Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director’s Perspective Dale K. Adair, MD Medical Director/Chief Psychiatric Officer OMHSAS 1
Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director’s Perspective Dale K. Adair, MD Medical Director/Chief Psychiatric Officer OMHSAS 1
Conflicts of Interest None Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Overview • Diagnosis • Scope • Treatment Options Warning Signs • Challenges Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS Tom Corbett, Governor Beverly Mackereth, Acting Secretary Dennis Marion, Deputy Secretary OMHSAS
Drug Utilization Past Month Illicit Drug Use among Persons Aged 12 or Older: 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Heroin Use Statistics Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Drug Utilization Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2011 and 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Drug Utilization Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2002-2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Past Month Drug Use Past Month Illicit Drug Use among Persons Aged 18 or Older, by Employment Status: 2011 and 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Past Month Drug Use Age 12 and older Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Pain Relievers-Nonmedical Use Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2011-2012 among Past Year Users Aged 12 or Older: 2011 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Illicit Drug Use Age 12 or older First Specific Drug Associated with Initiation of Illicit Drug Use among Past Year Illicit Drug Initiates Aged 12 or Older: 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Specific Illicit Drugs Past Year Initiates of Specific Illicit Drugs among Persons Aged 12 or Older: 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Illicit Drugs-Age Specific Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Treatment Locations Locations Where Past Year Substance Use Treatment Was Received among Persons Aged 12 or Older: 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Most Recent Substance Treatment Substances for Which Most Recent Treatment Was Received in the Past Year among Persons Aged 12 or Older: 2012 Past Year among Persons Aged 12 or Older: 2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Recent Treatment-Pain Relievers Received Most Recent Treatment in the Past Year for the Use of Pain Relievers among Persons Aged 12 or Older: 2002-2012 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Drug Dependence or Abuse Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Single Day Counts Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Buprenorphine Treatment Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Illicit Drug Dependence or Abuse Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Past Year Drug Use Treatments Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Overdose Deaths in PA Overdose Deaths in Pennsylvania • In 1990, note for the 64 grey counties, the death rate is too low to be accurately counted, at less than 3 deaths per 1,000 citizens. The state average is 2.7 deaths per 1,000 citizens, so any colored counties are above average, while grey is below average. Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Overdose in PA In 2000, note for the 52 grey counties, the death rate is too low to be accurately counted, at less than 3 deaths per 1,000 citizens. The state average is 7.4 per 1,000 citizens, so the light blue, yellow and orange counties are above average, while grey and dark blue are below average. Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Prescription Opioids Use Prescription opioids: use • Prescription opioids frequently used by adult enrollees – 28.3% with any short-acting use in 2012 – 1.8% with any long-acting use • Most use for short duration – 40.8% filled single prescription in 2012 – 65.3% had <30 days supply *Julie Donohue, PhD Associate Prof University of Pittsburgh Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Prescription Opioids Prescription opioids: the prescribers • Primary care, emergency medicine physicians, dentists are top prescribers – 48% opioid prescribers are PCPs – 22% are EM physicians – 17% are dentists • These three specialties write 84% of opioid scripts – PCPs write 65% of scripts – ED physicians write 10% – Dentists write 9% *Julie Donohue, PhD Associate Prof University of Pittsburgh Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Medication Misuse Misuse is defined as non-adherence to prescription directions and can be either willful or accidental. One-quarter of the prescription drugs sold in the United States are used by the elderly, use more meds than any other age group. Older adults are likely to experience more problems with relatively small amounts of medications because of increased medication sensitivity as well as slower metabolism and elimination. Factors associated with prescription medication misuse and abuse by older adults include female sex, social isolation, history of substance use or psychiatric disorder, poly-pharmacy, and chronic medical problems. Commonly prescribed drugs with misuse potential include those for anxiety, pain, and insomnia, such as benzodiazepines, opiate analgesics, and skeletal muscle relaxants. Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Risks Populations Who is at greatest risk for medication misuse/abuse? • Factors associated with prescription drug misuse/abuse in older adults – Female gender – Social isolation – History of a substance abuse – History of or mental health disorder – older adults with prescription drug dependence are more likely than younger adults to have a dual diagnosis – Medical exposure to prescription meds with abuse potential (Source: Simoni-Wastila, Yang, 2006) Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Emergency Department Use Emergency Department (ED) Use Related to Misuse/Abuse • One fifth of ED visits involving prescription medication misuse/abuse among adults were made by persons aged 70 or older • Medications involved in ED visits made by older adults: - Pain relievers (43.5%) - Medications for anxiety or insomnia (31.8%) - Antidepressants (8.6%) • In 2008, there were 256,097 such visits, representing an increase of 121.1 percent • 37.5% were admitted to the hospital SAMHSA, DAWN Report, 2010 Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Intervention Referral Simple vs Brief Intervention Referral Attended 1 st Appointment Motivational Session 70% Control Group 32% p = .006 Zanjani F, Oslin D (2005). Telephone Based Referral-Care Management. Grant Supported by Philadelphia Veteran’s Affairs: Mental Illness Research Education and Clinical Center (MIRECC) Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
Brief Advice Brief Advice • Shown to decrease drinking and adverse health outcomes • Two components: – Advice – Link drinking to health • Recommended by the US Preventative Task Force Tom Corbett, Governor Beverly Mackereth, Secretary Dennis Marion, Deputy Secretary OMHSAS
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