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.
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.
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This document summarizes a presentation on preventing hepatitis C and HIV outbreaks. It includes learning objectives about informing attendees of risks of infectious disease outbreaks related to injection drug use and describing collaborations between injury and infectious disease programs. The presentation features four speakers from Indiana and North Carolina public health departments and focuses on lessons learned from an HIV outbreak in Indiana linked to injection drug use.
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.
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 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_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.
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.
View only rx16 prev tues_1230_1_duwve_2adams_3proescholdbell-sachdevaOPUNITE
This document summarizes a presentation on preventing hepatitis C and HIV outbreaks. It includes learning objectives about informing attendees of risks of infectious disease outbreaks related to injection drug use and describing collaborations between injury and infectious disease programs. The presentation features four speakers from Indiana and North Carolina public health departments and focuses on lessons learned from an HIV outbreak in Indiana linked to injection drug use.
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.
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 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.
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.
The document discusses the increasing abuse of heroin in the United States and its link to prescription drug abuse. It provides data from reports showing that people who abuse prescription painkillers are 19 times more likely to abuse heroin. With increased demand, drug trafficking organizations have increased heroin availability and purity. Law enforcement data demonstrates rising heroin seizures and overdose deaths linked to increased prescription opioid abuse. The document examines how some prescription opioid abusers may be turning to cheaper heroin as painkiller restrictions take effect.
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 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.
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.
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 a presentation on medication-assisted treatment for opioid addiction. It discusses the history of treatment approaches, including the development of methadone and buprenorphine maintenance therapies. Studies show that agonist therapies like methadone and buprenorphine are more effective at retaining patients in treatment and reducing illicit opioid use than non-medication approaches. While both methadone and buprenorphine are effective, buprenorphine has a safer side effect profile but its effectiveness may be limited by lower monitoring and adherence compared to methadone treatment. The document reviews several studies demonstrating the benefits of long-term agonist therapy over detoxification or short-term medication approaches for opioid
This document summarizes a presentation on state and federal responses to the opioid epidemic. It discusses innovations from the Kentucky Attorney General including legislative measures targeting pill mills and heroin, programs to expand treatment and recovery, and education initiatives. It also describes the federal response through the Organized Crime Drug Enforcement Task Force (OCDETF), including their national heroin initiative targeting criminal organizations trafficking illegal opioids and heroin, and partnerships with other agencies to address public health and public safety aspects of the epidemic. The presentation outlines strategies at both state and federal levels aimed at improving access to treatment while also enforcing penalties on dealers through investigation and prosecution efforts.
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.
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 opioid prescribing trends, policies, and their impacts in Canada and at the US-Canada border. It finds that while Canada and the US have high opioid consumption, Canadian policies like introducing tamper-deterrent OxyContin and a prescription monitoring program reduced potentially inappropriate prescribing by 1%. However, over 1 million such prescriptions remain, and inconsistencies in provincial policies and lack of prescriber access to prescription data limit the policies. The approval of generic long-acting oxycodone in Canada did not increase trafficking into the US, though losses cannot be tracked. Ongoing evaluation is needed to improve policies around opioid availability and curb misuse across the border.
The document discusses addressing the opioid epidemic through a public health lens. It provides data on the rise in opioid-related deaths in Massachusetts from 2000-2016. It also discusses prevention, intervention, treatment and recovery efforts through Governor Baker's Opioid Working Group. This includes adopting core medical competencies focused on substance use, expanding treatment beds and recovery programs, and the Chapter 55 data initiative to better understand the epidemic through linking multiple health datasets.
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.
April 3, 2017
The current opiate epidemic has spurred long-overdue scrutiny on the pharmaceutical production and distribution of opiate medication, but it also raises questions of public policy and law regarding the regulation of medical access to and use of opiate medications with high potential for addiction. Expert panelists will address the challenges that arise from efforts to balance restrictions on access to opiates to limit addiction while also preserving sufficient access for legitimate medical management of pain.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/opiate-regulation-policies
The document discusses factors that can lead to transition from misuse of prescription opioid analgesics to heroin initiation. Through qualitative interviews with 31 individuals in New York City, four key factors were identified: 1) Use of high dose opioid analgesics; 2) Intranasal route of administration; 3) Development of physical opioid dependence; and 4) Dissolution of stigma regarding heroin in social networks. The trajectory toward heroin use was found to be similar regardless of whether opioid analgesic initiation was recreational or medical in nature.
