Evergreen Treatment Services (ETS) CPAA Council Learning Session - PowerPoint PPT Presentation

Evergreen Treatment Services (ETS) CPAA Council Learning Session

Prescription Opioids Distributed in WA State The total number of daily doses of opioids sold to hospitals and pharmacies in WA State peaked in 2011 at 112 million. The increase over time was enormous, it has since declined modestly. http://adai.washington.edu/wadata/ARCOSopiates.htm

Prescription Opioids Distributed in WA State http://adai.washington.edu/wadata/ARCOSopiates.htm

Drug Overdose Rates 3 4/25/2017

WA Heroin vs Rx Opioid Deaths Over Time 4 4/13/17

WA Drug Overdoses vs Motor Vehicle Accidents 5 4/25/2017

WA Deaths by Race/Ethnicity 6

WA Unintentional Deaths

Center for Disease Control 8 Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled . From 2000 to 2015 more than half a million people died from drug overdoses. WA State: 1 person dies from drug OD every 1.5 days 4/25/2017

Police Evidence Testing- What’s on “the street” Data source: WA State Patrol Forensic Laboratory Services Bureau Data analysis: Alcohol and Drug Abuse Institute, UW http://adai.washington.edu/WAdata/cases.htm

WA State Data – Treatment Admissions: Opioids 10 4/25/2017

Treatment Admissions 11 4/25/2017

Regional Data

Mapping of Opioid Deaths

# All Controlled Substances Rx by County, 2014: Statewide Rate Recipients per 1,000 Residents (Age-Gender adjusted) = 296  336–377  317–335  293–317 304 Whatcom Whatcom Pend Pend San Juan  174–293 Oreille Oreille Okanogan Ferry Okanogan Ferry 282 333 Skagit 324 303 Skagit 321 Island 270 357 Stevens Stevens Clallam Clallam Snohomish Snohomish 325 317 Chelan Chelan Jefferson 294 Jefferson 335 Douglas Douglas 312 344 Spokane Spokane Kitsap 307 291 King King Lincoln Lincoln 319 281 Grays Grays Mason Mason Harbor Harbor 293 Kittitas Kittitas Grant Grant 336 317 276 293 Adams 276 Adams Pierce Pierce Thurston Whitman Thurston 267 Whitman 42 327 Lewis Lewis 358 Franklin Franklin Pacific Pacific Garfield Garfield Yakima Yakima 318 377 Columbia Columbia 292 321 352 37 350 Cowlitz Cowlitz 294 354 Asotin Asotin Skamania Skamania 338 Wahkiakum Benton Benton Walla Walla Walla Walla 309 174 Klickitat Klickitat Clark Clark 301 Source: WA Dept of Health

# Opioids Rx by County, 2014: Recipients per 1,000 Residents (Age-Gender adjusted) Statewide Rate = 232  274–302  252–273  227–252 227 Whatcom Whatcom Pend Pend San Juan  136–227 Oreille Oreille 207 Okanogan Ferry Okanogan Ferry 282 Skagit 253 252 Skagit 273 Island 210 299 Stevens Stevens Clallam Clallam Snohomish Snohomish 261 251 Chelan Chelan Jefferson 231 Jefferson 268 Douglas Douglas 252 289 Spokane Spokane Kitsap 249 226 King King Lincoln 263 Lincoln 210 Grays Grays Mason Mason Harbor Harbor 240 Kittitas Kittitas Grant Grant 279 249 210 227 Adams 218 Adams Pierce Pierce Thurston Whitman Thurston 215 Whitman 42 274 Lewis Lewis 291 Franklin Franklin Pacific Pacific Garfield Garfield Yakima Yakima 257 302 Columbia Columbia 227 269 287 37 272 Cowlitz Cowlitz 222 284 Asotin Asotin Skamania Wahkiakum Skamania 273 Benton Benton Walla Walla Walla Walla 238 136 Klickitat Klickitat Clark Clark 237 Source: WA Dept of Health

# Hydrocodone Rx by County, 2014: Statewide Rate Recipients per 1,000 Residents (Age-Gender adjusted) = 143  181–214  154–181  144–152 148 Whatcom Whatcom Pend Pend San Juan  78 –142 Oreille 126 Oreille Okanogan Ferry Okanogan Ferry 200 Skagit 160 154 Skagit 192 Island 124 214 Stevens Stevens Clallam Clallam Snohomish Snohomish 151 148 Chelan Chelan Jefferson 144 Jefferson 195 Douglas Douglas 149 192 Spokane Spokane Kitsap 149 135 King King Lincoln 164 Lincoln 120 Grays Grays Mason Mason Harbor Harbor 152 Kittitas Kittitas Grant Grant 176 149 140 142 Adams 142 Adams Pierce Pierce Thurston Whitman Thurston 129 Whitman 42 181 Lewis Lewis 181 Franklin Franklin Pacific Pacific Garfield Garfield Yakima Yakima 168 210 Columbia Columbia 136 169 213 37 177 Cowlitz Cowlitz 157 198 Asotin Asotin Skamania Wahkiakum Skamania 166 Benton Benton Walla Walla Walla Walla 148 78 Klickitat Klickitat Clark Clark 147 Source: WA Dept of Health

