Legislature(2019 - 2020)CAPITOL 106
05/09/2019 03:00 PM House HEALTH & SOCIAL SERVICES
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| Presentation(s): Substance Abuse Treatment System | |
| Adjourn |
* first hearing in first committee of referral
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ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
May 9, 2019
3:06 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
MEMBERS ABSENT
Representative Sharon Jackson
Representative Lance Pruitt
OTHER LEGISLATORS PRESENT
Representative Bryce Edgmon
COMMITTEE CALENDAR
PRESENTATION(S): SUBSTANCE ABUSE TREATMENT SYSTEM
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ANDY JONES, Director
Office of Substance Misuse and Addiction Prevention (OSMAP)
Office of the Commissioner
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: As part of the presentations on the
substance abuse treatment system, provided a PowerPoint
slideshow titled "Addressing Alaska's Poly-Substance Epidemic."
GENNIFER MOREAU-JOHNSON, Acting Director
Division of Behavioral Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: As part of the presentations on the
substance abuse treatment system, provided a PowerPoint
slideshow titled "Division of Behavioral Health."
BRADLEY GRIGG, Chief Behavioral Health Officer
Bartlett Regional Hospital
Juneau, Alaska
POSITION STATEMENT: As part of the presentations on the
substance abuse treatment system, described what Bartlett
Regional Hospital is seeing in the patients it is serving.
SHERRIE WILSON HINSHAW, President & CEO
Volunteers of America-Alaska (VOA)
Anchorage, Alaska
POSITION STATEMENT: As part of the presentations on the
substance abuse treatment system, described what VOA is doing.
LANCE JOHNSON, Director
Behavioral Health Services (BHS)
Norton Sound Health Corporation (NSHC)
Nome, Alaska
POSITION STATEMENT: As part of the presentations on the
substance abuse treatment system, described what NSHC is doing.
ADELE LANDROCHE, Advocate
Anchorage, Alaska
POSITION STATEMENT: As part of the presentations on the
substance abuse treatment system, provided the perspective of
being the mother of children with additions.
DOUG WOOLIVER, Deputy Administrative Director
Alaska Court System
Juneau, Alaska
POSITION STATEMENT: As part of the presentations on the
substance abuse treatment system, discussed the role of the
therapeutic courts.
ACTION NARRATIVE
3:06:01 PM
CO-CHAIR IVY SPOHNHOLZ called the House Health and Social
Services Standing Committee meeting to order at 3:06 p.m.
Representatives Claman, Drummond, Zulkosky, and Spohnholz were
present at the call to order. Representative Tarr arrived as
the meeting was in progress. Representative Edgmon was also
present.
^PRESENTATION(S): SUBSTANCE ABUSE TREATMENT SYSTEM
PRESENTATION(S): SUBSTANCE ABUSE TREATMENT SYSTEM
3:06:37 PM
CO-CHAIR SPOHNHOLZ announced that the only order of business
would be a presentation on the Substance Abuse Treatment System.
CO-CHAIR SPOHNHOLZ noted the committee has been working on a
series of crime bills for much of the last month. She said she
feels that any conversation about crime is incomplete without a
discussion about the need to address addiction, which drives
most of the crime in the state of Alaska.
3:07:35 PM
ANDY JONES, Director, Office of Substance Misuse and Addiction
Prevention (OSMAP), Office of the Commissioner, Department of
Health and Social Services (DHSS), provided a PowerPoint
slideshow titled "Addressing Alaska's Poly-Substance Epidemic."
Displaying slide 2, he described the magnitude of the problem.
He said drug overdoses are now the leading cause of accidental
death in the U.S., exceeding automobile deaths. In 2016, drug
overdoses killed 65,000 Americans - more in a years' time than
were killed in the Vietnam, Iraq, and Afghanistan wars combined.
In 2017, the number increased to 70,237. In 1999, the rate was
about 6.1 deaths per 100,000 in population and in 2018 it
skyrocketed to 21.7 per 100,000.
3:09:58 PM
MR. JONES moved to slide [3] and explained that epidemics come
in waves and this epidemic is probably the third wave to happen.
He said driving factors in this epidemic include medical
fallacies that resulted in over prescribing, such as being able
to measure pain objectively and the mentality that tolerance is
just under-dosing. Another fallacy is pseudo-addiction, the
thought that persons who display drug-seeking behavior are
simply in pain and need more opioids. These types of thought
come from inadequate training in pain management for doctors.
MR. JONES displayed slide 4 and said scaring him the most is the
transition from the prescribed opioid problem to the illicit
street drug problem of heroin, fentanyl, and carfentanil; three
out of four new heroin users report having misused prescription
opioids. Too often people with a sports or other injury are
prescribed opioids and then become addicted to the substance.
Heroin doesn't require a prescription and the street price of
heroin is much cheaper than prescription opioids. The danger is
a higher risk of overdose from street drugs because they can
have unknown ingredients. For example, recently law enforcement
officials seized fentanyl that was pill pressed in "Mallinckrodt
30s." A pain patient unable to get a prescription anymore, and
who bought this pill on the street thinking it was a
Mallinckrodt 30, would face almost instant death because this
pill was pure fentanyl. Dealers do this because it is cheaper
for fentanyl and lots of money can be made by pill pressing it.
He pointed out that morphine is dangerous, heroin very dangerous
[50 times], and fentanyl even more dangerous [100 times].
3:13:32 PM
MR. JONES turned to slide 5, a graph of drug incidents for
opioids and methamphetamine provided by the Department of Public
Safety. The numbers for incidences in 2018 are down, but he
explained, current cases are still open, so by the time they are
closed the numbers will remain close. Methamphetamine is one of
Alaska's biggest problems today. It is no longer local cooking
in labs - it is coming from Mexico in very high potency and
purity rates. e're moving towards more of a poly-substance
approach when it comes to our response," he continued. es, we
focused a lot on opioids and yes we still do, and the money is
there; whenever we secure money, we're looking at trying to make
our resources, our capabilities, our capacities, as broad as
possible."
MR. JONES showed slide 6 and said alcohol is still Alaska's
biggest problem. Methamphetamine is big, heroin is still big,
and cocaine is starting to come back.
MR. JONES addressed slide 7. He explained it is a poly-
substance misuse epidemic. Agencies are now focusing on what
methamphetamine treatment looks like and what the interdiction
processes look like as an attempt to get ahead of the game.
About 95 percent of the individuals in Alaska who die from a
drug overdose have multiple substances in their bodies.
3:15:35 PM
MR. JONES displayed slide 8 and explained that the depicted
response structure to the opioid epidemic is Alaska's incident
command system and it takes all state agencies. He said a state
disaster was declared in [2017] because people had died, there
was crime and property destruction in relation to the epidemic,
and communities were asking for help. To this day Alaska is
pushing more naloxone than any other state in the U.S. and is
saving many lives. Alaska's system includes locals, tribal,
federal, and [non-governmental] state partners to ensure
communication and inclusion of the people who are doing the work
on the ground. Approaches within the system include a multi-
agency approach, a multi-agency coordination (MAC) group where
the commissioners come together for monthly briefings, joint
information systems to help with coordination, and utilization
of the Alaska Criminal Information and Analysis Center which is
with the troopers and that is fed to the incident commander and
deputy incident commander. Mr. Jones said this provides
information on the drug trends that are going on and helps him
as an individual to focus his prevention treatment efforts and
where to put resources.
MR. JONES spoke to slide 9. Cross-sector collaboration, he said,
is extremely important because without all the pieces and the
players together there will be duplicative efforts.
