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Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
Building public safety_public_health_partnerships_final
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Building public safety_public_health_partnerships_final

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Law Enforcement Track, National Rx Drug Abuse Summit, April 2-4, 2013. Building Public Safety and Public Health Partnerships to Reduce Prescription Drug Abuse presentation by Laurence Busching, Dr. …

Law Enforcement Track, National Rx Drug Abuse Summit, April 2-4, 2013. Building Public Safety and Public Health Partnerships to Reduce Prescription Drug Abuse presentation by Laurence Busching, Dr. Denise Paone and Dr. Jessica Kattan.

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  • 1. Building  Public  Safety  and  Public  Health   Partnerships  to  Reduce  Prescrip9on   Drug  Abuse   Laurence  Busching   First  Deputy  Criminal  Jus2ce  Coordinator,  City  of  New  York   Denise  Paone   Director  of  Research  and  Surveillance,  Bureau  of  Alcohol   and  Drug  Use  Preven2on,  Care  and  Treatment,  New  York   City  Department  of  Health  and  Mental  Hygiene   Dr.  Jessica  Ka@an      CDC  Health  Systems  Integra2on  Program  Scholar,   Centers  for  Disease  Control  and  Preven2on,  SciMetrika   Contractor,   Assigned  to  New  York  City  Department  of  Health  and   Mental  Hygiene.  
  • 2. How  To  Work  with  Public  Health   Data  in  Inves9ga9ons   April  2  –  4,  2013   Omni  Orlando  Resort     at  ChampionsGate  
  • 3. Learning  Objec9ves  •  Outline  strategies  to  create  alliances  across   agency  lines.  •  Explain  how  to  leverage  public  health  data  in   inves2ga2ons.  •  Outline  the  importance  of  collabora2on   between  public  health  officials  and  law   enforcement  in  inves2ga2ons.   3  
  • 4. Disclosure  Statement  Laurence  Busching,  Dr.  Jessica  KaXan,  Dr.  Denise  Paone,  Chauncey  Parker,  and  Edward  Carrasco  have  no  financial  rela2onships  with  proprietary  en22es  that  produce  health  care  goods  and  services.   4  
  • 5. Outline  •  The  Threat  in  New  York  City    (Dr.  Denise  Paone,  NYC  DOHMH)  •  Mayor’s  Task  Force  on  Prescrip9on  Painkiller  Abuse    (Laurence  Busching,  New  York  City’s  Mayor’s  Office)  •  Public  Health/Public  Safety  Ini9a9ves   –  RxStat  (Dr.  Denise  Paone,  NYC  DOHMH)   –  Prescribing  Guidelines  (Dr.  Jessica  KaCan,  NYC  DOHMH)   –  Public  Safety  (Chauncey  Parker,  NY/NJ  HIDTA)   –  NYPD  Ini9a9ves  (Edward  Carrasco,  NYPD)  •  Public  Health/Public  Safety  Partnerships   5  
  • 6. Dr.  Denise  Paone,  Director  of  Research  and  Surveillance  New  York  City  Department  of  Health  and  Mental  Hygiene  THE  THREAT  IN  NEW  YORK  CITY    
  • 7. Opioid  analgesic  misuse  and  the  associated  consequences  have  led   to  a  public  health  crisis  in     New  York  City.   7  
  • 8. •  From  2005-­‐2011,  the  rate  of  opioid  analgesic   overdose  deaths  increased  65%,  heroin   overdose  deaths  decreased  8%.  •  In  2011,  more  than  one  fatal  opioid  analgesic   overdose  occurred  every  other  day  in  New   York  City.  •  In  2005,  opioid  analgesics  were  involved  in   16%  of  overdose  deaths;  in  2011,  they  were   involved  in  35%.   8  
