This document provides an overview of state strategies to address the prescription drug abuse epidemic, focusing on New Mexico's experience. It outlines how New Mexico built a statewide coalition including healthcare organizations, government agencies, community groups and legislators to reduce overdose death rates. This coalition implemented strategies targeting prescribers, medical facilities, educators and other stakeholders based on New Mexico's successes. These strategies included education, prescribing guidelines, prescription drug monitoring programs, pain clinic regulation, and increasing access to naloxone to reverse overdoses. The presentation aims to identify effective intervention and policy approaches as well as resources for advocacy.
This document summarizes a presentation on insights from state policies and interventions to curb prescription drug overdoses. It describes several interventions:
1) PRIMUM, a system in North Carolina that alerts prescribers to patients' risk of misusing or abusing opioids at the point of care.
2) A project in Rhode Island that developed protocols to improve opioid prescription safety for trauma patients, including alerts if prescriptions exceed dosage thresholds and requiring naloxone co-prescriptions.
3) A study in Pennsylvania that used Medicaid claims data to identify risk factors for opioid overdoses, such as high dosage and multiple prescribers/pharmacies, to target high-risk patients.
This document summarizes a presentation on using prescription drug monitoring program (PDMP) data for public health purposes. State and local health officials in Washington State work with de-identified PDMP data to coordinate opioid abuse prevention and mitigation efforts. Examples are given of data reports generated for counties, including opioid prescribing rates, concurrent opioid and benzodiazepine prescriptions, and changes over time. Challenges with PDMP data are discussed, such as de-duplicating patient records and processing large datasets. The goal is to provide actionable information to local jurisdictions to inform resource allocation and policies.
Rx16 federal tues_330_1_spitznas_2baldwin_3welchOPUNITE
This document discusses patient review and restriction programs (PRRs) as tools to help curb prescription drug abuse and coordinate patient care. It describes state Medicaid PRR programs and recent efforts to expand PRR programs to Medicare. It also describes the role of PRR programs in the CDC's Prescription Drug Overdose Prevention for States grant program, the Office of National Drug Control Policy's national strategy, and the federal budget.
This document provides an overview of a presentation on preventing opioid overdose deaths. The presentation features four speakers and focuses on explaining the opioid overdose crisis epidemiology, describing treatment options to reduce overdose deaths, and advocating for advancing research and clinical practice. The learning objectives are listed as explaining the overdose epidemic, describing treatment options for clinicians, and advocating for research and practice directions. Brief biographies and disclosures are provided for each speaker.
Web only rx16 pdmp-tues_330_1_kreiner_2ringwalt-schiroOPUNITE
This document discusses three projects in North Carolina aimed at reducing harm from prescription drug abuse: 1) Identifying prescribers who prescribe very high levels of controlled substances using PDMP data and algorithms, in partnership with state agencies and the medical board. 2) Identifying prescribers with multiple patients who died from opioid-related overdoses. 3) Providing immediate feedback to prescribers on high-risk patients through electronic health records integrated with PDMP data, in partnership with health systems. The goals are to develop valid methods to identify problematic prescribing patterns using multiple data sources and address technical and policy hurdles to information sharing.
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document summarizes a presentation on insights from state policies and interventions to curb prescription drug overdoses. It describes several interventions:
1) PRIMUM, a system in North Carolina that alerts prescribers to patients' risk of misusing or abusing opioids at the point of care.
2) A project in Rhode Island that developed protocols to improve opioid prescription safety for trauma patients, including alerts if prescriptions exceed dosage thresholds and requiring naloxone co-prescriptions.
3) A study in Pennsylvania that used Medicaid claims data to identify risk factors for opioid overdoses, such as high dosage and multiple prescribers/pharmacies, to target high-risk patients.
This document summarizes a presentation on using prescription drug monitoring program (PDMP) data for public health purposes. State and local health officials in Washington State work with de-identified PDMP data to coordinate opioid abuse prevention and mitigation efforts. Examples are given of data reports generated for counties, including opioid prescribing rates, concurrent opioid and benzodiazepine prescriptions, and changes over time. Challenges with PDMP data are discussed, such as de-duplicating patient records and processing large datasets. The goal is to provide actionable information to local jurisdictions to inform resource allocation and policies.
Rx16 federal tues_330_1_spitznas_2baldwin_3welchOPUNITE
This document discusses patient review and restriction programs (PRRs) as tools to help curb prescription drug abuse and coordinate patient care. It describes state Medicaid PRR programs and recent efforts to expand PRR programs to Medicare. It also describes the role of PRR programs in the CDC's Prescription Drug Overdose Prevention for States grant program, the Office of National Drug Control Policy's national strategy, and the federal budget.
This document provides an overview of a presentation on preventing opioid overdose deaths. The presentation features four speakers and focuses on explaining the opioid overdose crisis epidemiology, describing treatment options to reduce overdose deaths, and advocating for advancing research and clinical practice. The learning objectives are listed as explaining the overdose epidemic, describing treatment options for clinicians, and advocating for research and practice directions. Brief biographies and disclosures are provided for each speaker.
Web only rx16 pdmp-tues_330_1_kreiner_2ringwalt-schiroOPUNITE
This document discusses three projects in North Carolina aimed at reducing harm from prescription drug abuse: 1) Identifying prescribers who prescribe very high levels of controlled substances using PDMP data and algorithms, in partnership with state agencies and the medical board. 2) Identifying prescribers with multiple patients who died from opioid-related overdoses. 3) Providing immediate feedback to prescribers on high-risk patients through electronic health records integrated with PDMP data, in partnership with health systems. The goals are to develop valid methods to identify problematic prescribing patterns using multiple data sources and address technical and policy hurdles to information sharing.
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document provides information about an advocacy track presentation on advocating for change related to addiction issues. The presentation features Gary Mendell, founder and CEO of Shatterproof, and Kim Manlove from the Indiana Addictions Issues Coalition. They will discuss strategies for influencing legislation and how people in recovery can become advocates. The learning objectives focus on advocating for state laws on PDMP usage, explaining strategies to influence legislation, describing how people in recovery can advocate, and providing counsel as part of a treatment team. The presentation then provides details on Shatterproof's story, the overdose epidemic, solutions for different populations, and legislative accomplishments in various states related to expanding access to naloxone and mandating PDMP usage.
This document summarizes a presentation on best practices for treating opioid addiction in the criminal justice population. It outlines the challenges of treatment in this population and identifies best practices for using medication-assisted treatment (MAT) and behavioral therapy. The presentation reviews key points from the ASAM National Practice Guideline, including that MAT is the standard of care for opioid use disorder and should be continued, initiated, or made available for inmates. Discontinuing treatment can be dangerous and contradicts evidence-based practices. The implications discussed are that the guideline supports higher quality care for inmates and a rehabilitative approach, while also helping to address the opioid epidemic.
Rx16 federal tues_200_1_gladden_2halpin_3greenOPUNITE
This document provides information about the emerging fentanyl overdose epidemic in the United States from the national and state perspectives. It discusses the rise in fentanyl-related overdoses and seizures from 2013-2014 according to data from various sources. The learning objectives are to explain the epidemiology of the rise in fentanyl overdoses, identify lessons from an Ohio investigation, and describe one state's experience. Recommendations include improving detection of fentanyl through testing and surveillance, expanding naloxone access, and long-term efforts to reduce opioid overdoses through prescribing guidelines and treatment expansion.
