Opioid Overdose in Oregon: A Public Health Perspective Mary Borges PDO Coordinator Drew Simpson PDMP Coordinator Oregon Public Health Division

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1 Opioid Overdose in Oregon: A Public Health Perspective Mary Borges PDO Coordinator Drew Simpson PDMP Coordinator Oregon Public Health Division Mid-Willamette Valley Pain Conference Sept 2017

2 Objectives Objectives To understand: 1. The Oregon Opioid Initiative goals and strategies 2. Oregon s Prescription Drug Monitoring Program and how that can assist clinicians in appropriate prescribing of controlled substances.

3 Disclosure The presenters have no financial relationships with a commercial entity producing health care related products and/or services. POLICY AND ANALYTICS Transformation Center 3

4 Prescription Opioids in Oregon: Oregon and prescription Scope of the opioids Problem Pain Treatment with Prescription Opioids ~20% of Oregonians have chronic pain (760,000) In 2016, almost 1 in 4 Oregonians received a prescription for opioid medications (>900,000) Non-Medical Use of Prescription Opioids Tied for 2 nd in the nation in ; 1 st in ,000 Oregonians (5% of population); 9% of year olds

5 Prescription Opioids in Oregon: Scope of the Problem Hospitalizations 330 hospitalizations for overdose; 4300 for opioid use disorder $8 million in hospitalization charges in 2014 Death Rate 180 deaths (4.5 per 100,000 residents) for pharmaceutical opioid overdose in 2015 Source: National Survey on Drug Use Health (NSDUH) 1

6 REDUCE RISKS TO PATIENTS BY MAKING PAIN TREATMENT SAFER AND MORE EFFECTIVE, emphasizing non-opioid and nonpharmacological treatment The Oregon Opioid Initiative Aim: Reduce deaths, non-fatal overdoses, and harms to Oregonians from prescription opioids, while expanding use of non-opioid pain care REDUCE HARMS FOR PEOPLE TAKING OPIOIDS AND SUPPORT RECOVERY FROM SUBSTANCE USE DISORDERS by making naloxone rescue and medication-assisted treatment (MAT) more accessible and affordable Protect the community by REDUCING THE NUMBER OF PILLS IN CIRCULATION through implementation of safe prescribing, storage, and disposal practices OPTIMIZE OUTCOMES BY MAKING STATE AND LOCAL DATA AVAILABLE for informing, monitoring, and evaluating, policies and targeted interventions 4

7 Oregon Opioid Initiative: Strategies Pain treatment Reduce harms Reduce pills Non-opioid therapies for chronic pain Best practices for acute, cancer, end of life pain Ensure availability of treatment for opioid use disorder Increase access to naloxone and MAT Decrease the amount of opioids prescribed Data Use data to target and evaluate interventions

8 OHA opioid grant projects CDC PDO Prevention for States Fund high-burden regions to coordinate prevention infrastructure Develop toolkit and training for implementation of opioid prescribing guidelines Pain Management Improvement Team providing TA and trainings to health systems and clinics Tele-Pain for rural providers Enhance OPC pain training module Regional opioid/pain summits SAMHSA State Targeted Response Increase MAT and OTPs in rural/frontier counties OHSU Project ECHO for rural providers Tribal needs assessment Department of Corrections: peer recovery support, individual and family support, housing for community transitions Expands and enhances CDC PDO grant Public awareness campaign

9 CDC Prevention for States PDO Implementation activities PDO Implementation work group developing clinical toolkit Toolkit piloting in 6 Southern OR primary care clinics through August Stakeholder/ test user group meets monthly to review material Oregon MED calculator is live: Metrics work group aligning measures across OHA, PDO toolkit, and in collaboration with Washington state Six health care organizations as Implementation Sites OR Pain Commission pain training module enhancements OrCRM/Lines for Life: planning regional pain summits for Marion County, Tri-Counties, Tribal Health Naloxone toolkit for pharmacists is live Prescribing and Overdose Data Dashboard updated for Q STR grant (CURES Act) expanding and enhancing PDO grant activities Adding additional funded regions, continuing original funded regions Pain/Opioids public awareness campaign Tribal needs assessment and opioids summit

10 Funded high-burden regions 4. Clatsop, Tillamook, Columbia 1. Multnomah, Washington Based on prescribing data, opioid overdose outcome rates, and population 8. Clackamas 7. Marion, Yamhill, Polk 5. Lincoln, Linn, Benton 2. Lane, Douglas 3. Coos, Curry, Josephine 6. Deschutes, Crook, Jefferson Jackson Countydeveloped the community model 9. Baker, Umatilla, Malheur, Union

11 PDMP Overview Purpose: Provide data on controlled substance prescriptions to improve patient safety and health. Authorized and authenticated users only Available to providers, pharmacists, and their delegates Voluntary use liability protection

12 PDMP Up-coming Changes New Platform Transitioning to Appriss PMP AWARxE Health IT Integration HB 4124 now implemented HB 3440 Becomes operational Jan 2018

13 Oregon Opioid Prescribing: Q2 2015: 232 opioid prescriptions per 1,000 residents Q2 2017: 187 opioid prescriptions per 1,000 residents Source: healthoregon.org/opioids Data dashboard

14 Oregon Opioid Prescribing by Age: 2016 Prescription Opioids by Age, Oregon Q Fills Per 1,000 residents Age group (years) 14

15 Oregon Risky Prescribing: > 120 MED Individual per 100K pop Source: healthoregon.org/opioids Data dashboard

16 Oregon Risky Prescribing: Overlapping Opioid / Benzodiazepine per 1000 Residents Source: healthoregon.org/opioids Data dashboard

17 Resources OHA Opioids Website: Interactive Data Dashboard Community Information Guidelines Oregon Prescription Drug Monitoring Program Website: Statewide PIP website: Project.aspx

18 Questions? Mary Borges Drew Simpson Website: healthoregon.org/opioids