Drug Epidemic 197 7 Imagine if a Plane Fell From the Sky Each Day 72000 deaths 2017 CDC How We Got in This Mess 1990s Big Pharm amp the 5 th Vital Sign 2010 Rapid Increase in Heroin Deaths ID: 726675
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Slide1
Making a Difference in Our Nation’s Deadliest Drug EpidemicSlide2
197
7
Imagine if a Plane Fell From the Sky Each Day
72,000 deaths – 2017 - CDCSlide3
How We Got in This Mess
1990’s – Big Pharm & the 5
th
Vital Sign
2010 - Rapid Increase in Heroin Deaths
Mid 2013 - FentanylSlide4
U.S. Prescription Practices
Starting Addictions that Progress to Heroin Use
4 /
5
80%/99%/30X
Ankle
Sprains?
92%; 10%
3,900
PEOPLE
Body Temperature
Heart Rate
Respiratory Rate
Blood Pressure
Pain
- the 5
th
Vital Sign?Slide5
Maryland Impact?
Taxing Public Health & Law Enforcement
#
1 in Opioid Hospitalizations
!
Up 245% - 1375 Last Year!Slide6
We’re Not Just Numbers!!!6
Brooke
Alex
Myles
Darrell
MattSlide7
Time for a Seismic Shift?
Drug Abuse is a
Treatable Brain Disease!
Tough On Crime?
Or, Smart on Crime!Slide8
The Changing Drug Supply
Cheaper, More Potent Drugs are Readily Available
While More Treatment is NotSlide9
Fast Forward from Toluca
& the Cyber-underworld
Egbert Ltd.
$3800 kg
Shanghai Wonderful Trading
$2500 kg
9
Vast Chemical and Pharmaceutical Industries
— Combined with Lax Regulation, Low
Production Costs, and Government Corruption
160,000
2005-2007
芬太尼
9 W TechnologiesSlide10
Street Economics In 3
Easy Lessons
2 Pills = $160
vs
4 Caps = $40
1 kg H =
$25k to 60k+
vs
1 kg F = $2,500
H = 3 - 4 x
vs
F = 16 - 24 xSlide11
Heroin:
A
Plant Based Opioid
Source Regions
Heroin Markets
They’re #1Slide12
Ivan
Guzman
Alfredo
Guzman
Heroin:
Sinaloa CartelSlide13
The Synthetic Storm: CJNG
El
Mencho
Nemesio
Oseguera
CJNG
Fentanyl is Now an Adulterant
Found in Many Recreational
D
rugs!Slide14
CocaineFear of Adulteration Has Never Been Greater
89%Slide15
Counterfeit RxModern-Day Russian RouletteSlide16
K-2 SpiceCentral Maryland – 27
Western Maryland – 11
Eastern Shore – 5
Southern Maryland - 1
*44 cases; 3 deaths – 9/28/2018Slide17
The Narco-Superhighways
“Los
Cincos
”;
“Los Dos
Laredos
”; “Traps, Mules & Ants”
5
85
35Slide18
Heroin & Fentanyl Seizures“Diablito”, “Comida China”, “Fire”, “Got Nyl?”
6+
tons
of heroin
485+ kgs
of fentanylSlide19
Heroin Mill & Tabletop:
Baltimore Style
Fentanyl
SpraySlide20
BRMLE, PH & Community Collaboration +
Best Practices
Law
Enforcement
It’s a Crime
Scene Too
Protect the Scene, but also Yourself
Next 3 Logical
Steps
Use Opioids? Treatment Works & Recovery is Possible
Public Health
Continuing Med Ed Creds
Crisis Intervention Teams
Community & Schools
MappingSlide21
Situational Awareness!
Mapping -
An
Award Winning Best Practice
The 2015 Baker Public Health Impact Award Winner:
Making a Difference in an Epidemic of Fentanyl Deaths in Maryland-
Geographic Information Systems (GIS) and Collaboration with the DEASlide22
Scheduling: a Collaboration Operation Mike & Mike?
DEA SFL-1
Mike at DEA HQ
OCME in Baltimore
DEA Baltimore
Mike at US EMBASSY BeijingSlide23
What Can Doc’s Do?Best Practices
Use PDMP
Remove Effective Treatment Barriers
Buprenorphine / Methadone
Discuss
Risks
& Benefits with Patients
Follow Best Practices
Screen for Substance Abuse / Mental Health Issues
Prescribe Lowest Effective DoseSlide24
What Can Consumers Do?Best Practices
How will my pain be managed before, during and after surgery/injury?
How much discomfort is usually associated with this procedure/injury?
What non-narcotic pain control options do I have?
What side effects can I expect?
How will I manage long-term pain?Slide25
What Can Your State Do?
The 6 Key IndicatorsSlide26
Maryland’s Report CardLagging Behind, but ImprovingSlide27
The Courage to Change
vs Too
Big to
Fail
Veterans Administration
Baltimore, MD
“Opioid Decision Taper Tool”
FDA
“Rationalized Prescribing”
Sinai Hospital
Baltimore, MD
“Local Anesthetics & Nerve Blocks”
Johns Hopkins Hospital
Baltimore, MD
“20 Common Operations”Slide28
Some Good Things
MAPPA’s 20 Years of Prevention Partnering
Run In My Shoes
U of MD & Yale re: Buprenorphine in ER
Maryland’s PDMP now Mandatory
Peer Recovery
Specialists
Drug
Treatment
Court Slide29
Illicit Drugs Are Like a Box of ChocolatesYou Never Know What You’re Gonna Get!Slide30
3 Keys to Success
Make Your Bed!
Form Partnerships!
Don’t Tap Out!