KS Rx and Opioid Advisory Committee Meeting Minutes

Transcription

1 KS Rx and Opioid Advisory Committee Meeting Minutes :00 pm - 2:30 pm Attendees Adrienne Hearrell Alexandra Blasi Amanda Bridges Becky Gillgannon Chris Sturgeon Cristi Cain Daniel Warren Douglas Fain Ericka Welsh Erin McGuire Fan Xiong Greg Lakin Jamie Katz Janet Waugh Jon Rosell Karen Braman Katie Mahuron Krista Machado Linda Sheppard Lisa Chaney Lori Haskett Lynne Hinrichsen Reyne Kenton Rosanne Rutkowski Sara Hilliard Sara Hortenstine Sarah Gideon Sharon Kearse Sheri Catania Susan Wood Teesha Miller Partner Updates Topeka Public Library- Marvin Auditorium 101 B Kansas Department of Health and Environment (KDHE) Kansas Board of Pharmacy Kansas Foundation for Medical Care (KFMC) Kansas Foundation for Medical Care (KFMC) Topeka Police Department Kansas Department of Health and Environment (KDHE) University of Kansas School of Medicine- Wichita American Association of Oral and Maxillofacial Surgeons Kansas Department of Health and Environment (KDHE) Kansas Foundation for Medical Care (KFMC) Kansas Board of Pharmacy/KDHE Kansas Department of Health and Environment (KDHE) Johnson County Mental Health Center Kansas Department of Education Kansas Medical Society Kansas Hospital Association (KHA) Kansas Department of Health and Environment (KDHE) DCCCA Kansas Health Institute (KHI) Greenbush- Southeast Kansas Education Service Center Kansas Department of Health and Environment (KDHE) US Department of Agriculture - Rural Development Kansas Board of Pharmacy (KBOP/KTRACS) Kansas Healthcare Collaborative (KHC) University of Kansas Medical Center- Continuing Education Child Death Review Board Health Innovations Network of Kansas (HINK) Kansas Department for Aging and Disability Services (KDADS) United States Attorney's Office - District of Kansas Kansas Association for the Medically Underserved Jackson County MO PDMP KDHE is running the CDC Rx Awareness Campaign January analytics show significant reach using radio ads-have had people approach them about the ads and discuss some of the ads that came out about Opioid Use Awareness-Positive things being said about the campaign. KDHE CDC DDPI Grant EHR Integration Project KDHE is funding hospitals, pharmacies, and clinics to integrate KTRACS with their Electronic Health Records. Saving an estimated 4 minutes per patient, some have reported it saves them between 5-10 minutes. Finney County Opioid Summit- Partnership between St. Catherine s Hospital, LiveWell Finney County Health Coalition, Kansas Hospital Association, and DCCCA. The event had over 100 people in

