1. Opiate Roundtable March 29, 2018 Karen Burgess, MD

2. OVERVIEW OF PROBLEM
During 2015, there were 52,404 overdose deaths in the US.
33,091 which is (63)% involved opioids.
That is an average of 91 opioid overdose deaths each day.
It is estimated in 10 years over 650,000 will die from overdose deaths.
From ADMH Presentation 2/8/18

3. Drug overdoses are now killing more Americans than car crashes.
Whites and Native Americans are dying at double or triple the rate of African Americans and Latinos.
Four in five new heroin users started out misusing prescription painkillers.
Synthetic Opioid deaths across the U.S for have increased 73%.
From ADMH Presentation 2/8/18

4. ALABAMA’S PROBLEM
Alabama ranks #1 as highest painkiller prescribing state in the Nation. #2 Tennessee
ADMH indicates an 85% increase in heroin admissions for veterans in
4.71% of Alabama’s population above the age of 17 over 175,000 individuals are estimated to have used pain relievers for nonmedical purposes in the past year.
Nearly 30,000 Alabamians, over the age of 17 are estimated to be dependent upon heroin and prescription painkillers.
From ADMH Presentation 2/8/18

5. Alabama had 282 opioid overdose deaths in 2015.
For the first time ever in 2015 admissions for opioid use disorders exceeded those for alcohol use disorders.
The number of substance use disorder diagnoses for Blue Cross members increased almost 500 percent from 2010 to 2016.
Majority of the treatment admissions for opiates were among females 55.9% with males having 44.1% of treatment admissions.
Alabama had 282 opioid overdose deaths in 2015.
From ADMH Presentation 2/8/18

6. ADMH admissions data show a steady increase of opioid use disorders since Drug of Choice at Admission
2014
2015
2016
Opioids
4,672
5,259
5,650
Alcohol
6,637
6,112
5,708
Marijuana
6,077
5,907
5,944
Meth
2,298
2,538
3,171
From ADMH Presentation 2/8/18

7. More common in white females

11. 8/31/08

13. Alabama Council on Opioid Misuse and Addiction
Established 6 standing committees:
DATA
TREATMENT – RECOVERY
LAW ENFORCEMENT
PRESCRIBER – DISPENSER
RESCUE (NALOXONE)
PREVENTION – EDUCATION
COMMUNITY ENGAGEMENT
8/31/08
From ADMH Presentation 2/8/18

14. 5 INITIATIVES Reduce the opioid supply
Develop a centralized data repository
Reduce overdose deaths through access to naloxone.
Implement prevention and education strategies
Improve access to care
Reduce the opioid supply through 1) modernization and enhancement of the Prescription Drug Monitoring Program creating a more user-friendly system ($1.1 million)thus generating more participation in the PDMP, and (2) legislation to establish crimes of trafficking in fentanyl and carfentanil.
Develop a centralized data repository (CDR) to hold data and distribute results allowing for rapid response to outbreaks of overdoses and other opioid-related events.
Reduce overdose deaths through access to naloxone.
Implement prevention and education strategies through techniques to generate greater community awareness and participation aimed at reducing the stigma associated with substance use disorder and increasing the addiction knowledge base of the public.
Improve access to care by addressing barriers to receiving treatment and improving the knowledge of the general public on how to seek care for themselves or a family member.
8/31/08
From ADMH Presentation 2/8/18

15. STATE RESPONSE Grants Provider Training CME Ask Dentist Survey
CURES
MAT-PDOA
Block Grant
Provider Training
CME Ask
Dentist Survey
Narcan Program
8/31/08

16. 8/31/08

17. HEALTH HOME INVOLVEMENT
Regional round table discussions
Screening of recipients with instruments
Monitoring pharmacy claims
Staff education and training
Regional resource lists
Pain management action plan

18. B, D, E Round Table Feedback
Offer Medicaid recipients “Alternative” treatment methods for chronic pain (physical therapy, massage therapy, counseling and acupuncture).
More user friendly Patient Drug Monitoring Program (PDMP)
Increase treatment facilities/access
Education:
PMP-Opioid guidelines (CDC)
Medicaid patients (opioid alternatives, risk, safety and storage)
Community – Opioid crisis and prevention
Network with other agencies

19. B, D, E Round Table Feedback
Enhanced Communication between:
Provider and treatment centers
ER and Providers regarding patient’s medical history/comorbidities
Specialist and providers regarding patient’s opioid prescription history
Real Time Claims Data
Make available to PMP individualized patient report card including names of all medical providers to include specialists
Development of resources to treat opioid addicted patients
Integrated medical and behavior health

20. rhc.ua.edu

22. 8/31/08

24. Dental Survey

26. RECOGNIZING an OPIOID OVERDOSE
From ADMH Presentation 2/8/18

27. From ADMH Presentation 2/8/18

28. STANDING ORDER OF THE STATE HEALTH OFFICER NALOXONE DISTRIBUTION FOR OVERDOSE PREVENTION
PURPOSE This standing order is intended to ensure that naloxone is readily obtainable by any person who is: An individual at risk of experiencing an opioid‐related overdose; or A family member, friend, or other individual, including law enforcement, fire department, rescue squad, and volunteer fire department personnel, who is in a position to assist a person at risk of experiencing an opioid‐related overdose.
AUTHORITY This standing order is issued pursuant to Act 2016‐307, which authorizes the State Health Officer to prescribe naloxone via standing order.
From ADMH Presentation 2/8/18

29. AUTHORIZATION This standing order may be used as a prescription to obtain naloxone from a pharmacy in the event there is an inability to obtain naloxone or a prescription for naloxone from an eligible person’s regular health care provider or another source. This order is authorization for pharmacists to dispense naloxone and devices for its administration solely in the forms prescribed herein.
ORDER TO DISPENSE Upon receipt of written communication that provides a factual basis for a reasonable conclusion that the person to receive the naloxone is an eligible person, and upon receipt of basic instruction and information on how to recognize and respond to a possible opioid overdose and how to administer naloxone, dispense one naloxone kit. (Refer further to Protocol, Pharmacist Actions set out on page 5.) Pharmacists should use clinical judgment to determine preferred formulation. Unlimited refills are authorized.
From ADMH Presentation 2/8/18