Goal 4 Opioid Response Work plan – Data Workgroup Updates July 18, 2019

Goal of the Workgroup: Use data and information to detect opioid misuse, monitor morbidity and mortality and evaluate interventions.

Goal 4 Workgroup relaunched on March 26th, and is meeting quarterly to: • share data resources • communicate and coordinate data activities related to the opioid crisis • identify data needs and gaps • discuss and address data challenges related to data access, data analysis, interpretation and reporting • review/align the opioid response plan data strategies and activities • review/align/update the opioid plan metrics

Workgroup met on June 26th and reviewed and updated the current Goal 4 Work Plan, including the status of activities. Goal 4 strategies were modified slightly to reflect a more comprehensive array of data sources. Activities were updated to reflect data activities going on locally, regionally, at state agencies, at UW Alcohol and Drug Abuse Institute, in tribal communities, and at tribal epidemiology centers. Feedback from meeting is being incorporated and a revised draft of the Work Plan will be shared with workgroup participants for review before finalizing by the end of August. Revised strategies include:

• 4.1 Improve opioid and opioid-related data quality, timeliness, completeness, access and functionality • 4.2 Public Health and Healthcare Surveillance – using data sources to track the opioid crisis • 4.3 Monitor progress towards goals and strategies and evaluate the effectiveness of interventions • 4.4 Decision support and dissemination of data and reports

One concern raised was expansion of data activities to include drugs beyond opioids. Group acknowledged some data activities are expanding, for example inclusion of psychostimulant deaths, but opted to keep focus predominantly on opioid-related data activity. Next steps once work plan is finalized:

• Develop a schedule of all data sources showing when data is targeted for updates • Revisit opioid response plan metrics and consider modifying • Identification of data sources/activities group would like to learn more about

Staffing the Goal 4 Workgroup is a group of largely state agency staff involved in data collection, analysis and reporting from state databases with information related to the opioid crisis. The next meeting of the Goal 4 Workgroup will be on September 25th from 10-12 am in TC3 Room 265 at Dept. of Health. There will also be a webinar option for people to attend remotely. People not on the Goal 4 workgroup mailing list who wish to be added can send an email to Ramona Nelson at Ramona.nelson@doh.wa.gov Questions about Goal 4 work can be sent to Kris Shera kris.shera@hca.wa.gov or Cathy Wasserman cathy.wasserman@doh.wa.gov

OPIOID RESPONSE PLAN:

DATA WORKGROUP UPDATE

July 18, 2019

Goal 4 Opioid Response Plan| 2

Drug Overdose Deaths, WA residents, 2000-2018*

0

2

4

6

8

10

12

14

16

2000 2002 2004 2006 2008 2010 2012 2014 2016 2018*

Age

-Ad

just

ed R

ate

(p

er 1

00

,00

0)

Any Drug All Opioid Psychostimulants

449

Source: DOH death certificates *preliminary

1136

710# of deaths

Goal 4 Opioid Response Plan| 3

Opioid-related Overdose Deaths, WA residents, 2000-2018*

0

2

4

6

8

10

12

14

16

2000 2002 2004 2006 2008 2010 2012 2014 2016 2018*

Age

-Ad

just

ed R

ate

(p

er 1

00

,00

0)

All Opioid Heroin

Synthetic Opioid (not methadone) Prescription Opioid (Non-Fentanyl)

314

291

213

Fentanyl

Source: DOH death certificates*preliminary

710

# of deaths

Goal 4 Opioid Response Plan| 4

Overdose Deaths by Drug Type, WA residents (2017, 2018*, 2019*)

(as of July 15, 2019)

1163

739

306 342

142

390

1136

710

314 291213

449373

251

112 82 98157

0

200

400

600

800

1000

1200

1400

Any Drug Any Opioid Heroin Rx_Opioid (not

fentanyl)

Synthetic Opioid

(not methadone)

Psycho-Stimulant

Nu

mb

er

of D

ea

ths

2017

2018*

2019*

Source: DOH death certificates* Preliminary

Goal 4 Opioid Response Plan| 5

SUDORS Data

State Unintentional Drug Overdose Reporting System

13 counties – about 75% of overdose deaths in state

Information from medical examiners and toxicology lab

Provides context and circumstances of death

Analyzing first year of data, deaths July 2017 – June 2018

Goal 4 Opioid Response Plan| 6

Naloxone Distribution and OD Reversals

Collecting data on naloxone kits paid for by HCA/DOH

Distribution to emergency personnel, agency professionals and lay individuals

Distribution of naloxone kits doubled from 2017 to 2018

More than 3,200 overdose reversals reported by syringe service program clients in 2018

Goal 4 Opioid Response Plan| 7

Overdose deaths are the tip of the

iceberg.Deaths

739

Opioid Overdose Hospitalizations

1,615

Persons 12+ years who misused pain-relievers in

the past year324,000

Adults on Medicaid needed treatment

medication for Opioid Use51,615

2017 data

Drug Overdose Hospitalizations, WA 2000-2017

76.7

20.2

4.7

15.5

0

10

20

30

40

50

60

70

80

90

100

2000 2002 2004 2006 2008 2010 2012 2014 2016

Ag

e-A

dju

ste

d R

ate

(p

er

10

0,0

00

)

Any Drug All Opioid Heroin Non-Heroin Opioid

Source: DOH CHARS

Goal 4 Opioid Response Plan|8

ICD-9-CM ICD-10-CM

Goal 4 Opioid Response Plan| 9

New Reports

Goal 4 Opioid Response Plan| 10

Adult Medicaid Patients Who Need and are Receiving Treatment Medications for Opioid Use

Goal 4 Opioid Response Plan| 11

New Report

https://www.dshs.wa.gov/node/31072/

1.2.A.i: Decrease the rate of Opioid overdose deaths from 9.8 per 100,000 in 2015 to 9.0 in 2020

Current pain killer use by 8th, 10th, 12th graders

Source: WA State Healthy Youth Survey

Goal 4 Opioid Response Plan| 13

Neonatal Abstinence Syndrome, WA 2000–2017

Source: DOH Comprehensive Hospital Abstract Reporting System

Note: Includes infants born to mothers receiving appropriate treatment for drug use, receiving prescriptions for other

health conditions, or misusing drugs. Use of opioids, benzodiazepines, antidepressants, barbiturates and/or alcohol can

result in infant drug withdrawal. Excludes infants born with NAS after release from birth hospitalization.

