Arizona State Office of Rural Health Webinar Series

Transcription

1 Arizona State Office of Rural Health Webinar Series

2 Mute your phone &/or computer microphone Time is reserved at the end for Q&A Please fill out the post-webinar survey Webinar is being recorded Recording will be posted on the SWTRC and the AzCRH

3 Arizona State Office of Rural Health Monthly Webinar Series Focused on providing technical assistance to rural stakeholders to disseminate research findings, policy updates, best-practices and other rural health issues to statewide rural partners and stakeholders throughout the state.

4 Arizona s Opioid Epidemic: Understanding the Problem and Finding Solutions 1. Understand the ontology of the rising rates of opioid use nationally and in Arizona 2. Understand the deleterious consequences occurring as a result of the rising trends in opioid use 3. Identify solutions that individuals can take across healthcare, substance abuse treatment and the general community

5 Today s presenter: Shana Malone Clinical Initiatives Project Manager AHCCCS - Office of the Director Shana Malone is a Clinical Initiatives Project Manager in the Office of the Director at the Arizona Health Care Cost Containment System. Shana oversees the agency initiative to reduce the effects of the opioid epidemic in Arizona. Shana has an M.S. in Human Development with a clinical specialty in family systems therapy and completed her doctoral coursework in the School of Social and Family Dynamics at Arizona State University. Her academic work focused on computational social science, social and emotional development and dynamical systems applications. Prior to coming to AHCCCS, Shana was the Director of the Statistical Analysis Center at the Arizona Criminal Justice Commission where she developed the original pilot model for the Arizona Prescription Drug Misuse and Abuse Initiative. Shana has worked on several local and national multi-systemic prevention and evaluation health outcome projects, and she has experience as a therapist in Arizona UA Board of Regents

6 Arizona s Opioid Epidemic Understanding the Problem and Finding Solutions

7 The National Opioid Influx A 4 fold increase in the quantity of Rx Opioids sold in the U.S. The U.S. makes up 4.6% of the world s population, but consumes 80% of its Rx opioids 91 opioid deaths every day!

8 Percent (%) of Youth Reporting Misuse/Use Past 30 Day Rx Drug Misuse Among Arizona Youth (AYS) 12% 10.4% 10% 8% 7.9% 6.3% 6.6% 6% 4% 2% 0% 0.8% 0.4% 0.3% 0.3% *Y-axis altered for visual purposes; accurate representation is out of 100% AnyRx Heroin 8

9 Percent (%) Youth Reporting Misuse Past 30 Day Youth Rx Drug Misusers Reporting Cocktailing (AYS, 2016) What puts our kids at elevated risk even though we only have 6.6% misusing Rx Drugs? Alcohol+Rx Opioids *Y-axis altered for visual purposes; accurate representation is out of 100% Rx Opioids+Rx Sedatives 9

10 Percent (%) Reporting Misuse Arizona Adult Rx Drug Misuse (BRFSS, 2014) 100% 90% 80% 70% 60% 50% 40% 30% 56.8% 20% 10% 19.6% 32.5% 0% Past 30 Days Past 12 Months but Not Past 30 Days Lifetime but Not Past 12 Months 10

11 Emerging Heroin Trends 11

12 Fentanyl 12

13 What the Opioid Epidemic is Costing Arizona 13

14 Event Rate Per 100,000 Population Arizona Opioid-Related ED Encounters and Hospital Admissions % Increase % Increase EMERGENCY ENCOUNTERS HOSPITAL ADMISSIONS

15 9 8 7 Neonatal Abstinence and Newborn Drug Exposure Rates per 1,000 Births AHCCCS represented 51% of Arizona hospital births between 2008 and 2014, but was the payer for 79% of the NAS cases 218% Increase 6 245% Increase Neonatal Abstinence Syndrome (779.5) Narcotic Exposure (760.72) Cocaine Exposure (760.75) Fetal Alcohol Syndrome (760.71) Hallucinogen Exposure (760.73) 15

16 Number of drug poisoning deaths Number of Drug Overdose Deaths Involving Opioids, Arizona (ADHS) % Increase Opioid pain relievers* (T40.2-T40.4) % Increase Heroin (T40.1) *includes methadone Year

17 Finding a Solution

18 3 Groups to Target 1. Opioid-Naïve Individuals 2. The Chemically Dependent 3. Diverters

19 3 Strategies to Implement 1. Harm Reduction 2. Prescribing/Dispensing Practices and Patient Ed 3. Access to MAT

20 Why Naloxone? The obvious it saves lives! Reversals between Jan-March 2017 Creates awareness Community distribution Someone understands and cares Access to additional services and resources Pipeline to treatment referral 20

