two powerful sentences that speak to tonight's important event it is encouraging to see that so many of you have gathered with us for more information on the subject of the heroin epidemic that is affecting our communities close to home and around this nation because our communities are changing libraries are changing and transforming people are looking for information twenty four seven and a place to meet study and create with national library week only a few weeks away i invite you all to visit us across the street to see how we are transforming to meet the needs of our community where else can you watch a ventriloquist perform celebrate shakespeare's four hundredth anniversary and even join in a family drum circle if you don't have your new free wagon library card you're missing out on our network of twenty libraries sharing more than one million free items and countless free programs like the one we have for you this evening i would like to acknowledge  league of women voters of washington county as our valuable partner in tonight's endeavor their president this evening judy hughes will be filling in as moderator for jackie campbell and gene sperry from the league will be gathering your questions on note cards to be answered at the ends of tonight's program we encourage you to ask questions so please look for student volunteers who passed out pencils and note cards as you entered and when you if a question arises during the speaker's notes tonight just raise your hand with a card and one of our two students will be around to retrieve them we'll pass them along to gene and then we'll filter them up at the end of the program so that we can answer as many of your questions as possible in addition to the league of women voters from washington county i also wish to acknowledge our planning committee members tami taylor from the washington drug and alcohol commission and stacy ryback director of community outreach for the office of senator guy  also truly appreciate the support of the peters township school district and the peters township middle school staff who have graciously welcomed us once again to their stage for our second event in two months special thanks to brian griffin who will be helping us with our audio this evening and to the custodial staff for their assistance a program like the one we have planned for you this evening does not come together without the help of our library staff who have been involved on so many levels from registrations to publicity and we think margaret dates are and her team of program volunteers who are all here this evening please don't forget to visit our information tables in the lobby as you leave this evening to learn even more i also wish to acknowledge the community support here this evening including our peter's township school district administrators school board members our chamber of council commerce president district p t a members parents and most importantly our students as you can see our community cares about tonight's topic next i'd like to introduce tonight's speakers and their topics ranging from intervention prevention and treatment who i invite to stand when introduced peters township deputy deputy chief doug grimes will be speaking in place of harry frick and he has prepared a presentation tonight on the topic of legal issues owen trainer board certified emergency medicine physician and director of e m s and pre hospital care at st clair hospital will address medical issues from an emergency room perspective holly livingston will be speaking tonight in place of dr neil capriccio holley is the business development manager from gateway rehabilitation center and will speak on treatment options current and future cheryl andrews executive director of washington drug and alcohol commission will speak on prevention intervention and treatment and philip little education and outreach specialist from the office of the pennsylvania attorney general will further discuss prevention options schober washington county commissioner will offer tonight the closing remarks our moderator judy hughes will take my place at the podium and will keep our program moving along so that there will definitely be time for your questions  to begin tonight's program with an overview i ask you to please welcome washington county district attorney eugene the town appreciate the opportunity to talk about the opiate epidemic and on the flyer for this it says the heroin epidemic in our community that word epidemic is a powerful word and that's not hyperbole and that's not overstating what's going on in our nation right now that's exactly what we have here the centers for disease control has termed this and that the damage and the numbers that hopefully i'm going to relate to you will convince you that we have a serious problem here and that we need to really start looking at ways to solve this problem and this is no secret this is been going on for several years now there's been an unprecedented escalation in the use of prescription opi medications and heroin and two thousand and fourteen one point nine million americans have prescription opiate addiction and nearly six hundred thousand had an addiction to heroin the national figures on overdose this dramatic increase in deaths due to prescription medication you're going to see is closely intertwined with the heroin deaths that we see in the united states right now we average about one death for every twenty minutes the epidemic doesn't discriminate effects a broad cross section of our society be it age gender race ethnicity or economic status it cannot be overemphasized that where you live be a rural suburban urban it has no effect on insulating you from the problems of this epidemic and this is a public health in a public safety problem we know that overdosed s are increasing a dramatic raid throughout the country among men women and all most age groups heroin related deaths increased by four hundred six percent in eight years from two thousand and six to two thousand and fourteen while campaigning last year i had the opportunity to hear from people firsthand about the heartbreak and devastation the results from an addiction to heroin and prescription drugs i talk to families of lost breadwinners i talk to families of loss children i've seen the crimes that are committed in order to support an addiction i prosecute individuals who were originally prescribed medications for pain relief as i'm sure dr trainer will talk a little bit about the linkage and they ended up going to heroin and committing crimes for my eighteen years in the district attorney's office i knew that this was a new phenomena it was rare to have a heroin case as recently as ten years ago now it's rare not to have a case  drugs i think to fully understand i'm going to try this on my gosh i don't know that was behind me no wonder all you folks are like that was scary stuff annie white i think they're really understand what's going on and we have a couple pharmacists in the room and they could help me with a if they want to pitch again these are medications that are legally prescribed medication oxy opana and if you look at the heroin molecule you'll notice that there's a big simular t between all these drugs this is what's causing the problem is right now morphine and opium have been or used for the treatment of pain federal regulatory agencies that pushed the the medical community and encouraged them to use opiate based medications and non terminal pain settings particularly for chronic pain health care providers pharmaceutical companies present modem new pain medications that were coming out there and providers frequently weren't provided with enough education about appropriate opioid perscribe there was also a wide public  widespread public impression that was put out by pharmaceutical companies that these drugs did not carry the risk the high risk of addiction that we now know they possess that patients aren't appropriate to monitor probably marketed also as being abuse or resistant due to the extended release formulation the abused to turn aspects of the drug war quickly defeated many patients developed an addiction to opioid medications at that began to see extensive doctor shopping we saw a pill mills and you may have seen this on the news before going as far as the florida the pain pills in peter sonship we saw this right here in two thousand and twelve when a physician was arrested for over prescribing prescription medication that doctor over herndon was charged by federal authorities for dispensing these powerful opiate drugs oxy codeine an oxy morphine and you would see in his lot you would see cars from all over the area and from different states many form a season this is where pharmacies are to be commended my understanding of that case was that the pharmacist sort of first to recognize this and stop selling his prescriptions and they notified the and that's what led to the investigation during one visit to the doctor an undercover detective was told by herndon to get his prescription filled as far away from here as possible because he knew that he was being watched many of the pills that were being prescribed were sold on