This document summarizes presentations from public health officials in North Carolina and Northern Kentucky on community responses to the heroin epidemic. Key points include:
- Officials from North Carolina and Northern Kentucky outlined programs and partnerships implemented in their regions to address rising rates of opioid and heroin abuse, including treatment programs, harm reduction strategies, legislation, and education initiatives.
- Data presented showed increasing rates of overdose deaths, neonatal abstinence syndrome, and infectious diseases associated with intravenous drug use such as hepatitis C in Northern Kentucky.
- Community leaders and advocates in Northern Kentucky have worked to raise awareness, pass legislation to expand access to treatment, and establish prevention and support networks to address the heroin epidemic impacting the region.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
This document summarizes a presentation on advances in treating chronic pain and addiction. It includes:
- Presenters from PRIUM, American Airlines, and the Treatment Research Institute
- Learning objectives around chronic pain, psychosocial issues, Medicaid requirements for the ASAM Criteria, and implementing the criteria
- Disclosures from presenters about relevant relationships
- Overview of topics like the bidirectional relationship between physical and mental health, impacts of adverse childhood experiences, and the influence of stigma on substance use treatment
- American Airlines' workers compensation program which saw a 40% reduction in claims and lower pharmacy costs and disability after redesigning their approach to focus on early intervention and additional resources for employees with chronic
This document provides a summary of a presentation on the risks of medical marijuana and marijuana legalization. It begins with disclosures from the presenters and outlines six learning objectives. It then discusses concerns that marijuana is addictive, especially for those who start using it early, and impacts adolescent brain development. The document notes the lack of evidence that marijuana is effective for the conditions it is claimed to treat. It also discusses the risks of increased diversion of marijuana to youth and greater social acceptance of marijuana use negatively impacting public health. The document concludes with messages on how to discuss these issues with the public.
This document summarizes findings from interviews conducted as part of a study evaluating a chronic pain management pilot program for Medicaid patients in Rhode Island. Key findings include:
1) Patients reported that complementary and alternative therapies like acupuncture, massage and chiropractic care helped them better understand the relationship between stress and pain and provided an opportunity to build trusting relationships with providers.
2) Providers noted that the program allowed patients to receive hands-on care and personal connections that they may not receive otherwise due to lack of trust in the medical system and limited therapeutic relationships.
3) The program addressed transportation barriers by having some providers conduct home visits, improving access to care for patients with mobility issues.
4)
This document summarizes a presentation on closing treatment gaps in the health care and criminal justice systems for opioid use disorders. It introduces the presenters and moderator and provides learning objectives focused on improving identification and treatment of opioid use disorders in health care settings and strategies for improving outcomes for frequently incarcerated individuals. Disclosures are provided for the presenters stating that they have no relevant financial relationships.
The document discusses new developments in prescription drug monitoring programs (PDMPs) in California, Colorado, and Minnesota. It provides an overview of presentations given on upgrades to the PDMP systems in each state. Key points include: Colorado's PDMP has enhanced data reporting requirements and streamlined data retrieval; Minnesota's PDMP has focused on improving data quality and compliance; and California's upgraded PDMP (CURES 2.0) features automated registration, delegation of authority, patient flagging, peer-to-peer communication on patient safety, and de-identified data sets.
This document summarizes a presentation on drugs to watch including tramadol, hydrocodone, and naloxone. It includes:
- Disclosures from presenters declaring no conflicts of interest.
- Learning objectives focused on analyzing the impact of schedule changes for tramadol and hydrocodone, educating on tramadol dangers, and evaluating pharmacist perspectives on naloxone.
- Information presented on the drugs including their classifications, potencies, risks of abuse and addiction, and impacts of rescheduling hydrocodone and tramadol in California. Data showed decreased hydrocodone prescriptions but increased tramadol and overall opioid prescriptions, as well as increased over
The document outlines state responses to prescription drug and heroin abuse presented at an advocacy track session. It includes presentations from officials in Arizona, Virginia, and New Mexico on their state's strategies. Arizona's presentation focuses on the state's prescriber report cards. Virginia's presentation discusses the governor's task force recommendations and a new health and criminal justice data committee. New Mexico's presentation describes the state's high overdose rates and model of stakeholder collaboration to reduce overdose deaths.
Rx16 federal tues_1115_1_fretwell_2gabbert-wilkebrownOPUNITE
This document summarizes a presentation on state and community-level programs for preventing prescription drug misuse and expanding treatment options like medication-assisted treatment. Speakers from Georgia and Iowa discussed their strategies for engaging stakeholders, implementing prevention initiatives in targeted communities, leveraging funding sources, and addressing challenges in data and addressing disparities. Iowa described their efforts to expand access to medication-assisted treatment for opioid use disorders through a new grant, including challenges implementing changes quickly.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
This document summarizes a CDC training on using digital and social media to address the opioid epidemic. It includes:
- Presenters from the CDC's National Center for Injury Prevention and Control who will discuss communication principles, planning tactics, and using social media best practices.
- Learning objectives around explaining the value of communication, demonstrating social media processes, identifying best practices, and preparing to use social media to impact the opioid problem.
- An agenda that covers surveys, introductions, an opioid epidemic overview, health communication basics, social media basics and best practices, and exercises.
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
This document summarizes a presentation on the financial toll of prescription drug addiction from the perspective of third-party payers. It includes presentations from experts at the CDC, a private insurance company, and a university. The presentations outline national trends in opioid use and expenditures, strategies used by an insurance company to identify and manage high-risk opioid claims, and a description of North Carolina's Medicaid Lock-In Program aimed at curbing prescription drug misuse. The document provides disclosure statements for each presenter and learning objectives for the session.
This document summarizes a presentation on building local capacity to prevent prescription drug abuse. It discusses three panelists who will speak on approaches to prevent Rx drug misuse, abuse, and diversion. These include Terry Cline, Commissioner of Health for Oklahoma; Gregg Raduka, Director of Prevention/Intervention for The Council on Alcohol and Drugs; and Christopher Wood from the Georgia Department of Behavioral Health and Developmental Disabilities. The moderator will be Regina LaBelle from the White House Office of National Drug Control Policy. The panelists will discuss policy and program approaches, the role of state health agencies in collaborating with partners, and how to form and engage statewide Rx prevention collaboratives.
This document provides information about an advocacy track presentation on advocating for change related to addiction issues. The presentation features Gary Mendell, founder and CEO of Shatterproof, and Kim Manlove from the Indiana Addictions Issues Coalition. They will discuss strategies for influencing legislation and how people in recovery can become advocates. The learning objectives focus on advocating for state laws on PDMP usage, explaining strategies to influence legislation, describing how people in recovery can advocate, and providing counsel as part of a treatment team. The presentation then provides details on Shatterproof's story, the overdose epidemic, solutions for different populations, and legislative accomplishments in various states related to expanding access to naloxone and mandating PDMP usage.
This document summarizes a presentation on best practices for treating opioid addiction in the criminal justice population. It outlines the challenges of treatment in this population and identifies best practices for using medication-assisted treatment (MAT) and behavioral therapy. The presentation reviews key points from the ASAM National Practice Guideline, including that MAT is the standard of care for opioid use disorder and should be continued, initiated, or made available for inmates. Discontinuing treatment can be dangerous and contradicts evidence-based practices. The implications discussed are that the guideline supports higher quality care for inmates and a rehabilitative approach, while also helping to address the opioid epidemic.
