OPIOID OVERDOSE EPIDEMIC: What Healthcare Providers Need to Know

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1 OPIOID OVERDOSE EPIDEMIC: What Healthcare Providers Need to Know WHAT S NEW UPDATE CUMBERLAND, MD Renata J. Henry, M.Ed. Director, Central East ATTC March 16, 2016 Behavioral Health is Essential to Health Prevention Works Treatment is Effective People Recover

2 CENTRAL EAST ATTC Funded by SAMHSA Accelerate the adoption and implementation of evidence based and promising practices to treat addiction and co-occurring disorders; Increase the awareness, knowledge, and skills of the BH workforce; and Training, technical assistance, and education.

3 SERVING HHS REGION III Delaware District of Columbia Maryland Pennsylvania Virginia West Virginia

4 GOALS FOR TODAY 1. Understand factors that contribute to the epidemic 2. Describe Maryland s epidemiology 3. Understand the multiple health implications of opioid abuse and addiction 4. Describe efforts to reduce the impact of the epidemic 5. Identify strategies to use with patients in multiple care settings

5 EPIDEMIC DEFINED The CDC's official definition of an epidemic is: "The occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time. Between 2002 and 2013 the rate of opioid related overdose deaths has quadrupled Heroin use has increased across the US among men and women, most age groups, and all income levels Deaths from prescription opioids have quadrupled in the past decade

6 NEW DATA people die each day Nearly every aspect of the epidemic worsened Overdose deaths increased significantly: Opioid pain relievers 16% Heroin 28% Synthetic opioids (fentanyl, tramadol) 80%

7 PRESCRIPTION DRUG ABUSE IS A MAJOR PUBLIC HEALTH PROBLEM/EPIDEMIC In the US, 44 individuals die from an overdose of prescription painkillers each day Drug overdose deaths involving prescription pain medications have quadrupled since 1999 From 1999 to 2013 the amount of prescription opioids dispensed in the U.S. nearly quadrupled Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a 30 day supply Overdose rates are higher in states where prescription painkillers are prescribed more frequently.

8 PRESCRIPTION DRUG ABUSE IS A MAJOR PUBLIC HEALTH PROBLEM/EPIDEMIC SOURCE: IMS, National Prescription Audit (NPA), 2012

9 WHAT IS PRESCRIPTION DRUG ABUSE/NONMEDICAL USE? Taking a medication that has been prescribed for somebody else. Taking a drug in a higher quantity than prescribed. Taking a drug in another manner than prescribed. Taking a drug for another purpose than prescribed.

10 MOST ABUSED PRESCRIPTION DRUGS Opioids: Hydrocodone (Vicodin ), Oxycodone (OxyContin ) Central Nervous System Depressants: Diazepam (Valium ), Alprazolam (Xanax ) Stimulants: Methylphenidate (Ritalin and Concerta ), Amphetamines (Adderall )

11 RISK GROUPS FOR PRESCRIPTION DRUG ABUSE/OVERDOSE Men ages White and American Indian/Alaska Natives People in rural areas, especially in the Appalachian region People who obtain multiple controlled substance prescriptions from multiple providers Teens and young adults (One in four teens has misused or abused a prescription drug at least once in their lifetime) People who take high daily dosages of opioid pain relievers (veterans with injuries, those with occupational injuries, chronic pain

12 TODAYS HEROIN EPIDEMIC Heroin use is increasing: 145% since 2007 Between 2000 and 2014 the rate of heroinrelated overdose deaths quintupled Some of the greatest increases in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes Key market factors driving the increase: Low cost, high purity, availability

13 RISK FACTORS/GROUPS FOR HEROIN ABUSE People who are addicted to prescription opioid painkillers are at most risk for addiction to heroin People who are addicted to cocaine People without insurance or enrolled in Medicaid Non-Hispanic whites Males People living in a large metropolitan areas, particularly in the Northeast and Midwest CDC-2014

14

15 HOW IS HEROIN HARMFUL? Heroin is an illegal, highly addictive opioid drug A heroin overdose can cause slow and shallow breathing, coma, and death People often use heroin along with other drugs or alcohol. This practice is especially dangerous because it increases the risk of overdose Heroin is typically injected but is also smoked or snorted. When people inject heroin, they are at risk of serious, long-term viral infections such as HIV, Hepatitis C, and Hepatitis B, as well as bacterial infections of the skin, bloodstream, and heart

16 HEPATITIS EPIDEMIC 150% increase in new infections Almost 50% of new cases associated with injection drug use Occurring in young people (<30), in rural and suburban areas Use of oral prescription opioids before transitioning to injecting ATTC RESOURCE: HCV Current Online and in-person curriculum and training Downloadable provider tools

17 THE RELATIONSHIP BETWEEN HEROIN AND PRESCRIPTION OPIOIDS Both prescription opioids and heroin act on nerve cells in the brain and nervous system Use of prescription opioids can lead to an emergence of chemical tolerance Link between nonmedical use of prescription opioids and heroin use The cost of heroin on the street is cheaper often more available, more potent (high purity) People who are addicted to prescription opioid painkillers are at high risk for addiction to heroin

18 MARYLAND DATA Prescribers wrote opioid prescriptions per 100 people Has a drug overdose mortality rate of 14.6 deaths per 100,000 pop. (2010) , 40% of all AOD overdose deaths involved one or more prescription drugs admissions to state supported SUD treatment programs increased 110% In the period , mortality rate increased 19.2% to 17.4 deaths per 100,000 pop.

