1. 1. Education and Advocacy Track Collaboration, Coordination & Data: Three Keys for State Progress Presenters: Laurie Lovedale, MPH, CPS II, Manager, Prescription Drug Abuse Prevention Program, Peer Assistance Services, Inc. Dwight Holton, JD, CEO, Lines for Life E. Douglas Varney, Commissioner, Tennessee Department of Mental Health and Substance Abuse Services Karen Edwards, PhD, Research Director, Tennessee Department of Mental Health and Substance Abuse Services Moderator: Regina M. LaBelle, JD, Chief of Staff, White House Office of National Drug Control Policy (ONDCP), and Member, Rx Summit National Advisory Board
2. 2. Disclosures Laurie Lovedale, MPH, CPS II; Dwight Holton, JD; E. Douglas Varney; Karen Edwards, PhD; and Regina M. LaBelle, JD, have disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.
3. 3. Disclosures All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. The following planners/managers have the following to disclose: Kelly Clark Employment: Publicis Touchpoint Solutions; Consultant: Grunenthal US Robert DuPont Employment: Bensinger, DuPont & Associates-Prescription Drug Research Center Carla Saunders Speakers bureau: Abbott Nutrition
4. 4. Learning Objectives 1. Specify benefits of collaboration and coordination among entities engaged in Rx drug abuse. 2. Describe a method for empowering communities to tailor an effective local response to Rx drug abuse. 3. Explain how data can be used to mobilize the resources needed to combat Rx drug abuse.
5. 5. Collaboration, Coordination and Data: Three Keys for State Progress Laurie Lovedale, MPH, CPS II Manager, Prescription Drug Abuse Prevention Program Peer Assistance Services
6. 6. Disclosure Statement Laurie Lovedale, MPH, CPS II has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
7. 7. Session Objectives Specify benefits of collaboration and coordination among entities engaged in Rx drug abuse. Describe a method for empowering communities to tailor an effective local response to Rx drug abuse. Explain how data can be used to mobilize the resources needed to combat Rx drug abuse.
8. 8. Strategic Planning Process in Colorado 1st NGA Policy Academy CO Team includes representation from CDHS, CDPHE, DPS, DORA, HCPF, AGs Office and Governors Office CO Team identifies focus areas for state strategic plan CO Roundtables 185 experts and stakeholders convene including state health officials, health professionals, academics, professional membership organizations, law enforcement representatives and policymakers Draft of initial recommendations, expanding on major focus areas CO In-State Policy Academy 40 decision-makers and stakeholders reconvene Initial recommendations finalized and timeline established through May 2014 2nd NGA Policy Academy CO Team shares action plan and lessons learned with the six other states participating in the NGA Policy Academy CU School of Pharmacy recommendation to coordinate consortium, house strategic plan, make and track progress
9. 9. How will we do this ?
10. 10. Prescriber and Provider Education Workgroup Agency Co-Chair: Cathy Traugott, HCPF Univ Co-Chair: Lee Newman, MD PDMP Workgroup Agency Co-Chair: Chris Gassen, DORA Univ Co-Chair: Jason Hoppe, DO Safe Disposal Workgroup Agency Co-Chair: Shannon Breitzman, CDPHE Univ Co-Chair: Sunny Linnebur, PharmD Public Awareness Workgroup Agency Co-Chair: Stan Paprocki, OBH Univ Co-Chair: Carol Runyan, PhD Treatment Workgroup Agency Co-Chair: Denise Vincioni, OBH Univ Co-Chair: Paula Riggs, MD Data/Analysis Workgroup Agency Co-Chair: Barbara Gabella, CDPHE Univ Co-Chair: Ingrid Binswanger, MD Coordinating Center CU School of Pharmacy +Coordinating Committee Governor Policy Lead CO Attorney General Substance Abuse Trend & Response Task Force CO Legislature Colorado Consortium for Prescription Drug Abuse Prevention A coordinated, statewide, interuniversity/interagency network LEGEND = New = Existing Subcommittee
11. 11. Prescription Drug Abuse Prevention Program A State Priority Initiative funded by the Colorado Office of Behavioral Health 5-year funding cycle Funded for over 20 years
12. 12. 2010-2015 Program Objectives Increase awareness of the problem Increase availability of medication disposal programs statewide Encourage responsible prescribing practices Encourage patient responsibility Track data and trends
13. 13. Accomplishments of the Colorado Consortium for Prescription Drug Abuse Prevention 1st Year
14. 14. PDMP Work Group HB141283: PDMP Enhancement Bill Mandatory PDMP registration for all CO DEA registered prescribing practitioners & all CO licensed pharmacists Allows PDMPregistered prescribing practitioners & pharmacists to delegate access Allows the PDMP to send Unsolicited Reports (Push Notices) to affected prescribing practitioners and pharmacies As with outofstate prescribing practitioners in the past, it now allows outofstate pharmacists to obtain patient information from the PDMP;
15. 15. Provides Colorado Department of Public Health and Environment access to the PDMP for public health purposes Creates of a PDMP Taskforce to further study the effectiveness of the PDMP.