2 attendance. Summit provided opportunity for provider education and collaboration between disciplines. Speakers and Topics included: Scott Taylor, CEO, St. Catherine s Hospital Chief Mike Utz, Garden City Police Department Callie Dyer, Executive Director, LiveWell Finney County Karen Braman, Sr. Vice President, KHA - National & State Perspective Reyne Kenton, K-TRACS Program Manager, KBOP- K-TRACS Overview Daniel Warren, MD, University of Kansas School of Medicine, Wichita Physician Perspective Shane Hudson, CEO, Central Kansas Foundation Substance Use Disorder Treatment and Resources Krista Machado, Project Manager, DCCCA State Initiatives Troy Unruh, Consultant, LiveWell Finney County Local Initiatives Panelists: Daniel Warren, Shane Hudson, John Andrews, Finney County Undersheriff, Joanne Brown, DS, Melvin Viney, Meade District Hospital Panel Discussion KDHE provided printed CDC materials for the Finney County event free of charge. If any partner is interested in receiving printed CDC materials for an event or meeting please contact Lori Haskett or Adrienne Hearrell. Cristi Cain shared that the Governors Public Health Conference is coming up (April 4-5) in Wichita. The conference will include a session on Opioids (Greg Lakin will be one of the presenters) a session on Neonatal Abstinence Syndrome (NAS) and a session on SUD Prevention. The Pre-conference will provide a session on SBIRT (April 3 rd ). Dr. Southard, from Hazelton, will be presenting. He s the CMO and will be talking about the Public Health approach to substance abuse prevention. The conference has 320 registered to attend. Teesha Miller provided an update on the Missouri PDMP in Jackson County. Currently MO has 57 jurisdictions that are covered by a PDMP. They are working on increasing access and utilization of the states PDMP. APRISS is their vendor (same vendor as Kansas). Chris Sturgeon- Topeka Police Department added a permanent medication disposal drop box and collected 64 pounds in the first month. Lynne Hinrichsen USDA recently launched an opioid website to assist USDA, other Administration agencies, and partners at the state and local level move forward on the opioid issue. They are printing postcards with information on the website to raise awareness if anyone is interested in receiving postcards contact Lynne. Website link: Sharon Kearse- State Targeted Response to the Opioid Crisis initiative (STR) year two will begin in May regions funded in year 1 will receive funding in year 2 as well. KDADS will also be releasing a Request for Proposals (RFP) for mini grants to increase awareness (utilizing the Kansas It Matters campaign). Grants will be available for up to $8,000 and KDADS anticipates making awards. The target release date for the RFP is March 30 th, applications would be due April 30 th, and ideally mini grants will begin in June. Sharon was not sure if medication disposal products would be included as an allowable activity but will take it into consideration. Fan Xiong- Kansas Data Dashboard will be done soon, should be publicly accessible by next week. This dashboard will show data at the state and county level on indicators associated with prescription drugs and opioids. Will be integrated into the website and works best with Chrome or Firefox. Fan reported that opioid prescriptions have decreased in most counties from 2016 to Discussed adding a buprenorphine prescriber or treatment provider map to the dashboard as well.

3 KHA/KMS Joint Committee Update Karen Braman Kansas Hospital Association and the Kansas Medical Society have formed a Joint Committee on Opioid Misuse. That group, comprised of physician and hospital representatives, had its initial meeting this month. The KHA/KMS committee is focused on assessing the scope of opioid misuse in Kansas, reviewing current and emerging trends and strategies to address opioid misuse, and providing information and education to physicians, hospitals, and policymakers to reduce and prevent opioid misuse in Kansas. It is jointly chaired by Reta Baker, president and CEO, Mercy Hospital Fort Scott, and LaDona Schmidt, MD, Total Family Care in Lawrence. The group anticipates meeting regularly this spring and summer. The group's work and recommendations are expected to be completed later this year. Their next meeting is on April 12 th. They plan to bring Sam Quinones to Kansas in September to speak to the group. This committee is included in our provider education section of our state plan. EXECUTIVE ORDER Task Force to Address Substance Use Disorders Greg Lakin The Governor s taskforce will be chaired by Greg Lakin. The purpose of the taskforce is to put rules, regulations, and policies into place associated with substance use disorders. The first areas of focus will be the opioid crisis, there is also emphasis on addressing stimulants/meth. The first meeting will begin with an overview of strategies and recommendations developed from our Advisory Committee. The initial requesting delegates from each of the identified agencies should be going out this week. There will be coordination between the taskforce and our Kansas Prescription Drug and Opioid Advisory Committee. This taskforce will begin with our recommendations for polices/legislation we have established for the state plan and will complement our efforts. Taskforce updates will be provided at our monthly Advisory Committee meetings. The Executive order can be found at Media Development- Sheri Catania Discussed the need to provide education to educators, parents, and youth on opioids. Specifically, on the new trend of Whips- kids report seeing them at parties and cost around $10. Pointed out that it is cheaper than alcohol often but these are heroin capsules. Wanting to do a social media post or video to educate the general public on this. What it is, and what to look for. Discussed doing a focus group with parents and youth to develop messaging. Planning committee: Sheri, Krista, Reyne, Sharon, Lisa, Lynne, Adrienne, and Janet Opioid Conference

