Washington s Collaborative Effort to Address the Opioid Epidemic. Jaymie Mai, PharmD L&I Pharmacy Manager
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1 Washington s Collaborative Effort to Address the Opioid Epidemic Jaymie Mai, PharmD L&I Pharmacy Manager
2 The Opioid Epidemic Prescribing of opioids increased by 4-fold from 1999 to 2010 Enough opioids dispensed to medicate every adult around the clock for a month US accounted for 99% of global consumption of hydrocodone and 77% of oxycodone¹ Unintentional opioid-related deaths increased from 4000 to over 16,000 from 1999 to 2010 Hospitalizations for opioid-related overdoses in Washington increased 6-fold from 1995 to 2009 Addiction treatment admissions for prescription opioids increased 6-fold between 2003 and 2010 ¹
3 The First Opioid Dosing Guideline in US In 2006, the AMDG collaborated with a clinical advisory group with expertise in pain management to address the issue The draft guideline was sent to major provider organizations for feedback and a public meeting was held prior to guideline release In April 2007, the AMDG released the Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: an educational pilot to improve care and safety with opioid treatment Use the best practices that have been recommended since 2000 Stop and take a deep breath and ask for help before exceeding 120 mg/d MED Re-evaluate the benefit and risk of patients who have already exceeded 120 mg/d MED
4 Data on Effectiveness, Dose & Overdose Epidemiology studies revealed serious consequences (e.g. abuse, disability, addiction, NAS, sleep apnea, overdose) A 2014 AHRQ report found insufficient data on the effectiveness of long-term opioids to reach any conclusion Nearly half of all overdose hospitalizations occur with intermittent or low dose opioids There is no completely safe opioid dose
5 The 3 rd Edition of the AMDG Guideline In this update, the AMDG collaborated with a broad group of clinicians with expertise in pain management and addiction medicine and organizations Final draft was posted online for public comments and provider organizations were invited to provide feedback A conference was held on Evidence-Based Pain Care featuring a the new AMDG guideline on June 12, 2015
6 AMDG Guideline Advisory Committee Clinicians David Beck Grays Harbor Clinic Randi Beck Group Health Cooperative Malcolm Butler Columbia Valley Community Health Phillip Capp Swedish Medical Center Family Practice Greg Carter St. Lukes Rehabilitation Dianna Chamblin The Everett Clinic Pamela Davies UW/Seattle Cancer Care Alliance Supportive & Palliative Care Dermot Fitzgibbon UW/Seattle Cancer Care Alliance Andrew Friedman Virginia Mason Medical Center Debra Gordon Harborview Anesthesiology & Pain Medicine Lucinda Grande Pioneer Family Practice Chris Howe Valley Medical Center Ray Hsiao Seattle Children's Hospital/UW Department of Psychiatry and Behavioral Sciences Gordon Irving Swedish Pain and Headache Center Joseph Merrill UW/Harborview Medical Center Patricia Read-Williams UW Neighborhood Clinics Richard Ries UW/Harborview Medical Center Division of Addictions Andrew Saxon VA Puget Sound Health Care System/Center of Excellence in Substance Abuse Treatment and Education (CESATE)/UW Addiction Psychiatry Residency Program Michael Schatman Foundation for Ethics in Pain Care Mark Sullivan UW Center for Pain Relief/Department of Psychiatry and Behavioral Sciences David Tauben UW Center for Pain Relief/Division of Pain Medicine Greg Terman UW Department of Anesthesiology Stephen Thielke Seattle VAMC Geriatric Research, Education and Clinical Center Michael Von Korff Group Health Cooperative Health Plans Ken Hopper Amerigroup, Washington James Luciano & Thomas Paulson Wellpoint Companies Mary Kay O Neill Coordinated Care/Bree State Agencies Stephen Hammond - DOC Kathy Lofy - DOH Gary Franklin, Lee Glass, Nicholas Reul & Hal Stockbridge - L&I Dan Lessler & Charissa Fotinos - HCA Boards and Commissions Richard Brantner MQAC Chris Humberson PQAC
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8 Age-adjusted rate per 100,000 Prescription Opioid Involved Overdoses Washington State Deaths Hospitalizations
9 Challenges Salmon swimming upstream Powerful advocacy with perceived under treatment of chronic pain Fifth vital sign promoted increased opioid prescribing for pain in hospitals and emergency departments Aggressive marketing by pharmaceutical industry to providers Pseudoaddiction was used to describe patients who look addicted but were thought to need more opioids
10 Lessons Learned Addressing such a widespread problem required persistent focus and innovative collaboration between state agencies and pain leaders It is necessary to set standards or create best practice guidelines in order to provide clear guidance Identifying the problem and assessing the impact of intervention require robust surveillance to track prescribing practice and overdose events Incentivizing the use of best practices with both nonfinancial and financial means
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