16. 16. Public Awareness Work Group Statewide social marketing campaign All adult Coloradoans 18+ Pre/post survey Safe Use Safe Storage Safe Disposal Advocacy
17. 17. Safe Disposal Work Group Developed guidelines for safe disposal in Colorado Developed brochure to convey guidelines to public Distributed brochure to major pharmacy chains in Colorado and at multiple community events CDPHE expanded number of safe disposal sites through grantfunded provision of lock boxes to law enforcement agencies Created map of disposal sites
18. 18. Providers Education Work Group Online Training & Education for Providers Developed at the Colorado School of Public Health in the Center for Worker Health & Environment Launched in Fall 2012 Supported by an unrestricted educational grant from Pinnacol Assurance WWW.PAINMANAGEMENTCME.ORG
19. 19. Providers Education Work Group New Prescriber Education Dentists Veterinarians Physicians Dr. Brett Kessler, President, Colorado Dental Association
20. 20. DORA Boards Nursing Medical Pharmacy Dental Nurse Physician Advisory Taskforce (NPATCH)
21. 21. Data Analysis Work Group Created a data inventory Prioritized five indicators from the inventory to track over time Specified a data dashboard
22. 22. Naloxone Work Group Standing Orders Bill Explore integrating EHR with PDMP Expanding public awareness campaign to target certain populations
23. 23. National Rx Drug Abuse Summit: Oregons Regional Summit Agenda to Reduce Abuse, Misuse and Overdose Dwight Holton Chief Executive Officer Lines for Life
24. 24. Dwight Holton has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
25. 25. Lines for Life Team 14 Masters Level Counselors 120 Highly Trained Volunteers 20 Teens on YouthLine Nationally Accredited Suicide Line De-Escalate 98% of calls on LifeLine Trainers of Trainers
26. 26. Lines for Life Crisis Lines Overview
27. 27. The Oregon Epidemic Oregon ranks #1 In Non-Medical Use of Opioids (2010-2011, SAMSHA NSDUH) Over 3 million opioid prescriptions in 2013 (54% of all Rx) (OHA Injury and Violence Prevention Fact Sheet) 1.88 M hydrocodone 1.15 M oxycodone Over 100 million opioid pills every year Population: 3.9 million 25 pills for every man, woman and child
28. 28. Opioid Deaths 46 people die every day (Centers for Disease Control) ~110 Oregonians in 2014 150 Oregonians in 2013 193 in 2011 170 in 2012
29. 29. Source: SAMHSA Treatment Episode Data Set (TEDS), 2000-2010 28,326 37,649 45,882 52,664 60,824 71,048 82,359 98,386 122,185 142,124 157,171 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 20002001200220032004200520062007200820092010 More Than 5-Fold Increase In Treatment Admissions For Prescription Painkillers In the Past Decade 12 10 8 6 4 2 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 *Deaths are those for which poisoning by drugs (illicit, prescription, and over-the-counter) was the underlying cause. Drug OD in the US Have More Than Tripled since 1990 and INCREASES Greater for Women (Five-FOLD) National Vital Statistics System. Drug Overdose Death Rates by State 2008. 100 people die from drug overdoses every day in the US CDC Vital Signs, July 2013. Slide from Presentation of Dr. Nora Volkow, Director, Natl Institute of Drug Abuse, April 22, 2014 National Rx Summit
30. 30. Regional Summit Objectives 1. Decrease pills in circulation 2. Promote PDMP 3. Patient education 4. Change attitudes & perceptions 5. Reduce the volume of unwanted pills 6. Improve & expand access to treatment services
31. 31. Core Strategy Regional summits to develop regional action plans to reduce abuse Include all relevant stakeholders CCO Third party payers Hospitals/systems Treatment providers Prescribers Prevention Public health Law enforcement
32. 32. Prescription Rates Across Oregon County All Opioids Oxycodone HydroC. Benzo+Opiod Statewide 233.8 86.2 174.1 47.1 Malheur 181.1* 29.0* 163.6 36.9 Baker 218.5 58.1 175.0 40.4 Clatsop 270.6 124.6^ 184.2 49.9 Curry 279.1 59.8 238.1^ 63.6 Harney 219.4 83.8 156.1 47.7 Josephine 298.7^ 97.7 231.8 72.4^ Umatilla 204.7 61.6 167.4 30.7* Clackamas 240.7 100.3 170.5 46.3 Multnomah 224.7 89.0 161.4 39.9 *= lowest in Oregon ^= highest in Oregon
