Burden of Substance Use in New Mexico. Michael Landen, MD, MPH State Epidemiologist New Mexico Department of Health April 12, 2018

Transcription

1 Burden of Substance Use in New Mexico Michael Landen, MD, MPH State Epidemiologist New Mexico Department of Health April 12,

2 Objectives Describe the burden of substance use in NM Suggest reasons for this Compare the NM burden to that of the U.S. Provide recommendations for reducing the burden of substance use in NM 2

3 New Mexico Health Regions Northwest Northeast Metro Southwest Southeast 3

4 NM Urban-Rural County Classification Metropolitan Counties Small Metro Counties Mixed Urban/Rural Counties Rural Counties 4

5 Impact on Health Status of NM 5

6 Mortality is rising among Middle-Aged White Americans Rx Drugs & Heroin Suicide Alcohol Poisoning Driving Increase USW US Whites FRA France GER Germany USH US Hispanics UK United Kingdom CAN Canada AUS Australia SWE - Sweden Case & Deaton. Rising morbidity and mortality in midlife among white non-hispanic Americans in the 21st century, 2015.

7 Total DALYs per 100K Population DALYs: NM vs. US Age-Standardized Total DALYs Year New Mexico United States Source: University of Washington, Institute for Health Metrics and Evaluation, GBD Compare 7

8 DALYs: Top 10 Conditions Age-Standardized New Mexico vs. US, 2016 Drug use disorders Ischemic heart disease Low back and neck pain Road injuries Skin and subcutaneous diseases Depressive disorders Diabetes mellitus Self-harm Chronic obstructive pulmonary disease Cerebrovascular disease DALYs per 100K Population United States New Mexico Source: University of Washington, Institute for Health Metrics and Evaluation, GBD Compare 8

9 Life Expectancy at Birth New Mexico, and U.S., New Mexico U.S Source: New Mexico Indicator-Based Information system (NM IBIS); and ; CDC 9

10 Life Expectancy at Birth by Race/Ethnicity New Mexico, 2016 American Indian, Alaska Native 71.8 Asian, Pacific Islander 84.2 Black, African American 77.9 Hispanic 78.8 White Expected Number of Years of Life Source: New Mexico Indicator-Based Information System (NM IBIS) 10

11 Life Expectancy at Birth by Urban and Rural Counties New Mexico, 2016 Rural Counties 75.8 Mixed Urban/Rural Counties 76.7 Small Metro Counties 79.8 Metropolitan Counties Expected Number of Years of Life Source: New Mexico Indicator-Based Information System (NM IBIS) 11

12 Expected Number of Years of Life Life Expectancy at Birth by Health Region New Mexico, Northwest Region Northeast Region Metro Region Southeast Region Southwest Region Source: New Mexico Indicator-Based Information System (NM IBIS) 12

13 Deaths per 100,000 Population Total Deaths Rates New Mexico, and U.S., New Mexico U.S Rates have been age-adjusted to the standard U.S population Source: NM Vital Records and Health Statistics; CDC WONDER 13

14 Top 8 Leading Causes of Death, New Mexico, 2016 and U.S., 2015 New Mexico Rank United States Heart diseasee 1 Heart disease Cancer 2 Cancer Unintentional Injuries 3 Chronic lower respiratory diseases Chronic lower respiratory diseases 4 Accidents (unintentional injuries) Cerebrovascular diseases 5 Cerebrovascular diseases Diabetes mellitus 6 Alzheimer's disease Chronic liver disease and cirrhosis 7 Diabetes mellitus Alzheimer's disease 8 Influenza and Pneumonia Source, New Mexico: Vital Records and Health Statistics United States: National Center for Health Statistics (NCHS) 14

15 Smoking-attributable, Alcohol-attributable, and Drug Overdose Death Rates 1 New Mexico ( ) and US (2015) New Mexico U.S. Rate Ratio Smoking-attributable death rate Alcohol-attributable death rate Drug overdose death rate Rates are deaths per 100,000 population, age-adjusted to the 2000 U.S. standard population 2 Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC), apps.nccd.cdc.gov/sammec/index.asp, 2015 for US and for NM 3 Alcohol-Related Disease Impact (ARDI), nccd.cdc.gov/dph_ardi/default/default.aspx, for NM and 2015 for US 4 Defined as International Classification of Diseases, tenth revision (ICD-10) codes X40-X44, X60-X64, X85, and Y10-Y14, for NM and 2015 for US 15

