State Action to Prevent and

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1 State Action to Prevent and Treat Prescription Drug Abuse Paul Jarris, MD, MBA Executive Director Association of State and Territorial Health Officials Hearing from Each Other: State Reports NGA Policy Academy Meeting Burlington, VT June 8, 2015

2 About ASTHO ASTHO is the national nonprofit organization representing public health agencies in the United States, the U.S. Territories, and the District of Columbia, and over 100,000 public health professionals these agencies employ. ASTHO members formulate and influence sound public health policy and ensure excellence in state-based public health practice.

3 Death rates from heroin overdose are increasing rapidly as death rates from prescription opioids level off. 18,000 16,000 Rx Opioids 14,000 12,000 10,000 8,000 Heroin 6,000 Cocaine 4,000 2, Source: CDC, National Center for Health Statistics, National Vital Statistics System.

4 Prevention Education Surveillance Monitoring (PDMPs) Diversion Control Law Enforcement Licensure Treatment Recovery

5 2014 President s Challenge P r e s c r i p t i o n D r u g Misuse and Abuse Reduce the rate of nonmedical use and the number of unintentional overdose deaths involving controlled prescription drugs 15 percent by 2015.

6 Prevention 32 pledges Surveillance 35 pledges Enforcement 22 pledges Treatment 23 pledges Primary prevention Tools for consumers, families, and prescribers Linking data sources Increasing use of PDMPs Geospatial analyses, hotspotting Drug takebacks Naloxone SBIRT training Increase access to MAT

7 2014 Policy Inventory: State Action U s i n g s u r v e y d a t a t o u n d e r s t a n d h o w s t a t e s a r e s c a l i n g u p r e s p o n s e s t o p r e s c r i p t i o n d r u g a b u s e.

8 Prescription Drug Profiles Data from ASTHO state and territorial health agency survey used to create individual profiles: Online survey: June August total responses, including: Guam, Palau, CNMI 32-items, five (5) topic areas: prevention, PDMPs, enforcement, treatment, NAS Respondents indicated the extent to which their state or territory had taken action on a specific measure Download a summary of key findings:

9 Prescription Drug Profiles Three types of questions appear on the survey: (1) Policy Does your state have a policy requiring [x]? (2) State or Organizational Activities Are there any agencies or organizations in your state providing [x]? (3) Environmental Strategies and Approaches Example: Are controlled substance disposal options available?

10 Column for total yes responses This column provides an estimate of activities occurring nationwide and illustrates areas where the data suggest there may be uniform trends of action.

11 Prevention Where are these programs taking place? Select all that apply.

12 PDMPs Examples: individuals with a history of substance abuse opioid addiction treatment centers to monitor patients use of other controlled substances individuals who have a record of emergency department overutilization

13 Example: Ohio Practice Insight Report l i s t s p a t i e nts with highest m o r p h i n e e q u i va l e nt doses (80 MED thre s h o l d ). Prescriber self-monitoring tool Approx. 70% of 2,491 prescribers and pharmacists surveyed in Ohio felt confident in identifying potential red flags on an OARRS report which may help identify patients in need of referral to treatment. More than half reported screening patients. As reported by the Ohio Department of Mental Health and Addiction Service and Ohio State Board of Pharmacy. Ohio was awarded a SAMHSA Electronic Health Records (EHR) Integration and Interoperability grant and conducted this survey as part of an evaluation. (JULY 2014)

14 Enforcement Which laws addressing diversion are being evaluated?

15 Treatment and Recovery Who is on the task force? Select all that apply. Clinics, hospital facilities, treatment centers (36 respondents) Public health agencies or organizations (35 respondents) Law enforcement/public safety (27 respondents) Pharmacies (25 respondents) Schools (18 respondents)

16 Neonatal Abstinence Syndrome Responses indicated work in progress and partnerships with: existing perinatal quality improvement collaboratives hospital-based initiatives See also:

17 Using the Profiles Illustrates a menu of strategies that form a comprehensive approach Enables better planning and response with appropriate and complementary strategies Determining how to strengthen resource sharing, collaborations, and partnerships between states to advance similar goals: Who should I talk to about? Ideas for replicating successful programs, policy language and guidance, communication materials

18 Prevention Education Surveillance Monitoring (PDMPs) Diversion Control Law Enforcement Licensure Treatment Recovery