Treat Opioid Use Disorder Now! Save Lives in Your Community!
References I have no financial disclosures.
ADDICTION IS NOT A MORAL FAILING. It is a chronic disease that requires medical treatment.
Chronic Brain Condition with Treatment Substance Use Disorder Chronic–Relapsing Needs Chronic Care
No Longer Chasing the High Euphoria Normal Opioid Withdrawal Agonist Tolerance & Physical Dependence Acute use Chronic use Therapy
The Problem
70,237 people Rise in Drug Died from drug overdoses in the US in 2017 Overdose Deaths Drug overdose deaths, 1980 to 2017
In 2017 overdose deaths passed fatal motor vehicle collisions 1 IN 96 DIE OF AN 1 IN 103 DIE IN OVERDOSE… CAR CRASHES
DRUG-RELATED ED VISITS a lost opportunity… ● 17% of patients discharged from acute care with a Substance Use Disorder (SUD) diagnosis ● For every 1,000 people over 15, there are 25 drug-related ED visits ● 28% of adult ED patients screen positive for SUD
HOSPITAL ACQUIRED CONDITION OVERDOSE 15 x overdose increase in month after discharge
CA Bridge Delivers Addiction Treatments When it Matters Most Number of deaths after ED treatment for nonfatal overdose by number of days after discharge in the first month (n=130) Study of patients treated in • Massachusetts EDs for opioid overdose 2011-2015 Illustrates the short-term increase in • mortality risk post-ED discharge Of patients that died, 20% died in the first • month Of those that died in the first month, 22% • died within the first 2 days Source: Weiner, Scott, et al.. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Annals of Emergency Medicine. April 2, 2019.
Treatment Starts Here
Medications for Opioid Use Disorder • “Detox” = 80-90% relapse rates • Addiction is a chronic disease requiring medication • With MOUD (aka MAT) – 70% ↓ mortality – ↓ illicit opioid use – ↓ HIV and Hep C transmission – Employment, improved quality of life • Medication for opioid use disorder is more successful than counseling Pierce Addiction 2016 Clark Health Affects 2011 Kimber BMJ 2010
Buprenorphine.. “ partial agonist” Respiratory depression • Treats cravings and physical symptoms • “Ceiling” effect protects against euphoria or significant respiratory depression….very safe • High affinity to opioid receptors…bumps off full agonist – Decrease in receptor activity induce withdrawal if patient just used opioid (heroin or pills)
Benefits of MAT: Decreased Mortality Live Longer! Bup Saves Lives! Standardized Mortality Ratio Dupouy et al., 2017 Evans et al., 2015 Sordo et al., 2017
37% vs 78%
Replacing One Drug For Another? Buprenorphine Abuse? • Brain chemistry and structure of OUD is changed. • Those changes require a medication to stabilize the disease. • Diabetes - insulin is a stabilizing medication • Dosage of meds used does not get them high. Restores balance in the brain’s circuits. • Abuse among opioid-dependent people is low • “Street use” of bup is for patients dependent on opiates without access to MOUD. Lofwall RA. J Addic Med 2014
California Bridge Program 24-7 access to high quality treatment of substance use disorders in all California hospitals. Now 50+ hospitals as the access point for patients with substance use disorders.
Changing Lives, Changing Health Care: 8 months of California Bridge in 52 Hospitals 5078 3818 2605 2273 patients identified Patients provided with OUD with treatment OUD Opioid Use Disorder MAT Medication for Addiction Treatment
What is COWS? How sick do you feel?
ASK THESE QUESTIONS: 1. How sick do you feel? 2. When was the last time you used? 3. What did you use? (frame the question “because I don’t want to make you sick, I want to help you get better” 4. Have you used Methadone recently?
DEA REGULATIONS • If patient is admitted for a medical or surgical reason other than opioid dependency: • Methadone and buprenorphine can be administered to maintain or detoxify, including new starts • If the patient presents to ED or urgent care in withdrawal: • Legal to administer 72 hours of methadone or buprenorphine to treat withdrawal • On discharge, regular rules apply
Marshall 2019 ED DATA: • 119 patients with Opioid Use Disorder TREATED • 97% Follow-Up Rate, CARES and STEPS • 82 % in treatment at 1 month • 65% of all 2019 starts still in treatment as of February, 2020
Get your X-waiver NOW! PCSSNOW.ORG Did som eone say 24 hours of CME? WHAT?? Sign m e up for CME and TRAINING to provide LIFE SAVING TREATMENT!! Online is FREE. WORKSHOP : 3:30 -5:30 TODAY AND TOMORROW to COMPLETE YOUR FIRST 4 HOURS!!!
Arianna Sampso n, PA-C, APP L e ad Marshall Me dic al Ce nte r, Plac e rville, CA Dire c to r, Co -Princ ipal I nve stigato r, CA Bridge Pro gram Co Dire c to r, CA Substanc e U se Navigato r (SU N) Pro gram Arianna@bridge to tre atme nt.o rg (530)409-3048
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