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 drug use patterns among New York City residents based on several data sources. It finds that nearly 1 million NYC residents report illicit drug use annually, with marijuana being the most commonly used drug. Excluding marijuana, NYC residents report higher rates of illicit drug use than nationwide. Cocaine and prescription pain reliever use have increased in recent years among some groups. Drug-related emergency department visits, hospitalizations, and deaths remain high, with opioids, cocaine, benzodiazepines, and alcohol frequently involved in overdoses. The report recommends expanding screening, brief interventions, and opioid overdose prevention programs to reduce drug-related harms.
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.
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.
The document discusses the increasing abuse of heroin in the United States and its link to prescription drug abuse. It provides data from reports showing that people who abuse prescription painkillers are 19 times more likely to abuse heroin. With increased demand, drug trafficking organizations have increased heroin availability and purity. Law enforcement data demonstrates rising heroin seizures and overdose deaths linked to increased prescription opioid abuse. The document examines how some prescription opioid abusers may be turning to cheaper heroin as painkiller restrictions take effect.
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 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.
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.
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 a presentation on medication-assisted treatment for opioid addiction. It discusses the history of treatment approaches, including the development of methadone and buprenorphine maintenance therapies. Studies show that agonist therapies like methadone and buprenorphine are more effective at retaining patients in treatment and reducing illicit opioid use than non-medication approaches. While both methadone and buprenorphine are effective, buprenorphine has a safer side effect profile but its effectiveness may be limited by lower monitoring and adherence compared to methadone treatment. The document reviews several studies demonstrating the benefits of long-term agonist therapy over detoxification or short-term medication approaches for opioid
This document summarizes a presentation on state and federal responses to the opioid epidemic. It discusses innovations from the Kentucky Attorney General including legislative measures targeting pill mills and heroin, programs to expand treatment and recovery, and education initiatives. It also describes the federal response through the Organized Crime Drug Enforcement Task Force (OCDETF), including their national heroin initiative targeting criminal organizations trafficking illegal opioids and heroin, and partnerships with other agencies to address public health and public safety aspects of the epidemic. The presentation outlines strategies at both state and federal levels aimed at improving access to treatment while also enforcing penalties on dealers through investigation and prosecution efforts.
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.
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 opioid prescribing trends, policies, and their impacts in Canada and at the US-Canada border. It finds that while Canada and the US have high opioid consumption, Canadian policies like introducing tamper-deterrent OxyContin and a prescription monitoring program reduced potentially inappropriate prescribing by 1%. However, over 1 million such prescriptions remain, and inconsistencies in provincial policies and lack of prescriber access to prescription data limit the policies. The approval of generic long-acting oxycodone in Canada did not increase trafficking into the US, though losses cannot be tracked. Ongoing evaluation is needed to improve policies around opioid availability and curb misuse across the border.
The document discusses addressing the opioid epidemic through a public health lens. It provides data on the rise in opioid-related deaths in Massachusetts from 2000-2016. It also discusses prevention, intervention, treatment and recovery efforts through Governor Baker's Opioid Working Group. This includes adopting core medical competencies focused on substance use, expanding treatment beds and recovery programs, and the Chapter 55 data initiative to better understand the epidemic through linking multiple health datasets.
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.
April 3, 2017
The current opiate epidemic has spurred long-overdue scrutiny on the pharmaceutical production and distribution of opiate medication, but it also raises questions of public policy and law regarding the regulation of medical access to and use of opiate medications with high potential for addiction. Expert panelists will address the challenges that arise from efforts to balance restrictions on access to opiates to limit addiction while also preserving sufficient access for legitimate medical management of pain.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/opiate-regulation-policies
The document discusses factors that can lead to transition from misuse of prescription opioid analgesics to heroin initiation. Through qualitative interviews with 31 individuals in New York City, four key factors were identified: 1) Use of high dose opioid analgesics; 2) Intranasal route of administration; 3) Development of physical opioid dependence; and 4) Dissolution of stigma regarding heroin in social networks. The trajectory toward heroin use was found to be similar regardless of whether opioid analgesic initiation was recreational or medical in nature.
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 drug use patterns among New York City residents based on several data sources. It finds that nearly 1 million NYC residents report illicit drug use annually, with marijuana being the most commonly used drug. Excluding marijuana, NYC residents report higher rates of illicit drug use than nationwide. Cocaine and prescription pain reliever use have increased in recent years among some groups. Drug-related emergency department visits, hospitalizations, and deaths remain high, with opioids, cocaine, benzodiazepines, and alcohol frequently involved in overdoses. The report recommends expanding screening, brief interventions, and opioid overdose prevention programs to reduce drug-related harms.