the street someone he was arrested mr hicks in the u s attorney told me that the price of opana on the street actually doubled that very day he was successfully prosecuted in federal court for drug act by elations it was also prosecute for medicare fraud and he's in jail now when those addicted to the medications could no longer obtain opiate medication they quickly learned to go to heroin  did they go to heroin well was plentiful and the other thing is in the the heroin we have valuable to us right now is a lot different than what it was as recently as twenty years ago the purity we're dealing with it's about four times as powerful it can be snorted previously you needed to inject it to get the effects that you wanted but the cost is also gone down so there's a common public misperception that the prescription drugs are less dangerous when abused than the oliebol dress so that was the factor to lead to what we're running into it was the medications going to the heroin the other thing is there are a couple other factors i'd like to just bring your center really quickly and we can talk about washington county our society is constantly bombarded with marketing and i know if you watch t v late at night you'll see prescription medication commercials the pharmaceutical  community is now going directly to consumers to get them to try to buy medications there's also so many pills out there it's unbelievable how many pills are in the united states at this time i saw a kids have access to this and we're going to talk a little bit about that later there's also problems with third party health care payment systems encourage many pills where a few pills maybe something is necessary so hopefully this gives you a little flavor of the public health public safety crisis we've had thirty two hundred cases last year in the criminal division of the washington county court of common pleas that's a thousand more than we used to have just five or six years ago ninety percent of those cases are driven by drugs and that's why i'm here and that's why i'm talking to you but there's more to it than just the criminal cases the human toll is just simply astounding these are figures from tim workout has done a fantastic job as our corner tracking data and i'm going to use a lot of his data here he actually has a back the one nine hundred ninety two i'm not real good a power point so i didn't go that far back but in one thousand nine hundred two we had two overdoses i was a paramedic for twenty years and i can tell you from thousands of calls both here and peter sajan throughout washington county i never had a fatal accidental overdose so when i took office in two thousand and eleven and i saw that number right the forty six i'm like what the hell's going on this is crazy this is pretty much stayed the same the number of fire motor vehicle license that we've had we've been bought two dozen a year it's stayed the same we've actually gone down lately which is great this is just astounding i don't know if you can see the bottom on two thousand and fifteen we had seventy three overdose that some washington county in five years if you had a mop that's two hundred  forty nine people in washington county that die due to overdoses and poisoning caused by opiate drugs and heroin this isn't just a problem though for young people and this is some more data this is from things data for the last five years as you can see forty six percent are almost forty seven percent of our people there dying from this are over the age of forty whether they're doubling up on their medications whether they've had back problems and they've switched to the heroin whether they've they're using different medications a lot of which are going to see what sam's data is and this is all available on the county web site by the way  forty six percent of the cases were combinations two or more drugs and fifty seven percent were from prescription medications primarily opiates we're not talking about disposable human beings here these are fathers mothers brothers sisters friends public servants wage earners health care providers and friends many became available are addicted through legitimate means and talking with cheryl we were in the conference a couple of weeks ago on our way to harrisburg and she told me seventy five percent of the people are presenting for treatment of her agency she does all the assessments which will tell you a little bit more about what she does a little later on but seventy five percent of the people that are becoming addicted they report that they're starting with legitimate medical prescriptions so these aren't people that are just partying too much and getting sick and getting an addiction and then having problems these are people that have legitimate medical needs and pant this combination is particularly deadly if you look at corner work as data you're going to see that what we go on about in washington county where we start our response in two thousand and twelve at that time there was a much attention being given to this and what we immediately identified as a problem was a prescription drug problem and the fact that we're having kids that were using pills because they thought the pills were safe they're coming from a pharmacy they thought this was something safe and we were having some issues with that so we immediately started working on this in the schools but our our our approach and it's evolved as a majority a little bit and we're going to continue to evolve as we go forward but what we've been doing is  trying to not necessarily prosecute people that are addicts we just don't have enough resources i mean even if we want to put them all in jail there's not enough jail space it's also counterproductive it doesn't do you any good they need to be indigent so what will you learn quickly as we can incarcerate our way out of this problem to date the criminals yes they need to be held accountable and they need to make restitution and make arrangements to repay people that they victimized but they also need an opportunity to get treatment and then to recovery otherwise we're just going to be right back where we started and we saw that with the number of people that were on our criminal trial is that we're coming back for five six seven different  cases we've established diversion programs through a court of common pleas to get nonviolent offenders into treatment at the earliest possible face were used to happen is you'd be sitting on a trial list for about twelve months and then maybe when you've got in front of the judge ordered drug and alcohol treatment we've cut that down that we're trying to front load the system the where people are being identified as addicts getting into treatment getting assessed and we give them the opportunity to get better they do better if they dump them we have other things we can the field it's now possible for first responders police and fire to do this when somebody overdoses is going to respond or tory reston quit breathing too long or that they're dead along some reverses the effects of the drugs and they're able to break a misconception has been out there about the locks on that and then navels people to use drugs full to the extent it keeps them alive so that they can use again i guess that's true  on the other hand no addict if you talk to them once nor can i listen to a seminar today at seven springs with a physician and he told me that actually they're using that as kind of a twist to get people  to do things that they need to do in the emergency room by telling them that they're going to get narky and if they don't i'm going ari i have to interrupt oh well thank you your time is up and we need to move on to our next speaker  fully when we get chance the questions at the end of the presentation the next speaker is the assistant chief of police of p this township mr grimes douglas good times and he's going to cover the legal side of the problem we'll get rid of that picture first of ok lesson learned good evening and it's awesome that you all came out to hear this tonight it shows an extreme interest in a very difficult subject and a topic that is near and dear to all of our hearts are involved in law enforcement first responders and the like in the medical field as you can see i'm not chief harry frick chief rick was unable to be here tonight so i'm going to talk to you just briefly about the laws and what we deal with as we encounter these you know harold peril one laws in general revolves around what's called the schedule of drugs or the classification of drugs that's used at a federal level in the state level as well in pennsylvania heroin is classified as a schedule one drug and what that means is that it has a very high potential for misuse and as a result of being a schedule one drug it carries a heavy penalty the highest penalty that you key and for drugs heroin laws in general revert back to narcotics being illegal both in the state and federal system and that's significant because they can be prosecuted at either level the significance of that comes down to the federal laws are much stronger and the penalties carry much more significant weight than the state laws