Arizona Opioid Planning Summit A Look at the Data & ADHS Actions April 16, 2019 Cara Christ, MD, MS Director Arizona Department of Health Services
Emergency Declaration
Opioid Surveillance June 15, 2017- April 11, 2019 Updates posted at www.azhealth.gov/opioid
Opioid Surveillance Interactive Dashboard includes Map by Zip Code of Reported Suspect Overdoses Updates posted at www.azhealth.gov/opioid
Suspect & Verified Non-Fatal Opioid Overdoses: Based on Surveillance Data 1600 1400 1200 1000 800 600 400 200 0 Suspect Verified
Suspect & Verified Opioid Deaths: Based on Surveillance Data 300 250 200 150 100 50 0 Suspect Verified
Opioid Induced Deaths, Arizona 2008-2018 1400 1153 1200 Total Opioid Deaths 949 1000 Heroin Deaths 800 Rx Opioid Deaths 800 679 671 781 621 586 569 561 600 526 605 575 454 532 517 489 400 438 431 389 379 372 362 344 311 200 248 190 137 123 96 89 92 69 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Note: 2018 data is preliminary data from Vital Records
The majority of possible opioid overdoses reported since the enhanced surveillance began were male. 40% 60%
For verified cases that occurred between October 1, 2018 & April 4, 2019, in males, the most fatal & non- fatal overdoses were reported in ages 25 – 34 years old. In females , the most fatal overdoses were reported in ages 35 – 44 years old & non - fatal overdoses were reported in ages 25 – 34 years old 40% Male 30% 20% 10% 0% ≤ 14 Y 15-17 Y 18-24 Y 25-34 Y 35-44 Y 45-54 Y 55-64 Y 65-74 Y > 75 Y Not Fatal Fatal 40% Female 30% 20% 10% 0% ≤ 14 Y 15-17 Y 18-24 Y 25-34 Y 35-44 Y 45-54 Y 55-64 Y 65-74 Y > 75 Y Not Fatal Fatal
Of the people who overdosed between June 15, 2017 and April 4,2019 60% had public insurance (unknown insurance status excluded) 100% 80% 60% 40% 20% 0% Private Insurance Public Insurance Self-Pay
Oxycodone and heroin were the opiate drugs most commonly noted in overdoses determined to be due to opioids during review, October 1, 2018 - April 4, 2019 Oxycodone Heroin Fentanyl Methamphetamine Benzodiazepine Other Rx Opiate Cocaine Morphine Hydrocodone Methadone Hydromorphone Tramadol 0% 5% 10% 15% 20% 25%
Verified Opioid Overdoses by Opioid Type 180 160 140 120 100 80 60 40 20 0 Rx Opioids Fentanyl Heroin
Heroin Involved Verified Overdoses by Age 150 130 110 90 70 50 30 10 -10 Under 18 18-34 35-54 55+
Fentanyl Involved Verified Overdoses by Age 150 130 110 90 70 50 30 10 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 -10 Under 18 18-34 35-54 55+
Prescription Opioid Involved Verified Overdoses by Age 150 130 110 90 70 50 30 10 -10 Under 18 18-34 35-54 55+
From October 1, 2018 - April 4, 2019, more than half of verified overdoses cases had only one substance identified as involved in the overdose. 6% 13% 52% 29% 1 Drug Involved 2 Drugs involved 3 Drugs Involved 4+ Drugs Involved
On review, the most common drug combination in fatal & non- fatal overdoses was heroin & methamphetamine , 10/1/2018 – 4/4/2019 Heroin+Methamphetamine Fentanyl+Oxycodone Fentanyl+Methamphetamine Oxycodone+Methamphetamine Fentanyl+Benzodiazepine Oxycodone+Benzodiazepine Heroin+Benzodiazepine Oxycodone+Heroin 0 50 100 150 200 250 300 Fatal Not Fatal
75% of the overdoses were determined to be unintentional upon review, 6/15/2017 – 4/4/2019 10% 15% 75% Suicide Unintentional Unknown
History of substance abuse, including alcohol and chronic pain were the two most common pre - existing condition for overdoses determined to be due to opioids during review for cases that occurred from October 1, 2018- April 4, 2019. History of substance abuse, including alcohol Chronic pain Suicidal ideation Depression Anxiety Cancer Bipolar disorder Diabetes PTSD COPD Schizophrenia or schizoaffective 0 200 400 600 800 1000 1200
More people who were alone at the time of an overdose had a fatal overdose , 6/15/2017 – 4/4/2019 100% 80% 60% 40% 20% 0% Alone at time of overdose Not alone at time of overdose Not Fatal Fatal
The majority of people who overdosed did so in their personal residence, 6/15/2017 – 4/4/2019 100% 80% 60% 40% 20% 0% Not Fatal Fatal