16 Alcohol 16

17 Excessive Alcohol Consumption as a Public Health Concern New Mexico has one of the highest per capita costs of excessive alcohol use $2.2 billion ($2.77 per drink or an average of $1,084 per person) in % of these costs were paid by government 75% of these costs are from binge drinking Sacks JJ, Am J Prev Med, 2015

18 Excessive Alcohol Consumption Definitions Binge drinking 4 drinks per occasion for women or 5 drinks per occasion for men Heavy drinking Defined as consuming 8 drinks per week for women or 15 drinks per week for men Any consumption by pregnant women or people younger than age 21

19 Percent of Adults Binge Drinking and Heavy Drinking Among Adults, New Mexico, BFRSS, Binge Drinking Heavy Drinking NM BRFSS ; Note on gaps: Definition of binge drinking changed in BRFSS methodology changed in 2011.

20 Percent of Adults Binge Drinking by Demographics Among Adults, New Mexico, NM BRFSS

21 Percentage Percentage of NM Adults with Binge Drinking at Least Once in Past 30 Days by Gender and Educational Attainment New Mexico, % Males Females 80% 60% 40% 20% 22.2% 25.0% 6.6% 9.3% 21.6% 11.9% 14.4% 8.4% 0% Below High School High School or GED Some College or Tech College Graduate Source: NM Behavioral Risk Factor Surveillance System 21

22 Percentage of NM Adults with Binge Drinking at Least Once in Past 30 Days by Gender and Urban/Rural Counties New Mexico, 2016 Male Female Metropolitan Small Metro Mixed Urban/Rural Rural 18.9% 10.4% 19.9% 9.0% 23.8% 9.2% 22.1% 8.4% 0% 20% 40% 60% 80% 100% Percentage Source: NM Behavioral Risk Factor Surveillance System 22

23 Percent (%) Alcohol Related Behaviors Grades 9-12, , NM Current drinking First drink before age 13 Binge drinking Drinking and driving

24 Current Drinking by Urban and Rural Status, Grades 9-12 New Mexico, 2015 Metropolitan 23.1% Small Metro 26.6% Mixed Urban/Rural 27.2% Rural 29.6% 0% 10% 20% 30% 40% 50% Percentage Source: NM Youth Risk and Resiliency Survey (YRRS). 24

25 Selected Risk Behaviors by Sexual Orientation, Grades 9-12 New Mexico, 2015 LGB Straight Physical fighting 24.1% 36.4% Bullied at school Skipped school due to safety issues 6.1% 16.1% 16.0% 32.1% Current cigarette smoking Binge drinking 9.5% 12.9% 24.6% 24.3% Used painkiller to get high 5.3% 23.6% 0% 10% 20% 30% 40% 50% Percentage 25 Source: NM Youth Risk and Resiliency Survey (YRRS).

26 Selected Risk Behaviors by Country of Birth, Grades 9-12 New Mexico, 2015 Born in US Used painkiller to get high Binge drinking 6.9% 13.6% 18.3% 23.6% Foreign born Current cigarette smoking Skipped school because of safety concerns 6.8% 10.9% 16.2% 16.6% Bullied on school property 18.1% 21.7% In a physical fight 24.5% 31.8% 0% 10% 20% 30% 40% 50% Percentage 26 Source: NM Youth Risk and Resiliency Survey (YRRS).

27 Selected Risk Behaviors by Housing Stability, Grades 9-12 New Mexico, 2015 Forced sexual intercourse In a physical fight Bullied on school property Skipped school because safety concerns Current smoking Binge drinking Took a pain killer to get high Current heroin use 6.3% 21.7% 23.6% 52.5% 17.6% 30.1% 6.3% 28.2% 9.7% 12.8% 5.8% 1.0% 41.5% 43.2% 40.1% 30.6% Stable housing Unstable housing 0% 20% 40% 60% 80% 100% Percentage at risk of selected behavior 27 Source: NM Youth Risk and Resiliency Survey (YRRS).

