The Opioid Epidemic in Alabama

Transcription

1 The Opioid Epidemic in Alabama The Problem and Ways to Address It Mark E. Wilson, MD Health Officer Jefferson County Department of Health

2 HEADLINE: Community action needed as heroin deaths rapidly climb (opinion from Joyce Vance) Special to AL.com, September 22, 2013 This is not your grandma s heroin. It is highly pure and deadly. The demographic for heroin use is: your children. This is not someone else s problem. We need a community-wide effort among educators, parents, medical workers to help those who are addicted, along with the work of law enforcement to attack the supply. It is easier to walk your child into a rehab center, than it is to say goodbye, forever, over a casket.

3 Heroin Deaths through 2013 Jefferson County, AL Source: Jefferson County Coroner s Office

4 The Pathway to Rising Heroin Deaths A Community Alert & Call to Action June 10, 2014

5 The United States Attorney s Office Addiction Prevention Coalition Community Foundation of Greater Birmingham Jefferson County Department of Health UAB School of Public Health UAB School of Nursing UAB School of Health of Professions UAB College of Arts and Sciences

6 Pills to Needles Initiative, August 2014 Purpose LONG-TERM: To create a comprehensive community network model responsive to important public health issues. SHORT-TERM: To reduce the ill-effects of heroin and prescription drug abuse through a collaborative community plan. Public Awareness To create a community communications plan to educate and raise awareness among parents, schools, churches, organizations and others. Partnership with Law Enforcement To develop creative partnerships and solutions to reduce the supply and use of heroin. S T R A T E G I C P R I O R I T I E S Medical Community Engagement S T R A T E G I C G O A L S To collaborate with medical professionals to address the overprescribing of controlled substances and to reduce unintended diversion of controlled substances. Effective Research and Policy To develop research partnerships that reduce heroin deaths and harm. To develop and promote policies that reduce heroin deaths and harm. Access to Resources To engage addicts, their families, the addiction treatment and advocacy communities to ensure optimal access to addiction resources and services.

7 The Scope of the Opioid Problem

8 Scope of the Problem: U.S. and Alabama Every day in the US, 91 people die of opioid overdose. We now lose more individuals to opioid overdose deaths than car accidents or homicides. 4 out of 5 heroin users start with an addiction to opioid pain medication. In 2016 Alabama recorded 756 overall drug overdose deaths (rate of 16.2 overdose deaths per 100,000) probably underreported.

9 Opioid Prescriptions per 100 people, 2016 (Centers for Disease Control)

10 CDC: Age-adjusted Rates of Overdose, 2016

11 Opioid prescriptions per 100 people, by County, 2016 (Centers for Disease Control)

12 Franklin 223 Walker 235 Jefferson 117 Tuscaloosa 111 Shelby 101 Sumter 41 Clarke 165 Mobile 136 Madison 114 Etowah 157 Calhoun 161 Coosa 25 Lee 65 Montgomery 88 Covington 171 Houston 143 Prescriptions per 100 people, 2016

13 Heroin Deaths Jefferson County, AL Source: Jefferson County Coroner s Office

14 Fentanyl Deaths Jefferson County, AL Source: Jefferson County Coroner s Office

15 Prescription Opioid Deaths Jefferson County, AL Source: Jefferson County Coroner s Office

16 Neonatal Abstinence Syndrome

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19 # of Infants with NAS, Alabama Alabama Medicaid Claims Data,

20 # of Infants with NAS Alabama (Rolling Annual Rate, BC/BS Claims) # of Infants with NAS July June 2013 July June 2014 July June 2015

21 % Infants with NAS Alabama (Rolling Annual Rate, BC/BS Claims) 0.90% 0.80% % Infants with NAS 0.70% 0.60% 0.50% 0.40% 0.30% 0.20% 0.10% 0.42% 0.58% 0.77% 0.00% July June 2013 July June 2014 July June 2015

22 Neonatal Abstinence Syndrome (2013)

23 Hepatitis C

24 Zibbell JE, Iqbal K, Patel RC, et al. Increases in Hepatitis C Virus Infection Related to Injection Drug Use Among Persons Aged 30 Years Kentucky, Tennessee, Virginia, and West Virginia, MMWR Morbidity and mortality weekly report. 2015;64(17):

25 UAB Emergency Department Universal Hepatitis C Testing October 15, 2015 to February 15, 2016 (Unpublished data from Jim Galbraith, MD, UAB Emergency Medicine, with permission) Total tested: 5,972 HCV-Ab+: 458 (7.7%) No. Tested, n HCV-Ab +, n (%) No. Tested, n HCV-Ab +, n (%) Born Total 2, (10.5) Sex Male 1, (14.8) Female 1, (6.2) Race White 1, (9.5) Black 1, (11.8) Other 39 3 (7.7) Missing 15 0 (0.0) Insurance Type Commercial (4.8) Medicare (9.5) Medicaid/Public (16.9) Uninsured (17.1) Other/Missing (6.7) Born After 1965 Total 3, (6.0) Sex Male 1, (8.5) Female 2, (4.1) Race White 1, (11.7) Black 2, (2.0) Other 96 1 (1.0) Missing 55 4 (7.2) Insurance Type Commercial 1, (2.2) Medicare (6.4) Medicaid/Public (5.1) Uninsured 1, (9.5) Other/Missing (9.0)

26 H.I.V.

27 Scott County, Indiana Rural county Baseline average of < 5 new HIV cases per year Sudden, major outbreak of HIV 135 cases within 6 months Virtually all cases linked to injection drug use (sharing needles), either directly or via sexual transmission from injection drug user.

