Opioids in Colorado. What Do the Data Tell Us? What s the Role of the Safety Net? Safety Net Advisory Committee (SNAC) Lab.

Transcription

1 Opioids in Colorado What Do the Data Tell Us? What s the Role of the Safety Net? Safety Net Advisory Committee (SNAC) Lab February 22, 2017

2 Objectives Leverage our collective focus on vulnerable populations. Provide a forum for opportunities and lessons learned. Share the latest strategies for using data to measure effectiveness. Synthesize input from the group and develop a shared body of knowledge. 2

3 Opioids in Colorado: What We Will Cover New at CHI What Do the Data Say? Tamara Keeney, CHI Provider Perspective: Lisa Gawenus, Denver Health Statewide Perspective: Marc Condojani, Office of Behavioral Health Facilitated Discussion 3

4 CHI is Tracking Federal Action on Obamacare A series of reports on rebuilding the Affordable Care Act ACA in Colorado Medicaid block grants High-risk pools Health savings accounts 4

5 THE STAKES Medicaid Funding is Irreplaceable 94% Feds/6% States Current funding for ACA Medicaid expansion $780 Million Cost to Colorado if Congress stops generous funding for ACA Medicaid expansion 5

6 THE LIKELY OUTCOME GOP Proposals in 30 Words Republican plans cover fewer people than the ACA currently does. They are generally better for people who are young, healthy, and higher income and worse for those who are older, sicker, and lower income. Sarah Kliff, Vox.com 6

7 Opioids in Colorado: What Do the Data Say? 7

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9 Opioids Are Driving the Rise in Overdose Deaths Total 152% Non- Opioid 66% Opioid 325% Source: CDPHE Vital Statistics 9

10 A Demographic Profile Deaths Due to Heroin or Opioid Painkiller Overdose Males more likely to die of a heroin overdose than females Highest death rate for heroin is the 26 to 34 age group Rates are highest for non-hispanic whites Source: CDPHE Vital Statistics 10

11 Source: SAMHSA 11

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13 What s Next for CHI? Introducing Teresa Mannochio Medication-assisted treatment brief 13

14 Opioids in Colorado Provider Perspective: Lisa Gawenus, Denver Health Statewide Perspective: Marc Condojani, Office of Behavioral Health 14

15 Medication Assisted Therapy: Methadone 15

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17 Understanding the medication Heroin Methadone Synthetic Opioid Each individual has a different dose stops cravings Controls physical symptoms not emotional desire 17

18 History of Methadone 1947 FDA Approved 1950 Treating heroin withdrawal 1964 Daily medication stabilizes heroin users 2015 EFFECTIVE 18

19 Deaths Related to Methadone Overdose Methadone comprises 5% Methadone is responsible for 33% Of total opioid prescriptions Of opioid overdose deaths 19

20 Special Populations Abrupt discontinuation of opioids in an opioiddependent pregnant woman can result in preterm labor, fetal distress, or fetal demise. 20

21 Neonatal Abstinence Syndrome (NAS) Expected and treatable condition that follows prenatal exposure to opioids Symptoms begin within 1-3 days after birth NAS occurs with notable variability 55-94% with symptoms Medication is required in approximately 50% of cases 21

22 Welcome to Fort Knox 22

23 42 CFR II SAMHSA CSAT Denver Health Hospital Authority DEA OBHS Signal Joint Commission Colorado Office of Behavioral Health 23

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30 HUB & SPOKE FQHC Private Prescriber Methadone Clinic Non-MAT Program 30

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32 Opioids in Colorado Provider Perspective: Lisa Gawenus, Denver Health Statewide Perspective: Marc Condojani, Office of Behavioral Health 32

33 33 Colorado Drug Trends Rebecca S. Helfand, Ph.D. Director of Data and Evaluation

34 Caveats Focus: Alcohol, Marijuana, Prescription Opioids, Heroin, Cocaine, and Methamphetamine Treatment admissions for OBH licensed facilities only Information based on Primary Drug only 34

35 35 Treatment Admissions Calendar Year % 1% 8% 3% 12% Alcohol - 59% Marijuana - 14% Cocaine - 3% 14% 59% Methamphetamine - 12% Heroin - 8% Prescription Opioids - 3% Other 1%

36 36 Regional Differences 2014 Drug 2015 Drug Region CO Population Marijuana Cocaine Meth Heroin Rx Opioids Region CO Population Marijuana Cocaine Meth Heroin Rx Opioids Northeast 13.0% 18.0% 7.2% 22.2% 7.9% 13.1% Denver / Boulder South Central 56.0% 46.4% 61.9% 38.7% 57.0% 44.8% 14.0% 15.8% 12.7% 17.8% 12.2% 12.9% Southeast 6.0% 10.0% 14.4% 8.6% 18.1% 21.7% Southwest 4.0% 2.5%.7% 4.5%.9% 1.9% Northwest 7.0% 7.3% 3.1% 8.2% 3.8% 5.6% Northeast 13% 17.2% 8.2% 23.5% 8.7% 14.9% Denver / Boulder South Central 56% 47.4% 68.3% 37.6% 51.3% 45.2% 15% 15.7% 8.9% 16.6% 11.5% 10.9% Southeast 5% 8.3% 11.5% 9.3% 22.4% 18.8% Southwest 4% 2.7%.7% 4.4% 1.7% 3.2% Northwest 7% 8.7% 2.4% 8.5% 4.5% 7.0%

37 37 Non-Medical Use of Prescription Opioids

38 Treatment Admissions Non-Medical Use of Prescription Opioids January 2008 December 2015 SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 38

39 39 National Prevalence Data National Survey on Drug Use and Health Data, SAMHSA

40 Non-Medical Use of Prescription Opioids by Age January 2008 December 2015 SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 40

41 Non-Medical Use of Prescription Opioids Age of First Use and First Treatment SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 41

42 Non-Medical Use of Prescription Opioids Treatment Admissions by Race and Gender SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 42

43 Non-Medical Use of Prescription Opioids Route of Administration SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 43

44 Heroin 44

45 Treatment Admissions Heroin January 2008 December 2015 SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 45

46 Heroin by Age January 2008 December 2015 SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 46

47 Heroin Age of First Use and First Treatment SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 47

48 Heroin Treatment Admissions by Race and Gender SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 48

49 Heroin Route of Administration SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 49

50 Injection Drug Use in Colorado SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) 50

51 Discussion Questions What are the policy opportunities that emerge from these perspectives? What can researchers, philanthropists and advocates do to fill the gaps? What stories do you have to illustrate the key barriers and solutions to this problem? 51

52 Alex Caldwell

53 2017 SNAC Labs April 12 May 31 July 26 October 4 December 6 53