in*north*carolina* Medica'on*and*Drug*Overdoses*

Transcription

1 Medica'on*and*Drug*Overdoses* in*north*carolina* * Alan*Dellapenna,*Jr.,*Branch'Head,'' Injury'and'Violence'Preven?on'Branch' North'Carolina'Division'of'Public'Health' * Updated'Aug'2015'

2 1989' Pain,'5 th ' Vital'Sign' National Vital Statistics System, multiple cause dataset Source:'Death'files'1968L2012,CDC'WONDER' Analysis'by'Injury'Epidemiology'and'Surveillance'Unit' 2

3 Number of deaths 1,400' 1,200' 1,000' 800' 600' 400' Medica'on*or*Drug*Overdose*Deaths*by*Intent* North*Carolina*Residents,*1999B2014** All'intents' Uninten?onal' SelfLinflicted' Undetermined' Assault' 1,287' 1,052' 350%'increase'in'deaths'since'1999' 1,000+'Deaths'per'year' 20,000+'Emergency'Dept.'visits'per'year' 200' 0' 1999' 2001' 2003' 2005' 2007' 2009' 2011' 2013' 198' 36' 2014' Source:'N.C.'State'Center'for'Health'Sta?s?cs,'Vital'Sta?s?csLDeaths,'1999L2014'(*2014'data'is'provisional)'' Analysis'by'Injury'Epidemiology'and'Surveillance'Unit' Medica?on'or'drug'overdose:'X40LX44,'X60LX64,'Y10LY14,'X85'

4 Substances*Contribu'ng*to*Medica'on*or*Drug*Overdose*Deaths* North*Carolina*Residents,*1999B2014** 900' 800' 700' Prescrip?on'Opioid' Cocaine' Heroin' 20%'decline'in' medica?on'deaths'' 709' Number of deaths 600' 500' 400' 300' 200' 100' 565%'increase'in'Heroin' deaths'since'2010' 252' 221' 0' 1999' 2001' 2003' 2005' 2007' 2009' 2011' 2013' 2014' Source:'N.C.'State'Center'for'Health'Sta?s?cs,'Vital'Sta?s?csLDeaths,'1999L2014'(' *2014'data'is'provisional'and'subject'to'change' Analysis'by'Injury'Epidemiology'and'Surveillance'Unit' '

