What does it mean? What can we do?

Transcription

1 PRESCRIPTION DRUG ABUSE IN ST. CLAIR COUNTY: What does it mean? What can we do? Annual Insurance Symposium May 8, 2013 Annette Mercatante MD, MPH Medical Health Officer St. Clair County Health Department

2 County Health Rankings & Roadmap

3 TAKE ACTION CYCLE Communities can work together to improve health by following the steps around the Take Action Cycle. Assess Needs & Resources Focus on What s Important Communicate Choose Effective Policies & Programs Act on What s Important Evaluate Actions Work Together

4 COUNTY HEALTH RANKINGS MODEL The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play.

5 ST. CLAIR COUNTY HEALTH FACTORS St. St. Clair Clair County County Ranks Ranks 54 out of out of 82

6 ST. CLAIR COUNTY HEALTH OUTCOMES St. St. Clair Clair County County Ranks Ranks 67 out of out of 82

7 Prescription Drug Abuse

8 A NATIONAL EPIDEMIC

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10 YOUNG ADOLESCENTS In 2010, High School Seniors: 1 in 12 reported using Vicodin for non-medical reasons 1 in 20 reported abusing OxyContin There s a link between Rx drug abuse and higher rates of smoking, heavy episodic drinking, and marijuana, cocaine, and other illicit drug use among year olds.

11 In 2009, deaths from drug overdoses continues to climb: Opioids Methadone Heroin Cocaine Opiate addiction treatment has quadrupled from with the highest rates in ages Traffic deaths involving Opiates has increased 40% from

12 ALARMING TRENDS - ST. CLAIR COUNTY Since drug related deaths have steadily increased Majority of drug deaths are accidental due to taking multiple prescription medications 8% of our youth sought treatment for: other Opiates or Synthetics through CMH-Thumb Alliance Coordinating Agency (those with Medicaid or no insurance)

13 ACCIDENTAL DEATHS MEDICAL EXAMINER (ME)

14 2011 MAPS DATA COUNTY STIMULANTS HYDROCODONE OXYCODONE METHADONE Units Per Capita Units Per Capita Units Per Capita Units Per Capit a Jackson 1,265, ,325, ,624, , Lapeer 660, ,179, , , Macomb 8,740, ,107, ,299, ,680, Monroe 1,264, ,270, ,947, , Sanilac 318, ,943, , , St. Clair 2,481, ,042, ,698, , Michigan 92,084, ,646, ,947, ,980,

15 UNINTENTIONAL CONSEQUENCES Law Enforcement increased in home invasions countywide SCC Intervention Center - 80% of prisoners are poly-drug users (survey indicated) Day Treatment /Night Watch Program - 80% of youth are drug users (survey indicated) Local Hospital ER s - increased in the number of people seeking pain medications (included repeaters)

16 DRUG & ALCOHOL EXPOSURE In St. Clair County, babies who were born with drug or alcohol exposure are referred to the Early On program

17 RX ACCESS POINT

18 A national survey published in the Archives of Families Medicine in 201ArchiShanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:

19 Prescription Drug Abuse

20 PRESCRIPTION DRUG ABUSE WORKGROUP ST. CLAIR COUNTY Workgroup formed under the Community Services Coordinating Body (CSCB) February 2012, Community Kick Off meeting: Workgroup agreed RX Drug Abuse is an issue locally Created two Committees due to complexity of issues: 1) Medical 2) Community October 2012, sponsored a Community Symposium at SC4

21 CSCB PRESCRIPTION DRUG ABUSE WORKGROUP MEMBERS

22 Prescription Drug Abuse

23 Education PILLARS OF RESPONSE A crucial first step in tackling the problem of prescription drug abuse is education of: Parents, youth, and patients about the dangers of abusing prescription drugs. All prescribers on the appropriate and safe use. Everyone on proper storage and disposal of prescription drugs. Monitoring Implement Prescription Drug Monitoring Programs (PDMPs) in every state to reduce doctor shopping and diversion. Enhance PDMPs to ensure data can be shared across states and used by healthcare providers.

24 PILLARS OF RESPONSE Including Proper Medication Disposal Develop convenient and environmentally responsible Drug Monitoring Programs (PDMPs) to help decrease the supply of unused prescription drugs in the home. Enforcement Provide law enforcement with the necessary tools to eliminate improper prescribing practices and stop pill mills.

25 PAIN CONTRACT Develop a county-wide Pain Contract that is used consistently (Suggestion from the CSCB s Medical Committee) Pain Contract Key Components: Report honestly Obtain drug information from one resource Utilize MAPS and USG Report outcomes and noncompliance

