Community Responses to Heroin: Huntington, WV, and Camden County, NJ

1. Community Responses to Heroin:
Huntington, WV, and
Camden County, NJ
Presenters:
• Jan Rader, RN, Deputy Chief, Huntington Fire Department
• William J. Lynch Jr., RPh, Clinical Staff Pharmacist, Kennedy Health System,
and Member, Camden County Addiction Awareness Task Force
• Harry Earle, MA, Chief of Police, Gloucester Township (NJ) Police
Department, and Member, Camden County Addiction Awareness Task Force
Heroin Track
Moderator: Jackie L. Steele, Jr., JD, Commonwealth Attorney,
Kentucky 27th Judicial Circuit, and Vice Chairman, Operation UNITE
Board of Directors

2. Disclosures
• Harry Earle, MA; Jan Rader, RN; and Jackie L.
Steele, Jr., JD, have disclosed no relevant, real
or apparent personal or professional financial
relationships with proprietary entities that
produce healthcare goods and services.
• William J. Lynch, Jr., RPh wishes to disclose he
is a consultant with Pernix Therapeutics and
with Iroko Pharmaceuticals.

3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center

4. Learning Objectives
1. Examine two communities’ responses to their
heroin crises, emphasizing collaboration among
stakeholders.
2. Describe the programs being implemented by
Huntington, WV, as part of its holistic approach
to heroin addiction.
3. Outline the programs developed in Camden
County, NJ, to respond to its heroin epidemic.
4. Provide accurate and appropriate counsel as
part of the treatment team.

5. Portal to Recovery
“These aren't bad people trying to
get good, these are sick people trying
to get well.”
Deputy Chief Jan K. Rader, RN
City of Huntington Fire Department
Mayor’s Office of Drug Control Policy

6. Huntington, WV
• Located in Cabell and
Wayne Counties along the
Ohio River, Huntington is
the second largest city in
the State of West Virginia
• Huntington population is
49,000, Cabell County
population is 96,000
• Biggest employers are
Marshall University, Cabell
Huntington Hospital, St.
Mary’s Hospital and CSX
Transportation

7. Introduction
• There is a reason why greater than 500 Detroit
residents have been arrested in Huntington over the
past decade.
• There is a reason why over 200 Detroit residents are
now embedded in Huntington.
• In 2014 heroin was selling $200/gram in Huntington.
Due to the increase in supply, the cost is currently $75-
$100/gram. This is designed to increase DEMAND.
• The reason is ADDICTION
“Addiction is when you can stop you don’t want to, and when
you want to stop you can’t”. – Luke Davies

8. Operation River to Jail
June 2014

9. What is next?
• 50 years of fighting the “Drug War” with the
same tactics and the problem has continued to
worsen
• We can change what has not worked without
fear of failure or condemnation
• “We can’t arrest our way out of this.”
• We need to think outside the box
• Begin focusing on the disease of ADDICTION
• Creation of The Mayor’s Office of Drug Control
Policy

10. Mayor’s Office of Drug Control Policy
• Mission – To serve as a leader for improving
the health and safety of individuals by
promoting strategic approaches and
collaboration to reduce drug trafficking and
related crime while promoting prevention and
treatment options for addicts.
• Vision: Decrease the Demand/Heal the
Addiction

11. History of Area Drug Use
• 1990’s - Prescription drug abuse became popular
– New synthetic opiates marketed to be non-addictive
– Pain management explosion
– Profit margin
• 2010-2011 - Pill Mill crackdown
– Law enforcement started targeting 2010
– 2011 Florida laws assisted
• Addicts turned to heroin
– Cheaper
– More readily available

12. Geography of Drug Offenses 2004

13. Geography of Drug Offenses 2014

14. Grams of Heroin Seized

15. Overdose Calls CC911

16. Cabell County Overdoses 2015
944 overdoses
Average age of an overdose 37
58% were male, 42% female
70 overdose deaths
Average age of an overdose death 38
69% male, 31% female
89% Caucasian, 11% black

