The National Opioid Crisis

Overdose Deaths per 100,000 New York Times: https://nyti.ms/2jVUlKb

Overdose Deaths per 100,000 New York Times: https://nyti.ms/2jVUlKb

Overdose Deaths per 100,000 New York Times: https://nyti.ms/2jVUlKb

Overdose Deaths per 100,000 New York Times: https://nyti.ms/2jVUlKb

Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.

California MAT Expansion Project California will strategically focus on three populations to improve MAT services: 1. Counties without a NTP in the geographic area. 2. Increase the availability and utilization of buprenorphine statewide. 3. Improve MAT access for CA’s American Indian and Native Alaskan tribal communities through the IHP-MAT Project.

The CA H&SS Project

Network # & Hub location Yuba Yolo Ventura Napa Tuolumne Monterey Tulare Mono Trinity Modoc Tehama Merced Sutter Mendocino Stanislaus Mariposa Sonoma Marin Solano Madera Siskiyou Los Angeles Sierra Lassen Shasta Lake Santa Cruz Kings Santa Clara Kern Santa Barbara Inyo San Mateo Imperial San Luis Obispo Humboldt San Joaquin Glenn San Francisco Fresno San Diego El Dorado San Bernardino Del Norte San Benito Contra Costa Sacramento Colusa Riverside Calaveras Plumas Butte Placer Amador Orange Alpine Nevada Alameda 8 1 2 3 4 5 6 7 9 11 12 13 14 15 16 10 18 17 19 CA H&SS Hubs and Spokes Network # & Hub location Spokes 1 Lake County (1)   Mendocino County (2) Nevada County (1) 2 Siskiou County (2) Trinity County (1) Del Norte County (1) 3 El Dorado County (1) Placer County (1) 4 Butte County (2) Lassen County (1) Tehama County (1) Plumas County (1) 5 Humboldt County (6) 6 San Joaquin County (1) Stanislaus County (1) 7 Contra Costa County (TBD) 8 San Francisco County (TBD) 9 Sonoma County (1) Yolo County (1) Colusa County (1) Napa County (1) 10 Los Angeles County (10) 11 Marin County (8) 12 Yolo County (2) Sacramento County (1) 13 Santa Cruz - N County (6) 14 Santa Cruz - S County (4) San Benito County (1) Monterey County (1) 15 Fresno County (TBD) 16 Solano County (TBD) 17 San Diego County (7) 18 19 San Bernadino County (1) Riverside County (6) San Diego County (2)

What is the Hub and Spoke? It is designed to treat opioid use disorder as a chronic disease under the Vermont Blueprint for Health Main goal is to prevent overdose and deal with the opioid crisis in the state It divides Vermont into regions by counties Each region has a specialized addiction center of expertise known as the HUB that is an opioid treatment program (OTP) Each Hub is connected to all the waivered buprenorphine doctors’ offices known as SPOKES All SPOKES have a dedicated MAT (medication assisted treatment) team A MAT team is made of 1 registered nurse and 1 licensed clinical social worker for 100 patients on buprenorphine under Medicaid

SPOKES Linked to a regional HUB All buprenorphine prescribers in an office can participate as SPOKES Can be 1 doctor in private practice or group practice with many prescribers Can refer complex patients to the HUB for stabilization All SPOKES take advantage of the MAT teams in the region

MAT (Medication Assisted Treatment) Team Cornerstone of the SPOKES effectiveness Many buprenorphine providers had declined to increase the number of people they treated due to the extra work involved in caring for those with OUD Consists of 1 each fulltime equivalent registered nurse and licensed clinical social worker Pays for the services of both people per 100 buprenorphine patients enrolled in Medicaid

Opioid Coalitions All CA H&SS must submit an Outreach Plan which includes how the system will participate and collaborate with the 36 local county opioid safety coalition networks.

