SBIRT Implementation in NYC Louis F . Cuoco, DSW, LCSW-R, ACSW - PowerPoint PPT Presentation

SBIRT Implementation in NYC Louis F . Cuoco, DSW, LCSW-R, ACSW Director Aisha A. Muhammad, LMSW SBIRT Coordinator John McAteer, LCSW-R Health Care Systems Coordinator Office of Program Initiatives and Community Liaison Bureau of Alcohol and Drug Use Prevention, Care, and Treatment

Overview 1. Alcohol-related morbidity among individuals in NYC 2. Drug-related prevalence, morbidity, mortality in NYC 3. Testing SBIRT in diverse venues in NYC 4. Challenges and next steps

Binge ¡Drinking ¡is ¡Common ¡Among ¡ ¡New ¡Yorkers* ¡Who ¡Drink ¡ 60 Drinker 50 Percent of Population 40 30 20 10 Binge Heavy 0 2002 2003 2004 2005 2007 2008 * aged 21 and over Year

The Drinking Patterns of New Yorkers are Similar to Americans Overall 60% Percent Using Alcohol in Past Any Drinking-NYC 50% Heavy Drinking-NYC Binge Drinking-NYC 40% Month US Prevalence 30% 20% 10% 0% 12-20 years 21years and older Age Group *Source: National Survey of Drug Use and Health, - NYC 2007-2008 averaged; US 2008 only

One-third of NYC Teens Drink and Binge Drinking is Common 45 41 Drink Binge 40 39 35 34 33 Percentage of Population 30 27 25 19 20 18 15 15 13 12 10 5 0 9 10 11 12 Total Grade Level Data Source: 2007 NYC Youth Risk Behavior

Among NYC Teens Who Drink Most Began Drinking at Age 14 or Younger How old were you when you had your first drink of alcohol other than a few sips? 2.9 never/only a few sips 13.1 �������� 9-10 years 38.3 11-12 years 13-14 years 21.4 15-16 years ��������� 7.8 10.7 5.9 Data Source: 2007 NYC Youth Risk Behavior Survey

Alcohol-Related ED Visits Are Increasing in NYC 3.0% 21 to 64 12 to 20 2.5% Percent of Total ED Visits 2.0% 1.5% 1.0% 0.5% 0.0% 2004 2005 2006 2007 2008 2009 Year Source : NYC DOHMH Syndromic

The Rate of ED Visits Related to Alcohol Use Among Underage Drinkers Has Nearly Doubled in Recent Years 300 264.2 244.8 250 Rate per 100,000 Population 198.4 200 179.2 139.5 150 100 50 0 2004 2005 2006 2007 2008 Year Source : Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2008 (11/2009 update).

Alcohol Related Hospitalizations Are Increasing, 1999-2006 120000 12.0% Number of Alcohol-related Hospitalizations Percent of Alcohol-related Hospitalizations 10.1% 10.1% 10.0% Number of alcohol-related hospital discharges Percent of Alcohol-related hospital discharges 9.8% 100000 10.0% 9.6% 9.6% 9.3% 9.0% 80000 8.0% 60000 6.0% 40000 4.0% 20000 2.0% 0 0.0% 1999 2000 2001 2002 2003 2004 2005 2006 Source: NYSDOH SPARCS, 1999-2006

1 in 10 of All Hospitalizations in New York City Are Alcohol-Related Any Alcohol Alcohol Dependence Alcohol Abuse Source : NYS DOH SPARCS, 2006

Overall prevalence past year use selected drugs, NYC (06-07 averaged) and US (2007) 7 6 Past Year NYC Past Year US Percent of population aged 12 years + 5 4 3 2 1 0 Cocaine Heroin Psychotherapeutics Pain Relievers Tranquilizers Source : SAMHSA NSDUH

Past year drug use by age group, NYC (2005-07 averaged) 30 Marijuana Cocaine Heroin Psychotherapeutics 25 Pain Relievers Note: included in Percent of population aged 12 years + Psychotherapeutics 20 15 10 5 0 12-17 years 18-25 years 26-34 years 35-44 years 45-54 years 55 years+ Source : SAMHSA NSDUH

Drug-related ED visits, NYC (2004-07) 450 Cocaine 400 350 Rate per 100,000 population 300 250 Heroin 200 Marijuana 150 Prescription 100 Opioids Benzodiazepines 50 Sedatives 0 2004 2005 2006 2007 Source : SAMHSA DAWN

Accidental overdose deaths involving prescription drugs are not declining in NYC 600 Number of Unintentional Drug Poisoning Deaths 500 400 300 Cocaine Heroin 200 Benzodiazepines 100 Opioid Analgesics 0 2005 2006 2007 2008 2009 Year of Death Source : NYC DOHMH ADUPCT (OCME)

Trends in Opioid Analgesic Use and Consequences, 2004-2010 Data from CHI “Preventing Misuse of Prescription Opioid Drugs” http://www.nyc.gov/html/doh/downloads/pdf/chi/chi30-4.pdf

Opioid Analgesic Prescriptions Filled, NYC (2007-2010) Source: New York State Prescription Drug Monitoring Program

