Update From OASAS Where are we and where are we going? Steven Kipnis MD, FACP, FASAM Medical Director, NYS OASAS

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1 Update From OASAS Where are we and where are we going? Steven Kipnis MD, FACP, FASAM Medical Director, NYS OASAS

2 Prescription drug misuse remains a critical and pervasive health concern that poses unique challenges because of the need to balance prevention, education, and enforcement, with the need for legitimate access to scheduled medications and the protection of patient care.

3 2011 Expanding on the Office of National Drug Control Policy (ONDCP) plan, OASAS put together active workgroups in the following areas: public education, prescriber education, monitoring, medication disposal, enforcement, overdose prevention, treatment access, adolescent issues/prevention, and outcomes.

4 What we Delivered Rx Misuse Website Medication disposal policy Medication Drop Box grant Guidance for physicians on when to consult Guidance for physicians on interpreting the UDS Medicine Cabinet inventory sheet Palm Cards for Pharmacists

5 NYS DROP BOX LOCATIONS

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8 I-STOP With the passage of the I-STOP legislation, the workgroups were merged so as to guide NYSDOH. Lead by OASAS staff, the Public Awareness workgroup and the Continuing Education Workgroup were formed. o o Public Awareness issued numerous educational pieces for parents, schools and prescribers. The Continuing Education Workgroup made recommendations for prescriber and pharmacist education and prescribing guidelines.

9 SafeMedNY Brochures Produced Prescription Drug Misuse... A Household Problem Prescription Safety How to Know...I think my child is using alcohol and/or drugs Medicine Cabinet Inventory Protect Your Children: Information for Parents Stop Prescription Pain, Medication Misuse

10 Where are we now?

11 Prescription Drug Abuse: Strategies to Stop the Epidemic 2013 report released by The Trust for America s Health New York s summary is: o New York has the sixth lowest drug overdose mortality rate in the United States, with 7.8 per 100,000 people suffering drug overdose fatalities o The report also finds that New York received nine out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Nationally, 28 states and Washington, D.C. scored six or less New Mexico and Vermont scoring the highest, with a 10 South Dakota scoring the lowest with two out of 10

12 Admissions to NYS OASAS Certified Chemical Dependence Programs by Primary Substance and Age Group, CY Prescription opiates admissions increased from 9,969 in 2007 to 23,913 in 2012, a 140% increase. Prescription opiates admissions increased for all age groups between 2007 and The greatest percent increases during that period were among year olds (214%) and year olds (214%). Prescription opiates admissions are admissions where the primary substance at admission was OxyContin or another synthetic opiate.

13 Heroin admissions increased from 57,320 in 2007 to 61,583 in 2012, a 7% increase. The greatest percent increase during that period was 85% among year olds. There was a 30% decrease in heroin admissions by year olds. Heroin admissions are admissions where heroin was the primary substance at admission.

14 Regulatory Flexibility To ensure that existing beds are utilized Such flexibility is important for two initiatives: o Ancillary Withdrawal Services Has allowed our outpatient programs to provide mild to moderate withdrawal (detox) services. This authority has not only increased our state-wide capacity to provide outpatient withdrawal services, but has also allowed for better engagement in continuing with outpatient treatment after the withdrawal services.

15 Regulatory Flexibility Swing Beds o o We are allowing providers who offer multiple levels of detox services to utilize their treatment beds as a combined program OASAS authorized Alcohol and Drug Dependency Services in Buffalo as the first provider in this model and we will look to expand this model. The project has proceeded without incident. Patients transition easily through levels of care. Patient care is improved due to expanded and flexible medication availability. No patients have been turned away due to lack of capacity in either level. The program has seen a substantial increase in patients served.

16 Regulations All Medical Directors in the OASAS system much be buprenorphine authorized All new Medical Directors have 4 years to become AAAP, ASAM or AOA Addiction certified

17 Create new treatment capacity OASAS repurposed capital appropriations and in April 2013 made capital project awards to build two 25 bed Young Adult/Adolescent Treatment programs o o Horizon Village in Western NY Outreach in LI Both awards are in process

18 Adolescent TA Grant Marc Fishman MD (Baltimore) 2 day meeting to produce guidance document Clear that a strategy was needed and not just detox o Use of Vivitrol or other blockers while engaged in treatment

19 Comprehensive Psychiatric Emergency Program (CPEP) and Emergency Departments An important component of treatment for the prescription drug misuser. OASAS presented at several OMH Comprehensive Psychiatric Emergency Program (CPEP) and Psychiatric Emergency Department meetings in order to familiarize the groups with the OASAS Provider system and how to make referrals. For the Emergency Departments we established July 2013 as Partnership Month for our programs to introduce themselves to Emergency Departments. The 2 nd phase of the Partnership Campaign was a reminder in called TAKE THE FIRST STEP where we sent out an OASAS HOPELINE flyer/poster to all the providers which will allow them to enter their contact info on the flyer. We had over 100 programs participating statewide.

20 Narcan Overdose Prevention We trained over 1000 which included patients, families, police, sheriffs, physicians, school nurses, EMTs to name a few. o Have your local police been trained? August 31 st, NYS OD Prevention Day All ATCs gave community training on overdose prevention the week of August 31, 2013

21 NYCDOHMH We worked with NYCDOHMH on proper dosing guidelines

22 What can we do next?

23 Narcan Overdose Prevention Expand the program to include: o o o o o o School nurses College Dorm RA s Club Security College Security First responders Prisoners on release (UK program: N-ALIVE)

24 Education Toolkits for schools PSAs for TV and radio in targeted markets. Prescriber education recommendation Continue to educate parents that treatment and not detox is needed

25 Possible New Regulations Check I-STOP as a part of each admission assessment Narcan to be available on every shift in an OASAS program

26 Reducing Prescription Drug Misuse Through the Use of a Citizen Mail-Back Program as in Maine VA program since 2008, now in 47 states

27 Why Did They Do This and What We Don t Know Why did FDA approve Zyhydro? Why did the FDA approve Ambien for mid-night awakening? Will I-STOP limit availability and drive users to heroin?

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