Definition: 2000-Q32015 ICD9CM diagnosis code 779.5; Q42015-2016 ICD10CM diagnosis code P96.1

0

2

4

6

8

10

12

2000 2002 2004 2006 2008 2010 2012 2014 2016

Rate

per

1,0

00 h

ospital liv

e b

irth

s

Birth Year

n=727

ICD-10-CMICD-9-CM

Goal 4 Opioid Response Plan| 14

Patients with Any Opioid Prescription

Goal 4 Opioid Response Plan| 15

Controlled Substance Prescriptions Dispensed and Queries, Washington PMP

Goal 4 Opioid Response Plan| 16

Dashboards – Data Visualizations

Taking Action to End the Opioid Crisis (Results Washington)o Opioid-related overdose death (trend)

o Rate of patients receiving an opioid prescription (trend)

o Adult Medicaid patients who need and receive MAT for opioid use

o https://results.wa.gov/special-projects/taking-action-end-opioid-crisis

Overdose Deaths and Hospitalizationso Overdose death & hospitalization rates by county, ACH, drug type, trend

o Tabular death and hospitalization counts

o https://www.doh.wa.gov/DataandStatisticalReports/HealthDataVisualization/OpioidDashboards

Controlled Substance Prescriptionso Patients with any opioid prescription by county, ACH, quarter, trend

o Patients with chronic opioid prescriptions

o Patients with high dose opioid prescriptions

o Patients with concurrent opioid and sedative prescriptions

o Days’ supply for patients with new opioid prescription

o Patients with new chronic opioid prescription

Goal 4 Opioid Response Plan| 17

Dashboards – Data Visualizations

Healthy Youth Surveyo Fact sheet on current substance use and trends by grade, county, gender

o Fact sheet on polysubstance use

o Fact sheet on prescription medication use

o Ability to cross tabulate two variables – Q by Q analysis

o www.askhys.net

Accountable Community of Health Opioid Project Monitoringo Seven indicators of treatment initiation, retention, and provider capacity

for Medicaid population by ACH

o https://fortress.wa.gov/t/51/views/OUDTreatment/Dashboard?:isGuestRedirectFromVizportal=y&:embed=y

Washington State Substance Use Data & Resourceso Deaths, treatment admissions, crime lab cases, legal wholesale distribution

of opioids to hospitals and pharmacies

o Statewide and King County data

o http://adai.uw.edu/wadata/index.htm

Goal 4 Opioid Response Plan| 18

State Opioid Response Plan Metrics

Overall Health Outcomes Frequency

Opioid overdose death rate Quarterly

Prescription opioid overdose death rate Quarterly

Heroin overdose death rate Quarterly

Percent of 10th graders using pain killers to get high Biannually

Infants born with Neonatal Abstinence Syndrome Quarterly

Goal 1 - Prevent Opioid Misuse and Abuse

Patients on high-dose chronic opioid therapy > 90 mg MED Quarterly

New opioid users who become chronic users Quarterly

Chronic opioid users with concurrent sedative use Quarterly

Days of opioids supplied to new users Quarterly

Goal 2 - Treat Opioid Dependence

Buprenorphine recipients per 1000 residents from providers approved to prescribe for addiction TBD

Percent of Medicaid clients with an opioid use disorder receiving medication assisted treatment Annually

Goal 3 - Prevent Deaths from Overdose

Naloxone kits distributed by syringe service provider programs Quarterly

Number of opioid overdose reversals reported by syringe service provider programs

Quarterly

Goal 4 Opioid Response Plan| 19

Workgroup Update

Meeting quarterly

Reviewed and updated Goal 4 Work plan

Include status updates on activities in revised plan

Feedback being incorporated; finalize by end of August

Next steps

o Develop schedule showing targets for data updates

o Revisit opioid response plan metrics and update

o Identify data sources/activities group wants to learn more about

Goal 4 Opioid Response Plan| 20

Goal 4: Use data and information to detect opioid misuse, monitor morbidity and mortality and evaluate interventions

Improve opioid and opioid-related data quality, timeliness, completeness, access and functionality

Public health and healthcare surveillance – using data sources to track the opioid crisis

Monitor progress towards goals and strategies, and evaluate the effectiveness of interventions

Decision support and dissemination of data and reports

Goal 4 Opioid Response Plan| 21

Next meeting:

September 25th, 10-12 am, TC3, Room 265

Join by webinar -

https://global.gotomeeting.com/join/482485949

United States: +1 (571) 317-3122Access Code: 482-485-949

Goal 4 Opioid Response Plan| 22

Contact

Cathy WassermanWashington State Department of Health

360-236-4246

cathy.wasserman@doh.wa.gov

Washington State Department of Health is committed to providing customers with forms

and publications in appropriate alternate formats. Requests can be made by calling

800-525-0127 or by email at civil.rights@doh.wa.gov. TTY users dial 711.