RxSafe Marin overview Outline Safe Prescribing Guidelines Decreasing total opioid prescriptions Decreasing benzodiazepine and opioid co-prescription Increasing community awareness of opioid risks Increasing options for safe medication disposal
Number of Non-fatal ED visits 120,000 100,000 80,000 60,000 40,000 20,000 0 Call to Action: Marin County 104,625 41,518 2004 2013 Narcotic Prescriptions 471 Emergency Department Narcotic Related Visits 198 222 289 300 295 344 2006 2007 2008 2009 2010 2011 2012
Non-Medical Use of Pharmaceuticals: Marin County 11 th Graders 25% 22% Marin County California 20% 17% 17% 15% 13% 10% 5% 10% 7% 7% 7% 7% 4% 3% 3% 0% Pain Killers Cold/Cough Stimulants Sedatives Diet Pills Barbiturates Source: California Healthy Kids Survey, 2009-2012
What can we do as a community to prevent prescription drug misuse and abuse and save lives?
The Life of a Pill Manufacture Marketing Prescribers Pharmacists Community Safe Use Disposal Unsafe Use
Public Health Approach Every system is perfectly designed to get the results that it gets. What are the key parts of the system? Paul Batalden, MD Healthcare, law enforcement, policymakers, community members, schools, public health, business etc. What are the results of the system? Overdose deaths Addiction and dependence Misuse How do we re-create the system to support safe medication use?
Community Based Prevention Action Team Data Collection and Monitoring Action Team Steering Committee: Data, Messaging, Policy Representatives from: Marin County Office of Education, Marin County HHS, Healthy Marin Partnerships, Residents Law Enforcement Action Team Intervention, Treatment and Recovery Action Team Prescribers and Pharmacists Action Team Backbone Support: HHS
Goals: Reduce total amount of narcotics prescribed in Marin County by 15% annually 2014-2016 Increase doctors promoting proven non-opioid alternatives for managing chronic pain Actions: Strategic Goal: Prescribers and Pharmacists Action Team Adopt safe prescribing guidelines for emergency rooms and clinics Create infographics of proven alternatives for MDs to use with patients
Opioid Prescriptions in Marin County
Prescribing Guidelines Excerpt F. CAUTIONS REGARDING CO-MORBIDITIES OR INTERACTIONS Caution should be used in patients taking other sedatives, including alcohol, antihistamines and benzodiazepines, as such use increases the risk of over-sedation and adverse events.
Total Number of Patients Opioid and Benzo Co-Prescribing by Age; Marin County, 2012-2015 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Younger than 15 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85 and older Number of Patients on Opioids 2012-13 Number of Patients Co-Prescribed within 30 days 2014-15
Opioid and Benzo co-prescribing by age; Marin County, 2012-2015 100% 90% 6% 14% 15% 18% 23% 26% 27% 28% 80% 42% 70% 60% 50% 40% Number on Opioids and Benzos within 30 days of each other Number on Opioids Alone 30% 20% 10% 0% Younger than 15 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85 and older
Prescribing Guidelines Excerpt B. PATIENT AND FAMILY INFORMATION Patients being offered opioids should be made aware that opioids are the leading cause of drug overdose deaths nationally
Goal: Strategic Goal: Community Based Prevention Action Team Residents make informed and responsible choices regarding prescription opioids Actions: Develop communication campaign highlighting the risks of opioid use
Prescribing Guidelines Excerpt H. SAFE STORAGE AND DISPOSAL Patients should receive education and information on safe storage and disposal or return of controlled substances.
Strategic Goal: Law Enforcement Goal: Action Team Community members will have more locations where they can safely and conveniently dispose of unwanted medicines Actions: Adopt county-wide ordinance for safe medication disposal
Take-back Forum Key Stakeholders Represented Environmental Interests Recovery Treatment Regional Partners Pharmacists Law Enforcement and Fire Probation / DA County Counsel Seniors Education Medical Waste Pharmaceutical Manufacturing Water and Sanitation Local Government Physicians HHS Representatives Stewardship Programs
Take-back Forum: Identified Challenges Drugs being misused are coming from medicine cabinets Unintended environmental harm from home disposal Existing disposal system is inadequate Lack of funding and resources to host additional take back bins and events Manufacturers don t share responsibility for disposal
Prescription Drug Take Back Site Interactive Map
Recommendation: Marin County Board of Supervisors consider an ordinance requiring drug manufacturers to share responsibility for designing, implementing, and maintaining a county-wide system for the safe and convenient disposal of unwanted medications for all Marin County residents.
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