The Burden of Opioid Use/Misuse in Pima County · 2017-09-19 · We all pay for substance misuse...
Transcript of The Burden of Opioid Use/Misuse in Pima County · 2017-09-19 · We all pay for substance misuse...
TheBurdenofOpioidUse/MisuseinPimaCounty
FranciscoGarcía,MD,MPHAssistantCountyAdministrator&ChiefMedicalOfficer19July2017
Health Department Video
AHealthyPimaCounty.Everyone.Everywhere.Everyday.
FrameworkforPublicHealthAction
Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health
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BehavioralHealthDisorders7
Source:ArizonaDepartmentofHealthServices,BureauofEpidemiologyandDiseaseControlServicesNote:includesfirstlisteddiagnosesonly
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Opioid-RelatedHospitalEncounters,2008-2016
Since2008,therehasbeenanearlytwo-foldincreaseinnumberofEDvisitsandin-patienthospitalstaysrelatedtoopioidmisuse
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Source:PimaCounty,HospitalDischargeDatabase
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SubstanceUseRelatedEmergencyDepartmentVisits
SignificantincreaseinthenumberofsubstancemisuserelatedEDvisitsacrossage-groupsfrom20to70years
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AZHospitalDischargeDatabase
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SubstanceUseRelatedIn-patient Hospitalizations
• Significantincreaseinthenumberofsubstancemisuserelatedhospitalizationsacrossage-groupsfrom20to75years
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AZHospitalDischargeDatabase
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Opiod-RelatedEDVisitRates/1,000PopulationbyPrimaryCareArea,2016
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Opiod-RelatedInpatientEncounterRates/1,000PopulationbyPrimaryCareArea,2016
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Opiod-Related,CombinedED&IPEncounterRates/1,000PopulationbyPrimaryCareArea,2016
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• 87%ofopioidrelatedEDvisitscomefrom10PCAs
• 37%ofopioidrelatedinpatientvisitscomefromjust2PCAs
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OpioidRelatedHospitalizationbyAgeandEthnicity,2008,11&15
AZHospitalDischargeDatabase
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OpioidRelatedEDEncountersbyHospital,2010&2016
OpioidrelatedEDencountershaveincreasedfornearlyeveryhospitalinPimaCounty
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OverdoseDeathsinPimaCounty,2016
•Overdoseaccountedfor263deaths(upfrom210in2011)•Male(66%)v.female(34%)•Singledrug(51%)v.multi-drug(49%)•Overdoseisthecause
•89%(233)accidentaldeaths•8%(21)suicidedeaths•3%(9)undeterminedcauseofdeath
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PimaCountyOverdoseDeathsbyAge-Group,2016
2016 Medical Examiner Report
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PimaCountyOverdoseDeathsbyDrug,2016
2016 Medical Examiner Report2016 Medical
Examiner Report
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PimaCountyOverdoseDeathsbyMisusedSubstanceCategory,2016
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Weallpayforsubstancemisuseandaddiction,2016
HospitalCareSetting 2016TotalCharges 2016PayerSource
EmergencyDepartment
$24.8M($10M morethan2010)
63% AHCCCS11%Medicare9%Commercial10%Other7%Self-pay
Inpatient $229.4M($76Mmore)
48%AHCCCS21% Medicare13%Commercial16%Other3%Self-pay
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TFDOverdose-RelatedCallResponses,2015to2017Q2
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Source:TFD
20151373
20161203
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CostsofYouthOpioidUse26
Sources:ADHS,hospitaldischargedata,2010-2015PimaCountyMedicalExaminer,2015
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PreventingSubstanceAbuse•YouthandFamily
• Healthyhomelife• Consistentparentalexpectations• Drugfreefriends• Healthyhabits• Highself-esteem• Havefun
•MedicalCommunity• Clinicianawareness• MedicallyAssistedTherapycapacity
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BuildingBlockstoPreventSubstanceAbuse•Neighborhood
• Cleanstreets• Well-litareas• Safeoutdoorspaces• Neighborhoodconnections
•Schools• Highqualityteachersandmentors• Encourageschoolattendance• Provideextracurricularactivities
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NumberofPregnantWomenUsingOpioids,PimaCounty
0
50
100
150
200
250
2010 2011 2012 2013 2014 2015
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1in10WomenWhoUseOpioidsArePregnant
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
2010 2011 2012 2013 2014 2015
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MostPregnantWomenUsingOpioidsinPregnancyare20to30
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PregnantOpioidUserHospitalizationsbyAge-groupandYear
Pregnant opioid users are not just increasing in number, they are also getting younger?
