Addressing the Rural Opioid Crisis 2016 National Coalition of Black Lung and Respiratory Disease Clinics Conference Lexington, Kentucky September 15, 2016 3:20-4:20 p.m.
Presenters • Nisha Patel, FORHP • Holly Andrilla, WWAMI Rural Health Research Center • Shane Britt, Scottsville Allen County Faith Coalition, Inc.
Federal Response to the Opioid Crisis Nisha Patel, MA, CHES Acting Associate Director/Senior Advisor Federal Office of Rural Health Policy Black Lung Coalition Meeting September 15 th , 2016
Historical Data • Since 2002, the rate of drug overdose deaths has increased by 79%, with 200% increase involving opioids • In 2014, opioids were involved in 28,647 deaths • Only 2% of US physicians have obtained DEA DATA waivers to prescribe buprenorphine • Only 16% of all psychiatrists have obtained waivers • Only 3% of all primary care physicians have obtained waivers • More than 30 million Americans live in counties without access to buprenorphine treatment • 82% of the counties without a physician who could prescribe were in rural areas 4
Though opioid abuse and opioid-related death has been on the rise nationally, rural communities are disproportionately affected Drug-related deaths 45% higher in rural Rural communities have a history of substance abuse Rural residents are most likely to be prescribed opioid painkillers • Rural has greater prevalence of risk factors and fewer options for treatment.
Rural Trends • Opioid-related overdose deaths have Trend 1 increased over the past 15 years in both rural and urban, with exponential increases in rural areas from 2013-2014 • Rural states are more likely to have higher Trend 2 rates of overdose death, particularly from prescription opiate overdose Trend 3 • Rural men may be using more, but rural women are dying more
Crude Heroin Overdose Mortality Rate (2014) >50% Rural <50% Rural Heroin Overdose Mortality Rates and Rurality (2014) Heroin Overdose Rate >2.9% OH, WV, NH, NM, MO, IL, CT, MA, RI, DE, DC , MD, NJ, in 2014 VT, MI, KY, WI, WA, PA, UT, NY, VA AK, OR, ME CO, AZ Heroin Overdose Rate <2.9% NC, IN, AL, TN, LA, NV, MN, FL, CA in 2014 TX, GA, SC, IA, MS, OK
Crude Overdose Mortality Rate (2014) >50% Rural <50% Rural Opioid Overdose Mortality Rates and Rurality (2014) Overdose Mortality WV, NH, NM, OH, KY, UT, OK, RI, MD, MA, CT , DE, DC >8.4% in 2014 ME, TN, NV, MO, WI, SC, MI, VT, AK, NC, CO, WA, Overdose Mortality Rate IL, WY, PA, AZ, OR, GA, IN, KS, VA, NY, NJ, FL, CA <8.4% in 2014 AL, MN, AR, LA, MT, IA, ID, SD, TX, HI, MS, ND, NE
HHS Opioid Initiative • Launched by Secretary Burwell in March 2015 • Three priority areas • Improve opioid prescribing • Increase use of naloxone to reverse opioid overdose • Expand use of Medication- Assisted Treatment (MAT) for opioid use disorders
HHS Response Secretary’s Opioid Initiative (announced March 2015) CDC HRSA NIH FDA SAMHSA AHRQ ACF IHS CMS ONC 1. Expand Medication Assisted Treatment 2. Expand Access to Naloxone 3. Improve usability of Prescription Drug Monitoring Programs
HRSA Related Efforts • 2016 Substance Abuse Service Expansion (BPHC) • In March 2016 HRSA expects to award 100 million to nearly 300 health center grantees for the expansion of substance abuse services • Substance Abuse Warmline (BPHC) • Peer-to-peer telephone consultation, focusing on substance use evaluation and management for primary care clinicians • Project ECHO Collaborative (BPHC) • 1-year project with 10 health centers around the topic of MAT for substance use • Secretary’s 50 State Convening Focused on Preventing Opioid Overdose (ORO) • Delegates from across the country convene to collaborate, take action on opioid epidemic 11
HRSA Related Efforts • HRSA Funded Research • Example: The FORHP funded Maine Rural Health Research Center project "Catastrophic Consequences: The Rise of Opioid Abuse in Rural Communities” • The Rural Opioid Overdose Reversal Grant Program (FORHP) • In September 2015, the FORHP awarded $1.8 million to support rural communities in reducing morbidity and mortality related to opioid overdoses • Health Care for the Homeless Demonstration Project (HAB ) • 5-year initiative that supports innovative practices to increase entry and retention into HIV care, as well as support services for patients who are homeless or unstably housed and those who are living with mentally illness or substance use disorders • Behavioral Health Workforce Education and Training Program (BHW) • Supports the training of the behavioral workforce to ensure an adequate supply of professional and paraprofessionals across the country, and in particular, within underserved and rural communities (FY2014) 12
