89 TH ANNUAL WEST TEXAS COUNTY JUDGES AND COMMISSIONERS ASSOCIATION CONFERENCE Wednesday, April 25, 2018 11:05 11:55 a.m. Opioid Epidemic as it Relates to Counties Ms. Jessica Cance Agency Analytics Unit Manager Ms. Kasey Strey National Prevention Network - Prevention Coordinator for Texas, SPF-Rx Project Director
Opioids in Texas: The County Perspective Jessica Duncan Cance, M.P.H., Ph.D. Texas Department of State Health Services Kasey Strey, A.C.P.S. Texas Health and Human Services Commission Objectives Describe the opioid crisis nationally and in Texas Understand the Bio-Psycho-Social aspects of substance misuse/substance use disorders Define the role of prevention in the opioid crisis Discuss evidence-based strategies designed to prevent opioid misuse and associated consequences 2 3 1
Drug Overdose in Texas In 2016, 2,790 Texans died due to drug overdose More than the population of a Texas 6A high school More than the population of nearly 60 percent of the cities and towns in Texas Sources: Texas DSHS Provisional counts of drug overdose deaths, 2/15/2018. U.S. Census Bureau (2017). Annual Estimates of the Resident Population in Texas: April 1, 2010 to July 1, 2016. Available at: https://www.census.gov/data/datasets/2016/demo/popest/total-cities-and-towns.html 4 What are Opioids? Type of Opioid Examples Natural opioids (sometimes called opiates) Morphine, Codeine, Thebaine Semi-synthetic Hydromorphone, Hydrocodone, Oxycodone, Heroin Fully synthetic Fentanyl, Methadone, Tramadol Source: National Institute on Drug Abuse 5 The Opioid System Controls pain, reward, and addictive behaviors Opioids attach to and activate opioid receptor proteins Opioids suppress perception of pain and calm emotional response to pain Source: Gutstein H, Akil H. Opioid Analgesics. In: Goodman & Gilman s the Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill; 2006:547-590. 6 2
Data Trends Understanding Opioid Misuse and Associated Consequences in Texas 7 15 Past Year Substance Use among Youth Ages 12-17: TX vs. US 12 10.5 12.3 9 6 3 4.2 3.7 0 0.6 0.6 Marijuana Cocaine Pain Reliever Misuse Texas U.S. 0.04 0.07 Heroin Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016. 8 15 Past Year Substance Use among Adults 18 or Older: TX vs. US 13.9 12 10.1 9 6 4.5 4.5 3 0 1.5 2.0 Marijuana Cocaine Pain Reliever Misuse Texas U.S. 0.22 0.36 Heroin Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016. 9 3
Accidental Poisoning Deaths in Texas: 1999-2015 2,500 2,226 2,000 Number of Deaths 1,500 1,000 1,174 Total Opioids Cocaine Psychostimulants 500 Benzodiazepines Other Drugs 0 1999 2003 2007 2011 2015 Source: Texas Death Certificates Accidental Poisonings based on County of Occurrence Prepared by Texas Department of State Health Services, Center for Health Statistics 3/6/2018 10 Texas Health Data: Opioid-Related Deaths 11 Drug-Related Inpatient Emergency Department Visits: 2016 3000 2,594 2250 1,970 1500 750 862 727 305 0 Opioids Benzodiazepines Psychostimulants Cocaine Marijuana Source: Texas Hospital Inpatient Discharge Public Use Data Files, Q1 Q4 2016. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. 3/7/2018. 12 4
Texas Health Data: Opioid-Related Inpatient ED Visits 13 Texas Poison Center Network Drug-Related Exposure Calls: 2000-2017 9000 7500 Antidepressants 6000 4500 5265 Benzodiazepines 3000 All opioids 1500 Stimulants 0 2000 2002 2004 2006 2008 2010 2012 2014 2016 Source: Texas Poison Center Network, 2000-2017. Analyses include only those calls involving drug exposures; calls asking for information were not included. 14 Texas Health Data: Opioid-Related Exposure Calls 15 5
Rate of Opioid-Related Poison Center Network Calls, by County: 2011-2015 16 Why Do People Use? Risk Factors for Opioid Misuse 17 BioPsychoSocial Framework Biological -Genetics -Neurochemistry -Drug Effects -HPA Axis Psychological -Emotions -Thinking -Attitudes -Beliefs -Stress Management -Perceptions Social -Social Support -Family Background -Interpersonal Relationships -Cultural traditions -Socioeconomic Status 18 6
