Substance Abuse System of Care Senate Health and Welfare Committee - PDF document

1/13/2016 Substance Abuse System of Care Senate Health and Welfare Committee Harry Chen, MD, Commissioner Barbara Cimaglio, Deputy Commissioner, Alcohol and Drug Abuse Programs January, 2016 Public Health Approach  Focuses on population and individual health  Using data to understand consumption and consequence patterns  Understanding the nature and impact of the problem to set priorities for policy, access, and infrastructure Vermont Department of Health 2 1

1/13/2016 ADAP’s Objective To Prevent and Eliminate the problems caused by alcohol and drug misuse As reported in the Legislative Report “Substance Abuse Treatment Services Objective and Performance Measures” Vermont Department of Health 3 Affordable Health Care – Percent of All Vermonters adolescents in have access to grades 9-12 affordable who used quality marijuana in the Support healthy healthcare past 30 days Vermonters are people in very stage (YRBS) Objective: Prevent and eliminate the problems caused by alcohol healthy of life – reduce the and drug misuse. percentage of Strong Families, Safe people who engage Percent of Communities: Indicators: in binge drinking of % of people adolescents who Vermont’s 1) % of adolescents age 12-17 binge drinking in the past 30 days alcohol beverages who need and drank alcohol in children live in 2) % of adolescents in grades 9-12 who used marijuana in the past 30 the past 30 days do not receive stable and days (YRBS) treatment for supported Decrease % of 3) % of persons age 12 and older who need and do not receive alcohol families and youth who binge alcohol treatment safe communities 4) % of persons age 12 and older who need and do not receive illicit drink - 2020 Percent of drug use treatment adolescents who % of people reported ever Decrease % of youth High Quality who need and Performance Measures: using a and Affordable who used marijuana prescription drug do not receive 1) Are we appropriately referring students who may have a substance Education: in the past 30 days - without a treatment for abuse problem? Learners of all 2020 prescription 2) Are youth and adults who need help starting treatment? illicit drugs ages have the (YRBS) 3) Are youth and adults who start treatment sticking with it? opportunity for % of persons age 4) Are youth and adults leaving treatment with more support than success in when they started? 12+ who need and education 5) Are adults seeking help for opioid addiction receiving treatment? do not receive (under development) alcohol treatment Vermont Department of Health, Division of Alcohol and Drug Abuse Programs, January 2015 2

1/13/2016 State Substance Abuse Services Other State VDH/ADAP DVHA DCF/ Care Coordination – Preferred Provider Reach Up & Lund Screening Team Care Oversight & Quality AHS VCCI, Spoke Staff Integrated Family Services Prevention – Community, DOC Screening School-Based Services, High Risk Populations Treatment - DOC Therapeutic Communities Private Practitioner Intervention – PIP, IDRP, Pre-Trial Services Outpatient SBIRT, School Health, VPMS, Hospital Detoxification Court Screening Naloxone, Rocking Horse Spoke/Physician Services Pharmacy/Medication Treatment – DMH Co-Occurring Preferred Provider Outpatient DMH Elder Care Clinicians Intensive Outpatient Utilization Review - DAIL – Screening Residential Residential Services Hub – Methadone AOE – School Based Health Halfway/Transitional Housing Services Support Services - DLC – Regulation & Training Recovery Services – Laboratory, Transportation Recovery Centers, Peer DOT – Impaired Driver Prevention Support Vermont Department of Health 5 Substance Abuse Continuum of Care Specialty Fewest Hospital, DOC (Res, Number Medical Services Hubs) of Highest Level of Intensive People Partial Hospitalization Outpatient Care Treatment (IOP) Physician (spoke) OP Outpatient Treatment Services, Private (OP) Practitioner/DMH OP Screening, Brief Intervention, AHS-SATC Screening Largest Referral for Treatment (SBIRT) Number of People Lowest Prevention Services Level of Care Recovery Services are Available to Those at All Levels of Care Vermont Agency of Human Services 6 3

1/13/2016 Actions to Address Opioid Drug Abuse Enforcement/Regulation Education Tracking and • Identification verification at • Prescriber Monitoring pharmacies education • Vermont Prescription • Law enforcement training on • Community Drug Monitoring prescription drug misuse and education System (VPMS) diversion • Naloxone • Regulation for prescribing distribution opiates Proper Medication Disposal Treatment Options • Keeping medications safe at home • Care Alliance for Opioid Addiction • Proper medication disposal guidelines Regional Treatment Centers • Outpatient and residential treatment consistent with FDA standards • Community take-back programs at state-funded treatment providers • Media Campaign • Recovery Centers Vermont Department of Health 7 Investing in Substance Abuse Services Saves Money  Prevention: $1 invested in substance abuse prevention saves $10 – $18 in costs associated with health care, criminal justice, and lost productivity  Intervention: Substance abuse screening and brief counseling is as effective as other health prevention screenings  Treatment: $1 invested in addiction treatment saves between $4 – $7 in costs associated with drug related crime, criminal justice, and theft  Recovery: Relapse rates for addiction resemble those of other chronic diseases such as diabetes, hypertension, and asthma Vermont Department of Health 8 4