CA H&SS Services Required Treatment Services Prescribe and dispense all FDA approved MAT for an OUD Counseling Provide naloxone and training HIV and HCV testing and referral to services Case management Professional medical, social work, and mental health services, offered to patients onsite or by referral Recovery and/or peer support services Local access to maternal addiction treatment Serve as the subject matter expert on opioid dependence and tx to the Spokes Utilize the OBOT Stability Index and the Treatment Need Questionnaire tool

California Opioid Hub and Spokes Project DHCS Marlies Perez, State Project Director Michael Freeman, Project Manager; Kevin Masuda, Project Analyst CA H&SS Implementation Team UCLA Richard Rawson, Principal Investigator Mark McGovern (Stanford), Learning Collaboratives Thomas Freese, Training/Technical Assistance Gloria Miele, Learning Collaborative Coordinator Beth Rutkowski, Training Liaison Training Coordinator and assistants Consultants John Brooklyn Tony Folland Barbara Cimaglio Regional CA Addiction and Primary Care MDs Evaluation Team Darren Urada, Principal Investigator Vandana Joshi, Co-Investigator Howard Padwa, Co-Investigator Data Collection Coordinator and assistants Advisors Betsy Hall Yih-Ing Hser Lynn Brecht UCLA Program Director Valerie Antonini Advisory Group Implementation & Evaluation experts, H&SS participants, community members, DHCS representatives, CSAM, CHCF CSAM Kerry Parker, Jean Marsters, MD, Steve Eickelberg, MD CHCF Kelly Pfeifer, MD

California Opioid Hub and Spokes Project Implementation Activities Implementation Team UCLA Chair: Richard Rawson; Co-Leader: Valerie Antonini Learning Collaboratives: Mark McGovern, Gloria Miele Purpose: Engage H&SS participants in process of shared learning and experience to facilitate implementation of services, assist with procedural changes, and provide opportunities for interactive problem solving. Activities: Conduct Regional Quarterly LC meetings Training and Technical Assistance: Thomas Freese, Gloria Miele, UCLA Trainers Purpose: Meet training and technical assistance needs of H&SS participants through just-in-time training including online self paced courses, in person and online training. Activities: Bi-annual Best Practices conferences, Bi-annual Clinical Skills trainings, Quarterly community-wide MAT training, and ongoing assistance with additional resources. Consultants Consultants will be available to provide additional technical assistance including: John Brooklyn, Tony Folland, Barbara Cimaglio, Kelly Pfeifer/CHCF, and California Addiction and Primary Care MDs. ------------------------------------------------------------------------------------------------------------------------------------------------- CSAM Jean Marsters, MD, Steven Eickelberg, MD, Kerry Parker Purpose: Provide support to providers in spokes to build confidence in prescribing Activities: Four-day mentored learning experiences for approximately 60 spoke participants who will attend the CSAM Annual Conference in August 2018 in San Francisco; updating of the Guideline for Physicians Working in CA Opioid Treatment Programs published in 2009; and two CSAM educational webinars

Training and Technical Assistance Face-to-Face Training Skill based trainings provide guided practice of skills with feedback (e.g., practicing MI skills) Opportunity for learning from the experience of other H&SS networks Demonstrations of evidence-based practices Developing strategies for implementation in clinical settings Community Forums on MAT Distance and face-to-face training for the community at large to broaden understanding of MAT, why it’s important, and how the medicines work Opportunity for discussion of hopes and concerns among participants about the planned expansion of MAT services

Tribal MAT Project Funding specific to the American Indian and Alaskan Native Project Echo Suicide Prevention Naloxone Distribution to First Responders Culturally Specific MAT Programs Needs Assessment, Education and Training Support for MAT Access Expansion under the Indian Health Program-ODS

California Society of Addiction Medicine Mentoring Scholarships for 75 physicians Revising NTP Guidelines with all FDA Approved Medications Webinars and other MAT training Members of the MAT Expansion Project Roll-out Assisting with recruitment of waivered prescribers for the spokes in the CA H&SS

CALIFORNIA H&SS UNPRECEDENTED OPPORTUNITY To save lives and to foster recovery To succeed or fail as care providers To innovate or do more of the same To destroy stigma and discrimination for persons who suffer addiction To bring care of addiction into the “big house” of health care To develop practices, processes and relationships that last---