Opioid Epidemic as it Relates to Counties Ms. Jessica Cance Agency - PDF document

89 TH A NNUAL W EST T EXAS C OUNTY J UDGES AND C OMMISSIONERS A SSOCIATION C ONFERENCE Wednesday, April 25, 2018 11:05 – 11:55 a.m. “Opioid Epidemic as it Relates to Counties” Ms. Jessica Cance Agency Analytics Unit Manager Ms. Kasey Strey National Prevention Network - Prevention Coordinator for Texas , SPF-Rx Project Director

4/11/2018 Opioids in Texas: The County Perspective Jessica Duncan Cance, M.P.H., Ph.D. Texas Departm ent of State Health Services Kasey Strey, A.C.P.S. Texas Health and Hum an Services Com m ission Objectives • Describe the opioid crisis nationally and in Texas • Understand the Bio-Psycho-Social aspects of substance misuse/substance use disorders • Define the role of prevention in the opioid crisis • Discuss evidence-based strategies designed to prevent opioid misuse and associated consequences 2 3 1

4/11/2018 Drug Overdose in Texas • In 2016, 2,790 Texans died due to drug overdose • More than the population of a Texas 6A high school • More than the population of nearly 60 percent of the cities and towns in Texas Sources: Texas DSHS Provisional counts of drug overdose deaths, 2/15/2018. U.S. Census Bureau (2017). Annual Estimates of the Resident Population in Texas: April 1, 2010 to July 1, 2016. Available at: https://www.census.gov/data/datasets/2016/demo/popest/total-cities-and-towns.html 4 What are Opioids? Type of Opioid Exam ples Natural opioids Morphine, Codeine, Thebaine (sometimes called opiates ) Hydromorphone, Hydrocodone, Semi-synthetic Oxycodone, Heroin Fully synthetic Fentanyl, Methadone, Tramadol 5 Source: National Institute on Drug Abuse The Opioid System • Controls pain, reward, and addictive behaviors • Opioids attach to and activate opioid receptor proteins • Opioids suppress perception of pain and calm emotional response to pain Source: Gutstein H, Akil H. Opioid Analgesics. In: Goodman & Gilman’s the Pharmacological Basis of 6 Therapeutics . 11th ed. McGraw-Hill; 2006:547-590. 2

4/11/2018 Data Trends Understanding Opioid Misuse and Associated Consequences in Texas 7 Past Year Substance Use among Youth Ages 12-17: TX vs. US 15 12.3 12 10.5 9 6 4.2 3.7 3 0.6 0.6 0.04 0.07 0 Marijuana Cocaine Pain Reliever Heroin Misuse Texas U.S. Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016. 8 Past Year Substance Use among Adults 18 or Older: TX vs. US 15 13.9 12 10.1 9 6 4.5 4.5 3 2.0 1.5 0.22 0.36 0 Marijuana Cocaine Pain Heroin Reliever Misuse Texas U.S. Source: SAMHSA, Center for Behavioral Health Statistics and Quality, 9 National Survey on Drug Use and Health, 2015 and 2016. 3

4/11/2018 Accidental Poisoning Deaths in Texas: 1999-2015 2,500 2,226 2,000 Number of Deaths 1,500 Total 1,174 Opioids 1,000 Cocaine Psychostimulants 500 Benzodiazepines Other Drugs 0 1999 2003 2007 2011 2015 Source: Texas Death Certificates Accidental Poisonings based on County of Occurrence 10 Prepared by Texas Department of State Health Services, Center for Health Statistics 3/6/2018 Texas Health Data: Opioid-Related Deaths 11 Drug-Related Inpatient Emergency Department Visits: 2016 3000 2,594 2250 1,970 1500 862 727 750 305 0 Opioids Benzodiazepines Psychostimulants Cocaine Marijuana Source: Texas Hospital Inpatient Discharge Public Use Data Files, Q1 – Q4 2016 . Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. 3/7/2018. 12 4

4/11/2018 Texas Health Data: Opioid-Related Inpatient ED Visits 13 Texas Poison Center Network Drug-Related Exposure Calls: 2000-2017 9000 Antidepressants 7500 6000 Benzodiazepines 5265 4500 All opioids 3000 1500 Stimulants 0 2000 2002 2004 2006 2008 2010 2012 2014 2016 Source: Texas Poison Center Network, 2000-2017. Analyses include only those calls involving drug exposures; 14 calls asking for information were not included. Texas Health Data: Opioid-Related Exposure Calls 15 5

