Outline RxSafe Marin overview Safe Prescribing Guidelines Decreasing total opioid prescriptions Decreasing benzodiazepine and opioid co-prescription Increasing community awareness of opioid risks Increasing options for safe medication disposal
Call to Action: Marin County 120,000 104,625 100,000 80,000 Narcotic Prescriptions 60,000 41,518 40,000 20,000 0 2004 2013 471 Number of Non-fatal ED visits Emergency 344 Department 300 295 289 Narcotic Related 222 198 Visits 2006 2007 2008 2009 2010 2011 2012
Non-Medical Use of Pharmaceuticals: Marin County 11 th Graders 25% 22% Marin County California 20% 17% 17% 15% 13% 10% 10% 7% 7% 7% 7% 4% 5% 3% 3% 0% Pain Killers Cold/Cough Stimulants Sedatives Diet Pills Barbiturates Source: California Healthy Kids Survey, 2009-2012
What can we do as a community to prevent prescription drug misuse and abuse and save lives?
The Life of a Pill Manufacture Marketing Prescribers Pharmacists Community Safe Use Unsafe Use Disposal
Public Health Approach • “Every system is perfectly designed to get the results that it gets.” – Paul Batalden, MD • What are the key parts of the “system”? – Healthcare, law enforcement, policymakers, community members, schools, public health, business etc. • What are the results of the system? – Overdose deaths – Addiction and dependence – Misuse • How do we re-create the system to support safe medication use?
Community Based Prevention Action Team Data Collection and Steering Committee: Law Enforcement Action Monitoring Data, Messaging, Policy Team Action Team Representatives from: Marin County Office of Education, Marin County HHS, Healthy Marin Partnerships, Residents Intervention, Treatment and Prescribers and Pharmacists Recovery Action Team Action Team Backbone Support: HHS
Strategic Goal: Prescribers and Pharmacists Action Team • Goals: • Reduce total amount of narcotics prescribed in Marin County by 15% annually 2014-2016 • Increase doctors promoting proven non-opioid alternatives for managing chronic pain • Actions: • Adopt safe prescribing guidelines for emergency rooms and clinics • Create infographics of proven alternatives for MDs to use with patients
Opioid Prescriptions in Marin County
Prescribing Guidelines Excerpt • F. CAUTIONS REGARDING CO-MORBIDITIES OR INTERACTIONS • Caution should be used in patients taking other sedatives, including alcohol, antihistamines and benzodiazepines , as such use increases the risk of over-sedation and adverse events.
Opioid and Benzo Co-Prescribing by Age; Marin County, 2012-2015 16,000 14,000 12,000 Total Number of Patients 10,000 8,000 6,000 4,000 2,000 0 Younger than 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85 and older 15 Number of Patients on Opioids 2012-13 Number of Patients Co-Prescribed within 30 days 2014-15
Opioid and Benzo co-prescribing by age; Marin County, 2012-2015 100% 6% 14% 15% 18% 90% 23% 26% 27% 28% 80% 42% 70% 60% Number on Opioids and Benzos within 30 50% days of each other Number on Opioids Alone 40% 30% 20% 10% 0% Younger 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85 and than 15 older
Prescribing Guidelines Excerpt • B. PATIENT AND FAMILY INFORMATION • Patients being offered opioids should be made aware that opioids are the leading cause of drug overdose deaths nationally
Strategic Goal: Community Based Prevention Action Team • Goal: • Residents make informed and responsible choices regarding prescription opioids • Actions: • Develop communication campaign highlighting the risks of opioid use
Prescribing Guidelines Excerpt • H. SAFE STORAGE AND DISPOSAL • Patients should receive education and information on safe storage and disposal or return of controlled substances.
Strategic Goal: Law Enforcement Action Team • Goal: – Community members will have more locations where they can safely and conveniently dispose of unwanted medicines • Actions: – Adopt county-wide ordinance for safe medication disposal
Take-back Forum Key Stakeholders Represented Environmental Recovery Regional Pharmacists Interests Treatment Partners Law Enforcement Probation / DA County Counsel Seniors and Fire Pharmaceutical Water and Education Medical Waste Manufacturing Sanitation Local HHS Stewardship Physicians Government Representatives Programs
Take-back Forum: Identified Challenges • Drugs being misused are coming from medicine cabinets • Unintended environmental harm from home disposal • Existing disposal system is inadequate • Lack of funding and resources to host additional take back bins and events • Manufacturers don’t share responsibility for disposal
Prescription Drug Take Back Site Interactive Map
Recommendation: • Marin County Board of Supervisors consider an ordinance requiring drug manufacturers to share responsibility for designing, implementing, and maintaining a county-wide system for the safe and convenient disposal of unwanted medications for all Marin County residents.
THANK YOU Stay connected! www.RxSafeMarin.org Facebook.com/RxSafeMarin RxSafeMarin@gmail.com
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