For those that survived an overdose, hospital discharge recommendations & referrals varied, 6/15/2017 – 4/4/2019 100% 80% 60% 40% 20% 0% Referred to Referred for Referred to Given Given the OAR Connected to Behavioral Medication Pharmacy for Naloxone Number on Care with OAR Health or SUD Management Naloxone Discharge Line Treatment
Referrals by Hospitals to Behavioral Health or Substance Use Disorder Treatment for Patients with Verified Overdose was highest in November 2018 at 82% 100% 80% 60% 40% 20% 0%
Referrals by Hospitals to Behavioral Health/SUD Treatment by Age, 6/15/2017 – 4/4/2019 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 14 and 15-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ under
People with public insurance were more likely to be referred to behavioral health or substance use disorder treatment, 6/15/2017-4/4/2019 100% 80% 60% 40% 20% 0% Private Insurance Public Insurance Self-Pay
ADHS Response Activities Treatment Capacity Survey • Under the Arizona Opioid Epidemic Act of 2018, each facility that provides inpatient or outpatient substance use disorder treatment (SUDT) is required to submit a quarterly ADHS • The first survey was sent out in August 2018 • The estimated response rate for the surveys has been: – Quarter Ending September 2018: 31.8% – Quarter Ending December 2018: 26%
ADHS Response Activities Treatment Capacity Survey Results September 2018 December 2018 • • Facilities reported having 4,727 Less than 25% of facilities accept patients under 18 years of age. inpatient treatment beds, 90% were occupied, and 52,416 outpatient • In the three months prior to the treatment places, 99% occupied. survey, 3,148 people presented for care, but were unable to receive • Respondents indicated that they had a services. Most of these individuals total of 307 MAT providers, a 127% (68%) were seeking services in increase from previous quarter. Tucson. • Respondents indicated that there were • 40% of respondents offered any type 138 people interested in becoming of medication assisted treatment waivered MAT providers, a 44% (MAT) with Suboxone the most commonly offered (53%). increase over previous quarter. • 33% offer peer support services.
Monitoring Indicators of Progress
Percent of Suspect Opioid Overdoses who had Prescriptions from 10 or More Prescribers 100% 80% 60% 40% 20% 0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Naloxone Administered Pre- Hospital: Based on Surveillance Data 900 800 700 600 500 400 300 200 100 0 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18
Naloxone dispensed by pharmacies peaked in May 2018 after Opioid Epidemic Act went info effect. 4000 3500 3000 2500 2000 1500 1000 500 0 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19
Percent of Prescribers who Checked the CSPMP at Least Once in the Month Prior to Prescribing a Controlled Substance 100% 80% For opioids and benzodiazepines only, 44.6% checked prior to 60% prescribing in March 2019 40% 20% 0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17Dec-17 Jan-18 Feb-18Mar-18Apr-18 May- Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18Dec-18 Jan-19 Feb-19Mar-19 18
Number of Opioid Prescriptions Filled in Arizona 450000 400000 350000 300000 250000 Fiscal Year to Date Comparison 200000 July 18 - Mar 19 = 2,643,242 July 17 - Mar 18 = 3,211,869 150000 18% Decline 100000 50000 0 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May- Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 18
Average Morphine Milligram Equivalent Prescribed 70 60 50 40 30 Declined 29% between April 2018 and March 2019 20 10 0 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May- Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 18
Individuals who Were Opioid Naive Prescribed Opioids for 5 or More Days 2500 Declined 55% between April 2018 2000 and March 2019 1500 1000 500 0
Number of Individuals Opioid Naive Prescribed 90 MME+ 140 120 Declined 65% 100 between April 2018 and March 2019 80 60 40 20 0 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
ADHS Implementation Highlights
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