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.
This document discusses the use of poison center data to track trends in prescription drug abuse and overdoses. It shows that between 1999-2011, prescription opioid exposures reported to poison centers increased over 150% in the US and 164% in Kentucky. Specific opioids like oxycodone, hydrocodone, and tramadol also increased substantially. Poison center data can provide real-time surveillance to identify emerging problems and formulate strategies to address them.
We honor ourselves when we speak out for recovery. We show the world that recovery matters because it brings hope and peace into the lives of individuals and their loved ones. ~ Beth Wilson
The only person you are destined to become is the person you decide to be. ~ Ralph Waldo Emerson
Success is the sum of small efforts, repeated day in and day out.
~ Robert Collier
This document summarizes drug trends in New York City in 2013. Key findings include heroin and opioid analgesics playing a large role in drug deaths, with opioids involved in 71% of overdose deaths. Heroin-related overdose deaths increased 84% from 2010 to 2012. Opioid analgesic prescriptions among NYC residents increased 30% from 2008 to 2012. Cocaine was the second most common drug identified in drug crime lab tests after marijuana.
Syringe services programs (SSPs) have been effective in reducing HIV transmission among injecting drug users in New York. SSPs first opened in New York City in 1987 and there are now 20 programs across the state. These programs have contributed to an 83% decrease in new HIV infections among injecting drug users in New York City from 1991 to 2008. African Americans and Latinos are disproportionately affected by HIV among injecting drug users in New York. SSPs have also been shown to be cost-effective, with every $1 invested in syringe services resulting in $3-7 in savings.
This document summarizes drug use trends and issues in New York State. Some key points:
- New York has higher than average rates of cocaine, illicit drug dependence, and young adult illicit drug dependence compared to other states. Heroin is the most common drug in treatment admissions.
- Approximately 9.82% of New York residents reported past-month illicit drug use compared to the national average of 8.82%.
- Drug-induced deaths in New York are lower than the national average, though still number over 1,700 per year.
- The document outlines state and federal efforts to address issues like prescription drug monitoring programs, drug take-back initiatives, and drugged driving laws.
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.
ER visits for opioid overdoses is rising in the U.S. Accurate ER reports from medical transcription services and proactive action can help minimize risks.
Opioid Epidemic - Causes, Impact and FutureCitiusTech
In 2017, everyday, more than 130 people died in the US after overdosing on opioids. This document talks about America's worst drug crisis ever and shares how technology can play a role to cope up with this epidemic.
This document discusses evidence-based substance use disorder treatment and the use of medication-assisted treatment (MAT). It provides context on Kentucky's high rates of substance use disorders and overdose deaths. The document outlines principles of effective treatment for criminal justice populations, including that treatment should be evidence-based and tailored to individual needs. It describes therapeutic communities and MAT as evidence-based approaches used in Kentucky correctional facilities. Preliminary outcomes data on MAT programs in Kentucky prisons and after release show promise in reducing relapse. Special considerations are discussed for effectively implementing evidence-based practices in criminal justice settings.
This document provides an overview of a conference on chronic pain and addiction that will take place from April 10-12, 2012 at Walt Disney World Swan Resort. The conference will focus on prescription drug abuse in the US, the effects of prescription pain medication abuse over time, and advocating for continued education on addiction for pain management providers. Key statistics on prescription drug abuse in the US are presented, including that opioid analgesics are now the leading cause of accidental drug overdose deaths. Abuse of prescription drugs is rising among both adolescents and older adults.
This document describes a presentation on using data to drive down prescription drug abuse. It discusses how various agencies in Madison-Dane County, WI collaborated using multiple data sources to understand the local prescription drug problem and develop strategies to address it. Data on overdoses, deaths, hospital visits, and a community survey revealed high overdose rates and barriers to treatment. This informed a multifaceted initiative including a naloxone pilot program, Good Samaritan law, and increased treatment support. Policy changes at the state level further supported these efforts.
This document summarizes substance abuse issues faced in emergency departments. It notes that substance abuse patients are frequent emergency department users who require significant resources. Over 5 million emergency department visits annually are related to drugs, including 2.5 million specifically for drug abuse or misuse. Prescription opioid abuse and overdoses have risen dramatically in recent years. New CDC guidelines aim to curb opioid prescribing practices to help address this crisis. Emergency physicians are on the front lines of this issue and see the consequences of opioid addiction firsthand.
