EMERGENCY RULES FOR OPIOID POISONING-RELATED REPORTING Arizona - PowerPoint PPT Presentation

EMERGENCY RULES FOR OPIOID POISONING-RELATED REPORTING Arizona Department of Health Services azopioid@azdhs.gov

Introductions

How Did We Get Here?

Opioid Use is Increasing in the U.S.

http://www.azdhs.gov/documents/audiences/clinicians/clinical-guidelines- recommendations/prescribing-guidelines/arizona-opioid-report.pdf

Opioid Deaths are Increasing • More than two Arizonans die each day from an opioid overdose • In the past decade, 5,932 people died from opioid- induced causes • Arizona opioid death rates start to rise in the late teens and peak at age 45-54 • 74% increase in deaths since 2012 • Full report available at azhealth.gov/opioid

Opioid death counts among Arizona residents and non- residents in Arizona from 2007 to 2016

Opioid-Related Deaths are Increasing in Arizona

What are we doing about it?

On June 5, 2017, Arizona Governor Doug Ducey declared a State of Emergency due to an opioid overdose epidemic

ADHS Responsibilities • Provide consultation to governor on identifying and recommending elements for Enhanced Surveillance • Initiate emergency rule-making for opioid prescribing and treatment practices • Develop guidelines to educate providers on responsible prescribing practices • Provide training to local law enforcement agencies on proper protocols for administering naloxone in overdose situations • Provide report on findings and recommendations by September 5, 2017

azhealth.gov/OpioidActionPlan

Goals to address the opioid epidemic • Increase patient and public awareness and prevent opioid use disorder • Improve prescribing and dispensing practices • Reduce illicit acquisition and diversion of opioids • Improve access to treatment • Reduce opioid deaths

What have we learned from the enhanced surveillance?

azhealth.gov/opioid http://www.azhealth.gov/opioid

TITLE 9. HEALTH SERVICES CHAPTER 4. DEPARTMENT OF HEALTH SERVICES NONCOMMUNICABLE DISEASES ARTICLE 6. OPIOID POISONING-RELATED REPORTING • Governor Ducey’s August 10th, 2017 Executive Order issuing an opioid Enhanced Surveillance Advisory ended on October 9 th . • ADHS has amended the rules in 9 A.A.C. 4 to include Article 6 – Opioid Poisoning-Related Reporting in order to maintain a surveillance system for opioid overdoses, similar to other non-communicable diseases. • As the regular rule making process continues stakeholders will have an opportunity to provide input. Presenters • Bureau of EMS and Trauma System • Office of Injury Prevention

R9-4-602. Opioid Poisoning-Related Reporting Requirements A. An ambulance service, an emergency medical services provider, or a law enforcement agency shall, either personally or through a representative, submit a report to the Department, in a Department- provided format and within five business days after an encounter with an individual with a suspected opioid overdose, that includes: 1. The following information about the ambulance service, emergency medical services provider, or law enforcement agency: Name; a. Street address, city, county, and zip code; b. Whether the entity reporting is: c. An ambulance service, i. An emergency medical services provider, or ii. A law enforcement agency; and iii. d. If applicable, the certificate number issued by the Department to the ambulance service; and

2. The name, title, telephone number, and email address of a point of contact for the entity required to report; 3. The street address, city, county, state, and zip code of the location at which the ambulance service, emergency medical services provider, or law enforcement agency encountered the individual; 4. If applicable, the date and time the ambulance service, emergency medical services provider, or law enforcement agency was dispatched to the location specified according to subsection (A)(3); 5. The following information about the individual with a suspected opioid overdose or who died of a suspected opioid overdose: Name, a. Date of birth, b. Age in years, c. Gender, d. Race and ethnicity, and e. Reason for suspecting that the individual had an opioid overdose; f.

