Examining What’sHappening Across America April 10-12, 2012 Walt Disney World Swan Resort
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.
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.
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
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).
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.
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.
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.
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).
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)
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)
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
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
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
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
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
Addressing Target Popula1ons: Mississippi • Development of print materials targeted towards adolescents. • Trainings for care givers of older adults.
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
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)
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%
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
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
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.
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.
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).
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.
Highlights: Connec1cut • Community preven1on coali1ons are priori1zing prescrip1on drug abuse and misuse. • Drop Boxes are installed in mul1ple police sta1ons across the State.
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).
Conclusion • This is a complex problem. • Collaborate with your State Substance Abuse Agency. Contact Informa2on: Email: email@example.com Website: www.nasadad.org