unfortunately federal charges may apply in the crime when there are multiple states involved when the federal department of whether it's the or whoever is involved in the investigation of the case and they're looking at it they can bring the charges we can also involve the u s attorney some of those charges many states now offer unfortunately or fortunately depending on how you view this drug treatment programs and the drug treatment programs are used to give first offenders the opportunity to be rehabilitated and it only applies when they plead guilty in most cases simple possession of heroin there are three ways that you can get arrested possession  the simple possession of less than one gram of heroin in pennsylvania is a misdemeanor and it carries with it a maximum penalty of one year in jail for the first offense first offense can be modified but generally that's what you see subsequent offenses can revolve result in prison terms of up to three years purchasing heroin is the second way that you can get arrested the purchase of heroin and is a separate crime and can be charged in addition to to buy heroin in pennsylvania defendants generally are charged with just the simple possession and not the purchase possession of paraphernalia you say what is paraphernalia in the case of heroin paraphernalia can be something as simple as a spoon but paraphernalia involved it's a misdemeanor offense and it can be brought as an additional charge against anybody whether or not it contains residue if we come into possession through an investigation of a needle somebody who is using heroin that needle whether or not it has been us contains residue in the needle itself or in the syringe can be bring a charge of possession of paraphernalia since a new drug court is used for minor offenses tanzania drug court program exists just typically for a very limited opportunity a very limited window typically that drug court consists of the judge the prosecutor the o probation and parole and usually the defense counsels involved with it and there may be some others the goal of these drug programs are to divert these users and give them the opportunity to kind of turn their life around just recently had an opportunity to speak here at the school when a program at the school district has called character counts and we got to talk to kids about that we had a drug addict a recovering drug addict in here who talked to the kids and it was interesting to see the interaction and hear the story from someone who's lived this life and experienced it and has kind of come back from the brink he in that particular case was an individual who had been on death's door two different times but to see him speak to the kids was nothing short of dramatic dealing in trafficking heroin in pennsylvania brings three different sections that are involved in the pennsylvania crimes code anything between two grams but not less than ten grams can be up to a two year prison sentence of five thousand dollars fine or a larger amount if that's the term and by the court to exhaust the assets from the legal activity that has to do with asset forfeiture least ten grams not less than one hundred grams is a three year prison sentence with a fifteen thousand dollar fine and again that fine can be increased and then finally anything one hundred grams or over will bring a five year prison sentence and a fine of twenty five thousand dollars again the federal sentencing for these same offenses is much more significant dealing in trafficking in each of these sections that i talked about have a clause in them that raises the prison term another five and the fine if at the time of the arrest and sentencing the defendant has been convicted of another drug trafficking crime so you begin to look at what's called a prior record score the number of offenses that they're involved in mandatory sentencing in pennsylvania there's no authority by any court to impose a lesser sentence just things that judges don't typically like mandatory sentences right but they cannot impose a lesser sentence they can bring a little harsher sentence but not lesser and then nothing in this section shall present prevent the number elative really new to this area i grew up around here grew up in jefferson but i'm relatively new to this area and i spent twenty eight years with state police and then in august started here in peter's after i retired from  p and one of the things that i heard about peters this community before i came back was there's a great area and it really is the fantastic area of tremendous opportunity here in your schools in your community and what you have in front of you but just because it's a great area doesn't mean that were excluded from this epidemic this photograph here and it's a little tough to see from where you sit but those are open packets of heroin from a peters township case that's a lot of heroin sitting there and that's a story that i constantly hear when i travel around while you think this stuff really happens and taters yes it absolutely does it's here and the fact that it's here you need to have your eyes open need to have them open wide for anyone you love anyone you know anyone you care about and look at what's going on in their lives look for changes changes in their behavior here some paraphernalia look for changes in the way they conduct themselves in their grades in their work attendance in whatever in their demeanor these are the beginning signs this drug will change a person beyond anything you could have ever imagined the people who use this drug will steal from their grandmother they'll steal the ring that they got the grandma got married with if that's what it takes to get that next high and then some of the other people here will talk a little bit more about some of that but thank you fix the problem i can start off without talking about some to to cicle things and i don't think it's important to know these numbers but i think it's important to look at how quickly change has occurred how steep the curves of death are in the last few years i think it's also important to look as the number of addicts increase that the death rate is increasing quicker higher and the matter what groups you look at just about all the demographic groups have increased the amount of addiction and death here's a connection between other substances and heroin the average heroin user is using three drugs if you're alcoholic patient you're two times more likely to be using heroin if you abuse marijuana three times more likely if it's cocaine it's fifteen and opioid prescription drugs forty times more likely to be addicted to heroin so a cut a swath of course all of the substance abuse problems we face in this country but it's about human lives more than those numbers doesn't look like this person is very happy or this life places that you wind up and the place and we were bo know when this sort of thing happens the way you wind up in the medical system this was from a broad a video released by africa darby police in pennsylvania this week is going viral and a warning here it's hard to watch the video shows twenty five year old michael meaney shooting heroin into his arm while riding on a crowded bus at one o'clock in the afternoon i mean he starts to nod off falls out of his seat the result of an overdose officers arrived at the scene they use nor can spray it's a heroin antidote to save how many votes he gave you a bunch of peas how many d and how many are just merely voting present like our senators ok well the correct answer of course is increased alertness doesn't happen with opiates it's slow next question all the following may legally administer no locks on or nor can to a person with a suspected heroin overdose except so if a is firefighters be a paramedic to or lay people legislation that you spoke about earlier it allows laypeople to administer no locks on to people who need it so if you have a family member or a friend who are on opioids or if you know somebody who is using heroin you can get a prescription from your doctor and some training and you can save a life so all of us can help so how does it work let's travel back to the days of science we took in middle school well it turns out that opioids as you showed have similar structures to naturally occam occurring chemicals in about equal endorphin that hit a receptor on  and they fit on there and then it causes reduction of pain it can cause decreased mental status or alertness constricted pupils slow respiration suppression of the central nervous system so that's how that works what about the locks on well it turns out that no lock zone has a shape that can fit in those receptor also and it will bind to that receptor more avidly more strongly than the heroin well and so it is places the heroin from that agencies have gone into the community can partner with firefighters and with police officers to give no locks on opiate abuse patient or overdose patients we've elected not to use an injection and have a needle because many of these patients fear needles might have hepatitis c or hiv infection so rather than at risk exposure to blood products we use an intern a salute in which the