3:18:35 PM
MR. JONES moved to slide 10 and elaborated on the response
framework. When Alaska's response was started in 2007, he said,
only a few states had declared disasters. In 2016 the Alaska
Opioid Policy Task Force was formed and its [recommendations]
were released in [January 2017]. However, locals informed him
that it was a policy document meant for people like himself and
legislators, not communities. Something needed to be changed to
make it work for communities, but there needed to be a response
framework. The question was whether DHSS should work on a plan
right away or save lives. The decision was to save lives and it
began by saturating the market with Narcan kits [medication that
temporarily blocks or reverses the effects of opioids].
[Addiction] is a chronic condition of the brain, not a moral
failing, and people need help and often more than one chance.
Drug disposal bags were distributed to reduce prescription drugs
in houses; these bags contain activated charcoal to which water
and the substance are added and the substance is then destroyed.
MR. JONES continued and drew attention to the graphic on slide
10. He explained that tertiary prevention [acute health event
control and prevention] is naloxone and working with syringe and
needle exchanges. He said these exchanges have been extremely
helpful because Alaska doesn't have drug paraphernalia laws.
The choice is to either have these exchange sites or have
needles everywhere, which can cause hepatitis outbreaks. The
exchange sites also help to connect with the individual who is
suffering. The secondary prevention [chronic disease screening
and management] is increasing screening, reducing the stigma,
and understanding that addiction is a chronic disease. Primary
prevention [environmental controls and social determinants]
includes things like adverse childhood experience, judicious
prescribing, and doing upstream prevention that is being talked
about and worked on right now.
3:21:29 PM
MR. JONES discussed the prevention resources listed on slide 11.
He said DHSS has secured quite a bit of funding for prevention.
The Alaska Partnerships for Success is a coalition across the
state that comes together to focus on substance use disorders
and misuse. The Community Substance Misuse and Abuse Task
Forces are local citizens who come together, and they have been
phenomenal is making changes. The Office of Substance Misuse
and Addiction Prevention (OSMAP) was created, which focuses
solely on integrating public health approaches to reduce or
minimize subsistence use disorders. Other resources are Data
Dashboards and the department's Opioids in Alaska website.
MR. JONES spoke to slide 12 regarding the Alaska State Troopers
and the Statewide Drug Enforcement Units. He said this is
important because while talking about treatment there must also
be talk about enforcement and the criminal. Alaska cannot just
arrest its way out, but the state can't just treat its way out
of this either, it's a balanced approach. He advised that drug
trafficking organizations (DTOs) and cartels are coming into
Alaska. Enforcement units need to be focusing on those
individuals who are feeding on the misery of Alaskans and
hooking Alaskans to these substances, while DHSS in partnership
with the troopers and other agencies works on enhancing and
building the capacities of treatment capability. In addition to
the troopers there are narcotics interdiction teams. These
teams are made up of local, tribal, state, and federal agencies.
3:23:45 PM
MR. JONES displayed slide 13 and noted that about 80 percent of
the offenders in custody with the Department of Corrections
(DOC) struggle with substance abuse. Thirty percent of the
offenders who are assessed report abuse of opioids, probably one
of the state's biggest populations when it comes to substance
use disorders. The Department of Corrections has been building
a comprehensive substance abuse program. Currently, vivitrol is
used for medication-assisted treatments (MATs) in DOC's
programs. Upon re-entry or release, an offender will receive
this shot if he or she qualifies, and then the offender goes
through the re-entry service programs and is connected to the
community. The DOC is looking at increasing the footprint of
MAT, which could include things like bridging with methadone or
integration of suboxone. Getting offenders treatment and care
from day one is much better than giving them treatment and care
a month before release.
MR. JONES turned to slide 14 and discussed policy, partnerships,
outcomes, and results. Regarding partnerships he said DHSS is
currently working to implement the patient Voluntary Non-opioid
Directive that was signed into law by a previous governor. The
department now has the authority to emergency schedule a
substance if it's on the federal list, allowing DHSS to take
immediate action if a trend is being seen in a certain substance
coming through a community. First-time opioid prescriptions are
limited to no more than a seven-day supply with exceptions; the
exceptions help with rural Alaska. As of 7/1/18, the controlled
substance prescription database was required to be updated
daily, which has been instrumental.
3:26:05 PM
MR. JONES addressed slide 15 regarding community coalitions. He
said isolation fuels addiction and community provides the cure
and the groups listed on the slide are the true boots-on-the
ground individuals. [Mat Su Opioid Task Force, Anchorage Opioid
Task Force, Juneau Opioid Work Group, Fairbanks Opioid Work
Group, Southern Kenai Peninsula, Change 4 Kenai Coalition,
Aleutian Pribilof Islands Opioid and Substance Misuse Task
Force, Ketchikan Substance Abuse Task Force, Bristol Bay Opioid
Task Force, THRIVE Mat Su.]
MR. JONES moved to slide 16 and discussed prevention with
partnerships. He reported that Project HOPE (HOPE stands for
Harm reduction, Overdose Prevention, Education) currently has
102 overdose response programs; has distributed 18,000 overdose
rescue kits; and has saved over 260 lives. He explained that
the number of lives saved is much higher than 260, but 260 is
the documented number. Regarding the medication deactivation
disposal bags, he reported that 46,000 bags have been
distributed since 2017, which represents a potential reduction
of over 2 million pills in the state. In addition, DHSS and the
Department of Education and Early Development developed a
teaching module called Opioids and Opioids Epidemic 101 that is
available to teachers and parents. There is also first
responder training, which is a compassion fatigue training
because first responders get exhausted from seeing this every
day and often seeing the same individual. As well,
consideration is being given to implementing a Fatal Overdose
Death Review Committee that would look at the cases to see if
policy and prevention are working.
3:28:26 PM
MR. JONES spoke to slide 17 regarding partnerships, outcomes,
and results of enforcement. He explained that the designation
of a High Intensity Drug Trafficking Area (HIDTA) has been
received, which is important and can be equated to the special
operations of narcotics. This designation brings in about $2.5
million annually from the U.S. Office of National Drug Control
Policy. This funding goes to the various task forces outlined
on [slide 15], thereby increasing the footprint to do things
like better interdiction and information sharing so it can be
understood what is being seized throughout the entire state.
Better private sector partnerships are also being developed and
paying for overtime for officers. A director has been hired to
build the system in partnership with DHSS's local, state, and
federal partners.
MR. JONES displayed side 18 and elaborated about the
partnerships, outcomes, and results of strategic direction. He
said DHSS traveled to 15 communities in 2018 to conduct
Community Caf? events to build a Statewide Opioid Action Plan.
The department also went to other communities and held townhall
events. In the Community Caf? events DHSS spent one day meeting
with the medical community to understand what the barriers and
gaps are and another day meeting with community members about
prevention, treatment, re-entry, criminal justice population,
what is currently in the community, what's not working, what are
the barriers to change, and what is needed. The University of
Alaska Anchorage (UAA) and DHSS compiled this data and then DHSS
brought in 100 experts from across the state to spend two and
half days building a plan. The plan is a long-term approach and
will be used to help fund future coalition activities through
federal grants.
3:31:00 PM
MR. JONES turned to slide 19 regarding the preliminary results
of the number of opioid-related overdose deaths in the U.S. He
reported that the percent-age-adjusted rate in deaths increased
from 6.1 in 1991 to 21.7 in 2017. In 2018, Alaska saw downward
trends across the board. For example, in drug overdose deaths
in 2015, Alaska had an age-adjusted rate of 16 percent, which
increased to 17 percent in 2016, then increased again to 19.3
percent in 2017, and in 2018 it decreased to 11.9 percent.
While the rest of the U.S. is battling fentanyl, Alaska went
from 28 fentanyl deaths in 2017 to 7 deaths in 2018. However,
Alaska still has lots of people who need to get into treatment
and many people are still dying. He attributed the decline to
the combination of hard work and sense of community in Alaska,
the partnerships helping to remove the stigma of use, and the
use of naloxone. The downward trend, he said, doesn't mean
Alaska can sit back and think the job is done, it means Alaska
needs to remain diligent.