26 Pain Medication Agreement Physician Signature: Date: I agree to the following guidelines for continued treatment for my pain with Dr. I agree: 1. To take all medications as prescribed by Dr. and I will report honestly the effects of the medication during follow-up appointments. 2. To NOT seek or accept any pain medication from any other doctor / dentist / Emergency Room / Urgent Care Clinic, family, friends or anyone on the street etc. 3. Refills will be provided only as the previous prescription ends and at the sole discretion of the physician. Refills may be requested by phone 4. To report immediately any severe reactions I am having as a result of the medication to my doctor 5. Tell this doctor about all medications, including all over the counter medicines, vitamins, and herbal medicines I am taking 6. Get all medications from one pharmacy: Name of Pharmacy Address: Phone Number: I understand that the pharmacy will be listing all pain medication into the statewide data system called MAPS and that my physician has access to this information as a way to help monitor my case. 7. To comply with any drug screening required by my doctor. 8. To follow through with my physicians recommendations and referrals. Examples could be: physical therapy, support group, behavioral pain management program etc. 9. That lost or stolen medication will not be refilled under any circumstances. It is my responsibility to protect and secure any medication by locking it up at all times when not in use 10. Not use any alcohol, illegal drugs or street drugs, sedatives or other pain medication without telling my doctor. 11. Not share, sell or trading my medications to any other person under any circumstances. 12. That there are risks and possible side effects of taking opioid medication to clinically treat my pain, and that this medication is intended to increase my ability to do more with pain, and is unlikely to eliminate my pain completely. 13. That if there is evidence that I am no longer receiving therapeutic benefit from the medication, or my doctor determines that I am no longer a good candidate to continue the medication it is in my best interest to stop it. I realize that if I do not agree with or break this contract that the doctor / patient relationship may be in jeopardy. Dr. has the right to: No longer prescript opioids medication Refer me to be seen by another specialist No longer agree to treatment me Prescribe non- opioid medications Refer me to substance use treatment or some other outpatient program I agree that I have full right and power to sign and be bound by this agreement, and that I have read, understand, and accept all terms. Patient Signature: Date:

27 SAFE STORAGE Take inventory of your prescription and all over-thecounter medicines have patient monitor the contents. Store all medications in original container in a safe, secure, dry place, out of reach from a pet, child, teenager, or stranger. Secure your medicines in locked boxes; storing Opioids in several locations around the home is not recommended. Caregivers or guardians should have access to the patient s locked box. Resource: ugclass/ucm htm

28 PROPER DISPOSAL SCC Sheriff Department DEA Drug Take Back Program yearly Rx Drug Abuse Workgroup is exploring starting the Red Barrel Campaign What about your office? Follow Disposal Guidelines: No matter who you are, you can help address this issue in your home. By following the guidelines, you reduce the risk of unintentional diversion or harm. m htm

29 PREVENTION Communicate with all referrals Communicate with other providers Develop a communication system with frequently used specialists and ancillary healthcare providers in your community Tell the providers what you need to know when you see their patients! Utilize a pain contract Ask your patients about all medications; including over-the-counter and herbal Utilize MAPS Don t t just say it do it!

30 BEST PRACTICE Use MAPS for Opioids prescriptions every patient Have your MA pull MAPS every 3-4 months on chronic RX more often as needed, along with vitals Educate every patients about MAPS what it will mean if MAPS indicates filling Rx from multiple or undisclosed providers (part of pain contact) Implement a pain contract when appropriate

31 URINE DRUG SCREEN Used (typically) for compliance and monitoring for use on non-prescribed and illicit substances Used in non-confrontational and open minded formats Clinical utility is still being debated Know your lab and parameters; including false positives, negatives and limits of specificity Urine drug concentrations tend be higher than serum Allow longer detection times Be aware of adulteration and subversion in UDS

32 l a c i d e M CSCB mittee Com ings t Mee WHEN? 4th Thursday o f ev er y mo nt h WHERE? St. Clair Coun ty Health Dep a r tm en t TIMES? Physicians - 7 :30 a.m. Committee - 1 :00 p.m. Lets Work Together to Help Put a Dent in this Community Issue!

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34 Clinic Services : Confidential testing, diagnosis, treatment, counseling and education for STIs. Anonymous and confidential HIV counseling and testing. Pregnancy testing Head lice diagnosis and education Preventative Health: Diagnostic, testing, treatment, follow-up and surveillance of communicable diseases Vision and Hearing Services

35 Educational: Programs Presentations Resources Consultations Services: Schools Groups Community Outreach Services: Visit Amy Bishop at the SCCHD Table

36 Childhood, Adolescent, and Immunizations Titers for Immunity TB Testing Travel Consultations with Vaccines Dispense Biologics Vaccine for Children (VFC) Program

37 Women, Infants & Children Maternal Infant Health In-Home Pregnancy Education Childbirth & Parenting Education Referrals for Baby Supplies Transportation Help Breastfeeding Support Hearing & Vision Screening

38 (810) Campus of Port Huron High School A medical clinic that provides teen focused educational programs, primary acute and chronic health care to adolescents years. Services: Physical examinations (including sports physicals) Immunizations STI testing and treatment HIV counseling and testing Mental health counseling referral

39 REFERENCES National Resources: 1. Highlights of the National Institute on Drug Abuse s 2011 Monitoring the Future Survey (this includes survey data on high school students 2. Epidemic: Responding to the American s Prescription Drug Abuse Crisis 2011 Presidential Report 3. CSC Morbidity and Mortality Weekly CSC Grand Rounds: Prescription Drug Overdoses a US Epidemic 4. The New York Times Money & Policy October 4, NIDA Research Report Series What is Prescription Drug Abuse? 6. Pharmacy Insights A Look at: Prescription Medication Abuse by Michigan Pharmacists Association 7. CSCB Policy Impact: Prescription Painkiller Overdoses

40 REFERENCES Michigan Resources: 1. Report on the 2009 Prescription and Over the Counter Drug Abuse Summit MDCH bureau of BSAAS 12/8/10 2. Prescription and Over the Counter Drug Abuse Strategic Plan Oct 1, 2012 September 30, MAPS 2010, 2011, & Youth Behavioral Risk Assessment Local Resources: 1. Information from the SCC Sheriff Drug Task Force 2. Information from the SCC Medical Examiner s Office 3. Information from SCC RESA - Early On Program 4. Information from SCC Community Mental Health 5. Information from the SCC Sheriff Department on Suicide Attempt

41 St. Clair County Health Department Annette Mercatante MD, MPH Medical Health Officer th Street Port Huron, MI Phone: (810)