Rx16 federal tues_200_1_gladden_2halpin_3greenOPUNITE
This document provides information about the emerging fentanyl overdose epidemic in the United States from the national and state perspectives. It discusses the rise in fentanyl-related overdoses and seizures from 2013-2014 according to data from various sources. The learning objectives are to explain the epidemiology of the rise in fentanyl overdoses, identify lessons from an Ohio investigation, and describe one state's experience. Recommendations include improving detection of fentanyl through testing and surveillance, expanding naloxone access, and long-term efforts to reduce opioid overdoses through prescribing guidelines and treatment expansion.
This document summarizes presentations from public health officials in North Carolina and Northern Kentucky on community responses to the heroin epidemic. Key points include:
- Officials from North Carolina and Northern Kentucky outlined programs and partnerships implemented in their regions to address rising rates of opioid and heroin abuse, including treatment programs, harm reduction strategies, legislation, and education initiatives.
- Data presented showed increasing rates of overdose deaths, neonatal abstinence syndrome, and infectious diseases associated with intravenous drug use such as hepatitis C in Northern Kentucky.
- Community leaders and advocates in Northern Kentucky have worked to raise awareness, pass legislation to expand access to treatment, and establish prevention and support networks to address the heroin epidemic impacting the region.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
This document summarizes a presentation on advances in treating chronic pain and addiction. It includes:
- Presenters from PRIUM, American Airlines, and the Treatment Research Institute
- Learning objectives around chronic pain, psychosocial issues, Medicaid requirements for the ASAM Criteria, and implementing the criteria
- Disclosures from presenters about relevant relationships
- Overview of topics like the bidirectional relationship between physical and mental health, impacts of adverse childhood experiences, and the influence of stigma on substance use treatment
- American Airlines' workers compensation program which saw a 40% reduction in claims and lower pharmacy costs and disability after redesigning their approach to focus on early intervention and additional resources for employees with chronic
This document provides a summary of a presentation on the risks of medical marijuana and marijuana legalization. It begins with disclosures from the presenters and outlines six learning objectives. It then discusses concerns that marijuana is addictive, especially for those who start using it early, and impacts adolescent brain development. The document notes the lack of evidence that marijuana is effective for the conditions it is claimed to treat. It also discusses the risks of increased diversion of marijuana to youth and greater social acceptance of marijuana use negatively impacting public health. The document concludes with messages on how to discuss these issues with the public.
This document summarizes findings from interviews conducted as part of a study evaluating a chronic pain management pilot program for Medicaid patients in Rhode Island. Key findings include:
1) Patients reported that complementary and alternative therapies like acupuncture, massage and chiropractic care helped them better understand the relationship between stress and pain and provided an opportunity to build trusting relationships with providers.
2) Providers noted that the program allowed patients to receive hands-on care and personal connections that they may not receive otherwise due to lack of trust in the medical system and limited therapeutic relationships.
3) The program addressed transportation barriers by having some providers conduct home visits, improving access to care for patients with mobility issues.
4)
This document summarizes a presentation on closing treatment gaps in the health care and criminal justice systems for opioid use disorders. It introduces the presenters and moderator and provides learning objectives focused on improving identification and treatment of opioid use disorders in health care settings and strategies for improving outcomes for frequently incarcerated individuals. Disclosures are provided for the presenters stating that they have no relevant financial relationships.
The document discusses new developments in prescription drug monitoring programs (PDMPs) in California, Colorado, and Minnesota. It provides an overview of presentations given on upgrades to the PDMP systems in each state. Key points include: Colorado's PDMP has enhanced data reporting requirements and streamlined data retrieval; Minnesota's PDMP has focused on improving data quality and compliance; and California's upgraded PDMP (CURES 2.0) features automated registration, delegation of authority, patient flagging, peer-to-peer communication on patient safety, and de-identified data sets.
This document summarizes a presentation on drugs to watch including tramadol, hydrocodone, and naloxone. It includes:
- Disclosures from presenters declaring no conflicts of interest.
- Learning objectives focused on analyzing the impact of schedule changes for tramadol and hydrocodone, educating on tramadol dangers, and evaluating pharmacist perspectives on naloxone.
- Information presented on the drugs including their classifications, potencies, risks of abuse and addiction, and impacts of rescheduling hydrocodone and tramadol in California. Data showed decreased hydrocodone prescriptions but increased tramadol and overall opioid prescriptions, as well as increased over
The document outlines state responses to prescription drug and heroin abuse presented at an advocacy track session. It includes presentations from officials in Arizona, Virginia, and New Mexico on their state's strategies. Arizona's presentation focuses on the state's prescriber report cards. Virginia's presentation discusses the governor's task force recommendations and a new health and criminal justice data committee. New Mexico's presentation describes the state's high overdose rates and model of stakeholder collaboration to reduce overdose deaths.
Rx16 federal tues_1115_1_fretwell_2gabbert-wilkebrownOPUNITE
This document summarizes a presentation on state and community-level programs for preventing prescription drug misuse and expanding treatment options like medication-assisted treatment. Speakers from Georgia and Iowa discussed their strategies for engaging stakeholders, implementing prevention initiatives in targeted communities, leveraging funding sources, and addressing challenges in data and addressing disparities. Iowa described their efforts to expand access to medication-assisted treatment for opioid use disorders through a new grant, including challenges implementing changes quickly.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
This document summarizes a CDC training on using digital and social media to address the opioid epidemic. It includes:
- Presenters from the CDC's National Center for Injury Prevention and Control who will discuss communication principles, planning tactics, and using social media best practices.
- Learning objectives around explaining the value of communication, demonstrating social media processes, identifying best practices, and preparing to use social media to impact the opioid problem.
- An agenda that covers surveys, introductions, an opioid epidemic overview, health communication basics, social media basics and best practices, and exercises.
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
This document summarizes a presentation on the financial toll of prescription drug addiction from the perspective of third-party payers. It includes presentations from experts at the CDC, a private insurance company, and a university. The presentations outline national trends in opioid use and expenditures, strategies used by an insurance company to identify and manage high-risk opioid claims, and a description of North Carolina's Medicaid Lock-In Program aimed at curbing prescription drug misuse. The document provides disclosure statements for each presenter and learning objectives for the session.
This document summarizes a presentation on building local capacity to prevent prescription drug abuse. It discusses three panelists who will speak on approaches to prevent Rx drug misuse, abuse, and diversion. These include Terry Cline, Commissioner of Health for Oklahoma; Gregg Raduka, Director of Prevention/Intervention for The Council on Alcohol and Drugs; and Christopher Wood from the Georgia Department of Behavioral Health and Developmental Disabilities. The moderator will be Regina LaBelle from the White House Office of National Drug Control Policy. The panelists will discuss policy and program approaches, the role of state health agencies in collaborating with partners, and how to form and engage statewide Rx prevention collaboratives.
The document summarizes a presentation on abuse-deterrent formulations of opioids given by Douglas Throckmorton of the FDA and Richard Dart. It discusses the FDA's efforts to encourage development of abuse-deterrent opioids through guidance and regulatory decisions. While progress has been made, challenges remain in developing, testing, and assessing the real-world impact of abuse-deterrent technologies. The FDA aims to improve treatment of pain while reducing risks of prescription drug abuse and overdose through multiple strategies.