MR. JONES discussed the next steps outlined on slide 20. He
said these next steps include a transition out of the Incident
Command System (ICS) and going more towards the long-term
recovery approach. Execution of the Statewide Opioid Action
Plan needs to be continued as part of the next steps. Other
steps include implementation and building of the Alaska High
Intensity Drug Trafficking Area. As well, the next steps
include continuing to secure more federal funding to build
capability and capacity.
3:33:25 PM
REPRESENTATIVE TARR drew attention to slide 7 regarding poly-
substance misuse and noted that in her work in Anchorage she has
heard the term "garbage addict" for people who will use any kind
of substance that they can obtain. She asked how a person
addicted to alcohol is defined and what "addicted to" means in
that context.
MR. JONES replied that a person using multiple substances might
get counted more than once. He said he would consult with the
state medical officer and get back with an answer as to how the
medical officer picks a substance and defines it. When multiple
substances are found in the body it often will be attributed to
poly-substance. Regarding "garbage addict," he said he personal
believes that this term would put more of a stigma on an
individual. He said he doesn't even like the term "addict" and
would prefer it be called "somebody who is struggling with
substances" to reduce stigma and prevent these people from being
returned to the shadows.
REPRESENTATIVE TARR pointed out that people who are compromised
by their health conditions might be willing to use substances
that are typically considered recreational drugs, for example
anti-anxiety medication, as opposed to substances that are
considered recreational drugs.
MR. JONES concurred. A problem is being seen with stimulants,
he said. People don't understand what a stimulant can do if
misused and what a stimulant can do if misused with an opioid.
That is some of the messaging that DHSS wants to get out.
Through partnering with methadone clinics and drug testing
companies, things like gabapentin are coming up on the radar.
Through this public health work, radar is being kept on all the
different systems to see what the trends are and to then begin
messaging and education prior to enforcement.
3:36:57 PM
CO-CHAIR SPOHNHOLZ said one of the things she learned from Dr.
Butler was the value of medication-assisted treatment (MAT),
particularly for opioid addition. She inquired about the
barriers to accessing medication-assisted treatment.
MR. JONES responded that there is a definite stigma associated
with treatments. There has been a movement from substance use
as a stigma to the treatment use and that feels like more of a
battle in the communities. What he means by that is suboxone
versus vivitrol, abstinence versus MAT, and he sees that as one
of the biggest barriers other than building capacity and
capabilities on services across the state and doing it
appropriately with the medication aspect of it as well as
assisted therapy. It must be ensured that the providers who are
popping up are providing a complementary service. Getting past
the stigma of MAT is needed.
3:38:33 PM
CO-CHAIR SPOHNHOLZ noted that the history of the recovery
community is an abstinence-only model, which doesn't work for
everyone because moving away from dependence is a physiological
process that takes a lot of time. Dr. Butler related to her
that diabetics wouldn't be told they didn't need insulin and
they should just muscle through it. The same is true for people
who are experiencing withdrawal from opioids; the person's body
must change significantly and access to medication can be access
to a normal productive healthy life. She asked whether there is
anything beyond vivitrol for MAT in Alaska's prisons.
MR. JONES answered that vivitrol is currently the only thing and
he would love to see this changed in Alaska's prisons; other
states have been introducing suboxone. He related that he
shadowed someone who was released from jail and this person
struggled with going to treatment and having a job because it
was very difficult. He said he thinks that if MAT and other
treatment were begun as soon as a person entered jail, rather
than a month before release, the recidivism rate would drop.
3:40:49 PM
REPRESENTATIVE DRUMMOND requested that an easier-to-read copy of
the response structure on slide 8 be provided to the committee.
She said numerous constituents have contacted her because drug
takeback doesn't happen every day and she has distributed drug
disposal bags to these constituents. She asked how to get the
word out about the drug disposal bags and where to obtain them.
She further asked where the disposal bags should be disposed of
once they have been filled with medications.
MR. JONES agreed to provide the committee with copies of the
appropriate slides on response structure. He said he would
provide drug disposal bags to those committee members who send
him their email addresses.
REPRESENTATIVE DRUMMOND asked whether drug disposal bags could
be made available at all pharmacies in the state.
MR JONES replied that there is no sustainable long-term funding
source for this. He said he would like for pharmacies to
purchase the bags and provide them for discount or free, but it
may not make sense for a business model. However, it would make
sense for community-based models. He said DHSS is having the
different coalitions distribute the bags because it is a great
way for them to connect with individuals who are struggling and
with individuals who don't understand the opioid epidemic or
addiction. If he had unlimited funding and an unlimited supply
of the bags, he would have them everywhere.
3:44:17 PM
REPRESENTATIVE TARR expressed her surprise at hearing there is a
stigma around going to treatment. She requested Mr. Jones to
elaborate further.
MR. JONES responded that the recovery community was very
abstinence based and everyone is learning as they go along. He
said treatment plans are extremely important in this epidemic.
Somebody who has been using for 30 years may be on suboxone for
forever, but maybe somebody who has used for 15-20 years could
be on suboxone under a step-down plan. The recovery community
has been asking for that. In the criminal justice world,
abstinence based is a lot more eye opening and probably more
appropriate than a non-abstinence based. When courts across the
country tell someone on suboxone to taper off and get on
vivitrol it puts a stigma on people and doesn't work and is why
there is a high failure rate. He noted that DHSS has been
working on use and now it is working on treatment.
3:46:27 PM
GENNIFER MOREAU-JOHNSON, Acting Director, Division of Behavioral
Health, Department of Health and Social Services (DHSS),
provided a PowerPoint slideshow titled "Division of Behavioral
Health." Displaying slide 1, she explained she will describe
how the division oversees services, how it is currently
delivering services across Alaska, how it got here, what the
challenges are, and where the division is looking to go.
Addressing slide 2, she said the programs and services overseen
by the division include: Prevention and Early Intervention,
Alcohol Safety Action Program, Tobacco Compliance Unit,
Treatment and Recovery Grants Services, and Behavioral Health
Medicaid Services. She noted that, for the division, the use of
the word "prevention" is a specific reference to preventing
these conditions before the behavior starts.
3:48:20 PM
MS. MOREAU-JOHNSON showed slide 3 regarding Prevention and Early
Intervention. She said the division engages with communities to
determine community needs and form coalitions. These coalitions
and grantees use the Strategic Prevention Framework (SPF), which
is from the federal Substance Abuse and Mental Health Services
Administration (SAMHSA). Through these SPFs, coalitions assess,
plan, strategize, implement, and evaluate community-based
services. Every community and coalition is different, but one
example is the positive messaging of the Be(You) Initiative that
is aimed at preventing underage drinking by challenging the
misconception that most teens drink. She said 78 percent of
Alaskan teens do not drink alcohol and noted that Be(You)
campaigns are active in ten locations throughout Alaska. Moving
to slide 3, she played a video from the Be(You) Initiative.
3:50:30 PM
MS. MOREAU-JOHNSON noted the Be(You) Initiative is funded by
state dollars through the Division of Behavioral Health. These
state dollars leverage other funders of the initiative, which
are: Alaska Native Tribal Health Consortium, the Mat-Su Health
Foundation, Rasmuson Foundation, Alaska Wellness Coalition, and
the Mental Health Trust Authority. With all those funders there
is a keen interest in knowing how well it's doing and the Youth
Risk Behavior Survey (YRBS) assesses how well it is working.
This survey, done every two years, asks specific questions about
teen drinking.
