The Opioid Epidemic: HHS Response Christopher M. Jones, PharmD, MPH Acting Associate Deputy Assistant Secretary (Science and Data Policy) Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services
Epi in Brief
Number of Individuals Age 12 Years and Older Prescription opioid and heroin use, 2015 14,000,000 Rx Opioids Heroin 12,462,000 12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000 0 2,126,000 2,038,000 828,000 591,000 135,000 PY Initiation PY Misuse/Use PY Use Disorder Source: SAMHSA, 2015 NSDUH
Overdose Death Rate per 100,000 population Source: CDC, NVSS, 2016 Drug Overdose Deaths as a Percentage of Total Deaths Overdose death trends Percent of Total Deaths Drug Overdose Any Opioid Commonly Prescribed Opioids Heroin Synthetic Opioids 18 2.5 16 14 2 12 10 1.5 8 1 6 4 0.5 2 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 0
Synthetic opioid deaths closely linked to illicit fentanyl supply 14,000 NFLIS Fentanyl Exhibits Synthetic Opioid Overdose Deaths 12,000 10,000 8,000 6,000 4,000 2,000 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Source: DEA and CDC NVSS 2017.
Impacts of Heroin and Synthetic Opioids by U.S. Census Region Source: O Donnell et al, MMWR, 2017
Fentanyl and counterfeit products broadens at-risk population
Estimated Number of Overdose Deaths Heroin and synthetic opioids driving increase in cocaine-related deaths Cocaine-Related Overdose Deaths No Opioid Involved Cocaine-Related Overdose Deaths Any Opioid Involved Cocaine-Related Overdose Deaths Heroin or Synthetic Opioids Involved 5,000 4,500 4,000 3,500 APC = 11.3% APC = -19.0% APC = 19.3% 3,000 2,500 APC = -1.0% 2,000 1,500 APC = 17.6% APC = -11.2% APC = 36.1% 1,000 APC = 11.1% APC = -8.4% 500 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Source: Jones CM, et al. AJPH 2017, Mar;107(3):430-432.
Age-Adjusted Rate per 100,000 population Provisional estimates for 2016 indicate continued increases in overdose deaths 25 20 18.9 19.3 19.9 16.3 16.2 16.7 16.1 15 10 5 0 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Prov Q2 2016 Prov Q3 2016 Prov Source: DC NCHS 2017.
Provisional estimates for 2016 indicate continued increases in overdose deaths Jan 2016 Jan 2017 Heroin 13,219 15,446 Natural/Semi-Synthetic Opioids 12,726 14,427 Methadone 3,276 3,314 Synthetic Opioids 9,945 20,145 Cocaine 6,986 10,619 Psychostimulants with Abuse Potential 5,922 7,663 Source: CDC/NHCS https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdf
Opioid epidemic and increasing injection drug use Rising rates of HCV HIV outbreak in Scott County, Indiana in 2015 Source: Suryaprasad et al. Clin Infect Dis. 2014 & Peters et al., NEJM 2016
Source: Van Handel et al, JAIDS 2016 Counties deemed highly vulnerable to rapid dissemination of HCV or HIV
Prescribing Trends
Rate Increases in Rx opioid prescribing coincide with increases in Rx opioid overdose deaths 8 KG ME per 10,000 Pop Rx Opioid Overdose Deaths per 100,000 Pop 7 6 5 4 3 2 1 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Source: Analysis of CDC National Vital Statistics Data and DEA ARCOS data,1999-2015.
Number of Prescriptions Opioid prescriptions and MME declining in last few years Morphine Milligram Equivalents Opioid Prescriptions Moprhine Milligram Equivalents 80,000,000 80,000,000,000 70,000,000 70,000,000,000 60,000,000 60,000,000,000 50,000,000 50,000,000,000 40,000,000 40,000,000,000 30,000,000 30,000,000,000 20,000,000 20,000,000,000 10,000,000 10,000,000,000 0 0 Source: IMS Health National Prescription Audit, data extracted 2016-2017
Number of Unique Patients Consistent increases in number of patients receiving buprenorphine and naltrexone 800,000 Naltrexone Buprenorphine 700,000 600,000 500,000 400,000 300,000 200,000 100,000 0 Source: IMS Health National Prescription Audit, data extracted 2016-2017
Number of Prescriptions Exponential increase in naloxone prescriptions 50,000 45,000 40,000 35,000 30,000 State laws changing on Naloxone at rapid pace 25,000 20,000 15,000 10,000 5,000 0 Source: IMS Health National Prescription Audit, data extracted 2016-2017
Source: Shah et al, MMWR 2017 Initial prescribing and long-term use
PDMP Research
New PDMP research Patrick et al., 2016 Implementation of PDMPs Associated with Reductions in Opioid-Related Death Rates Dowell et al., 2016 Mandatory Provider Review and Pain Clinic Laws Reduce the Amounts of Opioids Prescribed and Overdose Death Rates Sajid et al., 2016 PDMP Data Tracking of Opioid Addiction Treatment Outcomes in Integrated Dual Diagnosis Care Involving Injectable Naltrexone Ali et al, 2017 PDMPs, Nonmedical Use of Prescription Drugs, and Heroin Use: Evidence from the NSDUH Brown et al., 2017 Impact of New York PDMP, I-STOP, on Statewide Overdose Morbidity Hartung et al., 2017 Using PDMP Data to Characterize Out-Of-Pocket Payments for Opioid Prescriptions in a State Medicaid Program Source: Dowell et al, 2016
HHS Opioid Strategy
HHS Opioid Strategy Increases in opioid-related harms in the U.S. are fundamentally tied to two primary issues Significant rise in opioid prescribing that began in the midto-late 1990s Profound lack of health system and provider capacity to identify, engage, and provide individuals with high-quality, evidence-based opioid addiction treatment These facts underpin the development and implementation of the HHS Opioid Strategy
Goals of the Strategy Empower the public, patients and providers through education and awareness Prevent opioid abuse and overdose and related health consequences Improve function and quality of life for individuals living with pain Ensure patients who need opioid addiction treatment have access to it Support people to achieve long-term recovery
HHS OPIOID STRATEGY Improving access to prevention, treatment, and recovery services Advancing the practice of pain management Comprehensive Evidence-based Targets drivers of epidemic Flexible to emerging threats Targeting availability and distribution of overdose-reversing drugs Supporting cuttingedge research Strengthening timely public health data and reporting
Conclusions Continued urgency to address the public health crisis of opioid abuse, addiction and overdose Epidemic continues to evolve and our policy response must be nimble Comprehensive approach that engages federal, state, and local partners and non-governmental stakeholders is key to success
THANK YOU QUESTIONS? CHRISTOPHER.JONES@HHS.GOV