4 Date: November 15 th, 2018 Location: Topeka- Capitol Plaza Hotel and Convention Center Call for proposals for presentations will open mid-may and close mid-july (DCCCA will put together a Call for proposals and send out to the committee for feedback) Conference will be similar to last year having tracks on Provider Education, Prevention, Treatment and Recovery. This year will likely have a specific track for Law Enforcement and an additional track on other intervention/topics such as NAS. This would be 5 tracks instead of just 4. CME, CNE, and other CE credit will be provided again. Discussed the interest in having a second one in a different location, Ideally in Western Kansas This would require additional funding, DCCCA will be seeking partners. Date for a second conference could fall in the Spring to space out events. Potential locations for a second conference with appropriate space: Wichita, Hayes, Manhattan State Planning Updates and Discussion State plan timeline: Sub-Committees deadline for written section of state plan: April 13 th Draft of full state plan by the end of April early May. Sub-committees have completed a draft version of action plans associated with strategies and recommendations selected. Now working on writing sections of the plan and developing Specific, Measurable, Attainable, Relevant, and Time-bound (SMART) objectives to measure outcomes. CMS Rule Daniel Warren Daniel Warren- CMS Rule would restrict opioid doses to Medicare patients to the equivalent of 90 Morphine Milligram Equivalents (MME) a day. The Rule would also create a hard stop at pharmacies for prescriptions of 90+ MME. The CMS rule, if finalized, would complicate opioid prescribing practices significantly. Even if CMS doesn t finalize the rule, PBMs, payers, and pharmacists will be under increasing pressure when filling any opioid prescription that has red flags. Potentially the rule could be finalized April 2, with implementation in With that being 9 months away, if it s finalized, we should develop a proactive response to prepare prescribers across the state to be aware quickly so they can start tapering patients who might get their prescription refused. Next steps- Daniel will be meeting with KU s School of Pharmacy to develop local collaboration on this issue and a follow-up discussion will be coordinated at the state level to develop a plan for statewide collaboration. Workgroup Meeting Schedule (1:00-2:30) Agenda Description Location April 26th, 2018 Planning Meeting State Planning May 24th, 2018 Speaker- Open Meeting Leslie Porth- MHA work on MAT and Peer Support referrals in EDs Topeka Public Library Anton 202 Topeka Public Library - Marvin Auditorium 101B

5 June 28th, 2018 July 26 th, 2018 Speaker/Committee Meeting Planning Meeting Troy Ross- President and CEO, Mid-America Coalition on Healthcare - employer s perspective Topeka Public Library - Anton Room 202 Topeka Public Library - Anton Room 202

6 Handouts 1) KS Rx and Opioid Advisory Committee: Sub-committees and Priorities 2) KS Rx and Opioid Advisory Committee: Sub-committees Selected Strategies 3) Governor's Task Force Executive Order 4) Article on proposed CMS rule

7 DRAF T Treatment and Recovery Kansas Prescription Drug and Opioid Advisory Committee Chair: Krista Machado Co-Chair: Lori Haskett Neonatal Abstinence Syndrome Expand Medication Assisted Treatment Chair: Daniel Warren Sub-Committees Chair: Sarah Fischer Data and Reporting Expand Peer Support Workforce Development Access to Residential Services Provider Education Chair: Talal Khan Prevention Chair: Adrienne Hearrell Law Enforcement Chair: Ed Klumpp Pregnant Women Treatment Access Vermont Oxford Network Prevention Education Student Education KTRACS Utilization Best Practices Education Resource Repository Develop Website Community Mobilization Safe Use, Storage, Disposal Public Education Statewide Campaigns Justice-Involved Treatment Access Naloxone Utilization Law Enforcement Education Membership Kansas Department for Aging and Disability Services Kansas Department of Health and Environment DCCCA Kansas Bureau of Investigation Kansas Hospital Association Kansas Foundation for Medical Care University of Kansas School of Medicine- Wichita University of Kansas Medical Center Kansas Poison Control Center US Department of Health and Human Services Kansas State Child Death Review Board Kansas Pharmacists Association Kansas Department of Corrections Kansas Attorney General s Office Kansas Board of Pharmacy Kansas Board of Healing Arts Kansas Medical Society Kansas Association of Chiefs of Police Kansas Sheriffs Association Kansas Native American Affairs US Attorney's Office District of Kansas Kansas Healthcare Collaborative Kansas Health Institute Kickapoo Social Services Iowa Tribe of Kansas and Nebraska Substance Abuse Center of Kansas Hutchinson Clinic Beacon Health Options Greenbush- Southeast Kansas Education Service Center Kansas Department for Children and Families Mirror Inc. Sunflower Health Plans Shawnee Mission Medical Center Topeka Police Department Shawnee Mission Medical Center American Association of Oral & Maxillofacial Surgeons Kansas Family Partnership Allen County Multi-Agency Team Safe Streets Wichita Central Kansas Foundation Blue Valley School District Douglas County Health Department

