The Opioid Epidemic Dr. Joh McAuliffe Medical Director, Sauk Prairie Memorial Hospital Sharo Boesl, Ph.D., LMFT Metal Health ad Recovery Services Sauk Couty Departmet of Huma Services Slides are courtesy of: Opioid Pai Relievers Drivig U.S. Overdose Epidemic, Heroi Catchig Up 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Rx Opioids Heroi (overdose deaths ca ivolve multiple drugs - ot mutually exclusive) Origial Data Matt Gladde, CDC 1
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Epidemiology Wiscosi Surveillace: Data Sources ad Systems p Death certificates p Hospital discharge ad emergecy departmet data p Prescriptio Drug Moitorig Program (PDMP) p Medical Examier or Coroer data p Emergecy departmet ecouter data p Wiscosi Ambulace Ru Data System 3
Wiscosi Age-Adjusted Ijury Death Rate, 1999-2013 70 65 27% icrease 60 55 50 45 40 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 CDC WISQARS, 9/2/2015 Leadig Ijury Death Rates, Wiscosi Residets, 1999-2013 18.0 Deaths per 100,000 people 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1999 2000 2001 2002 2003 2004 2005 2006 Year 2007 2008 2009 2010 2011 2012 2013 Falls Drug Overdose Motor Vehicle Trafficrelated Age-adjusted, Source: DHS, OHI 4
Wiscosi Uitetioal Drug Poisoig, Age-Adjusted Death Rates, 1999-2013 All Races, Both Sexes, All Ages ICD-10 Codes: X40 X44 Rates per 100,000 14 12 10 8 6 4 2 0 122 deaths 2.3 3.0 3.3 4.4 5.0 5.3 6.7 7.9 8.4 7.7 8.1 8.3 9.6 708 deaths 10.1 12.5 CDC WISQARS: Natioal Ceter for Ijury Prevetio ad Cotrol, CDC Data Source: NCHS Vital Statistics System for umbers of deaths. Bureau of Cesus for populatio estimates. Number of Drug Overdose Deaths Ivolvig Opioid (morphie-like) Pai Relievers ad Other Drugs, Wiscosi, 1999 2014 450 400 350 300 250 200 150 100 50 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 3.5X icrease i heroi, from 2009 (77) to 2014 (267) Opioid pai relievers (T40.2- T40.4) Bezodiazepies (T42.4) Heroi (T40.1) Cocaie (T40.5) Source: DHS, OHI 5
Overdose Deaths by Age Group ad Opioid Type, 2010-2014 (Ay Metios) 250 Five Year (total cout) 200 150 100 50 0 <15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ OPIOIDLSMTD(4b) 8 18 83 142 149 150 167 226 230 189 89 73 HEROIN(5) 17 150 194 140 115 74 70 72 40 28 7 4b=All Prescriptio Opioid Aalgesics, except Methadoe Source: DHS, OHI Rate of Deliveries With Materal Opioid Use, Rate of Neoatal Abstiece Sydrome, Wiscosi, 2009 2014 Materal Opioid Use 12 2009 2010 2011 2012 2013 2014 335 506 719 842 1001 1041 NAS N=227 305 384 398 540 508 12 Source: DHS 6
Effects o Pregacy p Chroic utreated heroi use is associated with: Risk of fetal growth restrictio Abruptio placetae Fetal death Preterm labor Exposure to episodes of withdrawal The lifestyle issues associated with illicit drug use also create risk for the mother ad developig fetus. Neoatal Abstiece Sydrome Ifats with eoatal abstiece sydrome may have ucoordiated suckig reflexes leadig to poor feedig, become irritable, ad produce a high-pitched cry. Log term outcome study of ifats with i utero exposure to opioid exposure are limited. From: Committee Opiio, The America College of Obstetricias ad Gyecologists (May 2012). 7
Actios to Prevet Opioid Harm ad Abuse Educatio Prescriber educatio Commuity educatio Naloxoe access Trackig ad Moitorig Prescriptio Drug Moitorig System (PDMP) Surveillace Reversal Naloxoe Access Eforcemet Idetificatio verificatio at pharmacies Law eforcemet traiig o prescriptio drug misuse ad diversio Medicatio Disposal Keepig medicatios safe at home Proper medicatio disposal guidelies cosistet with FDA stadards Commuity take-back programs Treatmet Optios Treatmet Ceters Outpatiet ad residetial treatmet at state-fuded treatmet providers Policies Supportig all sectors Our local project: Sauk Couty Medicatio Assisted Treatmet Grat The grat s goals: 1. Icrease medicatio assisted treatmet as a optio for sobriety ad icrease the umber of providers i each area to provide better access to treatmet. 2. Utilize the C.A.R.E. cocept/process (Commuity Activated Recovery Ehacemet) as a model i four (4) strategic locatios ad iclude commuity stakeholders i all aspects of developig a coordiated respose to this alarmig health issue. 3. Utilize all existig fudig resources FIRST for treatmets icludig idividual s existig health care fudig such as private isurace/medical Assistace. 4. With oversight ad State approval some fuds (about 25%) are desigated for gap populatios idividuals who are particularly vulerable ad i eed of services ad commuity support (idividuals trasitioig from icarceratio, pregat, idividuals with Hepatitis C, ad uisured idividuals.) 8
Medicatio-Assisted Treatmet FDA approved medicatios Bupreorphie products (Suboxoe ad Subutex) Naltrexoe (Vivitrol) Methadoe Bupreorphie Products (Suboxoe ad Subutex) Schedule III arcotic medicatio for the maiteace treatmet of opioid depedece Reduces cravigs ad withdrawal symptoms Available at OTPs ad from DATA waived physicias 9
