1. The Opioid Epidemic in Alaska: A Baseline for Measuring Prevention
Bridget L. Hanson, PhD
Jodi D. Barnett, MA
Center for Behavioral Health Research & Services
December 8, 2017
ISER publications and presentations are solely the work of individual authors and should be
attributed to them, not to ISER, the University of Alaska Anchorage, or the research sponsors.

2. Alaska’s Opioid Epidemic
In 2016
89 overdose deaths due to opioids
In approximately 1 in 5 drug overdose deaths, no specific drug is listed on the death certificate. In many deaths, multiple drugs are present, and it is difficult to identify which drug or drugs caused the death (for example, heroin or a prescription opioid, when both are present).3
Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. ePub: 16 December DOI: 
57%
51%
Health Analytics & Vital Records:

3. Alaska’s Opioid Epidemic
All substances
Any opioid
Rx opioids
Some nationwide and Alaska stats – mortality mostly (or entirely). Don’t include consumption data here.
Health Analytics & Vital Records:

4. Alaska’s Opioid Epidemic
All substances
Any opioid
Heroin
Some nationwide and Alaska stats – mortality mostly (or entirely). Don’t include consumption data here.
Health Analytics & Vital Records:

5. Alaska’s Opioid Epidemic
+32
+752
Some nationwide and Alaska stats – mortality mostly (or entirely). Don’t include consumption data here.
Alaska Automated Information Management System (AKAIMS) DBH Uniform Reporting (UR) Client Profile Tables: 3S (Substance Abuse, including Co-occurring) for both AKAIMS and EDI agencies.

6. Alaska’s Opioid Epidemic
U.S. Total
Some nationwide and Alaska stats – mortality mostly (or entirely). Don’t include consumption data here.

7. Prevention: Partnerships for Success
Overview
Funding -- SAMHSA to AK Division of Behavioral Health
Goals -- Prevent/reduce NMUPO and heroin use and build capacity
Target population --12 to 25 year olds
6 funded regions
Implement evidence-informed and sustainable environmental strategies
Description of the project

8. Combined the PFS regions cover over 80% of the state’s population.

9. Prevention: Partnerships for Success
Prioritized Intermediate Variables
NSDUH data from Among year olds in Alaska who misused Rx opioids, 66.8% got their Rx opioids for misuse though a friend or relative while 19.6% got them through a provider
Social Access
Retail Access
Perceived Risk of Harm
Perceived Risk of Harm

10. Evaluation of PFS What changes do we observe over the project?
How does opioid and heroin use change within the target population?
What changes occur in intermediate variables?
How does the State of Alaska’s prevention capacity and infrastructure change?

11. Use and Consequences Consumption data: Consequence data:
Past 30 days/year/lifetime use from YRBS
No good local/state data for year olds -- GAP
Consequence data:
ER visits from HFDR (ICD-9 / ICD-10 codes)
Intermediate variable data:
Social Access – NSDUH
Retail Access – NSDUH, PDMP
Perceived risk of harm – NSDUH, YRBS
Young Adult
Opioid Survey

12. Young Adult Opioid Survey
Background
Fill a consumption data gap among year olds
Learn about prioritized intervening variables
Brief Methods
Baseline 2016 / Follow-up 2019
Purchased mailing list of year olds in AK
7,469 invited to participate
3 survey invitations delivered via mail over 6 weeks
Survey completed online or via paper
$15 gift card and raffle for Alaska Airlines ticket

13. Young Adult Opioid Survey
Asked if: (a) prescription opioids misused or heroin used in past 30 days; (b) received an opioid prescription in the past 3 years

14. Survey invitations mailed Surveys excluded / age ineligibility
Young Adult Opioid Survey
Goal
1,500 (20%)
>150 per region
Survey invitations mailed
n = 7,469 (100%)
Surveys completed
n =1,032 (13.8%)
Surveys excluded / age ineligibility
n = 253 (24.5%)
Final response rate
n = 779 (10.4%)