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.
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.
Project Lazarus is a secular, non-profit organization that provides technical assistance to community groups and clinicians throughout North Carolina and beyond to prevent drug overdoses. It uses a five-step approach: 1) building community knowledge and coalitions, 2) epidemiologic monitoring, 3) prevention, 4) rescue, and 5) program evaluation. The organization works to reduce supply, demand, diversion and harm from prescription drug abuse through community awareness, strategic planning, and harm reduction programs.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
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 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 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.
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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 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 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.
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)
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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1. NYC
RxStat:
A
Collabora0ve
Approach
to
Surveillance
of
Prescrip0on
Drug
Misuse
and
Associated
Consequences
April
23,
2014
Atlanta
Marrio2
Marquis
1
2. Learning
Objec0ves
1. Describe
how
public
health/public
safety
partnership
informs
City’s
response
to
opioid
analgesic
misuse
2. Real-‐Gme
data
in
acGon:
Use
Gmely
data
to
shape
response
to
public
health
events
3. Data-‐driven
policy:
Use
data
to
inform
City’s
opioid-‐related
policies
and
strategies
2
3. Disclosure
Statement
Steven
Newmark,
Michelle
Nolan,
Michael
Clarke,
Alexandra
Harocopos
and
Ellenie
Tuazon
have
no
financial
relaGonships
with
proprietary
enGGes
that
produce
health
care
goods
and
services
3
4. Outline
• RxStat
Overview
(Steven
Newmark,
NYC
Office
of
the
Mayor)
• Public
Health
Data
Sources
(Michelle
Nolan,
NYC
Dept.
of
Health
and
Mental
Hygiene)
• Public
Safety
Data
Sources
(Michael
Clarke,
NYC
Mayor’s
Office
of
Criminal
JusFce)
• Opioid
Analgesics
in
New
York
City:
A
Qualita0ve
Study
(Alexandra
Harocopos,
NYC
Dept.
of
Health
and
Mental
Hygiene)
• Data
Driven
Opioid
Policies
and
Strategies
in
New
York
City
(Ellenie
Tuazon,
NYC
Dept.
of
Health
and
Mental
Hygiene)
4
5. RXSTAT
OVERVIEW
Steven
Newmark,
JD/MPA,
Sr.
Policy
Advisor
&
Counsel
to
the
Deputy
Mayor
for
Health
and
Human
Services
New
York
City
Office
of
the
Mayor
5
6. Opioid
Analgesics
Are
a
Public
Health
Crisis
in
New
York
City
*Paone D, Bradley O’Brien D, Shah S, Heller D. Opioid analgesics in New York City: misuse, morbidity and
mortality update. Epi Data Brief. April 2011. Available at
http://www.nyc.gov/html/doh/downloads/pdf/epi/epi-data-brief.pdf .
6
8. RxStat:
Four
Core
Principles
• Timely,
accurate
analysis
of
drug
misuse
indicators
from
mulGple
sources
(e.g.,
mortality,
EDs,
PMP,
drug
treatment,
law
enforcement,
etc.)
