The document summarizes a vision session on prescription opioid overdose that included presentations from the Oklahoma Commissioner of Health and the president of ASTHO. Key points discussed include: - The growing epidemic of prescription opioid overdose deaths and costs to the healthcare system. - ASTHO's Prescription Drug Overdose Prevention Challenge which aims to reduce overdose rates and engages state health officials and partners across sectors. - Strategies discussed to address the epidemic through prevention, monitoring, enforcement, treatment and recovery efforts.

1. Vision Session
Tuesday, April 22, 2014; 8:00 – 8:45 a.m.
Terry Cline, PhD
Oklahoma Commissioner of Health
ASTHO President

4. 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/

5. 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.

6. • 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

7.  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.

8. Best Practice
Sharing
Policy Support
and Advocacy
Leadership
Development and
Network
Technical
Assistance

9. 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

10. 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!

11. 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

12. 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)

13. 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

14. 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.

18. As of 04/01/2014, 26 states and one territory have accepted the Challenge!
www.astho.org/rx

19. 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)

20. Preven&on
Strategies

21. 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)

22. Example: Arizona State Board of Pharmacy
Quarterly Report Cards Pilot

23. 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.

24. 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)

25. 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.

26. 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)

27. Treatment
Recovery

28. 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

29.  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