1/13/2016 VDH/ADAP FY15 Expenditures by Level of Care Average Cost/Person Level of Care Total Expenditures Served Prevention $3,549,893 $9 Intervention $4,043,957 $159 Treatment* $36,059,656 $3,148 Recovery $2,064,089 $453 *This reflects only ADAP expenditures. DVHA incurs additional expenditures for treatment costs provided by physicians, hospitals, private practitioner mental health counselors, medication costs (buprenorphine), and labs (urinalysis). Vermont Department of Health 9 More than 90% of SFY15 Medicaid-Funded Substance Abuse Services are Paid through the DVHA and ADAP Medicaid Appropriations ADAP, $25,447,622 Outpatient DAIL, Intensive Outpatient Residential SA $144,192 DVHA, Hub $38,304,866 DCF, $953,228 Hospital Pharmacy/Medication Physician & Spoke DMH, Private Practitioner MH/SA $847,312 Laboratory Includes: Primary Diagnosis Codes 291-292.9, 303-305.9, 305.2-305.9, Drug Therapeutic Classes H3W and C0D, DRGs 895,896,897 5

1/13/2016 MEDICAID Claims with Substance Abuse ADAP Uninsured Diagnoses by Department Paying for Services SFY2015 SFY2015 1676 Unique 12,858 Unique Individuals Individuals ADAP DVHA and Only DVHA ADAP ADAP 4813 5213 Only 1676 451 185 1882 164 150 DVHA Funded Services ADAP Funded Services ADAP Funded Services Hospital Outpatient ADAP services for people Pharmacy/Medication Intensive Outpatient without insurance and for Physician & Spoke Residential SA services not covered by Private Practitioner MH/SA insurance Hub Laboratory Includes: Primary Diagnosis Codes 291-292.9, 303-305.9, 305.2-305.9, Drug Therapeutic Classes H3W and C0D, DRGs 895,896,897 Most Common Substances Used by Vermonters ages 12+ by Type of Substance 100 Alcohol- Past 30 day use Marijuana - Past 30 day use 90 Non-Medical Use of Pain Relievers - Past year use 80 70 62 61 60 61 61 60 60 59 59 59 58 60 50 40 30 20 13 13 13 11 12 12 10 10 9 9 10 10 * 5 5 5 5 5 5 5 5 0 5 4 3 2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 * Statistically significant reduction 2011/12 to 2012/13. Source: National Survey on Drug Use and Health, 2003-2014 12 Vermont Department of Health 6

1/13/2016 Non Medical Use of Pain Relievers is Decreasing in Vermont for all Age Groups Percent of Vermonters reporting past year non-medical use of pain relievers by age in years (NSDUH) 16 14 12 10 * ♦ 12+ 8 12-17 6 * 18-25 4 * 26+ 2 0 * Statistically significant reduction: * from 2011/2012, ♦ from 2012/2013 Vermont Department of Health 13 The number of Vermonters treated for opioid addiction continues to increase Number of people treated in Vermont by substance 7,000 Alcohol Marijuana/Hashish Heroin/Other Opioids All Others 6,000 5,000 4,000 3,000 2,000 1,000 0 Vermont Department of Health Source: Alcohol and Drug Abuse Treatment Programs 14 7

1/13/2016 The number of individuals using heroin at treatment admission is increasing faster than for other opioids/synthetics Type of Opioid Being Used on Admission to Treatment Heroin Other Opioids/ Synthetics Non-prescription Methadone 3500 3000 People Treated 2500 2000 1500 1000 500 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Vermont Department of Health 15 People seek treatment for opioid addiction much sooner after first use than with alcohol Elapsed Time (Years) Between Age of First Use and Age at Treatment Admission for Daily Users of Opioid and Alcohol Alcohol Opiates 700 Number of admissions 600 500 400 300 200 100 0 Elapsed Time (Years) Opioids Alcohol Average Elapsed Time 8.2 +/- 7 years 24.8 +/- 12 years Number of Admissions 6776 6207 Source: Alcohol and Drug Abuse Treatment Programs, admissions 2005-2011 Vermont Department of Health 16 8