This document discusses the growing problem of prescription drug abuse and misuse in the United States. It summarizes recent trends showing increasing rates of prescription drug misuse and overdose deaths. It outlines how commonly abused drug classes like opioids and stimulants affect the brain and explains why people abuse these drugs for their rewarding effects. It also describes strategies being developed to increase treatment, such as new medications to treat addiction and reverse overdoses, as well as health applications and interventions to address this important public health issue.
This document summarizes NIH efforts to advance pain relief while curbing opioid abuse. It discusses research on abuse-deterrent drug formulations, easier-to-use naloxone delivery methods, digital interventions to prevent overdose, and vaccine development to treat addiction. Monitoring the Future study results on nonmedical prescription opioid and heroin use among youth are presented. The director highlights collaborative work on an oral oxycodone prodrug and a promising heroin vaccine in development.
Midwestern states have adopted various harm reduction strategies to address the opioid epidemic, including syringe exchange programs, medication-assisted treatment, overdose prevention, and prescription drug monitoring programs. Syringe exchanges provide sterile supplies to injection drug users to prevent disease spread, and are permitted in some form in most Midwestern states. All states except Kansas allow naloxone access to reverse overdoses. Several states mandate medication-assisted treatment coverage by Medicaid and most have implemented prescription drug monitoring programs, though requirements vary between states.
8 pharmacy track pharmacists working with local coalitions and pdm psOPUNITE
This document summarizes a presentation on pharmacists working with local coalitions and prescription drug monitoring programs (PDMPs). It discusses Nicole O'Kane presenting on how pharmacists can utilize PDMPs to screen for safety concerns and optimize patient care. It also discusses Kristina Clark and Christina Merino presenting on how a local coalition in Coffee County, TN engaged pharmacists and other stakeholders to reduce prescription drug abuse through education, monitoring, and evaluation.
The director of the CDC discussed the prescription drug and opioid overdose epidemic in the United States. He noted that over 145,000 lives have been lost to prescription opioid overdoses in the past decade as opioid prescribing has increased 4-fold since 1999. The CDC is working with multiple states experiencing outbreaks of HIV linked to injection drug use. The director outlined a potential "technical package" of interventions including improving prescribing practices, increasing access to treatment, reducing drug availability, and public awareness campaigns. Progress requires a comprehensive, evidence-based public health approach with law enforcement and community involvement.
Duplication prescribing and misuse of medicine can harm patients and lead to death. Duplication prescribing occurs when multiple medications are prescribed for the same condition without coordination. Misuse involves using medication other than as intended, such as through addiction. Strategies to reduce these risks include implementing electronic health records and clinical decision support to avoid therapeutic duplication, educating patients, and enhancing prescription drug monitoring programs and enforcement of drug disposal laws.
This document summarizes a presentation on recent developments related to Prescription Drug Monitoring Programs (PDMPs). The presentation covered: an overview of PDMPs including their role in tracking controlled prescription drugs; best practices for PDMPs based on research; evidence that PDMPs can effectively reduce prescription drug abuse and overdoses when certain criteria are met; and current initiatives to improve interstate data sharing and integrate PDMP data into healthcare workflows through health IT. The goal is to leverage PDMPs to improve clinical care and public health outcomes related to prescription drug misuse.
This document summarizes a presentation on legislative and medication trends impacting third-party payers. It discusses several topics: physician dispensing and repackaged medications, opioid utilization, treatment guidelines and closed formularies, and compounded medications. For each topic, it outlines related legislative strategies and regulatory approaches taken by different states to influence costs and utilization for third-party payers. The presentation aims to identify issues relevant to third-party payers and explain how they can shape legislative and regulatory outcomes.
This document summarizes a presentation on data-driven trends related to prescription drug abuse. It outlines national trends in doctor shopping, overdoses, drugged driving, and opioid/heroin overdose deaths. It also evaluates the effectiveness of some state laws and programs aimed at reducing doctor shopping and responding to overdoses. Some promising policy strategies discussed include reducing inappropriate prescribing, focusing on overdose response, improving prescription drug monitoring programs, and linking overdose victims to treatment.
Global Medical Cures™ | Responding to America's Prescription Drug Abuse CrisisGlobal Medical Cures™
This document summarizes the growing problem of prescription drug abuse in America. Key points include:
- Prescription drug abuse is now the nation's fastest growing drug problem, with opioids like oxycodone being abused at increasing rates.
- Education of healthcare providers, patients, and the public is needed to increase awareness of the dangers of prescription drug misuse and how to properly use and dispose of medications.
- Tracking programs like prescription drug monitoring programs (PDMPs) in states can help identify "doctor shoppers" and reduce diversion, though more research is still needed on their effectiveness.
- A multifaceted approach including education, monitoring, safe disposal, and enforcement is needed to address the crisis of prescription drug
This document summarizes a presentation on engaging physicians in prevention efforts to address the opioid epidemic. It was presented by Yngvild Olsen and included the following key points:
1. Multiple policies like PDMPs, medication-assisted treatment, and naloxone access need to work together to reduce opioid misuse and overdoses.
2. Programs that educate physicians about prescription drug abuse and its link to heroin, and engage them in prevention, screening, and treatment can help address the epidemic.
3. Expanding access to evidence-based treatment with medications like buprenorphine and naloxone, combined with behavioral therapies, can help manage opioid addiction as a chronic disease
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.
Use of medical marijuana (MM) has been legalized on a state-by-state basis; however, federally, it is still illegal and is a Schedule I drug. This has led to provider confusion regarding prescription practices, a lack of randomized control trials on the use of MM for pain and symptom management, minimal access to dispensaries, and health insurance restrictions.
National Rx Drug Abuse Summit, April 2-4, 2013. General Session presentation, "Prevention and Prosecution," Frances M. Harding, Director, Center for Substance Abuse Prevention, SAMHSA
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
This document discusses drug utilization research. It defines drug utilization research as studying drug use and effects in populations to support rational and cost-effective drug use. The document outlines the need for drug utilization research to facilitate rational drug use. It describes different types of drug use information that can be collected, including drug-based, problem-based, patient-based, prescriber-based, and cost-based information. The document also discusses various study designs and steps involved in conducting drug utilization research studies.
This study analyzed results from over 900,000 urine drug tests conducted between 2006-2009 on patients prescribed chronic opioids. The results showed:
- 11% tested positive for illicit drugs
- 29% tested positive for non-prescribed medications
- 38% did not detect the prescribed medication
- 15% had lower than expected levels of the prescribed medication
- 27% had higher than expected levels of the prescribed medication
These high rates of potential issues like non-compliance, abuse or diversion demonstrate the importance of periodic urine drug screening for patients on long-term opioid therapy to identify problems and ensure appropriate use of medications.
This document summarizes New Jersey's response to the rise in prescription drug and heroin abuse. It discusses several key aspects of New Jersey's approach, including the prescription drug monitoring program (NJPMP), drug take-back programs like Project Medicine Drop, educational campaigns, a Good Samaritan law providing legal protection for those reporting overdoses, expansion of drug treatment programs, and a Medicaid lock-in program. The strategies aim to curb prescription drug diversion and abuse, expand access to treatment, prevent overdoses, and reduce related harms like the spread of HIV/AIDS and hepatitis C.