17. Overdose Deaths

18. IV Drug Use
• Heroin is typically an injected drug
• Syringes are reused and shared among users
• IV drug use leads to major healthcare
complications

19. Hepatitis B & C
• Hepatitis B & C is an infectious (contagious) liver disease that
spreads through blood-to-blood contact with an infected
person
• Lives outside the body for up to 7 days, in a syringe for 63 days
• Average lifetime medical cost estimated at $65,000 - $500,000
depending on need for liver transplant
• West Virginia has the second highest rate of new Hepatitis C
cases in the country
• West Virginia has the highest rate of new Hepatitis B cases in
the country
• Infant mortality rates in Cabell County are some of the highest
in the nation, with 8.3 deaths per 1,000 live births

20. Hepatitis C

21. Hepatitis B

22. See a Trend?

23. Neonatal Abstinence Syndrome

24. Estimated Medical Cost of Drug Abuse
in Cabell County in 2015

25. Short Term Strategies
• “United Front” - meet with stakeholders
• LEAD Program – Law Enforcement Assisted
Diversion
• SAMHSA CAPE 2 Grant (Substance Abuse &
Mental Health Services Administration)
• Harm Reduction Program
• Centralized Information System for First
Responders and Health Care Providers
• Drug Court Expansion – WEAR Program

26. United Front
Liaison with:
• Local/regional medical facilities
• Local/regional health departments
• Local/regional treatment/recovery programs
• Local/regional first responders
• Local/regional schools
• Faith based community organizations
• Neighborhood associations and community
groups

27. LEAD Program
Law Enforcement Assisted Diversion
• A pre-booking diversion program that allows officers to
redirect low-level offenders engaged in drugs or
prostitution activity to treatment services instead of jail
and prosecution
• Designed for addicts to kick their habits and give those who
survive by selling drugs a chance at legitimate employment
and a future
• The Mayor’s Office of Drug Control Policy and the
Huntington Police Department have formed a partnership
with U.S. Attorney’s Office, Prestera Center and Day Report
Center
• Prestera provides mental health counselors to evaluate
possible clients in the program

28. CAPE 2 Grant
• Partnered with United Way
• Grant is for research to develop early warning
systems
• This will allow us to develop an early warning
protocol based on community behavioral health
issues
• We need to be proactive, what drug will affect
our community next?
• An early warning system will be a PORTAL to
RECOVERY

29. Harm Reduction
A program that prevents people from causing irreversible
damage to themselves and others. (located and run by the
Cabell-Huntington Health Department)
• Other harm reduction programs have lowered the rate
of Hepatitis by 50% within the first year
• Harm reduction programs leads a high number of
participants to treatment (>50%)
• Harm reduction programs lower the healthcare cost
associated with complications from IV drug use
considerably
• Babies born with NAS (neonatal abstinence syndrome)
will be lowered through planned parenthood

30. Harm Reduction
• Cabell-Huntington Health Department, first in the state
• Education, syringes, vaccinations, social services,
treatment
• Recovery Coaches on site during program
• Wednesdays from 10:00 am till 4:00 pm, began Sept. 2nd
– first day there were 15 participants, two asked for
help
• Sept. 2nd – Dec 30th : Individuals served 625, Total
number of syringe exchange visits 1266, close to 38,000
syringes given out. 50/50 male/female, 45% are known
hep C +

31. Centralized Information System
“The Call WV”
• Partnership between the U.S. Attorney’s Office, Trifecta
Productions and the Mayor’s Office of Drug Control Policy
• Designed assist first responders, healthcare workers and
family members in locating available services
• Will give us the ability to disseminate vital information
quickly (videos)
• Will give us the ability to collect vital information

32. W.E.A.R. Program
• Women’s Empowerment and Addiction Recovery
Program
• The W.E.A.R. Program will target high-risk, high-need
adult, non-violent felony offenders who are prostitutes,
drug addicts, and residents of the Cabell County area
• The goals of the program are to:
– To treat the drug addiction and mental health needs of
prostitutes.
– To offer women in prostitution a complete exit strategy
from the sex trade.
– To shift the approach to drug and prostitution offenses to
treat the root cause of criminal activity through providing
services rather than incarceration.