MS. MOREAU-JOHNSON said that during fiscal year (FY) 2020,
statewide and local community partners will assemble a statewide
alcohol prevention alliance to revise and to implement the
moving of prevention upstream. That is the strategic plan for
underage drinking and adult binge and heaving drinking in
Alaska. It is anticipated that the plan will include community-
based intervention, statewide intervention, mass-reach health
communications, surveillance and evaluation infrastructure,
administration and management, and will promote screening, brief
intervention, and referral to treatment.
3:52:12 PM
MS. MOREAU-JOHNSON stated that the graphic on slide 5 shows the
intersection and efforts around substance use disorder (SUD)
treatment, which is when the problem appears. She explained
that primary prevention is the effort to prevent these
conditions from ever happening and SUD is the early intervention
of the continuum. The graphic depicts the intersection and
efforts across various components that are all part of the
system. These components are made up of services that an
individual may have contact with and that identify the person as
someone who needs help. They are the treatment and recovery
providers and services, the agencies that provide the grant
funding, agencies that receive the grant funding, data sources,
and data sets. The graphic identifies these at the community,
state, and federal levels - the components interact with each
other within a ring and flow both inward and outward within the
circle. For example, data about an individual may end up at the
federal level in the Treatment Episode Data Set (TEDS), while
funding from the federal level gets funneled through the state
down to the individual.
3:53:46 PM
MS. MOREAU-JOHNSON requested committee members to keep the image
of this graphic in mind as they look at slide 6, which depicts
the distribution of SUD funding by service area and program type
across Alaska. She said slide 6 illustrates much effort and
great achievement on the part of the state, federal government,
and provider agencies in piecing together a system. But, she
noted, it also represents a system that is pieced together.
Using state general funds, a myriad of federal grants, and
Medicaid - each with its own reporting and management
requirements and each with its own set of unique regulations -
the result is that there are these services, which is good, but
service providers are struggling to keep on top of the
administration and yet still provide the service. It also ends
up with an uneven distribution based on a variety of influences
for how these how these services are available across the state.
MS. MOREAU-JOHNSON continued discussing slide 6, pointing out
that Alaska has 26 outpatient programs specifically funded by
the Division of Behavioral Health for SUD treatment, including
youth. The state also has four methadone clinics - one in
Wasilla, two in Anchorage, and one in Fairbanks. Alaska has 366
medical professionals certified to treat addiction using
buprenorphine and 22 residential treatment programs which is 300
beds, four women and children's programs, and three youth
programs. While the graphic shows that Alaska has a lot, it
also represents the fragmentation. She said she will be
discussing some of the division's solutions, which includes
reducing the administrative burden to providers by onboarding
the administrative services organization with a performance
measure of reducing the administrative burden on providers
providing these services.
3:56:10 PM
CO-CHAIR SPOHNHOLZ observed the chart on slide 6 shows that for
2019 Alaska will spend $26.8 million in addition treatment.
That is just in the grants, she pointed out; missing from the
chart are the Medicaid payments for substance abuse treatment.
She cited another chart that was provided to her earlier by
DHSS, which showed that in 2015 Alaska spent about $38.5 million
on addiction treatment through Medicaid billing and by 2018 that
number was up to almost $151 million. Co-Chair Spohnholz said
this other chart further showed that Alaska went from about
13,000 people getting addiction treatment through Medicaid
billing in 2015 to about 30,734 in 2018. This big piece of
Alaska's addiction treatment system isn't shown in the chart on
slide 6. She said she will provide committee members with this
chart because it is important to know that most addiction
treatment in the state of Alaska is being paid for by Medicaid.
3:57:44 PM
MS. MOREAU-JOHNSON moved to slide 7 and said Medicaid coverage
for SUD treatment is essential funding to the state for
treatment and is also how [the state] looks forward to
developing a more robust continuum of care. It is anticipated
that implementation of Alaska's Section 1115 Behavioral Health
Waiver ("Section 1115 Waiver") will expand funding to include
federal match, which will be a more sustainable source and the
continuum will be equally distributed regionally across the
state. The Mental Health Trust Authority has funded an
infrastructure analysis study by the division that is nearing
completion. Given these new federal funding opportunities for
the Section 1115 Waiver and the new federal funding opportunity
through the Family First Prevention and Services Act, this gap
analysis explored the capacity of existing service providers to
leverage these new funding sources, including Medicaid, in order
to expand existing services or onboard new services. The
division and the Office of Children's Services (OCS) visited 14
communities [Anchorage, Mat-Su, Fairbanks, Soldotna, Homer,
Nome, Kotzebue, Utqiavik, Bethel, Juneau, Sitka, Ketchikan,
Kodiak, Dillingham]. At this point the division has met face-
to-face in these communities with 68 agencies across Alaska and
has about 6 left to go. The visits allowed candid and deep
conversations with providers about what it means to them to
bring on the Section 1115 Waiver. Specific data is being
collected related to the volume of screens in and out, child
protective service reports, and the number of children in
custody. The report will include recommended actions and will
be complete and available to the public by summer's end.
4:00:05 PM
MS. MOREAU-JOHNSON concluded with slide 8 regarding the Section
1115 Waiver demonstration project, which was required of the
department in 2016 through Senate Bill 74. She related that the
state submitted its application in 2018 and received its first
approval from the Centers for Medicare and Medicare Services
(CMS) in November 2018. Alaska received approval from CMS to
fast track its substance use disorder components of the Section
1115 Waiver and has negotiated an implementation plan with CMS.
The approved implementation plan is available to the public on
the division's website. The division is now getting regulations
in place and is targeting July 1 implementation of the SUD
services through the Section 1115 Waiver. She noted she has
distributed the list of services that are approved, and it is
the full continuum from community-based services all the way up
to exemption from the Institutions for Mental Diseases (IMD)
exclusion for facilities of 16 beds or more.
4:02:11 PM
CO-CHAIR SPOHNHOLZ stated she is thrilled that the Section 1115
Waiver includes allowing for larger facilities because a 16-bed
facility is a financial strain. She requested Ms. Moreau-
Johnson to elaborate about the community-based services.
MS. MOREAU-JOHNSON replied that "a bucket of services" is being
offered through Community Recovery and Support Services. She
said she calls it a "bucket" because it includes component
services. These component services include peer support;
assistance navigating social services, including housing
assistance and transportation; support in employment, which is
essential for the recovery model of care; and case management.
These multiple component services are delivered to the
individual in the community setting to help people recover fully
and become contributing members of their community.
CO-CHAIR SPOHNHOLZ requested Ms. Moreau-Johnson to explain how
people will be identified as eligible for these services.
MS. MOREAU-JOHNSON responded that anyone with a substance use
disorder diagnosis would be eligible for this full array of
services. People will be identified as the Section 1115 Waiver
demonstration project promotes universal screening. Screening,
brief intervention, referral, and treatment are being
implemented in every setting from hospitals to primary doctor
offices. Provider roundtables are being used to identify the
best screening tools, practices, and assessments for universal
screening.
4:04:36 PM
MS. MOREAU-JOHNSON returned to slide 8 and added that [the
division] is continuing to negotiate for the services in the
remaining sections of the Section 1115 Waiver. Relevant to what
the committee is looking at is the target population of at-risk
family and youth. Addressing adverse childhood experiences is a
way to bend the curve. At-risk families and youth population
will be identified through screening for indicators of adverse
childhood experiences, one of which is substance use in the
home. If at a well-child check a child is identified as living
in a substance use home, the child would be eligible to receive
in-home support to help the family remain whole and healthy.
4:05:54 PM
BRADLEY GRIGG, Chief Behavioral Health Officer, Bartlett
Regional Hospital, stated he will describe what the hospital is
seeing in the patients it is serving. He said Bartlett Regional
Hospital has a broad addictions program on its campus that
includes a co-ed adult residential treatment facility of 16
beds. Mainly because of the IMD exclusion, Bartlett has had to
attend to this business model in order to bill Medicaid for its
services, which is about 95 percent of its population both pre-
and post- Medicaid expansion. Bartlett is therefore excited
about the possibility of the Section 1115 Waiver helping the
hospital to expand its [residential treatment facility].
