building public safety_public_health_partnerships_final
DESCRIPTION
Law Enforcement Track, National Rx Drug Abuse Summit, April 2-4, 2013. Building Public Safety and Public Health Partnerships to Reduce Prescription Drug Abuse presentation by Laurence Busching, Dr. Denise Paone and Dr. Jessica Kattan.TRANSCRIPT
Building Public Safety and Public Health Partnerships to Reduce Prescrip9on
Drug Abuse Laurence Busching
First Deputy Criminal Jus2ce Coordinator, City of New York
Denise Paone Director of Research and Surveillance, Bureau of Alcohol and Drug Use Preven2on, Care and Treatment, New York
City Department of Health and Mental Hygiene
Dr. Jessica Ka@an CDC Health Systems Integra2on Program Scholar,
Centers for Disease Control and Preven2on, SciMetrika Contractor,
Assigned to New York City Department of Health and Mental Hygiene.
How To Work with Public Health Data in Inves9ga9ons
April 2 – 4, 2013 Omni Orlando Resort
at ChampionsGate
Learning Objec9ves
• Outline strategies to create alliances across agency lines.
• Explain how to leverage public health data in inves2ga2ons.
• Outline the importance of collabora2on between public health officials and law enforcement in inves2ga2ons.
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Laurence Busching, Dr. Jessica KaXan, Dr. Denise Paone, Chauncey Parker, and Edward Carrasco have no financial rela2onships with proprietary en22es that produce health care goods and services.
Disclosure Statement
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Outline • The Threat in New York City (Dr. Denise Paone, NYC DOHMH)
• Mayor’s Task Force on Prescrip9on Painkiller Abuse (Laurence Busching, New York City’s Mayor’s Office)
• Public Health/Public Safety Ini9a9ves – RxStat (Dr. Denise Paone, NYC DOHMH)
– Prescribing Guidelines (Dr. Jessica KaCan, NYC DOHMH)
– Public Safety (Chauncey Parker, NY/NJ HIDTA) – NYPD Ini9a9ves (Edward Carrasco, NYPD)
• Public Health/Public Safety Partnerships 5
THE THREAT IN NEW YORK CITY
Dr. Denise Paone, Director of Research and Surveillance
New York City Department of Health and Mental Hygiene
Opioid analgesic misuse and the associated consequences have led
to a public health crisis in New York City.
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• From 2005-‐2011, the rate of opioid analgesic overdose deaths increased 65%, heroin overdose deaths decreased 8%.
• In 2011, more than one fatal opioid analgesic overdose occurred every other day in New York City.
• In 2005, opioid analgesics were involved in 16% of overdose deaths; in 2011, they were involved in 35%.
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Exis9ng Data/Surveillance on Opioid Analgesic (Pain Reliever) Misuse
Prescribing Prescrip2ons
Filled? PDMP Data
Morbidity Health
consequences? ED Visits, Treatment
Admissions
Prevalence How Many Users?
Na2onal Survey on Drug User Health
Mortality Overdose deaths?
