The Arizona Opioid Assistance and Referral OAR Line

The Arizona Opioid Assistance and Referral (OAR) Line Tribal Opioid/Substance Use Conference - April 3, 2019 Daniel E. Brooks MD Medical Director; Banner Poison & Drug Information Center for Toxicology and Pharmacology Education & Research; Uof. A College of Medicine-Phoenix

US Poisoning Deaths Number per year = ~ 72, 000 (in 2017) US Incidence rate ~ 14 / 100, 000 Japan Incidence rate ~ 4 / 100, 000 33% of deaths are from Rx medications Death rate has tripled over 30 years

Rates of US Poisonings by Age

Causes of US Deaths: 1980 -2008 CDC: 2008

Unintentional Deaths: CDC data

US Drug (opioid) Deaths: 1999 - 2017

June, 2017

The Arizona Opioid Assistance and Referral Line Partnership between CTPER and Az DHS OAR Line 888 -688 -4222 Soft Start Date: Friday, February 26, 2018 Go-Live Date: March 26, 2018 (advertised to providers, first)

US Poison Control Centers

Poison Center Staffing Certified Specialists in Poison Information: Nurses and Pharmacists Physicians serve as Medical Directors and 24/7 backup Other trained staff answer information calls

2017 Arizona Poison & Drug Information Centers ~ 83, 000 calls from Arizona residents/providers ~ 56, 500 human exposures ~ 12, 000 scorpion stings and bites ~ 5, 000 opioid-related calls Staff perform > 110, 000 follow up calls (homes and HCFs)

The Arizona OAR Line Assist patients, families and healthcare providers with any/all opioid-related issues: Acute toxicity Opiate withdrawal Drug-interactions Pregnancy-related issues MAT (medication-assisted treatment) Chronic pain Referrals for medical and behavioral health services Virtual case management (negotiate insurance issues)

OAR Line Services for HCFs and Providers 24/7 free, HIPAA-exempt call service for patient Real-time consults for providers / prescribers EMR for companies and providers Onsight and remote education (for patients, groups and providers) Data analysis of high-risk pts, ‘super-users’ and specified cohorts

OAR Line Services for HCFs and Providers Patient follow-up calls Warm transfers to available (or specified) services Assistance with transport needs Patient discharge information

OAR Discharge Information Include OAR Line information in patient discharge materials - ED and inpatient discharges - EMR / System identified patients (based on specific criteria; e. g. Rx for > 50 MME)

Patient Enrollment Process Passive - healthcare provider, caregiver or agency contacts the OAR Line on behalf of the patient. Active - patient contacts the OAR Line. Protocolized - EMR, HCF or Healthcare Provider consents pts and then contacts the OAR Line with of appropriate pts (e. g. Rx > 50 MME, ‘superusers’, PMHx of opioid OD)

Patient Enrollment Process Required information: Patient name Substance Date of birth preferred Contact information (cell #) Specifics (needs) Patient information can be submitted to the OAR Line via: Phone (real-time calls or patched) Secure fax (specific form provided) Secure email file

Patient Enrollment - Protocolized Agency identifies patients with opioid-related issues Inform patient about the OAR Line Services, verbal consent (written consent for plans to study identified data for outcomes) Agency transfers patient data via phone, fax or email OAR Line staff perform scheduled follow-up calls based on protocol or specific patient needs

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Questions / Slides daniel. brooks@bannerhealth. com 602 -402 -8210 (cell) OAR LINE: http: //phoenixmed. arizona. edu/opioid CTPER: http: //phoenixmed. arizona. edu/centers/toxicology