Through funding by the City and Borough of Juneau and Bartlett
general funds, the number of residential treatment beds is being
expanded. As well, four specific withdrawal management, or
detox, beds are being added to the Rainforest Recovery Center
facility, which will provide detox for alcohol and opioid
withdrawal. The bid has been awarded for the project and
construction will begin in about two months.
4:07:58 PM
MR. GRIGG stated that Bartlett wasn't waiting for its referrals
and numbers to increase in order to expand; rather, it was
waiting on an opportunity for the IMD waiver so Medicaid could
be billed. He explained that if Bartlett had had more than 16
beds, it wouldn't have been able to bill for the patients on
Medicaid, but now it will be able to do so. Bartlett is looking
at a minimum of 20 beds total to help serve these patients and
is also looking at as many as 24 total and that would include
the detox patients. Given Bartlett is a hospital, it has been
able to provide detox services for years, which is done on its
medical floor as a medical service. The challenge has been with
the opiate piece because it is a very different level of
withdrawal - the medical concerns and the risk associated with
opiate withdrawal as opposed to alcohol withdrawal is very
different. Bartlett is grateful for the opportunity to build
these beds that will address its ongoing needs for alcohol detox
as well as opioid detox.
MR. GRIGG related that Bartlett-specific data reports show that
over the last three years alcohol has been the number one drug
of choice on patients' self-reports. In FY 2018, four out of
five of Bartlett's patients, 80 percent, reported that alcohol
was either their number one drug of choice or their only drug
abuse. Over the last three years the hospital has learned that
drug abuse is not a monogamous relationship when it comes to
individuals struggling, so a poly-substance approach is being
taken. Ironically, compared to three years ago, Bartlett has
seen a distinct shift in the patient populations it is serving.
Alcohol has now gone from 80 percent to below 55 percent as the
drug of choice on the self-reports, with the other 45 percent
split evenly between methamphetamines and opiates. It doesn't
mean those individuals aren't using alcohol, it means that their
self-reported drug of choice is now opiates and methamphetamines
over alcohol.
4:10:41 PM
MR. GRIGG said that in addition to its residential treatment and
detox, Bartlett also provides outpatient substance use services
to kids and adults. The Division of Behavioral Health recently
awarded Bartlett a combination capital and operational grant to
build a crisis stabilization program for adults and kids ages 10
and up. Two separate programs will be housed in the same
facility that will serve behavioral health needs as it comes to
mental health crisis stabilization, but also substance use
stabilization that could be in the form of 23.5 hour observation
for a person who is intoxicated and possibly suicidal at the
same time. But it does not have the capacity for Bartlett to be
able to put them in its inpatient mental health unit.
MR. GRIGG noted that Rainforest Recovery Center, like many
others, is serving individuals statewide. On any given day 16
patients are in the 16-bed facility. Over the past 6 months, a
bed is only empty when someone has had to be discharged and the
center is waiting on the arrival of the patient that the bed has
been obligated to. As of today, 12 of the 16 patients are not
from Southeast Alaska. A challenge is that as soon as people
are moved in and the beds full, there are also people on the
waitlist. Today, 13 people from all over the state are on the
waitlist to get into treatment. The average length of stay in
the program is about 24 days, so a three-week period is used to
say how quickly someone can get in. This bottleneck effect at
Rainforest has a statewide impact because the center takes
individuals from across the state. Juneau and Southeast Alaska
individuals are treated, but the waitlist is prioritized based
on who has come to the table for acceptance first and possibly
who has the most complex needs.
4:13:31 PM
MR. GRIGG said a challenge seen every day with patients is that
along with addictions, patients are also struggling with co-
morbidities around medical conditions, such as diabetes and
hypertension. Twenty beds are not going to meet the need, but
Bartlett believes these [four] additional beds can be added
without putting extra pressure on its staffing outside of adding
additional psychiatric and medical coverage, which is critical
to the service it delivers. Adding these beds will help be a
part of the solution even though Bartlett is only one agency of
many doing that.
MR. GRIGG noted that Bartlett also provides medication-assisted
treatment, both in its residential and its outpatient programs,
in the form of suboxone and vivitrol. There are no methadone
services per se in Juneau or Southeast Alaska.
4:14:52 PM
CO-CHAIR SPOHNHOLZ asked about the number of people that can be
served in Bartlett's outpatient program for addiction treatment.
MR. GRIGG replied that Bartlett currently has just under 100
individuals in outpatient treatment for addictions. Bartlett's
outpatient program serves both mental health and substance abuse
and co-occurring disorders. The caveat is that the number 100
is where substance abuse is primary over mental health.
Bartlett has 200 active patients in its outpatient program. Of
those other 100, the majority also have addiction history or
current experiences with addictions, but mental health seems to
be their driver at the point in time when it gets to why
Bartlett is serving them.
4:15:50 PM
REPRESENTATIVE DRUMMOND inquired whether the Section 1115 Waiver
limitations are what kept Bartlett from growing beyond 16 beds.
MR. GRIGG answered that that was a major driver; it definitely
wasn't meeting the need. Sixteen was the maximum we've done for
over two decades now mainly because of the IMD exclusion.
REPRESENTATIVE DRUMMOND observed from a list of facilities
provided by the co-chair that most are 16 beds or under.
CO-CHAIR SPOHNHOLZ responded that this is because of the
Institutes for Mental Disease limitation on billing at the
federal level, a federal regulation that was passed a long time
ago. That rule was put into place because in the Lower 48 there
was a problem where people who experienced mental illness were
often housed in large institutions that operated more like
prisons than health care facilities. It had good intentions and
resulted in the de-institutionalization of people that had
primarily really been warehoused for mental health issues or
developmental disabilities. An unintended consequence was to
not be able to have mental health care facilities and substance
abuse treatment facilities that were economic to operate. Many
states are applying for waivers that will allow them to have
larger facilities given there is now a more patient-centered
model for doing things rather than warehousing people.
4:17:57 PM
MR. GRIGG returned to his testimony, stating that since Senate
Bill 91, the criminal justice reform bill, went into effect two
fiscal years ago, a growing number of referrals are coming from
the Department of Corrections (DOC) for individuals re-entering
the community. So, a new dynamic is the challenge of what is
called a bed-to-bed transfer. Having an available bed when an
individual is discharged from corrections and getting that
person from bed to bed is critical because a lot can happen in
the time from discharge to the time to the hospital. With these
additional beds, Bartlett is trying to increase that access for
bed-to-bed transfers because it will give these individuals a
better chance of being successful as they exit.
4:19:02 PM
CO-CHAIR ZULKOSKY asked whether Bartlett has a prioritization
process for the wait list; for example, pregnant women or people
who have had close encounters with overdoses.
MR. GRIGG replied that federal regulations guide part of the
hospital's practice around priority populations and includes
pregnant women and intravenous (IV) drug users. When looking at
the wait lists, those rise to the top no matter where they are
coming from in the state. Those two priority populations are
actively served in Bartlett's program.
4:20:07 PM
SHERRIE WILSON HINSHAW, President & CEO, Volunteers of America-
Alaska (VOA), explained VOA is an Alaska-based company providing
behavioral health services to youth since 1981. She said VOA
has a residential substance abuse treatment program, a 24-bed
facility, in Eagle River; outpatient and intensive outpatient
programs in Anchorage; and prevention and early intervention
services in Anchorage and other areas. The VOA serves youth all
over the state, the primary ages served being 13-24. With that,
VOA has affordable housing, family and senior housing, a youth-
supportive housing program for homeless youth, and a kinship
care program for families who are the primary caregiver of
related children due to parental substance abuse in the house.