A new study adds further evidence to suggest that opioid prescribing in the U.S. is skewed and concentrated among a few providers. Researchers looked at prescribing patterns in data from an unspecified national private insurer between 2003-2017.
Around 670,000 providers prescribed more than 8 million standard doses of opioid prescriptions — but more than a quarter of these prescriptions were written by only 1% of physicians. And in 2017, these physicians prescribed nearly half of all the dispensed opioids. This small group of doctors also prescribed higher doses than recommended, and for longer durations than guidelines allow.
What’s encouraging, the authors suggest, is that the vast majority of physicians do seem to follow guidelines. Some caveats: The study was based on one company’s data, and didn’t look at medical reasons behind prescriptions.
Intro to Prevention: Psychopharmacology Guest LectureJulie Hynes
Current A&D Conditions in lane County: And why we need prevention. Guest lecturer: Julie Hynes, MA, RD, CPS - PreventionLane at Lane County Public Health
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
Web rx16 prev_tues_200_1_bretthaude-mueller_2scott_3debenedittis_4cairnes copyOPUNITE
This presentation covered multi-media prevention strategies for issues like prescription drug overdoses. It discussed the CDC's digital Rx drug prevention campaign, best practices for digital messaging, and programs using expectancy challenge theory and media literacy education in schools. Presenters included representatives from the CDC, Media Literacy for Prevention, and the Hanley Center Foundation who discussed their work developing and implementing digital communications and single-session prevention programs.
This document summarizes a presentation on linking and mapping prescription drug monitoring program (PDMP) data. It discusses the benefits of linking PDMP data to clinical data, including improving patient safety, evaluating prescribing decisions, and assessing the impact of PDMP interventions. It describes challenges with linking data, such as obtaining consent and negotiating data use agreements. It also discusses Washington State's MAPPING OPIOID AND OTHER DRUG ISSUES (MOODI) tool, which integrates PDMP data with other databases to map and target treatment and overdose prevention efforts at the community level.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
Web only rx16 pharma-wed_330_1_shelley_2atwood-harlessOPUNITE
This document discusses a presentation on pharmacy burglary, robbery, and diversion of prescription drugs. The presentation covers trends in prescription drug diversion, particularly those involving robbery and burglary of pharmacies. It identifies preventative measures to enhance pharmacy security and safety. Strategies to reduce pharmacy crimes are outlined. The offender perspective is examined based on interviews with convicted offenders. Routine activities theory is discussed as relating to suitable targets, capable guardians, and motivated offenders. Partnerships between regulatory agencies and law enforcement are emphasized as key to prevention efforts.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
This document discusses drug court models and the role of law enforcement in drug courts. It begins with introductions from presenters and outlines learning objectives about explaining drug court operations and benefits, how law enforcement can utilize drug courts, and identifying best practices. The following sections provide details on drug court models, including how they integrate treatment into the justice system using a non-adversarial approach. Key components of drug courts are outlined, and presenters discuss issues like prescription drug and heroin abuse as well as outcomes from drug courts in reducing recidivism and saving money. Law enforcement can play roles in prevention, addressing domestic violence, and targeting the right populations for drug court involvement through assessment.
This document summarizes presentations from two communities - Huntington, WV and Camden County, NJ - on their responses to heroin crises. It outlines programs implemented in Huntington, including a harm reduction program, centralized information system, and drug court expansion. It also discusses the region's history with prescription drug abuse and rise in heroin and associated issues like hepatitis and neonatal abstinence syndrome. Long-term strategies proposed include expanding treatment services, promoting career opportunities for those in recovery, and preventing relapse through environmental design changes.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
Web only rx16-adv_tues_330_1_elliott_2brunson_3willis_4deanOPUNITE
This document outlines an advocacy track presentation on activating communities to address prescription drug abuse. It provides biographies of the presenters and moderators and discloses any conflicts of interest. The learning objectives are to identify best practices for implementing CADCA's seven strategies for community change to impact prescription drug issues. It then provides examples of how various coalitions across the country are utilizing each of the seven strategies, such as providing education, enhancing skills, supporting communities, and changing policies.
This document discusses recovery ready ecosystems and recovery community organizations. It introduces presenters from Young People in Recovery and Hope House Treatment Track who will discuss interventions, prevention, and recovery programs. Examples of Young People in Recovery chapters, programs, and services are provided, including employment workshops, education workshops, housing workshops, and recovery support services. The document also discusses recovery community organizations and initiatives in Texas and Georgia, such as the Association of Persons Affected by Addiction in Dallas and the Georgia Council on Substance Abuse.
This document summarizes a presentation on youth performance-enhancing drugs and ADHD medication. It discusses trends in misuse of these substances among young people. The presentation is given by representatives from various organizations focused on prevention, health promotion, and substance abuse issues among youth and college students. The presentation covers types of performance-enhancing drugs and their potential side effects. It also discusses trends in attitudes towards these substances and risks of misuse. Strategies are presented for helping adolescents pursue their goals without these drugs. The document concludes by outlining plans for addressing misuse of ADHD medication among college students through education and collaboration between various stakeholder groups.
Web only rx16 pharma wed_200_1_hagemeier_2fleming_3vernachioOPUNITE
Community pharmacists are well positioned to help address the growing problem of opioid and benzodiazepine addiction but face challenges. Early identification of at-risk patients, supportive benefit structures, and intervention training could empower pharmacists. While many recognize their responsibility, behavioral engagement in prevention is often lacking due to practice barriers, lack of patient information, and fear of responses. Standardizing communication expectations and screening tools could help pharmacists better fulfill their role on the treatment team.
1. Two states, South Carolina and Wisconsin, improved integration of PDMP data into electronic health systems by establishing connections between their PDMPs and various health IT platforms like EMR systems and pharmacy dispensing software.
2. States face challenges with PDMP integration like legal definitions of access, costs of integration projects, and establishing necessary agreements and user authorizations.
3. Florida operates drug surveillance systems through a medical examiners commission and PDMP. Analysis found declines in prescription opioid overdoses after implementation of legislative and regulatory interventions including a PDMP in 2011. However, heroin overdose deaths increased as some shifted to heroin.
Web only rx16 len wed_200_1_augustine_2napier_3darr - copyOPUNITE
This document summarizes a presentation about the Handle with Care program, which aims to help children who have been exposed to trauma. The presentation discusses how drug abuse and violence impact children, showing statistics on drug seizures and crimes in certain areas. It then describes the Handle with Care program, where law enforcement notifies schools of children who were exposed to a traumatic event so the school can provide trauma-informed support. School interventions discussed include therapy dogs, academic accommodations, and on-site therapy. The presenters emphasize that Handle with Care aims to help children succeed in school by providing trauma-sensitive support.
The document summarizes a Heroin Response Strategy presented by experts from various High Intensity Drug Trafficking Areas. The strategy involves 3 components: 1) Establishing a regional public health and public safety information sharing network through "Points of Light" teams in each state. 2) Implementing community education and prevention programs. 3) Creating a platform for regional public health and public safety partnerships through annual symposiums. The goal is to reduce drug overdoses through enhanced collaboration between law enforcement and health agencies.
