An Introduction to the Opioid Epidemic: Working Together To End The Nation s Opioid Epidemic

Transcription

1 Morehouse School of Medicine Department of Psychiatry & Behavioral Sciences HBCU-Center for Excellence in Behavioral Health Behavioral Health Webinar Series An Introduction to the Opioid Epidemic: Working Together To End The Nation s Opioid Epidemic Patrice A. Harris, MD, MA Chair, AMA Opioid Task Force HBCU Center for Excellence April 2018

2 HBCU - Center for Excellence OVERVIEW Overview Through a Cooperative Agreement with the Substance Abuse and Mental Health Services Administration s (SAMHSA) Center for Substance Abuse Treatment, (CSAT) and Center for Mental Health Services, (CMHS) Morehouse School of Medicine established the Historically Black Colleges and Universities Center for Excellence in Behavioral Health (HBCU-CFE), funded as Grant No. TI

3 Goals of the HBCU - CFE Goals of the HBCU-CFE Promote student behavioral health to positively impact student retention Expand campus service capacity, including the provision of culturally appropriate behavioral health resources Facilitate best practices dissemination and behavioral health workforce development

4 Patrice A. Harris, MD, MA Chair, AMA Opioid Task Force American Medical Association Patrice A. Harris, MD, MA, a psychiatrist from Atlanta, has diverse experience as a private practicing physician, public health administrator, patient advocate and medical society lobbyist. She was elected to the American Medical Association Board of Trustees (BOT) in June Active in organized medicine her entire career, Dr. Harris has served on the board of the American Psychiatric Association (APA) and was an APA delegate to the AMA. She has also been a member of the governing council of the AMA Women Physicians Congress, testified before and served on AMA reference committees, and has served on AMA work groups on health information technology, SGR and private contracting. The AMA-BOT appointed her to the AMA Council on Legislation in 2003, and she was elected by the council in 2010 to serve as its chair. Dr. Harris has held many leadership positions at the state level as well, including serving on the board and as president of the Georgia Psychiatric Physicians Association and on the Medical Association of Georgia s Council on Legislation, its Committee on Constitution and Bylaws, and its Membership Task Force. She was also the founding president of the Georgia Psychiatry Political Action Committee. In 2001 Dr. Harris was selected Psychiatrist of the Year by the Georgia Psychiatric Physicians Association. In 2007 she was inducted into the West Virginia University Academy of Distinguished Alumni. Governing themes in Dr. Harris professional life are a passion to improve the lives of children and service to others. Starting with medical school at West Virginia University, followed by a psychiatry residency and child psychiatry and forensics fellowships at Emory, and then as the Barton senior policy fellow at the Emory University School of Law, she has worked for children both clinically and in the advocacy arena. At Emory she addressed public policy for abused and neglected children before the Georgia legislature and in public education programs. Dr. Harris has also given invited lectures and presentations on children s mental health, childhood trauma, integration of health services, health equity, and the intersection of athletics and health. As past director of Health Services for Fulton County, Ga., which includes Atlanta, Dr. Harris was the county s chief health officer, overseeing all county health-related programs and functions, including a wide range of public safety, behavioral health, and primary care treatment and prevention services. She spearheaded the county s efforts to integrate public health, behavioral health and primary care services. Dr. Harris also served as medical director for the Fulton County Department of Behavioral Health and Developmental Disabilities. Currently, Dr. Harris continues in private practice and consults with both public and private organizations on health service delivery and emerging trends in practice and health policy. She is an adjunct assistant professor in the Emory Department of Psychiatry and Behavioral Sciences.

5 An Introduction to the Opioid Epidemic: Working Together To End The Nation s Opioid Epidemic Patrice A. Harris, MD, MA Chair, AMA Opioid Task Force HBCU Center for Excellence April 2018

6 Illicit fentanyl and heroin leading causes of opioid-related mortality

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9 Opioid-related mortality: percent of deaths by ethnicity, Source: Kaiser Family Foundation,

10 Opioid overdose death rates by race and ethnicity White Black, non-hispanic Hispanic Source: 10

11 What does the literature say about race and pain? Black patients less likely to receive pain medication in the emergency department Physicians are more likely to underestimate the pain of black patients relative to nonblack patients Medical students and residents who have false beliefs about race (e.g. blacks skin is thicker than whites ) show racial bias in the accuracy of their pain treatment recommendations and that blacks feel less pain than whites

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13 Physicians taking action: PDMP use increasing; opioid supply decreasing 350,000, ,000, ,000,000 PDMP queries: ,814,801 Retail filled opioid analgesics: ,462, ,000, ,000, ,780, ,051, ,000, ,001,292 50,000, Source: AMA survey of state PDMP administrators Source: Xponent, IQVIA; PayerTrak, IQVIA 13

14 2012: Rx opioid prescribing starts to decline 2013: PDMP use begins to increase : States implement majority of PDMP, opioid prescribing restrictions

15 Opioid MME decreasing; significant regional variability

16 AMA Opioid Task Force recommendations

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19 Percent population needing but not receiving treatment for illicit drug use Source: NSDUH,

20 Lack of Access to Treatment: Substance Abuse Facilities Offering All Three Forms Of Medication-Assisted Treatment, 2016 Source: Substance Abuse and Mental Health Services Administration s National Survey of Substance Abuse Treatment Services.

21 Barriers to MAT are nationwide Source: Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment. The American Society of Addiction Medicine,

22 We all have to work together Remove prior authorization and step therapy for MAT Monitor and enforce network adequacy requirements, substance use disorder and mental health parity laws Increase access to comprehensive, multidisciplinary pain care, including non-opioid alternatives Evaluate what works change what is not helping our patients

23 Which guideline/recommendation/best practice/policy is a physician supposed to follow?

24 A few of the reasons why we have reason to be optimistic

25 There is much more work to do Ensure a public health focus PDMPs we must work to transform these database tools into clinical tools Treatment we must continue to urge payers to remove barriers to care Overdose prevention naloxone co-prescribing can save lives, lead to important discussions Policy with the hundreds of new laws, regulations and other policies, we must evaluate what works and amend what doesn t Coalition building ending the epidemic requires us all to work together!

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27 Contact us Dr. Harris and the AMA Opioid Task Force can be reached at:

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29 Contact Us! HBCU-Center for Excellence at Morehouse School of Medicine 720 Westview Dr. SW - Atlanta, GA Office: HBCU (4228) Viswwwwwww.hbcucfe.net Dr. Eugene Herrington Co-Project Director HBCU-Center for Excellence eherrington@msm.edu Mrs. Joan Trent Program Coordinator HBCU-Center for Excellence jtrent@msm.edu