MS. WILSON HINSHAW explained that the youth seen at VOA are
trying to fill a void. They feel lonely, scared, pushed aside,
and are often self-medicating. There are impulsive behaviors
given where they are in life and they don't have a fully
developed pre-frontal cortex. When a chaotic home life and
trauma are added in, they face multiple barriers. In working
with them, VOA's goal is to help them grow, change, and overcome
the obstacles. The journey of recovery looks different for
different people and VOA is helping them find meaning and
purpose in their life beyond just what their substance use
profile says. The impact of trauma and addiction in communities
is seen by VOA daily and VOA sees the state as a partner in this
work. Having served families in Alaska for decades, VOA has
been through times of instability and fiscal challenges, but
these last few years have been unusually difficult for VOA and
many other organizations.
4:22:36 PM
MS. WILSON HINSHAW related that the Anchorage Health Department
undertook a comprehensive community assessment around substance
misuse, which it recently presented to an assembly committee.
That assessment echoes what VOA sees in its work on a daily
basis, which is: alcohol remains the most misused substance,
stigma around behavioral health treatment remains a barrier even
though gains have made, lack of treatment options and realities
prevent access to care, methamphetamine use and vaping are
increasing, and the effect of adverse childhood experiences and
inter-generational trauma are all factors that need to be
focused on. Substance use disorder (SUD) rates of Anchorage
youth are among the highest in the nation - 6.54 percent
compared to the U.S. rate of 4.13. The teens and high school
students seen by VOA is around the misuse of alcohol, vaping,
marijuana, tobacco, and prescription medications.
MS. WILSON HINSHAW said she will discuss the three major areas
that constitute the reality of life as a provider in trying to
deliver these services: 1) the mission and reasons why VOA is
doing this work; 2) gaps in the system; and 3) stability of the
system. The reality of being a treatment provider, she
explained, is operating in a business environment - VOA must run
a business that is consistent and available for those who are
seeking care; funding and system decisions affect VOA's ability
to consistently deliver those services and grow to meet the
needs of the community. There is a high level of uncertainty
with funding. It is hard to imagine another system where the
expectation is to grow to meet demand and live in an uncertain
funding system when lives are really on the line. This means
that families seeking services don't know where to go, they
can't get the care they need at the right level, or they can't
get the full continuum of services that they need. Funding
availability directly ties into VOA's ability as a provider to
hire clinical staff to deliver those services, which ties
directly into VOA's ability to serve the number of individuals
that need VOA's services.
4:25:10 PM
MS. WILSON HINSHAW advised that VOA sees gaps in the system
around work with parents - working with the whole family is not
currently a reimbursable service. She said the Section 1115
Waiver does address some of the gaps, but there are concerns.
Partial hospitalization is a gap in the system, especially for
youth, where they can access the same level of clinical
intensity of services that they would in residential except go
home at night. Some states are using this model to do recovery
high schools where it is really centered around recovery and
trauma-informed care while [the youth] are addressing deficits
in education and continuing in their high school. She pointed
out that peer mentoring and support is another gap that is
included in the Section 1115 Waiver, which VOA is happy to see.
Prevention, she continued, is also a gap in the system. As seen
on the chart shown earlier, about $2 million is provided for
prevention. Clearly not enough is being invested in prevention
in a way that is needed going upstream. Some amazing
professionals across Alaska are taking that investment in
prevention and turning it into meaningful things, such as the
community coalitions of which VOA is a participant. Those
coalitions are a part of distributing naloxone kits, but more
must be done in prevention so there can be a shift away from
being a crisis response system.
4:27:10 PM
MS. WILSON HINSHAW addressed the level of uncertainty and a
well-functioning system. She noted that a system itself is an
interconnected set of elements that are organized in a way that
achieves something. The Alaska behavioral health system is
often focused on crisis management versus prevention or being a
responsive system that changes as the environment changes and as
community needs change. On the continuum of health promotion,
prevention, early intervention, treatment and recovery, the
state must look at how to adequately address all those areas.
MS. WILSON HINSHAW explained that VOA teaches its clients to not
be reactive, to respond in the moment, and to regulate emotion
so they can make the best possible choice. That parallels the
many wonderful things in the Section 1115 Waiver, which
addresses so many gaps in the system. But, she cautioned, the
devil is in the details because VOA's current reality as a
provider is that rates do not cover the cost of care. It has
been a great expense to VOA to continue to provide services that
it knows are needed and to meet VOA's mission. Even the recent
Medicaid rate increases in January [2019], which VOA is thankful
for, do not cover the cost of care and limit an organization's
ability to grow to meet the need of the community.
4:28:52 PM
MS. WILSON HINSHAW noted there are a high number of unknowns in
the timeline of implementing the Section 1115 Waiver - what that
will look like and how that will change services on the street
for those seeking the services and those families in care. She
urged that thought be given to rolling out change in manageable
steps so that the system isn't destabilized by trying to change
too much too quickly. She offered her hope that committee
members will come away from today's presentations with an
understanding of the reality of trying to offer these services
and that without the certainty of stable and consistent funding,
it is difficult for providers to confidently deliver and grow
those services that they know are needed. There must be a shift
away from being a reactive system and being crisis driven. This
means looking at the whole continuum of care and then rolling
out changes in manageable steps that don't destabilize what is
already had. She thanked the committee members for what they do
to address community needs and substance misuse.
4:30:44 PM
CO-CHAIR ZULKOSKY addressed Ms. Wilson Hinshaw's comments about
not destabilizing the system and the need for stable resources
to provide reliable treatment support for those individuals
needing it and providing opportunities for providers to grow
their programs. She said this really resonates, especially with
the backdrop of all the financial decisions and challenges that
the legislature is currently grappling with. She requested
identification of the specific revenues coming into programs.
MS. WILSON HINSHAW replied that the $26 million in comprehensive
behavioral health treatment and recovery grants is the gap
filler that funds everything Medicaid won't. So, any cuts to
that -- she offered her belief that cuts are proposed right now.
She said the purpose for bringing the Section 1115 Waiver online
on [7/1/19] would correspond with grant cuts, so having grant
cuts at the same time as adapting to a new system with many
things yet undefined is very concerning for providers. In
particular, she was referring to those cuts.
4:32:33 PM
CO-CHAIR ZULKOSKY surmised Ms. Wilson Hinshaw was online when
Co-Chair Spohnholz talked about the significant amount of
investment Medicaid has made in treatment services. She
surmised Medicaid treatment funds are critical to maintaining
moving forward.
MS. WILSON HINSHAW responded that Medicaid rates for behavioral
health were not adjusted for over 10 years and do not cover the
cost of care even with the [recent] increases. Any cuts to
Medicaid directly impact VOA's ability to deliver services.
CO-CHAIR ZULKOSKY asked about the impact that would be seen at
the community level if cuts were made to Medicaid funding or to
the aforementioned grants.
MS. WILSON HINSHAW replied the impact would be a lessening of
what availability the system does have right now. For example,
VOA would have to lower staffing in its outpatient, intensive
outpatient, and residential treatment programs to a level that
VOA could sustain. This would mean VOA serving less youth who
are coming in for services.
4:34:40 PM
LANCE JOHNSON, Director, Behavioral Health Services (BHS),
Norton Sound Health Corporation (NSHC), offered his appreciation
for the comments of his colleagues, stating they highlight the
issue that is being addressed, which is the rampant substance
misuse concerns that are had throughout the state. He said he
will provide a rural perspective and highlight some positive
developments in Nome that can also benefit the state as well,
namely the wellness center that is being built and a day shelter
that has been opened.