Web only rx16 len wed_1230_1_daugherty_2baier-haasOPUNITE
This document summarizes a presentation on investigating and prosecuting drug-related homicides. It discusses signs that can indicate an overdose death, such as the presence of drugs, track marks, and foam coming from the mouth. It emphasizes treating the death scene like a homicide scene by thoroughly photographing and collecting all potential evidence. This includes searching for drug packaging, needles, phones and surveillance footage. The document also outlines interviewing witnesses to build a timeline and identify the victim's source of drugs. It suggests attempting a controlled buy from suspects to obtain contemporaneous drug samples and strengthen cases.
Rx16 federal wed_1230_1_kelly_2bohn-killorinOPUNITE
1) The National HIDTA Program provides assistance to law enforcement agencies in critical drug trafficking regions through 28 regional HIDTA programs. It facilitates cooperation among federal, state, local, and tribal law enforcement.
2) Each HIDTA program has an executive board that identifies threats, develops strategies, and requests funding for initiatives. It brings together over 7,400 federal agents, 15,700 state and local officers, and 500 agencies across the country.
3) In response to the opioid epidemic, HIDTA employs law enforcement targeting of heroin and fentanyl trafficking, public health prevention efforts, and training on investigating heroin organizations. It has committed additional funds to enhance intelligence sharing and public health partnerships.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Ea 3 green weiss_katzman
1. Educa&on
and
Advocacy
Track:
Overview
of
State
Strategies
to
Stop
the
Epidemic
Presenters:
Sherry
L.
Green
Joanna
Katzman,
MD,
MSPH
Jennifer
Weiss,
MBA,
BSIT
Moderator:
Karen
H.
Perry,
2. Disclosures
• Sherry
L.
Greenhas
disclosed
no
relevant,
real
or
apparent
personal
or
professional
financial
rela&onships.
• Joanna
Katzman
has
disclosed
no
relevant,
real
or
apparent
personal
or
professional
financial
rela&onships.
• Jennifer
Weiss
has
disclosed
no
relevant,
real
or
apparent
personal
or
professional
financial
rela&onships.
3. Learning
Objec&ves
1. Outline
implementa&on
strategies
to
reduce
prescrip&on
drug
abuse
based
on
the
successes
New
Mexico
has
had
specifically
with
prescribers,
medical
facili&es,
legislatures,
educators,
and
other
key
stakeholders.
2. Build
a
statewide
coali&on
comprised
of
an
academic
medical
center,
state
agencies,
community
coali&ons,
legislatures,
and
key
community
stakeholders
in
an
effort
to
reduce
overdose
death
rates.
3. Iden&fy
resources
to
advocate
for
change,
with
specific
focus
on
state
strategies.
4. 2014 NATIONAL PRESCRIPTION DRUG
ABUSE SUMMIT
EDUCATION & ADVOCACY TRACK:
OVERVIEW OF STATE STRATEGIES TO
STOP THE EPIDEMIC
APRIL 22, 2014 3:15 P.M. – 4:30 P.M.
SNAPSHOT OF SELECTED STATE
PRESCRIPTION DRUG LAWS & POLICIES
SHERRY L. GREEN, CEO
NATIONALALLIANCE FOR MODEL
STATE DRUG LAWS (NAMSDL)
5. NAMSDL
● 501(c)(3) non-profit corporation
● Successor to the President’s Commission of
Model State Drug Laws
● 20 years
● Congress funds NAMSDL’s services
● Provides legislative and policy services on
over 40 types of drug and alcohol laws to
stakeholders at the local, state, and federal levels
6. TYPES OF LAWS & POLICIES USED TO
ADDRESS PRESCRIPTION DRUG
PROBLEMS
● State prescription drug monitoring programs
(PMPS)
● Regulation of pain clinics/pain management
● Prescribing & dispensing guidelines/practices
● Proper disposal of unused medications
● Education for the public and health care
providers
7. ● Treatment & prevention
● Good Samaritan & naloxone access
● Identification of person picking up prescription
● Lock-in programs
● Doctor shopping
8. SNAPSHOT OF FOUR TYPES
● State PMPs
● Regulation of pain clinics/pain management
● Prescribing & dispensing guidelines/practices
● Good Samaritan & naloxone access
9. MORE RESEARCH NEEDED
● National Governors Association
Reducing Prescription Drug Abuse: Lessons
Learned from an NGA Policy Academy,
February 2014
● More research needed to determine:
Effective interventions to reduce abuse
Effective approaches to change prescribing
Effective public messaging to change
consumer behavior
10. STATE PRESCRIPTION DRUG MONITORING
PROGRAMS (PMPS)
Law and Policy
● Statewide electronic databases that collect
prescription controlled substance data
● 49 states and D.C. have laws
● 48 PMP programs operational
11. ● Increase usefulness of PMPs as health care tools
Allow delegates/authorized agents for
prescribers and dispensers
Expand healthcare professionals who can use
PMP data
Medical examiners/coroners
Increase frequency of dispenser reporting
Oklahoma – real-time reporting
Most states – 7 days/weekly
12. Provide interstate data sharing
Permit proactive alerts
Mandate registration for prescribers/
dispensers
No clear consensus about usefulness
Mandate use by prescribers/dispensers
No clear consensus about usefulness
13. Research – surveys, studies, assessments
● State practitioners surveys in OH, KY, OK, and
OR suggest that PMPs can enhance patient care
and patient safety by:
Helping practitioners become more
informed prescribers, and
Helping practitioners determine if a patient
may have an abuse or addiction problem
14. Example: Use of OHIO OARRS data by ER
physicians (2009)
41% changed patient prescription plan
61% of patients received fewer or no opioids
39% of patients received more pain
medication than planned
Baehren, DF, Marco CA, Droz DE, Sinha S,
Callan EM, Akpunonu P. A statewide
prescription monitoring program affects
emergency department prescribing behaviors.
Annuals of Emergency Medicine, 2010 Jul; 45
(1):19-23
15. ● 2014 evaluation of impact of state PMPs on opioid
dispensing
Implementation of state PMPs through 2008 had
no measurable overall impact on prescription
opioids dispensed
Result likely related to unexamined factors:
interstate sharing, frequency of reporting,
education about PMP, restrictions on access,
integration into health care systems
J Brady, H Wunsch, C DiMaggio, B Lang, J
Giglio, G Li. Prescription Drug Monitoring and
Dispensing of Prescription Opioids. Public Health
Reports, March-April 2014; vol. 129: 139-147.
16. ● 2012 analysis of Poison Control Center data
In states with PMPs, rate of increase in opioid
misuse/abuse less than in states with no PMP
Independent of # of patients filling
prescriptions
Reifler L., Droz D, Bailey J, Schnoll S, Fant
R, Dart R et al. Do prescription monitoring
programs impact state trends in opioid abuse/
misuse? Pain Medicine 2012; 3(3):434-42.