medication would be sprayed into the nose so here's another video let's place the mad nasal gently but firmly against the nasal opening and briskly compress the syringe plunger the medication exits the tip of the mad nasal as a fine atomized mist resulting in broad coverage of the nasal new co a thin layer of drug the medication rapidly absorbs across the mucous membrane into the bloodstream as well as directly into the cerebral spinal fluid of the brain of voiding first pass metabolism  levels comparable to injections once in the bloodstream the medication circulates throughout the body in the central nervous system it enters the brain and binds to neural receptors exerting the desired clinical effect and leading to resolution and improvement valve that's an excess you have to buy yourself so one m l into the nostril so that's half as it turns out if you put a little bit more a little less it won't matter and matter is getting it all in and then if the patient wakes up we still would like to see them in observe them at the hospital here's a theoretical concern that the half life of the heroin will last longer than the half life of the particularly if they have long acting opiate you may have heard about fentanyl patches that somebody would wear to get pain medicine for three days if somebody eats from one of those or ingest them and we need to watch them for the least twenty four hours so we would like to see all of these people and we'd like to have the opportunity to talk with them and maybe try to get them into the next phase in the phase of meeting with the rehab people and getting off the medication getting off the  i have three minutes and twenty five seconds left you have any questions or comments have is that sometimes the pendulum swings too far one way hey you're not giving taking care of pain well enough and now it's gone back to the other way now you're giving too much pain medicine who would hate to see people who really need that medicine deprived of it and there's an article that's going to be published shortly that they interviewed fifty nine heroin addicts who are in the emergency department and they asked them how many of you received your first dose of opiates in the emergency department and it was seventeen percent of them and then if you start doing some math like saying well seventeen percent people been at it for about fifteen years that's one percent a year and or two hundred eighty nine thousand heroin use in the last month that we have data on so that means it's three sixty one percent of those people had pain fifty one percent of those people see some pain medicine and you drag it out all the way down to it takes according to this study seventy eight hundred sixty four people to get opioid pain  department to make one heroin addict i don't know of those are the true numbers that's one little study with fifty nine people but it says there's some connection in where i work periodically i get a letter from a prescription drug benefit plan that said your doctor number eight you wrote for twelve i couldn't tablets for somebody and there's a list of twelve doctors and somebody wrote for ninety of them somebody wrote one hundred twenty of them and they're telling me for months after i wrote that prescription on a patient i may never see again one of the components we need to do to make a plan that really works is to look for the high risk people and not write prescriptions for them look for the people who are diverting the persistence and giving them to other people seven other people we need to do that one of the ways would be to have a central database that before i write the prescription i put in the patient's name and i see in the last two months they had six hundred tablets of percocet or viking and they went to seventeen different pharmacies in five different states so i write that prescription now the c d c has a new thing a new guidelines that said that just was published in the last week that says if you write a prescription write for the lowest possible strain for the shortest amount of time not more than seven days and three days is often enough but after that the family doctor the doctor can prescribe after that they need to have a talk with you about what's reasonable and we need to study main means of taking care of pain that are non pharmacol i just wanted to take us a few seconds to remind you if you want to have a question and said that there was students handing out index cards since you came into the auditorium  please write your questions and hold them off and those students will collect them and bring them down here to the stage area the next speaker is holly sharing with some of my colleagues the panel that we did last week there were seven individuals in attendance so this is by far our preference thank you all for for taking time out of your busy evenings yeah definitely as was stated my name is holly livingston my background prior to coming into the business side of rehab was in clinical i was an adolescent therapist for a number of years and spent the majority of my career on that side and so my experience lends itself to every level of care that's out there particularly for adolescents and young adults and i want to share some of that information with you as you're thinking of your questions this evening please feel free to ask any and all questions i know myself and our colleagues here we'll do our best to get an answer for you and if we can answer it for you and i will get some answers as well so with that our top three drugs of abuse for adolescents and young adults still remain tobacco alcohol and marijuana alcohol being the number one drug of choice that is technically legal at the age of twenty one for adolescents as well as in adults marijuana being the number one illegal drug drug of choice for adolescents as well as young adults what this slide illustrates is that  columns you have marijuana in the first column pain killers in the second they are neck and neck and so what we're seeing is a definite trend that you all are hearing about in various forms to take that a step further in pennsylvania we lead the country in the number of prescriptions sold and we have risen from number fourteen to number seven in overdose related deaths and so oftentimes people say well holly how did we get here how in our state in our communities did we get to this point it's marketing its business the united states in new zealand of the only two countries in the world that have direct to consumer marketing of pharmaceuticals we encourage people to ask their doctor about fill in the blank the number one prescribe or prescriptions are primary care physicians with virtually no training in mental health or substance use disorders the second highest prescribe ors are dentists they're very regimented in their prescribe and practices and therefore our access has become infinite the consequence that we face now is that we have a generation that  desensitized to the use of prescriptions we have young people that have been inundated their entire lives with commercials where you can literally diagnose yourself there's a pill for everything combined that with natural adolescent development they're naturally impulsive they have an inability to delay gratification and an inability to manage normal life stressors our young people assume that taking a prescription as you heard even if it's not their own house to be safer than what they're going to get on the my facility how that has played out is a lot of data driven decision making we've had to shift gears in the traditional methods that we use in our treatment approach as we've seen a decrease in outpatient admissions we've shifted that to an increase that's been offset by inpatient admissions we have a young adult population where we used to treat a lot of thirteen to seventeen year olds we now have shifted that demographic to that young adult population the eighteen to twenty five the new workforce that new generation of parents and community members we also see an increase in our female population rivaling our males and with that our patients have said that opiates are oftentimes their primary drug of choice and what that means is they have told us they've never tried a cigarette they've never taken a drink of alcohol they have never smoked marijuana when they started is with a sports related injury they had their wisdom teeth taken out they had a legitimate issue that got out of hand young people don't understand that pain killers are related to heroin morphine and fentanyl particularly with signs and symptoms of of those in withdrawal they don't understand that your body develops a tolerance needing more of the drug to get the same effect and later in life if you need surgery because of that tolerance it may make you more difficult to be sedated or have pain medication for legitimate surgery because you free ride your heart your brain chemistry essentially what we're dealing with are underdeveloped brains and inexperienced users because of the age of eighteen technically our young people are considered adults however we know now that the body and the brain specifically doesn't completely form until the