The Opioid Scourge DR. CAROLINE CARNEY CHIEF MEDICAL OFFICER

Transcription

1 The Opioid Scourge NOUN: A PERSON OR THING THAT CAUSES GREAT TROUBLE OR SUFFERING SYNONYMS: AFFLICTION, BANE, CURSE, MENACE, BURDEN, EVIL DR. CAROLINE CARNEY CHIEF MEDICAL OFFICER

2 1,000,000,000,000

3 72,000 49,000

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5 $1,000,000,000,000 economic toll on the United States since

6 ,000 drug fatalities 49,000 deaths from opioids In comparison 58,000 US soldiers died in the entire Vietnam War 37,500 Americans died of motor vehicle accidents in ,640 women, men and children will die from all types of cancer in 2018 More than 43,000 died due to HIV/AIDS during that epidemic's peak in 1995 Nearly 40,000 died of guns during the peak of those deaths in report of provisional 2017 data National Center for Health Statistics

7 1 One death of a mother, father, sister, brother, son, daughter, husband, wife, partner friend, colleague, neighbor, student, worker to irrevocably change the lives of those living through all the days that follow

8 Today s talk The money The mortality The why The real story

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12 This is your brain on drugs OR WHY IT ISN T EASY TO BEAT THE OPIOID CRISIS

13 Biology/Genes Genetics Gender Mental disorders Environment Chaotic home and abuse Parent s use and attitudes Peer influences Community attitudes Poor school achievement Route of administration Effect of drug Early use Availability Cost Children s earliest interactions within the family are crucial to their healthy development and risk for drug use. Brain Mechanisms Addiction 13 8

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15 Neurology

16 Where addiction happens 16

17 Dopamine, pleasure, dependence, and addiction 17 NIDA, 2017

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19 Neurobiology (continued) Over time the opioid receptors in the VTA become less sensitive to dopamine, whether made naturally, or released because of opioids More opioids are needed to achieve the same amount of pleasure even usual pleasurable activities in life no longer feel good This is called tolerance taking the same amount or more to feel the same effect Dependence physiologic adaptation to an opioid, the absence of which leads to withdrawal Addiction the drive to keep taking the drugs the behaviors and lack of insight Craving and withdrawal symptoms reinforce the need to keep taking opioids

20 Addiction is what turns a soccer mom into a heroin addict 20

21 How do opioids kill?

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23 Why Not Seek Help? Shame Fear of loss Social stigma Addiction itself Opioid withdrawal syndrome Access to Medication Assisted Treatments (Suboxone) Access to psychosocial care The wrong provider

24 The wrong provider 24

25 In your own back yard... In the Western District of Pennsylvania, four defendants all physicians were charged in various health care fraud and drug diversion schemes. One scheme involved 32,000 dosage units of buprenorphine. 25

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27 Nationally, at least 1,350 of 12,780 buprenorphine doctors have been sanctioned for offenses that include excessive narcotics prescribing, insurance fraud, sexual misconduct and practicing medicine while impaired. New York Times, November 2013

28 The Perils of Predatory Treatment: Rehab Centers Patient Brokering Predatory Web Practices Urinalysis Abuse Up-charging and Overutilization Out of Network Schemes Kickbacks Clinical Misrepresentations Paid Call Center/Directory/Call Aggregation Research evidence shows that inpatient rehabilitation is not superior to outpatient programs 28

29 Worst Case Scenario Scenario 1: The opioid deaths forecast for 2027 is 93,613. The forecasted change is 183% since 2015 when it was 33,091. This curve assumes total drug overdoses climb at the same rate they have for decades. It s also based on the assumption opioid deaths keep making up roughly the same percentage of all drug deaths. NATALIA BRONSHTEIN/STAT, 2018

30 HOPE Oft expectation fails, and most oft there where most it promises and oft it hit where hope is the coldest and despair most fits William Shakespeare,

31 Best Case Scenario Scenario 10: The opioid deaths forecast for 2027 is 21,300. The forecasted change is -36% since 2015 when it was 33,091. This curve assumes doctors prescribe fewer opioids, states embrace prescription drug monitoring programs, and there are reforms to increase treatment access and actual quality of treatment. NATALIA BRONSHTEIN/STAT, 2018

32 Medication Assisted Therapy (MAT) Evidence-based treatment for opioid addiction Suboxone, Vivitrol and Methadone 32

33 Prevention: It makes (dollars) and sense Benefit-per-dollar cost ratios for evidence-based interventions range from small returns per dollar invested to more than $65 every dollar invested Dose and duration limits Education on the treatment of acute and chronic pain Licensing pain treatment and addiction centers Creating policy to prevent payment for predatory treatment practices To understand what addiction really is a brain disease complicated by the social structures in which it occurs Seek integration of behavioral and physical health services with addictions create the team of providers Monitoring the Future national survey results on drug use: : Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan. 33

34 Addiction is a chronic disease 34

35 Google Blocks Predatory Drug Rehabs from Buying Anymore Ads The opioid addiction epidemic in America, which killed more than 53,000 people in 2016, has fueled the drug treatment industry's growth, with rehabs and drug treatment facilities popping up all over the country. But the $35 billion treatment industry is plagued with untrustworthy facilities that have learned how to game Google search results. Many drug treatment centers have mastered SEO practices and buy ad words on Google to make sure their business appears first when an addict, or desperate family member, types "drug treatment center" or "rehab" into the search bar, doctors and public health experts say. 35

36 Tenets of treatment The best care occurs in the least restrictive environment necessary The best care occurs in the community in which the patient lives The best care occurs when the patient and their family system are actively engaged and thoroughly informed about all aspects of their care, and are as involved as possible The best care occurs when the treatment team actively partners with the health plan and health system, including primary care, specialty care, and behavioral health providers 36

37 What s ahead? Naloxone distribution (More) prescribing limitations Needle exchange programs Screening programs for Hep C, HIV/AIDS Precision medicine for prescribing Coverage of medications for Hepatitis C and HIV/AIDS Policy decisions that promote access to quality care Policy decision to prevent predatory providers What is the role of law enforcement? Public health? How do privacy rules affect identification and treatment? What is the role of education? 37

38 The Real Story

39 1 One death of a mother, father, sister, brother, son, daughter, husband, wife, partner friend, colleague, neighbor, student, worker to irrevocably change the lives of those living through all the days that follow