the opioid scourge - magellan health2017 72,000 drug fatalities 49,000 deaths from opioids in...
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The Opioid Scourge
NOUN: A PERSON OR THING THAT CAUSES GREAT TROUBLE OR SUFFERINGSYNONYMS: AFFLICTION, BANE, CURSE, MENACE, BURDEN, EVIL
DR. CAROLINE CARNEYCHIEF MEDICAL OFFICER
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1,000,000,000,000
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72,00049,000
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$1,000,000,000,000economic toll on the United States
since 2001
https://altarum.org/about/news-and-events/economic-toll-of-opioid-crisis-in-u-s-exceeded-1-trillion-since-2001
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201772,000 drug fatalities
49,000 deaths from opioids In comparison
• 58,000 US soldiers died in the entire Vietnam War
• 37,500 Americans died of motor vehicle accidents in 2016
• 609,640 women, men and children will die from all types of cancer in 2018
• More than 43,000 died due to HIV/AIDS during that epidemic's peak in 1995
• Nearly 40,000 died of guns during the peak of those deaths in 1993
www.CDC.Gov 2017 report of provisional 2017 data National Center for Health Statistics
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1One death
of a mother, father, sister, brother, son, daughter, husband, wife, partner
friend, colleague, neighbor, student, workerto irrevocably change the lives
of those living through all the days that follow
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Today’s talk
• The money
• The mortality
• The why
• The real story
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https://altarum.org/about/news-and-events/economic-toll-of-opioid-crisis-in-u-s-exceeded-1-trillion-since-2001
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This is your brain on drugs
OR WHY IT ISN’T EASY TO BEAT THE OPIOID CRISIS
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Biology/Genes Environment
Genetics Gender
Mental disorders Chaotic home and abuse Parent’s use and attitudes
Peer influences Community attitudes Poor school achievement
Route of administration • Effect of drug •
Early use • Availability • Cost
Children’s earliest
interactions within the family are crucial to their healthy development and
risk for drug use.
Brain Mechanisms
Addiction8
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Neurology 101
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Where addiction happens
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Dopamine, pleasure, dependence, and addiction
17NIDA, 2017
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Neurobiology (continued)
• Over time the opioid receptors in the VTA become less sensitive to dopamine, whether made naturally, or released because of opioids
• More opioids are needed to achieve the same amount of pleasure—even usual pleasurable activities in life no longer feel good
• This is called tolerance—taking the same amount or more to feel the same effect
• Dependence—physiologic adaptation to an opioid, the absence of which leads to withdrawal
• Addiction– the drive to keep taking the drugs—the behaviors and lack of insight
• Craving and withdrawal symptoms reinforce the need to keep taking opioids
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Addiction
is what turns a soccer mom into a
heroin addict
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How do opioids kill?
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https://www.statnews.com/2016/09/29/why-fentanyl-is-deadlier-than-heroin/
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Why Not Seek Help?
• Shame
• Fear of loss
• Social stigma
• Addiction itself
• Opioid withdrawal syndrome
• Access to Medication Assisted Treatments (Suboxone)
• Access to psychosocial care
• The wrong provider
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The wrong provider
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In your own back yard. . .
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In the Western District of Pennsylvania, four defendants – all physicians – were charged in various health care fraud and drug diversion schemes. One scheme involved 32,000 dosage units of buprenorphine.
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Nationally, at least 1,350 of 12,780 buprenorphine doctors have been sanctioned for offenses that include excessive narcotics prescribing, insurance fraud, sexual misconduct and practicing medicine while impaired.
New York Times, November 2013
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The Perils of Predatory Treatment: Rehab Centers
Patient BrokeringPredatory Web Practices Urinalysis Abuse Up-charging and Overutilization Out of Network Schemes KickbacksClinical Misrepresentations Paid Call Center/Directory/Call Aggregation
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Research evidence shows that inpatient rehabilitation is not superior to outpatient programs
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Scenario 1: The opioid deaths forecast for 2027 is 93,613. The forecasted change is 183% since
2015 when it was 33,091. This curve assumes total drug overdoses climb at the same rate they
have for decades. It’s also based on the assumption opioid deaths keep making up roughly the
same percentage of all drug deaths. NATALIA BRONSHTEIN/STAT, 2018
Worst Case Scenario
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HOPE
Oft expectation fails,and most oft there where most it promises
and oft it hit where hope is the coldestand despair most fits
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William Shakespeare, 1833
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Best Case Scenario
Scenario 10: The opioid deaths forecast for 2027 is 21,300. The forecasted change
is -36% since 2015 when it was 33,091. This curve assumes doctors prescribe fewer
opioids, states embrace prescription drug monitoring programs, and there are
reforms to increase treatment access and actual quality of treatment. NATALIA
BRONSHTEIN/STAT, 2018
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Medication Assisted Therapy (MAT)
• Evidence-based treatment for opioid addiction
• Suboxone, Vivitrol and Methadone
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Prevention: It makes (dollars) and sense
• Benefit-per-dollar cost ratios for evidence-based interventions range from small returns per dollar invested to more than $65 every dollar invested
• Dose and duration limits
• Education on the treatment of acute and chronic pain
• Licensing pain treatment and addiction centers
• Creating policy to prevent payment for predatory treatment practices
• To understand what addiction really is—a brain disease complicated by the social structures in which it occurs
• Seek integration of behavioral and physical health services with addictions—create the team of providers
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Monitoring the Future national survey results on drug use: 1975-2013: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.
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Addiction is a chronic disease
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Google Blocks Predatory Drug Rehabs from Buying
Anymore Ads
The opioid addiction epidemic in America, which killed more
than 53,000 people in 2016, has fueled the drug treatment
industry's growth, with rehabs and drug treatment facilities
popping up all over the country. But the $35 billion treatment
industry is plagued with untrustworthy facilities that have
learned how to game Google search results. Many drug
treatment centers have mastered SEO practices and buy ad
words on Google to make sure their business appears first
when an addict, or desperate family member, types "drug
treatment center" or "rehab" into the search bar, doctors and
public health experts say.
https://www.inc.com/will-yakowicz/google-restricts-ad-sales-to-drug-treatment-rehab.html
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Tenets of treatment
• The best care occurs in the least restrictive environment necessary
• The best care occurs in the community in which the patient lives
• The best care occurs when the patient and their family system are actively engaged and thoroughly informed about all aspects of their care, and are as involved as possible
• The best care occurs when the treatment team actively partners with the health plan and health system, including primary care, specialty care, and behavioral health providers
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What’s ahead?• Naloxone distribution
• (More) prescribing limitations
• Needle exchange programs
• Screening programs for Hep C, HIV/AIDS
• Precision medicine for prescribing
• Coverage of medications for Hepatitis C and HIV/AIDS
• Policy decisions that promote access to quality care
• Policy decision to prevent predatory providers
• What is the role of law enforcement? Public health?
• How do privacy rules affect identification and treatment?
• What is the role of education?
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The Real Story
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1One death
of a mother, father, sister, brother, son, daughter, husband, wife, partner
friend, colleague, neighbor, student, workerto irrevocably change the lives
of those living through all the days that follow