Rob Morrison

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Examining What's Happening Across America
National Rx Drug Abuse Summit 4-11-12

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Rob Morrison

  1. 1. Examining What’sHappening Across America April 10-12, 2012 Walt Disney World Swan Resort
  2. 2.  Accepted  Learning  Objec1ves:  1.  Analyze  the  characteris1cs  of  effec1ve  programs  designed  to   reduce  the  growth  of  prescrip1on  drug  abuse  and  provide   evidence-­‐based  programs  that  can  be  replicated  in  rural  and   urban  communi1es.  2.  Iden1fy  common-­‐interest  issues  related  to  grassroots   preven1on  and  treatment  programs.  3.  Describe  resources  to  advocate  for  change,  with  specific   focus  on  model  state  drug  laws.  
  3. 3. Disclosure  Statement  All  presenters  for  this  session,  Sherry  Green,  Robert  I.L.  Morrison,  and  Steve  Pasierb,  have  disclosed  no  relevant,  real  or  apparent  personal  or  professional  financial  rela1onships.  
  4. 4. State  Substance  Abuse  Agencies   and  Prescrip2on  Drug  Abuse   Ini1al  Results  from  a     NASADAD  Membership  Inquiry  Robert  Morrison,  Execu1ve  Director  Cliff  Bersamira,  Research  Analyst  Na1onal  Associa1on  of  State  Alcohol  and  Drug  Abuse  Directors,  Inc.  (NASADAD)  April  2012  
  5. 5. Na1onal  Associa1on  of  State  Alcohol   and  Drug  Abuse  Directors,  Inc.  •  State  Substance  Abuse  Agency  Directors  (SSAs)   manage  the  publicly-­‐funded  State  substance  abuse   preven1on,  treatment,  and  recovery  systems.  •  NASADAD  established  in  1971  in  Washington,  DC.  •  Component  Groups:  Na1onal  Preven1on  Network   (NPN)  and  Na1onal  Treatment  Network  (NTN).  
  6. 6. Poisoning  is  the  Leading  Cause  of  Death   from  Injury  in  30  States  (CDC,  2011)  Warner  M,  Chen  LH,  Makuc  DM,  Anderson  RN,  Miniño  AM.  Drug  poisoning  deaths  in  the  United  States,  1980–2008.  NCHS  data  brief,  no  81.  Hya`sville,  MD:  Na1onal  Center  for  Health  Sta1s1cs.  2011.  
  7. 7. Opioid  Analgesics  Involved  in  More  Than  40%   of  Drug  Poisoning  Deaths  in  2008  (CDC,  2011)    Number  of  drug  poisoning  deaths  involving  opioid  analgesics  and  other  drugs:  United  States,  1999–2008   Warner  M,  Chen  LH,  Makuc  DM,  Anderson  RN,  Miniño  AM.  Drug  poisoning   deaths  in  the  United  States,  1980–2008.  NCHS  data  brief,  no  81.  Hya`sville,   MD:  Na1onal  Center  for  Health  Sta1s1cs.  2011.  
  8. 8. NASADAD  Membership  Inquiry:   Primary  Objec1ves  • Understand  how  States  Substance   Abuse  Agencies  are  addressing   prescrip1on  drug  abuse.  • Iden1fy  effec1ve  prac1ces  and   challenges/barriers.  • Iden1fy  training,  technical  assistance,   and  resource  needs.  
  9. 9. Membership  Inquiry:  Overview  • Web  survey  conducted  in  March  2012.  • Invited  State  Directors  (SSAs),  Treatment   Leads  (NTNs),  and  Preven1on  Leads   (NPNs)  to  par1cipate.  • 46  States,  2  Territories,  and  the  District   of  Columbia  responded.  • Analysis  includes  46  States  and  the   District  of  Columbia  (N  =  47  States).  
