Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.”...

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Substance Use in Colorado Presentation to the Colorado Commission on Affordable Health Care Tamara Keeney Policy Analyst April 10, 2017

Transcript of Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.”...

Page 1: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

Substance Use in Colorado

Presentation to the Colorado Commission on Affordable Health Care

Tamara KeeneyPolicy Analyst

April 10, 2017

Page 2: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

1. Overdose deaths in Colorado are rising, driven by an increase in opioid-related deaths.

2. The biggest gaps in treatment are related to an insufficient workforce.

3. A small percentage of spending for substance use disorder is for treatment.

4. Activities in Colorado to increase treatment are underway, but opportunities remain.

Takeaways

2

Page 3: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

Source: CHI analysis of CDC National Vital Statistics System Mortality Data

Page 4: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

Source: CHI analysis of CDC National Vital Statistics System Mortality Data

Page 5: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

Opioids Are Driving the Rise in Overdose Deaths

Source: CDPHE Vital Statistics

Page 6: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

Alcohol is the Most Common Reason for Treatment

2015 Treatment Admissions by Drug

Source: Drug/Alcohol Coordinated Data Systems, Office of Behavioral Health, Colorado Department of Human Services

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Substance Use Care Continuum

Enhancing Health

Primary Prevention

Early Intervention

Treatment

Recovery Support

Source: The Surgeon General’s Report on Alcohol, Drugs and Health (2016).

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Colorado has a shortage of treatment services.

Sources: NSDUH (2015), Jones (2015), Keystone Policy Center analysis of LinkingCare.org (2016)

Coloradans in need of substance use treatment services who receive them.

Page 9: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

Source: Keystone Policy Center analysis of LinkingCare.org

Page 10: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

Source: Keystone Policy Center analysis of LinkingCare.org

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• MAT is an evidence-based approach to treating opioid dependence• Combination of medication plus other social

support services, such as counseling.

• Clinically effective by helping reduce the potential for relapse.

• Better adherence to programs than those without medication.

Medication-Assisted Treatment

Source: Volkow, N. et al (2014)

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Source: SAMHSA treatment locator.

Page 13: Presentation to the Colorado Commission on Affordable ... · Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456462. – April

• Economic burden of substance use (2015)$700 billion/year

Cost To the System: All Substances

Source: NIDA (2015)

Health Care OverallTobacco $130 billion $295 billion Alcohol $125 billion $224 billionIllicit Drugs $11 billion $193 billion

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Cost To the System: Prescription Opioids

Source: Florence et al 2013

Distribution of the Economic Burden of Prescription Opioid Overdose, Abuse and Dependence

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• Treatment of substance use disorders is effective in decreasing medical cost and substance use.

• When savings related to health care are added to savings to other systems, total savings can exceed costs by a ratio of 12:1.

Research on Treatment is Strong

Sources: Walter et al (2005); Mojabai and Zivin (2003) Health Services Research; NIDA (2012)

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• Methadone • Treatment for opioid addiction with methadone

return of $4-5 for every $1 invested.• Buprenorphine

• Treatment group saw overall reduced health care expenditures compared to non-adherent group.

• Found to reduce emergency department utilization, but not hospitalization.

Cost Savings: Medication-Assisted Treatment

Sources: Center for Substance Abuse Treatment (2005); Tkacz (2014); NIDA (2012); Schwarz (2012)

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• 2008: Prescription Drug Monitoring Program (PDMP) goes live

• 2008: Mental Health Parity and Addiction Equity Act

• 2013: Colorado Consortium on Rx Abuse established

• 2015: Naloxone standing orders

• 2016: Comprehensive Addiction and Recovery Act

• 2016: 21st Century CURES

Timeline of Recent Policies

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• SB74Create Medication-Assisted Treatment Pilot Program

• SB146Access to Prescription Drug Monitoring Program

• SB193Research Center for Prevention of Substance Abuse Addiction

Current Colorado Legislation

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• New Jersey Parental consent

• MassachusettsSeven day limit on pain pills

• Vermont Hub and spoke model

• California1115 waiver for continuum of care

Ideas from Other States

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• Colorado Consortium on Prescription Drug Abuse Prevention

• Office of Behavioral Health Needs Assessment

• Keystone Policy Center Stakeholder Assessment

• Substance Abuse Trend and Response Task Force

Other Activities in Colorado

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• Market advisory recommendations • Enforce parity • 1115 waiver for continuum of care

• Support pilots to expand access• Workforce education and training

Potential Recommendations

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References• Center for Substance Abuse Treatment (2005). Medication assisted treatment for opioid addiction in opioid

treatment programs. Treatment Improvement Protocol (TIP) Series 43. HHS Publication No. (SMA) 14-4892R. Rockville, MD. Substance Abuse and Mental Health Services Administration.

• Florence, CS et. al. (2013) The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States. Medical Care: 54 (10).

• Jones, Christopher M,PharmD., M.P.H., Campopiano, M., M.D., Baldwin, Grant,PhD., M.P.H., & McCance-Katz, E. (2015). National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health, 105(8), E55-E63.

• Mojtabai, Ramin, and Joshua Graff Zivin. "Effectiveness and Cost-effectiveness of Four Treatment Modalities for Substance Disorders: A Propensity Score Analysis." Health Services Research 38.1p1 (2003): 233-59.

• National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), National Institutes of Health, 2012.

• Schwarz, Ryan, et al. “Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence.” Journal of Substance Abuse Treatment. Volume 43, Issue 4, Pages 451–457. December 2012.

• Tkacz, Joseph, et al. “Relationship Between Buprenorphine Adherence and Health Service Utilization and Costs Among Opioid Dependent Patients.” Journal of Substance Abuse Treatment. Volume 46, Issue 4, Pages 456–462. April 2014.

• US Department of Health and Human Services, Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health. Washington, DC: HHS, November 2016.

• Volkow, Nora D., Thomas R. Frieden, Pamela S. Hyde, and Stephen S. Cha. "Medication-assisted Therapies--tackling the Opioid-overdose Epidemic." The New England Journal of Medicine 370.22 (2014): 2063.

• Walter, Lawrence J., Lynn Ackerson, and Steven Allen. "Medicaid Chemical Dependency Patients in a Commercial Health Plan: Do High Medical Costs Come down over Time?" The Journal of Behavioral Health Services & Research 32.3 (2005): 253-63.