age of twenty one as i mentioned our our patient evaluation and admission piece changed at the time back in two thousand and ten we were evaluating approximately five hundred young people and admitting approximately four hundred fifty fastforward approximately four years later we're evaluating four h twenty five an imaging three seventy five counter to that are impatient has increased by one hundred students we treat an average of six to seven hundred students per year with our age distribution again over four your span we were seeing more of that thirteen to seventeen year old which has now shifted to the eighteen to twenty five's and again that is a direct correlation with regard to that rivalry between marijuana versus our opiate use now in our rehab center we start treating at age thirteen and we go all the way through adult and what this looks like is approximately thirty percent of our population is within that range that young adult range but we've had to divide our program so we still have our traditional teen program but we've had to use some configuring with a young adult population that eighteen to twenty five and then also segregated out that older adult the thirty year olds the forty year olds because the life experiences are much different the patterns of use are very different just another illustration of how our female population is catching up with our ma and then as we start to look at specific diagnosis again this just reiterates the national trend we're right in line with those statistics i showed you the beginning cannabis and opiates being the primary diagnosis with cannabis being specifically thirty two fifty three percent while opiates have comprise thirty two to about forty nine percent this number of opiates has almost doubled in a four year time frame and then in our operation level of care we are still seeing the traditional cannabis as well as alcohol in terms of diagnosis our options the two most immediate are in school support and private practice how many are familiar with your student assistance program in the district inviting school folks don't count ok administration please look around and make sure that you are promoting this program because it is literally the best kept secret of early intervention in pennsylvania student assistants is comprised of a team of individuals in the district it's a kindergarten through twelfth grade model it was a stablished in one thousand nine hundred four by the pennsylvania department of education the department of drug and alcohol programs and the department of human services those entities oversee the model which was adapted from employee assistance what we knew back in one thousand nine hundred four is that there was a surge of opiate related deaths heroin specific at the time in western pennsylvania and a group of individuals got together and started to search for appropriate models that would be effective to intervene at the school level and so they modeled student assistance after that employee assistance process our rehab center provides training and consultation for student systems teams including peters township to identify those student barriers to learning and connect with services the beauty of this model is that you have administrative support you have faculty student services would be your guidance your social worker your nurse school resource officers juvenile probation as needed and then you have county mental health and drug and alcohol liaison's we're also encouraging schools to train your coaches because when you move from elementary to middle school middle school high school your coaches and your band director see a large volume of students they have a good report with parents and community and they are also another set of eyes and ears that can help with that early identification as a process of student assistance there can be a screening assessment and based on pennsylvania data eighty six percent of students who have gone through soon assistance and received an assessment also followed through with treatment recommendations that's an awesome thing that is a wonderful in school resource that you as community members as parents as neighbors as parishioners have at your disposal the fourteen percent in the corner that did not receive treatment this pre medicaid expansion and so there were still and still are some barriers to treatment however i think eighty six percent is a pretty good outcome and what that assessment can lead to if it is determined that there is a drug and alcohol issue are various treatment levels of care in a detox vocation level that's a medically monitor process for me to give me thirty six to forty eight hours and i can physically get you clean that's essentially the easy part of the treatment provider because then once you're clean we need to get you out of your head the thinking the feeling the emotions we have to start to learn to live life on life's terms and identify those triggers those stressors whether it's family or school or friends or work environment whatever those life stressors are we have to start to begin to learn the tools and how to manage without the drink or the drug once you're medically stable from a d a cation you're moving into an inpatient level of care depending on your circumstance it may be a week it could be two weeks it could be a month it varies one sure stable at that level we're going to step you down to an outpatient level this is essentially where the rubber meets the road you are practicing these skills that you learned in in patient in a resume or in an outpatient community setting the difficulty for teens that is different than adults is that kids can't change people places and things they can't divorce their family they can't change their school or move out of their community so as treatment providers we have to go through a different model in order to effectively impact that student and provide the support mechanisms around them to start to begin that life recovery and then with aftercare essentially what we're looking for is how is the student managing those stressors what is going on at school at home with friends how are things being received do we need to go back and really learn some different types of skills and so those are things that are again taken into practice as i mentioned we enhanced a lot of our programming because we have seen that shift in demographic and what that involves is if someone needs a clinical evaluation you can get it with my facility within twenty four hours we also added a case management component we have a specific that answers the phone she comes out she travels she will do that evaluation she will walk that parent or family member through the entire process and get that individual to where they need to go we have a twenty four seven three hundred sixty five day admission process as well the excess ability we're trying to make as convenient as possible we also understand that gender those girls that are catching up with the boys we need to do gender specific programming to look at things like friendships relationships family that are unique to male versus female st clair hospital we have a great relationship with and we will do a direct hospital transfer so when we were talking about those patients that are coming into the e r and getting stable that's a conversation that we have then to see is there about available and how can we as smoothly make that transition family education is a large component and always has been but particularly with that eight hundred twenty five year old range those individuals tend to stay at home a little bit longer they are not necessarily launching as we would like them to and so we have to take the family through that process of support without enabling it's not just about fixing the individual the addicted individual it's about helping the family to learn also how to manage that person without that drug or the drug in the system and then we have and continue to enhance our evidence based treatment practices we start to look at things like trauma informed care abuse and neglect issues post traumatic stress issues any number of things that can come into our doors we want to be able to provide the best comprehensive care that we possibly can i begin a young ready yes yes ok i think i only have seven minutes so we're going to just fly right through this and some of my slides have already been utilized so hopefully i can get through things i am cheryl andrews i'm the executive director for washington drug and alcohol commission we are we had a table set up out there we were handing out information our website is here i would encourage you to visit our website where a wealth of information basically we are a nonprofit independent agency that holds the contract with the state of pennsylvania we are the single county authority in washington county and we provide prevention intervention treatment in the sense of case management and recovery support services our mission is to engage educate and empower individuals to live healthy addiction f suit graciously shared the similarities between prescription medication and heroin one of the things that we really like to start