The Opioid Addiction Emergency In Virginia June 8, 2017

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1 The Opioid Addiction Emergency In Virginia June 8, 2017 Marissa J. Levine, MD MPH State Health Commissioner Virginia Department of Health

2 Chronic Disease of Addiction Definition: A primary, chronic disease of the brain Addiction shares many similarities to the disease of depression including permanent changes to brain function. Treatment for both conditions is effective. Normal brain function is hijacked. Image to left shows how disease of addiction changes brain function similar to heart disease. 24,542 years of potential life lost (to age 65) from overdose - more than diabetes, liver disease, or cerebrovascular disease. Rate of neonatal abstinence syndrome doubled from 2009 to JLARC estimates that untreated substance abuse costs Virginia state and local governments $613 million per year in public safety and health care services alone. Much of the cost is driven by public safety expenses (i.e. jail, police, prison costs) along with health care costs for expensive co-morbidities such as HIV/AIDS, Hepatitis B and C, and kidney failure. 700% Return on Investment (ROI). Virginia saves $7 for every $1 invested in treatment.

3 TOP 3 METHODS OF UNNATURAL DEATH Total Number of Motor Vehicle, Gun, and Drug Related Fatalities by Year of Death, Number of Fatalities * Motor Vehicle Related Gun Related Fatal Drug Overdose Top 3 methods of death (motor vehicles, guns, and drugs) include all manners of death (accident, homicide, suicide, and undetermined)

4 ALL FATAL DRUG OVERDOSES Total Number of Fatal Drug Overdoses by Quarter and Year of Death, % 1200 Number of Fatalities * Q Q Q Q Total Fatalities

5 ALL OPIOIDS Total Number of Fatal Opioid Overdoses by Quarter and Year of Death, % Number of Fatalities * Q Q Q Q Total Fatalities

6 OPIOIDS- A DIFFERENT PERSPECTIVE Total Number of Prescription Opioid (excluding Fentanyl), Fentanyl and/or Heroin, and All Opioid Overdoses by Year of Death, Number of Fatalities * All Opioids Prescription Opioids (excluding fentanyl) Fentanyl and/or Heroin

7 FENTANYL (RX, ILLICIT, AND ANALOGS) 700 Total Number of Fatal Fentanyl Overdoses by Quarter and Year of Death, % Number of Fatalities * Q Q Q Q Total Fatalities

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9 Count of Emergency Department Visits for Unintentional Overdose by Heroin among Virginia Residents by Month, Count of Visits Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Month of Visit The Virginia Department of Health receives data on visits to 82 acute care hospital emergency departments (EDs) and 13 free-standing EDs in Virginia for purposes of public health surveillance. Chief complaint and discharge diagnosis are analyzed to identify visits for acute, unintentional overdose by heroin. Out-of-state visits among Virginia residents and in-state visits of non-virginia residents are not included.

10 Rate of Emergency Department Visits for Unintentional Overdose by Heroin among Virginia Residents by Month and Health Region, Previous 12 Months Rate of Visits per 100,000 Population May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr Month of Visit Central Eastern Northern Northwest Southwest

11 Rate of Emergency Department Visits for Unintentional Overdose by Heroin among Virginia Residents by Month and Health District, Previous 12 Months Rate of Visits per 100,000 Population May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Month of Visit Portsmouth Rappahannock Rapidan Roanoke Lord Fairfax Norfolk Top 5 health districts with highest average overdose rate for previous 12 months 3 health districts (Roanoke City, Portsmouth, Rappahannock-Rapidan) among top 5 for both overdose by opioid/unspecified and overdose by heroin

12 Stig-ma 1. a mark of disgrace associated with a particular circumstance, quality, or person: "the stigma of mental disorder"

13 The sense of stigma is most likely to diminish as a result of public education and broader acceptance of addiction as a treatable disease. Institute of Medicine

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15 15 Executive Leadership Co-Chairs: Secretary of Health &Human Resources William A. Hazel, Jr., MD Secretary of Public Safety & Homeland Security Brian J. Moran Policy and Legislative Recommendations Goal Setting : State Support Local Support VSP Region 1 VSP Region 3 VSP Region 5 VSP Region 7 VSP Region 2 VSP Region 4 VSP Region 6 Local needs, implementation of prevention strategies, efforts, scoring Resources, consultation, programs, policy interventions

16 Public Health Approach Data and Surveillance Prevention Screening/Treatment Harm Reduction Provider-level Education (Prescription Monitoring, Safe Prescribing Practices, Risk Assessment, Safe drug storage, Injury prevention) Increase Access to Substance Use Disorder services via Project ECHO Testing and Treatment for Infectious Disease (HIV, HCV, STI) Support enhancements to Prescription Monitoring Program Establish a policy-focused coalition to develop standardized, evidence based opioid prescribing and treatment guidelines Medication Assisted Therapies Addiction Disease Management Provider Trainings Increase Access to Naloxone Establish Perinatal Collaborative : Improving care for infants and families influenced by Neonatal Abstinence Syndrome Syringe Services Programs Leadership

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18 Before ARTS Medicaid Provider Network Adequacy Opioid Treatment Program Source: Department of Medical Assistance Services - Provider Network data (March 20, 2017). Circles # of Medicaid providers included in network adequacy access calculation. Accessible is considered to be at least two providers within 60 miles of driving distance. Driving distance is calculated by Google services based on the centroid of each zip code.

19 After ARTS Medicaid Provider Network Adequacy Opioid Treatment Program Source: Department of Medical Assistance Services - Provider Network data (March 20, 2017). Circles # of Medicaid providers included in network adequacy access calculation. Accessible is considered to be at least two providers within 60 miles of driving distance. Driving distance is calculated by Google services based on the centroid of each zip code. 19

20 opioid-overdose/

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23 Resources VaAware Data, Services and Other Resource VDH Opioid Dashboard: Virginia Department of Health Opioid website: