Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-2 - HEALTH PRIORITIES › Section 410-2-2-.07 - Substance Use Disorder

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 According to the 2018 National Survey on Drug Use and Health nearly one (1) in
			 five (5) people aged 12 or older (19.4%) used some form of illicit drug in
			 2018, which is an increase from 2015 - 2016. Deaths from opioid overdoses alone
			 were more than 42,000 in 2016.[1] In Alabama the
			 death rate from drug overdoses climbed 82% from 2006 to 2014. The drug
			 crisis[2] affects Alabama hospitals, schools,
			 prisons, and businesses. (Unless otherwise stated, all statistics related to
			 substance use disorders quoted in this section come from the 2018 National
			 Survey on Drug Use and Health).
(2)
			 During 2018, approximately 20.3 million people aged 12 or older had a substance
			 use disorder (SUD) related to use of alcohol or illicit drugs during the
			 previous year, including 14.8 million people with an alcohol use disorder and
			 8.1 million people with an illicit drug use disorder. The most common illicit
			 drug use disorder reported was the misuse of marijuana (4.4 million people). An
			 estimated 2.0 million people reported an opioid use disorder, including 1.7
			 million people with a prescription pain reliever use disorder and an additional
			 500,000 people with a heroin use disorder.
(3) In terms of recent initiates (new users
			 within the previous year) to use or misuse of substances, the substances most
			 used or misused were alcohol (4.9 million new users), marijuana (3.1 million
			 new users), prescription pain relievers (1.9 million new misusers), and
			 cigarettes (1.8 million new users). According to the Substance Abuse and Mental
			 Health Services Administration ("SAMHSA"), in 2018 more than 4 out of 5 people
			 aged 12 or older perceived great risk of harm from weekly use of either cocaine
			 (86.5%) or heroin (94.3%), while less than one-third of people perceived great
			 risk of harm from weekly marijuana usage (30.6%). Approximately 2 out of 3
			 people perceived a great risk from daily binge drinking (68.5%), and nearly 3
			 out of 4 people perceived great risk from smoking one or more packs of
			 cigarettes daily (71.8%).
(4)
			 Substance abuse is more common among both adolescents and adults who have a
			 co-occurring mental health issue than among those who do not. Adolescents with
			 a mental health issue were reported as more likely to binge drink (8.5%) or use
			 an illicit drug (32.7%) versus those who do not report a mental health issue
			 (binge drinking 4.1%, illicit drug use 14%). Similar difference in use are
			 reported for adults aged 18 and older.
(5) According to SAMHSA, in 2018 an estimated
			 21.2 million people aged 12 and older needed substance use treatment in America
			 (7.8%). This includes approximately 3.8% of adolescents aged 12 - 17; 15.3% of
			 young adults aged 18 - 25; and 7% of adults aged 26 and older. Of these,
			 approximately 3.7 million people in America aged 12 and older received
			 treatment for substance use (1.4%), 2.4 million of whom received treatment at a
			 specialty facility. Among the estimated 18.9 million people aged 12 and older
			 who needed substance use treatment but did not receive any, approximately
			 964,000 perceived a need for treatment. Of those, approximately 40% did not
			 receive treatment because they were not ready to stop using, and approximately
			 one-third had no health care coverage and were not able to afford the cost of
			 treatment.
(6) The State should
			 encourage and promote a variety of treatments for SUD. Traditional treatments
			 for SUD include abstinence-based systems such as 12-step programs. Methadone
			 has been used successfully in recent years, especially for severe cases. SAMHSA
			 has recently reported significant success with Medication-Assisted Treatment
			 (MAT) which uses medications (primarily buprenorphine), in combination with
			 counseling and behavioral therapies, to provide a "whole-patient" approach to
			 the treatment of substance use disorders. Research shows that a combination of
			 medication and therapy can successfully treat these disorders, and for some
			 people struggling with addiction, MAT can help sustain recovery.
(7)
Marijuana.
The primary
			 illicit drug used in 2018 was marijuana, with more than 43.5 million reported
			 users within the previous year. The percentage of people aged 12 or older
			 reporting marijuana usage within the previous year (15.9%) was higher than
			 percentages reported to SAMHSA from 2002 - 2017. The increase is primarily due
			 to increases reported in young adults (aged 18 - 25) as well as in adults (aged
			 26 or older). By comparison, and in contrast to these numbers, adolescents aged
			 12 - 17 did not show an increase in usage between 2014 - 2018.
