4/12/2018. Opioid Addiction and Prescribing. Disclosure Statement of Financial Interest

Transcription

1 Opioid Addiction and Prescribing Mitchell Mutter, MD Director of Special Projects Nashville, TN April 12, 2018 Disclosure Statement of Financial Interest I, Mitchell Mutter, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Key Findings in 2017 Source: CSMD 2018 Legislative Report 1

2 The Opioid Crisis by the Numbers 2

3 Chronic Pain Guidelines Expert Panel Public Chapter 430 Requires the development of the TN Chronic Pain Guidelines 1 st edition nd edition 2017 Annual review Risk Proof Your Practice How many patients on greater than 120 MEDD? How many patients drive a far distance to practice site? How many patients are on combinations? Resources available in office Naloxone handouts Education on near misses Education on street drugs 3

4 Public Chapter 1033 Pain Management Clinics transitions from certificate system to licensure system Medical director holds license Non-transferable Only a pain specialist is eligible to be medical director > 50% of patients being treated for pain qualifies as a pain clinic and must be registered No pharmacy Clinic can be suspended based on specific violation No new patients Monitored Went into effect on July 1, 2017 TN Pain Management Clinics per County, 7/3/2017 Annual NAS Trends Source: Neonatal Abstinence Surveillance System. TN Dept. of Health 4

5 Neonatal Abstinence Syndrome Surveillance Summary Week 09: February 25 March 03, 2018 NAS Rate per 1,000 Live Births, 2016 Source: Neonatal Abstinence Surveillance System. TN Dept. of Health NAS Rates by Region 2016 Data are provisional. Source: Neonatal Abstinence Surveillance System. TN Dept. of Health 5

6 Consequences of Opioid Epidemic Tennessee in-state variability assessment for a Rapid Dissemination of HIV or HCV Infection Event utilizing data about the opioid epidemic. More granular data improved insights into county-level HIV/HCV outbreak vulnerability compared to national models. Source: Clinical Infectious Diseases, December 7, 2017 Scott County, Indiana Outbreak 220 U.S. counties had highest vulnerability 41 small counties located in TN 25 overlapped with more granular TN data CDC acquired HIV 2016 Source: Clinical Infectious Diseases, December 7, Predictors Used to Compute each County Risk Score MME/Capita Death from Heroin/Opioids Socioeconomic IV Drug Use Mental Health Services Uninsured Percentage Other, see December 7, 2017 Clinical Infectious Diseases Source: Clinical Infectious Diseases, December 7,

7 Risk Ranking Source: Clinical Infectious Disease, December 7, 2017 Public Chapter 476 Currently, the top 50 prescribers of controlled substances in the state are annually identified and sent a letter notifying them of their inclusion on this list and asked to respond with a justification for their prescribing patterns. Public Chapter 476 adds the top 10 prescribers from all of the combined counties having populations of fewer than 50,000 Effective/Signed May 18, 2015 MMEs Prescribed by Top 50 Prescribers and Dispensed in Source: CSMD 2018 Legislative Report 7

8 Why do Prescribers and Dispensers Check the CSMD? Source: CSMD 2018 Legislative Report Prescription Drug Overdose Dashboard Source: Tennessee Drug Overdose Data Source: 8

9 Tennessee Drug Overdose Data Source: Age-adjusted drug overdose death rates,by state, United States,2016 NOTES: Deaths are classified using the International Classification of Diseases, Tenth Revision. Drug-poisoning (overdose) deaths are identified using underlying cause-of-death codes X40 X44, X60 X64, X85, and Y10 Y14.. SOURCE: NCHS, National Vital Statistics System, Mortality. The Opioid Crisis by the Numbers 24.5 Tennessee 9

10 Drug overdose death rates,by selected age group: United States, Significant increasing trend from 1999 to 2016 with different rates of change over time, p < rate was significantly higher than for the rate for age groups 15 24, 55 64, and 65 and over, p < NOTES: Deaths are classified using the International Classification of Diseases, Tenth Revision. Drug-poisoning (overdose) deaths are identified using underlying cause-of-death codes X40 X44, X60 X64, X85, and Y10 Y14. SOURCE: NCHS, National Vital Statistics System, Mortality. Age Adjusted Rates for All Drug Overdose Deaths and by Sex and Race in TN by Year Tennessee Overdose Deaths where patient did not have prescriptions in CSMD 60 days prior to death 60% 50% 40% 30% All Drug 20% 10% 0% Source: TN Dept. of Health, Office of Informatics and Analytics 10

11 All Drug Deaths by Age Distribution, Number of Deaths years years years years years years years years 85+ years Source: TN Dept. of Health, Office of Informatics and Analytics All Fentanyl Deaths by Age Distribution, Number of Deaths years years years years years years years years 85+ years Source: TN Dept. of Health, Office of Informatics and Analytics 11

12 Opioids Present in Overdose Deaths in TN by Year Percentage of Overdose Death Opioid Fentanyl Heroin Buprenorphine * Percentages for fentanyl, heroin, buprenorphine are included in the opioid category and are broken out for clarity. Source: TN Dept. of Health, Office of Informatics and Analytics Access to Documents 2018 CSMD Legislative Report TDH Pain Management Clinic Statutes, Rules, and Guidelines Prescription Drug Overdose (PDO) Access to Documents Tennessee s In-State Vulnerability Assessment for a Rapid Dissemination of HIV or HCV Infection Event Utilizing Data about the Opioid Epidemic Neonatal Abstinence Syndrome (NAS) 12

13 Contact Me Mitchell Mutter, M.D. Director of Special Projects Tennessee Department of Health Health Related Boards 665 Mainstream Drive, 2 nd Floor Nashville, TN Thank You! 13