Methadone Rx by County, 2014: Statewide Rate Recipients per 1,000 Residents (Age-Gender adjusted) = 2.6  4.4 – 7.5  3.1 – 4.3  2.3 – 2.8 3.1 Whatcom Whatcom Pend Pend  1.4 – 2.1 San Juan Oreille Oreille 2.3 Okanogan Ferry Okanogan Ferry 6.3 Skagit 4.4 3.5 Skagit 4.5 Island 3.1 4.4 Stevens Stevens Clallam Clallam Snohomish Snohomish 7.5 3.9 Chelan Chelan Jefferson 4.8 Jefferson 2.6 Douglas Douglas 2.6 2.0 Spokane Spokane Kitsap 2.8 2.3 King King Lincoln 4.3 Lincoln 2.0 Grays Grays Mason Mason Harbor Harbor 2.4 Kittitas Kittitas Grant Grant 3.8 3.1 2.5 2.1 Adams 2.3 Adams Pierce Pierce Thurston Whitman Thurston 2.8 Whitman 42 2.6 Lewis Lewis 3.2 Franklin Franklin Pacific Pacific Garfield Garfield Yakima Yakima 1.5 4.6 Columbia Columbia 2.1 2.0 7.3 37 2.0 Cowlitz Cowlitz 3.5 1.4 Asotin Asotin Skamania Wahkiakum Skamania 3.8 Benton Benton Walla Walla Walla Walla 4.8 1.6 Klickitat Klickitat Clark Clark 2.1 Source: WA Dept of Health

(Preliminary) Buprenorphine Rx by Waivered Prescribers by County, 2015Q4 Recipients per 1,000 Residents (Age-Gender adjusted) (n=10,433) 2.3 – 4.4  1.5 – 2.2 2.9 Whatcom Whatcom  1.1 – 1.5 Pend Pend San Juan  0.3 – 1.1 Oreille Oreille Okanogan Ferry Okanogan Ferry 2.9 1.7 2.9 Skagit 1.4 Skagit 2.3 1.4 4.4 Island Stevens Stevens Clallam Clallam Snohomish Snohomish 3.3 2.2 Chelan Chelan Jefferson 0.6 Jefferson 1.7 Douglas Douglas 1.5 Kitsap * Spokane Spokane Kitsap 1.9 1.5 King King Lincoln 2.1 Lincoln 1.3 Grays Grays Mason Mason Harbor Harbor 1.3 Kittitas Kittitas Grant Grant 3.5 1.7 0.3 1.5 Adams 1.1 Adams Pierce Pierce Thurston Thurston * Whitman Whitman 42 2.7 Lewis Lewis 1.5 Franklin Franklin Pacific Pacific Garfield Garfield 1.1 Yakima Yakima * Columbia Columbia * 1.1 1.0 37 2.1 Cowlitz Cowlitz 1.5 * Asotin Asotin Wahkiakum Skamania Skamania 1.8 Benton Benton Walla Walla Walla Walla * 0.5 Klickitat Klickitat Statewide Rate = 1.5 * Rates based on fewer than Clark Clark 10 recipients are suppressed. 1.1 Data Source: Prescribers waivered to prescribe buprenorphine for medication assisted treatment, DEA. Waivered prescribers include those identified in July or December 2015 file. (Source WA DOH PMP)

Models of Care

Nurse Care Manager Model (Massachusetts) 20 Primary Care Model (Bup) • MD admits/initial • RN manages most visits thereafter  Under supervision of MD  Rx renewals  Coordination of care  Intensity of visit needs  UAs every visit • MD sees every 1-3 months • 1 full time RN: 100 patients • MD: 4 hrs/week 4/25/2017

Hub and Spoke Model (Vermont) 21 Partners Primary Care with OTPs (Bup) • Patients inducted/stabilized at OTP • Transferred to Primary Care clinic after stabilized • Bup Rx continued with PCP • Refer back to OTP as needed for restabilization 4/25/2017

Cooperative Opioid Prescribing (CoOP) - Maryland 22 Partners Primary Care with OTP (Bup) • Patients inducted/stabilized at either OTP or PCP • Remain with PCP if stable • Refer to OTP as needed for restabilization 4/25/2017

WA Models Currently Being Tested 23 • SAMHSA MAT-PDOA grant • Nurse Care Mgr Model + CoOP Model • Tested at ETS and HMC (OTP and Primary Care settings)  ETS sites in Grays Harbor and Olympia  Using telehealth for MD • First year outcome results have been published • People are desperate for treatment options 4/25/2017

Addiction is a brain disease: Management of a chronic medical condition Prevention, Intervention, Education Prescribers and users Medication Assisted Treatment Works: People do recover Treatment Benefits Society: Crime rates decline, costs decline

Medication Assisted Treatment

Acute to chronic opioid use Euphoria Withdrawal Normal Tolerance and Physical Dependence Acute use Chronic use

Pills to IV drug use 27 4/25/2017

Need and interest in treatment in WA State • Most drug injectors in WA State reported they would like help stopping or reducing their drug use • based on the 2015 WA State Syringe Exchange Survey http://adai.uw.edu/pubs/infobriefs/SEPoverview2015.pdf

Medication Assisted Treatment 29 • Addiction is a chronic, relapsing medical disorder • Disease of the brain’s reward system • Similar to hypertension and diabetes  Medication helps stabilize the disorder • Addiction doesn’t get cured. It gets managed. 4/25/2017

Medication Assisted Treatment: Goals 30 • Stabilize the body  Alleviate withdrawal  Alleviate craving  Normalize brain functioning • Engage the patient in recovery  Understand chronic, relapsing medical disorder  Medication is life-saving: 50% lower OD risk when in MAT  Duration of treatment is unknown 4/25/2017