/
21-Mar-14
AlaskaDispatchNews Heroin
Anchoragedrugbustnets30kinmeth,heroin CaseyGrove
http://www.adn.com/crime-justice/article/anchorage-drug-bust-nets-30k-meth-heroin/2014/03/21/
23-Oct-13
AlaskaDispatchNews Heroin
HeroinsalesleadtolengthyprisonsentencesforAlaskans
JerzyShedlock
http://www.adn.com/crime-justice/article/young-anchorage-men-receive-multi-year-sentences-heroin-sting/2013/10/24/
5-Aug-13
AlaskaDispatchNews Heroin
Anchorageheroindealersconvictedonfederaldrug,weaponscharges
http://www.adn.com/crime-justice/article/anchorage-heroin-dealers-convicted-federal-drug-weapons-charges/2013/08/06/
15-Feb-13
AlaskaPublicMedia Heroin
Addiction:FromHerointoWorkaholism KristinSpack
http://www.alaskapublic.org/2013/02/15/addiction-from-heroin-to-workaholism/
9-Jan-13
AlaskaDispatchNews Heroin
Fourmenchargedin'family-run'heroin,marijuanaoperation CaseyGrove
http://www.adn.com/crime-justice/article/four-men-charged-family-run-heroin-marijuana-operation/2013/01/09/
19-Oct-12
AlaskaPublicMedia Heroin
MayorSullivanReleasesRevisedBudgetProposal;HeroinontheRise
MichaelCarey
http://www.alaskapublic.org/2012/10/19/mayor-sullivan-releases-revised-budget-proposal-heroin-use-on-the-rise/
29-Dec-11 Alaska Heroin 14-year-old CaseyGrove http://www.adn.com/alaska-
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137
DispatchNews
injectedwithheroindies
news/article/14-year-old-injected-heroin-dies/2011/12/29/
29-Dec-11
AlaskaPublicMedia Heroin
GirlInjectedWithHeroinDies JoshEdge
http://www.alaskapublic.org/2011/12/29/girl-injected-with-heroin-dies/
27-Dec-11
AlaskaDispatchNews Heroin
Alaskateenin'dire'conditionafterheroinoverdose
RachelD'Oro
http://www.adn.com/alaska-news/article/alaska-teen-dire-condition-after-heroin-overdose/2011/12/28/
27-Dec-11
AlaskaPublicMedia Heroin
ManFacesFourChargesForInjectingTeenWithHeroin
LenAnderson
http://www.alaskapublic.org/2011/12/27/man-faces-four-charges-for-injecting-teen-with-heroin/
25-Dec-11
AlaskaDispatchNews Heroin
Manaccusedofinjectingheroinintogirlwhooverdosed
RosemaryShinohara
http://www.adn.com/alaska-news/article/man-accused-injecting-heroin-girl-who-overdosed/2011/12/25/
24-Aug-11
AlaskaDispatchNews Heroin
Anchorageheroindealerslappedwithlengthyprisonsentence
CraigMedred
http://www.adn.com/anchorage/article/anchorage-heroin-dealer-slapped-lengthy-prison-sentence/2011/08/25/
20-May-11
AlaskaPublicMedia Heroin
CustomsOfficialsSeize$1.2MillionWorthofHeroin JoshEdge
http://www.alaskapublic.org/2011/05/20/customs-officials-seize-1-2-million-worth-of-heroin/
19-Jun-10
AlaskaDispatchNews Heroin
Hooked(SevenPartSeries)
JuliaO'Malley
http://www.adn.com/anchorage/article/heroins-grip/2010/06/19/
2-Nov-09
AlaskaPublicMedia Heroin
HeroinUseontheIncreaseinAnchorage PatrickYack
http://www.alaskapublic.org/2009/11/02/herion-use-on-the-increase-in-anchorage/
22-Feb-09
AlaskaDispatchNews Opioid
Effortsmadetostartstatewideprescription-drugdatabase
ZazHollander
http://www.adn.com/science/article/efforts-made-start-statewide-prescription-drug-database/2009/02/23/
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APPENDIXH–PRIMEForLifeSurveyClassSite____________________________________Classdates__________to__________
VolunteersofAmerica,Alaska
PRIMEFORLIFE–ParticipantEvaluation
Note:Thissurveyisanonymous(noonewillbeabletoconnectyouranswerswithyou).Allcommentshelpusunderstandourstudentsandimproveasinstructors,sopleasegivehonestfeedback.Thankyou!
Instructor#1:Name_____________________Instructor#2:Name_______________________
1. PleaseratetheInstructoronthefollowingitems,usingascaleof1(Notatall)through10(exceptionallyso):
A) Theinstructorwasknowledgeableandwellprepared: Instructor#1)12345678910Comments: Instructor#2)12345678910
B) Theinstructortaughttheinformationandledthe Instructor#1)12345678910
discussionswithoutjudginganyone. Instructor#2)12345678910Comments:
C) Theinstructorrespondedwelltoquestions: Instructor#1)12345678910
Comments: Instructor#2)123456789102. PleaseratePrimeforLifeonthefollowingquestions(Checkallthatapply).
