Technology as a Weapon in the Opiates Crisis

Transcription

1 Technology as a Weapon in the Opiates Crisis 1

2 Shifting gears Technology as a Weapon in the Opiates Crisis Moderator: Paul Dommel, IBM Corp

3 Agenda Why it s important What s being done Perspectives from Virginia Next steps

4 Mr. Frederick Isasi Director, NGA Center for Best Practices Healthcare

5 Today s discussion Does not represent the official position of the Governors or NGA; I will be speaking from direct experience of working with Governors and state leaders; and My comments are off-the-record and not for attribution.

6 My comments Brief overview of the National Governors Association Brief overview of the national opioid crisis Brief summary of NGA s work with states Highlight sections from Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States

7 The National Governor s Association Nation s oldest organization serving the needs of governors and their staff (founded in 1908) Bipartisan Leadership: Chair Gov. McAuliffe (D-VA) and Vice-Chair Gov. Sandoval (R-NV) NGA Office of Government Relations (OGR): serves as the collective voice of the nation s governors in Washington, DC NGA Center for Best Practices: a hybrid think thank/consultancy that works to surface evidence-based practices, works directly with governors on specific policy projects, and provides support to OGR. The NGA Center divisions are: Health Education Energy, Environment, and Transportation Human Services and Workforce Homeland Security and Public Safety

8 About the NGA s health work NGA Center Health Division: Work focuses on governors most pressing and important health care issues Typically, project-based through competitive RFA process to you and your governors Our work is provided a service, free of charge projects funded through cooperative agreements with federal government, grants, and donations.

9 Continuum of Health Division activities Target Audience Health Division Activities Most Focused Governor Healthcare Leadership Retreats In-State Policy Retreats State-specific Technical Assistance Policy Academies Convenings of States Most Broad Collaboration with NGA s Office of Federal Relations Medicaid Transformation Toolkit, Opioid Roadmap Other Publications

10 Six current focus areas

11 Spread of the opioid crisis 1999 U.S. Map of Opioid Death by State, RAPID DRUG OVERDOSE INCREASE IN DEATH DRUG RATES OVERDOSE DEATH RATES Source: Centers for Disease Control and Prevention

12 Overview of the opiates crisis In 2014, 28,647 people died of an opioid overdose, more than any other year on record. Over 1,000 people will be treated today in an ER for an overdose people will die today of an overdose. 2 One person in the US will die from an opioid-related overdose roughly every 20 minutes. The Drug Enforcement Administration (DEA) expects overdose rates to increase in the next year as fentanyl makes its way through the states. In addition to the human cost, the epidemic is having an impact on state budgets. Total inpatient charges for hospitalizations related to opioid abuse/dependence more than tripled between 2002 ($4.57 billion) and 2012 ($14.85 billion). 3 The financial burden for this cost largely falls on state budgets; Medicaid funds about 50% of hospitalizations. 1 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The DAWN Report: Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. 2 R. Rudd, Increases in Drug and Opioid Overdose Deaths. 3 Matthew V. Ronan, and Shoshana J. Herzig Hospitalizations Related To Opioid Abuse/Dependence And Associated Serious Infections Increased Sharply, , Health Affairs 35 no. 5 (May 2016)

13 Reality of the opioid crisis This crisis is impacting constituents lives: It is a bipartisan issue (impacting red, blue, and purple states) It is urban and rural It affects people of all ages It affects people of all income levels and socioeconomic status It is an economic issue, with consequences for health care costs, lost productivity, and jobs and hiring within communities The solutions are not simple: Strategies may be slow to show results Several factors are compounding states progress Greater availability of heroin Spread of illicit fentanyl Data lag There is a lack of evidence for effective strategies Stigma surrounding opioid use disorder is changing States are viewing the problem as a public health crisis, rather than solely a public safety issue

