Presentation delivered at the University of Michigan Injury Center Opioid Overdose Summit, Ann Arbor, MI, December 1, 2015

1. Grant Baldwin, PhD, MPH
December 1, 2015
CDC Initiatives & Priorities to
Address the Prescription
Drug Overdose Crisis
National Center for Injury Prevention and Control
Division of Unintentional Injury Prevention

2. HHS Secretary’s Opioid Initiative
Focus on three priority areas that tackle the opioid crisis and significantly impact
those struggling with substance use disorders to help save lives
Providing training and educational resources
to assist health professionals in making
informed prescribing decisions
1
Increasing use of Naloxone
Expanding the use of Medication-Assisted
Treatment
2
3

3. Three Pillars of CDC’s Work
 Improve data quality and track trends
 Strengthen state efforts by scaling up effective public
health interventions
 Supply healthcare providers with resources to
improve patient safety

4. Improving the quality & timeliness of opioid
overdose surveillance
WHAT WE’RE DOING
 Generate near real-time surveillance of
emergency department visits related to drug
overdoses
 Improve surveillance of EMS transports
related to drug overdoses
WHY WE’RE DOING IT
 An early warning of large increases or
decreases of drug overdoses to better
target prevention efforts
 Better understand changing demographic
patterns of drug overdoses

5. Prevention for States (PfS)
 Provides states guidance and resources
to prevent prescription drug overdoses
by addressing problematic opioid
prescribing
 Builds on the success of the Prevention
Boost – Funding Opportunity
 16 states funded with average award
ranging from $750K to $1M
 Funding to states with high burden and
readiness to act
 Focus on high impact, data driven
activities and give states flexibility to
tailor their work

6. Expand or improve proactive PDMP reporting
Expand/maximize PDMPs as a surveillance system
Implement mandatory PDMP registration or use
Reduce PDMP data collection interval
Evaluate existing PDMP practices*
Enhance Patient Review and Restriction (PRR)
capacity
Enhance other health insurer/system practices*
Develop and apply metrics for inappropriate
prescribing
Identify high-risk groups among the insured
Conduct cost analyses
Identify effective benefit design strategies
Disseminate best practices info for insurers
Provide technical assistance to high burden
communities and counties*
Evaluate laws/policies/regulations implemented
in states, including their impact on heroin and
prescription drug abuse/overdose
Disseminate information on effective
laws/policies/regulations
Funding
Surveillance
expertise
TA on policy &
program
development
Evaluation
guidance
Dissemination
of best
practices
Short (1 year)
Policy/Program
Development
Medium (1−3 years)
Behavior Change
Authority to send proactive
reports
Mandatory registration & use
Reduced data collection interval
(e.g., real time reporting)
Increased use of standard PDMP
reports for surveillance and
other purposes
Long (3−5 years)
Health Outcomes
Increase enrollment in PRR
programs
Implemented robust drug
utilization review programs
Implemented enhanced drug
formularies
Revised policy on Medication
Assisted Treatment (MAT)
Evidence of effectiveness for
pain clinic laws
Evidence of effectiveness for
clinical guidelines/rules
Evidence of effectiveness for
licensure boards enforcement
policies and practices
Evidence of effectiveness for
immunity/naloxone laws
Increased use of PDMPs
Decreased rate of high-dose (>100
MME/day) opioid Rxs
Decreased rate of dangerous drug
combinations
Decreased prescribing patterns
inconsistent with guidelines/rules
Increased # of patients on MAT
Decreased use of methadone for
pain
Increased law enforcement and
licensure boards using PDMP data
Increased enforcement actions
against outlier providers
Decreased number of pill mills
Fewer drug diversion
cases
Increased opioid
substance abuse
treatment admissions
(ultimately want
decrease)
Improvement in
treatment of pain
Decreased drug
overdose death rate
Decreased rate of ED
visits due to controlled
prescription drugs
Decreased doctor shopping rate
Reduced barriers to seeking help
and responding with naloxone to
an overdose
Enhanced adoption of opioid
prescribing guidelines*
Increased number of patients
enrolled in PRR programs
Reduced number of providers and
MME/day among PRR enrollees
Increased use of claims reviews to
identify outlier providers
**High-Risk
Prescribing/
Patient
Behaviors
• High-dose opioids
(>100 MME/day)
• Multiple providers
• Co-prescribing of
opioids and
benzodiazepines
• Lack of access to
substance abuse
treatment
Enhance and Maximize PDMPs
Improve Insurer/Health System
Mechanisms
Evaluate Laws/Policies/Regulations
PDMPS
Insurers/Health Systems
Strengthened Evidence
Providers
Insurers/Health Systems
Oversight/Enforcement
LOGIC MODEL
Prescription Drug Overdose: Prevention for States and Prevention Boost*
Targeting High-Risk Prescribers and High-Risk Patients**
Patients
State-Level OutcomesOutputs/Strategies***Inputs
*These activities are being conducted through PFS only – all other
activities are conducted through both Boost and PFS.
***Through PFS, states can propose Rapid Response Projects that
break new ground in any of these areas.