• Develop
strategies
based
on
analysis
of
exisGng
and
newly
available
data
• Rapid
deployment
of
public
health
and
public
safety
resources
to
high
priority
areas
• Rigorous
follow-‐up
to
ensure
strategies
are
effecGve
8
9. RxStat
• Public
health
&
public
safety
collaboraGon
– Housed
at
NYC
Department
of
Health
&
Mental
Hygiene
(DOHMH)
leverages
experGse
and
infrastructure
• “Real-‐Gme”
(enhanced)
surveillance
• ParGcipants
and
stakeholders
at
city,
state,
and
federal
organizaGons
• Monthly
RxStat
Data
MeeGngs
9
11. Data
Sources
Reduce
Overdose
Deaths
PMP
Data
Treatment
Admissions
Poison
Control
Drug
ProsecuGons
HospitalizaGons
Jail
Data
Mortality
DEA
ARCOS
Pharmacy
Crime
Price/Purity
QualitaGve
Research
Medicaid
Fraud
Data
Syndromic
QualitaGve
Research
Mortality
Pharmacy
Crime
DEA
ARCOS
Drug
ProsecuGons
11
12. PUBLIC
HEALTH
DATA
SOURCES
Michelle
Nolan,
MPH,
RxStat
Data
Analyst
New
York
City
Department
of
Health
and
Mental
Hygiene
12
13. Outline
• Describe
opioid
analgesic
use
and
misuse
in
New
York
City
• Discuss
an
example
of
how
real-‐Gme
data
was
used
to
inform
a
public
health
response
13
14. Opioid
Analgesic
Use
and
Misuse
in
NYC
• In
2012,
700,000
New
Yorkers
filled
more
than
2
million
opioid
analgesic
prescripGons
• In
2010-‐2011,
4%
(162,000)
of
New
Yorkers
aged
12
and
older
reported
past
year
opioid
analgesic
misuse
• In
2011,
the
rate
of
emergency
department
visits
a2ributed
to
opioid
analgesic
misuse/
abuse
was
141.3/100,000
New
Yorkers
14
15. Opioids
Were
Involved
In
73%
of
Overdose
Deaths
in
NYC
0
100
200
300
400
500
600
700
800
900
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Number
Year of Death
Total
Opioids
Heroin
Opioid
Analgesics
NOTE:
Drugs
not
mutually
exclusive
Source: New York City Office of the Chief Medical Examiner & New
York City Department of Health and Mental Hygiene 2000-2012
15
16. 59 66
78 81
93
130
152
131 137
151
173
220
201
0.9
1
1.3 1.3
1.5
2
2.4
2
2.1
2.3
2.6
3.3
3.0
0
0.5
1
1.5
2
2.5
3
3.5
0
50
100
150
200
250
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Age-adjustedrateper100,000
Number
Number of unintentional opioid analgesic poisoning deaths
Age-adjusted rate per 100,000
Opioid
Analgesic
Overdose
Deaths
Increased
233%
from
2000
to
2012,
NYC
Source: New York City Office of the Chief Medical Examiner & New
York City Department of Health and Mental Hygiene 2000-2012
16
17. 373
416 400
438
358
379 388
301 317
288
209
284
382
5.9
6.3 6.3
6.9
5.7
5.9
6.1
4.7
4.9
4.4
3.1
4.2
5.7
0
1
2
3
4
5
6
7
8
0
50
100
150
200
250
300
350
400
450
500
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Age-adjustedrateper100,000
Number
Number of unintentional heroin poisoning deaths
Age-adjusted rate per 100,000
Heroin
Overdose
Deaths
Increased
84%
from
2010
to
2012,
NYC
Source: New York City Office of the Chief Medical Examiner & New
York City Department of Health and Mental Hygiene 2000-2012
17
18. What
About
Heroin?
• Increases
in
heroin-‐related
overdose
deaths
beginning
in
2011
preceded
decreases
in
opioid
analgesic-‐related
overdose
deaths
in
2012
• Similarly
the
increase
in
heroin
deaths
in
New
York
City
aher
2010
was
not
preceded
by
a
decrease
in
the
prescribing
of
opioid
analgesics,
suggesGng
that
the
heroin
overdose
increase
occurred
independent
of
any
changes
in
prescripGon
opioid
availability
18
19. Emergency
Ac0on
Plan
• Early
January,
2014:
Mid-‐AtlanGc
and
Northeast
states
reported
an
increase
in
the
number
of
overdoses
related
to
heroin
containing
fentanyl
• February,
2014:
Mass
media
coverage
of
heroin
following
the
death
of
a
public
figure
in
New
York
City
19
20. Within
24
Hours:
• NYC
DOHMH
data
review
of:
– Syndromic
surveillance
• No
detectable
increase
in
the
number
of
emergency
department
visits
for
overdose
– Poison
Control
Data
• No
increase
in
the
number
of
consultaGons
for
heroin
or
fentanyl
20
21. Within
24
Hours:
• Conferences
took
place
with:
– Medical
Examiner
• No
increase
in
the
number
of
overdose
cases
• Heroin
cases
to
be
tested
for
fentanyl
– Syringe
Exchange
Programs
• No
reported
increase
in
fatal
or
non
fatal
overdoses
– NYPD
and
DEA
labs
• No
reported
increase
heroin
samples
tested
containing
fentanyl
21
22. Emergency
Ac0on
Plan
Response
• NYC
DOHMH
released
two
advisories
regarding
cases
of
fentanyl-‐associated
overdoses
in
Mid-‐AtlanGc
and
Northeast
United
States:
1.
