Vision Session Tuesday, April 22, 2014; 8:00 – 8:45 a.m.

Terry Cline, PhD Oklahoma Commissioner of Health

ASTHO President

Source: CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. CDC Policy Impact: Prescription Painkiller Overdoses. Available at:

www.cdc.gov/homeandrecreationalsafety/rxbrief/

Sources: 1.  Strassels SA. Economic burden of prescription opioid misuse and abuse. J Manag Care Pharm. 2009;15:556–62. 2.  GAO Medicaid: Fraud and Abuse Related to Controlled Substances Identified in Selected States, GAO-09-957. Washington, DC. 3.  GAO Medicare Part D: Instances of questionable access to prescription drugs, GAO-11-699. Washington, DC. 4.  CMS National Health Expenditure Data: Type of service, source of funds, CY 1960-2008. Baltimore, MD: 2008.

The medical and prescription costs associated with opioid addiction and diversion have been estimated at $72.5 billion annually for private and public healthcare payers.1-4 American Journal of Managed Care, 2013

Rates of opioid overdose deaths, sales and treatment admissions have increased in parallel.

•  21.6 million people aged 12 and older identified with SUDs, only 10.8% receive treatment.

•  38% of the 45 million people reported to have psychological distress receive mental health care.

•  More than 8.9 million persons have co-occurring mental health and substance use disorders.

•  Increasing admissions for prescription opioid addiction as primary problem.

•  Increasing number of veterans reporting mental health and substance use disorders.

Source: SAMHSA, 2013

  Vision: Healthy people thriving in a nation free of preventable illness and injury.

  Mission: To transform public health within states and territories to help members dramatically improve health and wellness.

Best Practice Sharing

Policy Support and Advocacy

Leadership Development and

Network

Technical Assistance

KY, OH, OK, TN,

WV  

AL, AR, CO, KY, NM, OR, VA  

2012 States

2012-2013 NGA

States

2013 States

Tier 1

Tier 2

Tier 3

AZ, CT, DE, IL  

9 State Teams: AZ, CT, DE, IL, KY, OH, OK, TN, WV

Comprised of diverse partners: •  State Health Officials •  Legislators, Special Counsel, Office of Attorney General •  Public Safety, Criminal Justice, Law Enforcement •  Alcohol and Drug Abuse Services •  Behavioral and Mental Health Treatment Services •  Pharmacy Association/Board of Pharmacy •  Department of Education •  Consumer Protection •  Poison Control Center •  Physicians/Prescribers

Public health is poised to mobilize and encourage partnerships!

Focuses attention on a critical national health issue   Public health   Population impact

Public health strategies can be applied

Yields benefits and impact in a relatively short period of time

Goal: Improve health outcomes and reduce human and economic costs associated with prescription drug misuse, abuse, and overdose.

Pledge: Reduce the rate of nonmedical use and the number of unintentional overdose deaths involving controlled prescription drugs* 15 percent by 2015.

*(including opioid analgesics, stimulants, tranquilizers, and sedatives)

Encourages all S/THOs to apply strategies to achieve measurable reductions in controlled prescription drug misuse, abuse, and overdose

Identify at least one policy or program to implement, improve, or evaluate in the next year

Move beyond “silo-based” approaches to focus on collaboration with partners to carry out aligned, comprehensive efforts

American Academy of Pain Management American Pharmacists Association American Association of Poison Control Centers American Society of Addiction Medicine PDMP Center of Excellence (Brandeis University) Centers for Disease Control and Prevention Clinton Foundation Federation of State Medical Boards Kanawha-Charleston Health Department Maryland Poison Control Center National Alliance for Model State Drug Laws National Association of Chain Drug Stores National Association of County and City Health Officials National Association of State Alcohol and Drug Abuse Directors National Governors Association National Institute on Drug Abuse Office of the Army Surgeon General Ohio Department of Health Oklahoma State Department of Health Pennsylvania Department of Drug and Alcohol Programs

Personal Advocate Pharmaceutical Research and Manufacturers of America Project Lazarus Safe States Alliance Substance Abuse and Mental Health Services Administration Tennessee Department of Health United States Department of Justice University of Kansas School of Medicine University of Rochester Medical Center Vermont Department of Health White House Office of National Drug Control Policy

Ongoing Work: Expand and Strengthen Key Partnerships

and Collaborative Infrastructure

Prioritize multi-sector efforts and identify collaborations, partnerships, stakeholders, and corresponding efforts to address prescription drug abuse.

