Priority Health Topic: Substance Misuse


Background & History

Alaska’s State Health Assessment identified substance misuse as a topic of highest concern. Substance misuse data was tracked in the HA2020 plan with the LHI’s 14, 15a, and 15b that included measures on alcohol mortality rates, and adult and adolescent binge drinking. For all Alaskans, there was no progress on the alcohol induced mortality rate indicator, but both binge drinking indicators met their targets. The HA2030 team decided that the new State Health Improvement Plan will focus on both alcohol and drug-induced mortality rates to address multi-substance use, which aligns with Healthy People’s goal. There is considerable funding and community interest in drug and alcohol misuse prevention program action at this time, which may aid progress in this area. Efforts related to the binge drinking LHIs from HA2020 have been incorporated into the strategies and actions to lower alcohol mortality rates for HA2030.

The HA2030 team also decided to add a new objective to reduce the percentage of adults needing, but not receiving, substance use disorder treatment as a way to create strategies and actions focused on barriers to accessing treatment and support. This objective’s strategies will also support the progress on alcohol- and drug-induced mortality rates.

Objective 22: Reduce the alcohol-induced mortality rate per 100,000 population

Target: 23.6

Strategy 1: Promote policy, systems, and environmental changes that are designed to enhance community conditions to reduce alcohol-induced mortality

For successful health promotion strategies, models focused on policy, systems, and environmental change is a way of modifying the environment to make resources available to the at-risk and vulnerable population, and help facilitate healthy choices.

Sources:

Action Step 1

ActionPromote and support policy changes such as:
• Increases to the alcohol taxes statewide and/or locally,
• Continue with Title 4 review work,
• Create health and safety regulations for curbside and home delivery of alcohol,
• Revise Local Option Laws after thorough research and work with people in rural Alaska who are impacted by these laws,
• Prioritize and pursue other best practices in health policy.
MeasureNew/revised policies and healthcare guidelines get passed or changed.
Timeframe2020-2030
Key Partners• Recover Alaska
• Alaska Mental Health Trust Authority
• Mat-Su Health Foundation
• Alcoholic Beverage Control Board
• Advisory Board on Alcoholism and Drug Abuse (ABADA)
• Marijuana and Alcohol Control Board

Action Step 2

ActionShift in the way problems are solved across the local to state level through system changes that develop and support prevention professionals, including:
• Build communities of practice and cultivate the prevention profession, (e.g. Cohorts and coursework developed, Prevention Summit organized and implemented, prevention certification as a standard practice statewide)
• Address barriers experienced by rural and marginalized communities trying to access resources, (e.g.: resource flows from state and other funders.)
• Centralize data and story collection that provides real information that agencies and communities can trust and use.
MeasureImplementation of coursework, prevention summit, and certification as statewide standard; equitable distribution of funding that represents the needs of communities; and community involvement in the development and use of data and information.
Timeframe2020-2030
Key Partners• Alaska Alcohol Misuse Prevention Alliance (The Alliance)
• Community and local Stakeholders
• Alaska Training Cooperative
• University of Alaska Anchorage
• Alaska Native Tribal Health Consortium

Action Step 3

ActionChange the context that affects alcohol-induced mortality through the development and introduction of messaging to increase health and wellbeing, including:
• Conduct research on perceptions and beliefs around alcohol across the state, for use of localized data in media and health campaigns
• Develop and disseminate media that shifts social norms, amplifies community efforts, and re-writes the narrative in favor of a healthy and healing Alaska.
MeasureAnalysis and dissemination of data from existing data sources (e.g. NSDUH, BRFSS, and YRBS) on knowledge, perceptions, and beliefs around alcohol use; and implementation of a strategic communication plan that measures the outcomes of media and health campaigns.
Timeframe2020-2030
Key Partners• Recover Alaska
• Mat-Su Health Foundation
• Alaska Alcohol Misuse Prevention Alliance (The Alliance)
• Department of Health and Social Services

Objective 23: Reduce the drug-induced mortality rate per 100,000 population

Target: 14.2

Strategy 1: Promote policy, systems, and environmental changes that are designed to enhance community conditions to reduce drug-induced mortality

For successful health promotion strategies, models focused on policy, systems, and environmental change is a way of modifying the environment to make resources available to the at-risk and vulnerable population, and help facilitate healthy choices.