MR. JOHNSON stated Norton Sound Health Corporation operates the
only hospital and behavioral health services in the entire
Bering Strait region, which includes 15 remote villages and the
home community of Nome. The region is 24,000 square miles with
9,869 people and is only accessible by airplane. He has been
the director for behavioral health since 2012, he continued, and
the needs are high and are visible. Committed partners in the
region collaborate around common concerns that impact the
wellbeing of residents. For example, in recognition of public
concern about substance misuse in the region, a public safety
coalition was put together in the last month to examine basic
needs, wellness, and substance misuse, and to develop strategies
working outside of the silos with a goal of achieving measurable
and sustainable change. These partnerships are wholly important
to the region where localized care and treatment can have most
effective change. The State of Alaska has been a committed
partner in many of these efforts through grants, collaboration
with tribes and tribal entities, and to do expansion efforts.
4:37:10 PM
MR. JOHNSON said the negative is that there are glaring needs
and the issue is recognized throughout the state, but the
positive is that Norton Sound Health Corporation has devoted
staff and resources to projects that help with that substance
misuse. The significant contribution of historical, inter-
generational, and other trauma cannot be overlooked, he advised;
it is often masked through substance misuse by the people of the
region. The corporation opened a day shelter on 12/29/18 to
offer a warm weather and safe place for the several people seen
on the streets who were chronically homeless and at varying
levels of intoxication. The idea was to keep them safe but to
meet them where they are. It is foolish to think that everyone
who has a need is going to walk through the doors of behavior
health ready for treatment. Change and recovery will not always
occur within the four walls of a clinic. People need to be met
where they are, and trust and rapport need to be built. The day
shelter operates seven days a week 8:30 a.m. to 7:30 p.m. Since
opening it has served 122 unique individuals. Nearly 100
percent of the individuals have claimed homelessness and are
misusing substances. On triage forms all of them have said that
their top priorities are housing, employment, and treatment.
The day shelter is very grassroots. It's small and is not the
greatest setup physically in comparison to more established
shelters throughout the state, but it is an important need in
the continuum of care in this region.
MR. JOHNSON stated that BHS currently offers outpatient mental
health and substance misuse services. While wholly important
treatment options, they are not enough. A whole continuum of
care is necessary anywhere to address the multitude of needs any
one group of people may have. Because of this, NSHC has worked
on developing a wellness center that will offer a full continuum
of outpatient, intensive outpatient, day treatment, and a sober
housing that will replicate residential treatment. This means
people will be able to come in from the region's villages and
have a place to stay while receiving treatment for however long
that may take. A sobering center within the wellness complex
will serve as an entry point for many people into the other
services. It has been a nine-year project with planning support
from the Alaska Mental Health Trust Authority. So far, NSHC has
secured $7.1 million towards the project, with much of that
invested by the corporation. Another $8.3 million is needed.
Pylons were put in the ground this past year.
4:40:04 PM
MR. JOHNSON pointed out that these are important efforts in the
region because localized care is the most effective care and
right now the region is grossly limited. Building and operating
the wellness center will allow people to stay in the region
surrounded by familial and social supports, which are imperative
to successful recovery. As importantly, treatment will be
culturally reflected and familiar to people because it is in
their own region. When people are sent outside for substance
misuse treatment they are most often isolated from their
supports and their culture. The family component to treatment
where people learn and recover together is often lost. Mr.
Johnson said he is grateful for the services that are out there
because recovery can have many hills and many valleys and is a
lifelong journey. Staying home wrapped in supports and
resources offers the better and more sustainable outcomes.
MR. JOHNSON shared the example of "Kenny," who BHS has been
working with for the last two years. Over the years Kenny has
had more days of intoxication than sobriety. In the last two
months Kenny has been to the NSHC emergency room over 30 times,
admitted to the inpatient unit three times, and arrested three
times. He said Kenny's needs will only be met through high
levels of care that are not had in the region. Through the
first seven months of the relationship, Kenny would did not want
to engage BHS services. But, through BHS's commitment to work
with Kenny where he was at in his life and to offer support, a
trusting relationship was built where NSHC was able to scrape
beneath the masking substances and address those underlying co-
occurring issues. The point, Mr. Johnson advised, is that it
doesn't happen in a day, trust must be built to get to the core
of the problem. Right now, Kenny can go to a 35-day program or
he can wait for five or six months for a bed in one of the
state's long-term residential facilities. A 35-day program has
its place, but it took BHS seven months to build trust with
Kenny and to gain daylight into his severe trauma history, the
catalyst for his addiction. So, if Kenny could stay home and in
the place where he has said he would feel safest getting
treatment, and do that surrounded by his supports in his culture
and in a care environment he trusts and opens up to, Kenny would
spend a lot more time on the hills than down in the valleys.
4:42:37 PM
MR. JOHNSON expressed his appreciation for the committee's
interest in looking at ways to partner with agencies that might
have these capabilities. He said he is interested in having the
opportunity to partner. A lot of infrastructure has been built
in the urban areas, he noted, but there needs to be a new energy
in building infrastructure in rural Alaska. The more that can
be provided locally, the less strain will be put on an already
overburdened and under-resourced system. The less he has to
send people out of region for services and tie up those beds
that Mr. Grigg has, the less it overwhelms the system, the less
it costs in emergency room care, incarceration, and police
resources because people would be getting the right care in the
right place leading to recovery.
MR. JOHNSON explained that this happens best when rural
communities have the same or similar opportunities as nonrural
communities. For example, the State of Alaska released a
Request for Proposals (RFP) for state opioid response peer
support services on [11/21/18], but the opportunity was
restricted to communities in urban areas. Further disheartening
was that one month later there was another opportunity that
would have worked perfectly for NSHC that was only available in
urban areas. While the needs of urban areas are just as real as
those of rural areas, he said, the danger is that if investment
continues only in the infrastructure of urban communities then
rural communities will continue to depend on those out-of-region
services, leading to more cost, more strain, and more people
struggling to achieve recovery in the continuum.
4:44:52 PM
The committee took a brief at-ease.
4:45:18 PM
ADELE LANDROCHE, Advocate, stated she is a mother, grandmother,
and a retired teacher. She spoke as follows:
It is my hope that by coming before you I will leave
you with some additional knowledge and insight into
the world of addiction. ... Addiction is not just a
disease of an individual, it affects family and
friends of the addict as well. I am living proof of
that. While my experiences have been difficult and
sometimes tragic, I'm not all that different from any
other parent of an addict.
My three adult children have all struggled with
substance abuse. My oldest son died of an overdose
administered by his girlfriend who left him to die
alone. My daughter struggled through two pregnancies
fighting her heroine addiction and has emerged on the
other side as a happy successful adult. My other son
abused drugs as a teenager, went to treatment twice,
and was clean for seven years until his brother died.
He struggles with this and has been actively using for
several years. He's been in and out of jail and was
recently remanded in January. He wants to be clean;
he wants to be happy and successful; he wants to be a
good dad, son, and brother.
However, he can't do it alone. It is not enough that
his friends and family are there for him and that we
support his sobriety. What matters is the resources
that are available to him when he feels weak and lost.
And when you have to navigate the system of
assessments and admission paperwork in filling out
forms, et cetera, doing it on your own as an addict
must be an insurmountable task. I'm hoping that by
sharing my story with you and making the world of
addiction a little more personal, will help you to
understand, to have some insights into the challenges
that the addict and his or her family faces.
4:47:47 PM
My son was remanded to jail in January and immediately
started the process for admission into a residential
treatment facility. His requests went unanswered or
were rejected by corrections staff. In an attempt to
facilitate his admission to treatment, I sent dozens
of emails and made multiple phone calls with little
success. Over the next couple of months, he was sent
back and forth between Anchorage jail, Cook Inlet, and
Goose Creek. It seemed like every time he started to
make some headway they would transfer him. He
continued his efforts to get on the list for an
assessment and I continued sending emails and making
phone calls, most of them went unanswered.
