Nevadas Evolving Opioid Crisis: Successes and Challenges STEPHANIE - PowerPoint PPT Presentation

Nevada’s Evolving Opioid Crisis: Successes and Challenges STEPHANIE WOODARD, PSY.D. DHHS SENIOR ADVISOR ON BEHAVIORAL HEALTH KEITH CARTER, HIDTA YENH LONG, PHARM.D., BCACP NEVADA STATE BOARD OF PHARMACY

What’s HIDTA? High Intensity Drug Trafficking Area Functions under the executive office of the President Office of National Drug Control Policy (ONDCP)

HIDTA – Designated by Congress • A coalition of federal, state, and local law enforcement agencies • 17 TASK FORCES in Nevada working on drugs, gangs, violent crimes • Intelligence, Training and Prevention Programs Nevada HIDTA values partnership, innovation, leadership and excellence

National Drug Control Strategy This Strategy is focused on achieving one overarching strategic objective: Building a stronger, healthier, drug free society today and in the years to come by drastically reducing the number of Americans losing their lives to drug addiction in today’s crisis.

How will this be done? • Preventing the start of drug use • Providing treatment services leading to long-term recovery for those suffering from addiction • Aggressively reducing the availability of illicit drugs in America’s communities .

What are the strategies? • Develop “evidence” based programs • Expand the Use of Prescription Drug Monitoring Programs • Eliminating Barriers to Treatment Availability • Improve the Response to Overdose • Leverage the Full Capabilities of Multi-Jurisdictional Task Force Enforcement Programs

2016-2019 Trends • Nevada has fewer pharmaceutical drugs on the streets but more counterfeit pharmaceutical drugs • Trafficking, sales and use of methamphetamine remains high • Methamphetamine blended with opioid drugs • Trafficking, sales and use of heroin remains stable • Black market marijuana is robust • Counterfeit marijuana products blended with opioids • Cocaine trafficking and use has dramatically increased

Health and Human Services 5-Point Strategy To Combat the Opioid Crisis (Rx and Heroin) https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/index.html (Azar; 2017)

2018 National Safety Council 1. Mandating prescriber education 2. Implementing opioid prescribing guidelines 3. Integrating PMP into clinical setting 4. Improving data collection/sharing 5. Treating opioid overdose 6. Increasing availability of opioid use disorder treatment

Nevada’s MAT Treatment Infrastructure • 192 providers are waivered to provide buprenorphine however, not all prescribe. For those who do prescribe, very few prescribe to their upper limit. • 15 Opioid Treatment Programs within Clark, Washoe and Carson City • Capacity remains available overall however, connection to high-quality, integrated services remains a challenge • Rural/Frontier communities have limited access • Solutions include integrated treatment networks and increasing access within primary care

Integrated Opioid Office Treatment Based Substance Opioid Abuse and Recovery FQHCs Treatment Treatment Provider Centers Inpatient Withdrawal  ASAM Patient and IOTRC management residential Placement 3.5 and 3.7 services  Mobile Recovery Outreach Teams Opioid Treatment  Peer Recovery Transitional Program/ Support Housing Methadone CCBHC Unit  Screen, Assess, Stabilize, Hand-off

MAT Prescribers in Nevada, Fiscal Year 2018

MAT Prescribers in Nevada, Fiscal Year 2019

MAT Prescribers in Reno 2018

MAT Prescribers in Reno 2019

MAT Prescribers in Las Vegas 2018

MAT Prescribers in Las Vegas 2019

Overdose Education/ Naloxone Distribution Distribute Naloxone to individuals with Pharmacies to evaluate risk and high-risk for overdose such as: dispense without a prescription Overdose survivors; Release/discharge from controlled environment following detox: jails, detox facilities, residential treatment centers, prison; Individuals who self-identify as at-risk: i.e. needle exchanges Co-Prescribe for High Promote the Dosage/High Risk Pain Good Samaritan Law Patients

Overdose Education/ Naloxone • 56 Law enforcement and first responder agencies across the state have been supplied with 2,927 2-dose units of naloxone. Distribution • 13 Distribution across Nevada sites have distributed over 3,516 units of Naloxone (including the IOTRCs) • With the assistance of County Coalitions, Overdose Education and Naloxone Distribution trainings have distributed 1,506 2-dose naloxone kits to members of the community statewide • Over 277 reported opioid overdose reversals