Sources:

Action Step 1

ActionDevelop State government initiated policies and laws regarding controlled Substances Scheduling, Prescribing and Dispensing Policies, Harm Reduction, treatment, Integrated-information sharing, and linkages to care.
Measure• New/revised policies are developed and implemented
• Laws regarding controlled Substances Scheduling, Prescribing and Dispensing Policies, and Harm Reduction, get passed
Timeframe2020-2030
Key Partners• State of Alaska, Division of Public Health, Office of Substance Misuse and Addiction Prevention
• State of Alaska, Department of Public Safety
• Alaska Mental Health Trust Authority
• Advisory Board on Alcoholism and Drug Abuse (ABADA)
• Marijuana and Alcohol Control Board
• Alaska Pharmacists Association
• Senior Care Clinics

Action Step 2

ActionConduct professional development and provider trainings related to substance misuse, abuse and prevention to shift the way problems are solved across the local to state level through system changes including:
• Build communities of practice and cultivate the prevention profession, (e.g. cohorts and coursework developed, Prevention Summit organized and implemented.)
• Shared Factors work groups commence
• Provider education strategies aka Academic Detailing to promote judicious prescribing of opioids and other substances of concern, + project echo.
Measure• # of Academic Detailing Trainings Held
• # of Project Echo meetings held
• # of Shared Factors work group meetings held
Timeframe2020-2023
Key Partners• State of Alaska, Division of Public Health, Office of Substance Misuse and Addiction Prevention
• Alaska Native Tribal Health Consortium
• State of Alaska, Division of Behavioral Health
• UAA CHD, ANTHC, DOLWD

Action Step 3

ActionConduct Employer Toolkit “Addiction in the Workplace” trainings to change the context that affects drug-induced mortality through the development and introduction of messaging to increase health and wellbeing by supporting workforce wellness as it relates to substance use and access to supportive resources among Alaskan employers.
Measure# of Employer Toolkit “Addiction in the Workplace” disseminated and trainings held.
Timeframe2020-2021
Key Partners• State of Alaska, Division of Public Health, Office of Substance Misuse and Addiction Prevention
• Recover Alaska
• ANTHC

Action Step 4

ActionConduct research on perceptions and beliefs around substance misuse across the state, for use of localized data in health literacy campaigns, and develop and disseminate evidence-informed Core Messages.
Measure# of Core Messages developed and disseminated to inform public education, public education campaigns go live.
Timeframe2020-2021
Key Partners• State of Alaska, Division of Public Health, Office of Substance Misuse and Addiction Prevention

Strategy 2: Develop Strategy for Hepatitis C (HCV) elimination in Alaskans with Substance Use Disorder (SUD) to reduce morbidity and mortality in the SUD population

The limited data available to this topic shows that among the prison SUD population, up to 40% have HCV compared to a prevalence of about 1% in the non-institutionalized adult population in Alaska. The CDC has linked the increase in HCV infections to the worsening opioid crisis. There is evidence that attempts to reduce the supply and demand for drugs is associated with a reduction in HCV.

Sources:

Action Step 1

ActionReduce mortality through policy, system and environmental changes with an emphasis on rural Alaska including:
• Enhance access to treatment with innovative drug pricing models.
• Expand DOC treatment eligibility to all individuals with active HCV viremia
• Support syringe exchange programs
• Expand and increase lab testing capacity
MeasureIncreased testing of at-risk population, increased funding for syringe exchange programs, increased number of labs for testing, decreased Hepatitis C (HCV) infection rates in Alaska correction facilities.
Timeframe2020-2029
Key Partners• HCV Elimination Committee of Hepatitis Advisory Work Group (HAWG)
• State of Alaska, Department of Corrections (DOC)
• Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program
• State of Alaska, Division of Public Health, Section of Epidemiology, Hepatitis Prevention program
• State of Alaska, Department of Health and Social Services, Chief Medical Officer
• Medicaid

Objective 24: Reduce the percent of adults needing but not receiving substance use disorder treatment

Target: 7.9%

Strategy 1: Promote policy, systems, and environmental changes designed to enhance community conditions to reduce unmet needs for continuum of care for alcohol and substance use disorders, including but not limited to detox, treatment and substance recovery.

For successful health promotion strategies, models focused on policy, systems, and environmental change is a way of modifying the environment to make resources available to the at-risk and vulnerable population, and help facilitate healthy choices.