Pain in the United States In 2016, nearly one in five adults had chronic pain in the past six months Estimated cost of $635 billion Late 1990s, pain recognized as The Fifth Vital Sign Sources: QuickStats: Age-Adjusted Percentage of Adults Aged 18 Years Who Were Never in Pain, in Pain Some Days, or in Pain Most Days or Every Day in the Past 6 Months, by Employment Status National Health Interview Survey, United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:796. Gaskin, D.J., & Richard, P. (2012). The Economic Costs of Pain in the United States. The Journal of Pain, 13 (8), 715. 19 Correlates of Prescription Opioid Misuse Community Social Availability Community Norms Organizational Interpersonal Intrapersonal Retail Availability Prescriber Norms Caregiver Monitoring Communication Disapproval Peer Approval Number of Friends Using Refusal Skills Risk Perception Sources: McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351-377. 20 SAMHSA CAPT (2016). Preventing Prescription Drug Misuse: Understanding Who Is at Risk. Available at: https://www.samhsa.gov/capt/sites/default/files/resources/preventing-prescription-drug-misuse-understanding.pdf What Can We Do? Strategies to Prevent Opioid Misuse and Associated Consequences 4/11/2018 21 7
Public Health Approach to Preventing Substance Misuse and Addictions Source: http://www.astho.org/addictions/ 22 Evidence-Based Prevention Strategies Prevention Strategies What should we do? And how? Risk and Protective Factors But why here? Problems and Related Behaviors What? And why? Source: Luciani, N. (2016, September 26). Community-level Strategic Planning to Prevent Non-medical Use of Prescription Drugs in Texas. Lecture presented at CAPT Training - Fall Prevention Provider Meeting, Austin. 23 What is Primary Prevention? 24 8
Community Education Youth and Young Adults Communities Health Providers 25 Disposal and Storage Take-Back Events and Drop-Boxes Individual Medication Disposal Pouches Lock-Boxes Sources of Misused Prescription Medication among Texas College Students: 2017 60 55 Percentage 40 20 38 27 20 9 4 0 Someone Personal Someone with a Prescription without a Prescription Prescription Home Medicine Cabinet Stealing It On-Line Source: 2017 Texas College Survey of Substance Use: Main Report. 26 Available at: https://texascollegesurvey.org/wp-content/uploads/2017/08/cdas_report_final_2017.pdf Workforce Development Prevention, Treatment, and Recovery Professionals Prescribers and Other Health Care Professionals Source: Shah, A., Hayes, C.J., & Martin, B.C. (2017). Characteristics of initial prescription episodes and likelihood of long-term opioid use: United States, 2006-2015. MMWR Morb Mortal Wkly Rep; 66:265-269. 27 9
Prescribing Patterns, by County: 2015 Source: CDC Vital Signs, July 2017 Interactive maps: https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html 28 Data Infrastructure Prescription Monitoring Programs High Utilization Consistent Reporting Incorporate into Prevention Planning Source: www.cdc.gov/vitalsigns/opioids 29 Texas Prescription Monitoring Program Moved from the Department of Public Safety to the Texas Board of Pharmacy in 2016 Prescriber mandate passed Spring 2017 (House Bill 2561, 85 th Regular Session) Registration Requires patient look-up prior to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol 30 10
What is Secondary Prevention? 31 Referrals and Resources Outreach, Screening, Assessment, and Referral Centers (OSARs) Treatment Centers Peer Coaches Recovery 32 Outreach, Screening, Assessment, and Referral Centers (OSARs) Source: https://www.dshs.texas.gov/sa/osar/ 33 11
Screening & Brief Intervention (SBI) Designed for use by counselors and professionals who do not specialize in addiction treatment Person-centered methodology that uses motivational techniques based on the person s readiness to change Gives feedback and recommendations respectfully, without judgment or accusations, in the form of useful information 34 Treatment and Recovery Medication Assisted Therapies Methadone Buprenorphine Naltrexone 35 What is Tertiary Prevention? 36 12
Naloxone Source: San Francisco Department of Public Health. Naloxone for Opioid Safety. San Francisco Health Network Website. http://bit.ly/2t8gaky 37 Resources for academic institutions, community organizations, & healthcare providers Continuing education for pharmacists, prescribers, & social workers 38 Summary and Additional Resources Texas Health Data healthdata.dshs.texas.gov/home Outreach, Screening, Assessment, and Referral Centers (OSARs) www.dshs.texas.gov/sa/osar/ Operation Naloxone www.operationnaloxone.org CDC Opioid Overdose www.cdc.gov/drugoverdose/index.html Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities www.hhs.gov/about/agencies/iea/ partnerships/opioid-toolkit/index.html DEATakeBack.com U.S. Surgeon General Opioid Overdose Prevention https://www.surgeongeneral.gov/priorities/ opioid-overdose-prevention/index.html 39 13
Thank you Jessica.Cance@dshs.texas.gov Kasey.Strey@hhsc.state.tx.us 14