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29 Scott County, Indiana CDC called in, recommended needle exchange service After deliberation and delay, Governor Pence ordered needle exchange Outbreak completely halted by end of one year Total new HIV cases in outbreak: 181 Most also had Hepatitis C Estimated lifetime cost to treat: $70 Million

30 County-level Vulnerability to an Outbreak of HIV and HCV Infection among PWID (Top 5%) Walker, Winston, Marion and Franklin Counties Van Handel MM, Rose CE, Hallisey EJ, Kolling JL, Zibbell JE, Lewis B, Bohm MK, Jones CM, Flanagan BE, Siddiqi A-E-A, Iqbal K, Dent AL, Mermin JH, McCray E, Ward JW, Brooks JT: County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States. J Acquir Immune Defic Syndr 2016;73(3):

31 Needle exchanges (a.k.a. syringe service programs) are currently illegal in Alabama due to drug paraphernalia laws.

32 The Nature of Opioid Addiction 1. It can happen to anyone 2. You may not be able to see any signs 3. Some addictions are first triggered by an injury or surgery and first opioid Rx 4. Teens and young adults are more susceptible 5. Culture & pill-for-everything mentality are factors 6. Addiction to opioid pills often progresses to injection use (heroin +/- fentanyl) 3 out of 4 per CDC. 7. Cravings for opioids become intense, they take over

33 The Nature of Opioid Addiction, continued 8. Withdrawal symptoms drive ongoing use 9. People with addiction deny or minimize problem when confronted 10. Many people who overdose are not alone 11. The relational/family impacts are significant (Message appeals to young invincibles, vs. Just say no! ) 12. Addiction is a chronic condition relapse is a hallmark 13. Very few addicts can stop on their own 14. Without drugs available to reverse overdoses, many addicts won t live to get into treatment/recovery

34 Ways to Address the Problem Main Categories 1. Awareness 2. Prevention 3. Harm Reduction 4. Addiction Treatment

35 AWARENESS Outreach to Schools, Parent Groups, Churches, etc. Media, Social Media, Videos, Websites Community events, speaking engagements REMOVE STIGMA! etc. Improved data collection and sharing

36 PREVENTION Disruption of Supply (Law Enforcement) Security and Disposal of Medicines (Drug Take-Back Events, Rx Drop Boxes) Youth Education, Engagement, Drug-proofing, Parental Involvement Smarter Prescribing Practices Better Addiction and Pain Management Training for Medical Providers Patient Education via Prescribers and Pharmacists Better Access to Mental Health Services (and recognition & destigmatization of mental health problems)

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38 (Local Police Stations) Walgreens 24-hr Pharmacies (July 2016: Hoover, Roebuck, Bessemer)

39 HARM REDUCTION Good Samaritan Laws [Access to Antidote = Naloxone (Narcan); 911 Caller Immunity] Blood-borne Disease Screening Education of Drug Users on safer practices Syringe Exchange Services Opioid Replacement Therapy (also part of Treatment )

40 2015: New Legislation in Alabama 911 Good Samaritan Bill - Immunity to prescribers of naloxone (opioid antidote) - Immunity to pharmacists who dispense - Immunity to those who assist overdose victims of administer naloxone - Law Enforcement Training - Limited immunity to 911 Caller

41 Opioid Overdose Kits with Narcan (naloxone)

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43 The Growing Necessity of Syringe Service Interventions in the US

44 TREATMENT Recognize: Not a one-size-fits-all approach Expand capacity for Medication Assisted Treatment [buprenorphine (e.g. Suboxone, Subutex), naltrexone (Vivitrol), methadone] coupled with high quality substance abuse counseling and recovery support including resources for poor and uninsured Establish best practices for Medication Assisted Treatment Better coordination of care Need for centralized go-to and navigator resource

45 TREATMENT, continued Funding Insurance Coverage Parity Drug Courts Law Enforcement Assisted Diversion (LEAD) Decriminalization of Addiction Sentencing Reform Chemical Endangerment Law Reform

46 Phone: (205)

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48 Alabama Opioid Council Data Committee Treatment/Recovery Support Committee Rescue Committee Prescriber/Dispenser Practices Committee Prevention/Education Committee Law Enforcement/Criminal Justice Committee

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50 What can YOU do, personally? Raise awareness Help remove stigma and punitive approach Be vigilant with kids/teenagers/young adults Safeguard your medicines Properly dispose of unused medicines Help start a Community Partnership

51 @jcdhtweets