28 Selected Risk Behaviors by Family Relationships, Grades 9-12 New Mexico, 2015 In my home, a parent or other adult is interested in my school work. Not true/little bit true Very/Pretty much true In a physical fight Bullied on school property Skipped school because of safety concerns Current cigarette smoking 11.8% 16.3% 7.3% 5.9% 2.3% 10.3% 6.2% 22.8% Binge drinking Used a pain killer to get high Sexually active 22.5% 20.6% 17.5% 11.4% 6.3% 33.1% Source: NM Youth Risk and Resiliency Survey (YRRS). 0% 20% 40% 60% 80% 100% 28 Percent engaging in risk behavior

29 Academic Success by Selected Risk Behaviors, Grades 9-12 New Mexico, 2015 Without risk behavior With risk behavior In a physical fight Skipped school because of safety concerns 27.2% 39.0% 27.8% 42.0% Current cigarette smoking 18.7% 41.1% Binge drinking 25.0% 40.9% Used a pain killer to get high 19.1% 39.8% Sexually active 32.7% 41.2% 0% 10% 20% 30% 40% 50% Percent earning mostly A s in school 29 Source: NM Youth Risk and Resiliency Survey (YRRS).

30 Percent of Mothers Drank During Last Three Months of Pregnancy, New Mexico, PRAMS, PRAMS

31 Deaths per 100,000 population Alcohol-Attributable Death Rates New Mexico, , and U.S., NM US Source: NCHS (US); NMDOH BVRHS (NM); CDC ARDI v. 2 Data Sources: NCHS (US); NMDOH BVRHS; UNM-GPS; IBEB SAES; CDC ARDI Rates are age-adjusted to the 2000 U.S. standard population 2015 for the US, and 2016 for NM 31

32 New Jersey New York Hawaii Massachusetts Connecticut Maryland Nebraska Utah Virginia Minnesota Illinois Iowa New Hampshire Maine Indiana Rhode Island Pennsylvania North Dakota Vermont Kansas Delaware Ohio Georgia Texas Michigan Wisconsin Idaho North Carolina California Washington South Dakota Missouri Kentucky Alabama Arkansas Tennessee Oregon Florida South Carolina Louisiana West Virginia Colorado D.C. Mississippi Nevada Oklahoma Arizona Wyoming Montana Alaska New Mexico Deaths per 100,000 New Mexico Leads the Nation in Alcohol-Attributable Death Average annual alcohol-attributable death rate* by state, United States, New Mexico: U.S. total: *Deaths per 100,000 population, age-adjusted to the 2000 U.S. standard population Stahre M., Prev Chronic Dis, 2014

33 Alcohol-Attributable Death by Cause of Death, New Mexico, Alcohol poisoning 4% [CATEGORY NAME] [PERCENTAGE ] Homicide 5% Suicide 8% Fall injuries 8% Liver cancer 1% Drug overdose 10% Chronic Liver Disease 34% Other 8% [CATEGORY NAME] [PERCENT AGE] NMDOH BVRHS ; CDC ARDI

34 Deaths per 100,000 Alcohol-Attributable Death by Demographics, New Mexico, NMDOH BVRHS ; CDC ARDI; Rates by gender and race/ethnicity were ageadjusted using 2000 US Standard Population

35 Alcohol-Attributable Death Rates by Region New Mexico, Northwest Northeast 70.2 Metro Southeast Southwest New Mexico Deaths per 100,000 population Data Sources: NMDOH BVRHS; UNM-GPS; IBEB SAES; CDC ARDI Rates are age-adjusted to the 2000 U.S. standard population 35

36 Alcohol-Attributable Death Rates by Rural/Urban New Mexico, Metropolitan Small Metropolitan Mixed Urban-Rural 71.3 Rural New Mexico Deaths per 100,000 population Data Sources: NMDOH BVRHS and IBEB SAE; CDC ARDI Rates are age-adjusted to the 2000 U.S. standard population 36

37 Deaths per 100,000 Population Alcohol Related Death Rates by Census Tract Poverty Level* New Mexico, Less than 5% 5-9.9% % % 30% % 40% or more *Poverty level is the percentage of persons of all ages in the decedent s census tract living at or below 100% of Poverty. Alcohol related deaths are defined by ICD10: Alcohol-related deaths include deaths that are partially attributable to alcohol as well as 100% attributable alcohol-induced deaths. For more information, visit the CDC Alcohol-related Disease Impact (ARDI) software page: Rates have been age-adjusted to the standard U.S population. 37 Source: NM Vital Records and Health Statistics, U.S. Bureau of the Census, American Community Survey

38 Deaths per 100,000 Population Chronic Liver Disease and Cirrhosis Death Rates by Census Tract Poverty Level* New Mexico, Less than 5% 5-9.9% % % 30% % 40% or more *Poverty level is the percentage of persons of all ages in the decedent s census tract living at or below 100% of Poverty. Chronic liver disease and cirrhosis deaths are defined by ICD10: K70, K73-K74 Rates have been age-adjusted to the standard U.S population. Source: NM Vital Records and Health Statistics, U.S. Bureau of the Census, American Community Survey 38

