Opioid Review and MAT Clinic- Diversion

Transcription

1 1 Opioid Review and MAT Clinic- November 14, 2018

2 2 Announcements

3 Announcements CME evaluation forms are due to Katie Stangl by Friday, Nov. 16 th at 4:00pm. 3

4 Upcoming Presentations November 21: No ECHO next week! November 28: Children's Hospital presenting an Overview of Neonatal Abstinence Syndrome December 5: Dr. Charlie Reznikoff, Addiction Medicine at Hennepin Healthcare presenting on Benzodiazepine Withdrawal: Assessment and Tapers 4

5 Upcoming Presentations December 12 th : Hon. Marta Chou, Minnesota Fourth Judicial District December 19 th : Dr. Sanjeev Arora, founder of Project ECHO, presenting on Hepatitis C and IV Drug Use January 23 rd : Dr. Wilson Compton, MD, PhD, Deputy Director, National Institute on Drug Abuse 5

6 Buprenorphine Providers? If you or someone within you clinic is considering or will be starting to prescribe buprenorphine, please private message Katie. We would love to help in any way possible! If you are interested in participating in a specific nurse or physician meeting related to MAT and/or bup, please Katie and let her know 6

7 Missed a Session? If you have missed a session and wish to watch it, just Katie and she will send you the link to watch! 7

8 Outcomes Evaluate the many causes of prescription diversion Identify the different characteristics of individuals who divert medications 8

9 Multiple determinants of specific modes of prescription diversion (2011). 9

10 This paper examines sources of diverted drugs from 2 larges studies and characteristics of patients National sample of opioid treatment patients, N=1983 Florida sample of treatment patients, N=782 10

11 National Sample Florida Sample Age Sex M=F Ethnicity 82% Caucasian 56% Caucasian Income 70%<25,000 Mod/Severe Pain 59.2% 63% 11

12 Older patients and noninjectors Avoid dealers and theft More likely to see physicians, legit or not 12

13 Those with higher income or/and insurance were more likely to see a physician whether legit, or not Those with <$10,000 income more likely to have a dealer, share and steal meds 13

14 Female 48 years old Pain pills for double mastectomy 14

15 Women Less likely to use dealer More likely to see physician, legit or not More often share or trade Occasional theft 15

16 Male 23 years old Full time National Guard 16

17 Age year olds- more likely to use dealer and obtain through theft >45 years old- 3x less likely to use dealer 17

18 Female 25 years old Injecting prescription drugs 18

19 Patients who injected opioids were more likely to have a dealer 19

20 Female 43 years old History of Crohn s disease 20

21 When patients use a medical source to get medication they are misusing they are 2x more likely to have: Insurance Health problems Reported mod/severe pain in last 90 days 21

22 Male 34 years old Engineer at a refinery $60,000 in debt with dealer 22

23 Drug type Those who misused Oxy ER were more likely to get from a dealer (2x more than prescriber) 23

24 Female 42 years old Business owner 20 year history of receiving Norco for fibromyalgia 24

25 Drug type Those who misused hydrocodone were more likely to get from a prescriber Those who misuse methadone more often get from a prescriber 25

26 Female 30 years old Pharmacy technician 26

27 Theft of opioids Younger Twice as likely to be white IV user 3x as likely to steal meds Those that misuse oxycodone 27

28 Female Previous opioid use disorder diagnosis Being tapered off benzo 28

29 Veterinary 13% are aware of animals that were intentional injured to get pain medication 12% were aware of staff opioid abuse and diversion Vet office do not use pharmacies, there is NO requirement to log into state PDMP 29

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33 Elderly as a source of opioids Added income to social security Sell to family and friends Unaware of consequences 33

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35 Distance 35

36 How do we help decrease diversion? Provide appropriate treatment and prescribing to chronic pain patients Screen for opioid use disorder Urine screen (sometimes witnessed) to help identify patients who are diverting or have other substance use disorders 36

37 Resources The New Opioid Dealers. Eaton, Joe. June Multiple determinants of specific modes of prescription opioid diversion. Cicero TJ, Kurtz SP, Surratt HL, Ibanez GE, Ellis MS, Levi-Minzi MA, Inciardi JA. J Drug Issues Spring;41(2): The source and diversion of pharmaceutical drugs for non-medical use: A systematic review and meta-analysis. Hulme S, Bright D, Nielsen S. Drug Alcohol Depend May 1;186: doi: /j.drugalcdep Epub 2018 Mar 27. Outbreaks of Infections Associated With Drug by US Health Care Personnel. Schaefer, Melissa, MD., Perz, Joseph, DrPH. Mayo Clinic Proceedings, , Volume 89, Issue 7, Pages , Copyright 2014 The High Cost of Drug. Lindsay, Erica, PharmD., Pharmacy Times, 2016 January 3. Prescription Opioid Epidemic: Do Veterinarians Have a Dog in the Fight? Mason DS, Tenney L, Hellyer PW, Newman LS. Am J Public Health Sep;108(9): doi: /AJPH