The Opioid Addiction Emergency In Virginia June 8, 2017 Marissa J. Levine, MD MPH State Health Commissioner Virginia Department of Health
Chronic Disease of Addiction Definition: A primary, chronic disease of the brain Addiction shares many similarities to the disease of depression including permanent changes to brain function. Treatment for both conditions is effective. Normal brain function is hijacked. Image to left shows how disease of addiction changes brain function similar to heart disease. 24,542 years of potential life lost (to age 65) from overdose - more than diabetes, liver disease, or cerebrovascular disease. Rate of neonatal abstinence syndrome doubled from 2009 to 2014. JLARC estimates that untreated substance abuse costs Virginia state and local governments $613 million per year in public safety and health care services alone. Much of the cost is driven by public safety expenses (i.e. jail, police, prison costs) along with health care costs for expensive co-morbidities such as HIV/AIDS, Hepatitis B and C, and kidney failure. 700% Return on Investment (ROI). Virginia saves $7 for every $1 invested in treatment.
TOP 3 METHODS OF UNNATURAL DEATH Total Number of Motor Vehicle, Gun, and Drug Related Fatalities by Year of Death, 2007-2016 1600 1400 1200 Number of Fatalities 1000 800 600 400 200 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016* Motor Vehicle Related 1124 928 841 823 878 877 832 808 879 889 Gun Related 836 818 843 868 863 835 852 901 940 1057 Fatal Drug Overdose 721 735 713 690 819 799 913 994 1028 1420 1 Top 3 methods of death (motor vehicles, guns, and drugs) include all manners of death (accident, homicide, suicide, and undetermined)
ALL FATAL DRUG OVERDOSES Total Number of Fatal Drug Overdoses by Quarter and Year of Death, 2007-2016 1600 1400 +38.1% 1200 Number of Fatalities 1000 800 600 400 200 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016* Q4 205 195 183 179 232 240 248 263 262 366 Q3 152 180 157 170 191 199 217 257 270 359 Q2 188 162 172 159 215 190 230 246 243 332 Q1 176 198 201 182 181 170 218 228 253 363 Total Fatalities 721 735 713 690 819 799 913 994 1028 1420
ALL OPIOIDS Total Number of Fatal Opioid Overdoses by Quarter and Year of Death, 2007-2016 1200 1000 +39.7% Number of Fatalities 800 600 400 200 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016* Q4 156 151 136 131 168 179 202 201 207 293 Q3 104 134 122 116 136 137 158 202 213 275 Q2 130 120 128 109 156 134 173 185 195 272 Q1 125 133 144 142 141 122 150 187 196 293 Total Fatalities 515 538 530 498 601 572 683 775 811 1133
OPIOIDS- A DIFFERENT PERSPECTIVE Total Number of Prescription Opioid (excluding Fentanyl), Fentanyl and/or Heroin, and All Opioid Overdoses by Year of Death, 2007-2016 1200 1100 1000 Number of Fatalities 900 800 700 600 500 400 300 200 100 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016* All Opioids 515 538 530 498 601 572 683 775 811 1133 Prescription Opioids (excluding fentanyl) 400 422 417 426 496 435 459 501 398 469 Fentanyl and/or Heroin 148 157 150 112 153 185 309 351 471 810
FENTANYL (RX, ILLICIT, AND ANALOGS) 700 Total Number of Fatal Fentanyl Overdoses by Quarter and Year of Death, 2007-2016 600 +174.7% Number of Fatalities 500 400 300 200 100 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016* Q4 14 19 13 19 11 15 58 28 59 177 Q3 8 22 8 9 11 11 14 35 53 139 Q2 14 12 12 18 16 13 19 42 72 157 Q1 12 15 10 18 16 11 11 29 41 145 Total Fatalities 48 68 43 64 54 50 102 134 225 618
Count of Emergency Department Visits for Unintentional Overdose by Heroin among Virginia Residents by Month, 2015-2017 160 140 120 Count of Visits 100 80 60 40 20 0 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Month of Visit 2015 2016 2017 The Virginia Department of Health receives data on visits to 82 acute care hospital emergency departments (EDs) and 13 free-standing EDs in Virginia for purposes of public health surveillance. Chief complaint and discharge diagnosis are analyzed to identify visits for acute, unintentional overdose by heroin. Out-of-state visits among Virginia residents and in-state visits of non-virginia residents are not included.
Rate of Emergency Department Visits for Unintentional Overdose by Heroin among Virginia Residents by Month and Health Region, Previous 12 Months Rate of Visits per 100,000 Population 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr 2016 2017 Month of Visit Central Eastern Northern Northwest Southwest
Rate of Emergency Department Visits for Unintentional Overdose by Heroin among Virginia Residents by Month and Health District, Previous 12 Months Rate of Visits per 100,000 Population 14 12 10 8 6 4 2 0 May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 2016 2017 Month of Visit Portsmouth Rappahannock Rapidan Roanoke Lord Fairfax Norfolk Top 5 health districts with highest average overdose rate for previous 12 months 3 health districts (Roanoke City, Portsmouth, Rappahannock-Rapidan) among top 5 for both overdose by opioid/unspecified and overdose by heroin
Stig-ma 1. a mark of disgrace associated with a particular circumstance, quality, or person: "the stigma of mental disorder"
The sense of stigma is most likely to diminish as a result of public education and broader acceptance of addiction as a treatable disease. Institute of Medicine
15 Executive Leadership Co-Chairs: Secretary of Health &Human Resources William A. Hazel, Jr., MD Secretary of Public Safety & Homeland Security Brian J. Moran Policy and Legislative Recommendations Goal Setting : State Support Local Support VSP Region 1 VSP Region 3 VSP Region 5 VSP Region 7 VSP Region 2 VSP Region 4 VSP Region 6 Local needs, implementation of prevention strategies, efforts, scoring Resources, consultation, programs, policy interventions
Public Health Approach Data and Surveillance Prevention Screening/Treatment Harm Reduction Provider-level Education (Prescription Monitoring, Safe Prescribing Practices, Risk Assessment, Safe drug storage, Injury prevention) Increase Access to Substance Use Disorder services via Project ECHO Testing and Treatment for Infectious Disease (HIV, HCV, STI) Support enhancements to Prescription Monitoring Program Establish a policy-focused coalition to develop standardized, evidence based opioid prescribing and treatment guidelines Medication Assisted Therapies Addiction Disease Management Provider Trainings Increase Access to Naloxone Establish Perinatal Collaborative : Improving care for infants and families influenced by Neonatal Abstinence Syndrome Syringe Services Programs Leadership
Before ARTS Medicaid Provider Network Adequacy Opioid Treatment Program Source: Department of Medical Assistance Services - Provider Network data (March 20, 2017). Circles # of Medicaid providers included in network adequacy access calculation. Accessible is considered to be at least two providers within 60 miles of driving distance. Driving distance is calculated by Google services based on the centroid of each zip code.
After ARTS Medicaid Provider Network Adequacy Opioid Treatment Program Source: Department of Medical Assistance Services - Provider Network data (March 20, 2017). Circles # of Medicaid providers included in network adequacy access calculation. Accessible is considered to be at least two providers within 60 miles of driving distance. Driving distance is calculated by Google services based on the centroid of each zip code. 19
http://www.vdh.virginia.gov/data/ opioid-overdose/
Resources VaAware Data, Services and Other Resource www.vaaware.org VDH Opioid Dashboard: http://www.vdh.virginia.gov/data/opioidoverdose/ Virginia Department of Health Opioid website: http://www.vdh.virginia.gov/commissioner/opioidaddiction-in-virginia/