4/12/2018 Opioid Addiction and Prescribing Mitchell Mutter, MD Director of Special Projects Nashville, TN | April 12, 2018 Disclosure Statement of Financial Interest I, Mitchell Mutter, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Key Findings in 2017 Source: CSMD 2018 Legislative Report 1
4/12/2018 T T h he Op Op i oi oi d d C C ri r s s i i s s by by t t h he Nu Numbers 2
4/12/2018 Chronic Pain Guidelines Expert Panel Public Chapter 430 • Requires the development of the TN Chronic Pain Guidelines – 1 st edition 2014 – 2 nd edition 2017 – Annual review Ri Ri s s k k P roof oof Your Yo P P r rac t i c c e e • How many patients on greater than 120 MEDD? • How many patients drive a far distance to practice site? • How many patients are on combinations? • Resources available in office – Naloxone handouts – Education on near misses – Education on street drugs 3
4/12/2018 Public Chapter 1033 • Pain Management Clinics transitions from certificate system to licensure system – Medical director holds license – Non-transferable – Only a pain specialist is eligible to be medical director – > 50% of patients being treated for pain qualifies as a pain clinic and must be registered – No pharmacy – Clinic can be suspended based on specific violation • No new patients • Monitored – Went into effect on July 1, 2017 TN Pain Management Clinics per County, 7/3/2017 Annual NAS Trends Source: Neonatal Abstinence Surveillance System. TN Dept. of Health 4
4/12/2018 Neonatal Abstinence Syndrome Surveillance Summary Week 09: February 25 – March 03, 2018 NAS Rate per 1,000 Live Births, 2016 Source: Neonatal Abstinence Surveillance System. TN Dept. of Health NAS Rates by Region 2016 Data are provisional. Source: Neonatal Abstinence Surveillance System. TN Dept. of Health 5
4/12/2018 Consequences of Opioid Epidemic • Tennessee in-state variability assessment for a “Rapid Dissemination of HIV or HCV Infection Event” utilizing data about the opioid epidemic. • More granular data improved insights into county-level HIV/HCV outbreak vulnerability compared to national models. Source: Clinical Infectious Diseases, December 7, 2017 Scott County, Indiana Outbreak • 220 U.S. counties had highest vulnerability • 41 small counties located in TN • 25 overlapped with more granular TN data • CDC – acquired HIV 2016 Source: Clinical Infectious Diseases, December 7, 2017 75 Predictors Used to Compute each County Risk Score • MME/Capita • Death from Heroin/Opioids • Socioeconomic • IV Drug Use • Mental Health Services • Uninsured Percentage • Other, see December 7, 2017 Clinical Infectious Diseases Source: Clinical Infectious Diseases, December 7, 2017 6
4/12/2018 Risk Ranking Source: Clinical Infectious Disease, December 7, 2017 Public Chapter 476 • Currently, the top 50 prescribers of controlled substances in the state are annually identified and sent a letter notifying them of their inclusion on this list and asked to respond with a justification for their prescribing patterns. • Public Chapter 476 adds the top 10 prescribers from all of the combined counties having populations of fewer than 50,000 • Effective/Signed May 18, 2015 MMEs Prescribed by Top 50 Prescribers and Dispensed in 2013 ‐ 2017 Source: CSMD 2018 Legislative Report 7
4/12/2018 Why do Prescribers and Dispensers Check the CSMD? Source: CSMD 2018 Legislative Report Prescription Drug Overdose Dashboard Source: https://www.tn.gov/health/health-program-areas/pdo/pdo/data-dashboard.html Tennessee Drug Overdose Data Source: https://www.tn.gov/health/health-program-areas/pdo/pdo/data-dashboard.html 8