  • 9. Exis9ng  Data/Surveillance  on  Opioid   Analgesic  (Pain  Reliever)  Misuse   Overdose   Mortality   Death  Cer2ficates   deaths?   Health   ED  Visits,  Treatment  Morbidity   Admissions   consequences?   Prescrip2ons  Prescribing   PDMP  Data   Filled?   How  Many   Na2onal  Survey  on  Prevalence   Drug  User  Health   Users?   9  
  • 10. Overdose  Deaths  Decreased  22%  in  NYC   500   Cocaine   Heroin   Methadone   400   Benzodiazepines   Opioid  Analgesics   300  Number     200   100   Drugs  are  not  mutually  exclusive     0   2005   2006   2007   2008   2009   2010   2011   Year  Source: New York City Office of the Chief Medical Examiner &New York City Department of Health and Mental Hygiene 2005-2011 10  
  • 11. Opioid  analgesic  overdose  deaths  increased  65%   250   4.0   Opioid  analgesic  overdose  deaths,  NYC,  2005-­‐2011    3.3   3.5   200   3.0   2.6   2.4   Age-­‐Adjusted  Rate  per  100,000   2.3   2.5   150   2.0   2.0   2.0   2.0  Number   100   1.5   1.0   50   0.5   130   152   131   137   158   173   220   0   0.0   2005   2006   2007   2008   2009   2010   2011   Number  of  opioid  analgesic  overdose  deaths   Age-­‐adjusted  opioid  analgesic  rates  per  100,000  popula9on  Source: New York City Office of the Chief Medical Examiner &New York City Department of Health and Mental Hygiene 2005-2011 11  
  • 12. Opioid  Analgesic-­‐related  Emergency  Department   Visit  Rates  Doubled  from  2004  to  2010     Opioid  analgesic  misuse/abuse  emergency  department  visits,   12,000   NYC  2004-­‐2010   129.2   140.0   113.1   110.3   120.0   Age-­‐adjusted  rate  per  100,000         10,000   103.2   89.8   100.0   8,000   79.8   Number   80.0   6,000   54.7   10,843   60.0   9,442   9,254   4,000   8,577   7,411   40.0   6,560   2,000   4,466   20.0   0   0.0   2004   2005   2006   2007   2008   2009   2010   Number  of  opioid  analgesics  ED  visits  Source: Drug Abuse Warning Network, Center for Behavioral Health Statistics andQuality, Substance Abuse Mental Health Services Administration, 2004-2010 12  
  • 13. Oxycodone  prescrip9ons  increased   51%  from  2008  to  2010  in  NYC   2,500,000   2,000,000   All  prescrip9ons  prescrip9ons   Number  of     1,500,000   Oxycodone   1,000,000   Hydrocodone   500,000   2008   2009   2010   Year  Dispensed   Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2008-2010 13  
  • 14. 15%  of  prescribers  write  82%  of   opioid  analgesic  prescrip9ons   Prescrip2ons  filled  by  NYC  residents,  2010   100% 1% 90% 15%   14% Very Frequent Prescribers 31% 530-10,185 RX/year 80% 70% Frequent 36% Prescribers 60% 50-529 RX/year 82%  Percent 50% Occasional Prescribers 51% 40% 4-49 RX/year 30% 49% Rare Prescribers 20% 1-3 RX/year 10% 15% 0% 2% Prescribers Prescriptions Prescribing frequencySource: New York State Department of Health, Bureau of NarcoticEnforcement, Prescription Drug Monitoring Program, 2008-2010 14  
  • 15. Neighborhoods  with  Highest  Rates  of  Opioid   Prescrip9ons  have  Highest  Rates  of  Overdose  Deaths   Rates  of  prescrip9ons  filled  for  opioid   Rates  of  uninten9onal  opioid   analgesics  by  NYC  neighborhood   analgesic  overdose  deaths  by  NYC   neighborhood  Source: New York State Department of Health, Bureau of NarcoticEnforcement, Prescription Drug Monitoring Program, 2008-2009;New York City Office of the Chief Medical Examiner &New York CityDepartment of Health and Mental Hygiene 2008-2009 15  