39 Deaths per 100,000 Population Chronic Liver Disease Death Rates New Mexico, and U.S., New Mexico U.S. 0.0 Rates have been age-adjusted to the standard U.S population Source: NM Vital Records and Health Statistics; CDC WONDER 39

40 Chronic Liver Disease Death Rates by Race/Ethnicity New Mexico, American Indian, Alaska Native 70.2 Asian or Pacific Islande 3.1 Black, African American 9.6 Hispanic 25.6 White Deaths per 100,000 Population Rates have been age-adjusted to the standard U.S population Source: NM Vital Records and Health Statistics 40

41 Deaths per 100,000 Population Chronic Liver Disease Death Rates by Health Region New Mexico, Northwest Region Northeast Region Metro Region Southeast Region Southwest Region Rates have been age-adjusted to the standard U.S population Source: NM Vital Records and Health Statistics 41

42 Total per Capita Consumption of Gallons of Alcohol by State, US, 2015 NIAAA Surveillance Report #108

43 Community Preventive Services Task Force Findings for Excessive Alcohol Interventions Directed to the General Population Dram Shop Liability Electronic Screening and Brief Intervention (e-sbi) Increasing Alcohol Taxes Maintaining Limits on Days of Sale Maintaining Limits on Hours of Sale Over-service Law Enforcement Initiatives Privatization of Retail Alcohol Sales Regulation of Alcohol Outlet Density Responsible Beverage Service Training Interventions Directed to Underage Drinkers Enhanced Enforcement of Laws Prohibiting Sales to Minors Recommended Recommended Recommended Recommended Recommended Insufficient Evidence Recommended Against Recommended Insufficient Evidence Recommended

44 Percent over Quota (1 per 2,000) by Local Option District* Santa Fe City Las Vegas Los Lunas Las Cruces Deming Rio Arriba County Los Alamos Lovington Santa Fe County McKinley County Eddy County -13% -17% -27% -28% -43% -52% -60% -71% 100% 67% 92% 100% 54% 43% 32% 0% 17% 27% 157% 209% 274% 300% % -50.0% 0.0% 50.0% 100.0% 150.0% 200.0% 250.0% 300.0% 350.0% PERCENT DIFFERENCE *Select LOD, October 2014; Source: NMRLD

45 Alcohol Screening and Brief Intervention (A-SBI) A-SBI can reduce the amount consumed on an occasion by 25% in those who drink too much United States Preventive Service Task Force B recommendation Recommendation: Screen all adult patients 29% of adults in New Mexico reported that they had not been asked about the amount of alcohol they drink in the previous 12 months 20% of binge drinkers had not been asked NMBRFSS 2015; CDC Vital Signs, January 2014

46 Drugs 46

47 Current Drug Use Grades 9-12, 2017, NM Marijuana 27.3 Painkillers to get high 6.9 Synthetic marijuana 5.2 Cocaine 5.1 Inhalants 4.8 Methamphetamine 3.2 Heroin 2.8 * Current use (not lifetime) Percent (%)

48 Percent (%) Current Drug Use Grades 9-12, , NM Painkillers to get high Synthetic marijuana Cocaine Inhalants Methamphetamine Heroin

49 Rate per 1,000 live births Neonatal Abstinence Syndrome NM ( ) & US ( ) NM US Sources: US: Weighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2000, Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual States and provided to AHRQ by the States. Total number of weighted discharges in the U.S. based on HCUP NIS = 36,417,565. New Mexico: Hospital Inpatient Discharge Data (HIDD).

50 Deaths per 100,000 persons Drug Overdose Death Rates New Mexico, , and U.S., New Mexico United States Year Rates are age adjusted to the US 2000 standard population Source: United States (CDC Wonder); New Mexico (NMDOH BVRHS/UNM GPS) Rates are age-adjusted to the 2000 US Standard Population ICD-10 codes include X40-X44, X60-X64, X85, and Y10-Y14 Source: CDC Wonder and NM Bureau of Vital Records and Health Statistics 50

51 Source: NY Times, Short Answers to Hard Questions About the Opioid Crisis, August 3, 2017 (retrieved on 4 august, 2017 from The US rate was roughly 2 percent in 2015

52 Drug Overdose Death Rates Leading States, U.S., 2016 Rank State Deaths per 100,000 1 West Virginia Ohio New Hampshire Pennsylvania Kentucky Maryland Massachusetts Delaware Rhode Island Maine Connecticut New Mexico 25.2 U.S Sources: CDC Wonder Rates are age-adjusted to the 2000 US Standard Population.