8 Kansas Prescription Drug and Opioid Strategies PREVENTION 1. Develop a collaborative, state website as an informational hub to increase public awareness and facilitate a coordinated response to prescription drug, and prescription/illicit opioid misuse, abuse, dependence, and overdose 2. Implement coordinated statewide health communication campaigns 3. Promote safe use, storage, and disposal of prescription drugs 4. Develop and disseminate educational materials for professional and non-professional audiences 5. Increase the number of community coalitions addressing prescription drug and illicit opioid misuse/overdose 6. Collect, analyze, use, and disseminate surveillance data to inform prevention efforts and monitor trends PROVIDER EDUCATION 1. Provide educational opportunities on evidence-based practices for opioid use disorder (OUD), medication assisted treatment (MAT), and pain management 2. Develop a joint committee to engage subject matter experts to identify and promote best practices 3. Increase registration and use of Kansas s prescription drug monitoring program, K-TRACS 4. Develop and disseminate a comprehensive resource toolkit for prescribers 5. Develop and implement opioid prescribing policies and prior authorizations TREATMENT & utilization RECOVERY 6. Increase access and of SBIRT TREATMENT AND RECOVERY 1. Expand access and utilization of MAT for OUD 2. Expand peer support services, to support a comprehensive treatment and recovery-oriented system of care NEONATAL ABSTINENCE 3. Increase access to sober living programs in Kansas accepting MAT/OUD patients SYNDROME 4. Increase access to residential and medically managed withdrawal treatment services for OUD 5. Recommend Kansas implement workforce development programs to increase appeal of the addiction profession LAW ENFORCEMENT 1. Increase utilization of evidence-based OUD treatment and recovery services among justice-involved populations 2. Increase awareness, availability, and utilization of Naloxone within Kansas law enforcement agencies 3. Provide face to face and online training opportunities to current and prospective law enforcement officers 4. Recommend that Kansas enact a 911 Good Samaritan Law NEONATAL ABSTINENCE SYNDROME 1. Promote prevention activities for OUD prior to pregnancy 2. Promote standardized universal screenings to identify those at risk 3. Increase access of substance use treatment for pregnant women with OUD 4. Identify standardized best practices for diagnosis, coding, and tracking of neonatal abstinence syndrome (NAS) 5. Establish a reporting protocol for tracking NAS cases 6. Facilitate connection/access to services for mom and baby 7. Provide NAS training opportunities for healthcare professionals through the Vermont Oxford Network (VON)