6. Whether naloxone was administered to the individual before the ambulance service, emergency medical services provider, or law enforcement agency encountered the individual and, if so: The number of doses of naloxone administered to the individual; and a. As applicable, that the naloxone was administered to the individual by: b. Another individual; or i. Another entity and, if so the type of entity that administered the naloxone to the individual; ii. 7. Whether naloxone was administered to the individual by the ambulance service, emergency medical services provider, or law enforcement agency and, if so, the number of doses of naloxone administered to the individual;

The following information about the disposition of the individual: 8. Whether the individual was pronounced dead at the location specified according to subsection (A)(3); a. Whether the individual was transported to a hospital and; if so: b. The name of the hospital to which the individual was transported, and i. The type of entity that transported the individual to the hospital; and ii. If known, whether the individual: c. Survived the suspected opioid overdose, i. Died from the suspected opioid overdose, or ii. Died from another cause after experiencing a suspected opioid overdose; and iii. The date of the report. 9.

Healthcare Institutions • Overdose reporting: – If allowed under Title 42 Code of Federal Regulations, Chapter I, Subchapter A, Part 2, healthcare institutions must report within 5 business days: • Any non-fatal clinically suspected opioid overdose • Any fatal clinically suspected opioid overdose – Only report overdoses that are clinically suspected to be opioids and only ones identified at your facility – Do not report : • An opioid overdose resulting from the administration of the opioid to a patient in the health care institution if the opioid overdose is addressed through the health care institution’s quality management program • Naloxone dispensed in connection with a surgical procedure performed in the health care institution. • Neonatal Abstinence Syndrome

Healthcare Institutions: Overdose Reporting will be done through the MEDSIS system • – For a new MEDSIS account e-mail: MedsisHelpDesk@siren.az.gov – The following information must be reported for each case: • Name of individual and name of guardian (if applicable) • Date of birth • Date of death (if applicable) • Age (in years) • Gender • Race/ethnicity • Pregnancy (if female) and expected date of delivery • Individual’s address • Date of suspected overdose • Date of diagnosis • Clinical signs/symptoms • Drug(s) suspected in overdose

Healthcare Institutions: Overdose • Additional reporting requirements: • Location of overdose • If naloxone was administered prior to arrival at the facility • Who administered pre-admission naloxone • If individual was alone at time of overdose • If the overdose appeared to be intentional • Opioid prescription history for past 90 days • Risk factors for overdose • Prior overdose(s) (if known) • Referral to behavioral health services • Discharge status • Date of the report • Name & contact information for reporting institution

Healthcare Institutions: Neonatal Abstinence Syndrome (NAS) • Reporting will be done through the MEDSIS system – For a new MEDSIS account e-mail: MedsisHelpDesk@siren.az.gov – The following information must be reported for each case: • Name of individual • Source of opioid believed to have caused • Date of birth NAS • Name of individual’s mother/guardian • If the source was not through a prescription, • Gender specific opioid used by mother • Race/ethnicity • Pregnancy (if female) • Reason for suspecting NAS • Date of diagnosis • Information about specimen & lab test for drug(s) involved • Maternal history of opioid use • Positive laboratory test for opioids individual’s mother • Positive laboratory tests for the individual

Medical Examiners: Suspect Opioid Fatalities Reporting will be done through the MEDSIS system or through the county health • department – For a new MEDSIS account e-mail: MedsisHelpDesk@siren.az.gov – The following information must be reported for each deceased individual: • Name of individual • Date of birth • Date of death • Cause of death (when determined) • Age (in years) • Gender • Race/ethnicity • Pregnancy (if female) & expected date of delivery • Individual’s address • Date of suspected overdose • Date of diagnosis • Clinical signs/symptoms • Drug(s) suspected in overdose

Medical Examiners: Suspect Opioid Fatalities • Additional reporting requirements: • If the patient received naloxone prior to death • Who administered naloxone • Location of overdose • If individual was alone at time of overdose • Information about specimens tested • Results of lab testing for suspected substance(s) • If the overdose appeared to be intentional • Opioid prescription history for past 90 days • Prior overdose(s) (if known) • Date of the report • Name & contact information of medical examiner reporting