33. 33. Regional Summit Agenda State of the state State of the region PDMP data and survey data Highlight Key Initiatives in Oregon Identify barriers to reducing abuse: Better Prescribing Reducing Volume of Unwanted Pills Improving and Expanding Treatment Expanded & Better Use of the PDMP
34. 34. Regional Summit Outcomes Regional Plans to Reduce Misuse, Abuse and Overdose Policy Recommendations to Governor and Legislature Improved patient, provider and system education
35. 35. Regional Survey Instrument Goals Identify existing regional strategies that should be supported Establish a baseline regarding use of evidenced based practices and standards to reduce abuse, misuse and overdose Identify and understand unique regional opportunities Identify and understand unique regional challenges Participants Systems Clinics Public Health Officials Providers
36. 36. Reducing the Pills in Circulation for each: Identify Barriers and Solutions Prescribing Practices Rx Guidelines Expanding use of guidelines Baseline components of effective guidelines Use of the PDMP Expanding use Standard of Care? Other? Reimbursement Strategies/Incentives Rx bias in reimbursement? Reimbursement cap? Other?
37. 37. Reducing the Pills in Circulation (2 of 2) for each: Identify Barriers and Solutions Expanding Use of Non-Opioid Therapies Non-opioid Therapies (movement, yoga, acupuncture) Primary Care Provider education In practice today In medical education Access/availability of providers Reimbursement incentives Moving non-opioid therapies above the line Addressing any reimbursement bias Alternative Pain Clinic Model
38. 38. Improving Treatment and Access to Treatment Improving access to medication assisted therapies Suboxone Reimbursement strategies Improving provider access Expanded certification Hub model Naloxone Co-prescription strategies Law enforcement / first responder access Post Naloxone intervention strategies
39. 39. ORCRM Oregon Coalition for Responsible Use of Meds Dwight Holton CEO Lines for Life 971.244.1371 DwightH@Linesforlife.org
40. 40. Collaboration, Coordination and Data: Three Keys for State Progress Doug Varney, Commissioner Karen Edwards, Ph.D., Research Director Tennessee Department of Mental Health and Substance Abuse Services Tennessee Department of Mental Health and Substance Abuse Services Varney & Edwards, 2/24/2015
41. 41. Disclosure Statements Doug Varney, Commissioner, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services. Karen Edwards, Ph.D., has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods or services. Tennessee Department of Mental Health and Substance Abuse Services 2 Varney & Edwards, 2/24/2015
42. 42. Learning Objectives 1. Specify benefits of collaboration and coordination among entities addressing Rx drug abuse. 2. Describe a method for empowering communities to tailor an effective local response to Rx drug abuse. 3. Explain how data can be used to mobilize the resources needed to combat Rx drug abuse. Tennessee Department of Mental Health and Substance Abuse Services 3 Varney & Edwards, 2/24/2015
43. 43. Gov. Haslam announces Prescription for Success Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 4
44. 44. Building an initiative: Prescription for Success Governor focus on collaboration Public Safety Subcabinet Prescription for Success Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 5
