The Burden of Opioid Use/Misuse in Pima County
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1 The Burden of Opioid Use/Misuse in Pima County Francisco García, MD, MPH Assistant County Administrator & Chief Medical Officer 19 July 2017 Health Department Video
2 2 What impacts health?
3 3 How do you get results?
4 4 Community Health Needs Assessment 2015
5 5 Framework for Public Health Action Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health
6 6 Opioid Use in Pima County
7 7 Behavioral Health Disorders Source: Arizona Department of Health Services, Bureau of Epidemiology and Disease Control Services Note: includes first listed diagnoses only
8 8 Opioid-Related Hospital Encounters, Since 2008, there has been a nearly two-fold increase in number of ED visits and in-patient hospital stays related to opioid misuse Source: Pima County, Hospital Discharge Database
9 9 Substance Use Related Emergency Department Visits Significant increase in the number of substance misuse related ED visits across age-groups from 20 to 70 years AZ Hospital Discharge Database
10 10 Substance Use Related In-patient Hospitalizations Significant increase in the number of substance misuse related hospitalizations across age-groups from 20 to 75 years AZ Hospital Discharge Database
11 11 Opiod-Related ED Visit Rates/1,000 Population by Primary Care Area, 2016
12 Opiod-Related Inpatient Encounter Rates/1,000 Population by Primary Care Area,
13 Opiod-Related, Combined ED & IP Encounter Rates/1,000 Population by Primary Care Area, % of opioid related ED visits come from 10 PCAs 37% of opioid related inpatient visits come from just 2 PCAs
14 14 Opioid Related Hospitalization by Age and Ethnicity, 2008, 11 & 15 AZ Hospital Discharge Database
15 Opioid Related ED Encounters by Hospital, 2010 & 2016 Opioid related ED encounters have increased for nearly every hospital in Pima County
16 16 Opioids, Negative Health Impacts
17 17 Overdose Deaths in Pima County, 2016 Overdose accounted for 263 deaths (up from 210 in 2011) Male (66%) v. female (34%) Single drug (51%) v. multi-drug (49%) Overdose is the cause 89% (233) accidental deaths 8% (21) suicide deaths 3% (9) undetermined cause of death
18 18 Pima County Overdose Deaths by Age-Group, Medical Examiner Report
19 2016 Medical 2016 Medical Examiner Report Examiner Report 19 Pima County Overdose Deaths by Drug, 2016
20 Pima County Overdose Deaths by Misused Substance Category, 2016
21 21 We all pay for substance misuse and addiction, 2016 Hospital Care Setting 2016 Total Charges 2016 Payer Source Emergency Department Inpatient $24.8 M ($10M more than 2010) $229.4M ($76M more) 63% AHCCCS 11% Medicare 9% Commercial 10% Other 7% Self-pay 48% AHCCCS 21% Medicare 13% Commercial 16% Other 3% Self-pay
22 22 TFD Overdose-Related Call Responses, 2015 to 2017 Q Source: TFD
23 23 Youth Substance Abuse, Pima County
24 24 Youth Substance Use, Pima County
25 25 Youth Opioid Use
26 26 Costs of Youth Opioid Use Sources: ADHS, hospital discharge data, Pima County Medical Examiner, 2015
27 27 Preventing Substance Abuse Youth and Family Healthy home life Consistent parental expectations Drug free friends Healthy habits High self-esteem Have fun Medical Community Clinician awareness Medically Assisted Therapy capacity
28 28 Building Blocks to Prevent Substance Abuse Neighborhood Clean streets Well-lit areas Safe outdoor spaces Neighborhood connections Schools High quality teachers and mentors Encourage school attendance Provide extracurricular activities
29 29 Opioid Use Among Pregnant Women in Pima County
30 30 Number of Pregnant Women Using Opioids, Pima County
31 31 1 in 10 Women Who Use Opioids Are Pregnant 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0%
32 32 Most Pregnant Women Using Opioids in Pregnancy are 20 to 30
33 33 Pregnant Opioid User Hospitalizations by Age-group and Year Pregnant opioid users are not just increasing in number, they are also getting younger?