53 Deaths per 100,000 Population Drug Overdose Death Rates by Health Region New Mexico, Northwest Region Northeast Region Metro Region Southeast Region Southwest Region Rates have been age-adjusted to the standard U.S population Source: NM Vital Records and Health Statistics; UNM-GPS; IBEB SAES; CDC ARDI 53

54 Drug Overdose Death Rates by Rural/Urban New Mexico, Metropolitan 25.4 Small Metropolitan 21.6 Mixed Urban-Rural 24.8 Rural 31.7 New Mexico Deaths per 100,000 population Data Sources: NMDOH BVRHS and IBEB SAE; Rates are age-adjusted to the 2000 U.S. standard population 54

55 Rio Arriba Catron San Miguel Lincoln Guadalupe Hidalgo Colfax Grant Sierra Santa Fe Taos Quay Mora Bernalillo Torrance Valencia Eddy Otero Socorro Chaves Sandoval De Baca San Juan Cibola Dona Ana Lea Luna Roosevelt Los Alamos McKinley Curry Union Harding New Mexico Deaths per 100,000 population Drug Overdose Death Rate by County NM, Rates are age adjusted to the US 2000 standard population Source: Bureau of Vital Records and Health Statistics, UNM/GPS population estimates

56 Deaths per 100,000 Population Drug Overdose Death Rates by Census Tract Poverty Level* New Mexico, Less than 5% 5-9.9% % % 30% % 40% or more *Poverty level is the percentage of persons of all ages in the decedent s census tract living at or below 100% of Poverty. Drug Overdose deaths are defined by ICD 10: X40-X44, X60-X64, X85, Y10-Y14. Rates have been age-adjusted to the standard U.S population. Source: NM Vital Records and Health Statistics, U.S. Bureau of the Census, American Community Survey 56

57 Deaths per 100,000 pop * Rates adjusted for specificity of reporting ( ) Drug categories are not mutually exclusive Rates are age adjusted to the US 2000 standard population Source: Office of the Medical Investigator, UNM/GPS population estimates Drug Overdose Death Rates for Selected Drugs, NM, Heroin Rx Opioids Methamphetamine

58 oxycodone alprazolam fentanyl hydrocodone methadone diazepam clonazepam morphine lorazepam tramadol zolpidem Top Rx Drugs in Overdose Death, NM, Overdose death involvements Deaths may involve more than one drug

59 Age Adjusted Rate per 100,000 8 Amphetamine Overdose Death Rate* New Mexico and US, US NM * : CDC WONDER (ICD-10 code T43.6); Age adjusted to 2000 U.S. Standard Population;

60 Source: CDC MMWR, 2017

61 Number of Controlled Substance Prescriptions Filled by Drug Type, NM, 2016 Opioids Benzodiazepines Stimulants Barbiturates Muscle Relaxants Other Source: New Mexico Prescription Monitoring Program Number of prescriptions filled

62 Patients Controlled Substance, Opioid and Benzodiazepine Prescribing, , , , ,756 Controlled substance patients 191, ,082 Patients receiving opioids 258, , , , , , ,000 97,711 99,029 96,231 93,526 90,169 Patients receiving benzodiazepines Q4 2017Q1 2017Q2 2017Q3 2017Q4 Source: NM PMP *The PMP platform changed in Q4 2016

63 Patients Patients with Concurrent Opioids and Benzodiazepines (>=10 days overlap), ,000 26,364 25,460 24,240 22,913 21,901 20,000 10, Q4 2017Q1 2017Q2 2017Q3 2017Q4 Source: NM PMP *The PMP platform changed in Q4 2016

64 Prescriptions filled High Dose Prescriptions, ,000 50,000 48,986 49,428 46,358 43,250 41,732 40,000 30,000 20,000 39,674 40,385 38,889 37,510 35,470 Number of high dose (>=90 MME/day) opioid prescriptions excluding buprenorphine/naloxone Number of high-dose(>=40 DME/day) benzodiazepine prescriptions filled 10, Q4 2017Q1 2017Q2 2017Q3 2017Q4 Source: NM PMP *The PMP platform changed in Q4 2016

65 Patients 5000 Patients with Multiple Prescribers and Pharmacies, or more prescribers or 4 or more pharmacies in 3 months 3,758 3,859 3,647 3,435 3, Q4 2017Q1 2017Q2 2017Q3 2017Q4 Source: NM PMP *The PMP platform changed in Q4 2016

