the burden of opioid use/misuse in pima county · 2017-09-19 · we all pay for substance misuse...

TheBurdenofOpioidUse/MisuseinPimaCounty

FranciscoGarcía,MD,MPHAssistantCountyAdministrator&ChiefMedicalOfficer19July2017

Health Department Video

https://www.youtube.com/watch?v=RF9iN8gPtKo

AHealthyPimaCounty.Everyone.Everywhere.Everyday.

Whatimpactshealth?

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Howdoyougetresults?

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CommunityHealthNeedsAssessment20154


FrameworkforPublicHealthAction

Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health

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OpioidUseinPimaCounty

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BehavioralHealthDisorders7

Source:ArizonaDepartmentofHealthServices,BureauofEpidemiologyandDiseaseControlServicesNote:includesfirstlisteddiagnosesonly


Opioid-RelatedHospitalEncounters,2008-2016

Since2008,therehasbeenanearlytwo-foldincreaseinnumberofEDvisitsandin-patienthospitalstaysrelatedtoopioidmisuse

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Source:PimaCounty,HospitalDischargeDatabase


SubstanceUseRelatedEmergencyDepartmentVisits

SignificantincreaseinthenumberofsubstancemisuserelatedEDvisitsacrossage-groupsfrom20to70years

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AZHospitalDischargeDatabase


SubstanceUseRelatedIn-patient Hospitalizations

• Significantincreaseinthenumberofsubstancemisuserelatedhospitalizationsacrossage-groupsfrom20to75years

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Opiod-RelatedEDVisitRates/1,000PopulationbyPrimaryCareArea,2016

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Opiod-RelatedInpatientEncounterRates/1,000PopulationbyPrimaryCareArea,2016

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Opiod-Related,CombinedED&IPEncounterRates/1,000PopulationbyPrimaryCareArea,2016

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• 87%ofopioidrelatedEDvisitscomefrom10PCAs

• 37%ofopioidrelatedinpatientvisitscomefromjust2PCAs


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OpioidRelatedHospitalizationbyAgeandEthnicity,2008,11&15



OpioidRelatedEDEncountersbyHospital,2010&2016

OpioidrelatedEDencountershaveincreasedfornearlyeveryhospitalinPimaCounty


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Opioids,NegativeHealthImpacts


OverdoseDeathsinPimaCounty,2016

•Overdoseaccountedfor263deaths(upfrom210in2011)•Male(66%)v.female(34%)•Singledrug(51%)v.multi-drug(49%)•Overdoseisthecause

•89%(233)accidentaldeaths•8%(21)suicidedeaths•3%(9)undeterminedcauseofdeath

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PimaCountyOverdoseDeathsbyAge-Group,2016

2016 Medical Examiner Report


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PimaCountyOverdoseDeathsbyDrug,2016

2016 Medical Examiner Report2016 Medical

Examiner Report


PimaCountyOverdoseDeathsbyMisusedSubstanceCategory,2016


Weallpayforsubstancemisuseandaddiction,2016

HospitalCareSetting 2016TotalCharges 2016PayerSource

EmergencyDepartment

$24.8M($10M morethan2010)

63% AHCCCS11%Medicare9%Commercial10%Other7%Self-pay

Inpatient $229.4M($76Mmore)

48%AHCCCS21% Medicare13%Commercial16%Other3%Self-pay

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TFDOverdose-RelatedCallResponses,2015to2017Q2

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Source:TFD

20151373

20161203


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YouthSubstanceAbuse,PimaCounty


YouthSubstanceUse,PimaCounty

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YouthOpioidUse

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CostsofYouthOpioidUse26

Sources:ADHS,hospitaldischargedata,2010-2015PimaCountyMedicalExaminer,2015


PreventingSubstanceAbuse•YouthandFamily

• Healthyhomelife• Consistentparentalexpectations• Drugfreefriends• Healthyhabits• Highself-esteem• Havefun

•MedicalCommunity• Clinicianawareness• MedicallyAssistedTherapycapacity

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BuildingBlockstoPreventSubstanceAbuse•Neighborhood

• Cleanstreets• Well-litareas• Safeoutdoorspaces• Neighborhoodconnections

•Schools• Highqualityteachersandmentors• Encourageschoolattendance• Provideextracurricularactivities

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OpioidUseAmongPregnantWomeninPimaCounty


NumberofPregnantWomenUsingOpioids,PimaCounty

0

50

100

150

200

250

2010 2011 2012 2013 2014 2015

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1in10WomenWhoUseOpioidsArePregnant

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

2010 2011 2012 2013 2014 2015

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MostPregnantWomenUsingOpioidsinPregnancyare20to30

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PregnantOpioidUserHospitalizationsbyAge-groupandYear

Pregnant opioid users are not just increasing in number, they are also getting younger?