45. 45. Department of Safety and Homeland Security Department of Mental Health and Substance Abuse Services Department of Childrens Services Tennessee Bureau of Investigation Department of Correction Board of Probation and Parole Military Department Department of Health Governors Highway Safety Office (Department of Transportation) Office of Criminal Justice Programs (Department of Finance & Administration) Law Enforcement Training Academy (Department of Commerce & Insurance) Additional Staff Support: Tennessee Criminal Justice Coordinating Council National Governors Association Center for Best Practices The Center for Non-Profit Management PUBLIC SAFETY SUBCABINET WORKING GROUP Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 6
46. 46. PUBLIC SAFETY ACTION PLAN Contains Three Key Initiatives/Focus Areas to Curb Crime and Help Create a Climate for Job Growth in Tennessee Communities. Violent Crimes Repeat Offenders An Atmosphere that Encourages Investment And Job Growth Tennessee Department of Mental Health and Substance Abuse Services 7 Varney & Edwards, 2/24/2015
47. 47. o All prescribers must access the controlled substance database prior to prescribing an opioid or benzodiazepine o Dispensers must check the database if a person tries to obtain a prescription for a controlled substance for fraudulent, illegal, or medically inappropriate purposes o Increases penalties for doctor shopping from a Class A misdemeanor to a Class E felony o Allows data sharing from the prescription monitoring database Prescription Drug Safety Act of 2012 Tennessee Department of Mental Health and Substance Abuse Services 8 Varney & Edwards, 2/24/2015
48. 48. o Neonatal Abstinence Syndrome Working Group o Substance Abuse Data Task Force Agreement to share data Standard definitions Footnote data source Review by data owner before sharing Safety Subcabinet Working Groups Tennessee Department of Mental Health and Substance Abuse Services 9 Varney & Edwards, 2/24/2015
49. 49. Prescription for Success Statewide Strategies to Prevent and Treat the Prescription Drug Abuse Epidemic in Tennessee Prescription For Success Partners Tennessee Department of Health Tennessee Department of Childrens Services Tennessee Department of Correction Tennessee Department of Safety & Homeland Security Tennessee Department of Health Care Finance Administration (TennCare) Tennessee Bureau of Investigation U.S. Department of Justice Drug Enforcement Administration Tennessee Department of Mental Health and Substance Abuse Services 10 Varney & Edwards, 2/24/2015
50. 50. PRESCRIPTION FOR SUCCESS Tennessee Department of Mental Health and Substance Abuse Services 11 7 Goals 1. Decrease the number of Tennesseans that abuse controlled substances. 2. Decrease the number of Tennesseans who overdose on controlled substances. 3. Decrease the amount of controlled substances dispensed in Tennessee. 4. Increase access to drug disposal outlets in Tennessee. 5. Increase access and quality of early intervention, treatment and recovery services. 6. Expand collaborations and coordination among state agencies. 7. Expand collaboration and coordination with other states. 33 Strategies Measures of Success Varney & Edwards, 2/24/2015
51. 51. TELL THE STORY OF PRESCRIPTION DRUG ABUSE IN TENNESSEE Using data to: Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 12
52. 52. Telling the Story of Prescription Drug Abuse in Tennessee Identify the problem Answer questions Track success Tennessee Department of Mental Health and Substance Abuse Services 13 Varney & Edwards, 2/24/2015
53. 53. IDENTIFY THE PROBLEM Use data to: Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 14
54. 54. Drug Overdose 342 391 422 484 660 753 868 963 972 924 929 1,059 1,062 1,094 0 200 400 600 800 1,000 1,200 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Drug overdose deaths in Tennessee: 1999-2012 (Source: Office of Policy, Planning and Assessment, Tennessee Department of Health - Death Certificates) Tennessee Department of Mental Health and Substance Abuse Services 15 Varney & Edwards, 2/24/2015
55. 55. Admissions to Publicly Funded Substance Abuse Treatment TN: Opioids TN: Alcohol US: Opioids Tennessee Department of Mental Health and Substance Abuse Services 16 Varney & Edwards, 2/24/2015