As of 04/01/2014, 26 states and one territory have accepted the Challenge!  

www.astho.org/rx

Expand and Strengthen Prevention Strategies •  Develop a public health awareness campaign supported by an online

clearinghouse and educational materials (AL) •  Develop prescribing guidelines for community practitioners to

complement existing ED guidelines (AZ) •  Implement CME training, modules for prescribers (DE, IL, TN) •  Enhance school-based programs and education curriculum (AZ, DE) •  Improve or pilot drug take-back and medication disposal programs (IN,

KS) •  Overdose Prevention Education and Naloxone

•  Amend regulations to allow first responders to carry naloxone, allow for bystander administration under Good Samaritan (MA)

•  Promote use of naloxone among populations, patients at risk of overdose (MA, WA)

Preven&on  Strategies  

Improve Monitoring and Surveillance •  Increase PDMP utilization (AL, AZ, CO, GU, IL, IN, UT) •  Issue “report cards” to prescribers allowing them to self-monitor

prescribing practices relative to other prescribers of their specialty types in their county (AZ)

•  Streamline PDMP workflow and integration, “user-friendly” (CO, WA) •  Increase reporting of pharmacy anomalies (GU) •  Map by county: mortality data, emergency department and hospitalization

discharge data (IN) •  Improve “high-risk patient” model; develop a “high-risk prescriber” and

“high-risk dispenser” model (TN) •  Link data sources (e.g., death certificate, hospitalization data) and

standardize data collection (CO, ID, IN, NC, TN, WA)

Example: Arizona State Board of Pharmacy Quarterly Report Cards Pilot

Source: Ohio Department of Alcohol and Drug Addiction Services SFY 2012 Annual Report

This map uses hot spot analysis to display the number of clients in treatment who list heroin (left), prescription opioids (right) as a

primary drug of choice by zipcode.

Expand and Strengthen Control and Enforcement •  Develop guidelines for chronic pain management (TN) •  Monitor PDMP database to identify violations of law (SC) •  Work with state task force to establish thresholds as part of the PDMP

(INSPECT) to generate automatic “flag” to investigate cases of potential over-prescribing or criminal activity (IN)

•  Consider reporting requirement for controlled substance diversion in health care facilities (IN)

•  Annually contact top 50 prescribers of controlled substances to understand their practices, specialty types, and encourage appropriate prescribing (TN)

Diversion  Control    

Licensure  

Law  Enforcement  

More than 9.8 billion milligrams of morphine equivalents (MME) were dispensed in Tennessee in 2013.

Source: Controlled Substance Monitoring Database. 2014 Report to the 108th Tennessee General Assembly. Tennessee Department of Health.

Improve Access to and Use of Effective Treatment and Recovery •  Develop strategic plan for statewide patient-centered, comprehensive substance

abuse treatment (DE) •  Support community health worker (CHW) initiatives by linking patients (priority:

pregnant women) to treatment services, provide ongoing recovery support (IN) •  Support tuition reimbursement for mental health providers working in underserved

areas (IN) •  Promote use of SBIRT protocols among health care, hospitals and community

providers (AZ, MT) •  Work with task force (community, state and federal partners) to create searchable

online database of treatment resources (AZ) •  Participate in Governor’s Mental Health Task Force (KS)

Treatment  

Recovery  

HB 1781 – Prescription Drug Monitoring Program (PDMP) Access Grants the Department of Health and the Department of Mental Health and Substance Abuse Services access to PMP; shared data may be used for statistical, research, substance abuse prevention provided that confidentiality is maintained.

HB 1782 – Naloxone Allows first responders to administer opiate antagonists without a prescription when encountering a person exhibiting signs of a drug overdose, and allows prescriptions to family members so they can administer in an overdose situation.

HB 1783 – Emergency Rule Changes Hydrocodone Refills Limits hydrocodone refills with no automatic refills; new prescription required.

$1.2 million appropriated specifically for prescription drug initiatives annually  

  Strategies must be comprehensive

  A strategy is only as strong as its weakest link

  We MUST be multidisciplinary

  We MUST anticipate consequences

  We CAN make a difference