SVP, Senior Medical Officer Sedgwick

Transcription

1 SPEAKER SVP, Senior Medical Officer Sedgwick

2 AGENDA The effect of opioids on the brain Best practice prescribing Potential causes Impact on aging population Trends and statistics Dangerous combinations Strategies for preventing and controlling abuse New CDC guidelines Side effects and consequences Recent headlines

3 HOW OPIOIDS IMPACT THE BRAIN Opioids attach to the Mu receptors in the brain The Mu receptors release endorphins Opioids stimulate these receptors and initially increase pleasure and relieve pain Repeated stimulation of these receptors creates a tolerance which requires more drug for the same effect Over a relatively short period of time the receptors become blocked/desensitized to the opioids This impacts mood, behavior, breathing, gastrointestinal motion and perception of pain

4 POSSIBLE EXPLANATIONS 1 out of every 3 Americans has chronic pain Congress passed a law in late 2000 declaring a Decade of Pain Control and Research, which was signed by the president Manufacturers misled physicians about indications and implications Addictive properties not well understood or communicated Doctors allow dosages to escalate in response to complaints of pain No objective measure for pain

5 OPIOID USE IN BENEFITS (GROUP HEALTH AND WC) of group health drug spend is on prescription opioids of drug spend for workers compensation is on opioids Studies show that overall the effectiveness of chronic opioid therapy on addressing pain is modest and effect on function is minimal. 1,2 1.Furlan AD, Yazdi F, Tsertsvadze A, et al. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain. Evid Based Complement Alternat Med 2012;2012: Noble M, Treadwell JR, Tregear SJ, et al. Long-term opioid management for chronic noncancer pain. The Cochrane database of systematic reviews 2010:Cd

6 THE MEDICAL PERSPECTIVE Pain relief Drowsiness Mental confusion Nausea Constipation Respiratory depression Hyperalgesia Addiction Dependence and tolerance

7 HOW OPIOIDS IMPACT HEALTHCARE WORKERS Need sharp cognitive skills Drug free work environment Health and safety issues In cases of addiction must be diligent about access to medications High demand for specific brand name drugs Relationship with prescribers very strong

8 OPIOID-INDUCED CONSTIPATION (OIC) PREVENT OPIOID ADDICTION PREVENT OIC Common phrase Large football game advertising for Movantik $5 million dollars for 30 second commercial Asked to instead spend some of that money on prevention of opioid addiction and refused OPIOIDS CAUSE THE WORST CONSTIPATION OF YOUR LIFE

9 BEST PRACTICE PRESCRIBING Focus on functionality Conduct risk assessment prior to prescribing Conduct random urine drug screens Check PDMP website Conduct pill and patch counts each visit Create an exit strategy with the first trial prescription In chronic cases use drug holidays Have an opioid agreement with the patient SERIOUS CONSEQUENCES INCLUDE Overdose Emergency room visits Immunosuppression Decreased testosterone Medication abuse Diversion Behavioral and social issues Need for other medications

10 OPIOID CONTRACT/INFORMED CONSENT

11 PRESCRIPTION DRUG MONITORING PROGRAMS Research is current as of October 18, 2016

12 URINE DRUG SCREEN Identify aberrant behavior Undisclosed drug use and/or abuse Verify compliance with treatment Based on risk assessment overdose or abuse Low risk once/year Moderate risk twice/year High risk three to four times/year Unusual or suspicious behavior any time Losing prescription Requesting early refills Multiple prescribers Demonstrating intoxication Slurred, slow speech

13 BEERS CRITERIA MEDICATIONS TO BE AVOIDED WITH OLDER ADULTS Drug to drug interactions Drugs that impact kidney function Medications can cause dementia and memory loss High likelihood of falls and dizziness

14 DANGEROUS COMBINATIONS HOLY TRINITY Methadone and medication used for cardiovascular/respiratory health Tramadol and SSRI medications such as Lexapro, Zoloft, Paxil or Celexa can cause serotonin syndrome (sweating, high body temperature, muscle rigidity and high blood pressure)

15 PUBLIC SERVICE ANNOUNCEMENT Lock up ALL medications Do not flush medicines, vitamins or other supplements down toilet or pour them down drain unless noted on packaging. Remove or conceal personal information and Rx number using black marker. Put undesirable substance such as used coffee grounds or cat litter into disposable container with lid (or plastic bag). Mix the medicines with undesirable substance. Pill parties Safe disposal of medications Seal medicines mixture with lid or inside plastic bag. Dispose mixture and medicine container in trash. Close or tie trash bag. Take trash bag out to garbage as close to garbage pick up time as possible. For more information on pharmaceuticals, personal care products and a link to the federal prescription drug disposal guidelines, visit:

16 THE LATEST OPIOID NEWS 200 people are dying each day due to drug overdose Every 8 minutes a person dies from drug overdose 134 out of 200 are from opioid overdose Largest drug overdose increase involves synthetic opioids which includes illicitly manufactured fentanyl Jan 31, 2019 federal officials say is the largest seizure in U.S. history of fentanyl Customs and Border Protection officers said Thursday they discovered 254 pounds of Fentanyl and 395 pounds of Methamphetamine hidden in a floor compartment of a truck loaded with cucumbers CBP valued the fentanyl at $3.5 million and the methamphetamine at $1.1 million The seizure was twice the size of the apparent previous record of 118 pounds which was found in Nebraska in year old arrested in Nogales, Arizona

17 NEWS AND OPIOID FACTS FROM THE CDC 134 people die each day related to opioid overdose 20% of male workforce is reduced in USA due to opioids 92,000 children added to foster care as a result of opioids Overdose deaths in 2017 increased by 10% compared to 2016, killing more than 72,000 Americans

18 DIRECT IMPACT ON HEALTHCARE WORKERS Risk in emergency situations of exposure Need for proper precaution Studies in the United States have shown that 10% 15% of health professionals will misuse substances during their lifetime Rates of prescription drug abuse and addiction are 5 times higher among physicians than in the general population High rates of benzodiazepine and opioid abuse Texas Board of Nursing found one third of all disciplinary actions taken against nurses were drug or alcohol related - Christie, J., Rosen, I., Bellini, L., Inglesby, T. V., Lindsay, J., Alper, A., & Asch, D. A. (1998). Prescription drug use and self-prescription among resident physicians. JAMA, 280(14), Bennett, J., & O'Donovan, D. (2001). Substance misuse by doctors, nurses, and other healthcare workers. Current Opinion in Psychiatry, 14,

19 HOW CAN EMPLOYERS HELP HEALTH PROFESSIONALS Adhere to strict employer policy Participate in impaired physician program Encourage treatment programs Implement peer support groups Awareness and strictly enforced access points and waste protocols

20 OPIOIDS IN THE NEWS Life expectancy drops again as opioid deaths surge in US Middle school students taught how to save lives with Narcan in New Jersey Mussels in the Puget Sound test positive for opioids

21 STATES RESPONDING TO THE OPIOID EPIDEMIC Formularies in 12 states 3 states going live in 2019 (NY, KY, MT) NE, PA, GA contemplating formularies HI HB1534 proposed mandating cannabis payment VT H14 bill require WC coverage of medical marijuana First fill of an opioid prescription is limited to 33 Federal Government trying to pass legislation limiting first fill Narcan available without prescription Requiring physicians to check the prescription drug monitoring database

22 NEW CDC GUIDELINES The rate of long-term use 1 Day = 6.0% on opioids 1 year >8 Days = 13.5% on opioids 1 year >31 Days = 29.9% on opioids 1 year (Authorization of a second opioid prescription doubles the risk for opioid use 1 year later) 50% of those taking an opioid for 30 days will be on it 3 years later 60% of patients taking an opioid at 90 days are still taking an opioid 5 years later (the 90 day cliff )

23 NEW CDC DATA 1.9 million people a year abuse or become dependent on opioids $20.4 billion is the yearly cost for opioid-related overdoses $53.4 billion for nonmedical use of prescription opioids One out of every 32 patients will die from opioids if on doses greater than 200 MED Methadone represents <2% of opioid prescriptions yet has been found to account for 30% of opioidrelated deaths

24 TURNING TO HEROIN (CDC STATISTICS)

25 MORE DATA FROM THE CDC 70% of abused prescriptions are provided by or stolen from friends and family 22% of opioid deaths involve alcohol More overdoes are caused by prescription drugs than illegal drugs Women are 30% more likely to use opioids than men

26 FENTANYL IS THE NEWEST CRISIS FOR HEROIN USERS Taste is a tell tale factor (heroin is bitter and fentanyl is sweet) 75% of heroin on the street is now laced with fentanyl Causes wooden chest chest wall rigidity Causes lock jaw Cannot do CPR Cannot perform rescue breathing Turn blue within seconds Only hope for reversal is Narcan Many using buddy system or shooting up in pharmacy parking lots

27 HIGHEST DEATH RATES FROM DRUG OVERDOSES

28 FENTANYL OVERDOSES

29 SPEAKER SVP, Senior Medical Officer Sedgwick