Naltrexoe (Vivitrol) A prescriptio ijectable medicatio cotaiig altrexoe Admiistered oce a moth to prevet relapse to opioid depedece after detox Must stop all opiates 7-10 days prior to ijectio Medicatio-Assisted Treatmet (MAT) p Provides comprehesive services Medicatio Couselig Case maagemet Recovery supports p Uses may paths to recovery Medical itervetio Professioal treatmet Mutual support groups Peer supports Family supports Faith supports 10
Medicatio-Assisted Treatmet (MAT) p Develops diversio practices ad policies p Develops Recovery-Orieted Systems of Care (ROSC), a itegrated care model: --A framework to guide system trasformatio --A value-drive approach to structurig behavioral health systems --A etwork of cliical ad o-cliical ad supports --A iitiative to fid service gaps ad commuity eeds to trasform the commuity ito a stroger support for life-log recovery William White o Recovery Orieted Systems of Care (ROSC) This movemet represets a shift away from crisis-orieted, professioally directed, acute-care approach with it s emphasis o isolated treatmet episodes, to a recovery maagemet approach that provides logterm supports ad recogizes the may pathways to healig. 11
Assertive Outreach ad Egagemet p Scree ad itervee i health care facilities p Establish relatioships with atural supports to promote early idetificatio p Offer pre-treatmet peer support groups p Use peers to welcome cosumers p Offer peer metors at first cotact p Build likages betwee levels of care through peer-based recovery support services DHS Efforts State Fuded Medicatio-assisted treatmet traiig for prescribers ad providers Heroi Opiate Prevetio ad Educatio (H.O.P.E.) Programs Federally Fuded (Grats) Commuity Activated Recovery Ehacemet (C.A.R.E.) Project Prescriptio Drug Moitorig Program ehacemet Prevetio grats focus o prescriptio drugs 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 H.O.P.E. Project North Cetral Regio Opioid Cosortium Headquarters: Woodruff 715-358-1221 dhs.wiscosi.gov/opioids/treatmet.htm November 2015 dhs.wiscosi.gov/opioids/treatmet.htm November 2015 Medicatio-Assisted Treatmet Programs Offerig Methadoe for Opioid Addictio Newly Fuded Opioid Treatmet Programs Opioid Treatmet Programs (OTP) Opioid Treatmet Services 1 2 2 1 3 4 5 4 6 7 8 9 3 10 11 17 14 12 13 15 16 4 Eau Claire Metro Treatmet Ceter, Eau Claire, 715-834-1078 Wiscosi Comprehesive Treatmet Ceters, Wausau, 715-845-3637 Wiscosi Comprehesive Treatmet Ceters, Gree Bay, 920-337-6740 Wiscosi Comprehesive Treatmet Ceters, Appleto (Valley Health S ervices), 920-733-4443 Addictio Medical Solutios, Oshkosh, 920-232-2332 Addictio Medical Solutios, Oalaska, 608-783-0506 Guderso Luthera Health Systems, La Crosse, 608-775-3395 Premier Care of Wiscosi, Fod du Lac, 920-926-0101 Wiscosi Comprehesive Treatmet Ceters, S heboyga, 920-458-6527 Wiscosi Comprehesive Treatmet Ceters, Madiso (Badger Road), 608-250-2512 Wiscosi Comprehesive Treatmet Ceters, Madiso (Madiso Health S ervices - World Dairy Expo Drive), 608-242-0220 Wiscosi Comprehesive Treatmet Ceters, Waukesha, 262-549-6600 Wiscosi Comprehesive Treatmet Ceters, West Milwaukee, 414-672-3801 Wiscosi Comprehesive Treatmet Ceters, Milwaukee (River S hores), 414-967-7012 Wiscosi Comprehesive Treatmet Ceters, Milwaukee (10 th Street), 414-744-5370 Wiscosi Comprehesive Treatmet Ceters, Racie, 262-598-1392 Wiscosi Comprehesive Treatmet Ceters, Beloit, 608-361-7200 Flip over for more optios These projects are fuded by either state or federal dollars ad provide a rage of services to help idividuals overcome a addictio to opioids. These programs do ot provide methadoe maiteace treatmet. H.O.P.E. Project: NorthLakes Commuity Cliic 1 Headquarters: Ashlad, 715-682-5207 H.O.P.E. Project: North Cetral Regio Opioid Cosortium 2 Headquarters: Woodruff, 715-358-1221 H.O.P.E. Project: Libertas/PreveaHealth Collaborative 3 Headquarters: Mariette, 715-735-0095 C.A.R.E. Project 4 Headquarters: Baraboo, 608-355-4200 H.O.P.E. Programs Norther tier of Wiscosi: Provide medicatio-assisted treatmet to the uderserved ad high-eed areas i Wiscosi Provide residetial detoxificatio ad stabilizatio services Reduce the rate of relapse ad umber of deaths Reduce the umber of ifats bor to utreated opioid addicted wome Create relatioships with commuity providers to improve treatmet availability 13
C.A.R.E. Project Sauk, Columbia, Richlad couties: Replicates a program origiated by St. Vicet DePaul i Prairie Du Sac Ivolves commuity stakeholders committees Expads the provisio of medicatio-assisted treatmet Employs Commuity Recovery Specialists Employs dually credetialed cliicia for assessmets ad treatmet plaig Adds a mobile urse to support idividuals who choose to detox at home Cotracts with providers for treatmet services, detox, outpatiet, ipatiet residetial, etc. For More Iformatio Elizabeth Collier State Opioid Treatmet Authority Elizabeth.Collier@dhs.wiscosi.gov 608-267-7707 Adrea Jacobso Substace Abuse Treatmet Coordiator adrea.jacobso@dhs.wiscosi.gov 608-261-0652 dhs.wiscosi.gov/opioids/idex.htm 14