(8)
Prescription Drugs.
The
			 second most reported form of illicit drug usage in 2018 was misuse of
			 prescription pain relievers, with 3.6% of the population reporting illicitly
			 using prescription pain relievers within the last year. For all people aged 12
			 or older, and for young adults aged 18 - 25, the percentage of the population
			 reporting illicit usage of prescription pain relievers decreased in 2018
			 compared to 2015 - 2017. Similar decreases were reported for adolescents aged
			 12 - 17 and for adults aged 26 or older compared to 2015 - 2016 but are similar
			 to the percentages reported in 2017. Among all people aged 12 or older in 2018
			 who misused pain relievers in the last year, a significant majority (63.6%)
			 reported that the main reason for misuse was to relieve physical pain. More
			 than half of people who misused pain relievers in the last year (51.3%)
			 reported obtaining the pain relievers from a friend or relative.
(9) According to the Alabama Department of
			 Public Health ("ADPH") 2017 Overdose Surveillance Summary, 836 people in
			 Alabama died of an overdose, 419 of which involved opioids. The top four (4)
			 drugs related to overdose deaths in 2017 were fentanyl (161 deaths); heroin
			 (128 deaths); methamphetamine (110 deaths); and cocaine (98 deaths).
			 Additionally, in 2018 there were 11,081 visits to hospital emergency
			 departments in Alabama related to overdoses, with, 2,180 involving opioids.
			 There was a total of 20,353 overdose-related 911 runs in 2018, with 4,373
			 involving opioids. In 2017, the rate of drug overdose deaths in Alabama was
			 17.1 per 100,000 population, an increase from both 2016 (15.4 per 100,000) and
			 2015 (14.9 per 100,000). The rate for opioid deaths in Alabama in 2017 (8.6 per
			 100,000 population) was also an increase from both 2016 (7.0 per 100,000) and
			 2015 (5.7 per 100,000).
(10)
Opioid Abuse
a. Opioids are a
			 class of drugs that include heroin as well as prescription pain relievers such
			 as oxycodone, hydrocodone, morphine and fentanyl. These drugs work by binding
			 to the body's opioid receptors in the reward center of the brain, diminishing
			 pain as well as producing feelings of relaxation and euphoria While most
			 overdose deaths are caused by illegal drugs, many people first become addicted
			 to opioids by using prescription drugs that were legally obtained.
b. According to the Alabama Opioid Overdose
			 and Addiction Council, over 42,000 Americans died from opioid overdoses in
			 2016. According to SAMHSA, approximately 10.3 million people aged 12 or older
			 misused opioids in 2018. This number corresponds to approximately 3.7 percent
			 of the population. Of these, the vast majority (9.9 million users) misused
			 prescription pain relievers, compared to a much smaller population (808,000)
			 who used heroin. The majority of people who misuse prescription pain relievers
			 (9.4 million) had not used heroin, but a small number (506,000) misused
			 prescription pain relievers and used heroin within the last year. Among those
			 12 - 17 years old, approximately 699,000 adolescents misused opioids within the
			 last year, with another 1.9 million young adults between the ages of 18 - 25
			 also misusing opioids.
c. In the
			 state of Alabama, the number of drug overdose deaths, including opioid deaths,
			 climbed eighty-two percent (82%) from 2006 to 2014. According to the Alabama
			 Department of Mental Health ("ADMH") Substance Abuse Division, in 2018 4,546
			 individuals were treated by the department, or by entities contracted by the
			 department, for heroin addiction with an additional 7,082 treated for addiction
			 to other opiates and synthetics. These statistics, however, do not include
			 individuals not treated by the department or its contracted entities. These
			 individuals make up approximately thirty-four percent (34%) of the patients
			 that received treatment for substance use related disorders by ADMH or
			 contracted entities.
d. Currently
			 ADMH works with eighty-three (83) Certified and Contract entities to provide
			 services to individuals suffering from substance use disorders, providing
			 substance abuse treatment, medication assisted therapy and prevention services.
			 An additional eleven (11) providers are certified to provide prevention or
			 treatment services to patients, but do not receive funding from the Department.