Healthcare Utilization Costs Opioid-Related Hospital Data, State of Nevada Residents, 2010-2019* In October 2015, ICD-10-CM codes were implemented. Previous to October 2015, ICD-9-CM codes were used for medical billing. Therefore, 2015 data consists of two distinct coding schemes, ICD-9-CM and ICD-10-CM respectively. Due to this change in coding schemes, hospital billing data from October 2015 forward may not be directly comparable to previous data. Emergency Room Emergency Room Percent Inpatient Inpatient Percent Year Encounters (ED) Crude Rates Change Admissions (IP) Crude Rates Change 2010 2,963 109.5 4,362 161.2 2011 3,188 117.1 7% 4,755 174.7 8% 2012 3,473 126.3 8% 5,042 183.3 5% 2013 4,122 147.2 17% 5,067 180.9 -1% 2014 4,543 159.8 9% 5,517 194.0 7% 2015 5,695 196.5 23% 7,032 242.7 25% 2016 7,495 253.8 29% 8,675 293.7 21% 2017 7,165 239.9 -5% 8,744 292.8 0% 2018 6,530 215.4 -10% 9,616 317.2 8% 2019* 1,515 2,433 Percent Change 2010-2018 97% 97% Rates are per 100,000 State of Nevada Population.

Nevada’s Opioid Overdose Deaths Opioid-Related Overdose Deaths, State of Nevada Residents, 2010-2018* *Data for 2018 are preliminary.

Opioid Crisis is Evolving • Nevada HIDTA has classified heroin, fentanyl, and methamphetamines as three of the top threats in 2018 (Nevada HIDTA, 2018) • Fentanyl is 50-100 times more potent than heroin • Can be mixed into drug supply (pills, heroin, methamphetamine) 2018 Overdose Deaths Clark Washoe Synthetic opioids including fentanyl, related-deaths 56 13 Methamphetamine-related deaths 200 50 Heroin related-deaths 76 16

Nevada’s Opioid Overdose Deaths Opioid-Related Overdose Deaths by Drug Category, State of Nevada Residents, 2010-2019* Natural and Semi- Synthetic Unspecified Year Heroin Methadone Synthetic Opioids Narcotic 2010 19 298 98 39 45 2011 40 300 97 45 46 2012 42 301 69 25 40 2013 48 241 70 25 39 2014 61 216 63 31 37 2015 79 254 57 31 37 2016 82 228 52 49 28 2017 92 234 45 64 18 2018* 102 207 33 76 10 2019* 32 40 7 26 1 A person can be included in more than one drug group, and therefore the counts above are not mutually exclusive. *Data for 2018 and 2019 are preliminary. Data for 2019 includes Quarter 1 only.

Nevada’s Opioid and Benzodiazepine Overdose Deaths Opioid-Related Overdose Deaths, State of Nevada Residents, 2010-2019* Opioid-Related Overdose Crude Percent Benzodiazepine Related Opioid and Benzodiazepine Year Deaths Rates Change Overdose Deaths Related Overdose Deaths 2010 437 16.2 161 139 2011 460 16.9 5% 166 143 2012 437 15.9 -6% 162 140 2013 396 14.1 -11% 126 106 2014 365 12.8 -9% 125 109 2015 409 14.1 10% 130 117 2016 393 13.3 -6% 155 126 2017 401 13.4 1% 123 106 2018* 356 11.7 -13% 139 112 2019* 92 22 19 Percent Change 2010-2018* -27% Rates are per 100,000 State of Nevada Population. *Data for 2018 and 2019 are preliminary. Data for 2019 includes Quarter 1 only. Each year: •Roughly 85% of all benzodiazepine-related overdose deaths also involve opioids. •Roughly 30% of all opioid-related overdose deaths also involve benzodiazepines.

Nevada Prescribing Patterns 2016 Opioid Painkiller Prescriptions per 100, 2011-2016 NV (PMP) NV (CDC Estimates) US *definitions vary slightly between US and NV opioid prescriptions and populations used to calculate rates (Sources: Guy et al., 2017; Office of Public Health Informatics and Epidemiology; Prescription Monitoring Program)

Opioid Painkiller Prescribing Rates Per 100, by County, 2016 County Rate Carson City 105.4 Churchill 106.8 Opioid Clark 84.3 Douglas 102.0 Prescription Elko 71.7 Esmeralda 72.5 Rates 2016 Eureka 92.7 Humboldt 75.5 Lander 85.2 Lincoln 60.7 Lyon 130.0 Mineral 158.2 Nye 155.6 Pershing 69.5 Storey 146.9 Washoe 87.5 White Pine 99.9 Statewide 87.5 (Sources: Office of Public Health Informatics and Epidemiology; Prescription Drug Monitoring Program)

Controlled Substance Abuse Prevention Act (AB474; 2017)  Prioritize patient safety and responsibility  Preserve clinical decision-making  Promote the patient-prescriber relationship  Reduce the amount of inappropriate prescribing  Prevent addiction to prescription drugs through monitoring and mitigating risk  Enhance the quality of care for patients with acute and chronic pain  Avoid legislation of the practice of medicine by establishing a standard of care