Procedura di gestione emergenze Integrato QA

Procedura di gestione emergenze Integrato QA

Procedura adatta a Sistema di Gestione Integrato ISO 9001:2015 e ISO 14001:2015, in Word modificabile, di gestione delle emergenze ambientali, completa di file Word per la pianificazione e simulazione delle emergenze.

 

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Community Impact

Will the proposed MAT increase the number of resident drug addicts or homeless?


While predicting the actual impact on our local homeless or drug-addicted population is an imprecise science, it is not unreasonable to anticipate some changes. A responsible approach might be to look at other communities where MAT clinics have been installed as examples. Our researchers have not yet found a comparable example in the State of Washington where a similar sized town has had a similar sized MAT facility placed within the retail district or city limits. We do not speculate on the reasons for this, although community input may help us to locate a good example and anticipate such impact, if any. Until we have data to present to this question, we can only look to dissimilar site examples.




Most of the information I am told seems positive. Why do you oppose the MAT?


Some articles and studies attest that there is no negative impact while others claim there are. We cannot speculate as to the impact for Sequim. We do encourage a skeptical approach to researching the topic. At the risk of engaging in an information-based war of words, we feel a few guidelines and examples could be offered. 1. Google is your friend, but not your best friend. Initial searches reveal good news. A lot of good news. So much good news in fact it begs the question, "if the news is so good, why does our society look so bad?" Look deeper. Follow the links in studies and articles. They often tell a different story. Search for the sponsor of the information. Do they have motive? 2. Ask questions about the statistics. Numbers tell a story, but not the whole story and can be used to lead readers to an incorrect conclusion. For example, the 2012 study showing Clallam county to have the highest opioid use in the State of Washington did not reveal if the data included end of life, chronic pain, or nursing home data. These points matter. Click here 3. Crime statistics can change over time due to reasons unrelated to actual crimes committed. For example Seattle has stopped making arrests for low level crimes and posession of less than one gram of Heroin. This policy will make it appear that the crime rates are going down when in fact they may even be going up. We are told that Sequim does not differentiate between an overdose of heart medicine vs. illicit drugs. 4. Check for dates and trends. Not all old studies are irrelevant, and not all new studies are accurate. For example, The statistics for opioid overdoses used to support the need for this new clinic used data from 2016 - the year our opioid OD's peaked. it has been lower every year since, yet the lower numbers are barely mentioned.




What are some examples of communities affected negatively by MAT?


Large city (Queens New York) MAT quietly placed within community: Click here Down the coast in southern Orange County, sheriff’s officials said homelessness has increased in recent years, in tandem with an influx of new drug treatment centers. Click here Community shares our concerns with proposed center. “It’s not that we don’t want people to receive help. [It’s] a facility in the middle of a residential area, on a strip of commercial land where there is a dollar store and a Save-A-Lot. So, we have our kids and our elderly in the midst of that.” Click here




Do services such as MAT draw or attract people?






Unanswered Concerns

How will clients be limited to our region?


The clientele for this MAT clinic cannot be limited to a geographic area because of the mobile nature of this subset of society.





General FAQs

First, what is Save our Sequim all about?


Save Our Sequim is an organic grass roots organization fighting for the future of our town. Sequim, population 7,108, does not need a 25,000 square foot, regional scale opioid addiction treatment center/mental health facility in the heart of its economic core! Furthermore, Sequim does not have the resourses and infrastructure needed to support such a facility.

Sequim was targeted for this facility because of its proximity to the developers existing medical offices - which already offer opioid treatment. There are no recent studies to verify the need for additional opiod treatment facilities in Sequim, while existing facilities twelve miles away in nearby Port Angeles continue to operate below capacity. Furthermore, a new facility offering methadone treatment is expected to open in Port Angeles within the current year. Click Here For more information acess links in FAQs below.




What is being proposed?


Jamestown S’Klallam Tribe, Olympic Medical Center and Jefferson Healthcare (the Developers), in collaboration with city, county, state, and congressional leaders-have made plans to bring a regional scale, multi-phased opioid addiction rehabilitation center and mental health inpatient facility to tiny Sequim. Click Here

Despite having excess treatment capacity located within twelve miles of Sequim, and no current data to confirm additional need, the Developers have proposed:

  1. A 15,000 square foot opioid addiction and drug treatment facility in the retail core of Sequim
  2. Serving 300+ addicts utilizing the Medication-Assisted Treatment (MAT) daily dosing protocol using Methadone, Suboxone and Vivitrol
  3. Further expanding to include another 100 MAT treatment seats and a 10,000 square foot, 16 bed in-patient psychological Evaluate & Treat (E&T) involuntary commitment center, estimated to serve 350 lock-in patients per year
  4. The regional facility proposed in tiny Sequim is designed to serve hundreds of opioid addicts residing in Jefferson and Clallam Counties, despite a lack of current data indicating this level of opiate addiction in Sequim

The Developers have chosen to place this facility where there is no need or supporting infrastructure. Currently there are ample drug treatment facilities located in Jefferson and Clallam counties where the need has been established, and another treatment facility is scheduled to open in Port Angeles before the end of 2019. Click Here

If defined as a designated Essential Public Facility (EPF), the project must be reviewed by City Council through mandatory purblic process, rather than rubber stamped as proposed by city administrative staff. Click Here For more information acess links in other FAQs




Is Sequim the right location for a regional scale MAT treatment center?