56. 56. Neonatal Abstinence Syndrome Tennessee Department of Mental Health and Substance Abuse Services 17 Varney & Edwards, 2/24/2015
57. 57. ANSWER QUESTIONS Use data to: Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 18
58. 58. How does substance abuse for young adults change over time? How does Tennessee compare to the United States? United States Tennessee *NOTE: Tennessee began disaggregating heroin admissions from prescription opioids in July 2009. Substance abuse treatment admissions among young adults, ages 18-24, by primary substance of abuse: Tennessee and the United States from 2002 to 2011 (Data source: TEDS-A) 28.5% 15.3% 16.8% 4.4% 24.7% 25.8% 0.0% 2.3%* 15.5% 41.4% 14.5% 10.9% 0% 25% 50% 75% 100% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 34.6% 26.0% 7.4% 3.2% 30.3% 29.7% 13.5% 17.6% 2.4% 14.6% 11.9% 8.9% 0% 25% 50% 75% 100% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Tennessee Department of Mental Health and Substance Abuse Services 19 Varney & Edwards, 2/24/2015
59. 59. Where in Tennessee is prescription drug abuse a problem? Percent of TDMHSAS funded treatment admissions by county when prescription opioids are named as a substance of abuse (Data Source: TDMHSAS, 2011-2014) Tennessee Department of Mental Health and Substance Abuse Services 20 Varney & Edwards, 2/24/2015 FY 2011 FY 2014
60. 60. TRACK SUCCESS Use data to: Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 21
61. 61. Cumulative number of high utilization patients* by quarter in the Controlled Substances Monitoring Database (CSMD): CY 2011 to 2014 1,950 2,246 1,785 1,374 2,413 2,218 1,533 1,404 2,515 2,261 1,533 1,278 2,352 1,940 1,335 1,307 0 2,000 4,000 6,000 8,000 10,000 CY2011 CY2012 CY2013 CY2014 CountofHighUtilizationPatients Q1 Q2 Q3 Q4 *Note: Patients filled prescriptions from 5 or more prescribers at 5 or more dispensers within 90 days. Source: Tennessee Department of Health Decrease Doctor Shopping Tennessee Department of Mental Health and Substance Abuse Services 22 Varney & Edwards, 2/24/2015
62. 62. Increase Disposal Boxes Tennessee Department of Mental Health and Substance Abuse Services 23 Varney & Edwards, 2/24/2015 Source: Tennessee Department of Mental Health and Substance Abuse Services January 2012 to December 2014
63. 63. Increase Safe Housing Options for Individuals in Recovery 61 163 0 40 80 120 160 200 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14 Capacity(beds) Monthly capacity of Oxford Houses in Tennessee: July 2013 to December 2014 Tennessee Department of Mental Health and Substance Abuse Services 24 Varney & Edwards, 2/24/2015 Source: Tennessee Department of Mental Health and Substance Abuse Services
64. 64. Increase Access to Recovery Courts Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 25 1,284 1,612 2,057 2,267 2,267 2,542 2,542 - 500 1,000 1,500 2,000 2,500 3,000 Q2 Q3 Q4 Q1 Q2 Q3 Q4 CY2013 CY2014 Capacity Capacity of adult recovery (drug) courts: Q2 CY 2013 to Q4 CY 2014 Source: Tennessee Department of Mental Health and Substance Abuse Services
65. 65. Questions? Prescription for Success: http://tn.gov/mental/prescriptionforsuccess/ For more information contact: Karen Edwards, Ph.D. Karen.Edwards@tn.gov 615-532-3648 Varney & Edwards, 2/24/2015 Tennessee Department of Mental Health and Substance Abuse Services 26
66. 66. Education and Advocacy Track Collaboration, Coordination & Data: Three Keys for State Progress Presenters: Laurie Lovedale, MPH, CPS II, Manager, Prescription Drug Abuse Prevention Program, Peer Assistance Services, Inc. Dwight Holton, JD, CEO, Lines for Life E. Douglas Varney, Commissioner, Tennessee Department of Mental Health and Substance Abuse Services Karen Edwards, PhD, Research Director, Tennessee Department of Mental Health and Substance Abuse Services Moderator: Regina M. LaBelle, JD, Chief of Staff, White House Office of National Drug Control Policy (ONDCP), and Member, Rx Summit National Advisory Board