Death Cer2ficates
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0
100
200
300
400
500
2005 2006 2007 2008 2009 2010 2011
Num
ber
Year
Cocaine
Heroin
Methadone
Benzodiazepines
Opioid Analgesics
Drugs are not mutually exclusive
Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene 2005-2011
Overdose Deaths Decreased 22% in NYC
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Opioid analgesic overdose deaths increased 65%
Opioid analgesic overdose deaths, NYC, 2005-‐2011
Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene 2005-2011
130 152 131 137 158 173 220
2.0 2.3
2.0 2.0
2.4 2.6
3.3
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0
50
100
150
200
250
2005 2006 2007 2008 2009 2010 2011
Age-‐Adjusted Ra
te per 100,000
Num
ber
Number of opioid analgesic overdose deaths
Age-‐adjusted opioid analgesic rates per 100,000 popula9on
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4,466
6,560 7,411
8,577 9,442 9,254
10,843 54.7
79.8 89.8
103.2 113.1 110.3
129.2
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
0
2,000
4,000
6,000
8,000
10,000
12,000
2004 2005 2006 2007 2008 2009 2010
Age-‐adjusted rate per 100,000
Num
ber
Number of opioid analgesics ED visits
Source: Drug Abuse Warning Network, Center for Behavioral Health Statistics and Quality, Substance Abuse Mental Health Services Administration, 2004-2010
Opioid Analgesic-‐related Emergency Department Visit Rates Doubled from 2004 to 2010
Opioid analgesic misuse/abuse emergency department visits, NYC 2004-‐2010
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Oxycodone prescrip9ons increased 51% from 2008 to 2010 in NYC
All prescrip9ons
Hydrocodone
Oxycodone
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2008 2009 2010
Num
ber of
prescrip9on
s
Year Dispensed
Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2008-2010 13
15% of prescribers write 82% of opioid analgesic prescrip9ons
49%
2%
36%
15%
14%
51%
1%
31%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
Prescribers Prescriptions Prescribing frequency
Very Frequent Prescribers 530-10,185 RX/year
Frequent Prescribers 50-529 RX/year
Occasional Prescribers 4-49 RX/year
Rare Prescribers 1-3 RX/year
Prescrip2ons filled by NYC residents, 2010
15%
82%
Perc
ent
Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2008-2010 14
Neighborhoods with Highest Rates of Opioid Prescrip9ons have Highest Rates of Overdose Deaths Rates of prescrip9ons filled for opioid
analgesics by NYC neighborhood Rates of uninten9onal opioid
analgesic overdose deaths by NYC neighborhood
Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2008-2009; New York City Office of the Chief Medical Examiner &New York City Department of Health and Mental Hygiene 2008-2009 15
0%
1%
2%
3%
4%
5%
2002-‐03 2004-‐05 2006-‐07 2008-‐09 2010-‐11
Percen
t
Self-‐reported year of use (two year average)
Opioid Analgesics
Cocaine
Heroin
Benzodiazepines
Self-‐reported drug use in past 12 months, NYC, aged 12+
Most Commonly Used Drugs Are Opioid Analgesics
Source: Substance Abuse Mental Health Services Administration, Office of Applied Studies, 2002-2009 National Surveys on Drug Use and Health 16
NYC MAYOR’S TASK FORCE ON PRESCRIPTION PAINKILLER ABUSE
Laurence Busching, First Deputy Criminal Jus2ce Coordinator
New York City Office of the Mayor
NYC Mayor’s Task Force on Prescrip9on Painkiller Abuse
Co-‐chair, Criminal Jus2ce Coordinator
Co-‐chair, Deputy Mayor for Health and Human Services
New York City Department of Health and Mental Hygiene
New York City Police Department
New York City Department of Educa2on
Health and Hospitals Corpora2on
Human Resources Administra2on
Mayor’s Office of Policy and Strategic Planning
Richmond County District AXorney’s Office
Office of the Special Narco2cs Prosecutor
Drug Enforcement Administra2on
NY/NJ HIDTA 18
Task Force Work Groups
• Data • Legisla9on • Preven9on and Treatment
• Law Enforcement
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RXSTAT: NYC’S COMPREHENSIVE DRUG SURVEILLANCE SYSTEM “COMPSTAT for PrescripNon Drug Abuse”
Dr. Denise Paone, Director of Research and Surveillance
New York City Department of Health and Mental Hygiene
• Facilita2ng accurate and 2mely analysis of public health and public safety data.
• Targe2ng resources and coordina2ng efforts to provide the most effec2ve and efficient City response.
• Providing measures to track strategies.
Reduce prescrip+on drug misuse in NYC and associated health and safety consequences by:
RxStat Goals “COMPSTAT for PrescripNon Drug Abuse”
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RxStat “COMPSTAT for PrescripNon Drug Abuse”
• Public Health & Public Safety Collabora2on.
• “Real-‐2me” (enhanced) surveillance.
• Par2cipants and stakeholders at city, state, and federal organiza2ons.