promoting is the fact that we need to shift our conversation and we need to start talking about addiction as a disease as a chronic illness and the question is how do you catch this disease some people have a predisposition genetically but because it involves basic brain functions everyone will become an addict is sufficiently exposed to drugs or alcohol so as was stated especially for mr of a tone that this knows no boundary and we just heard that young people are becoming addicted because of sports injuries so again we need to be very mindful that the more we put in our the more were rounded the more likely we have an addiction issue the doctor graciously talked about what to look for  people that are using opioids and signs of an overdose one thing that i would like to add to that is the fact that many times many times you won't find somebody like this with track marks a needle in their arm but when you come upon someone their skin will be blue or purple the longer they have been their breathing has been suppressed they will literally have a blue color to them so who are we where washington drug and alcohol commission and basically i mentioned these are our focuses in this is what we do so in the prevention department we have train staff with years of experience and we offer free prevention services to all fourteen school districts in washington county we use evidence based programming we we do pre and post tests we have good results from those and we do programming from pre k all the way through older adults we collaborate in washington county with the county prescription drug summits with the take back days that we promote and we are involved with positive messaging campaigns intervention currently our greatest intervention is our no locks and training in distribution and this is in collaboration with the district attorney so far we've trained over five hundred individuals and that includes twenty four police department i don't even know how many fire departments first responders community members were actually coming back to peter's township to the library next week and doing a community narky and training this is one way that we are intervening with the overdose prevention and it's been incredible the response that we've had in setting up the training and distribution of narky and holly mentioned the student assistance program we have representation on all the student assistance programs in the fourteen districts the purpose is early identification of substance use disorders or problems with substances and we can make that referral to treatment in a very timely fashion and one other thing that we offer in washington county we contract with treatment providers to provide treatment right in the school district to eliminate the barriers of of transportation or having to make appointments after school we also provide intervention educational groups currently for adults and we will soon be adding intervention groups for adolescents our case management unit this is this is the big component of what we do and how we're addressing some of the overdose issues within the county so we've screened thirteen hundred people since july one people have called or rave intercepted them they have a problem they want to go to treatment proximately thousand assessments of that thirteen hundred actually had assessments and then fewer would be referred to treatment the biggest thing about our case management unit is that we're targeting so no longer do we have to wait for a phone call for people to say i need help we're intercepting them at the points when they may need it so we have dedicated case managers assigned to the school district to do assessments when the sat team identifies as stupid we have dedicated case managers for our criminal justice system which includes courts probation and all the diversionary programs that we're putting into place the idea is that we want to get people into treatment on the front end and not the back end of all the legal issues we have field base case managers for our washington county hospitals and for children in use services this is huge we are really paving the way at targeting where where people need help because people just aren't always raising their hand in volunteering and coming in for treatment we provide recovery supports their certified recovery specialist these are individuals who are in long term recovery themselves they have bad issues with substance abuse they work for our office and they support other people that are working a recovery program actually a study was done over the last three years of implementing recovery supports and it's proven to save a cost savings through all the systems of about thirty three thousand dollars a month so basically this peer support helps to eliminate barriers ok so if i could just finish real quick we need to change the conversation from problem to solution move to a public health model approach reduce stigma treatment rather than incarceration and we need to continue to have legislative support and finally there is my pennsylvania so it's very we're very lucky that he made the trip that today at this evening well thank you can everyone hear me ok all right first and foremost i want to thank the peters township library and the washington county woman le voters for hosting this event i have the responsibility as being the education and outreach specialist of the pennsylvania office the attorney general doing education and outreach for over ten counties of western pennsylvania it's an awful lot of driving an awful lot of meeting a lot of people throughout my time i come to an awful lot of these events as well and this by far is the best attended event i have ever seen holly mentioned that i think prior she went to one and there was about four people there and fortunately that's the norm i am so impressed with you guys as a community coming out here to give yourselves around the block knows no boundaries i call an equal opportunity destroyer that it doesn't matter where you live your age your gender your socioeconomic background it will take everything from you through my travels being an education outreach specialist i have had the privilege of meeting many people in recovery and when you think about addiction you typically pick think of people getting addicted that are a young age teens and early twenty's one story particularly sticks out in my mind of a gentleman who is forty years old had a great job as a construction manager never done a drugs in his life was on the work site the one day and gets his leg crushed needs knees surgery and is prescribe prescription opioids and right there started the downward spiral and before you knew it into short years he lost his job his house and his marriage because he became addicted to heroin unfortunately that gentleman story is not unique many of you in this room here today may have a personal story like that and i as well in our family our friends and loved ones we all know so well i want to talk about today is how do we prevent this from happening so are there pictures there behind me that scare you they're usually have this on a peer right there but how do we prevent this from happening because that's a big thing that we need to understand so let's talk about a few things that we as a community can do to prevent the spread of heroin abuse in prescription opioids the first thing i want to talk about here is is what we have the office of the attorney general of done and prevention of per script and drugs and as you can see behind me in the statistic between february of two thousand and fourteen in february two thousand and fifteen we at the office of the attorney general have destroyed fifty thousand pounds of prescription drugs or twenty five tons that's an awful lot of prescription drugs and here's the thing that people don't understand when it comes to prescription drugs these things kill more people than heroin and cocaine can bind you in one year they kill more people three hundred percent more people than all gun related deaths do per year but any of you that are responsible gun owners out there know we keep our guns locked up and know where they're at at all times but yet these things right here behind me are unlocked in our medicine cabinets sitting beside our nightstands and beside our kitchen sink where children can get a hold of them you have peters township have a great opportunity to destroy your prescription drugs by going to your local police department and putting them in a drug take back box located in the lobby that is wind way that you can prevent those prescription drugs that we all have laying around from getting wisdom teeth taken our previous surgeries that we all have in our house getting them and putting them in that drug take back box is one step that we can do to prevent them from being in the hands of someone who can abuse them there's one step that we can do as a community here the thing i want to talk about is the deaths in the united states and how big of an issue this truly is well just this past year  since beginning of this year and this statistic came out yesterday i looked own most sixty nine hundred people have died from