14 Timeline of NGA activities Joint effort between Health and Homeland Security and Public Safety : NGA convened two prescription drug abuse policy academies with 13 states Round 1: Alabama*, Arkansas, Colorado*, Kentucky, New Mexico, Oregon and Virginia Round 2: Michigan, Minnesota, Nevada*, North Carolina, Vermont* and Wisconsin *denotes policy academy co-lead governor February 2016: During the NGA Winter Meeting, governors agreed that collective action is needed to end the opioid crisis Summer Fall 2016: 46 governors sign Governors Compact to Fight Opioid Addiction NGA releases Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States Launches Learning Lab: Improving Information Sharing and Data Analysis Between Law Enforcement and Public Health (Summer 2016) Launches Learning Lab: State Strategies for Combatting Heroin and Illicit Fentanyl (Fall 2016) Publications: Six Strategies for Reducing Prescription Drug Abuse. (September 2012) Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy (February 2014) Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. (July 2016)

15 Timeline of NGA activities Joint effort between Health and Homeland Security and Public Safety : NGA convened two prescription drug abuse policy academies with 13 states Round 1: Alabama*, Arkansas, Colorado*, Kentucky, New Mexico, Oregon and Virginia Round 2: Michigan, Minnesota, Nevada*, North Carolina, Vermont* and Wisconsin *denotes policy academy co-lead governor February 2016: During the NGA Winter Meeting, governors agreed that collective action is needed to end the opioid crisis Summer Fall 2016: 46 governors sign Governors Compact to Fight Opioid Addiction NGA releases Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States Launches Learning Lab: Improving Information Sharing and Data Analysis Between Law Enforcement and Public Health (Summer 2016) Launches Learning Lab: State Strategies for Combatting Heroin and Illicit Fentanyl (Fall 2016) Publications: Six Strategies for Reducing Prescription Drug Abuse. (September 2012) Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy (February 2014) Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. (July 2016)

16 Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States

17 Road Map Highlights: Key Factors

18 Road Map Highlights: Comprehensive Policy Frameworks

19 Road Map Highlights: Select Healthcare Strategies Prevention: Develop and update guidelines for all opioid prescribers Limit new opioid prescriptions for acute pain, with exceptions for certain patients Develop and adopt a comprehensive opioid management program in Medicaid and other state-run programs Remove methadone for managing pain from Medicaid preferred drug list Treatment and Recovery: Change payment policies to expand access to evidence-based Medication Assisted Treatment (MAT) and recovery services Increase access to naloxone Expand and strengthen the workforce and infrastructure for providing evidencebased MAT and recovery services Create new linkages to evidence-based MAT and recovery services

20 Road Map Highlights: Select Public Safety Strategies Reducing Illicit Supply and Demand for Opioids: Establish a collaborative information sharing environment that breaks down silos across state agencies to better understand trends Leverage assets from partner entities to improve data collection and intelligence sharing to restrict the supply of illicit opioids Expand statutory tools for prosecuting major distributors Expand partnerships and data access to better target overprescribers Responding to the Crisis: Empower, educate and equip law enforcement personnel to prevent overdose deaths and facilitate access to treatment Reinforce use of best practices in drug treatment courts Ensure access to MAT in correctional facilities and upon reentry into the community Strengthen pre-trial drug diversion programs to offer individuals the opportunity to enter into substance use treatment

21 Road Map Highlights: Select Public Safety Strategies Reducing Illicit Supply and Demand for Opioids: Establish a collaborative information sharing environment that breaks down silos across state agencies to better understand trends Leverage assets from partner entities to improve data collection and intelligence sharing to restrict the supply of illicit opioids Expand statutory tools for prosecuting major distributors Expand partnerships and data access to better target overprescribers Responding to the Crisis: Empower, educate and equip law enforcement personnel to prevent overdose deaths and facilitate access to treatment Reinforce use of best practices in drug treatment courts Ensure access to MAT in correctional facilities and upon reentry into the community Strengthen pre-trial drug diversion programs to offer individuals the opportunity to enter into substance use treatment