19 ADVERSE HEALTH IMPLICATIONS Injecting drug use increases the risk of serious, long-term viral infections such as HIV, Hepatitis B and C 11% of new HIV infections are IDU 50% of new HepC infections are IDU 114% increase in ED visits Neo-natal abstinence syndrome Increase in fractures in older adults due to falls Significant co-occurring MI with SUD Anxiety, mood disorders, depression Impact on CD4 count and viral load

20 WHAT SHOULD WE DO? Comprehensive Address the combined and interrelated epidemics Prevention, intervention, treatment, recovery Cross System Legal, health, government, private/public, education, research/science, law-enforcement, personal Evidence Based Supported by research

21 A PUBLIC HEALTH APPROACH PREVENTION Educating the public on the consequences of misuse Safe storage and disposal Risk of heroin use Educating healthcare providers on responsible prescribing EARLY INTERVENTION Access to and training on the use of naloxone Access to sterile injection equipment How to recognize an opioid overdose Identifying patients and connecting them to care TREATMENT and RECOVERY Access to medication assisted treatment Expand recovery support services Know you local treatment system and resources

22 EVIDENCE-INFORMED POLICIES, LAWS AND PROGRAMS Operational PDMP Expansion of Medicaid coverage for medication assisted treatment Prescriber education requirement Review data and practices of Medicaid, workers comp programs, benefit managers Pharmacy lock-in programs Prescribing guidelines Good Samaritan laws Doctor shopping laws Expansion of access to and training on use of Naloxone Physical exam requirement prior to prescription ID requirement prior to dispensing controlled substances

23 WHAT IS HHS DOING? FY 2016 Budget includes $133 million in new funding FY 2017 $559 million Three Priority Areas Opioid Prescribing Practices Improved clinical decision making (guidelines) Enhance prescription monitoring - PDMP s and HIT Expanding Use of Naloxone Development of new formulations Grants to states: training, purchase Medication Assisted Treatment Expansion in states Rule changes

24 WHAT IS MARYLAND DOING? Governor s Task Force Opioid Overdose Prevention Plan Expansion of Medicaid coverage for SUD Tx Active PDMP Expansion of access to and training on use of Naloxone Good Samaritan Laws Prevention and education for patients and the public Doctor shopping law Pharmacy lock-in program

25 WHAT CAN I DO? INDIVIDUAL Talk with your doctor about: The risks of prescription painkillers and other ways to manage your pain Making a plan on when and how to stop, if a choice is made to use prescription painkillers Use prescription painkillers only as instructed by your doctor Store prescription painkillers in a safe place and out of reach of others Help prevent misuse and abuse by not selling or sharing prescription painkillers Never use another person's prescription painkillers

26 WHAT CAN I DO? PRESCRIBER Talk with your patients about the risks of taking prescription opioids, including addiction/tolerance, overdose and death Prescribe the lowest effective dose, only the quantity needed for the expected duration of pain and/or discuss other options to manage pain Follow best practices for responsible opioid prescribing Use your state s PDMP to identify patients who might be misusing prescription drugs and are at risk of overdose

27 WHAT CAN I DO? HEALTHCARE/TREATMENT PROVIDER Treat the whole person integrated approach Regularly screen for depression and use of substances Address SUD and MI simultaneously with integrated HIV services Consider the severity, duration and effects of MI/SUD on HIV illness and TX, including medication adherence Address health beliefs and wellness, health literacy Integrate behavioral interventions along with pharmalogical treatments Talking with patients about safely using, storing and disposing of prescription drugs.

28 WHAT CAN I DO? ALL OF US Learn more about the risks of using heroin and other drugs Learn how to recognize and respond to an opioid overdose Know how to access treatment resources in your community Be aware of what policies and practices that the state is implementing Stay updated!

29 RESOURCES SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) Opioid Overdose Toolkit CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) NATIONAL INSTITUTE ON DRUG ABUSE (NIDA) TRUST FOR AMERICA S HEALTH AMERICAN SOCIETY FOR ADDICTION MEDICINE

30 QUESTIONS THANK YOU! Renata J. Henry, M.Ed.

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