7. Enhance and
Maximize
PDMPs
Community or
Health System
Interventions
State Policy
Evaluation
Rapid Response
Projects
 Move toward universal PDMP
registration and use
 Make PDMPs easier to use and
access
 Move toward a real-time PDMP
 Expand and improve proactive
reporting
 Conduct public health
surveillance with PDMP
 Implement or improve opioid prescribing
interventions for insurers, health systems,
or pharmacy benefit managers. This
includes:
 Prior authorization,
prescribing rules, academic
detailing, CCPs, PRRs,
 Enhance adoption of
opioid prescribing
guidelines
 Allow states to move on quick,
flexible projects to respond to
changing circumstances on the
ground and move fast to
capitalize on new prevention
opportunities.
 Build evidence base
for policy prevention
strategies that work
like pain clinic laws
and regulations, or
naloxone access
laws
Prevention for States Program
COMPONENTS
1 2
34

8. Opioid Prescribing
Guidelines for Chronic Pain
Outside of Active Cancer, Palliative,
& End-of-life Care
PRIMARY CARE

9. Leveraging
AHRQ
Systematic
Review
Sept 2014

10. Process Used to Develop the Guidelines
 GRADE Method
 Multi-staged development with stakeholder input
 Projected release in January 2016

11. Opioid Prescribing
Guideline
 Intended for primary care
providers.
 Will apply to patients >18
years old in chronic pain
outside of end-of-life care
Clinical Practices Addressed
in the Guidelines
 Determining when to initiate or continue
opioids for chronic pain
 Opioid selection, dosage, duration,
follow-up, and discontinuation
 Assessing risk and addressing harms of
opioid use

12. Research priorities: Insurer, health system,
and pharmacy benefit manager strategies
 Which insurance and pharmacy benefit
manager interventions change prescribing
behaviors most effectively (e.g., drug
utilization review, patient review and
restriction, prior authorization)?
 Which of these interventions are most cost-
effective?
 What are the effective ways that state public
health departments can engage insurers and
pharmacy benefit managers to foster adoption
of these interventions?

13. Research priorities: State policies and
strategies
 What are the impacts of innovative, untested
policies and strategies at the state level?
 Which PDMP strategies (e.g., mandatory
registration) enhance use and produce the
greatest impacts?
 What are the cost implications and cost savings
of identified policy changes?
 How can communications campaigns influence
physician opioid prescribing and patient opioid
use?

14. Research priorities: Risk and protective
factors for prescription drug and heroin mortality
 How can PDMP, coroner, medical examiner,
and law enforcement data be used to identify
risk and protective factors for drug overdose?
 What are the patterns of co-use of prescription
opioids and heroin, injection of opioids, and
overdose?
 Does controlled substance prescribing,
including opioid pain reliever prescribing,
increase risk for heroin overdose?

15. Research priorities: Clinical practice
guidelines and coordinated care plans
 What are the clinical decision support needs,
barriers, and effective approaches to
promoting guideline adherence in primary
care?
 What factors facilitate adoption of coordinated
care plans in health systems?
 What are the patient and health system
impacts of guideline, clinical decision support,
and coordinated care plan implementation?
http://www.cdc.gov/injury/researchpriorities/More Information:

16. For more information please contact Centers for
Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-
6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not
necessarily represent the official position of the Centers for Disease Control
and Prevention.