FREE WEBINAR July 18, 2018 12 1:30 pm Opioids and Older Minnesotans: What to Know and What to Do Aaron Leppin, MD, MSc, Assistant Professor-Researcher, Division of Health Care Policy and Research, Mayo Clinic; Aging Policy Fellow, Minnesota Board on Aging Kate Erickson, MSW, \Opioid Overdose Prevention Director, Minnesota Department of Health Handouts: mngero.org Tweet: @mngero Facebook: /mngerosociety Jodie Dvorkin, MD, MPH, Associate Medical Director, Institute for Clinical Systems Improvement ICSI Type your questions during the webinar Webinar Sponsors 1
Opioids and Older Minnesotans: What to Know and What to Do Kate Erickson, MSW; Minnesota Department of Health Jodie Dvorkin, MD, MPH; Institute for Clinical Systems Improvement Aaron Leppin, MD, MSc; Mayo Clinic and Minnesota Board on Aging Learning Objectives 1. Provide overview of the opioid epidemic and its impact on older adults 2. Describe the State s approach to addressing the epidemic in Minnesota 3. Describe healthcare s efforts to addressing the epidemic in Minnesota 4. Outline specific actions you can take to support these efforts 2
Why this webinar? Older adults are a population of increasing priority Baby boomers have aged into this demographic Older adults commonly have chronic pain We need a workforce and society that can support older adults efforts to maintain function and quality of life while appropriately weighing the risks and benefits of opioid medications and identifying and addressing signs of an opioid use disorder. Opioid Dashboard: one-stop shop for opioid-related data and information in MN Kate S. Erickson Opioid Overdose Prevention Director Injury and Violence Prevention Section MN Department of Health (MDH) www.health.state.mn.us/opioiddashboard 3
Emergency Response: Overdose Signs of overdose Sleepiness/loss of consciousness Slow, shallow breathing Pale, blue, or cold skin Choking/gurgling sounds Constricted, pinpoint pupils Emergency Response: Overdose What to do Call 911/get help! Call MN poison control 24/7 at 1-800- 222-1222 Provide rescue breaths Administer naloxone (Narcan) if available https://www.youtube.com/watch?v=gpb qpdool14&feature=youtu.be 7/9/2018 8 4
Emergency Response: Obtaining Naloxone Pharmacies: can dispense to at-risk individuals or people that know at-risk individuals on request if enrolled in appropriate program Community Organizations (provide free training and kits) Steve Rummler Hope Network Rural AIDS Action Network Valhalla/Meridian **Opioid Dashboard: Nonfatal Overdose Naloxone Intervention and Treatment: Person-Centered Care Plans Review pain symptoms, impact on function/quality of life Review pain medications, look for interactions (benzos), contraindications Assess for opioid use disorders (CAGE-AID) Consider and integrate non-opioid pain management strategies (e.g. physical activity, mind-body, non-opioid treatments, group-based self-management support/training) Psychological Intervention Biophysical Approaches Person-Centered Pain Management Social Issues 5
https://www.integration.samhsa.gov/images/res/cageaid.pdf CAGE-AID 7/9/2018 11 Intervention and Treatment: Opioid Use Disorder Assessment Get a Rule 25 chemical dependence (CD) assessment (anyone can request for self or someone else) Determines eligibility for publicly-funded chemical dependency treatment Contact health plan or county/tribe for all MNCare/MA individuals (list of contacts maintained on DHS website) Diagnostic assessment (DA) is for co-occurring disorders and must be completed by mental health specialist **Opioid Dashboard: Prescription Opioid Misuse Resources 6