66 Key Interventions Reduce high risk prescribing Increase access to naloxone Increase medication assisted treatment

67 Reduce High Risk Prescribing Prescription Drug Monitoring Program (PMP) changes in Web-based, direct inquiry system Require PMP registration for controlled substance license Data to PMP within 24 hours of dispensing Governor s Prescription Drug Misuse and Overdose Prevention and Pain Management Advisory Council (2012) Recommendations, including licensing board rule changes Further work on PMP metrics and reporting (2015) Reports to prescribers and licensing boards Health care provider boards rules changes (2016) Legislation requiring PMP use for opioids; Urine drug screening CDC Prescribing Guidelines (2016)

68 Increase Access to Naloxone NMDOH provides naloxone free of cost with syringe exchange (2001) Good Samaritan Law (2007) Mainstreaming Naloxone Medicaid reimbursement for naloxone rescue kits (2013) Pharmacist prescriptive authority (2014) Working to get pharmacies to stock naloxone (about 150 pharmacies) Encouraging co-prescription by opioid prescribers Standing Order Law (2016) SAMHSA funding to HSD provides more free naloxone Naloxone provision requirements (2017)

69 4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Counts Medicaid Processed Naloxone Claims from Outpatient Pharmacies & Number of Outpatient Pharmacies Filing Claims, New Mexico Medicaid Out-patient Pharmacies Naloxone Claims Pharmacist Prescriptive Authority Protocol (August 26, 2013) Medicaid MCOs to cover naloxone (September 27, 2013) SB262 - Naloxone Standing Order signed into law (March 4, 2016) Pharmacist Statewide Standing Order for Naloxone issued (March 18, 2016) Calendar Year

70 Increase Medication Assisted Treatment for Opioid Addiction Medication assisted treatment is treatment for addiction that includes the use of medication along with counseling and other support Medications Methadone Buprenorphine Naltrexone Medicaid ended preauthorization requirement for buprenorphine (2013) Nurse practitioners and PAs can prescribe buprenorphine (2016)

71 Patients Medication Assisted Treatment Total Buprenorphine/Naloxone Treatment Patients, ,669 Buprenorphine/naloxone patients (>=10 days) 5,260 4,872 5,012 5, Q4 2017Q1 2017Q2 2017Q3 2017Q4 Source: NM Prescription Monitoring Program

72 Treatment Abuse or Dependence Estimated Number of People with Abuse/Dependence on Opioids and Number of People in Treatment (MAT), NM, 2017 Prescription Pain Relievers Heroin 19,376 Buprenorphine/Naloxone Q Methadone March , ,000 8,000 12,000 Number of People Source: NMDOH Syringe Services; NM Prescription Monitoring Program; NM BHSD

73 Harding Catron Lincoln Sierra Roosevelt Curry Quay Union Colfax Chaves Hidalgo Grant Otero Luna Lea Cibola Dona Ana Guadalupe Los Alamos Rio Arriba Valencia De Baca Bernalillo San Juan Sandoval San Miguel Santa Fe Taos Mora Torrance Eddy McKinley Socorro New Mexico 30 Buprenorphine/naloxone Patients (2016) per Opioid Overdose Death, NM, ( ) Sources: NM DOH Bureau of Vital Records and Health Statistics; NM Board of Pharmacy PMP

74 Conclusions NM overdose death rates did not change in 2016 while many other states have had large increases NM state ranking dropped to 12th Benzodiazepine and methamphetamine OD deaths have increased NM ranked 2 nd in meth overdose deaths in 2016 High risk prescribing continues to decrease gradually Compliance with PMP requirement can improve MAT use continues to increase Naloxone access is increasing Opioid crisis is at the core, but substance use (alcohol, methamphetamine, benzodiazepines) in NM is the long-term driver of epidemic We have more work to do

75 Recommendations: Drug Overdose Prevention Prescribing Enforce board rules requiring PMP use and strengthen rules as needed Enhance feedback on dangerous prescribing to practitioners and licensing boards Treatment Increase medication assisted treatment (MAT), particularly in areas with less access Increase number of NP/PA providers prescribing buprenorphine Develop system to assure persons needing treatment are offered treatment Enhance linkage to care Naloxone Increase co-prescription of naloxone with high risk opioid RXs Assure that all retail pharmacies stock naloxone Fully implement standing orders and HB370 Enhance public health surveillance of drug use, NAS, overdose and death