  10. 10. Importance  of  Prescrip1on  Drug  Abuse   to  State  Substance  Abuse  Agencies   4%   Most  Important  (11)   15%   23%   Very  Important  (27)   Important  (7)   Moderately  Important  (2)   Of  Li`le  Importance  (0)   58%   Unimportant  (0)  
  11. 11. State  Task  Force  Addressing   Prescrip1on  Drug  Abuse   4%   Yes,  currently   exists  (29)   19%   Yes,  once  existed   but  no  longer   ac1ve  (7)   No  (9)  15%   62%   Unsure  (2)  
  12. 12. State  Task  Force  :  California  • State  Agency  Task  Force  established  in  2008.  • Task  Force  included:  Department  of  Jus1ce;   Department  of  Public  Health;  California   Universi1es;  Partnership  for  a  Drug-­‐Free   America;  AOD  workforce  professionals;  State   Substance  Abuse  Agency  • Summary  Report  and  Recommenda1ons  on   Prescrip1on  Drugs:  Misuse,  Abuse  and   Dependency  (2009)   h`p://www.adp.cahwnet.gov/Director/pdf/Prescrip1on_Drug_Task_Force.pdf    
  13. 13. State  Task  Force:  Iowa  • 370%  increase  (1999-­‐2009)  in  those  seeking   treatment  for  prescrip1on  drug  abuse   •  187  in  1999  to  878  in  2009  • Iowa  Prescrip1on  Drug  Abuse  Reduc1on  Task   Force  (PAR)  • Iowa  Plan  for  Reducing  Prescrip1on  Drug   Abuse  (2011)   h`p://nursing.iowa.gov/images/pdf/BM%20A`achments/ReducPresDrgAbuse.pdf     •  Educa1on/Interven1on;  Safe  Disposal;   Monitoring;  Enforcement  
  14. 14. State  Legisla1on  Addressing   Prescrip1on  Drug  Abuse   Any  Legisla2on  (N  =  47)   Breakdown  by  Legisla2on  Focus  (N  =  47)   Yes  (37)   No  (9)   Focus  on  Demand   62%   30%  6%   No  Response  (1)   2%  19%   Focus  on  Supply   45%   36%   17%   Focus  on  Legal   51%   30%  17%   Dispenser/Pharmacy   Focus  on  Prescriber   40%   43%   15%   Percent  of  States   79%   Yes   No   Unsure   No  Response  
  15. 15. Educa1ng  the  General  Public  on   Prescrip1on  Drug  Abuse   Any  Educa2on  (N  =  47)   By  Educa2on  Type  (N  =  47)   Yes  (39)   No  (8)   Yes,  Printed   materials   64%   17%   Yes,  Internet   campaign   26%   Yes,  Mul1media   (radio  or  television)   40%   Yes,  Other   32%   No   17%   83%   0%   20%   40%   60%   80%   Percent  of  States  
  16. 16. Programs  or  Ini1a1ves  for   Target  Popula1ons   Yes   No   Unsure   No  Response   •  Other  Popula1ons  Cited:   •  Na1ve  Americans  and  Adolescent/   6%  Young  Adults   53%   34%   6%   Tribes  (2)   •  Pregnant  Women  (2)   •  Those  with  Chronic  Older  Adults   23%   47%   13%   17%   Health  Condi1ons  (1)   •  Post-­‐Natural  Disaster   Communi1es  (1)   Women   19%   55%   13%   13%   Percent  of  States  
  17. 17. Addressing  Target  Popula1ons:   Mississippi  • Development  of  print  materials   targeted  towards  adolescents.  • Trainings  for  care  givers  of  older   adults.  
