20 [Information required: past prescription history and current dosage, past engagement with opioids, prescriptions by multiple physicians, allergies, basic medical information, traumatic experiences, social and environmental factors, experience and outcomes from treatment programs, income and expense situation, family history of support services] As Kerry continued to struggle with her addiction, as her access to prescribed medications dwindled and then ended, she sought alternative relief. She began to purchase pills on the street, but the price continued to rise, and she became aware that heroin was much less expensive. Her 22-year-old son told her that heroin could address her pain. Reluctantly, she asked him to obtain some for her, which he did. She came to use heroin as a substitute. She would often stay out all night. Because she was violating the shelter rules, she and her children were evicted. The shelter notified child welfare services and the three children were placed into foster care, each in a different home. [Information required: Past prescription history and current dosage, past engagement with opioids, prescriptions by multiple physicians, allergies, basic medical information, traumatic experiences, social and environmental factors, experience and outcomes from treatment programs, family history of support services, prior history of services to children, children’s medical and school records] A week later, Kerry lost control of the car she was driving and hit a traffic light pole. When the police arrived and searched the car, they found seven “big bags” of heroin in the pocket of a coat that was in the back seat. Kerry was arrested on charges of felony drug possession, intent to distribute heroin and impaired driving and violating her probation. Kerry was placed in the county jail because she could not make bail. At the arraignment hearing, a public defender explained that Kerry was going through heroin withdrawal because of her opioid addictions, and the judge transferred her to the jurisdiction of a specialized drug court. There, the judge approved her request to participate in another detox program. The drug court’s pre-trial services worker contacted the behavioral health system, which sent a case manager to the courthouse to assess Kerry; the recommended treatment was a specialized 30-day detox program for women who had previously been in treatment and relapsed quickly thereafter. A vacancy in this program was expected in three days. Following the assessment, Kerry was taken back to the county jail, and her case manager made arrangements for her to be transported from there to the treatment facility once a bed became available. During her stay at the detox program, Kerry was concerned about how she was going to maintain her sobriety, so she called the behavioral health office case manager for help. Kerry also told the case manager that she was worried that, once she left the treatment facility, she would have no place to live where her children could visit and eventually be returned to her custody. Kerry asked the case manager to arrange for a visit with her children while she was in rehab. The case manager tried several times to reach the child welfare social worker, but they never connected. [Information required: substance use disorder diagnoses, housing support services provided, past engagement with opioids, prescriptions by multiple physicians, allergies, basic medical information, traumatic experiences, social and environmental factors, treatment plans and experience and outcomes from treatment programs, family history of support services, prior history of child welfare services to children, children’s medical and school records] The County Human Services Director has seen the increasing number of opioid-related cases that are impacting caseloads across her continuum of services. Mental health, child welfare, adult and aging services, housing and homelessness services, and drug and alcohol departments are all dealing with the consequences of this growing crisis. The increased usage of heroin, as well as fentanyl, has been particularly troublesome. The director is hearing from her counterparts in law enforcement, corrections, first responders, public health care and the courts that their respective caseloads also are being affected by this epidemic on a daily basis. [Information required: data describing the portion of the caseload related to opioid use and addiction, caseload statistics for law enforcement, mental health, child welfare, adult services, housing services showing the percentage of cases involving opioid use disorder, meaningful statistics about the extent of particular drug involvement, overdose (both fatal and non-fatal) statistics by geographical area]