5 North*Carolina s*response*to*the*drug*overdose*epidemic* Capt.*Alan*Dellapenna*Jr.*(Ret.),*ScoQ*K.*Proescholdbell* Injury'and'Violence'Preven2on'Branch,'N.C.'Division'of'Public'Health' The'Division'of'Public'Health'collaborates'with'a'broad'network'of'partners'to'combat'the'epidemic'of'medica?on'overdose'deaths'with'policy,'epidemiology,'and'communityLbased'strategies.' Number2of2Deaths 1,500 1, Unintentional Suicide Homicide Undetermined All2Poisonings Prescrip'on*medica'ons*are*the*leading*cause*of*overdose* deaths*in*north*carolina.* Medicine'Drop' Since*1999,*the*number*of*medica'on*related* overdose*deaths*have*increase*300%.* ' 'CDC'Epi'Aid'' of'overdose'deaths' in'wilks'co.' CDC'EPI'Aide'inves?ga?on'of' increased'poisoning'deaths' conducted.'findings'lead'to' establishment'of'a'governor s' Task'Force.' Comprehensive Community Approach Chronic Pain Initiative Drug*Treatment' 'help'those' Contact:'Alan'Dellapenna' 'Injury'and'Violence'Preven?on'Branch' 'NC'Division'of'Public'Health' 'alan.dellapenna@dhhs.nc.gov' '(919)'707L5441' with'addic?on'to'recover.'* Prescription Drug Carolinas Poison Center Policy Monitoring System Drug Take Back Opioid Death Task Force Public Health Divs. of Public Health, Medical Assistance, Mental Health/DD/ Substance Abuse Poisoning Death Study Substance Abuse Policy & Practice Research Enforcement SBI & Medical Board 2000' 2002' 2003' 2004' 2005' 2007' 2008' 2009' 2010' 2011' 2012' 2013' 2014' Surveillance'iden?fies'an' increase'in'drug' poisoning'deaths' The'North'Carolina'Controlled'Substances' Repor?ng'System'Act'(CSRS)'enacted.'CSRS'is'a' statewide'repor?ng'system'to'improve'the'state s' ability'to'iden?fy'people'who'abuse'and'misuse' prescrip?on'drugs.'' Governor s'task'force'to'prevent' Deaths'from'Uninten2onal'Drug' Overdoses'convened.' Recommenda?ons'include' establishment'of'a'controlled' substance'repor?ng'system.'' 2010' 'Opera?on' ini?ated,'largest' 1101 drug'takelback' campaign'in'us' Wilkes'County'has'the'3 rd ' highest'drug'overdose'death' rate'in'the'na?on.'' 2007' 'NC s'pdmp' ini?ated.' Drug'overdose'deaths'in'Wilkes'County'drops'69%.' North'Carolinians'have'safely'disposed'of' approximately'61'million'total'doses'of'medica?on' at'opera?on'medicine'drop'events'since'the' campaign s'establishment'in'2009.'' Enhanced'surveillance'of' drug'overdose'deaths' ini?ated'by'the'division'of' Public'Health.'' Project'Lazarus'established'in'Wilkes'County' combat'the'overdose'epidemic.'' Drug% Treatment% Harm% Reduc+on% The*Hub* Community*Awareness' 'of'the'problem'of' overdose'from'prescrip?on'opioid'analgesics' Coali'on*Ac'on' 'to'cooperate'all'sectors'of'the' community'in'a'response' 'Data*and*Evalua'on' 'to'ground'community s' unique'approach'in'their'locally'iden?fied'needs.'* The'Sate'Advisory'Council'(SAC)'on' Poisoning/Overdose'established.'The' group'advises'and'coordinates'on' overdose'communica?ons,'research' and'policy' Collabora?on'with'the'UNC'Injury' Preven?on'Research'Center''on' the'overdose'epidemic''begins.'''' Project*Lazarus*Model* Community% Educa+on% Pain% Pa+ent% Support% Community* Awareness* Coali'on*Ac'on* Data*&*Evalua'on* Diversion% Control% Provider% Educa+on% Hospital% ED% The*Wheel' Community*Educa'on* ' improve'the'public s'capacity'to' recognize'and'avoid'the'dangers' of'misuse/abuse'of'prescrip?on' opioids.'' Provider*Educa'on* 'improve' effec?ve'treatment'of'chronic' pain;'support'treatment' addic?on,'mental'health'illness' and'pain.'' Hospital*ED*Policies' 'help' emergency'departments'avoid' drug'seeking'behavior.' Diversion*Control' 'reduce'the' presence'of'excess'medica?ons' in'society.'' Pain*Pa'ent*Support' 'help' successfully'and'safely'manage' their'pain.'' Harm*Reduc'on' 'help'people' who'do'abuse'opioids'prevent' overdose'death.'' UNC'IPRC'conducts'a'CSRS' users'evalua?on.''' Community'Care'of' North'Carolina,' supported'by'a'$2.6' million'grant'from'the' Kate'B.'Reynolds' Charitable'Trust'and' matching'funds'from' the'office'of'rural' Health'expands'Project' Lazarus'approach' statewide'' The'Revise'the'Controlled' Substances'Repor?ng'System'Act' enacted.'components'include:''' automated'repor?ng'of' ques?onable'pa?ent'and'provider' behavior,'steps'to'increase' u?liza?on'of'csrs'by'providers,'and' enhanced'public'health'surveillance' of'csrs.'' NC'Harm'Reduc?on' Coali?on'documents' 50'overdose'reversals' thru'legal'use'of' Naloxone.' NC'Pharmacy'Board' approves'changes'to' Naloxone'rule,' establish'standing' orders'for'phn' distribu?on'of'' Naloxone'by'local' Health'Departments.' State'EMS'Medical' Director'revises' Naloxone''policy,' establishes'protocol'for' EMS'and'law' enforcement' distribu?on'of' Naloxone.'' Program'Evalua?on' Division'of'the'General' Assembly'conducts'an' evalua?on'of'the'csrs,' legisla?on'introduced' to'further'revise'csrs.' The'Good'Samaritan'Law/Naloxone'Access' Act'enacted;'establishes'limited'immunity' from'prosecu?on'for'repor?ng'drug'and' alcohol'overdoes,'and'prescribing'and' administering'the'opioid'an?gen'naloxone.''