A) Whichpartofthecoursewasmostusefultoyou?£Instructor £AlcoholInformation £TobaccoInformation£Video’s £MarijuanaInformation £OtherDrugInformation£Book&Packet £RxInformation £Other_______________
B) What,ifanything,doyouthinkyouwilldodifferentlyaftertakingthisclass?£Nochange £Waittilllegal £StopusingMarijuana£Useless £Stopusingdrugs £Other_______________£Shareinformation £StopusingAlcohol £Other_______________
3. Startingageofuse(ifeverused):
Alcohol:Ageoffirstuse_______Marijuana:Ageoffirstuse_______
Cigarettes:Ageoffirstuse_______ IllegalRxdrugs:Ageoffirstuse_______
4. Drugandalcoholsources:Wheredoyouusuallygetthealcoholyoudrink?(pleasecheckone)€ 1:Ihavenothadanyalcoholtodrink
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€ 2:Iboughtitinastore,restaurant,bar,club,oratapubliceventsuchasaconcertorsportingevent
€ 3:Igavesomeoneelsemoneytobuyitforme
€ 4:Itookitfromafamilymember
€ 5:Someoneunder21gaveittome
€ 6:Afamilymember,over21,gaveittome
€ 7:Someoneelse,over21,gaveittome
€ 8:Igotitsomeotherway:_____________________________________________________
Wheredoyouusuallygetthemarijuanayouhaveused?(pleasecheckoneifyouhaveusedpotor
weed)
€ 1:Someonesmokeditwithorgaveittome
€ 2:Iboughtitinapublicbuilding,suchasastore,restaurant,bar,club,orsportsarena
€ 3:Iboughtitinsideaschoolbuilding
€ 4:Iboughtitoutsideonschoolproperty
€ 5:Iboughtitinsideahomeorapartment
€ 6:Iboughtitoutsideinapublicarea,suchasaparkinglot,streetorpark
€ 7:Igotitsomeotherway:____________________________________________________
Wheredoyouusuallygetthecigarettesyouhavesmokedortobaccoyouused(ifyouhaveusedtobacco)?1:Iboughtthem/itinastore
2:Igavesomeonemoneytobuythem/itfor
me
3:Itookthem/itfromafamilymember
5:Afamilymember,over19,gavethem/itto
me
6:Someelse,over19,gavethem/ittome
4:Igotthem/itsomeotherway:_______________________________________________
WheredoyouusuallygetIllegal(Rx)prescriptiondrugsyouhaveused(ifyouhaveusedpillsorpharmed)?1:Igavesomeonemoneytobuythemforme
2:Itookthemfromafamilymember
3:Igotthemsomeotherway:(Notfroma
doctor)_________________________________
__________
4:Afamilymember,over19,gavethemtome
5:Someelse,over19,gavethemtome
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APPENDIXI–FourA’sSurveyPartnershipsforSuccessSurveyIntroductionThissurveywasdesignedbyfolksattheAlaskaInjuryPreventionCenter.WeareworkingwiththeHealthyVoices,HealthyChoicescoalitiontolearnaboutheroinuseandopioidusebeyondmedicalrecommendations.Manyofushavefamilymembersandfriendswhouseopioidsandheroinandwewouldliketofigureoutwaystoeliminateoverdosedeaths.WewillusetheinformationyouandothersprovidetobegintocomeupwithsolutionstothesesubstanceuseissuesinAnchorage.Itisgoingtotakeinputfromyouandothercommunitymemberstobegintofigureouthowwecanallworktogethertowardssolutions.• Wewillbeusingwhatwelearnfromthissurveytoworktowardsfiguringouthowto
reducetheopioidusebeyondmedicalrecommendationsandheroinuseinAnchorage.• Everyonehasdifferentandvaluableexperiencesandperspectivesregardingprescription
opioidandheroinuse.Thismakesyourinsightsandideasveryimportant.
ConfidentialityandPrivacy• Asyouanswerthequestions,feelfreetotellyourownpersonalstories:orifyou’drather,
youcanrefertoexperiencesofafriendoracquaintance.• Yournamewillnotbeincludedinanyreportsassociatedwiththeinformationyou
provide.• Youmaybeassuredofcompleteprivacy.• Someofthequestionsmaybeuncomfortableandtriggerpainfulemotions.Pleasefeel
freetostopansweringthequestionsatanytime.Yourparticipationiscompletelyvoluntary,andwewillgiveyoutheincentivenomatterhowmuchinformationyoufillout.