15. Consumption Lifetime Misuse/Use
Data figures

16. Social Access to Rx Opioids through Friends or Family
57.3% had not seen any awareness messages to reduce social access
Among individuals prescribed opioids in the past 3 years:
75.3% who had pills leftover from a prescription did not dispose of them
73.0% reported no discussion with their provider or pharmacist about safe storage of pills or not sharing pills with others 67.1%
Data figures

17. Retail Access to Rx Opioids through a Provider
49.0% have been prescribed an opioid in their lifetime
Among individuals prescribed opioids in the past 3 years:
73.2% had pills leftover
80.4% reported no discussion with their provider or pharmacist about alternatives to opioids or to take pill as prescribed 46.3%
Data figures

18. Perceived Risk of Harm 43.9% 22.7%
Believe regular misuse does not cause great risk of harm
43.9%
22.7%

19. Prevention Capacity & Infrastructure Assessment
KI interviews with stakeholders who had state-level knowledge
16 key informants from DHSS, law enforcement, education, health providers
Interview domains: state climate and efforts; partnerships and coordination; policies, practices, and laws; data and monitoring; knowledge and readiness
Template and SWOT analysis for themes

20. Strengths High levels of concern about the issue
Increasing amount of education and awareness
Grants and activities targeting this issue
Community groups forming
Agencies partnering with people in recovery
PDMP useful tool for providers and dispensers
Senate Bills 74 & 23
CDC’s new prescription guidelines
Insurance coverage for medication-assisted treatment
Many good data sources
Improvements on health facility reporting requirements
Increased sharing of data and utilization
High knowledge among state leadership
Current work is appropriate for preparing and starting
Training and education for students, residents, and providers

21. Weaknesses Lack of available detox and treatment Overprescribing
Criminal justice approach
Lack of education for youth
Not every state dept is coordinated
Collaborations are new
Not enough tribal representation
PDMP barriers, including sole responsibility of providers, not user-friendly, and stigma
No Alaska prescribing guidelines
Policies and regulations limit access to services in rural Alaska
Missing data on accidental overdose vs misuse
Lacking good treatment data
Low awareness about data
Low-to-moderate knowledge among leadership and lack of communication
State is not prepared to address opioid crisis
Lack of knowledge among providers

22. Opportunities Statewide strategic plan
Supporting recovery by addressing mental health issues
More communication and media messaging
Increasing treatment options with clear and easy access
Proactive coordination
Best practices in policies and statutes
Support for PDMP among providers and stakeholders
Require electronic prescribing or tamper-resistant forms
CME requirements for providers
Data from OCS, Senior Services, Medical Examiner, and medical labs are unavailable or under-utilized
Timely data for prescribers
Education for state leadership and legislature
Education for practicing providers
Reform of medical school education
Education for patients about opioid risks
Education and prevention activities for youth

23. Threats Fiscal Crisis Stigma of addiction Culture change is difficult
Opioids as crisis and not addressing root problem
Search for single, straightforward solution that doesn’t exist
Legislature unsupportive of PDMP and not prioritizing policies
Marijuana legalization as gateway for youth
Time needed for analysis
Lack of funds for analyst positions
Lack of workforce resources, in state government and in healthcare/communities
Changing prescribing habits is difficult

24. Tracking Change
Tracking and documenting significant events and progress indicators in real time
This slide may not be needed.

25. Media Messaging June August October 2017
OSMAP begins work with PFS grantees on developing responsive media campaigns
Statewide media campaign launched by OSMAP
PFS grantees receive an Rx Opioid media toolkit
2017
The statewide media launch appeared to be duplicated in the spreadsheet once in January and once in August. I am not sure if two different campaigns launched or if it was just in the spreadsheet at different times
June
August
October

26. Support for PDMP March/ April July September July 2016 2017
SB74 passes AK House and Senate
PDMP changes take effect including mandatory registration
New PDMP full-time manager hired
SB74 signed by Gov Walker
March/ April
September
July
July
2016
2017

27. Future Plans Continue progress tracking Monitor state-level outcomes
Conduct final YASUS and KI interviews in fall 2019
Support community-level evaluation during implementation and monitor fidelity