6 Project Lazarus initiated in Wilks County The overdose death rate dropped 69% in two years.

7 Project Lazarus Model The Project Lazarus model is conceptualized as a wheel, Community' Educa?on' Provider' Educa?on' The Hub - 3 core components that must always be present, and Addic?on' Treatment' Public Awareness Coalition Action Hospital'ED' Policies' The Wheel - 7 components, initiated based on specific community needs. Harm' Reduc?on' Data & Evaluation Diversion' Control' Pain'Pa?ent' Support' The%Hub%is%core%public%health%func+ons%of% local%&%state%health%departments.%

8 Project Lazarus Model Expands State Wide with $3.64M in Grant Funding Evaluation Implementation

9 Impact*in*Wilkes*County* 2011*B*No*overdose*decedent*in*Wilks*County*had*an* opioid*prescrip'on*from*a*wilkes*county*prescriber.**

10 North*Carolina*Injury*and*Violence*Preven'on*Branch* Epidemiology,*Policy,*Partners,*Community* Comprehensive'Community'Approach' Chronic'Pain'Ini?a?ve' North Carolina ' ' ' Opioid'Death'Task'Force' ' ' ' Poisoning'Death'Study' Preven?on'&'Harm' Reduc?on' Substance' Abuse' Prescrip?on' Drug'' Monitoring' Program' SAC'Poisoning'TeamL' Communica?on,'Policy' &'Advocacy' Policy'&'Prac?ce' Research' Drug'Take'Back' DPH,'DMA,'DMH/DD/SAS' Enforcement'''''''''''''' SBI'&'Medical'Board'

11 Impact*of*North*Carolina s*2013** Good*Samaritan/*Naloxone*Access*Law* Since'August'1,'2013' 14,000+'overdose'rescue'kits' distributed' 948'confirmed'overdose'reversals' 2015' 724'confirmed'overdose'reversals' Approaching'a'Tipping'Point'in'2015:'' More%overdose%reversals%than%overdose%deaths.''

12 County*Opioid*Overdose*Reversals*with*Naloxone*Reported*to*the** North'Carolina'Harm'Reduc?on'Coali?on'' 8/1/2013'L'7/21/2015' Asheville*(178)* Elkin*(1)* Maiden*(1)* Greensboro*(142)* High*Point*(78)* Rocky*Mount*(1)* NC'Harm'Reduc?on'Coali?on' targets'high'overdose'areas' for'naloxone'distribu?on.'' 4'reversals'in'an'unknown'loca?on'in'North'Carolina'and'11'reversals'in'other'states' reported'to'nchrc.'

13 31*Law*Enforcement*Agencies*in*NC*Carry*Naloxone* * Maggie*Valley*Police*Dept* Waynesville*Police*Dept* Haywood*Co.*Sheriff* Canton*Police*Dept* App*State*University*Police* Watauga*Co.*Sheriff* Guilford*Co.*Sheriff* Orange*Co.*Sheriff* Clyde*Police*Dept* Rutherfordton*Police*Dept* Henderson*Co.*Sheriff* Brevard*Police*Dept* Cramerton*Police*Dept* Transylvania*Co.*Sheriff* FayeQeville*Police*Dept* Carrboro*Police*Dept* Ayden*Police*Dept* Roanoke*Rapids*Police*Dept* Halifax*Co.*Sheriff* Kinston*Police*Dept* Lenoir*Co.*Sheriff* Pink*Hill*Police*Dept* Greenville*Police*Dept* East*Carolina*Univ*Police*Dept* PiQ*Co.*Sheriff* Agencies*that*have*reported*opioid*overdose*reversals*with*Naloxone* N.C.*State*Bureau*of*Inves'ga'on*and*Alcohol* Law*Enforcement*also*carry*Naloxone.*

14 Prescrip+on%Drug%Overdose:%Preven+on%for%States** Priority*Strategies* CDC'awarded'16'states'annual'between'$750,000'and'$1'million'to'advance'preven?on' in'four'key'areas:' ' Enhancing'and'Maximizing'State'Prescrip?on'Drug'Monitoring'Programs'(PDMPs)' Implemen?ng'Community'or'Insurer/Health'Systems'Interven?ons' Conduc?ng'Policy'Evalua?ons' Developing'and'Implemen?ng'Rapid'Response'Projects' We'propose'to'evaluate' and'improve'efforts'as' one'of'the'16'states' funded''under'the'new' CDC'grant.''