34 34 Opioid Use Related Hospitalizations Among Pregnant Women, Pima County ED & Hospital ED&Hosp (%) ED Only ED Only (%) Hosp Only Hosp Only (%) Age Group Total
35 35 Profile of Opioid Related Hospital & ED Visits Pregnant Women, Pima County 2015 No pregnant opiod overdose deaths Racial/Ethnic Breakdown NH White 51% Am Ind 5% Hispanic 37% Asian 0% Black/Af Amer 4% Other 3% Medicare/Government payer 89% v Private payer 11% Average Hospital Charges: $12,952/episode 1/3 pregnant women in PCADC are opioid involved and on MAT
36 36 Preventing Substance Among Pregnant Women Individual Fostering resilience Peer support Health Care Systems Opioid prescribing guidelines Prescription Monitoring Program Medically Assisted Therapy Correctional care Community Poverty Economic opportunity Housing Supportive services
37 37 Opioid Use Among Seniors in Pima County
38 38 Opioid Use Related Hospitalizations Among Seniors, Pima County 2015 ED & Hospital ED&Hosp (%) ED Only ED Only (%) Hosp Only Hosp Only (%) Age Group Total Deaths 24 Attempt Suicide 30
39 39 Profile of Opioid Hospitalized Seniors, Pima County 2015 Female 57.7% v Male 42.3% Racial/Ethnic Breakdown NH White 77% Am Ind 1.4% Hispanic 17% Asian 0.5% Black/Af Amer 3.4% Other 0.7% Medicare/Government payer 81.3% v Private payer 18.7% Average Hospital Stay: 123 hours (5.1 days) Prescription Drug 97%
40 40 Pima County Overdose Deaths by Age-Group, Medical Examiner Report
41 41 Preventing Substance Abuse Among Elders Individual Awareness/PCOA Be Med Smart Medication security Medication disposal Peer support Clinician Opioid prescribing guidelines Prescription Monitoring Program Drug interaction awareness Polypharmacy Community Combating isolation Supportive services
42 The AZ Rx (PMP) Prescription Monitoring Program
43 Controlled Substances Prescription Monitoring Program Arizona s 48th Legislature passed H.B Signed by the Governor on July 2, 2007, effective on September 19, under the Rx Monitoring Website
44 Sample Report Card
45 Sample Report Card #2
46 Health Care Systems Call to Action Provide Patient education training and materials for prescribers and pharmacists. Encourage that Health Care Professionals register and implement (PMP) Controlled Substances Prescription Monitoring Program. Go to the PMP AWARxE login page For support contact Raul Munoz, Proram Coordinator-Community Engagement Phone:(520)
47 18-month pilot project for mothers with children under 18 Partnership between the county and five organizations Comprehensive program model built around the Getting Ahead: Extended coaching support after Getting Ahead Health-related curriculum and connection to resources An effort to create change at the systems level Moms as expert, empowered advocates of their community Educating and engaging those who serve people in poverty
48
49 49 Mac Arthur Foundation funded initiative to safely reduce over-incarceration by addressing racial/ethnic disparities Data driven decision making combined with evidence-based practices to inform policy change Goal: Reduce average daily jail population from 2,136 in 2014 to 1,574 and a $2 M/year savings Pretrial Services: Risk screening of all misdemeanor defendants Behavioral/health screening and linkage to treatment Enhance pretrial supervision of behavioral health patients
50 50 Pay-for-Success (Social Investment Bond) Project Funded by HUD & DOJ to develop new models of financing to expand permanent supportive housing for reentry populations Housing First with Forensic Assertive Community Treatment Target Population Homeless individuals Incarcerated more than twice a year Behavioral health diagnosed Outcome Metrics Social: Criminal Justice, Housing, Job Readiness, Costs Health: Health Insurance Enrollment, Beh health, ED visits, PCP
51 51 Opioid Use in Pima County
52 52 Framework for Public Health Action Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health
53 53 Contact Information Francisco García, MD, MPH Assistant County Administrator & Chief Medical Officer Pima County 130 W Congress St, 10 th Floor Tucson, Arizona Francisco.garcia@pima.gov (520)
54 54 Pima County Health Department Mission Vision To ensure the health, safety, and well-being of our community through leadership, collaboration, and education. A Healthy Pima County: Every one. Every where. Every day. Health Department Video
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