Post on 23-Jun-2020
LEARNINGS FROM THE OPIOID CRISIS
William A Hazel Jr. M.D.
Senior Advisor for Innovation and Community Engagement
Distinguished Visiting Professor of Public Policy
Schar School of Policy and Government
George Mason University
September 21, 2019
G E O R G E M A S O N U N I V E R S I T Y
1999 ESTIMATED
DRUG
OVERDOSE
DEATHS
G E O R G E M A S O N U N I V E R S I T Y
2004 ESTIMATED
DRUG
OVERDOSE
DEATHS
G E O R G E M A S O N U N I V E R S I T Y
2009 ESTIMATED DRUG
OVERDOSE DEATHS
G E O R G E M A S O N U N I V E R S I T Y
2014 ESTIMATED
DRUG
OVERDOSE
DEATHS
G E O R G E M A S O N U N I V E R S I T Y
DRUG ENFORCEMENT AGENCY ARCOS DATABASE
6
G E O R G E M A S O N U N I V E R S I T Y
O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R P L A N N I N G A N D E V A L U A T I O N
12-MONTH DRUG OVERDOSE MORTALITY
(PREDICTED)
24
50000
55000
60000
65000
70000
75000
11
/1/2
01
5
12
/1/2
01
5
1/1
/20
16
2/1/
201
6
3/1
/20
16
4/1
/20
16
5/1
/20
16
6/1/
201
6
7/1
/20
16
8/1
/20
16
9/1
/20
16
10/1
/20
16
11
/1/2
01
6
12
/1/2
01
6
1/1/
201
7
2/1/
201
7
3/1
/20
17
4/1/
201
7
5/1
/20
17
6/1/
201
7
7/1
/20
17
8/1/
201
7
9/1/
201
7
10/1
/20
17
11
/1/2
01
7
12
/1/2
01
7
1/1
/20
18
2/1/
201
8
3/1
/20
18
4/1
/20
18
5/1
/20
18
6/1/
201
8
7/1/
2018
8/1/
2018
9/1/
2018
10/1
/20
18
11/1
/20
18
12/1
/20
18
1/1/
2019
2/1/
201
9
12
MO
NTH
MO
RTA
LITY
12 MONTHS ENDING IN MONTH
HHS OPIOIDS TEAMGOALReduce US drug overdose mortality
by at least 15% (>10,000 lives)
by January2021
3.4% Decrease Since
Corresponding 12-month Interval
Source: CDC National Vital Statistics System,
reported August2019
G E O R G E M A S O N U N I V E R S I T Y
O F F I C E O F T H E
NUMBER OF INDIVIDUALS RECEIVING PHARMACOTHERAPY FOR OUD
345,443
520,398
46,860
382,867
581,613
450,247
648,864
64,02073,260
0
100000
200000
300000
400000
500000
600000
700000
Methadone NaltrexoneBuprenorphine
2016 2017 2018
921,692
8A S S I S T A N T S E C R E T A R Y F O R P L A N N I N G A N D E V A L U A T I O N
1,028,500
1,172,371
0
200000
400000
600000
800000
1000000
1200000
1400000
2016 2017 2018
Total Number receiving MAT
(all types)
Source: 2018NSDUH
G E O R G E M A S O N U N I V E R S I T Y
G E O R G E M A S O N U N I V E R S I T Y
G E O R G E M A S O N U N I V E R S I T Y
G E O R G E M A S O N U N I V E R S I T Y
12
Source: CDC
G E O R G E M A S O N U N I V E R S I T Y
G E O R G E M A S O N U N I V E R S I T Y
G E O R G E M A S O N U N I V E R S I T Y
G E O R G E M A S O N U N I V E R S I T Y
19.3
33.9
7.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0Neonatal Abstinence Syndrome,
Three-Year Average Annual Rates per 1000 Live Births by Health District: Far Southwest Region, Virginia, 1999-2014
Cumberland Plateau
Lenowisco
Mount Rogers
16
G E O R G E M A S O N U N I V E R S I T Y
VIRGINIA’S RESPONSE
CultureChange
Interdict theIllegalSupply
Initiating and
Maintaining Recovery
Prevention
Addressing the Harm to
Self and Others
G E O R G E M A S O N U N I V E R S I T Y
RISK MITIGATION MEASURES
• Made naloxone available without prescription
• Passed good Samaritan law to encourage reporting of overdoses
• Changed laws regarding new mothers with Substance Use Disorder to keep cases open with Social Services
• Created a framework for needle exchange (two have been approved)
• Supported Therapeutic Court development
• Supported jail treatment programs
G E O R G E M A S O N U N I V E R S I T Y
IMPLEMENTATION OF CDC OPIOID PRESCRIBING GUIDELINES
19
65,975
20,390
268,464
82,420
$168,897.84
$48,576.22
0
50000
100000
150000
200000
250000
300000
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17
Decrease in Opioid Quantity, Cost and Days Supply (FFS)Form Virginia Department of Medical Assistance Services
Days Supply Total Quantity FFS Paid
Implementation of CDC Guidelines
BOM Emergency Opioid Prescribing Regulations
G E O R G E M A S O N U N I V E R S I T Y
Over a million pills NOT dispensed!!