			 There are twenty-one (21) Opioid Replacement Therapy (ORT) clinics throughout
			 the state that specifically target individuals suffering from Opioid Use
			 Disorders. Additionally, there are nineteen (19) public, nonprofit regional
			 mental health boards, called 310 boards, throughout the state. Of these,
			 fourteen (14) provide substance abuse treatment services. Birmingham and
			 Tuscaloosa have regional boards, with additional mental health centers attached
			 to them.
e. Governor Ivey created
			 the Alabama Opioid Overdose and Addiction Council through Executive Order 708
			 on August 8, 2017. The Council, co-chaired by the Commissioner of the Alabama
			 Department of Mental Health, the Attorney General of Alabama, and the State
			 Health Officer, was created to "study the State's current opioid crisis and
			 identify a focused set of strategies to reduce the number of deaths and other
			 adverse consequences of the opioid crisis in Alabama." The Council was given a
			 set of directives related to this purpose, including:
1. Advise and assist the Governor in the
			 development of a comprehensive, coordinated strategy to combat Alabama's opioid
			 crisis;
2. Gather and review data
			 characterizing the opioid crisis facing Alabama, including the threat of
			 synthetic opioids;
3. Review
			 strategies and actions already taken in Alabama to combat the opioid
			 crisis;
4. Review strategies and
			 actions of other States and the National Governor's Association Compact to
			 Fight Opioid Addiction; and
5.
			 Develop a comprehensive strategic plan to abate the opioid crisis in Alabama.
f. The State of Alabama
			 Opioid Action Plan, created by the Alabama Opioid Overdose and Addiction
			 Council and published December 31, 2017, describes a four-pronged approach to
			 addressing the current opioid crisis in Alabama. The four prongs to the
			 approach described by the council are:
1.
			 Prevention of opioid misuse. Including strategies to modernize the state's
			 Prescription Drug Monitoring Program (PDMP) to fully realize technological
			 improvements in how prescription opioids are prescribed and dispensed,
			 continuing improvements in the education of prescribers and
			 prescribers-in-training, the reduction of stigma attached to opioid addiction,
			 and the development of a centralized data repository that can be used to
			 understand and combat the problem;
2. Intervention within the law enforcement
			 and justice systems. Addressing drug trafficking laws and working with drug
			 courts in Alabama to encourage the use of medication assisted treatment (MAT)
			 for those with Opioid Use Disorders (OUD);
3. Treatment of those with OUDs. Increasing
			 access to care for those with OUD in Alabama and encouraging the use of
			 evidence-based practices to improve the identification and treatment of those
			 with OUD; and
4. Community Response
			 that engages ordinary Alabamians to become involved with finding solutions at a
			 local level. Focus on expanding the availability and usage of naloxone (a
			 potentially life-saving opioid reversal drug); the building of partnerships
			 with businesses, educational institutions and community organizations to
			 improve awareness and involvement; and encouragement for counties to adopt the
			 Stepping Up Initiative, which provides tools to create data driven strategies
			 that work within the judicial system.
g. ADMH has received several grants in recent
			 years in order to combat substance use disorders, including the State Opioid
			 Response Grant, the Medication Assisted Treatment Prescription Drug Opioid
			 Abuse grant (in specific counties), another grant to expand Drug Courts into
			 specific rural counties, as well as grants from both the USDA (to provide
			 telehealth equipment in specific counties) and the CDC (in partnership with
			 ADPH to provide peer counseling in Emergency Departments).
h. In 2019, Governor Ivey secured funding in
			 the state's operating budget to improve the Prescription Drug Monitoring
			 Program to, in part, make it easier to use for both physicians and pharmacists.
			 Also, Governor Ivey signed a law making it a crime to traffic in either
			 fentanyl or carfentanil, which are synthetic opioids with a higher potency than
			 heroin. The new law makes it a felony to knowingly possess more than a half
			 gram of fentanyl or a related synthetic opioid or to possess, sell, or deliver
			 a mixture containing fentanyl or a related synthetic opioid. Both Acts were
			 directly recommended by the Alabama Opioid Overdose and Addiction Council.
i. ADMH recently partnered with
			 Auburn University to create the Opioid Training Institute, providing education
			 to both community members and health care professionals about the current
			 status of opioid abuse in Alabama and to provide strategies and solicit ideas
			 on how to combat the crisis moving forward. The Department has also worked with
			 ADPH to supply naloxone to first responders throughout the state in order to
			 improve access to a potentially life-saving drug to any law enforcement or
			 medical professional who may be called upon to assist an individual suffering
			 from an opioid overdose.