Technology as a Weapon in the

Opiates Crisis

1

Shifting gearsTechnology as a Weapon in the Opiates Crisis

Moderator: Paul Dommel, IBM Corp

Agenda

Why it’s important

What’s being done

Perspectives from Virginia

Next steps

Mr. Frederick Isasi

Director, NGA Center for Best Practices

Healthcare

• Does not represent the official position of the Governors or NGA;

• I will be speaking from direct experience of working with Governors and

state leaders; and

• My comments are off-the-record and not for attribution.

Today’s discussion

Brief overview of the National Governors Association

Brief overview of the national opioid crisis

Brief summary of NGA’s work with states

Highlight sections from Finding Solutions to the Prescription Opioid

and Heroin Crisis: A Road Map for States

My comments

• Nation’s oldest organization serving the needs of governors and their staff (founded

in 1908)

• Bipartisan Leadership: Chair Gov. McAuliffe (D-VA) and Vice-Chair Gov. Sandoval

(R-NV)

• NGA Office of Government Relations (OGR): serves as the collective voice of the

nation’s governors in Washington, DC

• NGA Center for Best Practices: a hybrid think thank/consultancy that works to

surface evidence-based practices, works directly with governors on specific policy

projects, and provides support to OGR. The NGA Center divisions are:

• Health

• Education

• Energy, Environment, and Transportation

• Human Services and Workforce

• Homeland Security and Public Safety

The National Governor’s Association

• NGA Center Health Division:

• Work focuses on governors most pressing and important health care issues

• Typically, project-based through competitive RFA process to you and your

governors

• Our work is provided a service, free of charge –projects funded through

cooperative agreements with federal government, grants, and donations.

About the NGA’s health work

Continuum of Health Division activities

Target Audience

Most Focused

Most Broad

• Governor Healthcare Leadership

Retreats

• In-State Policy Retreats

• State-specific Technical Assistance

• Policy Academies

• Convenings of States

• Collaboration with NGA’s

Office of Federal Relations

• Medicaid Transformation

Toolkit, Opioid Roadmap

• Other Publications

Health Division Activities

Six current focus areas

U.S. Map of Opioid Death by State, 1999 - 20141999 DRUG OVERDOSE DEATH RATES2002 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2005 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2008 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2011 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2014 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2014 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES

Source: Centers for Disease Control and Prevention

Spread of the opioid crisis

• In 2014, 28,647 people died of an opioid overdose, more than any other year on record.

• Over 1,000 people will be treated today in an ER for an overdose.1

• 78 people will die today of an overdose.2

• One person in the US will die from an opioid-related overdose roughly every 20 minutes.

• The Drug Enforcement Administration (DEA) expects overdose rates to increase in the next year as fentanyl

makes its way through the states.

• In addition to the human cost, the epidemic is having an impact on state budgets.

• Total inpatient charges for hospitalizations related to opioid abuse/dependence more than tripled between

2002 ($4.57 billion) and 2012 ($14.85 billion).3

• The financial burden for this cost largely falls on state budgets; Medicaid funds about 50% of

hospitalizations.

1 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The DAWN Report: Highlights of the 2011 Drug Abuse Warning Network

(DAWN) Findings on Drug-Related Emergency Department Visits.

2 R. Rudd, “Increases in Drug and Opioid Overdose Deaths.”

3 Matthew V. Ronan, and Shoshana J. Herzig “Hospitalizations Related To Opioid Abuse/Dependence And Associated Serious Infections Increased Sharply, 2002–12,” Health Affairs 35 no. 5

(May 2016)

Overview of the opiates crisis

• This crisis is impacting constituents lives:

• It is a bipartisan issue (impacting red, blue, and purple states)

• It is urban and rural

• It affects people of all ages

• It affects people of all income levels and socioeconomic status

• It is an economic issue, with consequences for health care costs, lost productivity, and

jobs and hiring within communities

• The solutions are not simple:

• Strategies may be slow to show results

• Several factors are compounding states’ progress

• Greater availability of heroin

• Spread of illicit fentanyl

• Data lag

• There is a lack of evidence for effective strategies

• Stigma surrounding opioid use disorder is changing

• States are viewing the problem as a public health crisis, rather than solely a public safety

issue

Reality of the opioid crisis

• Joint effort between Health and Homeland Security and Public Safety

• 2012 – 2015: NGA convened two prescription drug abuse policy academies with 13 states

• Round 1: Alabama*, Arkansas, Colorado*, Kentucky, New Mexico, Oregon and Virginia

• Round 2: Michigan, Minnesota, Nevada*, North Carolina, Vermont* and Wisconsin

*denotes policy academy co-lead governor

• February 2016: During the NGA Winter Meeting, governors agreed that collective action is needed to end

the opioid crisis

• Summer – Fall 2016:

• 46 governors sign Governors Compact to Fight Opioid Addiction

• NGA releases Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States

• Launches Learning Lab: Improving Information Sharing and Data Analysis Between Law

Enforcement and Public Health (Summer 2016)

• Launches Learning Lab: State Strategies for Combatting Heroin and Illicit Fentanyl (Fall 2016)

• Publications:

• Six Strategies for Reducing Prescription Drug Abuse. (September 2012)

• Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy (February 2014)

• Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. (July 2016)

Timeline of NGA activities

• Joint effort between Health and Homeland Security and Public Safety

• 2012 – 2015: NGA convened two prescription drug abuse policy academies with 13 states

• Round 1: Alabama*, Arkansas, Colorado*, Kentucky, New Mexico, Oregon and Virginia

• Round 2: Michigan, Minnesota, Nevada*, North Carolina, Vermont* and Wisconsin

*denotes policy academy co-lead governor

• February 2016: During the NGA Winter Meeting, governors agreed that collective action is needed to end

the opioid crisis

• Summer – Fall 2016:

• 46 governors sign Governors Compact to Fight Opioid Addiction

• NGA releases Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States

• Launches Learning Lab: Improving Information Sharing and Data Analysis Between Law

Enforcement and Public Health (Summer 2016)

• Launches Learning Lab: State Strategies for Combatting Heroin and Illicit Fentanyl (Fall 2016)

• Publications:

• Six Strategies for Reducing Prescription Drug Abuse. (September 2012)

• Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy (February 2014)

• Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. (July 2016)

Timeline of NGA activities

Finding Solutions to the Prescription Opioid and Heroin Crisis:

A Road Map for States

Road Map Highlights: Key Factors

Road Map Highlights: Comprehensive Policy Frameworks

• Prevention:

• Develop and update guidelines for all opioid prescribers

• Limit new opioid prescriptions for acute pain, with exceptions for certain patients

• Develop and adopt a comprehensive opioid management program in Medicaid and

other state-run programs

• Remove methadone for managing pain from Medicaid preferred drug list

• Treatment and Recovery:

• Change payment policies to expand access to evidence-based Medication Assisted

Treatment (MAT) and recovery services

• Increase access to naloxone

• Expand and strengthen the workforce and infrastructure for providing evidence-

based MAT and recovery services

• Create new linkages to evidence-based MAT and recovery services

Road Map Highlights: Select Healthcare Strategies

• Reducing Illicit Supply and Demand for Opioids:

• Establish a collaborative information sharing environment that breaks down silos

across state agencies to better understand trends

• Leverage assets from partner entities to improve data collection and intelligence

sharing to restrict the supply of illicit opioids

• Expand statutory tools for prosecuting major distributors

• Expand partnerships and data access to better target overprescribers

• Responding to the Crisis:

• Empower, educate and equip law enforcement personnel to prevent overdose

deaths and facilitate access to treatment

• Reinforce use of best practices in drug treatment courts

• Ensure access to MAT in correctional facilities and upon reentry into the community

• Strengthen pre-trial drug diversion programs to offer individuals the opportunity to

enter into substance use treatment

Road Map Highlights: Select Public Safety Strategies

• Reducing Illicit Supply and Demand for Opioids:

• Establish a collaborative information sharing environment that breaks down silos

across state agencies to better understand trends

• Leverage assets from partner entities to improve data collection and intelligence

sharing to restrict the supply of illicit opioids

• Expand statutory tools for prosecuting major distributors

• Expand partnerships and data access to better target overprescribers

• Responding to the Crisis:

• Empower, educate and equip law enforcement personnel to prevent overdose

deaths and facilitate access to treatment

• Reinforce use of best practices in drug treatment courts

• Ensure access to MAT in correctional facilities and upon reentry into the community

• Strengthen pre-trial drug diversion programs to offer individuals the opportunity to

enter into substance use treatment

Road Map Highlights: Select Public Safety Strategies

Road Map Highlights: Finalize, Implement, and Evaluate

The Honorable William A. Hazel, Jr., M.D.

Secretary of Health and Human Resources,

Virginia

Silos come in many forms

Policy, funding, workflow, people

Program and services mapVA Health and Human

Resources SecretariatSSA DOL AOA NIH

ACL ACF FNS CDC SAMHSA EPA CMS

DARS DBHDS DHP DMAS VDSS OCS VBPD VDBVI VDDHH VDH VFHY

• Vocational

Rehabilitatio

n

• Disability

Determinatio

n

• Community

Rehabilitatio

n for

Disabled

• Aging

Services

• Adult

Protective

Services

• Development

al Disability

Services

• Mental

Health

Services

• Substance

Abuse

Treatment

Services

• Behavioral

Health

Emergency

Response

Services

• Provider

Licensing

• Licensing

and Health

Profession

Regulation

• Prescription

Monitoring

Program

(PMP)

