New Jersey Mental Health and Addiction Providers Meeting April 26, Shereef Elnahal, M.D., M.B.A. Commissioner New Jersey Department of Health
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1 New Jersey Mental Health and Addiction Providers Meeting April 26, 2018 Shereef Elnahal, M.D., M.B.A. Commissioner New Jersey Department of Health
2 DOH Healthcare & Public Health Priorities Reduce disparities in public health outcomes Improve & expand access to medicinal marijuana Decrease maternal mortality & improve access to reproductive care Eradicate the opioid epidemic Increase health coverage & lower costs Enhance access and quality of mental health care Value-Based Care Interoperability
3 Eradicating the Opioid Epidemic $100M FY19 Budget $56M -Prevention, Treatment and Recovery $31 Million - Social Risk Factors $13 Million - Infrastructure and Data June 5 Population Health Opioid Summit
4 Opioid Addiction journey Incarceration
5 Prevention: Expansion of Medicinal Marijuana In States with Medicinal Marijuana Programs (compared to states without): 5.88% lower rate of opioid prescribing (Bradford, et al. JAMA Int. Med. 2018) million fewer daily doses filled (Bradford, et al. JAMA Int. Med. 2018) 24.8% lower mean annual opioid overdose mortality rate (Bachhuber, et al. JAMA Int. Med. 2014) And importantly the association strengthens with program expansion
6 Prevention: Effect trends stronger with expansion From: Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, JAMA Intern Med. 2014;174(10): doi: /jamainternmed Figure Legend: Association Between Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in Each Year After Implementation of Laws in the United States, Point estimate of the mean difference in the opioid analgesic overdose mortality rate in states with medical cannabis laws compared with states without such laws; whiskers indicate 95% CIs. Date of download: 4/16/2018 Copyright 2014 American Medical Association. All rights reserved.
7 Opioid Addiction journey Incarceration
8 Intervening Before Neonatal Abstinence Syndrome Since 2008, cases of NAS in NJ have doubled to 685 babies diagnosed in 2016 Most common substances used by NJ s pregnant women: Heroin (59.8%) Other opiates (9.7%) Marijuana (13.5%); and Alcohol (9.3%)
9 Opioid Addiction journey Incarceration
10 Treating Behind the Wall About 65% of 2.3M U.S. inmates meet medical criteria for substance abuse addiction But only about 11% actually receive treatment Risk of death from overdose in 2 weeks following release is 129 times general population. DOH Pilot Program John Brooks Recovery Center Mobile Van/Atlantic County Jail Began in August 2017 Served 204 people to date Source: National Center on Addiction and Substance Abuse Behind Bars II, Substance Abuse and America s Prison Population. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison a high risk of death for former inmates. N Engl J Med 2007
11 Treating Behind the Wall in Rhode Island Rhode Island Department of Corrections 1 st state to offer broad range of therapies & 3 forms of Medication Assistance Treatment (MAT) to all inmates Inmates can take methadone or buprenorphine for up to a year Vivitrol is given 1-2 months before release Counseling is provided along with MAT & continues after release Decedents: Recent Incarceration First 6 Months 2016 First 6 Months 2017 Decrease YES (65%) NO (3%) TOTAL (12%) Source: Green, et al. Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System. JAMA Psychiatry; Feb 2018
12 How can mental health and addictions treatment providers help NJDOH meet its public health objectives?
13 1. Provide your best practices for each stage of the addiction journey.
14 2. Provide your best practices for safe, high-quality inpatient mental health care. Operational tool kits that have led to superior results in your institutions, in the following areas: Minimizing inpatient suicide risk and optimizing mental health environment of care standards Minimizing patient-to-patient violence Offer a safe, rewarding and attractive professional working environment for providers, staff and management Fast, innovative recruitment and hiring of health care providers Strategies to incorporate use of APNs & PAs Ongoing/focused professional practice evaluations (OPPE/FPPE) JCAHO/Medicare Accreditation success Function as a collaborative partner in continuum of inpatient and outpatient BHS and community support services Support workforce development for professionals at all levels Support and encourage innovation in care delivery
15 Interoperability: The Case for Patients and Caregivers Your family member? You?
16 New Jersey Health Information Network: Interoperability as a Public Good Federal Trusted Data Sharing Organization (HIEs, ACOs and Health Systems and Hospitals) Master Person Index Communicable Disease NJDOH Data Hub Syndromic Surveillance Immunization Registry State Labs Specialized Registry TDSO Members: Clinicians, Health Systems, LTPACs iphd Pharmacies Retail Labs
17 3. What electronic health record (EHR) would you recommend? Inpatient care? Outpatient care? Comprehensive solutions?
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