The Shelby County Drug Free Coalition and other community partners are making Deterra® drug disposal pouches available at no cost to residents of Shelby County as part of drug take back and safe disposal efforts.

The launch of the safe-disposal program will coincide with National Drug Take Back Day October 23. Drug Take Back Day is promoted by the Drug Enforcement Agency as a way to safely remove unwanted and unused prescription medications from homes, to prevent theft, abuse and accidental poisoning.

Distribution points are being set up throughout Shelby County, and include: Senior Center of Sidney, Fair Haven, The Meal Prep Life, Wilson Health, Bunny’s Pharmacy, Family Resource Center, Jackson Center Pharmacy, and the Sidney-Shelby County Health Department. Other agencies also participating include: STAR House, Samaritan Works, Mercy Mission House, Shelby County Veterans Services, Botkins Village Hall and Jackson Center Village Hall. The Shelby County Sheriff’s Office and the Sidney Police Department, including the Sidney Addiction Assistance Team, will make the disposal bags available along with the drug take-back drop boxes in their respective lobbies.

The Deterra® pouches use activated charcoal and water to dissolve and deactivate a wide range of medications, including fentanyl, ketamine, quetiapine, tramadol, and zolpidem. Unlike most drug take-back drop boxes, which will only accept pills or powders, the pouches can also neutralize creams, liquids, patches and films. Once in the bag and deactivated, the substances cannot be absorbed by the body, even if ingested. They are also prevented from entering the ecosystem, as can happen when flushing or disposing in landfills without a deactivating process.

Shelby County Commissioner Julie Ehemann said: “Shelby County is excited to be launching a project utilizing Deterra® pouches, which can rid any home of dangerous, leftover drugs in minutes. Our goal is to reduce the risk of abuse, misuse and accidental ingestion of leftover medication, especially prescription opioids.”

The pouches were obtained through the Rx Abuse Leadership Initiative and Shelby County Department of Job & Family Services at not cost to the county. The Rx Abuse Leadership Initiative (RALI) convenes national, state and community leaders to exchange best practices and provide resources that help prevent misuse of prescription medicines.
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The Tri-County Board of Recovery and Mental Health Services maintains a list of area drug take-back drop boxes on its website at www.tcbmds.org/disposal.

Good afternoon Chairman Huffman and members of the Committee. Thank you for the opportunity to speak to you today. My name is Mark McDaniel and I am the Executive Director of the Tri-County Board of Recovery and Mental Health Services. We are the ADAMHS Board that serves Miami, Darke and Shelby Counties. I have been the Executive Director of the Board for over 17 years and have worked in the behavioral health system for over 36 years. Over the span of those years I have provided direct clinical services, managed treatment teams and worked with families with both mental health and addiction issues.

To examine how the role of ADAMHS boards – and behavioral health care itself – is changing, I would like to briefly review where we have been, where we are now, and where we must go in the near future to meet the needs of the communities we serve in the most efficient and cost-effective ways possible.

Timely clinical services are crucial to effective treatment of individuals with mental illness and addictions; but that effectiveness is tempered by what happens the other 23 hours of the day.  Housing, employment and other support services play a crucial role in an efficient system of care focused on long-term recovery.

Those who do well in recovery – that is, those who relapse less often, recidivate at a lower rate, and access fewer crisis services – are persons who have stable housing, meaningful employment, and social, emotional and wellness supports. Without these supports, those addicted to substances, and persons with severe mental illness, tend to follow the very inefficient path of living from crisis to crisis, taxing the most expensive point of interaction with emergency medical services; law enforcement, court and jail involvements; and emergency shelters.

In recent years, ADAMHS Boards in general and the Tri-County Board specifically have spent significant resources on the expansion of client supportive services, housing options and vocational training. 

One example of social supportive services, SafeHaven is a client support program that is now available in all three counties and open to individuals who need help with their personal recovery and opportunities at socialization.

In terms of vocational support, the Board maintains a contract with Opportunities for Ohioans with Disabilities that serves all three counties.  This provides assistance to clients with job preparation and search.

To provide stable and safe housing, the Tri-County Board owns houses and apartments in all three counties as well as maintains relationships with private landlords.  We also maintain contracts for Adult Care Facilities and mental health residential services.

Since access to Medicaid was extended in Ohio, the Board’s focus has shifted to providing 24/7 staffing at existing recovery homes to increase accountability and have expanded other recovery housing options.

To aid in early recovery, Vivitrol projects are now active in all three counties to help with the heroin issue. Detox and residential substance abuse services are accessible through our treatment services providers. Trained Recovery Coaches will be introduced for the first time in our system in the coming months.

Telemedicine was mentioned in several of the previous presentations.  We now have telemedicine available in each of the three counties which has expanded access to doctors for patients.

The Board has invested in reentry programs at both the prison and local jail level. This is a proactive approach to transitioning individuals returning to the community in a very structured and planned way.