Rural Opioid Overdose Reversal Grant Program (ROOR) • New FY15 Pilot Program • Total investment: 18 awards at $100,000/year ($1.8 Million) • Support rural community partnerships comprised of local emergency responders and other entities involved in the prevention and treatment of opioid overdoses • Increasing access to Naloxone in rural communities • Changing the mindset of law enforcement
Program Goals: • Improve Access: Increase the availability of naloxone through purchase and strategic placement; • Educate: Train licensed healthcare professionals and others using the devices to recognize the signs of opioid overdose, administer naloxone, administer basic cardiopulmonary life support, report results, and provide appropriate transport to a hospital or clinic for continued care after administration; • Coordinate Care: Referral to substance abuse treatment centers where care coordination can be provided by team of providers; • Improve Outcomes: Demonstrate improved and measureable health outcomes, including reducing opioid overdose morbidity and mortality in rural areas
Map of ROOR Grantees
586 600 500 400 300 200 47 100 0 Number of Trainings Number Trained
Narcan Devices Purchased 142 370 Nasal Narcan Injectable Evzio 1461
Opioid Crisis Meets Innovation • Diversion Alert, Maine • Serves Tribal communities • Created a patient education video for Native Americans prescribed take home naloxone on how to respond to an overdose. • Erie County Health Department, Ohio • Partnership includes mental health organizations • Training providers and family members to recognize overdose signs • Distribute Evzio to first responders and loved ones of high-risk drug users • “Circle of care,” ensuring substance use disorders are treated like other health issues.
Opioid Crisis Meets Innovation through Patient Navigation Domestic AIDS Network, Maine • Shift focus of providers • Treat patients with dignity and respect • Focus on addressing the harms associated with the addiction • Integration of behavioral health into primary care • Harm Reduction Coalition • Training and technical assistance to providers • Utilization of peer navigators • Establish trust with patients • Connect patients to care • Schedule appointments • Make travel and childcare arrangements
Other FORHP Resources Rural Healthcare Outreach Program Rural Telehealth Network Programs Programs Reduce opioid misuse and overdose
Integration Between Health and Human Services Armstrong Indiana Clarion • Rural Health Care Services Grantee (2012 & 2015) • Program serves people with substance abuse addiction • Program has expanded to cover numerous counties • Coordinated Team Approach • Deliver high quality of care to patients • Build trust with the patient and recognize family • Hospital, local provider, nurse navigator, case manager Hospital → Residential rehab → Outpatient care → Case • manager (transportation, daycare, medical assistance, housing, employment) Heroin addict arrived at hospital with suicide thoughts. She was admitted to hospital psychiatric, discharged home with a planned admission date for inpatient drug treatment, stayed in touch with case manager, changed her living environment and believes “this program saved my life”.
Collaboration is Key Families Patients Law Providers Enforcement Policymaker
For Patients & Families 1. SAMHSA Opioid Overdose Prevention Toolkit • http://store.samhsa.gov/product/Opioid-Overdose-Prevention- Toolkit-Updated-2016/SMA16-4742 2. Opioid Treatment Program Locator • http://dpt2.samhsa.gov/treatment/directory.aspx 3. SAMHSA Opioid Overdose Toolkit: Safety Advice for Patients & Families • http://store.samhsa.gov/shin/content/SMA13- 4742/Toolkit_Patients.pdf 4. Community Health Gateway Toolkits • Rural Services Integration Toolkit: https://www.ruralhealthinfo.org/community-health/services-integration • Rural Mental Health & Substance Abuse Toolkit: https://www.ruralhealthinfo.org/community-health/mental-health • Coming Soon: Addiction Toolkit
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