Medi-cal covered inpt tx in SoCo? Opioid Use Disorder (1) C.L.I.P.S. Who is at risk? What is at stake? Everyone! Opioid rx > 3 mths increases risk. Enough norco circulating for everyone in US to take 5/325 mg q4h for 6 weeks 2006 to 2009, 80% increase in CA tx program admissions for rx opioids 24% Sonoma Co 11th graders have taken rx opioids compared to 17% rest of CA 2014 data shows majority of heroin users seeking tx started use with rx opioids OUD is a fatal dz. So Co drug OD mortality rate 14.1/100K vs 10.5/100K rest of CA Treatment of OUD is primary prevention for HIV/HCV! Screen for risk before prescribing Opioid Risk Tool 5 categories (Fam or personal hx SUD, age 16-45, Hx of preadolescent sexual abuse, psych dx) Sens 0.58, spec 0.75. Not great.  Screen for mental health PHQ2, PHQ9 Screen for risk of respiratory depression STOP-BANG, sleep apnea screening tool Screen for compliance and diversion Urine drug screening Patient Activity Report Pill counts Dependence vs Abuse vs Addiction Doesn’t matter with DSM-V No “abuse.” Spectrum of “Use Disorders” More clear. Less pejorative.  Medi-cal covered inpt tx in SoCo? DAAC, WRS, CHD 37 non-CDJ beds 2-3 week wait [CDC]

Opioid Use Disorder (2) C.L.I.P.S. Opioid Use Disorder Criteria Opioids taken in larger amounts or over longer period than intended Persistent desire or failure to cut down/control opioid use Great deal of time spent trying to obtain or use opioids or recover from effects Craving Continued use despite failure to fulfill obligations at work, school, or home Continued use despite persistent social/interpersonal problems caused by use Give up other activities because of use Recurrent use in situations in which it is physically hazardous Continued use despite knowledge of persistent physical or psychological problems caused by use Tolerance* Withdrawal* Severity Mild: 2-3 Moderate: 4-5 Severe: 6+ Recent actions on the epidemic Pill mills shut down Pain guidelines revised Norco rescheduled Naloxone FDA approved PDMPs enhanced Macklemore on the mic What can you do? True or False? Tolerance and withdrawal are excluded from the diagnostic criteria if opioids are prescribed and taken properly. TRUE! JAMA Psychiatry. 2014;71(7):821-826 Updated 1/16 K.Greer