Intervention and Treatment: Opioid Use Disorder Treatment MAT (suboxone/buprenorphine) increasingly outpatient primary care Chemical Treatment Programs Primarily outpatient programs (less intensive, for people with social supports) Primarily inpatient programs (12 step/short programs for 3-8 weeks) Extended care (24/7 long-term residential setting for 6-12 months) Halfway house (transitional living focused on independence and recovery) Detox centers (medically managed withdrawal) **Opioid Dashboard: Prescription Opioid Misuse Resources Intervention and Treatment: Co-Occurring Disorder After receiving diagnostic assessment (DA) for cooccurring disorder, individual may receive a variety of integrated therapy supports Can be outpatient or inpatient Ultimately focused on paying equal attention to psychiatric and substance use issues May offer specialized treatment plans, support groups, peer counseling, dual medication strategies for psychiatric illness and addiction Mental Disorder Addiction Bridgingthegapofamerica.org 7
Intervention and Treatment: Opioid Use Disorder Treatment Can find and explore treatment centers and connect directly for services in many ways (if privately insured, best to go through insurer) www.fast-trackermn.org www.minnesotahelp.info DHS Licensing Lookup: https://licensinglookup.dhs.state.mn.us/ SAMHSA treatment center locator: https://findtreatment.samhsa.gov/ **Opioid Dashboard: Prescription Opioid Misuse Resources 7/9/2018 16 8
7/9/2018 17 Intervention and Treatment: Caregiver and Recovery Support Do not forget that the people you interact with may be caring for someone with an opioid use disorder!!! Families anonymous (12 step) Co-dependents anonymous Narcotics Anonymous (naminnesota.us) Minnesota Recovery Connection (www.minnesotarecovery.org) **Opioid Dashboard: Prescription Opioid Misuse Resources 9
7/9/2018 19 Intervention and Treatment/Primary Prevention Promoting Safe Use, Safe Storage, Safe Disposal of opioids Safe Use: always use as prescribed, dispose of extra Safe Storage: secure location, disguised Safe Disposal: designated location (pollution control agency) https://www.pca.state.mn.us/living-green/managing-unwanted-medications Earth 911 to find drop-off locations **Opioid Dashboard: Pharmaceuticals Distributed Resources 10
Primary Prevention: Promoting Non-opioid Pain Management Physical Activity Modalities: exercise, walking, swimming, yoga, tai chi, physical therapy https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4534717/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5461882/ Primary Prevention: Promoting Non-opioid Pain Management Non-Opioid Treatment Modalities: Tylenol (acetaminophen), NSAIDS (aspirin, ibuprofen), steroids (injections), acupuncture 11
Primary Prevention: Promoting Non-opioid Pain Management Mind-body Modalities: cognitive behavioral therapy (CBT), prayer, meditation, guided imagery https://www.ncbi.nlm.nih.gov/pubmed/17610459 Primary Prevention: Promoting Non-opioid Pain Management Group-based Self-Management Support/Training Programs Chronic Pain Self-Management Program Chronic Disease Self- Management Program Evidence-based exercise programs (including tai chi) https://www.ncoa.org/resources/issue-brief-implementingevidence-based-programs-address-chronic-pain/ 12
Primary Prevention: Promoting Non-opioid Pain Management https://yourjuniper.org/ http://www.wellconnectsemn.org/ (SE MN Only) 25 Primary Prevention: Promoting Healthy Communities Change the narrative about pain and the relationship with opioids Fight to address disparities, build community capacity Focus on social determinants and upstream predictors Build partnerships with community stakeholders **Opioid Dashboard: Social Determinants of Health 13
What to Do In Summary In case of overdose: 911, poison control, naloxone For people with opioid use disorder: support treatment plan and recovery, support caregivers/family For folks on opioids: assess for use disorder frequently; encourage safe use, storage, and disposal; connect to wrap-around services when needed For folks with pain: develop/participate in person-centered care plans Always: change the narrative and culture around pain; promote physical activity and positive, non-opioid pain management; address social determinants 7/9/2018 27 Questions? contact info@mngero.org NEXT WEBINAR August 16, 2018 noon 1:00 pm Beyond Diagnosis: Rehabilitation Aspects in Dementia Ed Ratner, MD, Associate Professor of Medicine, University of Minnesota; Associate Director for Education and Evaluation, Minneapolis VA Medical Center. 14