The site location that was chosen for this facility has more to do with convenience than actual need. Comments from the Developer's website (October, 2019) state:

"Sequim is where we operate a 35,000 square foot primary care clinic and is also home to many other health service facilities. As such, it makes it easier to operate and manage. In addition, the site behind big box stores was chosen because it was zoned as an Opportunity Zone for healthcare clinics and services of which the MAT Clinic qualifies."

This statement reflects the Developer's self-serving interests; they appear more concerned with zoning and the ease of administering the proposed regional facility than with community impact or their clientele. The site selection does not consider the actual need for opioid treatment in this area. In fact, the site selection could not be more mismatched to the neighborhood where it is proposed.

The Developers have since polished their statement, apparently to present a more benevolent public image (November, 2019):

“Sequim is where we operate a 35,000 square foot primary care clinic and is also home to many other health service facilities. That makes it easier for patients who might be receiving care at one of our other locations and makes it more efficient to manage. In addition, the site behind big box stores was chosen because it was zoned as an Opportunity Zone for healthcare clinics and services.”

Additionally, the federal government had determined that Sequim is a "Non-Optimal Area for Opioid Treatment" even during the height of the opioid crisis in 2016. The map below shows the assessment made by Substance Abuse and Mental Health Services Administration (SAMSHA). The Developers, along with state and local officials appear to disregard the study below which is intended to inform policy makers:

"The maps are created with a methodology that seeks to include the highest potential need areas from individual counties so that county-level stakeholders are also informed." (Click Here)

Sequim is a poor site location for a regional scale opioid treatment facility/psychological inpatient E&T clinic.

What other factors make Sequim a bad choice? Check out the additional FAQ's.




What is the current need for treating opioid addiction in Clallam county?


How do we determine the appropriate level of care to meet the need for our area? The data that drives these decisions focuses on drug-related overdoses and deaths, and crime statistics. Here we will focus on the drug-related statistics. At the peak of the opioid crisis in 2016, Clallam County had 16 opioid related deaths. In 2017 that number was down to 10 deaths. In 2018 the recorded number of opioid deaths was 2 Other factors may explain this decline, including the increased use of Narcan by emergency services, which reverses the effects of opioid poisoning. Nevertheless, during the same time period, the availability of MAT treatment increased each year and is currently up to what many could consider an excess need in Clallam County. Keeping in mind that, during the peak of the opioid epidemic in 2016, Sequim was considered a non-optimal area for increased treatment availability. Yet the centers were built, and currently there is at least one facility that is only open part time due to low enrollment. (NOHN) The diagram below shows capacity for all of the designated MAT clinics in Clallam County. When compared to the overall population of Clllam County the treatment density provided after construction of the proposed new facility would be 1:66 or one treatment seat for every 66 residents. Even IF we had that many addicts in Clallam County, they have to want to enter treatment first, and need insurance coverage to pay for it. In comparison to Pierce County, which has a much greater population and more need for this service, MAT coverage is considerably lower, 1:438 or one seat for every 438 residents. Where will the people in Pierce county go to get treatment if facilities are not available near their homes? It seems a better use of these funds would be to build MAT facilities in Pierce County. In fact it would require building over 10,000 more treatment seats to bring Pierce county MAT treatment up to the density offered in Clallam County if this new facility is built.




What is the current success rate for MAT clinics and how is success defined?


In the field of MAT success is NOT the number of addicts that are clean and back on their feet. Success is retention rate, which is the number of patients that are still enrolled in a program after a certain amount of time. According to the most recent study in Western Washington ( Click here) published in April of 2019: On Intake:

  • 13% of participants self- reported interactions with law enforcement, either arrests or pending charges

  • 30% reported intravenous drug use

  • 53% had stable housing

6 months after enrollment:

  • 18% of the patients self-reported the continued use of illegal opioids

  • 10% reported intravenous drug use

  • Job and school involvement increased 9%

  • Still only 55% had stable housing

At the 1 year follow up:

  • 12% self-reported continuing criminal justice involvement within the past 30 days

The success rate claimed by the developers is much higher. Read on to find out why.




Why is the 80% success rate claimed by the developer so high?


The developer describes their success rate as an 80% retention rate over 2 years. This number is explained by the Jamestown S'Klallam Health Director as an average reached by combining data from the Jamestown Family Health Clinic MAT program and the Swinomish Wellness Center MAT clinic in Anacortes, WA. Jamestown Family Health MAT program only serves 30 patients, according to the Washington State 2018 Hub and Spokes Directory ( Click here). This does not provide a large enough sample size to provide reliable data. Furthermore, HIPPA regulations prohibit access to this data by outside groups, making verification of the data impossible. One could further argue whether or not it should be considered a success to have 24 out of 30 people still enrolled in a Suboxone program two years after enrollment, since the primary goal should be to get people opioid and drug free. This "retention rate" also does not report continued illicit drug use of enrollees as reported in reputable studies ( Click here). The Swinomish Wellness Center opened in November 2017 with a very small patient volume, slowly increasing their numbers over time. Therefore it is impossible to make claims about a 2 year result when, at the time of this writing, the clinic has not been open for 2 years. Furthermore, private data is protected by HIPPA and is not indepently verifiable.





Economic Impacts

How do clinics of this type impact real estate values? Any research?


The following study by the Journal of Sustainable Real Estate concluded that by using a dataset from central Virginia real estate markets an 8%-17% real estate value reduction radius can be shown to occur around these centers. Link here.





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