21 Strategic Plan STRATEGY #1: Enhance Harm Reduction Strategies to Prevent Overdose o GOAL #1: Provide education and training on Naloxone to prescribers, pharmacists and AHCCCS members o GOAL #2: Increase member access to Naloxone. 21

22 Why Access Matters? Enough Rx opioids were dispensed last year to medicate every Arizona adult around the clock for more than 2 weeks 22

23 Percent (%) Youth Reporting Source How Access Translates into the Population 73.2% of Arizona youth who have misused Rx drugs in the past 30 days report getting them from friends, family or right out of the home 80 Percentage of Past 30 Day Youth Rx Misusers Obtaining Rx Drugs on the "Friends and Family Plan" (AYS) Note: Y-Axis altered for visual purposes; accurate depiction is out of 100% 23

24 The CSPMP: Sign up here:

25 Percent (%) Signed Up to Use the CSPMP Percentage of Arizona Pharmacists and Prescribers Signed Up to Use the CSPMP 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 338% Increase 334% Increase 30.0% 20.0% 10.0% 0.0% June 2012 December 2013 December 2014 December 2015 December 2016 Prescribers Pharmacists 25

26 WHY Opioid-Naïve Individuals? CDC MMWR, March

27 High Risk Populations Criminal Justice population American Indians Former users Veterans High MEDDs and Polypharm Trauma, depression, anxiety Rural communities/counties why are they important?

28 Why Target Polypharm? BMJ, March

29 Elevated Misuse in MH Population (NSDUH, 2015) 29

30 Specifically Those with Depression 30

31 And, Suicidal Thoughts 31

32 Strategic Plan STRATEGY #2: Promote responsible prescribing and dispensing policies and practices o GOAL #1: Reduce the number of opioid-naïve AHCCCS members unnecessarily started on opioid treatment o GOAL #2: Improve care processes for chronic pain and high-risk AHCCCS members. 32

33 Sign Up and USE the CSPMP Ensure Patient Safety Limit Liability Now Easier than Ever with Delegate Option

34 Facilitate Use of Best Practices

35 Register for FREE CME

36 Educate Patients

37 Project ECHO 37

38 Screening and Assessment Substance Use Mental Health 38

39 Co-Prescribing Naloxone >90 MEDDs Any combination of opioids with benzos, muscle relaxers and sleep medication Education and instructions key 39

40 Why MAT? Improves treatment retention Decreases opioid use Reduces risk of mortality 40

41 Stigma and Access to Healthcare How we talk about things impacts the way we think about things and vice versa Improved understanding that opioid use disorder is a complex interplay of biology and environment will decrease stigma and increase access to healthcare

42 Reward Pathway 42

43 Opioid Withdrawal Symptoms Pupillary dilation Tachycardia Diaphoresis Gooseflesh skin Runny nose/tearing Tremor Yawning Anxiety/irritability Restlessness Bone/joint aches GI upset

44 Strategic Plan STRATEGY #3: Enhance Access to Medication Assisted Treatment o GOAL #1: Assess statewide capacity of MAT providers available to AHCCCS members o GOAL #2: Increase access to integrated MAT for AHCCCS members 44

45 Opioid STR Grant MAT education and outreach Increase peer support services MAT COE for 24/7 access to care Hospital and ED discharge projects Diversion and incarceration alternatives Early MAT ID for re-entry population Expand residential/recovery home services 45

46 Thank You 46

47 Additional AZ Resources: Take the CME Safe & Effective Opioid Prescribing While Managing Acute & Chronic Pain -FREE for AZ only: -Non-AZ access here: Use the AZ Prescription Drug Misuse & Abuse Initiative Toolkit here (scroll down to Strategies): Order a physical copy from Lacie Ampadu, Lacie.Ampadu@azdhs.gov Sign up for the AZ Prescription Drug Monitoring Program here (FREE & required for licensing): Use the Arizona Opioid Prescribing Guidelines here: Request FREE physical copies from Lacie, Lacie.Ampadu@azdhs.gov. Request a Naloxone training and receive free Naloxone. Contact Hayley Coles to schedule at hcoles@spwaz.org. View the recorded webinar here (will post soon): Connect w/ county organizations working on this issue. Lacie, Lacie.Ampadu@azdhs.gov or Alyssa Padilla, alydilla@ .arizona.edu to connect you.

48 This webinar is made possible through funding provided by Health Resources and Services Administration, Office for the Advancement of Telehealth (G22RH24749). Arizona State Office of Rural Health is funded granted through a grant from US Department of Health and Human Services. Grant number H95RH This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, DHHS or the U.S. Government.