17. REGULATION OF PAIN CLINICS/PAIN
MANAGEMENT
Law and Policy
● 9 states with pain clinic regulation acts
● Definition of “pain clinic”
publicly or privately owned facility
majority of patients in a specific time frame,
usually a month, are prescribed or dispensed
certain substances, e.g., opioids
18. ● Ownership eligibility
Example: Must be physician with unrestricted
license
● Certification and training requirements for
owners and practitioners at clinic
● Prescribing and dispensing restrictions
● Requirement to access state PMP
● Owners/medical directors have to be on site % of
operating hours
19. ● Indiana
State medical licensing board required to
issue rules for prescribing of controlled
substances
December 2013 – emergency rules for use of
opioids for chronic pain patients receiving
certain dosage amounts
Requirements:
Discuss risks/benefits with patient
Schedule periodic visits
Check PMP at beginning of treatment
and annually
20. ● Alabama
All physicians providing pain management
services must register with the medical board
Registrants must access state PMP
21. Research – surveys, studies, assessments
● Florida – University of Central Florida, Criminal
Justice Assistant Professor Jacinta Gau
“Pill mill” legislation implemented as designed
Impact of legislation
● Kentucky – University of Kentucky, College of
Pharmacy, Institute for Pharmaceutical Outcomes
and Policy
Unintended consequences of pain clinic and
other laws
Recommendations for improvements
22. PRESCRIBING & DISPENSING GUIDELINES/
PRACTICES
Law and Policy
● Seven commonly recommended prescribing
practices for non-cancer or chronic pain
Required or recommended education on selected
topics
Comprehensive patient exam – physical and
substance abuse screening
Treatment plan
23. Informed consent
Periodic review
Use of state PMP
Recommended steps for high risk patients
Referral to addiction or pain management
specialists
Patient agreements – urine drug testing and
lock-in program
24. Limitations on number of days’ supply or
refills of Schedule II or Schedule III
prescriptions
Maintenance of complete and accurate
medical records
25. Research – surveys, studies, assessments
● Washington state evidence-based prescribing
guidelines
23% reduction in drug overdose death rate
since 2008
National Safety Council, Prescription Nation:
Addressing America’s Prescription Drug Abuse
Epidemic, 2013.
● Federation of State Medical Boards (FSMB),
Model Policy on the Use of Opioid Analgesics in the
Treatment of Chronic Pain, July 2013.
26. GOOD SAMARITAN & NALOXONE ACCESS
Law and Policy
● Good Samaritan – 14 states + D.C.
● Naloxone access – 18 states + D.C.
Removes civil and criminal liability for
prescribers and lay administration
Allows third party prescription
● The Network for Public Health Law, Legal
Intervention to Reduce Overdose Mortality:
Naloxone Access and Overdose Good Samaritan
Laws, March 2014.
27. Research - surveys, studies, assessments
● National Association of State Alcohol and Drug
Abuse Directors (NASADAD), Overview of State
Legislation to Increase Access to Treatment for
Opioid Overdose, December 2013.
Trained bystanders can safely and effectively
administer injections like naloxone
Peers able to administer second dose when
needed and prevent victims from additional
opioid use
No evidence that people will increase drug use
by removing threat of overdose
28. SARAH KELSEY
ACTING CEO
NAMSDL
1598 Gray Fox Trail
Charlottesville, VA 22901
Phone: 703-836-6100, ext. 119
Email: skelsey@namsdl.org
WEBSITE: www.namsdl.org
29. Overview
of
State
Strategies:
The
Crisis
of
Unintended
Opiate
Overdose
Deaths
in
New
Mexico
30. Joanna
Katzman,
MD,
MSPH
Associate
Professor,
Neurosurgery,
University
of
New
Mexico
Director,
University
of
New
Mexico
Pain
Center
Project
ECHO®
Pain
Jennifer
Weiss,
MBA,
BSIT
Execu&ve
Director,
Healing
Addic&on
In
Our
Community
31. Known
as
the
Land
of
Enchantment.
Popula&on:
2,085,500.
Biggest
City
is
Albuquerque.
Popula&on:
552,800.
We
are
NEW
Mexico,
not
Mexico.
Yes,
we
have
running
water.
We
are
home
to
the
largest
interna&onal
hot
air
balloon
fiesta.
You
will
be
asked
“red,
green
or
Christmas”
at
every
Mexican
food
restaurant
you
venture
into.
Facts
About
New
Mexico
32. Healing
Addic&on
in
Our
Community
501c3
Non-‐Profit
Dedicated
to
educa&on
and
awareness
regarding
substance
abuse
issues.
40+
volunteer
member
base
comprised
of
parents
and
people
in
recovery.
Speaking
engagements
(over
5,000
people),
advocacy,
grade
school
and
college
educa&on
programs,
legisla&ve
support,
provide
assistance
finding
treatment
resources.
Opening
NM’s
1st
Adolescent
Transi&onal
Living
Center.
33. Rest in Peace!
Grieve not, nor speak of me with tears, but laugh
and talk of me as if I were beside you there.!
34. Drug
Overdose
Death
Rates
Leading
States,
U.S.,
2009
Sources: CDC Vital Signs
Rates are age-adjusted to the 2000 US Standard Population.
35. 0.0
5.0
10.0
15.0
20.0
25.0
30.0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012*
Deaths
per
100,000
persons
Year
Drug
Overdose
Death
Rates
New
Mexico
and
United
States,
1990-‐2012
New
Mexico
United
States
36. 0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Union
Cibola
Curry
United
States
Luna
McKinley
Roosevelt
Lea
Los
Alamos
San
Juan
Dona
Ana
Sandoval
Chaves
Otero
Lincoln
Socorro
Colfax
New
Mexico
Valencia
Guadalupe
Eddy
Santa
Fe
Torrance
Bernalillo
Hidalgo
Grant
Taos
San
Miguel
Quay
Catron
Sierra
Mora
Rio
Arriba
Age-‐adjusted
Rated
per
100,000
persons
Drug
Overdose
Death
Rates
by
County
New
Mexico,
2008-‐2012*
and
U.S.,
2010
37. Senate
Bill
159
Added
new
sec&on
to
the
New
Mexico
Drug,
Devise
and
Cosme&c
Act
in
regard
to
prescrip&on
opioids
which:
Required
a
discussion
with
pa&ent
and
provide
educa&onal
pamphlet
on
opiate
addic&on/risk.
Required
that
prac&&oners
receive
wrilen
consent
from
pa&ents
receiving
opiates
for
the
first
&me
indica&ng
that
they
understand
the
risk.
Limited
those
with
cancer
pain,
chronic
pain,
or
those
in
hospice
care
to
a
30
day
supply
per
Schedule
II
opioid
prescrip&on.
Limited
those
with
acute
pain
or
cough
to
a
7
day
supply
per
Schedule
II
opioid
prescrip&on.
Forbade
refills
for
prescrip&on
opioids.
Mandated
use
of
a
Prescrip&on
Drug
Monitoring
Report.
38.
39. Senate
Bill
215
–
Passed
Senate
and
House
in
2012
Amended
the
pain
Relief
Act
in
the
following
ways:
Provided
specific
defini&ons
of
“chronic”
and
“acute”
pain.
Called
on
licensing
boards
to
adopt
rules,
standards,
and
procedures
for
the
applica&on
of
the
Pain
Relief
Act.
Required
provider
con&nuing
educa&on
(CEUs)
for
the
treatment
of
non-‐cancer
pain
management.
Established
the
Prescrip&on
Drug
Misuse
and
Overdose
Preven&on
and
Pain
Management
Advisory
Council
alached
to
DOH.
Mandatory
use
of
the
Prescrip&on
Drug
Monitoring
Program
(PDMP)
by
all
prescribers.
40.
41. In
2012….
NM
now
requires
all
clinical
licensing
boards
to
mandate
CME
specific
to
pain
and
addic&on.
