Facing the Opioid Epidemic (FOE): Assessing and Responding to Prescription and Illicit Opioid Use and Misuse in 5 New England States

Transcription

1 Facing the Opioid Epidemic (FOE): Assessing and Responding to Prescription and Illicit Opioid Use and Misuse in 5 New England States T h o m a s J. S t o p k a, P h D, M H S L e o B e l e t s k y, J D, M P H P e t e r K r e i n e r, P h D L e o n a r d Y o u n g, M S, M A A l e x a n d e r W a l l e y, M D, M P H T r a c i G r e e n, P h D, M P H E A S T R E G I O N A L P M P C O N F E R E N C E O C T O B E R 2 6,

2 Overview Background: National Syndemic Opioid overdose epidemic Infectious disease epidemics Methods GIS mapping and spatial analysis Qualitative interviews Preliminary Results Ongoing research Discussion

3 Collaborative Team Tufts University School of Medicine: Thomas Stopka, Rachel Hoh MDPH PDMP: Leonard Young Northeastern University: Leo Beletsky, Sarah Seymour Brandeis University: Peter Kreiner, Erin Doyle Boston University: Traci Green, Alexander Walley

4 Opioid Epidemic in the United States Opioids killed 28,000 people in person every 18 mins. More than any year since CDC started collecting these data Source: CDC: million people in U.S. are addicted to opioids Rx abuse fastest growing drug problem 65% of worlds supply of Dilaudid (Hydromorphone) in U.S. 80% of worlds supply of OxyContin in U.S. 99% of worlds consumption of Vicodin in U.S. Source: National Rx Drug Abuse & Heroin Summit:

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6 Heroin in the United States The surge in prescription drug abuse has led to unprecedented rates of heroin use. No. of women using heroin doubled; No. of male users increased 50% from 2002 to 2013 (CDC) 75% of these new heroin users reported using prescription opioids first (JAMA Psychiatry, 2014). For the cost of a sandwich and coffee, one can get high on heroin Source: Johns Hopkins Magazine, Fall 2016:

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8 New York Times

9 Kieran Healy, Duke University

10 Overdose Counts & Rates in MA

11 Syndemic Synergistic interaction of two or more coexistent diseases and resultant excess burden of disease. Develop under conditions of health inequities related to poverty, stress and structural violence, and contribute to a significant burden of disease. Singer M., Clair S. Syndemics and Public Health: Reconceptualizing disease in bio-social context. Med Anthropology Quarterly. 2003

12 Annual number of deaths from Hepatitis C Virus (HCV) and all other 60 nationally notifiable infectious conditions* listed as multiple causes of death in the United States between 2003 and 2013 (Holmberg, 2016) * 61 infectious conditions, as reported to CDC

13 Greatest increase in HCV seen in non-urban, especially rural and Appalachian counties east of the Mississippi From: Suryaprasad et al, Clin Infect Dis 2014; 59:1411-9

14 HIV Outbreak in Austin, Indiana (Peters et al., NEJM, 2016) Austin population=4, HIV infections diagnosed Nov 2014-Nov % of patients reported injecting Rx opioid (Opana) 92.3% co-infected with HCV 157 had HIV sequences that were highly related

15 D. Meyers et al. PlosOne, 2014

16 D. Meyers et al. PlosOne, 2014.

17 Largest increases in HCV in Massachusetts among youth and young adults, 2002 and 2009 Source: Onofrey et al MMWR: May 6, 2011 / 60(17);

18 New England Progress with PMDPs

19 Vermont

20 Connecticut One of the top 10 states for dependence on illicit drugs among young adults (National Survey on Drug Use and Health ) Drug-induced death is currently the leading cause of injury-related death in Connecticut (ONDCP 2015)

21 Rhode Island In 2013, RI had the highest rate of illicit drug use in the nation. On June 28, 2016, RI Governor Gina Raimondo signed a series of bills to address opioid misuse and abuse in the state focused on opioid prescription limits, insurance mandates, and calls to improve the usefulness and value of State PDMP programs (National Academy for State Health Policy, 2016)

22 Maine Source:

23 Maine

24 Collaborative Study of Opioid Epidemic in New England Facing the Opioid Epidemic (FOE): Assessing and Responding to Prescription and Illicit Opioid Use and Misuse in Five New England States Funding: Tufts Clinical Translational Science Institute (CTSI) (PI: T. Stopka) 5/1/16-4/30/17

25 Specific Aims Specific Aim 1. Identify and compile publicly available and private data sources that can inform the current status of prescription and illicit drug availability across New England (CT, MA, ME, RI, VT). Specific Aim 2. Use GIS maps & spatial epidemiological analyses to characterize the geographic distribution and clustering of prescribed and illicit opioids across New England. Specific Aim 3. Conduct pilot qualitative in-depth interviews with key informants.

26 Design Overview To combine our multidisciplinary expertise and institutional infrastructure to gain a deeper understanding of PDMP data systems, how they are used, and to ultimately contribute to stronger, data-driven, and locally tailored approaches to curb the opioid epidemic in New England.

27 Methods Identification, Assessment & Use of Quantitative Data Focus on CT, MA, ME, RI, VT from 2011 to 2015 GIS Mapping and Geospatial Analyses Compilation of Spatially Oriented Data and Spatial Analyses Descriptive mapping Qualitative Data Collection and Analysis In-depth interviews with public health and public safety officials Discuss geo-narratives

28 In-Depth Interviews: Sample Frame

29 In-Depth Interviews: Instrument PDMP and related data: Please tell me about prescription drug monitoring or other datasets you use or have access to PDMP, PBSS, Medicaid, EMS, other Can you tell me about how you use these datasets? To start, please describe your typical interaction with the system(s) that you use Which variables within PDMP data are most helpful to your work? What is the utility and quality of these datasets?

30 In-Depth Interviews: Instrument Geo-narratives: What are your reactions to these maps? What story do you see being told in the maps? How do these maps square with your own professional experience in the community? What other types of data would you like to see mapped? How can PDMP data, including its geospatial characteristics, be used to inform community-level prevention efforts?

31 Naloxone Sales in 45% of MA Pharmacies Stopka, 2016 Under review

32 Next Steps Obtain and analyze data for New England states (Young, Kreiner, Doyle, Stopka): GIS and geospatial analyses of PDMP Data (Stopka, Hoh): Maps for: CT, MA, ME, RI, VT Hotspot cluster analyses Qualitative in-depth interviews in MA (Beletsky, Seymour) Public health officials, pharmacists, substance use treatment providers, medical examiners Public Safety officials, law enforcement, DAs Conduct analyses, interpret findings, disseminate results (Stopka, Young, Beletsky, Kreiner, Green, Walley)

33 We need your help Seeking PDMP data Municipality level ZIP Code level Suggestions for GIS maps and spatial analyses Mapping of Rx s for specific opioids Mapping of Rx s for Buprenorphine, Naloxone Ideas for key informants for in-depth interviews

34 Overview Background: National Syndemic Opioid and overdose epidemic Infectious disease epidemics Methods GIS mapping and spatial analysis Qualitative interviews Preliminary Results Ongoing research Discussion

35 Thank you! Questions? Thomas J. Stopka, PhD, MHS Assistant Professor Department of Public Health & Community Medicine Tufts University School of Medicine (617)