• Monthly RxStat mee2ngs with key stakeholders.
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Enhanced Surveillance Efforts
Prescribing Quarterly PDMP data, Quarterly
DEA Data
Morbidity Daily ED Visits, Daily NYC PCC Calls, Quarterly Treatment Admissions
Mortality Monthly Monitoring, OCME BoXle Project*
Crime & Diversion
Monthly Prosecu2ons*, NYPD Data, Quarterly DEA Losses, Rx Crimes*
*Discussed in more detail later in the presentaNon.
Prevalence & Intelligence
Qualita2ve Component, Data Analy2cs/Mapping
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RxStat creates a plaqorm for collabora2ve problem solving to reduce prescrip2on drug abuse.
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RxStat “COMPSTAT for PrescripNon Drug Abuse”
BEST PRACTICES PRESCRIBING GUIDELINES
Dr. Jessica KaXan, CDC Health Systems Integra2on Program Scholar
Centers for Disease Control and Preven2on, SciMetrika Contractor
Assigned to New York City Department of Health and Mental Hygiene
Opioid Prescribing Guidelines
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Emergency Department Opioid Prescribing Guidelines: Goal and Ra9onale
• Establish standards for prescribing. • Balance pain treatment with reducing opioid analgesic misuse.
• Why Emergency Departments?
– Pain is a common presenta2on in EDs.
– Opioid analgesics are commonly prescribed in EDs, although EDs not the main source.
– One component of a mul2-‐pronged approach.
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Target & Adop9on
• Pa2ents discharged from EDs.
• Not meant for pallia2ve care programs or cancer pain.
• Adopted by all Health and Hospitals Corpora2on EDs (NYC’s public hospital system).
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ED Opioid Prescribing Guidelines
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Percep9ons
• Emergency Departments
• Media Response
• General Public
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APPLICATION IN PUBLIC SAFETY & RX CRIMES
Chauncey Parker, Director
New York/New Jersey High Intensity Drug Trafficking Area
Overdose Death Prescrip9ons
• Office of the Chief Medical Examiner (OCME) began collec2ng prescrip2on boXles at death scenes.
• Partnership allowed resources to log the boXle informa2on.
• Data in process of being compiled as poten2al supplemental intelligence.
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New York County 2012 Drug Prosecu9ons by Drug Type (reflec2ng 11,712 instances of drugs in 10,559 prosecu2ons)
“Benzodiazepines” includes Alprazolam, Clonazepam, Diazepam, etc. “Opioid Analgesics” includes pure & compound versions of Oxycodone, Hydrocodone, Oxymorphone, Morphine, etc. (excludes Methadone). 33
Oxycodone & Oxycodone Compounds Arrest Loca9ons Reflec9ng 160 Prosecu9ons in Three Upper Manha@an Precincts
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Rx Crimes
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• Central repository for Rx-‐related Robberies/Burglaries, direct LEA access to police reports.
• Fill cross-‐border/interagency sharing gap.
• Allow proac2ve analysis: — Emerging crime paXerns
(e.g., through the roof) — Security alerts — Sources of drugs — Targeted drugs
NEW YORK POLICE DEPARTMENT RX DRUG INITIATIVES
Edward Carrasco, Deputy Inspector
Office of Management Analysis and Planning
New York Police Department
NYPD Rx Drug Ini9a9ves
Emphasis on Community Engagement
• Partnership with schools
• Pharmacy Crimes Reduc2on Ini2a2ve
• Other awareness programs
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PUBLIC HEALTH & PUBLIC SAFETY PARTNERSHIPS
Laurence Busching, First Deputy Criminal Jus2ce Coordinator
New York City Office of the Mayor
Challenges & Conclusions • Legality of prescrip2on drugs • Complexi2es of regula2on
• Data availability/data silos • Terminology across fields
• Addressing misinforma2on
• Developing collabora2ve approaches
Common Goal -‐ Reduce prescrip+on drug abuse and the associated public health and public safety consequences.
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