9 EXECUTIVE ORDER Task Force to Address Substance Use Disorders WHEREAS, more than 42,000 Americans died from opioid and heroin overdoses in 2016, and 2 million Americans suffer from substance use disorders involving prescription drugs, and 591,000 suffer substance use disorders involving heroin; and WHEREAS, more than 1,500 residents of the state of Kansas have died from opioid or heroin overdoses since 2012, and more than 100 continue to do so each year; and WHEREAS, opioid and heroin addiction and overdoses continue to rise within the United States and within the State of Kansas; and WHEREAS, in 2016, drug poisoning was the underlying cause of death for more than 300 people in the state of Kansas, with 95 deaths caused by methamphetamine alone; and WHEREAS, substance use disorder is an illness which not only affects all areas of people s lives, but also their families, friends, and communities; WHEREAS, while steps have already been taken to address substance use disorders in Kansas, including 2017 Kansas House Bill 2217, discussions surrounding the Improving Outcomes for Substance-Exposed Infants and Families event in Topeka in August 2017, grant funding from the Kansas Department for Aging and Disability Services to Opioid Misuse Prevention Projects, and the work of the Prescription Drug and Opioid Advisory Committee, yet further measures can still be taken to prevent addiction and overdose deaths; and WHEREAS, the severity of this crisis necessitates yet greater cooperation and collaboration of state agencies, organizations, professionals, emergency response personnel, and others with policy making authority to address substance use disorders; and WHEREAS, the establishment of a Task Force will provide an effective and efficient mechanism for the Governor to obtain advice on a broad range of matters related to substance use disorders in Kansas. NOW, THEREFORE, pursuant to the authority vested in me as Governor of the State of Kansas, I hereby establish the Governor s Task Force to Address Substance Use Disorders ( Task Force ): 1. Membership shall be composed of the heads of the following agencies or associations, or their designees: a. Kansas Attorney General b. Kansas Department of Health and Environment c. Kansas Department for Aging and Disability Services d. Kansas Department for Children and Families e. Kansas Department of Corrections f. Kansas State Board of Pharmacy

10 g. Kansas State Board of Healing Arts h. Kansas State Board of Nursing i. Kansas Dental Board j. Kansas State Board of Emergency Medical Services k. Association of Community Mental Health Centers of Kansas l. Kansas Hospital Association m. Kansas Medical Society n. Kansas Association of Addiction Professionals o. Kansas Pharmacists Association 2. Additional membership shall be comprised of the following persons: a. One (1) pain management professional b. One (1) hospice industry professional c. One (1) representative of a Kansas nursing facility d. One (1) representative of law enforcement e. One (1) education professional 3. The Speaker of the House, President of the Senate, House Majority Leader, Senate Majority Leader, House Minority Leader, and Senate Minority Leader may each appoint one (1) member to serve on the Task Force. 4. The Task Force shall be chaired by the Chief Medical Officer at the Kansas Department of Health and Environment. Staff from the Cabinet agencies represented on the Task Force shall assist by providing relevant information and program expertise as appropriate. 5. The work of the Task Force may be facilitated by an outside entity at the discretion of the Chair. 6. Other persons with relevant experience may be invited to join the Task Force by the Governor or Chair of the Task Force. 7. The Task Force shall meet monthly, but may meet more or less frequently as its work requires and at the discretion of the Chair. 8. Members of the Task Force shall not receive compensation, subsistence, allowance or associated expenses. Officers or employees of state agencies who are appointed to the Task Force as part of their duties shall be authorized to participate on the Task Force and may claim subsistence, allowance, mileage or associated expenses as permitted by law. 9. The Task Force shall be subject to the Kansas Open Records Act and the Kansas Open Meetings Act. 10. Plans, reports, or recommendations of any nature adopted by the Task Force shall be considered advice to the Governor and Legislature, and shall not be construed as official policies, positions, or interpretations of laws, rules, or regulations by any department or agency of state government, nor shall any such department or agency be bound in any manner to consider such advice when conducting their advisory and regulatory affairs.

11 11. The Task Force s duties shall be to: a. Gather information regarding substance use disorder within the state of Kansas, particularly regarding the growing number of opioid and heroin overdoses in the state and the continued scourge of methamphetamine addiction; b. Evaluate and leverage existing resources, tools, and initiatives already established in the Kansas healthcare continuum, notably the work and recommendations of the Kansas Prescription Drug and Opioid Advisory Committee which is funded in part by the Kansas Department for Aging and Disability Services; c. Investigate various response options, including distributing naloxone to first responders, more comprehensively utilizing prescribing data, and otherwise revising state policy as appropriate; d. Examine best practices for prevention, treatment, and recovery of at-risk individuals through early detection and education for patients; e. Advise and make recommendations to the Governor; and f. Assist in implementing and executing a statewide response. 12. The Task Force shall submit a report including, but not limited to, its findings on substance use disorder in Kansas and the misuse of opioids, as well as its proposed response to the crisis, no later than six months from the date of this Executive Order, or as it becomes relevant during the intervening period.

