Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant...

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Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid- Related Deaths

Transcript of Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant...

Page 1: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

Arizona Opioid State Targeted Response GrantTargeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths

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What the Opioid Epidemic is Costing Arizona

2Reaching across Arizona to provide comprehensive quality health care for those in need

Page 3: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

3Reaching across Arizona to provide comprehensive quality health care for those in need

Page 4: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid
Page 5: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

ADHS Dashboard

5Reaching across Arizona to provide comprehensive quality health care for those in need

Figures from 7/11/17 12:42 PM

Page 6: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

6Reaching across Arizona to provide comprehensive quality health care for those in need

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• Criminal Justice population• American Indians• Former users• Veterans• High MEDDs and Polypharm• Trauma, depression, anxiety

High Risk Populations

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Elevated Misuse in MH Population (NSDUH, 2015)

Reaching across Arizona to provide comprehensive quality health care for those in need

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Specifically Those with Depression…

Reaching across Arizona to provide comprehensive quality health care for those in need

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And, Suicidal Thoughts

Reaching across Arizona to provide comprehensive quality health care for those in need

Page 11: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

What is Arizona Doing to Solve the Opioid Crisis?

11Reaching across Arizona to provide comprehensive quality health care for those in need

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Arizona Strategies• Naloxone• Prescribing Practices and Policy Change• Chronic Pain Management• Patient Education• Community-based prevention• Law Enforcement• Access to effective OUD Tx• Recovery Supports

12Reaching across Arizona to provide comprehensive quality health care for those in need

Page 13: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

How Does Opioid STR Fit into the Broader Strategic Plan to Solve the Opioid Crisis?

13Reaching across Arizona to provide comprehensive quality health care for those in need

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SAMHSA Formulary Grant

14Reaching across Arizona to provide comprehensive quality health care for those in need

• States are allocated amount based on prevalence and need

• Arizona receives $12,171,518 each year for 2 years = $24,343,406

• 12th highest award in the nation

Page 15: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

Requirements• No less than 80% on treatment• Access to all FDA approved MAT options**• Needs and capacity assessment• State strategic plan• Activities must begin within 4 months of

award• Can supplement but not supplant

15Reaching across Arizona to provide comprehensive quality health care for those in need

Page 16: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

Prevention• Naloxone for law enforcement – ADHS• GOYFF

o Purchase Rx drop boxeso Rx Drug Toolkit trainings and TAo Older Adults – WISE and Mental Health 1st Aido Marketing of GOYFF’s Prevention, Treatment

and Recovery Locatoro SBIRT screenings

16Reaching across Arizona to provide comprehensive quality health care for those in need

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Treatment• Goal: Improve access to,

participation and retention in comprehensive Medication Assisted Treatment (MAT) services to treat OUD.

17Reaching across Arizona to provide comprehensive quality health care for those in need

Page 18: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

Why MAT?• Most clinically sound and cost-effective way

to treat opioid addiction based on extensive clinical research (NIDA, ASAM and the U.S. Surgeon General).

o Improves treatment retentiono Decreases opioid useo Reduces risk of mortality

• Over 50,000 AHCCCS members with OUD

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Reward Pathway

19Reaching across Arizona to provide comprehensive quality health care for those in need

Page 20: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

Opioid Withdrawal Symptoms• Pupillary dilation• Tachycardia• Diaphoresis• Gooseflesh skin• Runny nose/tearing• Tremor

• Yawning• Anxiety/irritability• Restlessness• Bone/joint aches• GI upset

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Goals of Treatment• Risk reduction vs. complete abstinence• Overarching themes

o 1st stabilize the braino Address the psychological factors behind the

addictiono Pro-social behavioro Emotional and physical healtho Avoid justice involvement

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Treatment of Opioid Use Disorder: Maintenance Pharmacotherapies

• Full agonist therapy with methadone• Partial agonist therapy with buprenorphine• Antagonist therapy with naltrexone

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Solutions• Risk vs benefit• Reality is level of gray• No one size fits all

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Myths of MAT

24Reaching across Arizona to provide comprehensive quality health care for those in need

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More MAT Myths

25Reaching across Arizona to provide comprehensive quality health care for those in need

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Stigma and Access to Healthcare

• How we talk about things impacts the way we think about things and vice versa

• Improved understanding that opioid use disorder is a complex interplay of biology and environment will decrease stigma and increase access to healthcare

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MAT Education and Outreach• Community• Providers• Key Stakeholders• ASU – CABHP

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*Increase Peer Support Services• MAT treatment navigation• MAT treatment retention• Recovery support

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Page 29: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

*Centers of Excellence• 24/7 access • Coordinate intake and assessment• Review all MAT options • Referral to community treatment• Assignment to peer support• Opioid overdose education and Naloxone

access

29Reaching across Arizona to provide comprehensive quality health care for those in need

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*Hospital & ED Discharge Projects• “Hotspot” facilities• MAT options and referrals• Peer support• Opioid overdose education and Naloxone

access• ED-Buprenorphine Initiation Model

30Reaching across Arizona to provide comprehensive quality health care for those in need

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*Diversion and Incarceration Alternative Project• Pre- and Post- booking• Consensus building on model process• Training• Divert to case managers/care coordinators

o Review all MAT options o Navigate to MATo Peer supports

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*MAT Eligible Individuals being Released from Correctional Settings• Early identification prior to release• Review all MAT options• Provide referral• Align peer support for post-release

navigation

32Reaching across Arizona to provide comprehensive quality health care for those in need

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Recovery Supports for Post-Partum Mothers in OUD Tx• DCS: Substance Exposed Newborn Safe

Environment (SENSE) program• Supplement Nurse Visits• Address caregiving stressors that can affect

the mother’s treatment and recovery success

33Reaching across Arizona to provide comprehensive quality health care for those in need

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*OUD Residential/Recovery Homes • Expand services• Provide access to all MAT• Evidence-based practices for psychosocial

therapies

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Medical Community Solutions• “Open, honest discussions….are needed to examine

assumptions about opioid addiction, the historical context of its treatment, and associated ideologies as a way of bridging the divide around MAT.”

• “Patients deserve the opportunity to make a well-informed choice about which path they take to [their] recovery”

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Ask the PCSS-MAT Experts: Addressing Challenging Issues in Addiction Medicine: "Abstinence Based" Treatment Centershttp://www.asam.org/magazine/read/article/2015/04/10/abstinence-based-treatment-centers

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MAT is PART of the Bigger Plan• Naloxone• Prescribing Practices and Policy Change• Chronic Pain Management• Patient Education• Community-based prevention• Law Enforcement• Access to effective OUD Tx• Recovery Supports

36Reaching across Arizona to provide comprehensive quality health care for those in need

Page 37: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

Aligning STR with Medicaid System• Contract and policy being updated to

reflect the exact same MAT activities

• Opening up MAT on the acute side

• Adjusting CAP rates to meet the need

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Page 38: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

So, Now What, Arizona?

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Use What Works!

Page 40: Arizona Opioid State Targeted Response Grant · Arizona Opioid State Targeted Response Grant Targeted Efforts to Reduce Opioid Use Disorders and Opioid-Related Deaths. What the Opioid

Get Off the Train and Push

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Thank [email protected]

41Reaching across Arizona to provide comprehensive quality health care for those in need