  • 16. Most  Commonly  Used  Drugs  Are     Opioid  Analgesics   5%   Self-­‐reported  drug  use  in  past  12  months,  NYC,  aged  12+   Opioid  Analgesics   4%   3%   Cocaine  Percent     2%   Benzodiazepines   1%   Heroin   0%   2002-­‐03   2004-­‐05   2006-­‐07   2008-­‐09   2010-­‐11   Self-­‐reported  year  of  use  (two  year  average)   Source: Substance Abuse Mental Health Services Administration, Office of Applied Studies, 2002-2009 National Surveys on Drug Use and Health 16  
  • 17. Laurence  Busching,  First  Deputy  Criminal  Jus2ce  Coordinator  New  York  City  Office  of  the  Mayor  NYC  MAYOR’S  TASK  FORCE  ON  PRESCRIPTION  PAINKILLER  ABUSE  
  • 18. NYC  Mayor’s  Task  Force  on   Prescrip9on  Painkiller  Abuse  Co-­‐chair,  Criminal  Jus2ce  Coordinator  Co-­‐chair,  Deputy  Mayor  for  Health  and  Human  Services  New  York  City  Department  of  Health  and  Mental  Hygiene  New  York  City  Police  Department    New  York  City  Department  of  Educa2on    Health  and  Hospitals  Corpora2on  Human  Resources  Administra2on  Mayor’s  Office  of  Policy  and  Strategic  Planning  Richmond  County  District  AXorney’s  Office  Office  of  the  Special  Narco2cs  Prosecutor  Drug  Enforcement  Administra2on  NY/NJ  HIDTA   18  
  • 19. Task  Force  Work  Groups  •  Data  •  Legisla9on    •  Preven9on  and  Treatment  •  Law  Enforcement     19  
  • 20. Dr.  Denise  Paone,  Director  of  Research  and  Surveillance  New  York  City  Department  of  Health  and  Mental  Hygiene  RXSTAT:  NYC’S  COMPREHENSIVE  DRUG  SURVEILLANCE  SYSTEM  “COMPSTAT  for  PrescripNon  Drug  Abuse”  
  • 21. RxStat  Goals   “COMPSTAT  for  PrescripNon  Drug  Abuse”    Reduce  prescrip+on  drug  misuse  in  NYC  and  associated  health  and  safety  consequences  by:  •  Facilita2ng  accurate  and  2mely  analysis  of   public  health  and  public  safety  data.  •  Targe2ng  resources  and  coordina2ng  efforts  to   provide  the  most  effec2ve  and  efficient  City   response.  •  Providing  measures  to  track  strategies.   21  
  • 22. RxStat   “COMPSTAT  for  PrescripNon  Drug  Abuse”    •  Public  Health  &  Public  Safety  Collabora2on.  •  “Real-­‐2me”  (enhanced)  surveillance.  •  Par2cipants  and  stakeholders  at  city,  state,   and  federal  organiza2ons.  •  Monthly  RxStat  mee2ngs  with  key   stakeholders.   22  
  • 23. Enhanced  Surveillance  Efforts   Monthly  Monitoring,  OCME  BoXle   Mortality   Project*   Daily  ED  Visits,  Daily  NYC  PCC  Calls,   Morbidity   Quarterly  Treatment  Admissions   Quarterly  PDMP  data,  Quarterly   Prescribing   DEA  Data   Prevalence  &   Qualita2ve  Component,  Data   Intelligence   Analy2cs/Mapping     Crime  &   Monthly  Prosecu2ons*,  NYPD  Data,   Diversion   Quarterly  DEA  Losses,  Rx  Crimes*  *Discussed  in  more  detail  later  in  the  presentaNon.   23  
  • 24. RxStat  “COMPSTAT  for  PrescripNon  Drug  Abuse”     RxStat  creates  a  plaqorm  for  collabora2ve  problem  solving  to  reduce  prescrip2on  drug  abuse.   24  
  • 25. Dr.  Jessica  KaXan,  CDC  Health  Systems  Integra2on  Program  Scholar  Centers  for  Disease  Control  and  Preven2on,  SciMetrika  Contractor  Assigned  to  New  York  City  Department  of  Health  and  Mental  Hygiene  BEST  PRACTICES  PRESCRIBING  GUIDELINES  
