Arizonas Public Health Response to the Opioid Epidemic

Arizona’s Public Health Response to the Opioid Epidemic July 20, 2016 Cara Christ, MD, MS| Director/State Health Official

Topics to be covered • • • Prescription Drugs The Heroin Problem 3 Major Ways to Combat the Problem Recent Legislation What else does public health do? Helpful Resources

Prescription Drugs Arizona Specific Statistics • Enough Rx pain relievers dispensed to medicate every AZ adult around the clock for 2 weeks • Overdose of opioid Rx pain relievers=401 deaths (2015) – 2014: 372 deaths – Over 1 per day – Death rates are highest among middle age adults, 45 -54

Prescription Drugs Arizona Specific Statistics • 2014: Arizona had the 15 th highest drug overdose death rate in the U. S. • 2014: 438 babies were born with Neonatal Abstinence Syndrome – 235% increase since 2008

The Heroin Problem • 2015: 237 deaths due to heroin overdose – 2014: 180 deaths – While increasing, Arizona has TWICE as many Rx opioid deaths • Strongest risk factor for heroin addiction is addiction to Rx opioid pain relievers – Those addicted to Rx pain relievers are 40 X more likely to be addicted to heroin

3 Major Ways to Combat the Problem • Prevent prescription opioid drug abuse – Appropriate prescribing practices • Access to treatment – Especially Medication Assisted Treatment (MAT) • Reverse overdoses with Naloxone

Prevent Prescription Opioid Drug Abuse • Arizona Rx Misuse and Abuse Initiative – AZCJC, Board of Pharmacy, AHCCCS, Governor’s Office of Youth, Faith, & Family – Piloted 5 strategies in the counties of: • Yavapai • Pinal • Graham/Greenlee – Resulted in decrease of overdose deaths & hospitalizations – Resulted in an increase of drop boxes, physician awareness

Prevent Prescription Opioid Drug Abuse • Arizona Rx Misuse and Abuse Initiative – Piloted 5 strategies • Reduce illicit acquisition & diversion of medications – Safe storage and disposal of Rx drugs, drop boxes • Promote responsible prescribing and dispensing practices • Enhance Rx drug practices and policies among law enforcement • Increase public awareness and patient education • Enhance assessment & referral to substance abuse treatment

Prevent Prescription Opioid Drug Abuse • Arizona Rx Misuse and Abuse Initiative – Developed a Community Toolkit • Provides resources to communities to assist with implementing the 5 strategies at the local level • Can be found at www. azcjc. gov – Click on Rx initiative link

Prevent Prescription Opioid Drug Abuse • ADHS & Partners – Developed & issued guidelines for prescribing controlled substances in Emergency Departments – Developed & issued general Arizona Opioid Prescribing Guidelines for acute & chronic pain – Worked with U of A to develop free, online training for providers – Mapped permanent drop box locations for the public • www. dumpthedrugs. AZ. org – Implemented new rules requiring licensed health care facilities to have policies regarding prescribing controlled substances to minimize abuse

Prevent Prescription Opioid Drug Abuse • ADHS & Partners – Held a call to action meeting for health care providers, plans, licensing boards, & associations • Encouraging them to take steps to curb the epidemic (i. e. utilize the CSPMP) – Held a 2 day conference on Neonatal Abstinence Syndrome

Prevent Prescription Opioid Drug Abuse • ADHS & Partners – Implementing 4 year, $3. 6 million grant CDC grant to prevent overdose deaths related to Rx opioids – Focuses on prevention strategies & improving safe prescribing practices by funding: • 6 county health departments: Mohave, Gila, Yavapai, Navajo, Maricopa, & Pima to implement the 5 strategies in the Community Toolbox – Focus on encouraging the uptake of the prescribing guidelines • Enhancement of the CSPMP: report cards, increasing utilization, provide educational opportunities (CMEs)

Access to Treatment • MAT: uses medications in combination with counseling and behavioral therapies • 2013 single day count in AZ (2014 SAMHSA): – 6, 336 receiving methadone – 1, 040 receiving buprenorphine • ADHS licenses methadone clinics, outpatient treatment centers, health care institutions – GOYFF Map/resoures: http: //substanceabuse. az. gov • Designate health care provider shortage areas – Mental Health Provider shortage areas

Reverse Overdoses Through Naloxone • ADHS implemented state legislation allowing first responders and law enforcement to administer Naloxone – Requires • standing order issued by prescriber • Training on use prior to administration • Immunity for prescriber and those that administer – Over 5200 doses of Naloxone were administered in 2015 -May 2016 • Does not include Phoenix Fire or Tucson Fire Departments’ data

Recent Legislation • HB 2355: Naloxone – Pharmacists can dispense without a prescription to person at risk, family member or community member – Prescribers can prescribe – Requires school boards to prescribe and enforce policies and procedures for administration of naloxone by an employee

Recent Legislation • SB 1283: Controlled Substances Prescription Monitoring Program (CSPMP) – Requires prescribers to obtain a utilization report before prescribing: each new course of treatment and quarterly – Requires the Board of Pharmacy to obtain data sharing agreements with EHRs – Board has to assess satisfaction of program users annually

What else does public health do? • Surveillance – Death certificates, HDD, child fatality and maternal morbidity reviews, EMS/trauma data, board of pharmacy data – Provide data/presentations • Education – Promote & implement prescribing guidelines – Develop & implement educational campaigns • Work with federal and local public health partners – Recently hosted the Surgeon General, June 2016 – Applied for supplemental to CDC grant to expand to additional counties – Evaluate and promote federal resources • Home Visiting Programs for at risk families • Injury Prevention • State Health Improvement Plan: Injury Prevention & Substance Abuse

Additional Resources • Arizona Opioid Prescribing Guidelines: www. azdhs. gov – Click on clinician’s tab • Arizona Rx Misuse and Abuse Initiative: www. azcjc. gov – Click on Rx Initiative • Governor’s Office of Youth, Faith, & Family: http: //substanceabuse. az. gov – Houses information on treatment & prevention resources • Free, online CME on safe and appropriate prescribing practices: www. VLH. com/AZPrescribing • To find the closest permanent drop box locations: www. dumpthedrugsaz. org

Questions? Cara Christ, MD, MS| Director/State Health Official Cara. Christ@azdhs. gov | 602 -542 -1140 azhealth. gov @azdhs @drcarachrist facebook. com/azdhs