One [corrections officer (CO)] at Goose Creek, Kyle
Thompson, took an interest in actually helping my son
and facilitating this process and he finally got on
the list for an assessment. ... Paperwork didn't get
to the treatment facility's intake and so it was
another series of emails and phone calls and help from
the same CO at Goose Creek until the necessary
documents were received by the facility. Then it was
a waiting game until the bed was open for him. I'm
happy to say that he's finally in treatment and is
doing well.
Sadly, though, my son's story is typical of what
happens within [the Department of Corrections (DOC)].
Lots of waiting, unanswered requests, and resistance.
My son had the benefit of having me outside the system
and fortunately for him I am someone who persevered
until his assessment and admission were completed.
Many inmates don't have this support.
I have also seen the same kind of process that other
addicts have tried to work through outside of DOC to
get into some kind of treatment program. There are
very few detox beds in Anchorage and in the state of
Alaska, and if any of you know anything about addicts,
if they're asking for help right now, it needs to
happen right now. Addicts are known for their lack of
persistence and follow through. Expecting someone who
is actively using to make a phone call every morning
to see if a bed is open and available is not
realistic. The process of being admitted into a
treatment facility is so cumbersome that many addicts
either never begin the process or give up.
4:49:53 PM
Once a person is fortunate enough to go through detox,
then it's a waiting game to get into treatment. I
spent some time looking at the real-time chart of beds
available and open beds in the state and much of it
doesn't make sense to me. There are facilities that
listed a number of open beds yet had a waiting list
which went from a few days to more than a month. For
instance, on May 3 the men's treatment program at
Clitheroe has a total of 42 beds, 37 of them occupied,
with 5 open beds, there are 24 people on the wait
list, and the estimated days wait time for the next
available bed is 45. If you were the addict waiting
for your chance for an open bed, would that sound
promising to you.
I have seen all kinds of wonderful plans in writing
from different task forces and committees within the
state, as well as the mission statements that DOC has
published. This all sounds really good on paper;
however, I see very little evidence of any of these
great ideas being put into practice. We talk about
crime in our state and I'm not an expert. However, I
have done my fair share of research and a common theme
that runs through many of the people who are
committing crimes and are incarcerated is substance
abuse.
We seem to be attacking this problem from many angles
that don't seem to have a direct effect on reducing
crime in our communities. I have listened to debate
after debate and complaints from many people in the
state talking about [Senate Bill] 91 and the problems
that are inherent in it. I have heard very little
focus on the causative issues such as substance abuse
and support for people following incarceration.
Again, I'm not an expert, but I know how it goes. The
person is released from jail, has no money, no job, no
place to live, and very little support in the
community, and they're back on the streets. They seek
out the people that they previously have associated
with in the community and return to the lifestyle that
they were living prior to being in jail. This is a
catch-22 for most of them.
4:51:50 PM
And even for those recovering addicts who truly want a
better life and are making the effort to be a positive
contributing productive member of society, it is truly
an uphill battle. I don't wonder why most of these
people don't succeed at staying clean and sober and
being gainfully employed. I am amazed that some of
them actually make it.
It is imperative that after identifying the underlying
causative factors for addiction and crime in our state
we actually develop a plan to address these issues
that is reasonable, practical, and doable. We can't
keep talking about it and doing nothing and expect
things to get better.
4:52:36 PM
CO-CHAIR SPOHNHOLZ said she respectfully disagrees that Ms.
Landroche is not an expert and offered her appreciation for Ms.
Landroche's testimony.
CO-CHAIR ZULKOSKY commented that for someone who has endured
such heartache, Ms. Landroche has provided a very concise, clear
description of the need for treatment in Alaska. She thanked
Ms. Landroche for courageously sharing what must be a very
difficult story to share.
CO-CHAIR SPOHNHOLZ thanked Ms. Landroche for her courage and
vulnerability in sharing her family story.
4:53:28 PM
DOUG WOOLIVER, Deputy Administrative Director, Alaska Court
System, stated that Ms. Landroche's testimony highlights the
great benefits of therapeutic courts, which remove the confusion
and delay associated with trying to find a way into treatment.
He agreed it seems almost impossible to deal with all the things
that must be dealt with, to find treatment, and to get into
treatment. Therapeutic courts have contracts with treatment
providers in locations around the state. Under that contract,
once the person has shown an interest and looks like a good
candidate, the person is assessed within five days for his or
her needs. There is a bit of delay while the attorneys work out
a plea agreement and ensure the assessment is appropriate and
the person is a good candidate for the court. Under contract,
once accepted, that person is in treatment within five days.
MR. WOOLIVER said the therapeutic courts provide help with
housing, both finding it and through grants, particularly
through Partners for Progress, which has been a tremendous
champion for the therapeutic courts. It is a state funded grant
and they provide emergent funds for people to help cover the
first and last months' rent, a bus pass, and those types of
things that could otherwise make trying to get into a treatment
program or be successful in treatment all but impossible. Those
types of programs are very helpful.
4:55:30 PM
MR. WOOLIVER reported that at any given time the therapeutic
courts have about 280 people. More than 1,300 people have
graduated over the years from therapeutic courts. Like
corrections, the court system is a direct bridge between
treatment and the criminal justice system. Corrections has
treatment programs within its facilities and the court system
has the therapeutic courts to provide treatment as means to keep
people out of those facilities.
MR. WOOLIVER pointed out that one benefit of the therapeutic
court program is the number of healthy babies that are born to
someone who went through or is in the program. He related that
between 15 and 20 women going through the therapeutic court
programs became pregnant and gave birth to healthy babies. For
example, a fetal alcohol spectrum disorder (FASD) child ends up
costing the state in the long run. That doesn't count for the
human tragedy of the syndrome itself. But it is also a crime
reduction tool. The birth of a healthy baby is prevention, it
is keeping an FASD baby from coming down the pipeline who is
more likely to be in the juvenile justice and more likely to be
in the adult correctional facilities. So, while the people in
the therapeutic court are already in the system, the healthy
babies are a piece of the prevention angle that comes out of the
therapeutic courts.
4:57:40 PM
CO-CHAIR SPOHNHOLZ asked what percentage of the people working
their way through the court system every year participate in
therapeutic courts.
MR. WOOLIVER replied that it is a very small percentage. The
therapeutic court has about 280 people at any given time, about
400 people over the course of a year, and there are thousands
and thousands of people in the criminal justice system. It is a
challenge getting people into therapeutic courts.
CO-CHAIR SPOHNHOLZ inquired how people get identified to
participate in therapeutic courts.
MR. WOOLIVER responded that frequently people's attorneys or
other people in jail will tell them about therapeutic courts.
He noted that it's hard because the substance abuse courts are
about 18 months long. Many of the people going into therapeutic
courts have been to jail many times already and going to jail
for 90 days isn't that big of a deal, but 18 months of intensive
outpatient treatment is a big deal and people must be ready to
do it before they will start down that path. That is why a lot
of the therapeutic court's defendants are felons - there is more
time hanging over their heads, more to avoid. He added that
therapeutic courts are good programs, and more are wanted, but
there are as many as possible for right now.
CO-CHAIR SPOHNHOLZ remarked that Mr. Wooliver has given the
committee something to be hopeful about, although she hesitates
to get hopeful about something that serves such a small number
of people. She said she wishes that more therapeutic courts
could be done in Alaska because she thinks they are great.
4:59:52 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:59 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Andy Jones Addressing Alaska's Poly-Substance Epidemic_Presentation_Final for House HSS May 9 2019.pdf |
HHSS 5/9/2019 3:00:00 PM |
SUD treatment |
| 5.9.19 HHSS presentation SUD v2.pdf |
HHSS 5/9/2019 3:00:00 PM |
SUD Treatment |