Maine s Response to the Opiate Crisis. Christopher Pezzullo, DO State Health Officer Maine DHHS Maine CDC November 12, 2016

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1 Maine s Response to the Opiate Crisis Christopher Pezzullo, DO State Health Officer Maine DHHS Maine CDC November 12, 2016

2 Required Disclosure Text Font typically Times New Roman at least 20 point Try to have size consistent throughout Department of Health and Human Services 2

3 Unintentional Injury Deaths in Maine, By Type: In 2014, there were 208 drug-related overdose deaths compared to 131 motor vehiclerelated deaths Source: Office of the Chief Medical Examiner, Maine Bureau of Highway Safety/Maine Department of Transportation Department of Health and Human Services 3

4 Number of Drug Deaths in Maine Involving Specific Drug Types*: 2014** In 2014, more than one in three overdose deaths involved benzodiazepines. More than one in four overdose deaths involved heroin/morphine. *Some deaths may be caused by more than one key drug. **2014 results are preliminary ***Deaths caused by known pharmaceutical morphine removed from total. Source: Marci Sorg, Margaret Chase Smith Policy Center at University of Maine, Office of the Chief Medical Examiner Department of Health and Human Services 4

5 Heroin-Related Death Overdoses, Maine vs. Nation: Source, National Data: USCDC; Multiple Cause of Death Files from the National Vital Statistics System, Source, Maine Data: Maine Department of Health and Human Services, Office od Research, Data and Vital Statistics Department of Health and Human Services 5

6 Number of Drug Affected Baby Notifications* in Maine: In 2014, there were a total of 976reports of drug affected babies and 995 in From 2005 to 2014, the number of drug affected baby notifications increased by 480%. *This measure reflects the number of infants born in Maine where a healthcare provider reported to OCFS that there was reasonable cause to suspect the baby may be affected by illegal substance abuse or demonstrating withdrawal symptoms resulting from prenatal drug exposure (illicit or prescribed appropriately under a physician s care for the mother s substance abuse treatment) or who have fetal alcohol spectrum disorders. Source: Office of Child and Family Services (OCFS), Maine Automated Child Welfare Information System Department (MACWIS). of Health and Human Services 6

7 Additional Facts.. Maine is the #1 state in per capita long acting/extended release opioid prescriptions (USCDC, 2012). In 2014, more than 80 million opioid pills were prescribed in Maine. Studies have shown that greater than 75% of heroin users utilized prescription painkillers as their gateway. Department of Health and Human Services

8 Substance Abuse Treatment Spending in Maine In 2015, Maine spent more than $70 million on substance abuse treatment, an increase of 25% since Spending (in Thousands) Department of Health and Human Services 8

9 Maine Spending Per Capita Maine s per capita and GDP spending on substance abuse treatment is higher than the national average and greater than many of our counterparts in the Northeast. Note: This data reflects spending by the State Substance Abuse agencies only. It does not include Medicaid expenditures. Source: The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation; Substance Use Disorders and the Role of the States; March Based on 2013 data. Department of Health and Human Services 9

10 PL c. 488 Background In March 2016, under the LePage Administration, a bill was introduced and ultimately passed to combat Maine s opiate crisis. PL 2016, Chapter 488, An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program was passed in April 2016, and went into effect July 29, Department of Health and Human Services 10

11 Prescription Limits Morphine Milligram Equivalents (MMEs) Applies to new opioid patients, effective July 29, 2016 May not prescribe any combination of opioid medication in an aggregate amount of more than 100 MMEs per day Existing opioid patients with active prescription in excess of 100 MMEs per day as of July 2016 ( legacy patients ) From effective date of law until July 1, 2017, may not prescribe any combination of opioid medication in an aggregate amount of more than 300 MMEs per day Exceptions are granted for medical necessity that is documented in the medical record until January 1, 2017, or the effective date of the DHHS rulemaking on exceptions, whichever is later Department of Health and Human Services 11

12 Prescription Limit Exceptions When prescribing for: Active or aftercare cancer treatment Palliative care End-of-life hospice care Medication-assisted treatment for substance abuse disorder When directly ordered or administered in: An emergency department An inpatient hospital A long-term care or residential care facility Department of Health and Human Services 12

13 Prescription Limits for Opioid Medications Acute Pain Script may not be written for more than a 7-day supply Chronic Pain Script may not be written for more than a 30-day supply Department of Health and Human Services 13

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16 Prescriber Responsibilities Required PMP check as of January 1, 2017 Upon initial prescription of benzodiazepine or opioid medication Every 90 days thereafter for chronic prescriptions Exception A PMP check is not required for benzodiazepine or opioid medication that is directly administered in an emergency room, an inpatient hospital, a long-term care facility or a residential care facility Department of Health and Human Services 16

17 Prescriber Responsibilities Electronic Prescribing as of July 1, 2017 All prescribers with the capability to electronically prescribe must prescribe opioid medication electronically A waiver may be available in some circumstances Continuing Education as of December 31, 2017 A prescriber must complete three hours of CME on the prescription of opioid medication every two years as a condition of prescribing opioid medication Department of Health and Human Services 17

18 Other DHHS Initiatives: Maine DHHS, in coordination with 2-1-1, has established a 24/7 resources line for individuals struggling with addiction. Line provides a direct referral and warm hand-off to appropriate services. With more than 1,000 babies born drug-affected every year, DHHS has placed a particular focus on supporting pregnant moms through this resource line. Department of Health and Human Services 18

19 Other DHHS Initiatives: Medication Assisted Therapies Medication-assisted therapies (MATs) (e.g., methadone, Suboxone) must be comprehensive and treatment must be held to the same clinical standards as other chronic conditions. Maine DHHS has promulgated new Medicaid rules for MAT to help ensure appropriate behavioral health services are utilized, a comprehensive treatment plan is developed and adhered to, and that individuals not succeeding with their current treatment modality move to another treatment modality. Department of Health and Human Services 19

20 Other DHHS Initiatives: Medication Assisted Therapies Vivitrol, a MAT that suppresses the effects of opioid addiction by eliminating withdrawal symptoms, can help keep a person with substance abuse disorder from relapsing. Maine has developed a pilot that will provide monthly Vivitrol injections and therapy to more than 600 individuals over the next three years. The target populations for the pilot are youth, young moms who have been involved in the criminal justice system and individuals currently incarcerated to help them maintain abstinence upon release. Department of Health and Human Services 20

21 Other DHHS Initiatives: Serving the Uninsured The Office of Substance Abuse and Mental Health Services (SAMHS) funds more than $20,000,000 in substance abuse treatment and prevention services for the uninsured. Additionally, SAMHS is reforming the payment structure for the uninsured to focus spending directly on the individual with substance abuse disorder. Department of Health and Human Services 21

22 Other DHHS Initiatives: Protecting Kids More than 60% of the children coming into the State s protective custody is due to parental substance abuse as a risk factor. DHHS has launched an innovative pilot designed to support vulnerable and at-risk families by co-locating parenting education and substance abuse services. At least 250 eligible parents will receive coordinated, concurrent and co-located parent education and substance abuse treatment services. Department of Health and Human Services 22

23 Questions? Dr. Christopher Pezzullo State Health Officer Department of Health and Human Services 23