33. Long Term Strategies
• Promote the development/expansion of
services
• Promote career opportunities for people
recovering
• Partner with union leadership to introduce
legislation to assist with employment reentry
• Expand community prevention/intervention
efforts
• Relapse prevention through environmental
design
• Lower the number of babies born with NAS

34. Development/Expansion of Services
• Collaborate with respected healthcare facilities to
provide a new all encompassing treatment
program (St. Mary’s Medical Center, MU Center
for Rural Health, Prestera, Health Dept.)
• This would be an Intensive Outpatient Recovery
Program
– Provide MAT (medically assisted treatment) for
individuals who meet the criteria
– Provide in home intensive therapy based on the nursing
home health model for those who meet criteria

35. Career Opportunities
• Liaison with area businesses for employment
opportunities
• Explore economic incentives for employers
offering employment to those in recovery
(Work Opportunity Tax Credit is a federal tax
credit)
• Expand educational and training opportunities for
those in recovery
• Liaison with area unions for employment
opportunities

36. Relapse Prevention through
Environmental Design
• Micro Level - Assist with environmental
changes for individuals recovering
– Housing
– Friends
– Family
– Employment changes
• Macro Level - Removal of dilapidated
abandoned houses

37. Summary
• Addiction is a major public health problem
that impacts society on multiple levels
• We have a moral obligation to act
• We must unite to decrease the demand and
heal the addiction
• Dynamic strategies and tactics will lead
addicts through a
PORTAL to RECOVERY

38. We need to prepare, big changes
can come from small events.
~ The Tipping Point

39. Community Response to Heroin:
Camden County, New Jersey
Camden County Addiction Awareness Task Force

40. Community Response to Heroin:
Camden County, New Jersey
Camden County Addiction Awareness Task Force
William J. Lynch, Jr. BS-Pharm, RPh
Clinical Staff Pharmacist-Kennedy University Hospital
Core Teaching Affiliate of Rowan School of Osteopathic Medicine
Rutgers University, Ernest Mario School of Pharmacy Preceptor
Camden County New Jersey Addiction Awareness Task Force Member
- Education & Prevention Committee Co-Chair
State of New Jersey Police Training Commission Instructor
Camden County College Police Academy Instructor
National Prescription Drug Abuse & Heroin Summit
March 30, 2016
3:30 to 4:45 PM

41. Community Response to Heroin:
Camden County, New Jersey
Camden County Addiction Awareness Task Force
Chief W. Harry Earle, MA
Chief of Police-Gloucester Township NJ Police Department
President, Camden County NJ Police Chiefs’ Association
Camden County Addiction Awareness Task Force Member
-Availability Reduction Committee Co-Chair
FBI National Academy #234
National Prescription Drug Abuse & Heroin Summit
March 30, 2016
3:30 to 4:45 PM

42. Disclosure Statement
William J. Lynch, Jr. BS-Pharm, RPh wishes to disclose
he is a consultant with Pernix Therapeutics and with
Iroko Pharmaceuticals
He will present this content in a fair and balanced
manner

43. Disclosure Statement

44. Learning Objectives
• Examine two communities’ responses to their
heroin crises, emphasizing collaboration among
stakeholders
• Describe the programs being implemented by
Huntington, WV, as part of its holistic approach to
heroin addiction
• Outline the programs developed in Camden
County, NJ to respond to its heroin epidemic

45. 5,217
Number of heroin-related deaths recorded
in New Jersey 2004-2014
http://www.nj.com/news/index.ssf/2015/12/herointown_nj_the_states_heroin_crisis_in_10_graph.html

46. 781
Number of Heroin-Related Deaths in
New Jersey in 2014*
*Fourth straight year New Jersey saw an increase
http://www.nj.com/news/index.ssf/2015/12/herointown_nj_the_states_heroin_crisis_in_10_graph.html
781