Emergency Department Visits for Opioid Analgesic Misuse/Abuse Source: Drug Abuse Warning Network (DAWN)

Unintentional Opioid Analgesic Poisoning Deaths Note: Methadone is excluded from All Opioid Analgesics Source: NYC Office of the Chief Medical Examiner and Office of Vital Statistics

Summary: Alcohol and Drug Use in NYC ¡ • Harmful drinking behaviors – binge and heavy drinking – are common among New Yorkers who drink • Many teens in NYC begin drinking at a young age, increasing their risk for lifetime problems with alcohol- Binge drinking is common

Summary: Alcohol and Drug Use in NYC ¡ • Alcohol-related morbidity appears to be increasing in NYC • Marijuana, Cocaine, and pain reliever use is highest among 18-24 year olds ¡

¡ What is S creening B rief I ntervention & R eferral to T reatment (SBIRT)? An Evidence-based Model Program : - Identifying persons at ALL levels of alcohol and drug use through to dependence - Providing brief intervention to patients who are misusing alcohol and other drugs

What is S creening B rief I ntervention & R eferral to T reatment (SBIRT)? ¡ Assessing patients who may be using alcohol and/or drugs to determine if they would be eligible for treatment Referring patients who are probably alcohol and/or other drug dependent to addiction treatment. ¡ ¡

Efficacy in Primary Care Outcomes Source Randomized controlled trials of patients Meta-analysis of 22 RCTs (N=7619) Kaner EFS, Dickenson HO, presenting to primary care not specifically Beyer FR, Campbell F, Participants receiving BI had lower consumption for alcohol treatment with brief intervention Heather N, Saunders JB, than those in control group s/p 12 months or longer for up to four sessions. The studies were Burnand B, Poenaar D. (mean difference: -38 grams/week, 95% CI: -54to- culled from the literature utilizing seven Effectiveness of brief alcohol 23). data bases from 1962-2006 with data interventions in primary care Meta-regression showed little evidence of greater abstracted for trials that met criteria for populations. Cochrane reduction in alcohol consumption with longer trial quality. Database of Systematic treatment exposure or among trials which were less Reviews 2007, Issue 2. Art. clinically representative, No.:CD004148.DOI: Extended intervention was associated with a non- 10.1002/14651858.CD00414 significantly greater reduction in alcohol 8.pub3. John Wiley & Sons, consumption than brief intervention (mean LTD. (2009). difference=-28, 95%CI: -62 to 6 grams /week, I2=0% A systematic review of the literature from Calculated CPB was 176,000 QALYs saved over Solberg LI, Maciosek MV, 1992 through 2004 was made to identify the lifetime of a birth cohort of 4,000,000, with a Edwards NM. Primary Care relevant controlled trials and cost range in sensitivity analysis from -43% to +94%. Intervention to reduce Alcohol effectiveness studies was completed tin Misuse, Ranking Its Health Screening and brief counseling was cost-saving 2005. Clinically preventable burden (CPB) Impact and Cost from the societal perspective and a cost- was calculated as the product of Effectiveness. American effectiveness ratio of $1755/QALY saved. effectiveness times the alcohol- Journal of Preventive Sensitivity analysis indicates that from both attributable fraction of both mortality and Medicine 2008; 34(2) 143- perspectives the service is very cost-effective and morbidity (measured in quality –adjusted 152.e3 may be cost saving. life years or QALYs), for all relevant conditions. Cost effectiveness from both the societal perspective and the health system perspective was estimated.

¡ What is S creening B rief I ntervention & R eferral to T reatment (SBIRT)? ¡ ¡ ¡ ¡ ¡ SBIRT is a Paradigm Shift from the traditional model of service provision to one that is more inclusive, focusing on the “at-risk” individual for prevention and early intervention. ¡

Substance ¡use ¡occurs ¡ ¡ along ¡a ¡continuum ¡-­‑ ¡ ¡ SBIRT ¡is ¡grounded ¡in ¡this ¡perspective ¡

SBIRT ¡Covers ¡All ¡ ¡ Substance ¡Use ¡Disorders ¡ • Persons ¡who ¡use ¡mood ¡altering ¡drugs ¡ ¡ (including ¡alcohol ¡and ¡tobacco ¡users) ¡ ¡ • Persons ¡who ¡use ¡illicit ¡drugs ¡ ¡ • Persons ¡who ¡use ¡over-­‑the-­‑counter ¡or ¡ prescription ¡drugs ¡at ¡variance ¡with ¡ recommendations ¡ ¡

What ¡does ¡“at-­‑risk” ¡mean ¡for ¡alcohol ¡ users? ¡ • National ¡Institute ¡on ¡Alcohol ¡Abuse ¡and ¡Alcoholism ¡defines: ¡ ¡ ¡ -­‑ ¡Men ¡who ¡drink ¡more ¡than ¡14 ¡standard ¡drinks ¡per ¡week ¡or ¡more ¡ than ¡4 ¡drinks ¡on ¡occasion ¡ ¡ -­‑ ¡Women ¡who ¡drink ¡more ¡than ¡7 ¡standard ¡drinks ¡per ¡week ¡or ¡ more ¡than ¡3 ¡drinks ¡on ¡occasion ¡ ¡