4/11/2018 Rate of Opioid-Related Poison Center Network Calls, by County: 2011-2015 16 Why Do People Use? Risk Factors for Opioid Misuse 17 BioPsychoSocial Framework Biological -Genetics -Neurochemistry -Drug Effects -HPA Axis Social Psychological -Social Support -Emotions -Family Background -Thinking -Interpersonal -Attitudes -Beliefs Relationships -Stress -Cultural traditions Management -Socioeconomic -Perceptions Status 18 6

4/11/2018 Pain in the United States • In 2016, nearly one in five adults had chronic pain in the past six months • Estimated cost of $635 billion • Late 1990s, pain recognized as “The Fifth Vital Sign” Sources: QuickStats: Age-Adjusted Percentage of Adults Aged ≥ 18 Years Who Were Never in Pain, in Pain Some Days, or in Pain Most Days or Every Day in the Past 6 Months, by Employment Status — National Health Interview Survey, United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:796. Gaskin, D.J., & Richard, P. (2012). The Economic Costs of Pain in the United States. The Journal of Pain , 13 (8) , 715. 19 Correlates of Prescription Opioid Misuse Social Availability Community Norms Community Retail Availability Organizational Prescriber Norms Interpersonal Caregiver Peer Monitoring Approval Communication Number of Disapproval Friends Using Intrapersonal Refusal Skills Risk Perception Sources: McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion 20 programs. Health Education & Behavior , 15 (4), 351-377. SAMHSA CAPT (2016). Preventing Prescription Drug Misuse: Understanding Who Is at Risk. Available at: https://www.samhsa.gov/capt/sites/default/files/resources/preventing-prescription-drug-misuse-understanding.pdf What Can We Do? Strategies to Prevent Opioid Misuse and Associated Consequences 4/11/2018 21 7

4/11/2018 Public Health Approach to Preventing Substance Misuse and Addictions 22 Source: http://www.astho.org/addictions/ Evidence-Based Prevention Strategies Problems Risk and Prevention and Related Strategies Protective Behaviors Factors What should we What? do? And how? But why here? And why? Source: Luciani, N. (2016, September 26). Community-level Strategic Planning to Prevent Non-medical Use of Prescription Drugs in Texas . Lecture presented at CAPT Training - Fall Prevention Provider Meeting, Austin. 23 What is Primary Prevention? 24 8

4/11/2018 Community Education • Youth and Young Adults • Communities • Health Providers 25 Disposal and Storage • Take-Back Events and Drop-Boxes • Individual Medication Disposal Pouches • Lock-Boxes Sources of Misused Prescription Medication among Texas College Students: 2017 60 5 5 3 8 Percentage 40 2 7 2 0 20 9 4 0 Someone Personal Someone Home Stealing It On-Line with a Prescription without a Medicine Prescription Prescription Cabinet Source: 2017 Texas College Survey of Substance Use: Main Report. 26 Available at: https://texascollegesurvey.org/wp-content/uploads/2017/08/CDAS_report_final_2017.pdf Workforce Development • Prevention, Treatment, and Recovery Professionals • Prescribers and Other Health Care Professionals Source: Shah, A., Hayes, C.J., & Martin, B.C. (2017). Characteristics of initial prescription episodes and likelihood of long-term opioid use: United States, 2006-2015. MMWR Morb 27 Mortal Wkly Rep; 66:265-269. 9

4/11/2018 Prescribing Patterns, by County: 2015 Source: CDC Vital Signs, July 2017 Interactive maps: https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html 28 Data Infrastructure • Prescription Monitoring Programs • High Utilization • Consistent Reporting • Incorporate into Prevention Planning Source: www.cdc.gov/vitalsigns/opioids 29 Texas Prescription Monitoring Program • Moved from the Department of Public Safety to the Texas Board of Pharmacy in 2016 • Prescriber mandate passed Spring 2017 (House Bill 2561, 85 th Regular Session) • Registration • Requires patient look-up prior to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol 30 10

4/11/2018 What is Secondary Prevention? 31 Referrals and Resources • Outreach, Screening, Assessment, and Referral Centers (OSARs) • Treatment Centers • Peer Coaches • Recovery 32 Outreach, Screening, Assessment, and Referral Centers (OSARs) Source: https://www.dshs.texas.gov/sa/OSAR/ 33 11

4/11/2018 Screening & Brief Intervention (SBI) Designed for use by counselors • and professionals who do not specialize in addiction treatment Person-centered methodology • that uses motivational techniques based on the person’s readiness to change Gives feedback and • recommendations respectfully, without judgment or accusations, in the form of useful information 34 Treatment and Recovery • Medication Assisted Therapies • Methadone • Buprenorphine • Naltrexone 35 What is Tertiary Prevention? 36 12