an overdose of drugs or heroin since the beginning of this year to bring it to low closer to home the d a every year has comprehensive statistics that they bring out on the commonwealth and about drug overdoses and deaths just see as me just last year almost twenty five hundred people in our commonwealth alone died of drug overdoses so how do we stop that but one of the ways that we can do that is by utilizing our anonymous tip line and telling us about any drug that is happening in your community i had courage to all of you in the lobby there is this piece of paper out here with a magnet that has all the information behind me please put this on your fridge you can call us at the number behind me and we do not care who you are but we care about is getting those drugs off the street so someone can't use and we don't have another potential casualty also for any of you that are savvy with technology and texting you can te texting your tip the p a drugs at eight four seven four one one again this is a one other step that we can do to make sure that we have less casualties here in our community another big thing that i talk about in this is the thing that i take the most pride in cars on the education outreach specialist here in pennsylvania western pennsylvania is that we have comprehensive programs that we go throughout school districts boys and girl scouts church groups you name it if you think there is a need for us my information is right there behind you call attacked me this is a free program it is your tax dollars at work to give you an understanding of where we've been recently here in washington county we've been in the canons burke school district short's here susan trinity in washington any of you if you find this beneficial and you have an audience that wants to listen please contact us we can't have enough education with our young ones about this so that they are more informed and they choose not to pick up and use and then the last remarks i want to mention here is that we as law enforcement are not going to arrest our way out of this situation we're just not we need help we need help from the community in letting us know what happens but also we need to make this a multi pronged approach where it's not just law enforcement we need the help of our drug and alcohol our county drug and alcohol helping people as well as we need education because i can't say it enough everywhere i travel arresting someone and putting them in jail is not the answer the answer comes with a small type wrong approach w together as a community and we tackle this problem head on now well i said the beginning it's a great turn around here it's not everyone in peter's township so i have no homework for you as dr trainer said we're in school so you have some homework tonight i encourage you each and every one of you to tell your friends and family about what happened here tonight explain to them the things that are going on because again not everyone's here but we can spread that word because that is the best way to get the message out there is when we have those boots the ground and people in the community are empowered to spread that word so i want to thank you all for coming out here today god we have a representative from the county commissioner's office here holland chauffeur and he wants to speak to you for a few moments good evening everyone there's been a lot of information shared deceiving about the treatment legal issues and the importance of prevention as we work to the challenge of this drug epidemic some of you the younger generation a lot younger than me may not remember the question we would use sometimes in a state we'd make when we were confronting a big problem would say how do you eat an elephant and then answer would come back one bite at a time well we have a big elephant in the room tonight we have a big elephant in the nation and along with it what's in county and you can see there's supposed to be an elephant behind all these bites up here i needed a bigger elephant because when i start putting together all the different things that we need to do as a community and all the organizations i start running out of room pretty quick but this is an important thing that we have and one of the things i'll say is if he started before the elephant before the epidemic comes those things we're missing things like point out something called ivy now some of you may say ivy that's intervene as that's what we get in the hospital yes as of the lifesaving liquids that you need sometimes i'd i look at it as another i v called individual value part of the broader drug problem i think is that we don't think enough of each other in ourselves there's no respect out there and i think this starts wave beyond and we need to get that back as we look at that we have our faith our churches we have all different people out there that are trying to prevent as we said and it's hard being the last one in line i'm glad i'm just wrapping up because each one of these people brought something very important saving but there are so many things out here yes please slow and forstmann as it was said you'll never do law enforcement theoretic eight this problem we've got attacked this thing from all sides which i tried to demonstrate this elephant being the not we can't do it alone we need everybody involved in it someone came to me a parent the other day crying with the tears in her eyes and she said my son's in jail he had a drug issues went out and he caused the problem she said but i tried to get help before he got in trouble you know and that struck me so we have all kinds of programs we need to do a better job and getting that out letting people know when i see a child that's changing their symptoms things some of the things they're stated that we can say look there's somebody i can go to we need to advertise that we're going to push that a lot of these programs pre trial we're trying to take we're doing this at the county we just instituted this where instead of just thrown in jail for something that's not very violent because of the drugs you get assessed and you go into treatment instead of just sitting in jail waiting for something that happened but that's only going to treat some part of the population we have a reentry program you go through incarceration we're trying to rehab to get you back in to society but you can understand this is all going to have to work together no one has one plan to say how we're going to beat this epidemic you know i look at drugs and i say why can't we have drugs that don't make you high that no one would break into your house to get the drugs why because they wouldn't get so you can just say i'm just showing you how all the people tonight have brought different areas together and we need that as a community right here as your county commissioner my job along with my two counterparts is to provide support for all these various and we have an issue that a number of programs to help fight this problem one of the best ways to keep focused on this effort is to remember that any one of us in this room could be impacted in some way with this epidemic we must all work together and do our small part to help us move forward to a brighter future i thank you on behalf of judy and the others coming out tonight to see this turn out but we need to take this father we need to figure out how each one of us can leave we've got quite a few questions so i'm going to start by asking them right away so the time you can get home this evening holly this first question is dressed to you  says i understand the people network ready to support but how does it work all day identi find students at risk what is the process if someone is identified support mechanism that's always the first alternative if there is are in school supports as well as outside connectivity that needs to be made with either a community based service or a tree member vied or again her staff will make that linkage and parents are always provided and mandated to have written informed consent with that process so at no time does a parent or guardian not have the information necessary to follow through with whatever those recommendations are part of s that parents and or guardian have to be involved in that process thank you the next question is why don't abuse is want them do we have adequate facilities like gateway to meet the needs of abuse in our community i don't know who should love her trainer some people might not like  and do we have adequate providers to treat these individuals along with gateway rehab our agency contracts with over forty providers ranging from detox all the way to outpatient so the whole we have facilities throughout the state of pennsylvania that we do contract with and that are available and we have we have facilities if you have private insurance there are facilities even out of state that your insurance makeup or so is there a shortage of detox beds may be the issue is becoming that the detox bed may not be available at that very moment when we need sometimes we're waiting twenty four hours or longer for an actual detox bed so that is problematic right now thank you i know we have some school district