Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.”...
Transcript of Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.”...
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Substance Use in Colorado
Presentation to the Colorado Commission on Affordable Health Care
Tamara KeeneyPolicy Analyst
April 10, 2017
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1. Overdose deaths in Colorado are rising, driven by an increase in opioid-related deaths.
2. The biggest gaps in treatment are related to an insufficient workforce.
3. A small percentage of spending for substance use disorder is for treatment.
4. Activities in Colorado to increase treatment are underway, but opportunities remain.
Takeaways
2
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Source: CHI analysis of CDC National Vital Statistics System Mortality Data
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Source: CHI analysis of CDC National Vital Statistics System Mortality Data
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Opioids Are Driving the Rise in Overdose Deaths
Source: CDPHE Vital Statistics
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Alcohol is the Most Common Reason for Treatment
2015 Treatment Admissions by Drug
Source: Drug/Alcohol Coordinated Data Systems, Office of Behavioral Health, Colorado Department of Human Services
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Substance Use Care Continuum
Enhancing Health
Primary Prevention
Early Intervention
Treatment
Recovery Support
Source: The Surgeon General’s Report on Alcohol, Drugs and Health (2016).
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Colorado has a shortage of treatment services.
Sources: NSDUH (2015), Jones (2015), Keystone Policy Center analysis of LinkingCare.org (2016)
Coloradans in need of substance use treatment services who receive them.
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Source: Keystone Policy Center analysis of LinkingCare.org
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Source: Keystone Policy Center analysis of LinkingCare.org
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• MAT is an evidence-based approach to treating opioid dependence• Combination of medication plus other social
support services, such as counseling.
• Clinically effective by helping reduce the potential for relapse.
• Better adherence to programs than those without medication.
Medication-Assisted Treatment
Source: Volkow, N. et al (2014)
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Source: SAMHSA treatment locator.
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• Economic burden of substance use (2015)$700 billion/year
Cost To the System: All Substances
Source: NIDA (2015)
Health Care OverallTobacco $130 billion $295 billion Alcohol $125 billion $224 billionIllicit Drugs $11 billion $193 billion
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Cost To the System: Prescription Opioids
Source: Florence et al 2013
Distribution of the Economic Burden of Prescription Opioid Overdose, Abuse and Dependence
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• Treatment of substance use disorders is effective in decreasing medical cost and substance use.
• When savings related to health care are added to savings to other systems, total savings can exceed costs by a ratio of 12:1.
Research on Treatment is Strong
Sources: Walter et al (2005); Mojabai and Zivin (2003) Health Services Research; NIDA (2012)
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• Methadone • Treatment for opioid addiction with methadone
return of $4-5 for every $1 invested.• Buprenorphine
• Treatment group saw overall reduced health care expenditures compared to non-adherent group.
• Found to reduce emergency department utilization, but not hospitalization.
Cost Savings: Medication-Assisted Treatment
Sources: Center for Substance Abuse Treatment (2005); Tkacz (2014); NIDA (2012); Schwarz (2012)
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• 2008: Prescription Drug Monitoring Program (PDMP) goes live
• 2008: Mental Health Parity and Addiction Equity Act
• 2013: Colorado Consortium on Rx Abuse established
• 2015: Naloxone standing orders
• 2016: Comprehensive Addiction and Recovery Act
• 2016: 21st Century CURES
Timeline of Recent Policies
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• SB74Create Medication-Assisted Treatment Pilot Program
• SB146Access to Prescription Drug Monitoring Program
• SB193Research Center for Prevention of Substance Abuse Addiction
Current Colorado Legislation
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• New Jersey Parental consent
• MassachusettsSeven day limit on pain pills
• Vermont Hub and spoke model
• California1115 waiver for continuum of care
Ideas from Other States
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• Colorado Consortium on Prescription Drug Abuse Prevention
• Office of Behavioral Health Needs Assessment
• Keystone Policy Center Stakeholder Assessment
• Substance Abuse Trend and Response Task Force
Other Activities in Colorado
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• Market advisory recommendations • Enforce parity • 1115 waiver for continuum of care
• Support pilots to expand access• Workforce education and training
Potential Recommendations
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References• Center for Substance Abuse Treatment (2005). Medication assisted treatment for opioid addiction in opioid
treatment programs. Treatment Improvement Protocol (TIP) Series 43. HHS Publication No. (SMA) 14-4892R. Rockville, MD. Substance Abuse and Mental Health Services Administration.
• Florence, CS et. al. (2013) The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States. Medical Care: 54 (10).
• Jones, Christopher M,PharmD., M.P.H., Campopiano, M., M.D., Baldwin, Grant,PhD., M.P.H., & McCance-Katz, E. (2015). National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health, 105(8), E55-E63.
• Mojtabai, Ramin, and Joshua Graff Zivin. "Effectiveness and Cost-effectiveness of Four Treatment Modalities for Substance Disorders: A Propensity Score Analysis." Health Services Research 38.1p1 (2003): 233-59.
• National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), National Institutes of Health, 2012.
• Schwarz, Ryan, et al. “Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence.” Journal of Substance Abuse Treatment. Volume 43, Issue 4, Pages 451–457. December 2012.
• Tkacz, Joseph, et al. “Relationship Between Buprenorphine Adherence and Health Service Utilization and Costs Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456–462. April 2014.
• US Department of Health and Human Services, Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health. Washington, DC: HHS, November 2016.
• Volkow, Nora D., Thomas R. Frieden, Pamela S. Hyde, and Stephen S. Cha. "Medication-assisted Therapies--tackling the Opioid-overdose Epidemic." The New England Journal of Medicine 370.22 (2014): 2063.
• Walter, Lawrence J., Lynn Ackerson, and Steven Allen. "Medicaid Chemical Dependency Patients in a Commercial Health Plan: Do High Medical Costs Come down over Time?" The Journal of Behavioral Health Services & Research 32.3 (2005): 253-63.