Courtesy of the Virginia Department of Health Professions
IMPACT OF OPIOID PRESCRIBING REGULATIONS IN VIRGINIA
Year Fewer Prescriptions
Shorter Duration Fewer Longer
2015 325,695 143K or 44% of Rx <7days 41K or 13% of Rx for 22-30 days
2018 189,668 123K or 65% of Rx <7days 11K or 6% of Rx for 22-30 days
G E O R G E M A S O N U N I V E R S I T Y
PROVIDING SUD SERVICESTRANSFORMING THE DELIVERY SYSTEM OF MEDICAID SUD SERVICES
Addiction and Recovery Treatment Services (ARTS):Transforming the Delivery System of Medicaid SUD Services
21
ARTSInpatient Detox
Residential Treatment
Partial Hospitalization
Intensive Outpatient Programs
Opioid Treatment Program
Office-Based Opioid
Treatment
Case Management
Peer Recovery Supports
Effective July 1, 2017
Effective April 1, 2017
ARTS creates a fully integrated physical and behavioral health continuum of care
G E O R G E M A S O N U N I V E R S I T Y
VCU Evaluation: Outcomes From First Year of ARTS
More Medicaid members are receiving treatment for all Substance Use Disorders (SUD) and Opioid Use Disorder (OUD)
22
Before ARTS(Apr 2016-Mar 2017)
After ARTS(Apr 2017-Mar 2018)
% Change
↑57%Members with SUD receiving treatment
Members with OUD receiving treatment
15,703 24,615
↑48%10,092 14,917
G E O R G E M A S O N U N I V E R S I T Y
VCU Evaluation: Outcomes From First Ten Months of ARTS
Fewer inpatient hospitalizations related to Substance Use Disorder (SUD) and Opioid Use Disorder (SUD)
23
Before ARTS(Apr 2016-Jan 2017)
After ARTS(Apr 2017-Jan 2018)
% Change
↓4%Hospitalizations Related to SUD
Hospitalizations Related to OUD
3,520
12,650
↓6%2 3,315
13,182
The “Pillars” of Children’s Funding
# of Floors = # of Types of Services Provided
Bricks = Funding Streams Blue= General Funds Red = Federal Funds Orange = Grants
9 Agencies~70 Streams
4 Agencies~50 Streams
2 Agencies~10 Streams
6 Agencies21 Streams
Family Support Services
Early Childhood
Engagement
Child Welfare & Society
Workforce Development
Physical Health
Mental Health
Education
Juvenile Justice
Education
Food & Nutrition Programs
Family Support Services
Workforce Development
Family Support Services
Juvenile Justice
Engagement
Education
Child Welfare & Society
G E O R G E M A S O N U N I V E R S I T YCITY OF RICHMOND
$151
$1,071
$560 $560
($735)
($436)
$8
($1,000)
($800)
($600)
($400)
($200)
$0
$200
$400
$600
$800
$1,000
$1,200
Mo
nth
ly D
iscr
etio
nar
y In
com
e
Discretionary Monthly Income, After Taxes & Expenses
Hourly and Annual Pay
G E O R G E M A S O N U N I V E R S I T Y
• Opioid overdoses are one symptom of Substance Use Disorder
• Substance Use Disorder is a subset of chronic behavioral health conditions
• Treat the symptoms and address the underlying issues. Move upstream.
• Our job is to continually adapt and improve the systems.
• Build systems that are adaptable, scalable, and “interoperable”.
• Think in terms of system alignment – Collective Impact• Set goals
• Create measures – share the data across systems
• Choose mutually reinforcing “evidence informed” activities
• Communicate
• Be sure there is an infrastructure – someone has to be responsible or no one is.
KEY POINTS
Opioid Use Disorder
Prevention PlaybookA PRODUCT OF THE NATIONAL INTEROPERABILITY COLLABORATIVE
Premises of the Playbook
There exists substantial research on and strategies for
treatment of opioid use disorders
There are less well defined and replicated strategies for
prevention
Community-based collaborations are necessary to
address the opioid crisis
Collaborators seek evidence-based practices to
counter opioid use disorders
Elements of the Prevention Playbook
The foundations for collaboration
The explanation of a play
References to evidence supporting the play’s success
The theory of change implied by the play
Links to supporting resources
The foundation of collaborative plays
Multidisciplinary Collaboration
Information sharing across boundaries
Measuring outcomes
Evidence-based strategies11 POTENTIAL PLAYS
Common themes of prevention plays
Reduce the likelihood of an opioid use disorder
Up-front risk reduction (reduce early childhood
adverse experiences)
Alternatives to opioid use in pain mitigation
Reduce the supply of illicit drugs
Common themes of prevention plays
Improve Pain Management practices
Reduce the long-term use of opioids for pain management
Improve and expand prescription drug monitoring programs
Reduce the risk of treatment through education
Make provisions for safe disposal of unused opioids
Encourage the use of non-opioid formulations for pain management
Common themes of prevention plays
Prevent recurrence of an opioid use disorder
Shift policy from arrest and charging to diversion
to drug treatment programs
Provide medication assisted treatment to
inmates
Expand treatment programs after incarceration
HHS Opioid Strategy
https://www.hhs.gov/opioids
O F F I C E O F T H E
35A S S I S T A N T S E C R E T A R Y F O R P L A N N I N G A N D E V A L U A T I O N
• HHS launched its 5-point Opioid Strategy in April 2017
• Provides the overarching framework to leverage HHS expertise and resources of
HHS agencies in a strategic and coordinatedmanor