personnel here who might want to address this just let us know if you are if you're still here do the schools in the i think is an interesting question for parents to know the answer to if you find someone already not breathing should you still give narconon or just begin c p r the important thing is  the slide i showed ben's or die as a pins with the archie on is a particularly dangerous combination and we have seen that if you look at cornered workers there you'll see that we've had a number of deaths due eat it when i talk to people who are abusing those drugs they don't say i took a pill they say eight six up so it's obviously not a medication to them but they can to a food substance or how do you feel about safe shooter powers's i also read recently that one of the local townships floors are having a methadone clinic and i'm assuming that a place for addicts to go when they're when the regular services are not meeting their needs so what do you feel about that i guess i'll take that one there is absence base treatment and there is also medicated assisted treatment so methadone  vivitrol which i'm not going to get into all of those if the doc would like to explain those a little better but they are all means two to compliment if you would call admitted behavioral therapies so a methadone methadone is just another mechanism by which some people are able to maintain sobriety so i don't know if that answer and there was there was a beginning part of that what was all the state of new york is actually i read that they implemented these safe houses where people actually go and it's a safe place to shoot up and use heroin and basically because they're trying to to live it happed see hiv it's all those communities communicable diseases and  so that i don't know that that's something that we're looking at bringing to washington county at this point i know we have a representative write twenty or fewer tablets and in lots of states there asking for just two or three days of medicine can you get into your doctor in two or three days for people less likely to have that kind of thing so there's a lot of areas that need to be investigated and a lot of things need to change so that patient pain can be managed well but there is definitely difference between the acute management of n q t injury and something that's going to last longer so there's a gulf there and we need to research and find the best practices that work but i don't think we're there yet but as you said that's avoid going to the other extreme has some statistics from that one article i tell you where it takes seventy six hundred people  to get an opiate to make one heroin addict if you reduce ten percent opiate use in the emergency department then that means two and a half million people won't get help each year in the us and that means that you have to avoid treating three hundred eighteen people with an opioid to save one person from becoming a heroin addict and you've got a seventy five percent reduction now you're saying eighteen almost nineteen million people you can't have your pain managed and then i mean twenty two hundred ninety one people will be needed to prevent one heroin addict so there needs to be something done and people are starting to work together encouraged by that as i said i can't but we can i think that's what it's going to take thank you and thank you for coming this evening i have a question here for the district attorney why aren't we prosecuting drug trafficking criminals with more severe punishment actually we are one of the things that i didn't get a chance to get to this was originally written for a much longer presentation i thought i could get it trimmed down enough  morgue we have a federal prosecutor now embedded in the washington county d a s office most of the mandatories that were in place in pennsylvania have been removed what we're using now is federal mandatories and we're working very closely with the u s attorney out of out of pittsburgh david hicks and there's a twenty year mandatory that we don't have in pennsylvania and i've talked to senator barr lot about possibly considering getting this in the legislation what that mandatory allows us to do is if you provide heroin to somebody and they overdose and the person that gave them the drug we can take them federally and invoke a twenty year mandatory we've already done that with three people this year you're going to see more of that actually mr  enough to provide a lot of support to washington county and we're kind of the model for this we have a fusion center that's based in cranbury we had a training session about a month ago where we're working with the various police departments we want them to get funds we want them to treat overdose of events as crime scenes and to get the information interview people try to determine where this is coming from we're going to keep working with that model and we've had we've had a nationally it looks very promising the the twenty year mandatory is is a good incentive when it's amazing how many people you can get the start talking about where drugs come from it's been particularly helpful with the fentanyl laced heroin that we saw in february that came out we were able to get the individual at least one of the individuals responsible for that quickly so it's something we're in continue to work on continue to do as we evolve and move forward on this  you and then the question is why do doctors prescribe bandsaw is the thing that's how you pronounce it i'm not quite sure from the spelling to heroin addicts is this trading one addiction for another someday i think i don't think there's a reason for using benzodiazepines or other medications or mitigated the symptoms of withdrawal it's not saying you're a heroin addict years twenty vallium good luck to you you know it's in the specifically for you you said something as simple as a spoon can be paraphernalia but maybe i had putting with my lunch and ate it in my car my question is how can you tell the difference between paraphernalia and something that was used innocently in the case of something as simple as a spoon it would be during an investigation where we also encountered the heroin if you see heroin those packets some of those packets i showed you and if you look closely in that photograph with the syringes beside the syringes were a spoon that spoon is used as part of the paraphernalia to when it comes to that you know one thing's for putting one of the telltale signs is that they'll use that spoon makes the hair with water heated up the spoons are blacked out ben things of that nature other piece of paraphernalia you're going to see they call them grimes their works their cotton balls the filter through as they put it through the syringe there rubber bands to tie off a vein things of that nature but when it comes to a spoon there's no difference between delicious tapioca being on it and the spoon being blacked out because there's a flame underneath it heating it up for air one i guess i'm going to make this the last question because i know you guys want to get home this evening but the question is  call one of the things that you are beginning to see more and more of in law enforcement or drug recognition experts in that specific training for the front line officers who are encountering these traffic stops the intent to train them and teach them to look beyond just the simple traffic violation and try to be able to determine exactly what are we looking at and there are signs but there are some people who are very good at it in pennsylvania and  i wouldn't say that not necessarily it comes down to and this is something that we always talk with youths about that everyone starts typically at one scene i call the party scene and it starts with alcohol and marijuana right some people get out of that phase and they're ok others aren't and one of the big misconceptions i know this because with alcohol but it's marijuana with young people they see that it's legal in other states i don't think it's an issue but indeed it is a gateway drug everyone always starts in that position as i was out there talking to you i've met many people in recovery and they never tell me the drug they're there for is for heroin for cocaine or they started out using i'm sorry was heroin cocaine meth every time the drugs they said they started using alcohol and marijuana i know i've known of people who tell me that that doesn't lie right there so it can it can it all and jerry dr trainer mentioned this a little bit earlier the pm d p the prescription database it's a huge hole in our system it was passed a couple years ago so we can monitor where drugs are being distributed  of people are going to different per physicians a hit there for any oars and there was no way somebody like jerry would know who's getting lot and pennsylvania was like one of the last places to really pass legislation for an effective for scripture money database program unfortunately two years ago and fund the new budget that just got passed supposedly has money available when at the fund is hopefully that will cut down on it because these guys will know you know somebody very much thank you so