stepping up to take on the opioid epidemic cheac annual ... · california health care foundation 8...

1www.chcf.orgCalifornia Health Care Foundation 1www.chcf.orgCalifornia Health Care Foundation

Stepping Up to Take On the Opioid Epidemic

Kelly Pfeifer, MDOctober 18, 2018 CHEAC Annual Meeting


Presenters

John Connolly, PhD Kelly Pfeifer, MD Carmen Nevarez, MD, MPH

3www.chcf.orgCalifornia Health Care Foundation

STAT Special Report: 52 Weeks, 52 Faces Obituaries Narrate Lives Lost to the Opioid Epidemic

More people die from alcohol and tobacco use, but neither is likely to kill you tonight.


California statewide opioid strategy

PREVENTnew starts through safer pain prescribing

MANAGEpain safely: work with

patients to find safer regimens

TREATaddiction effectively with medications, at all points in the health care system

STOPdeaths through harm reduction (naloxone,

needle exchange)


MANAGEPREVENTCalifornia is making progress

Source: www.cdph.ca.gov/opioiddashboard

High-dose prescribingTotal opioid prescribing(morphine mg equivalents)

Patients using5+ prescribers/pharmacies Use of benzos and opioids

NA

6www.chcf.orgCalifornia Health Care Foundation 6www.chcf.orgCalifornia Health Care FoundationSource: www.cdph.ca.gov/opioiddashboard

Rising buprenorphine prescribing

However, access to SUD treatment still not adequate to meet demand.

Dropping overall opioid OD deaths

Rising heroin and fentanyl OD deaths

TREAT STOP DEATHSCalifornia is making progress, but we still have work to do


“Kelly Coltrain, 27, of Austin, was found dead in her cell in Nevada's Mineral County Jail on July 23, 2017, after suffering a seizure related to drug use . . .”

“Coltrain was a heroin user since 2008 and had been jailed because of traffic violations . . .”

People DO die from withdrawal, MAT is lifesaving


Deaths won’t stop until treatment is easier to get than street drugs

Brain in a tempest: day-to-day survival

Impact on long-term overdose death rate (in large real-world studies)

MAT stabilizes brain chemistry: can focus on recovery

Sordo et al., Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies, BMJ 2017; 357;j1550; Larochelle, et al. Ann Intern Med. 2018;169(3):137-145; DOI: 10.7326/M17-3107

MethadoneBuprenorphine (Suboxone)Naltrexone (Vivitrol)

Drug-free (detox)

➢ Cuts death by 67%➢ Cuts death rates by 50%➢ Long-term large trials: no

impact on death rate➢ 2-3x OD death rates


Diabetes vs. AddictionTreatment

Custody of children

Freedom (probation)

Housing

Family

Work

Identity

No Yes

No

No

No

No

Yes

Yes

Yes

YesNo

Yes

No Yes

You Make a Mistake: what could you lose?


Vision: MAT at all points of care in the health system

EDs, hospitals, primary care, mental health, residential treatment, jails….


Buprenorphine prescribing rates nearly doubled in coalition counties

CHCF launched local coalitions and pulled them together into a statewide network, now 40 counties strong.

Greater drops in prescribing rates in coalition counties

2015

2018


Smart Care California: leveraging power of purchasers and plans.

0% 20% 40% 60% 80%

Limit new starts

Limit concurrent prescriptions for opioidand benzodiazepines

Help providers develop taper plans forpatients on high opioid doses

Health Plan Approaches: PREVENT new starts and MANAGE pain 2017 2018

0% 50% 100%

Develop action plan to meet demand forMAT (buprenorphine)

Support provider education: buprenorphineprescribing

Remove PA for buprenorphine (for addiction)

Offer provider education: co-prescribingnaloxone

Health Plan Approaches: TREAT addiction and STOP deaths 2017 2018


What Can We Learn from Another Epidemic?

Source: Centers for Disease Control, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

US AIDS Deaths, 1981-2007

--- AIDS deaths

Effective medications.Massive effort to increase access.Anti-stigma campaign.


The French Experience: 80% Drop in Deaths

Heroin OD deaths

Methadone treatment

Buprenorphineprescriptions


Additional Resources


California Opioid Overdose Surveillance Dashboard

https://discovery.cdph.ca.gov/CDIC/ODdash/


Understanding addiction: how opioids change the brain

Addiction Neuroscience 101 https://youtu.be/bwZcPlRRcc

stepping up to take on the opioid epidemic cheac annual ... · california health care foundation 8...

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