A
Health
Alert
Network
le2er
for
clinicians
2. A
“Dear
Colleague”
le2er
for
program
staff
working
with
drug
users
22
23. PUBLIC
SAFETY
DATA
SOURCES
Michael
Clarke,
JD,
Special
Counsel
New
York
City
Mayor’s
Office
of
Criminal
JusGce
23
24. New
York
County
DA
Drug
Prosecu0ons
Involving
Opioid
Analgesics
(2012,
2013)
Source: New York County District Attorney’s Office
Number
of
ProsecuGons
Involving
Opioid
Analgesics
• From
2012
to
2013,
there
was
an
8%
increase
in
prosecuGons
by
the
New
York
County
DA
involving
opioid
analgesics.
• In
2012
and
2013,
opioid
analgesics
were
involved
in
approximately
5%
of
all
drug
prosecuGons
in
New
York
County
(excluding
marijuana).
ProsecuGons
involving
opioid
analgesics:
• 2012=
545
• 2013=
587
24
25. Pharmacy
Robberies
&
Burglaries
for
Rx
Drugs,
NYC
(2012
&
2013)
Burglary
Robbery
Grand
Total
2012
2013
2012
2013
2012
+
2013
Bronx
8
16
4
0
28
Kings
8
8
=
4
1
21
New
York
0
8
5
1
14
Queens
6
8
2
1
17
Richmond
0
1
0
0
=
1
Grand
Total
22
41
15
3
81
This
database
can
be
used
to
monitor
trends
in
real
Gme.
As
of
March
27,
2014
there
had
been
8
burglaries
and
2
robberies
in
NYC
in
2014.
25
26.
=
Burglary
=
Robbery
New
York
City
Pharmacy
Robberies
and
Burglaries
2012
-‐
2013
Note:
Image
created
using
Google
Maps
26
27. Controlled
Prescrip0on
Drugs
(CPD)
Loss/
Thed
Reports
(DEA
106
Forms),
NYC
• 211
incidents
reported
in
2013
– Includes
all
Schedule
II
–
V
controlled
substances
– 95
incidents
of
the
211
in
NYC
involved
opioid
analgesics
• Approximately
173,000
total
pills
lost
– Of
the
173,000
total
pills,
roughly
70%,
or
approximately
120,000,
were
opioid
analgesic
pills
27
28. Nearly
120,000
Opioid
Analgesic
Pills
Reported
Lost/Stolen
in
NYC
in
2013
Source: Drug Enforcement Administration
Armed
Robbery
4%
Customer
Theh
2%
Employee
Pilferage
16%
Lost
In
Transit
6%
Night
Break-‐In
58%
Other
14%
28
29. Public
Safety
Data
Synthesis
29
• While
there
is
evidence
that
drug
prosecuGons
by
the
New
York
County
DA’s
Office
involving
opioid
analgesics
may
be
increasing,
they
account
for
a
small
percentage
of
total
drug
prosecuGons.
• Pharmacy
burglaries
and
robberies
account
for
small
proporGon
of
crime
in
NYC
and
do
not
appear
to
be
significant
source
of
diverted
opioid
analgesics.
– Incidents
of
CPD
loss/theh
in
NYC
that
were
reported
to
the
DEA
also
do
not
appear
to
be
a
significant
source
of
diverted
opioid
analgesics.
The
primary
category
of
loss
is
night
break-‐in.
30. OPIOID
ANALGESICS
IN
NEW
YORK
CITY:
A
QUALITATIVE
STUDY
Alex
Harocopos,
MS,
Senior
RxStat
Data
Analyst
New
York
City
Department
of
Health
and
Mental
Hygiene
30
31. Study
Aims
To
explore:
-‐ Circumstances
of
opioid
analgesic
(OA)
iniGaGon
-‐ Trajectory
of
use
(including
transiGon
to
heroin)
-‐ Mechanisms
of
diversion
from
medical
to
non-‐medical
use
31
32. Data
Collec0on
• In-‐depth
interviews
(n=20)
with
professionals
• Focus
groups
(n=5)
with
individuals
who
have
experience
of
OA
misuse
• In-‐depth
interviews
(n=49)
with
current
or
recent
OA
misusers
(ongoing)
32
33. Demographic
Characteris0cs
Total
n**
49
Gender
Female
Male
19
30
Age
18
–
29
30
–
55
Median
age
28
21
28
Race/Ethnicity
Black
non-‐Hispanic
Hispanic
White
non-‐Hispanic
MulG-‐racial
2
6
39
2
EducaGon
Did
not
complete
high
school
Completed
high
school
or
GED
Some
college
(includes
trade
school)
Completed
4
year
degree
or
higher
9
13
18
9
Annual
household
income*
Under
$10,000
$10,000
to
$24,999
$25,000
to
$39,999
$40,000
to
$59,999
$60,000
to
$99,999
More
than
$100,000
13
6
8
3
6
7
Profile
of
OA
misusers
*6
respondents
were
unable
to
esGmate
their
annual
household
income
**
data
collecGon
is
ongoing
34. Emerging
Taxonomy
of
OA
Misusers
1. 18
to
30
years,
typically
iniGate
recreaGonally;
primarily
obtain
pills
through
street
sources
2. 31
years
and
above,
typically
iniGate
through
medical
treatment;
primarily
obtain
pills
through
medical
sources
3. Experienced
opioid
users
(i.e.