To give just one example, with support of the Tri-County Board, Community Housing Inc. has for more than two years implemented a prison in-reach reentry program to assess needs and connect inmates with services prior to their release. In that time, Community Housing has worked with 58 people. Just 7 of those – 12 percent – re-offended, compared to more than 27 percent statewide. Given the high cost of arresting, prosecuting, incarcerating and monitoring an offender, any opportunity to reduce recidivism by half or more – while at the same time helping those persons be productive and healthy citizens - must be seen as an efficiency.

There is much more that needs to be done and the Tri-County Board has a plan. In the very near future we will be announcing the opening of a one-stop shop facility in Miami County which will offer a single point of entry for mental health and addictions, crisis, housing, vocational, consumer support, prevention and wellness, medical and even dental services under one roof.  The overall goal of this plan is to streamline and create efficiency for access by individuals and families, and for those who refer.

To reduce the impact of addictions and mental illness over the long term, prevention and wellness planning and programming are vital. ADAMHS Boards are uniquely positioned to anchor coalitions of vested interests to assess community behavioral health needs, plan activities that can effect change over the long term, and evaluate those activities for effectiveness. To be clear, prevention and wellness programs move the needle on the scale of years, not months. We want to see our communities becoming healthier over generations.

Are prevention and wellness efforts efficient? Effective ones are. The Board is committed to supporting evidence-based prevention practices in our schools and in our communities. Being good stewards of the public trust means optimizing resources – both time and money – on prevention practices that meet national standards of effectiveness. In this way we maximize longterm outcomes and avoid using public resources where there is scant evidence for real change.

We’ve all heard the phrase “An ounce of prevention is worth a pound of cure.” Nowhere is that more true than in community behavioral health. Preventing one person from reaching a mental health crisis, or from becoming addicted, or even delaying first use of substances by young people until they are adults and physically and emotionally better prepared to make good decisions, all have significant benefits in dollars NOT spent over a lifetime. While it may be impossible to tally to a specific number, there is no question that effective prevention is an efficient use of public funds.

Yes, clinical services are the linchpin of behavioral health services. But what happens to that person in recovery the other 23 hours of the day are crucial to the effectiveness of treatment and the reintegration of that person into the community as a productive, tax-paying citizen. Safe, healthy communities are a goal we all share. The Tri-County Board is dedicated to finding ways for the people of Miami, Darke and Shelby Counties to work, live, laugh and love, free from the challenges of mental illness and addiction, and to do so efficiently and responsibly as a steward of the public trust.

I would be remiss if I didn’t speak to two programs we have had great experiences with in our tri-county area.  They have been mentioned in previous testimony but I wanted to speak to them.  The first is Mental Health First Aid; many of us in this room have taken CPR/First Aid from the Red Cross.  Mental health first aid curriculum is somewhat parallel to this widely established program in that it provides education to individuals about mental health, how to recognize the symptoms and what to do about it.  The second program is the Tri-County CIT Academy.  This collaboration between our system and the law enforcement agencies in our area has been a very strong one.  I am proud to state that this last spring the CIT Academy celebrated its tenth anniversary while graduating its tenth class.  The Miami, Darke and Shelby County area has 198 CIT trained officers and that is pretty good.

Thank you, Mr. Chairman, for this opportunity, and for your time and I will answer any questions.

The Darke County Sheriff will conduct a prescription drug drop-off collection at Family Health, 5735 Meeker Road, Greenville, Saturday, September 27, 2014, from 10AM to 2PM.

The drop-off event is intended to prevent prescription drug abuse and theft by removing unwanted, unused or expired pills from homes. Prescription drug abuse, particularly involving opioid pain medications, is a growing concern locally, statewide and nationally. One way prescription drugs enter the illicit abuse trade is by theft from homes where medications are left unattended.

The service is free and anonymous.

Miami County is also running a take-back event at the Miami County Transfer Station, 2500 N. County Road 25A, Troy, Saturday, September 27, 10AM to 2PM.

In addition to the one-day events, which are held several times a year, each county has a secure prescription pill drop box. Locations in the Tri-County Board service area are: Greenville Police Department; Shelby County Sheriff's Office; Miami County Sheriff's Office. Drugs must be in pill or powder form only; needles and liquids cannot be accepted in the drop boxes.

To find a Take-Back site in other areas, search the Drug Enforcement Agency's database of registered sites.

Williams was a superstar on television, film and stage. And as such, his death will dominate the news cycle for a day or two. But the conversations about suicide and mental illness and drug and alcohol addictions cannot go away. There will be celebrations and remembrances of Robin Williams the actor, the Hollywood persona so much bigger than life. But what about Robin Williams, the man? The person who, despite having every material resource at hand, could not defeat his demons, his addictions to alcohol and drugs, and the disorders of the mind that led him to his final act?

