DPH programs related to opioid use disorder. Judith Martin, MD Medical Director of Substance Use Services SFDPH

Transcription

1 DPH programs related to opioid use disorder Judith Martin, MD Medical Director of Substance Use Services SFDPH

2 Opioid safety, SF timeline

3 Opioid agonist treatment: methadone Seven clinics contract with DPH, with 25 programs. Includes outreach with vans Includes continued treatment in jail Includes enhanced perinatal support Includes maintenance and detoxification Includes hospital starts Includes primary care methadone OBOT Includes facilitated entry from outreach to homeless Includes centralized after- hours intake

4 THE DOSING WINDOW

5 Opioid treatment programs did well with enrollment of uninsured to DMC 3,500 Drug Medi-Cal served, methadone 3,000 2,500 2,000 1,500 1, DMC, MMT FY FY FY 14-15

6 Number served and funding, Methadone Treatment. Rise in DMC Persons served, DMC FY FY FY ,041 2,522 2,882 DMC funding 8,709,492 8,813,908 10,932,343 Total funding 13,609, , 868,386 15, 687, 279

7 SFDPH, methadone treatment numbers One month spot check: January ,504 total patients, 2,438 (85%) Medi-Cal Expected: continued enrollment of uninsured eligible patients to Medi-Cal. Changes related to parity and DMC/ODS 1115 Waiver include removal of counseling limit, and regulations to include buprenorphine within OTP.

8 SFDPH, Buprenorphine treatment Integrated model into primary care and mental health clinics Support for induction at 1380 Howard, between new patients per month. BHS Pharmacy contributes observed dosing and medication advice by specialized clinical pharmacist. BHS pharmacy provides medication for uninsured patients and for OBIC patients during stabilization. Estimated 100 patients dosing at window. Buprenorphine starts in jail began in Fall 2013 about 50% show up at OBIC upon discharge (so far about 50 patients) Buprenorphine starts at SFGH being piloted now Buprenorphine integrated into residential care and residential detoxification.

9 Transition to DMC, buprenorphine Transition of eligible patients to DMC, they become able to pick up medication at retail pharmacies. Census at BHS pharmacy limited to stabilization period. Reduction from 200 to 100 on average who pick up at Freed up capacity for new inductions.

10 Highlights: integration Overall wellness and recovery model in BHS. Marker of wellness in SUD is ability to manage the illness in primary care. DPH provides primary care methadone (OBOT). Patients of DSAAM, managed at Tom Waddell Urban Health clinic, at Potrero Hill Health Center, and Ward 86. Primary care physicians order the methadone, counseling provided on site. DPH provides primary care buprenorphine with qualified physicians at the clinics. Support from OBIC staff and BHS pharmacy

11 Primary care in methadone clinics: Four of the methadone clinics offer significant medical care on site. One clinic offers HIV positive prevention and antiviral dosing (Ward 93) One clinic treats hepatitis C and has a hepatitis support group (BAART Turk) Two clinics have a primary care medical home on site. (BAART Turk and Market)

12 What about chronic pain and opioids? Coordination relates to medication safety- chronic pain management workgroup participation, benzodiazepine prescriptions reduction. Sedative-hypnotic safety in mental health reduced prescriptions to patients on methadone maintenance. Training provided on comorbid pain and addiction, and use of buprenorphine in that population.

13 40.00% Percent MH clients with sedative-hypnotic prescription (red is methadone maintenance patients) 35.00% 32.75% 33.33% 32.55% 34.09% 35.06% 32.20% 34.92% 34.84% 31.33% 30.00% 26.53% 26.72% 25.00% 24.68% 22.71% 20.00% 15.00% 15.27% 14.85% 15.64% 15.16% 15.43% 15.07% 14.71% 15.26% 15.25% 14.78% 14.03% 14.62% 15.80% 15.79% 15.89% 15.83% 15.23% 14.72% 14.67% 14.72% 13.93% 13.71% 15.60% 15.39% 13.70% 12.64% 10.00% 5.00% % 18 and over on SedHyp % 60 and over on SedHyp %18 and over on MM and SedHyp 0.00%

14 Other initiatives: naloxone Naloxone rescue provision at opioid treatment programs and for primary care prescriptions of opioids. Naloxone rescue at jail release. Naloxone rescue for buprenorphine patients at the BHS pharmacy window.

15 Summary: Opioid use disorder treatment Robust system, with no wrong door for starting treatment of opioid agonist Wellness model, with treatment for stable patients located at medical home. Integrated care for needle-related chronic illness such as HIV and hepatitis C at OTPs. Safety and overdose rescue with reduced sedative-hypnotics, safer use of opioids for pain, and increased access to naloxone rescue. Excellent ongoing transition to expanded Medi-Cal benefit.