47. 8.3
Heroin Deaths in New Jersey per 100,000
>3 Times National Average
20.3 Heroin deaths in Camden County New Jersey per 100,000
More than 7.8 times the national average, 2.45 times NJ average
http://www.nj.com/news/index.ssf/2015/12/herointown_nj_the_states_heroin_crisis_in_10_graph.html

48. New Jersey’s Heroin Epidemic: Deaths Doubled Since 2011
*Camden, Middlesex, Ocean and Monmouth had the highest number of overdose deaths in 2014
*Bergen, Camden, Cumberland, Gloucester, Middlesex, Monmouth and Warren had the
percentage highest increases from 2013
http://patch.com/new-jersey/tomsriver/heroin-deaths-new-jersey-double-2011?utm_source=alert-
breakingnews&utm_medium=email&utm_term=police%20%26%20fire&utm_campaign=alert

49. We Have a Serious Problem
• New Jersey has 21 counties
• Camden County is:
– 8th most populated county (n=511,038 residents)
– Has 4th highest number of substance abuse
treatment admissions
• 6295 in 2012, 8.3% of total NJ Admissions of 75,837
• 5830 in 2013, 8% of total NJ Admissions of 72,864
• 5214 in 2014, 8.1% of total NJ Admissions of 64,766
– Was 1st, for greatest number of heroin deaths in
the state for 2014 with 93 of 781 in NJ (11.9%)

50. Heroin Pills
Photo courtesy of Pitman NJ Police website 11/17/14
www.northjersey.com/news/nj-state-news/heroin-pill-poses-potential-danger-for-new-jersey

51. 2015 Camden Overdose Spikes, Regional Operations Intelligence Center, NJSP, Drug Monitoring
Initiative Attorney General ‘s Heroin & Opiate Task Force. 1/26/16

52. 2015 Camden Overdose Spikes, Regional Operations Intelligence Center, NJSP, Drug Monitoring
Initiative Attorney General ‘s Heroin & Opiate Task Force. 1/26/16

53. s

54. AN EPIDEMIC

55. PEOPLE ARE DYING – AND NOT JUST FROM CRASHES
Year Deaths
2010 6
2011 9
2012 5
2013 9
2014 14
2015 20

56. SAVE INITATIVES

57. THE POWER OF A GROUP
SUPPORT the creation of additional
resources to treat and prevent
addiction to heroin & prescription
drugs
HELP to reduce the demand for and
availability of heroin & prescription drugs
CREATE awareness programs to help educate
residents about programs and resources
available to prevent and treat addiction
Mission:
To increase awareness among
county residents of heroin and
prescription drug abuse and the
devastating effects on our
community

58. THE POWER OF A GROUP
Religious
Organizations
Availability
Reduction
Education
Prevention
Awareness
Advertising
Sub-Committees

59. http://addictions.camdencounty.com/

60. INCREASING AWARENESS

61. CHANGING ATTITUDES
“Skell”
Daughter

62. AN EPIDEMIC

63. WORKING TOGETHER TO SAVING LIVES

64. WORKING TOGETHER TO SAVE LIVES
2014
517
2015
5,092
2016
158
NJ Statewide Naloxone Deployments, Regional Operations Intelligence Center,
NJSP, Drug Monitoring Initiative Attorney General ‘s Heroin & Opiate Task Force. 1/26/16

65. WORKING TOGETHER TO SAVE LIVES

66. REMEMBERING THE VICTIMS

67. AN EPIDEMIC
Genetic Pre-Disposition
It’s a Disease
Reduce the Stigma
6,000 lbs.
2015

68. WE NEED TO PREVENT THE OVERDOSE!

69. SAVE ADVOCATE
47%
REMAINING 53%?

70. SAVE ACTIONS - SOLICIT PARTNERS

71. SAVED BY NARCAN – NOW WHAT?

72. PREPARING FOR RE-ENTRY
Food Bank
Clothing Bank
SAVE Advocate
GTPD Family
Resource Center
GT Library
Community Re-
Entry Specialist

73. SAVE - DRUG DISPOSAL

74. How has the taskforce and epidemic affected
the county alcohol and addiction operations?
• Creation of an after-hours warm line
• Targeted prevention / education efforts
• Hosted Naloxone (Narcan®) trainings
• Increased visibility in the community via
presentations county-wide
• Partnered with other prevention / education groups
to work on shared goals

75. Creation of an after-hours warm line
• First, we needed an after hours warm line
• To accomplish this we partnered with an ‘ongoing
crisis line’ (called Contact Community Helplines)
• We ensured they were familiar with & understood
how the unit operates
• Understand where individuals and families who were
insured & not insured could seek out services
• Provide information, refer & keep statistics on callers

76. The Campaign
addictions.camdencounty.com

77. “Awareness Van”

78. Targeted Audiences
• Schools
• Teachers
• Athletic Directors
• Peer to Peer Youth Groups
• Physician Associations
• Parent Teacher Associations
• Faith Based Groups
• Business Community
Chambers, Rotaries
• Community Colleges
• Municipal Alliances
• Youth Service Organizations
• Community at Large
– Parents
– Teens
– Pre-teens
– Seniors/Grandparents
• Law Enforcement
• Health Care Professionals
• Anyone as it effects Everyone

79. Methods of Communicating
the Message
• Presentations
• Awareness and Prevention Events
• PSA’s & Videos
• Billboards
• Digital Marketing
• Awareness Tool-Kit

80. Outreach Initiatives
• Promotion of Rx Return Boxes
• Promotion of NJ Good Samaritan Law
• Physician Awareness Programs
• Promotion of Naloxone Availability & Training for
Residents

82. Brought to you by the Camden County Board of Freeholders’ Addiction Awareness
Task Force & Camden County Health Department

84. Camden County Addiction Awareness Task
Force Naloxone (Narcan®) Initiatives
• Naloxone (Narcan®) Training for Police/First Responders
• Naloxone (Narcan®) Training for General Public
• Naloxone (Narcan®) Over-the Counter Prescription with CVS in New
Jersey
– Over-the-Counter = Behind the Counter
– Universal Prescriber
• No need to have a prescription
• Prescription is provided for you
• Prescribed to the insured
– Available in:
• Injectable form (vial)
• Auto-injectable form: Evzio®
• Nasal naloxone
• Narcan® Nasal Spray (Adapt Pharma)

85. Camden County Addiction Awareness Task Force
Presentations
• Camden County College Police Academy
• Camden County Police Chiefs Best Practices Summit
• Camden County School Superintendent Meeting
• Camden Diocesan School Superintendent/Principal Meeting
• Municipal Alliances Meeting
• Regional Substance Abuse Counselor (SAC) Meeting
• CME accredited for Nurses in NJ
• CME accredited programs for physicians
• Grand Rounds at Kennedy Health System
• South Jersey Pediatric Networking Group
• New Jersey Prevention Network (NJPN)
• New Jersey Association of County Governments
• Association of Student Assistance Professionals-NJ (ASAP-NJ)

86. American Medicine Chest Phone
Application-Location to Dispose Meds
http://www.safecoalition.org/2013-05-30-american-medicine-chest-challenge-mobile-app_mxzsy

87. Bridging the Gap: Law Enforcement
& Medical Personnel
• Naloxone Purchasing Program
– Collaborative Agreement
• Candlelight Vigil
– Police & Medical Personnel in Uniform
• Law Enforcement Life Saving Award Ceremony
– 300+ naloxone saves
• New Jersey State Police Drug Monitoring Initiative
• CCPCA Drug Monitoring Initiative/Notification System
• Identification of Rx Drugs for Law Enforcement
– “M” and Codeine Phosphate from Argentina
– Diltiazem information for DMI monograph
– Reverse opiate overdose-naloxone/treat CCB overdose-glucagon
• Speakers Bureau-Tag Teams
– Law Enforcement & Medical Personnel
• Operating silos now robustly connected