heroin
and
methadone);
obtain
pills
through
both
street
and
medical
sources
34
35. Market
Dynamics
• Fractured
market
driven
predominantly
by
diversion
from
prescripGons
• Varying
levels
of
monitoring
by
doctors
– ConGnuum
ranges
from:
negligent
→
loose
→
rouGne
→
judicious
• Wide
variety
of
diversion
schemes
idenGfied
– Broad
range
of
criminal
complexity
– Visits
to
mulGple
prescribers
not
cited
as
a
primary
concern
35
36. Market
Dynamics
Diffuse
nature
of
sales
networks
compounded
by
social
proximity
of
buyers
and
sellers
– PrescripGon
opioid
sales
ohen
occur
within
closed
community
networks,
not
via
community
outsiders
36
37. Market
Dynamics
• Scarcity
of
OA
pills
in
some
networks
has
led
to
an
increase
in
price
• Heroin
is
increasingly
available
in
OA-‐using
networks
• Selling
OAs
may
fund
other
drug
use
(e.g.,
heroin,
crack)
37
38. Risk
awareness
and
service
u0liza0on
• Limited
understanding
of
risk
reducGon
– Awareness
of
risks
associated
with
sharing
needles,
but
not
of
sharing
paraphernalia
• Knowledge
of
overdose
prevenGon
is
ohen
lacking
• New
user
cohorts
tend
to
be
isolated
from
community
health
services
• Need
for
greater
acceptance
of,
and
access
to
medically-‐assisted
models
(i.e.,
buprenorphine
and
methadone)
38
39. USING
DATA
TO
INFORM
OPIOID
POLICIES
AND
STRATEGIES
IN
NEW
YORK
CITY
Ellenie
Tuazon,
MPH,
Research
and
Surveillance
Analyst
New
York
City
Department
of
Health
and
Mental
Hygiene
39
40. Data
Driven
Ini0a0ves
Reduce
Overdose
Deaths
MME
Calculator
Emergency
AcGon
Plan
NYPD
Naloxone
Project
Staten
Island
Detailing
ED
Guidelines
Overdose
PrevenGon
Programs
Opioid
Prescribing
Guidelines
Media
Campaign
Media
Campaign
MME
Calculator
Staten
Island
Detailing
NYPD
Naloxone
Project
Overdose
PrevenGon
Programs
ED
Guidelines
Opioid
Prescribing
Guidelines
Emergency
AcGon
Plan
DHS
Naloxone
Project
HHC
Prescribing
HHC
Prescribing
DHS
Naloxone
Project
40
41. Opioid
Prescribing
Guidelines
• Less
ohen:
avoid
prescribing
opioids
for
chronic
non-‐cancer,
non-‐end-‐of-‐life
pain
e.g.,
low
back
pain,
arthriGs,
headache,
fibromyalgia
• Shorter
duraGon:
when
opioids
are
warranted
for
acute
pain,
3-‐day
supply
usually
sufficient
• Lower
doses:
if
dosing
reaches
100
Morphine
Milligram
Equivalents
(MME)
,
reassess
and
reconsider
other
approaches
to
pain
management
• Avoid
whenever
possible
prescribing
opioids
in
paGents
taking
benzodiazepines
CitaGon:
Paone
D,
Dowell
D,
Heller
D.
PrevenGng
misuse
of
prescripGon
opioid
drugs.
City
Health
InformaGon.
2011;
30(4):
23-‐30
New
York
City
Opioid
Treatment
Guidelines,
Clinical
Advisors:
Nancy
Chang,
MD;
Marc
N.
Gourevitch,
MD,
MPH;
Mark
P.
Jarre2,
MD,
MBA;
Andrew
Kolodny,
MD;
Lewis
Nelson,
MD;
Russell
K.