  • 26. Opioid  Prescribing  Guidelines   26  
  • 27. Emergency  Department  Opioid  Prescribing   Guidelines:  Goal  and  Ra9onale   •  Establish  standards  for  prescribing.   •  Balance  pain  treatment  with  reducing  opioid   analgesic  misuse.   •  Why  Emergency  Departments?   –  Pain  is  a  common  presenta2on  in  EDs.     –  Opioid  analgesics  are  commonly  prescribed  in  EDs,   although  EDs  not  the  main  source.   –  One  component  of  a  mul2-­‐pronged                     approach.   27  
  • 28. Target  &  Adop9on  •  Pa2ents  discharged  from  EDs.  •  Not  meant  for  pallia2ve  care  programs  or   cancer  pain.  •  Adopted  by  all  Health  and  Hospitals   Corpora2on  EDs  (NYC’s  public  hospital  system).   28  
  • 29. ED  Opioid  Prescribing  Guidelines   29  
  • 30. Percep9ons  •  Emergency  Departments  •  Media  Response  •  General  Public   30  
  • 31. Chauncey  Parker,  Director  New  York/New  Jersey  High  Intensity  Drug  Trafficking  Area  APPLICATION  IN  PUBLIC  SAFETY  &  RX  CRIMES  
  • 32. Overdose  Death  Prescrip9ons  •  Office  of  the  Chief  Medical  Examiner  (OCME)   began  collec2ng  prescrip2on  boXles  at  death   scenes.  •  Partnership  allowed  resources  to  log  the   boXle  informa2on.  •  Data  in  process  of  being  compiled  as  poten2al   supplemental  intelligence.     32  
  • 33. New  York  County  2012  Drug   Prosecu9ons  by  Drug  Type   (reflec2ng  11,712  instances  of  drugs  in  10,559  prosecu2ons)  “Benzodiazepines”  includes  Alprazolam,  Clonazepam,  Diazepam,  etc.  “Opioid  Analgesics”  includes  pure  &  compound  versions  of  Oxycodone,  Hydrocodone,  Oxymorphone,  Morphine,  etc.  (excludes  Methadone).   33  
  • 34. Oxycodone  &  Oxycodone  Compounds  Arrest  Loca9ons   Reflec9ng  160  Prosecu9ons  in  Three  Upper  Manha@an  Precincts   34  
  • 35. Rx  Crimes    •  Central  repository  for  Rx-­‐related   Robberies/Burglaries,  direct  LEA   access  to  police  reports.  •  Fill  cross-­‐border/interagency   sharing  gap.  •  Allow  proac2ve  analysis:   — Emerging  crime  paXerns   (e.g.,  through  the  roof)   — Security  alerts   — Sources  of  drugs   — Targeted  drugs   35  
  • 36. Edward  Carrasco,  Deputy  Inspector  Office  of  Management  Analysis  and  Planning  New  York  Police  Department  NEW  YORK  POLICE  DEPARTMENT  RX  DRUG  INITIATIVES  
  • 37. NYPD  Rx  Drug  Ini9a9ves  Emphasis  on  Community  Engagement   •  Partnership  with  schools   •  Pharmacy  Crimes  Reduc2on  Ini2a2ve   •  Other  awareness  programs   37  
  • 38. Laurence  Busching,  First  Deputy  Criminal  Jus2ce  Coordinator  New  York  City  Office  of  the  Mayor  PUBLIC  HEALTH  &  PUBLIC  SAFETY  PARTNERSHIPS  
  • 39. Challenges  &    Conclusions  •  Legality  of  prescrip2on  drugs  •  Complexi2es  of  regula2on  •  Data  availability/data  silos  •  Terminology  across  fields  •  Addressing  misinforma2on  •  Developing  collabora2ve  approaches   Common  Goal  -­‐     Reduce  prescrip+on  drug  abuse  and  the   associated  public  health  and  public  safety   consequences.     39  
  • 40. Ques9ons  For  more  informa2on  contact:  John  Hreno  -­‐  jhreno@nynjhidta.org   40  

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