88. Naloxone Purchasing Program
• Collaborative Agreement between:
– Kennedy Health System (KHS)
– Camden County Police Chiefs’ Association (CCPCA)
– Expanded to Gloucester County Prosecutor’s Office
• Purchased by KHS Hospital Pharmacy
– Leverage group/bulk purchasing power
– CCPCA Vice President Chief Chris Winters requests
– KHS Director of Pharmacy Services orders
– Pass along savings/purchase outright
– 625 naloxone units supplied/cost $12,500 ($20/unit)
• All 36 municipalities in Camden County have police
officers carrying 2 units nasal naloxone/officer

89. CCAATF Speakers Bureau
• Speakers Identified to address this addiction issue
– Law Enforcement
– Medical Personnel
– Parents who have lost a child
– People in recovery
• Present at different events throughout the county
• Tag Teams
– At Police Academy: Rx Abuse & Naloxone Training
• Chief Earle/Chief Winters-Law Enforcement Perspective
• Patty DiRenzo-Parent of a child lost to this disease
• Bill Lynch-Pharmacist-addressing Rx abuse/disease of addiction

90. CCPCA Drug Monitoring
Initiative/Notification System
• Run of overdoses in hospital ER
• Notify NJSP ROIC DMI
• Notify CCPCA President and Vice President
• Notify Camden County Dispatch
– Notify all Chiefs of Police in Camden County
– Notify all officers on the street
• Two overdose deaths in same hospital ER within hours of each
other
– Notify officers
– Have backup respond
• May need more than 2 doses of nasal naloxone to reverse
– Overdose substance retrieved if available
• Sent to crime lab for evaluation/identification

91. Community Presentations for 2015
• Presentations: 128
• Attendees : 5935 (range: 10-750)
– Average 46 attendees/presentation
• Locations
– Schools (assemblies/health classes)
– Boy Scout/Girl Scout troops
– Churches
– Senior Citizen Community Center-BINGO! Brigade
– Sports Teams
– Hospitals/Treatment Centers
– Conferences
– Libraries
– Colleges/Universities
– Police Academies
– Police Chief Association Meetings
– School Superintendent Meetings (County & Diocesan)
• Post Presentation Survey

92. OPERATION SAL
(Save-A-Life)
Brought to you by the:
Camden County Addiction Awareness Task Force &
Camden County Health Department

93. Operation SAL-Save A Life!
Offer evidence based treatment to clients who:
• Have overdosed
• Were administered Narcan® (naloxone) by
municipal police department/first responders
• Are medically cleared
• Actively seeking treatment services

94. Acknowledgements: Thank You!
Rachel M. Lynch
• Doctor of Pharmacy Candidate 2016
• Rutgers University, Ernest Mario School of Pharmacy
Brian V. Blazovic
• Doctor of Medicine Candidate 2018
• Jefferson Medical College, Thomas Jefferson University
David Z. Yang
• Pharmacy Intern-Doctor of Pharmacy Candidate 2016
• Rutgers University, Ernest Mario School of Pharmacy
Kurt D. Meakim, Pharm D
• Pharmacy Intern-Rutgers University, Ernest Mario School of Pharmacy
Eric W. Lynch
• Doctor of Pharmacy Candidate 2020
• Rutgers University, Ernest Mario School of Pharmacy
Gregory E. Cabanas
• Pharmacy Intern, Doctor of Pharmacy Candidate 2016
• Rutgers University, Ernest Mario School of Pharmacy

95. We thank all of the members of
our Camden County Addiction
Awareness Task Force who
engage in battling this epidemic
in our community every day.
Together we ARE making a
positive difference!

96. Community Responses to Heroin:
Huntington, WV, and
Camden County, NJ
Presenters:
• Jan Rader, RN, Deputy Chief, Huntington Fire Department
• William J. Lynch Jr., RPh, Clinical Staff Pharmacist, Kennedy Health System,
and Member, Camden County Addiction Awareness Task Force
• Harry Earle, MA, Chief of Police, Gloucester Township (NJ) Police
Department, and Member, Camden County Addiction Awareness Task Force
Heroin Track
Moderator: Jackie L. Steele, Jr., JD, Commonwealth Attorney,
Kentucky 27th Judicial Circuit, and Vice Chairman, Operation UNITE
Board of Directors