NM
Medical
Board
and
other
clinical
licensing
boards
require
use
of
Prescrip&on
Monitoring
Program
(PMP)
at
least
on
ini&al
use
of
chronic
opioids
and
every
6
months.
NM
Board
of
Pharmacy
upgrades
PMP
to
share
data
with
other
states
regionally.
NM
Governor
developed
the
Prescrip&on
Drug
Misuse
and
Overdose
Preven&on
and
Pain
Management
Advisory
Council.
42.
43. Rules
and
Values:
A
Coordinated
Regulatory
and
Educational
Approach
to
the
Public
Health
Crises
of
Chronic
Pain
and
Addiction
• UNM
Health
Sciences
Center
• Joanna
G.
Katzman,
MD,
MSPH
• Cynthia
M.
A.
Geppert,
MD,
PhD,
MPH
• George
D.
Comerci,
MD,
FACP
• Sanjeev
Arora,
MD,
FACP
• Summers
Kalishman,
PhD
• Lisa
Marr,
MD
• Chris
Camarata,
MD
• Daniel
Duhigg,
DO,
MBA
• Jennifer
Dillow,
MD
• Eugene
Koshkin,
MD
• Denise
E.
Taylor,
MD
• Healing
Addic[on
In
Our
Community
• Jennifer
Weiss,
MBA,
BSIT
• Project
ECHO®
Ins[tute
• Sanjeev
Arora,
MD,
FACP
• Joanna
G.
Katzman,
MD,
MSPH
• George
D.
Comerci,
MD,
FACP
• Daniel
Duhigg,
DO,
MBA
• NM
Department
of
Health
• Michael
Landen,
MD,
MPH
• NM
Board
of
Pharmacy
• Larry
Loring,
RPH
• NM
Medical
Board
• Steven
M.
Jenkusky,
MD,
MA,
FAPA
• Presbyterian
Health
Care
Services
• Steven
M.
Jenkusky,
MD,
MA,
FAPA
• NM
Veterans’
Affairs
Health
Care
System
• Cynthia
M.
A.
Geppert,
MD,
PhD,
MPH
44. University
of
New
Mexico
Pain
Center
and
Project
ECHO
Pain
Clinical
Centers
of
Excellence
-‐
American
Pain
Society
UNM
Pain
Center-‐
the
only
interdisciplinary
Pain
Center
with
integrated
addic&on
services
in
New
Mexico
Project
ECHO
Pain-‐
began
in
2009,
par&cipants
include
primary
care
clinicians
from
New
Mexico
and
throughout
the
United
States
ECHO
Pain
Program
replicated
by
University
of
Washington
(TelePain),
UC
Davis,
Community
Health
Centers
(CHC),
the
VA
(SCAN-‐ECHO),
the
DoD
(Army
Pain
ECHO),
the
Indian
Health
Service
(ECHO
Pain
and
Addic&on),
and
Canada
(ECHO
Ontario
Pain
and
Addic&on)
University
of
New
Mexico
45. Family
Medicine
Internal
Medicine
Pediatrics
Psychiatry
Emergency/Urgent
Care
Series1
356
150
79
76
72
356
150
79
76
72
0
50
100
150
200
250
300
350
400
Total
=
733
Table
1:
Most
represented
UNM
Pain
Center
Course
par[cipants
by
MD
and
DO
specialty
46. NP
PA
DDS
CNM
Series1
214
113
18
12
214
113
18
12
0
50
100
150
200
250
Total
=
357
Table
1:
Most
represented
UNM
Pain
Center
Course
par[cipants
by
profession
for
non-‐physician
clinicians
47. 0
200,000,000
400,000,000
600,000,000
800,000,000
1,000,000,000
1,200,000,000
2008
Jan-‐
Jun
2008
Jul-‐
Dec
2009
Jan-‐
Jun
2009
Jul-‐
Dec
2010
Jan-‐
Jun
2010
Jul-‐
Dec
2011
Jan-‐
Jun
2011
Jul-‐
Dec
2012
Jan-‐
Jun
2012
Jul-‐
Dec
2013
Jan-‐
Jun
Total
MME
of
Opioids
Dispensed
Total
MME
of
Opioids
Dispensed
48. 0
200
400
600
800
1,000
1,200
1,400
2008
Jan-‐
Jun
2008
Jul-‐
Dec
2009
Jan-‐
Jun
2009
Jul-‐
Dec
2010
Jan-‐
Jun
2010
Jul-‐
Dec
2011
Jan-‐
Jun
2011
Jul-‐
Dec
2012
Jan-‐
Jun
2012
Jul-‐
Dec
2013
Jan-‐
Jun
Opioid
MME
per
prescrip[on
Opioid
MME
per
prescrip&on
49.
50. 0.0
5.0
10.0
15.0
20.0
25.0
30.0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012*
Deaths
per
100,000
persons
Year
Drug
Overdose
Death
Rates
New
Mexico
and
United
States,
1990-‐2012
New
Mexico
United
States
51. Drug
Overdose
Death
Rates
Leading
States,
U.S.,
2010
Sources: CDC Wonder
Rates are age-adjusted to the 2000 US Standard Population.
52. The
NM
Board
of
Pharmacy
has
noted
a
7%
decline
in
the
quan&ty
of
Schedule
II
and
Schedule
III
controlled
substances
dispensed
in
the
first
6
months
of
2013.
Opiate
prescrip&ons
and
benzodiazepines
decreased
more
than
7%
sugges&ng
safer
controlled
substance
prescribing.
New
Mexico
had
35
fewer
overdose
deaths
in
2012
compared
to
2011.
Down
from
521
deaths
to
486.
In
Summary:
53. Mandatory
PDMP
usage
Doctor
Shopping
laws
Support
for
Substance
Abuse
treatment
services
through
Medicaid
expansion
Prescriber
educa&on
required
Good
Samaritan
Laws
Rescue
Drug
Laws
ID
requirement
for
controlled
substances
Lock-‐in
programs
for
Medicaid
pa&ents
New
Mexico
Scored
10
out
of
10
on
New
Policy
Report
Card
of
Promising
Strategies
to
Help
Curb
Prescrip&on
Drug
Abuse
54. Lessons
Learned:
Iden&fy
ALL
of
your
stakeholders
and
bring
them
on
board
early
in
the
process.
Iden&fy
possible
unintended
consequences
and
acknowledge
them
and
alempt
to
address
them.
Don’t
make
assump&ons.
Address
all
issues
associated
with
whatever
change
you
are
proposing
and
work
with
people
to
find
out
pros
and
cons
from
all
perspec&ves.
Funding….
Ensure
you
have
a
plan
to
address
funding
issues
and
incorporate
this
plan
within
your
strategy.
55. Next
Steps
Increase
prescriber
knowledge
for
beler
pain
management
prescribing
prac&ces.
Increase
and
improve
the
use
of
the
PDMP.
Establish
evidence-‐based
drug
preven&on
programs
in
the
middle
and
high
schools.
Expand
and
improve
access
to
evidence-‐based
drug
addic&on
treatment.
Increase
Medically
Assisted
Treatment
and
the
number
of
Bupenorphine
prescribers.
Increased
Naloxone
distribu&on
statewide
in
communi&es,
pharmacies
(April
2014)
and
first
responders.