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.

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 and
Quality, 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 frequency
Source: New York State Department of Health, Bureau of Narcotic
Enforcement, 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 Narcotic
Enforcement, Prescription Drug Monitoring Program, 2008-2009;
New York City Office of the Chief Medical Examiner &New York City
Department 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