We are told that one in four people will suffer from some diagnosable mental illness. We are told that 90 percent of persons who complete suicide have some form of mental illness. We are told that those with serious mental illness have life expectancy 10 years less than average. The tide is turning on conversations and stigma about mental illness, but too slowly. Fear and denial keep too many from seeking help. There are still ignorant haters with popular soapboxes, perpetuating myths about mental illness and suicide.

Celebrity deaths, whether from mental illness, addictions, or recklessness, are always a double-edged sword with young people. On the one hand, there is a fear that young people will be more likely to follow their tragic idols. On the other, it opens a door to conversations. If there could be such a thing as a best-case scenario with a celebrity suicide, Robin Williams' may be it. He is famous enough, has been around long enough, and has appealed to generations of kids enough that anyone older than 7 is going to recognize his face, voice or characters. On the other hand, he is not the kind of celebrity whom young people will like likely emulate or idolize. Robin Williams is not Kurt Cobain.

Just as with so-called "physical" illnesses, not all mental illnesses are deadly, but some are. Mental health counselors identify three mental illnesses that are potentially deadly: addiction, eating disorders and depression. However, people are generally more comfortable talking about diabetes, heart disease, even cancer, than about mental illnesses. Any opportunity to make mental illnesses less dark, less mysterious, to shed light on these all-too-common afflictions, is an opportunity for teaching and, in some cases, early identification and intervention.

So, what's a parent to do when a child says "Mrs. Doubtfire is dead" or "Peter Pan killed himself"? There's no one, best answer. Understand that children are by nature both curious and resilient. Answering the question to the best of your ability is OK; deflecting or ignoring it drives the subject further into the darkness, where it can take on all sorts of misunderstanding.  This Mom wrote about how she talked with her kids, relating to his characters and other family experience. The American Foundation for Suicide Prevention offers a few tips for talking to kids about suicide. SAVE.org offers more help. The Jason Foundation website has information for teens, parents and schools.

Many families find comfort in speaking to pastors or other faith-based counselors. Your school may have a counselor you can speak to. The mental health agencies in the Tri-County network of care employ counselors who specialize in youth and family. NAMI of Darke, Miami and Shelby Counties has upcoming classes you may find useful. For someone in crisis, the Tri-County Hotline is open 24 hours a day at 800-351-7347, or the National Suicide Prevention Lifeline is 800-273-TALK (8255).

Every suicide is a tragedy. Celebrity amplifies the tragedy, and when the celebrity is someone with the multi-generational reach and appeal of Robin Williams, someone whose voice will continue to be heard through the timeless characters of his films, the loss is proportionally deep. If his illness and death create opportunities for a deeper understanding of mental disorders, then that is the solace we can take from it.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has opened public comments on Leading Change 2.0, it's strategic plan for 2015-2018.

"This strategic plan outlines work to increase the awareness and improve understanding about mental and substance use disorders, promote emotional health and wellness, and the prevention of substance abuse and mental illness, increase access to effective treatment, and support recovery. An important component of the plan is the prioritization of six Strategic Initiatives and the linkages between these initiatives and SAMHSA’s policy, programmatic, and financial planning. At its core, this plan offers a framework for planning around common categories of initiatives that enable cross-collaboration and organization of SAMHSA’s work."

The document can be downloaded from SAMHSA's website as a PDF file. Comments are to be posted to the website

A new report by the Centers for Disease Control and Prevention ranks states by the number of painkiller prescriptions per capita, and Ohio ranks 12th, with 100 per 100 people, according to the 2012 data in the report. Alabama (143), Tennessee (143) and West Virginia (138) are the three highest-prescribing states, while Hawaii (52), California (57), New York (60), Minnesota (62) and New Jersey (63) were the lowest.

According to the CDC: "Health issues that cause people pain don't vary much from place to place—not enough to explain why, in 2012, health care providers in the highest-prescribing state wrote almost 3 times as many opioid painkiller prescriptions per person as those in the lowest prescribing state in the US. Or why there are twice as many painkiller prescriptions per person in the US as in Canada. Data suggest that where health care providers practice influences how they prescribe. Higher prescribing of painkillers is associated with more overdose deaths."

The report offers recommendations for states to address the high numbers of prescription painkillers. Many of those recommendations are reflected in Ohio's recent or pending legislative actions to curb prescription drug availability and abuse. The CDC report identifies states that have taken action and seen significant results. For instance, in 2010, Florida regulated pain clinics and stopped health care providers from dispensing prescription painkillers from their offices. By 2012, Florida showed a 50% decrease in overdose deaths from oxycodone. New York in 2012 required prescribers to check a statewide prescription drug monitoring database before prescribing, and in 2013 saw a 75 percent drop in patients who were seeing multiple prescribers for the same drugs, greatly reducing risk of overdose.

The CDC report may also be downloaded as a PDF document here.

WHIO-TV's Northern Bureau Chief Steve Baker reports on a summer program for kids in Darke County, "Hooked on Fishing, Not on Drugs."

Watch the video...