Sources:

Action Step 1

ActionAdvocate for policy changes with an emphasis on rural Alaska including:
• Increasing access to treatment
• Increase sustainability of treatment by improving reimbursement for effective practice models
MeasureNew/revised policies and healthcare guidelines are passed or updated and reported annually to Healthy Alaskans Core Team.
Timeframe2020-2030
Key PartnersFederal, State and Local partners including:
• State of Alaska, Department of Public Safety
• Alaska Mental Health Trust Authority
• Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program
• Advisory Board on Alcoholism and Drug Abuse (ABADA)
• Marijuana and Alcohol Control Board

Action Step 2

ActionImplement systems change across the state and local level to:
• Improve the measurement of unmet treatment needs (e.g. purchase oversampling to increase NSDUH sample size)
• Increase use of Screening Brief Intervention Referral to Treatment (SBIRT) and/or AUDIT screening tool across providers statewide.
• Encourage providers to familiarize and utilize MAT for alcohol use disorders.
• Sustain partnerships with Division Juvenile Justice in their provision of treatment options for justice-involved youth
• Increase implementation of the full continuum of care and various treatment levels and options
MeasureIncreased availability of robust data (coverage, oversampling), increased usage of SBIRT, increased integration of behavioral health and primary care
Timeframe2020-2030
Key Partners• Alaska Native Tribal Health Consortium
• Alaska Mental Health Trust Authority
• State of Alaska, Department of Health and Human Services
• Health care and treatment facilities
• Emergency responders

Action Step 3

ActionChange the context that affects alcohol misuse through the development and introduction of messaging to increase health and wellbeing, including:
• Develop and disseminate media that shifts social norms, amplifies community efforts, and re-writes the narrative in favor of a healthy and healing Alaska.
• Increase promotion of tools connecting people to support services statewide (ie. MatSu Connect, Alaska 211, Crisis Now, treatmentconnection.com)
MeasureImplementation of a strategic communication plan including an evaluation plan that measures the outcomes of the media and health campaigns.
Timeframe2020-2030
Key Partners• Recover Alaska
• Alaska Alcohol Misuse Prevention Alliance (The Alliance)
• OSMAP

Strategy 2: Develop Strategy for Hepatitis C (HCV) elimination in Alaskans with Substance Use Disorder (SUD) by improving treatment in the SUD population

The limited data available to this topic shows that among the prison SUD population, up to 40% have HCV compared to a prevalence of about 1% in the non-institutionalized adult population in Alaska. The CDC has linked the increase in HCV infections to the worsening opioid crisis. There is evidence that attempts to reduce the supply and demand for drugs is associated with a reduction in HCV.

Sources:

Action Step 1

ActionImprove treatment through policy, system and environmental changes with an emphasis on rural Alaska including:
• Enhance access to treatment with innovative drug pricing models and STI Screening.
• Support and utilize Mobile Health Units to connect SUD population to screening, treatment, and counseling
• Support funding for HAV screening and treatment programs among SUD population
• Develop peer counselor strategies to message important knowledge about HCV among the SUD populations
• Support programs that improve continuity of care and counseling support to inmates returning to community setting
• Expand and increase lab testing capacity
MeasureIncreased testing of at risk population, model drug pricing programs implemented, increased funding, implementation of peer counseling programs, decreased HCV infection rates in Alaska correction facilities, increased number of labs that test for HCV in AK.
Timeframe2020-2030
Key Partners• HCV Elimination Committee of Hepatitis Advisory Work Group (HAWG)
• State of Alaska, Department of Corrections (DOC)
• Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program
• State of Alaska, Division of Public Health, Section of Epidemiology, Hepatitis Prevention program
• State of Alaska, Department of Health and Social Services, Chief Medical Officer
• Medicaid
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News Bulletins

Healthy Alaskans releases first set of 2030 health improvement scorecards, issues final report, scorecards from 2020 plan

January 31, 2023

Healthy Alaskans releases scorecards assessing Alaska’s health progress for 2020 and a health improvement plan for 2030 that sets goals for the next decade

February 4, 2021

State Health Improvement Plan, Healthy Alaskans 2030 (HA2030), Draft for Public Comment Released

August 5, 2020

Healthy Alaskans 2030 Sets Framework for Alaska’s Health Goals; Strengthening communities and empowering individuals

January 22, 2020

Healthy Alaskans 2020 successes

December 9, 2019