12 Proposed federal limits to opioid prescriptions draw opposition from physicians and patients By LEV MARCH 6, 2018 WASHINGTON In the final hours of public input on a controversial new rule limiting opioid prescriptions, a last-minute coalition emerged on Monday to oppose it. The Centers for Medicare and Medicaid Services rule would restrict opioid doses to Medicare patients to the equivalent of 90 milligrams of morphine per day. But a vocal group of doctors, pain patients, and public health experts including three who contributed to the Centers for Disease Control and Prevention s own prescribing guidelines emerged near the Monday deadline to voice their opposition via comment, letter, and social media. Hundreds of comments had been submitted to the CMS website on the rule as of Monday afternoon the vast majority in opposition. Dozens of other academics, doctors, and editors of pain journals have signed on to a letter claiming the proposed rule constitutes overreach by CMS into medical treatment and would carry serious consequences for the 1.6 million Medicare beneficiaries who reached that threshold for at least one day in The critics say the regulation is heavy-handed and measures health outcomes only in prescription levels. The 90-milligram morphine daily equivalent is roughly equal to four mid-range doses in a typical prescription of immediate-release oxycodone. There are a lot of Medicare providers that already do very aggressive dose control now, said Dr. Stefan Kertesz, a professor at the University of Alabama, Birmingham, who focuses on addiction and works with a variety of chronic pain patients. We know what real opioid safety looks like. This is not that. Instead, their letter says, the approach is a one-size-fits-all response to external pressure on CMS, and one that takes decision-making power away from doctors. Government pressure to act This proposal echoes a similar one last year in which CMS proposed to restrict opioid doses to 120 morphine milligram equivalents per day. This year s proposal, however, goes even further, by reducing the threshold and allowing pharmacists to deny prescriptions that exceed it. The rule would create a potentially time-consuming exemption process that would require the consent of pharmacies, payers, and doctors. The rule, set to be finalized April 2, is the first daily opioid dose limit proposal issued under the leadership of new CMS Administrator Seema Verma. Verma, who served as Indiana s top health official when Vice President Mike Pence was governor there, has cited the opioid crisis as a priority, and she has been a mainstay at administration events on the topic including the White House s opioids summit held last week. But Verma s agency is under pressure to act from multiple government oversight bodies, which have placed much of the responsibility for high opioid prescription levels on the agency. The Office of Inspector General in July highlighted that 1 in 3 Medicare Part D beneficiaries received opioids, for which Medicare paid $4.1 billion a statistic Attorney General Jeff Sessions cited last week in announcing the Justice Department s involvement in a slate of lawsuits against opioid manufacturers. The Government Accountability Office doubled down on the the inspector general s conclusion in January, issuing a report titled Medicare Should Expand Oversight Efforts to Reduce the Risk of Harm.

13 CMS new plan does neither, its opponents argue. Among the problems they see with opioid prescribing thresholds are the potential for decreased quality of life, pursuit of illicit drugs to replace opioids, and the potential for increased suicidal ideation among patients whose opioid doses are reduced or discontinued. The plan avows no metric for success other than reducing certain measures of prescribing, the letter reads. Neither patient access to care nor patient health outcomes are mentioned. Instead, Kertesz said in an interview with STAT, CMS should pursue a system that considers risk factors, and develops plans of care for patients being prescribed opioids. This is just an elaborate, bureaucratic show of force which CMS is under pressure to produce, he said. While the letter s authors acknowledged the role of opioid overprescription in creating the current crisis, their resistance to the CMS proposal comes at a time of broader concerns that the federal government s desire to forcefully address the epidemic could come at the expense of patients. A sweeping addiction bill introduced in the Senate last week goes further than any state legislature and even the CDC guidelines in limiting first-time opioid prescriptions to three days.