4/12/2018 Tennessee Drug Overdose Data Source: https://www.tn.gov/health/health-program-areas/pdo/pdo/data-dashboard.html Ag Age- ad adjus t ed drug ug ov overdos e de deat h rat ra es , by by s s t t at e, Un Uni t t ed e S S t t at es , 20 201 6 NOTES: Deaths are classified using the International Classification of Diseases, Tenth Revision. Drug-poisoning (overdose) deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14.. SOURCE: NCHS, National Vital Statistics System, Mortality. T T h he Op Op i oi oi d d C C r ri s s i i s s by by t t h he Nu Numbers 24.5 Tennessee 9
4/12/2018 Drug ug ov overdos e deat de h ra rat es , by by s s e elec c t t ed ag age gr group : Un Uni t t ed e S S t t at es , 1 999- 999- 20 201 6 1 Significant increasing trend from 1999 to 2016 with different rates of change over time, p < 0.05. 2 2016 rate was significantly higher than for the rate for age groups 15–24, 55–64, and 65 and over, p < 0.05. NOTES: Deaths are classified using the International Classification of Diseases, Tenth Revision. Drug-poisoning (overdose) deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. SOURCE: NCHS, National Vital Statistics System, Mortality . Age ‐ Adjusted Rates for All Drug Overdose Deaths and by Sex and Race in TN by Year Tennessee Overdose Deaths where patient did not have prescriptions in CSMD 60 days prior to death 60% 50% 40% All Drug 30% 20% 10% 0% 2013 2014 2015 2016 Source: TN Dept. of Health, Office of Informatics and Analytics 10
4/12/2018 All Drug Deaths by Age Distribution, 2012 ‐ 2016 500 450 400 Number of Deaths 350 300 2012 2013 250 2014 2015 200 2016 150 100 50 0 5 ‐ 14 years 15 ‐ 24 years 25 ‐ 34 years 35 ‐ 44 years 45 ‐ 54 years 55 ‐ 64 years 65 ‐ 74 years 75 ‐ 84 years 85+ years Source: TN Dept. of Health, Office of Informatics and Analytics All Fentanyl Deaths by Age Distribution, 2012 ‐ 2016 120 100 Number of Deaths 80 2012 2013 60 2014 2015 2016 40 20 0 5 ‐ 14 years 15 ‐ 24 years 25 ‐ 34 years 35 ‐ 44 years 45 ‐ 54 years 55 ‐ 64 years 65 ‐ 74 years 75 ‐ 84 years 85+ years Source: TN Dept. of Health, Office of Informatics and Analytics 11
4/12/2018 Opioids Present in Overdose Deaths in TN by Year 80.0 72.7 71.3 68.2 70.0 64.7 Opioid Percentage of Overdose Death 60.0 Fentanyl Heroin 50.0 Buprenorphine 40.0 30.0 18.0 20.0 14.1 15.9 12.0 11.6 10.0 5.4 5.5 4.6 3.7 3.4 4.1 2.0 0.0 2013 2014 2015 2016 * Percentages for fentanyl, heroin, buprenorphine are included in the opioid category and are broken out for clarity. Source: TN Dept. of Health, Office of Informatics and Analytics Access to Documents 2018 C CSMD L MD Legi gislat ative Repo e Report https://www.tn.gov/health/health-program-areas/health-professional-boards/csmd- board/csmd-board/reports.html TDH Pa H Pain in M Management C nt Clinic ic S Statut utes es, Ru , Rule les, a and Guid idelin lines es https://www.tn.gov/health/health-program-areas/health-professional-boards/pm- board/pm-board/statute-rules-and-guidelines.html Pres escr cription on D Drug O ug Over erdo dose (P (PDO DO) https://www.tn.gov/health/health-program-areas/pdo.html Access to Documents Tenness essee’s ee’s I In-St -State te V Vulne lnerab abil ility ity A Assess ssment f nt for a r a ‘Rapid D Dissemin inatio ation n of HIV o V or HCV In V Infect fection’ E n’ Event ent U Utili ilizi zing ng D Data about out the the Opioid E Epidem emic https://academic.oup.com/cid/advance-article/doi/10.1093/cid/cix1079/4706246 Neonat natal al A Abstin inence S Syndrome ( (NAS) https://www.tn.gov/health/nas.html 12
4/12/2018 Contact Me Mit Mitchell Mut Mutter, M.D M.D. Dir Director o of Spe Special Pr Projects 615-532-3541 Mitc Mitchell hell.Mut .Mutter@tn.g tn.gov Tennessee Department of Health Health Related Boards 665 Mainstream Drive, 2 nd Floor Nashville, TN 37243 Thank You! 13
Recommend
More recommend