• Ifyouhaveanyquestionsyoucanask4A’sstaffformoreinformation?• Thanksforparticipating.
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Thefirst15questionsareaboutusingopioidsbeyondtherecommendationsofaphysician.Ifyouhaven’tdonethis,pleaseskiptothesecondsectionthatasksaboutheroinuse.1. Whatdrugsdoyouthinkofwhenyouhearaboutprescriptionopioids?
2. Atwhatpointdoyouthinkusingprescriptionopioids,beyondmedicalrecommendations,
becomesdangerous?
3. Howdidyoustarttakingopioids?
o Prescriptionforasportsinjury ____o Prescriptionfromadentist ____o Prescriptionaftersurgery ____o PrescriptionfromtheER ____o Recreationaluse ____o Other
__________________________________________________________________________________________________________________________________________
4. Ifyoustartedwithaprescription:o Whydidyoustartusingbeyondtheprescriptionrecommendations?
o Didthedoctor:
§ warnyouaboutthedangersofnotfollowingtheprescription?___yes___no
§ suggestideasotherthanopioidsforpainrelief? ___yes___no§ talktoyouabouttaperingoffyouruse? ___yes___no§ prescribemorepillsthanyoureallyneededtodealwiththepain?___yes
___no
5. Howdoyou,orpeopleyouknowobtainprescriptionopioids?
___dealer___street___doctor___friends
___stealfromfamily___stealfromstrangers___Other___________________________
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6. Whatconsequenceshaveyouseenfromusingopioidsbeyondmedicalrecommendations?
___lossoffamily___lossoffriends___lossofjob___homelessness
___poorhealth___lossofideaofnormallife___jail___Other___________________
7. Whichoftheseconsequencesdidyouknowaboutbeforeyoustartedusing?___lossoffamily___lossoffriends___lossofjob___homelessness___poorhealth
___lossofideaofnormallife___jail___Other__________________________
8. Howlikelydoyouthinkitisthatpeoplewhouseopioidsbeyondrecommendationwillface
theseconsequences?
o Whichonesmighthavepersuadedyoutonotstartusing?
9. Whatotherthingscouldhavepreventedyouruse?
10. Whataresafewaystostoreopioidssothatonlythepersonwiththeprescriptioncanaccess
them?
11. Whatwouldyoudoifopioidsweren'treadilyavailable?
12. Whatresourcesarethereforpeoplewhowanthelpwithopioidaddiction?
13. Whatresourcesdoyouwishwereavailable?
14. HaveyouheardofNaloxone(sometimesknownasNarcan)?___yes___no
o Ifyouhaveheardofit,howlongdoyouthinkitlasts?o IfsomeonegetsNaloxoneafterOD’ing,dotheystillneedtogetmedicalhelp?___
yes___noo Howdoyouthinkitcouldbedistributedtomakeitmorereadilyavailable?
15. Whatadvicedoyouhaveforsomeonewhoisthinkingabouttakingprescriptionopioidsbeyondaprescriptionforthefirsttime?
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HeroinuseQuestions
1. Howdoyou,orpeopleyouknowobtainheroininAnchorage?___dealer___street___doctor___friends
___stealfromfamily___stealfromstrangers___Other________________________
2. Whatconsequenceshaveyouseenfromheroinuse?
___lossoffamily___lossoffriends___lossofjob___homelessness
___poorhealth___lossofideaofnormallife___jail___Other_______________________
3. Whichoftheseconsequencesdidyouknowaboutbeforeyoustartedusing?
___lossoffamily___lossoffriends___lossofjob___homelessness___poorhealth___lossofideaofnormallife___jail___Other__________________
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4. Howlikelydoyouthinkitisthatpeoplewhouseheroinwillfacetheseconsequences?
5. Whichconsequencesmighthavepersuadedyoutonotstartusing?
6. Whatotherthingsthatcouldhavepreventedyourheroinuse?
7. Whatwouldyoudoifheroinweren'treadilyavailable?
8. Whatresourcesarethereforpeoplewhowanthelpwithheroinuse?
9. Whatresourcesdoyouwishwereavailable?
10. HaveyouheardofNaloxone(sometimesknownasNarcan)?___yes___no
o Ifyouhaveheardofit,howlongdoyouthinkitlasts?_____________
o IfsomeonegetsNaloxoneafterOD’ing,dotheystillneedtogetmedicalhelp?___yes___no
o Howdoyouthinkitcouldbedistributedtomakeitmorereadilyavailable?
11. DoyouknowofprogramsinAnchoragethatofferdetoxortreatmentprograms?
12. Wheredoyougetinformationaboutheroinuseorrecovery?
13. Whatadvicewouldyouliketogivetosomeonewhoisthinkingaboutusingheroinforthefirsttime?
Thankyouagainfortakingthetimetoanswerthesequestions.Yourthoughtsandadvicewillhelpmakeadifference.