• Health

Practitioners

Data Center

• Medicaid

• Family

Access to

Medical

Insurance

Security

(FAMIS)

• Medicaid

Analytics and

Reform

• Supplement

al Nutrition

Assistance

Program

• Temporary

Assistance

for Needy

Families

• Child Care

• Energy and

Cooling

Assistance

• Eligibility

Determinatio

n

• Foster Care

and Adoption

Services

• Child

Support

Enforcement

• Child and

Adult

Protective

Services

• Licensure

• Community

Policy and

Managemen

t Teams

(CPMT)

• Family

Assessment

and

Planning

Teams

(FAPT)

• At-Risk

Youth and

Families

• Policy

Setting

• Grants for

Innovation

• Leadership

and

Advocacy

Training

Programs

• Disability

Services

Assessment

• Vocational

Rehabilitatio

n

• Randolph-

Sheppard

Vending

Program

(RSVP)

• Virginia

Industries for

the Blind

• General

Library

Services and

Education

Services

• Technology

Assistance

Program

(TAP)

• Virginia

Relay

• Outreach

and

Community

Services

• Interpreter

Services

• Family

Health

Services

• Emergency

Preparednes

s and

Response

• Environment

al Health

Services

• Licensure

and

Certification

• Epidemiology

• Virginia

Certificate of

Public Need

(COPN)

• Minority

Health and

Equity

• Drinking

Water

• Youth

Programs

• Youth

Tobacco

Use

Prevention

• Youth

Obesity

Prevention

IRS

A growing national issue

Silos come in many formsNumber of Fatal Prescription Opioid and

Heroin Overdoses in

Virginia Cities and Counties, CY2007-2014

Total drug overdoses

Emerging challenge: Fentanyl

Strategies

• Harm Reduction (naloxone, Suboxone, syringe exchange, NAS babies,

family breakup, and crime)

• Treatment (MAT, drug courts, peers, Medicaid Expansion)

• Prevention (legal opiate availability, better pain management, storage

and disposal, PMP)

• Prevention (illegal opiate interdiction, tracking and reducing supply)

• Culture change (removing youth belief that these drugs are harmless,

removing expectation of opiate pain management, removing stigma)

Challenges

• The nature of the drug is changing

• We are seeing an increase in synthetic fentanyl. Addicts often

believe they are buying heroin, but it is cut with fentanyl, which is

more deadly.

• The changing nature of the problem exacerbates the pressures

faced by first responders, hospitals, and law enforcement

Prevention

• Virginia has moved to limit legal opioids: greater reporting to PMP, increased medical education

• CDC is also recommending changes in how doctors treat pain and prescribe painkillers

• Full prevention efforts also involve public safety

• Need to share data and share information

• Center for Behavioral Health and Justice is part of Virginia’s response

Treatment

Substance Abuse Benefit

• $11 million in the first year

• Covers treatment, including medically assisted treatment

• Working to expand network of treatment providers

• Medicaid expansion would help provide this coverage to more who need it

Harm reduction

• Naloxone for first responders, family, etc

• MAT/Suboxone (with counseling)

– Need a better consensus. Without it, sheriffs are reluctant to try drug

courts with patients on Suboxone

2016 Medicaid benefit enhancement

Substance Use Disorder (SUD) Treatment Supports for Current Medicaid Members

Governance structure and information sharing

Executive Work Group

State Support Action Group: Focuses on: situational awareness and recommendation development

Primary PreventionSecondary Prevention/ Interdiction

Tertiary Prevention/

Incapacitation

Data and Surveillance

Local Support Action Group: Focuses on: Dissemination of information and

assisting local communities

Seven regions

Northern Shenandoah Valley Substance Abuse Coalition

• A dynamic, a multi-disciplinary collaboration of law enforcement

(prosecution and defense resources alike), public health, child

welfare, family courts, county and city leadership, and community

members impacted by the crisis of heroin and opiate addiction

• Has brought together a diverse set of local, community partners that

work collaboratively across disciplines to respond to a public health

crisis in the Valley contributing time, talent and treasure

• Working to develop a cost-effective drug treatment court as well as

compassionately and realistically expanding treatment options for

community members who need this service

Technology Implications

• Real-time information to direct resources– Where

– Effectiveness

• Collaboration: Health, Safety, Justice, Education

• Streamline access and simplify for addicts & families

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Post Session Housekeeping

• RATE this session in the conference app• To download the conference app search for APHSA Events

• VISIT the vendors in the Exhibit Hall during Breakfast and

the Networking Breaks to learn more about the solutions

presented throughout the day.

• DONATE to Childhelp – the ISM Technology for a Cause

campaign to raise $10,000 to help stop child abuse in

Arizona and across the country.

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See you again soon

THANKS FORCOMING