OpioidUseRelatedHospitalizationsAmongPregnantWomen,PimaCounty2010-2015

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ED&Hospital

ED&Hosp(%) EDOnly

EDOnly(%) Hosp Only

Hosp Only(%)

AgeGroup15-19 38 3.5 16 1.5 22 2.020-24 365 34.0 127 11.8 238 22.225-29 381 35.5 113 10.5 268 25.030-34 208 19.4 54 5.0 154 14.335-39 67 6.2 26 2.4 58 5.440-44 14 1.3 7 0.7 7 0.745-49 1 0.1 0 0 1 0.1Total 1680 100.0 343 31.9 748 69.6


ProfileofOpioidRelatedHospital&EDVisitsPregnantWomen,PimaCounty2015

•Nopregnantopiod overdosedeaths•Racial/EthnicBreakdown

NHWhite 51% AmInd 5%Hispanic 37% Asian 0%Black/Af Amer 4% Other 3%

•Medicare/Governmentpayer89%vPrivatepayer11%

•AverageHospitalCharges:$12,952/episode•1/3pregnantwomeninPCADCareopioidinvolvedandonMAT

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PreventingSubstanceAmongPregnantWomen

• Individual• Fosteringresilience• Peersupport

•HealthCareSystems• Opioidprescribingguidelines• PrescriptionMonitoringProgram• MedicallyAssistedTherapy• Correctionalcare

•Community• Poverty• Economicopportunity• Housing• Supportiveservices


OpioidUseAmongSeniorsinPimaCounty

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OpioidUseRelatedHospitalizationsAmongSeniors,PimaCounty2015

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ED&Hospital

ED&Hosp(%) EDOnly

EDOnly(%) Hosp Only

Hosp Only(%)

AgeGroup60-64 496 29.5 162 9.6 334 19.965-69 392 23.3 114 6.8 278 16.570-74 312 18.6 61 3.6 251 14.975-79 184 11.0 43 2.6 141 8.480+ 296 17.6 65 3.9 231 13.8Total 1680 100.0 445 26.5 1235 73.5

Deaths 24 Attempt Suicide 30


ProfileofOpioidHospitalizedSeniors,PimaCounty2015

•Female57.7%vMale42.3%

•Racial/EthnicBreakdownNHWhite 77% AmInd 1.4%Hispanic 17% Asian 0.5%Black/AfAmer 3.4% Other 0.7%

•Medicare/Governmentpayer81.3%vPrivatepayer18.7%

•AverageHospitalStay:123hours(5.1days)•PrescriptionDrug97%

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PimaCountyOverdoseDeathsbyAge-Group,2015

2015 Medical Examiner Report


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PreventingSubstanceAbuseAmongElders

• Individual• Awareness/PCOABeMedSmart• Medicationsecurity• Medicationdisposal• Peersupport

•Clinician• Opioidprescribingguidelines• PrescriptionMonitoringProgram• Druginteractionawareness• Polypharmacy

•Community• Combatingisolation• Supportiveservices


TheAZRx(PMP)PrescriptionMonitoringProgram


ControlledSubstancesPrescriptionMonitoringProgram

•Arizona’s48thLegislaturepassedH.B.2136

•SignedbytheGovernoronJuly2,2007,effectiveonSeptember19,2007.

•https://pharmacy.az.govunderthe“RxMonitoringWebsite”

https://pharmacy.az.gov/


SampleReportCard


SampleReportCard#2


HealthCareSystemsCalltoAction

• ProvidePatienteducationtrainingandmaterialsforprescribersandpharmacists.• EncouragethatHealthCareProfessionalsregisterandimplement(PMP)ControlledSubstancesPrescriptionMonitoringProgram.

• GotothePMPAWARxEloginpagehttps://Arizona.pmpaware.net/login

• ForsupportcontactRaulMunoz,ProramCoordinator-CommunityEngagementPhone:(520)[email protected]

https://arizona.pmpaware.net/login


§ 18-monthpilotprojectformotherswithchildrenunder18§ Partnershipbetweenthecountyandfiveorganizations§ ComprehensiveprogrammodelbuiltaroundtheGettingAhead:

§ ExtendedcoachingsupportafterGettingAhead§ Health-relatedcurriculumandconnectiontoresources§ Anefforttocreatechangeatthesystemslevel

§ Momsasexpert,empoweredadvocatesoftheircommunity§ Educatingandengagingthosewhoservepeopleinpoverty


MacArthurFoundationfundedinitiativetosafelyreduceover-incarcerationbyaddressingracial/ethnicdisparities

• Datadrivendecisionmakingcombinedwithevidence-basedpracticestoinformpolicychange• Goal:Reduceaveragedailyjailpopulationfrom2,136in2014to1,574anda$2M/yearsavings• PretrialServices:

• Riskscreeningofallmisdemeanordefendants• Behavioral/healthscreeningandlinkagetotreatment• Enhancepretrialsupervisionofbehavioralhealthpatients

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Pay-for-Success(SocialInvestmentBond)Project

• FundedbyHUD&DOJtodevelopnewmodelsoffinancingtoexpandpermanentsupportivehousingforreentrypopulations

• HousingFirstwithForensicAssertiveCommunityTreatment

• TargetPopulation• Homelessindividuals• Incarceratedmorethantwiceayear• Behavioralhealthdiagnosed

• OutcomeMetrics• Social:CriminalJustice,Housing,JobReadiness,Costs• Health:HealthInsuranceEnrollment,Beh health,EDvisits,PCP

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OpioidUseinPimaCounty

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FrameworkforPublicHealthAction

Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health

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ContactInformationFranciscoGarcía,MD,MPHAssistantCountyAdministrator&ChiefMedicalOfficerPimaCounty130WCongressSt,10th FloorTucson,[email protected](520)724-7931

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mailto:[email protected]


PimaCountyHealthDepartmentMission

Toensurethehealth,safety,andwell-beingofourcommunitythroughleadership,collaboration,andeducation.

VisionAHealthyPimaCounty:Everyone.Everywhere.Everyday.

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Health Department Video

https://www.youtube.com/watch?v=RF9iN8gPtKo

the burden of opioid use/misuse in pima county · 2017-09-19 · we all pay for substance misuse...

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