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OpioidUseRelatedHospitalizationsAmongPregnantWomen,PimaCounty2010-2015
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ED&Hospital
ED&Hosp(%) EDOnly
EDOnly(%) Hosp Only
Hosp Only(%)
AgeGroup15-19 38 3.5 16 1.5 22 2.020-24 365 34.0 127 11.8 238 22.225-29 381 35.5 113 10.5 268 25.030-34 208 19.4 54 5.0 154 14.335-39 67 6.2 26 2.4 58 5.440-44 14 1.3 7 0.7 7 0.745-49 1 0.1 0 0 1 0.1Total 1680 100.0 343 31.9 748 69.6
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ProfileofOpioidRelatedHospital&EDVisitsPregnantWomen,PimaCounty2015
•Nopregnantopiod overdosedeaths•Racial/EthnicBreakdown
NHWhite 51% AmInd 5%Hispanic 37% Asian 0%Black/Af Amer 4% Other 3%
•Medicare/Governmentpayer89%vPrivatepayer11%
•AverageHospitalCharges:$12,952/episode•1/3pregnantwomeninPCADCareopioidinvolvedandonMAT
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PreventingSubstanceAmongPregnantWomen
• Individual• Fosteringresilience• Peersupport
•HealthCareSystems• Opioidprescribingguidelines• PrescriptionMonitoringProgram• MedicallyAssistedTherapy• Correctionalcare
•Community• Poverty• Economicopportunity• Housing• Supportiveservices
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OpioidUseRelatedHospitalizationsAmongSeniors,PimaCounty2015
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ED&Hospital
ED&Hosp(%) EDOnly
EDOnly(%) Hosp Only
Hosp Only(%)
AgeGroup60-64 496 29.5 162 9.6 334 19.965-69 392 23.3 114 6.8 278 16.570-74 312 18.6 61 3.6 251 14.975-79 184 11.0 43 2.6 141 8.480+ 296 17.6 65 3.9 231 13.8Total 1680 100.0 445 26.5 1235 73.5
Deaths 24 Attempt Suicide 30
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ProfileofOpioidHospitalizedSeniors,PimaCounty2015
•Female57.7%vMale42.3%
•Racial/EthnicBreakdownNHWhite 77% AmInd 1.4%Hispanic 17% Asian 0.5%Black/AfAmer 3.4% Other 0.7%
•Medicare/Governmentpayer81.3%vPrivatepayer18.7%
•AverageHospitalStay:123hours(5.1days)•PrescriptionDrug97%
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PimaCountyOverdoseDeathsbyAge-Group,2015
2015 Medical Examiner Report
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PreventingSubstanceAbuseAmongElders
• Individual• Awareness/PCOABeMedSmart• Medicationsecurity• Medicationdisposal• Peersupport
•Clinician• Opioidprescribingguidelines• PrescriptionMonitoringProgram• Druginteractionawareness• Polypharmacy
•Community• Combatingisolation• Supportiveservices
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ControlledSubstancesPrescriptionMonitoringProgram
•Arizona’s48thLegislaturepassedH.B.2136
•SignedbytheGovernoronJuly2,2007,effectiveonSeptember19,2007.
•https://pharmacy.az.govunderthe“RxMonitoringWebsite”
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HealthCareSystemsCalltoAction
• ProvidePatienteducationtrainingandmaterialsforprescribersandpharmacists.• EncouragethatHealthCareProfessionalsregisterandimplement(PMP)ControlledSubstancesPrescriptionMonitoringProgram.
• GotothePMPAWARxEloginpagehttps://Arizona.pmpaware.net/login
• ForsupportcontactRaulMunoz,ProramCoordinator-CommunityEngagementPhone:(520)[email protected]
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§ 18-monthpilotprojectformotherswithchildrenunder18§ Partnershipbetweenthecountyandfiveorganizations§ ComprehensiveprogrammodelbuiltaroundtheGettingAhead:
§ ExtendedcoachingsupportafterGettingAhead§ Health-relatedcurriculumandconnectiontoresources§ Anefforttocreatechangeatthesystemslevel
§ Momsasexpert,empoweredadvocatesoftheircommunity§ Educatingandengagingthosewhoservepeopleinpoverty
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MacArthurFoundationfundedinitiativetosafelyreduceover-incarcerationbyaddressingracial/ethnicdisparities
• Datadrivendecisionmakingcombinedwithevidence-basedpracticestoinformpolicychange• Goal:Reduceaveragedailyjailpopulationfrom2,136in2014to1,574anda$2M/yearsavings• PretrialServices:
• Riskscreeningofallmisdemeanordefendants• Behavioral/healthscreeningandlinkagetotreatment• Enhancepretrialsupervisionofbehavioralhealthpatients
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Pay-for-Success(SocialInvestmentBond)Project
• FundedbyHUD&DOJtodevelopnewmodelsoffinancingtoexpandpermanentsupportivehousingforreentrypopulations
• HousingFirstwithForensicAssertiveCommunityTreatment
• TargetPopulation• Homelessindividuals• Incarceratedmorethantwiceayear• Behavioralhealthdiagnosed
• OutcomeMetrics• Social:CriminalJustice,Housing,JobReadiness,Costs• Health:HealthInsuranceEnrollment,Beh health,EDvisits,PCP
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AHealthyPimaCounty.Everyone.Everywhere.Everyday.
FrameworkforPublicHealthAction
Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health
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AHealthyPimaCounty.Everyone.Everywhere.Everyday.
ContactInformationFranciscoGarcía,MD,MPHAssistantCountyAdministrator&ChiefMedicalOfficerPimaCounty130WCongressSt,10th FloorTucson,[email protected](520)724-7931
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AHealthyPimaCounty.Everyone.Everywhere.Everyday.
PimaCountyHealthDepartmentMission
Toensurethehealth,safety,andwell-beingofourcommunitythroughleadership,collaboration,andeducation.
VisionAHealthyPimaCounty:Everyone.Everywhere.Everyday.
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