Portenoy,
MD;
Jack
Resnick,
MD;
Stephen
Ross,
MD;
Joanna
L.
Starrels,
MD,
MS;
David
L.
Stevens,
MD;
Anne
Marie
SGlwell,
MD;
Theodore
Strange;
MD,
FACP;
Homer
Venters,
MD,
MS
41
42. New
York
City
Emergency
Department
Discharge
Opioid
Prescribing
Guidelines
Clinical
Advisory
Group:
Jason
Chu,
MD,
Brenna
Farmer,
MD,
Beth
Y.
Ginsburg,
MD,
Stephanie
H.
Hernandez,
MD,
James
F.
Kenny,
MD,
MBA,
FACEP,
Nima
Majlesi,
DO,
Ruben
Olmedo,
MD,
Dean
Olsen,
DO,
James
G.
Ryan,
MD,
Bonnie
Simmons,
DO,
Mark
Su,
MD,
Michael
Touger,
MD,
Sage
W.
Wiener,
MD.
Emergency
Department
Guidelines
Released
January,
2013
Adopted
by
38
NYC
emergency
departments
42
43. NYC
Health
and
Hospitals
Corpora0on
(HHC)
• All
11
HHC
emergency
departments
use
NYC
Emergency
Department
Discharge
Prescribing
Guidelines
• Built
systems
to
evaluate
ED
prescribing
trends
43
44. Staten
Island
Public
Health
“Detailing”
Campaign
• 1-‐on-‐1
“detailing”
visits
from
Health
Department
representaGves
• Deliver
key
prescribing
recommendaGons,
clinical
tools,
paGent
educaGon
materials
• ~1,000
Staten
Island
physicians,
nurse
pracGGoners,
physicians
assistants
• June–August
2013
44
46. Morphine
Milligram
Equivalent
(MME)
Calculator
• A
tool
to
calculate
total
MME
per
day
• Gives
alert
for
dosages
>100
MME
• Quick
and
easy
to
use
• Web-‐based
applicaGon
– Search
for
“NYC
MME
Calculator”
h2p://www.nyc.gov/html/doh/html/mental/MME.html
• Smartphone
app
46
48. Media
Campaigns
• Campaign
One:
– Goal:
Increase
awareness
of
risk
of
opioid
analgesic
overdose
– Ran
twice
(2012,
2013)
• Campaign
Two:
– Goal:
Reduce
sGgma
and
raise
awareness
of
opioid
analgesic
misuse
– 2
tesGmonials
• Mom
lost
son
to
opioid
analgesic
overdose
• NYC
resident
in
recovery
– Ran
2013
and
2014
48
51. In
New
York
State,
trained
laypersons
can
legally
administer
naloxone
for
OD
preven0on
• Per
NYS
Public
Health
Law
“Opioid
Overdose
PrevenGon
Program”
– EffecGve
April
1,
2006
• Laypersons
can
become
Trained
Overdose
Responders
• Trained
Overdose
Responders
can
legally
carry
and
use
naloxone
51
52. Intranasal
Naloxone
Distribu0on
in
NYC
Since
2010
Other
(e.g.,
shelters,
hospitals)
14%
Syringe
Exchange
Programs
73%
>25,000
kits
distributed
>200
reversals
reported
(underrepor0ng)
Drug
Treatment
Programs
13%
52
53. NYC
Department
of
Homeless
Services
(DHS)
More
than
half
DHS
Peace
Officers
are
trained
and
carry
naloxone
in
all
city
shelters
53
54. NYPD
Naloxone
Project
• All
NYPD
officers
in
the
120
precinct
on
Staten
Island
(approximately
180)
have
been
trained
to
carry
and
dispense
naloxone
• Reported
reversals
54
56. Summary
• Opioid
misuse
and
its
health
consequences
consGtute
a
public
health
crisis
• MulG-‐pronged
approaches
are
needed
• Changing
prescribing
pa2erns
is
key
• Raising
public
awareness
• MulG-‐agency
use
of
naloxone
• Ensuring
access
to
effecGve
treatment
• This
problem
is
preventable!
56
57. Conclusion
• RxStat
is
a
collaboraGon
between
NYC
public
health
and
public
safety
toward
one
unifying
goal:
Reduce
overdose
deaths
in
NYC
• Timely/real-‐Gme
data
informs
comprehensive,
mulG-‐pronged
responses
to
opioid
analgesic
misuse
57