22 Road Map Highlights: Finalize, Implement, and Evaluate

23 The Honorable William A. Hazel, Jr., M.D. Secretary of Health and Human Resources, Virginia

24 Silos come in many forms Policy, funding, workflow, people

25 Program and services map IRS SSA DOL VA Health and Human AOA NIH Resources Secretariat DARS DBHDS DHP DMAS VDSS OCS VBPD VDBVI VDDHH VDH VFHY Vocational Rehabilitatio n Disability Determinatio n Community Rehabilitatio n for Disabled Aging Services Adult Protective Services Development al Disability Services Mental Health Services Substance Abuse Treatment Services Behavioral Health Emergency Response Services Provider Licensing Licensing and Health Profession Regulation Prescription Monitoring Program (PMP) Health Practitioners Data Center Medicaid Family Access to Medical Insurance Security (FAMIS) Medicaid Analytics and Reform Supplement al Nutrition Assistance Program Temporary Assistance for Needy Families Child Care Energy and Cooling Assistance Eligibility Determinatio n Foster Care and Adoption Services Community Policy and Managemen t Teams (CPMT) Family Assessment and Planning Teams (FAPT) At-Risk Youth and Families Policy Setting Grants for Innovation Leadership and Advocacy Training Programs Disability Services Assessment Vocational Rehabilitatio n Randolph- Sheppard Vending Program (RSVP) Virginia Industries for the Blind General Library Services and Education Services Technology Assistance Program (TAP) Virginia Relay Outreach and Community Services Interpreter Services Family Health Services Emergency Preparednes s and Response Environment al Health Services Licensure and Certification Epidemiology Virginia Certificate of Public Need (COPN) Youth Tobacco Use Prevention Youth Obesity Prevention Child Support Enforcement Minority Health and Equity Child and Drinking Adult Water ACL ACF Protective FNS Services CDC SAMHSA EPA Youth Programs CMS Licensure

26 A growing national issue

27 Silos come in many forms Number of Fatal Prescription Opioid and Heroin Overdoses in Virginia Cities and Counties, CY

28 Total drug overdoses

29 Emerging challenge: Fentanyl

30 Strategies Harm Reduction (naloxone, Suboxone, syringe exchange, NAS babies, family breakup, and crime) Treatment (MAT, drug courts, peers, Medicaid Expansion) Prevention (legal opiate availability, better pain management, storage and disposal, PMP) Prevention (illegal opiate interdiction, tracking and reducing supply) Culture change (removing youth belief that these drugs are harmless, removing expectation of opiate pain management, removing stigma)

31 Challenges The nature of the drug is changing We are seeing an increase in synthetic fentanyl. Addicts often believe they are buying heroin, but it is cut with fentanyl, which is more deadly. The changing nature of the problem exacerbates the pressures faced by first responders, hospitals, and law enforcement

32 Prevention Virginia has moved to limit legal opioids: greater reporting to PMP, increased medical education CDC is also recommending changes in how doctors treat pain and prescribe painkillers Full prevention efforts also involve public safety Need to share data and share information Center for Behavioral Health and Justice is part of Virginia s response

33 Treatment Substance Abuse Benefit $11 million in the first year Covers treatment, including medically assisted treatment Working to expand network of treatment providers Medicaid expansion would help provide this coverage to more who need it Harm reduction Naloxone for first responders, family, etc MAT/Suboxone (with counseling) Need a better consensus. Without it, sheriffs are reluctant to try drug courts with patients on Suboxone

34 2016 Medicaid benefit enhancement Substance Use Disorder (SUD) Treatment Supports for Current Medicaid Members

35 Governance structure and information sharing Executive Work Group State Support Action Group: Focuses on: situational awareness and recommendation development Local Support Action Group: Focuses on: Dissemination of information and assisting local communities Primary Prevention Secondary Prevention/ Interdiction Tertiary Prevention/ Incapacitation Data and Surveillance Seven regions

36 Northern Shenandoah Valley Substance Abuse Coalition A dynamic, a multi-disciplinary collaboration of law enforcement (prosecution and defense resources alike), public health, child welfare, family courts, county and city leadership, and community members impacted by the crisis of heroin and opiate addiction Has brought together a diverse set of local, community partners that work collaboratively across disciplines to respond to a public health crisis in the Valley contributing time, talent and treasure Working to develop a cost-effective drug treatment court as well as compassionately and realistically expanding treatment options for community members who need this service

37 Technology Implications Real-time information to direct resources Where Effectiveness Collaboration: Health, Safety, Justice, Education Streamline access and simplify for addicts & families

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39 39 Post Session Housekeeping RATE this session in the conference app To download the conference app search for APHSA Events VISIT the vendors in the Exhibit Hall during Breakfast and the Networking Breaks to learn more about the solutions presented throughout the day. DONATE to Childhelp the ISM Technology for a Cause campaign to raise $10,000 to help stop child abuse in Arizona and across the country.

40 40 THANKS FOR COMING See you again soon