Addressing the Opioid Epidemic New York State Department ... Presentation Opioids...
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Addressing the Opioid Epidemic New York State Department of Health Kitty Gelberg, Ph.D., MPH Director, Bureau of Occupational Health & Injury Prevention Work presented was supported by 1 NU17CE002742, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Transcript of Addressing the Opioid Epidemic New York State Department ... Presentation Opioids...
Addressing the Opioid EpidemicNew York State Department of Health
Kitty Gelberg, Ph.D., MPHDirector, Bureau of Occupational Health & Injury Prevention
Work presented was supported by 1 NU17CE002742, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
September 20, 2017 2
County of Death due to OpioidsRate per 100,000 Residents
September 20, 2017 3
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September 20, 2017 5
Opioid-related Overdose Deaths vs.
Motor Vehicle Deaths, NYS, 1999-2015
0
500
1000
1500
2000
2500
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Opioid-related Overdose Deaths Motor vehicle-related Injury Deaths
September 20, 2017 6
NYS – Opioid Epidemic
0
500
1000
1500
2000
2500
3000
3500
2010 2011 2012 2013 2014 2015
Nu
mb
er o
f D
eath
s
Year
NYC ROS NYS
September 20, 2017 7
Epidemic #1: Prescription Opioids
0
200
400
600
800
1000
1200
1400
2010 2011 2012 2013 2014 2015
Nu
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eath
s
Year
Number of Prescription Drug Deaths, NYS
NYC Rx ROS Rx NYS Rx
September 20, 2017 8
Epidemic #2: Heroin
0
200
400
600
800
1000
1200
2010 2011 2012 2013 2014 2015
Nu
mb
er o
f D
eath
s
Year
Number of Heroin Deaths, NYS
NYC ROS NYS
September 20, 2017 9
Epidemic #3: Synthetic Drugs
(Fentanyl)
0
100
200
300
400
500
600
700
800
2010 2011 2012 2013 2014 2015
Nu
mb
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eath
s
Year
Number of Synthetic Drug Deaths, NYS
NYC ROS NYS
September 20, 2017 10
Lethal dose of Fentanyl
September 20, 2017 11
Burden on Coroners/Medical Examiners
• Large number of deaths requiring
autopsies
– Time and expense
• Responding to Information Requests
– Law enforcement, NYS, DAs, Press
September 20, 2017 12www.health.ny.gov/Opioids
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Build Local Health Department Capacity
• Funding 4 counties based on opioid burden, size
of county and geographic location
• Erie, Onondaga, Sullivan, Broome
• Identifying strategies to implement through
broad-based County coalitions
September 20, 2017 14
Prescriber Education
• Aims to prevent poisonings, overdoses
and addictions before they occur
– Reduce opioid use in the general population
• Engage providers in improving opioid
prescribing practices
September 20, 2017 15
Opioid-Related Data
• Develop/Distribute County Level Reports
(NYS Legislation)
• Analyze multiple new datasets
• Develop Data Dashboard
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Opioid-Related Data
http://www.health.ny.gov/statistics/opioid/
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Other Factors Influencing Opioid TrendsEvent Implementation Date
Risk Evaluation and Mitigation Strategy (REMS) for long-acting
opioids received FDA approval
July 9, 2012
I-STOP legislation signed by Governor Cuomo (Bill S7637) August 27, 2012
Updates to the Controlled Substance Schedule February 23, 2013
I-STOP Registry Review Mandated August 27, 2013
Opioid Prescriber Education Program September 1, 2013
Electronic Prescribing of all Controlled Substances March 27, 2015
CDC Guideline for Prescribing Opioids for Chronic Pain –
United States – 2016 released
March 15, 2016
Governor Cuomo signs legislation to combat the heroin and
opioid crisis
June 22, 2016
7-day opioid supply limit for opioid naïve patients July 22, 201620
September 20, 2017 21
Community Programs
Law Enforcement
Firefighters
Basic Life Support EMS
School Settings
Corrections & Parole
Pharmacy
A Multi-Systemic Approach to Address
Opioid Overdose
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Drug User Health Hubs
Established 2016
• Outpatient ambulatory care programs for drug users
• Enhance local providers understanding and ability to
provide services to substance
• Provide on-site medically assisted treatment –
buprenorphine.
• Prevent overdoses; provide care post overdose.
• Law Enforcement Assisted Diversion (LEAD): Low level
offenders are diverted to SEP for care services instead
of being arrested.
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Drug User Health Hubs Core Elements
Syringes Buprenorphine Naloxone Hepatitis C Care
September 20, 2017 24
Drug User Health Hubs
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What is Naloxone?
• Naloxone is an
emergency medicine
that can reverse an
opioid overdose.
September 20, 2017 26October 28, 2015
0
5,000
10,000
15,000
20,000
25,000
2014Q4
2015Q1
2015Q2
2015Q3
2015Q4
2016Q1
2016Q2
2016Q3
Overdose Responders Trained: Oct 1, 2014-Sept 30, 2016
Community Responders
School
EMS
Fire Fighters
Law Enforcement 16,045
2,622
3,532
3,563
82,922
8,358
11,202
15,677
8,651
12,724
108,684TOTAL
Note: Data reported by registered programs.
21,411
16,609
14,142
September 20, 2017 27
Source: NYSDOH, AIDS Institute and Bureau of EMS and Trauma SystemsNote: Data as of June 2017. EMS totals represent only naloxone encounters that were reported in Regional Medical Control Data for Suffolk County, or electronically for other counties; therefore, the actual numbers of events may have been higher. Law enforcement totals do not yet comprehensively include reports from law enforcement agencies in New York City and Nassau County. Law enforcement and COOP program totals represent only naloxone administration reports submitted by law enforcement and registered COOP programs to the NYSDOH AIDS Institute. The actual numbers of naloxone administration events may have been higher.
12,659
11,033
968 658
17,307
14,595
1,575 1,137
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Total EMS Law Enforcement Community opioidoverdose prevention
(COOP) programs
2015 2016
Total Naloxone Administration for NYS, by
Responder Type
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Rationale for Creating the Naloxone Co-payment Assistance
Program (N-CAP)
• Increasing pharmacy access will allow more naloxone to get into the hands of people who
need it:
State resources can be
devoted to covering naloxone
for individuals not eligible for N-
CAP
• Uninsured;
• Individuals using it in the
line of duty;
• Vulnerable individuals:
• individuals being
released from prison;
• syringe exchange
program participants.
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Information will be
available at pharmacies,
registered programs,
homeless shelters,
LGBT centers
Getting the Word Out
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To find the nearest participating pharmacy or registered program,
please visit:
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Syndromic Surveillance
• Working to use Emergency Department real-time data to identify unusual clusters of overdoses
• Planning use of the syndrome
– Alert community partners to enhanced overdose risk
– Identify communities needing increased training, access to naloxone/buprenorphine
September 20, 2017 33
Also provided with:• Observed # vs.
Expected # for each zip code
• Details on each case including hospital, day, age, sex and chief complaint
SatScanresults provided to program
September 20, 2017 34
QUESTIONS?
Kitty Gelberg, Ph.D., MPH
518-402-7900