  18. 18. Educa1onal  Ac1vi1es  for  Physicians,   Pharmacists,  and  Pa1ents   Yes   No   Unsure   No  Response   Physicians/Other  Prescribers?   51%   28%   15%  6%   Target  Group   Pharmacists?   38%   32%   17%   13%   Pa1ents/Families?   53%   34%   11%   Percent  of  States  
  19. 19. State  Substance  Abuse  Agency  Involvement  with  the  Prescrip1on  Drug   Monitoring  Program  (PDMP)  (N  =  28)   3%   11%   Directly  oversees   PDMP  (3)   11%   Part  of  commi`ee  that   oversees  PDMP  (3)  43%   Serves  in  an  advisory   capacity  (9)   No  involvement  (12)   32%   Unsure  (1)  
  20. 20. Usefulness  of  PDMP  Data  to  State   Substance  Abuse  Agencies   6%   Very  Useful  (17)   11%   Useful  (13)  4%   36%   Somewhat  Useful  (6)  2%   Not  Par1cularly  Useful  (1)   Not  Useful  (2)  13%   Not  Applicable  (5)   Unsure  (3)   28%  
  21. 21. Highlights  of  State  Programs  and   Ini1a1ves:  Themes  across  States  •  Collaboraon   •  e.g.  across  State  agencies;  with  law  enforcement;  with   primary  care  providers;  across  States  •  Educaon  and  Prevenon   •  e.g.  provide  community  educa1on;  mobilize  preven1on   coali1ons;  educate  prescribers  and  pharmacists  •  Early  Idenficaon  and  Referral  to  Treatment   •  e.g.  SBIRT  training  for  physicians  •  Supply  Reducon   •  e.g.  take  back  iniaves  
  22. 22. Highlights:  Ohio  •  In  2009,  opiates  were  primary  drug  of  choice  for   18%  of  all  clients  (up  from  7%  in  2001).  •  Top  priority  of  Governor  Kasich  –  includes  a  Task   Force  led  by  SSA.    •  State  conference  in  2011.  •  “Recovery  2  Work”  Ini1a1ve  –  Led  by  SSA,   Rehabilita1on  Services,  and  County  Authori1es.   •  Integrates  addic1on  treatment  with  voca1onal   rehab  services  –  focus  on  jobs.   h`p://recovery2work.org    
  23. 23. Highlights:  Oregon  • In  2010,  the  State  Agency  developed  the   Prescrip1on  Opioid  Poisoning  Preven1on  (POP)   Ac1on  Plan  to  reduce  analgesic  overdose   deaths  in  the  State.  • This  plan  took  a  mul1-­‐agency,  public-­‐private   collabora1on  approach  to  addressing  four   areas:  1)  communica1on;  2)  educa1on;  3)   clinical  prac1ce  and  policy;  4)  system   coordina1on  clinical  prac1ce  issues.  
  24. 24. Highlights:  Utah  • Legisla1on  requires  prescribers  to  a`end   four  hours  of  substance  abuse  classes.  • April  is  designated  as  “Clean  Out  your   Medicine  Cabinet”  Month.  h`p://www.medica1ondisposal.utah.gov/cleanoutcabinet.htm  • Through  local  preven1on  coali1ons,   successful  take  back  events  have  collected   6,550  pounds  of  prescrip1on  drugs.  
  25. 25. Highlights:  Vermont  •  2nd  highest  State  per  capita  for  admissions  to   prescrip1on  opiates  treatment  in  2008.  •  Prescrip1on  Drug  Abuse  Work  Group.  •  State  Agency  sponsored  hospital  grand   rounds  –  call  a`en1on  to  awareness.  •  Conference  in  2009  on  Pain  Management.  •  Hub  and  Spoke:  5  loca1ons  with  specialty   treatment  /assessment/counseling  (hub)   monitoring/support/physician  prac1ces   (spoke).  
  26. 26. Highlights:  Arizona  • State  Agency  collaborated  with  Poison   Control  Centers  to  iden1fy  repeat   poisonings  and  make  referrals  to  SUD   treatment  services.  • Online  trainings  were  developed  for   Emergency  Department  doctors  to   increase  the  understanding  of  screening   and  referral  process.  
  27. 27. Highlights:  Connec1cut  • Community  preven1on  coali1ons  are   priori1zing  prescrip1on  drug  abuse   and  misuse.  • Drop  Boxes  are  installed  in  mul1ple   police  sta1ons  across  the  State.  
  28. 28. Remaining  Challenges:   Themes  across  States  •  Easy  access  (high  supply)  of  prescrip1on  drugs.  •  Lack  of  funding.  •  Need  for  workforce  development  (lack  of  capacity  to   address  this  issue).  •  Challenges  with  data  (lack  of  data;  data  that  doesn’t   capture  the  en1re  story).  •  Need  to  priori1ze  the  issue.  •  Challenges  with  collabora1on.  •  Need  for  PDMP  improvement  (need  for  improved   collabora1on  with  PDMP  host  agency;  lack  of  funding  for   PDMP).  
  29. 29. Conclusion  • This  is  a  complex  problem.  • Collaborate  with  your  State   Substance  Abuse  Agency.   Contact  Informa2on:   Email:  rmorrison@nasadad.org   Website:  www.nasadad.org  

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