1. Overdose Prevention for West Virginia
James E. Jeffries
Bureau for Public Health
Office of Maternal, Child and Family Health
September 7, 2018

2. Principal Objective
To strengthen the public health response to West Virginia’s opioid epidemic by shoring up greater expertise at the state level with regard to overdose surveillance and other prevention strategies to inform a comprehensive response to save lives and reduce injuries.

3. Centers for Disease Control and Prevention (CDC) Cooperative Agreements
West Virginia Violence and Injury Prevention Program (WVVIPP) is the Bureau for Public Health subunit responsible for the administration of the following cooperative agreements
Prescription Drug Overdose Prevention for States
Project Period: March 1, 2016 through August 31, 2019
Annual Budget: $2,217,897
Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality
Project Period: September 1, 2016 through August 31, 2019
Annual Budget: $445,472

4. Prescription Drug Overdose Prevention for States
Project Description: Via the ensuing strategies, the WVVIPP is facilitating the necessary connections and collaborative relationships needed to target high-risk prescribing and patient behaviors that drive overdose deaths.
Enhancing West Virginia’s Prescription Drug Monitoring Program (PDMP) and leveraging it as a public health and clinical decision making tool
Implementing community-level prevention and health system improvements to reduce overdose risk

5. Enhancing West Virginia’s PDMP
Known in West Virginia as the Controlled Substances Monitoring Program (CSMP), the PDMP is a core component of the State’s strategy to address prescription drug abuse and diversion.
Collaboration between the West Virginia Board of Pharmacy (PDMP authority) and WVVIPP has been vital.
Major activities include:
Making the CSMP easier to use and access (i.e., CSMP-EHR integration);
Expanding and improving proactive (i.e., unsolicited) reporting; and
Conducting public health surveillance of CSMP data and public dissemination of reports on CDC-directed metrics.

6. Health System Improvements
West Virginia Safe & Effective Management of Pain Program (SEMPP)
A coordinated care program to actively review prior authorizations for prescribers of patients within West Virginia Public Employees Insurance Agency (PEIA) & West Virginia Medicaid members who are utilizing a high risk opioid dosage of >/= 50 MME/Day chronically over at least three months regardless of any respective diagnoses.
The intent of this program is to facilitate the best practices in pain management becoming the standard of care. Patients are locked into one pharmacy for opioid medications, and prescribers are expected to utilize the state PDMP, have patient and providers agreements/contracts, and educate their respective patients on automatically being candidates for naloxone due to the high risk opioid dosing. Furthermore, the utilization of alternative pain management treatments (e.g., non-opioid, non-pharmacological, and adjuvant therapies) are also expected/recommended to respective prescribers.
Essentially, the efforts of the SEMPP ensure the utilization of the CDC guidelines for the safe prescribing of opioids for chronic pain.

7. Academic Detailing
WVVIPP employs trained personnel who make personal visits to prescribers' offices as a means to disseminate clinically relevant and rigorously sourced information regarding chronic opioid therapy strategies.
This is a state-level intervention for preventing prescription drug overuse, misuse, abuse, and overdose.
The concept for this activity is based, in part, on the success of educational outreach by pharmaceutical companies in marketing drugs to clinicians. The objective of this health system intervention is to align the state’s prescribers with the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain by closing the gap between the best available evidence actual clinical practice so that clinical decisions are based only on the most current and accurate evidence.
The WVVIPP academic detailing activities are informed by ongoing public health surveillance with PDMP data. Academic detailing staff target all prescribers in the counties with highest risk prescribing activity.

8. Naloxone Distribution
Deploying and coordinating intensive prevention efforts in high-burden communities
Naloxone Distribution
Collaborative effort between the Bureau for Behavioral Health, Bureau for Public Health and the West Virginia University Injury Control Research Center (ICRC) to leverage resources and infrastructure.
West Virginia’s non-EMS initial responders (law enforcement and fire service) and community-based naloxone “take-home” programs (e.g. harm reduction programs, health departments and related organizations whose patients or clients may be at high risk for overdose) were targeted to widen the availability of naloxone in support of the Access to Opioid Antagonists Act (WV Code Chapter 16, Article 46).
From late 2016 to June 2017, 8,250 two-dose naloxone rescue kits were distributed to 89 organizations in 38 of 55 counties.

9. Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality
Project Description: Funding supports states with a high burden of drug overdoses to quickly improve the timeliness of fatal and nonfatal opioid overdose surveillance, including overdoses related to opioid pain relievers and heroin.
Required Strategies:
Increase the timeliness of aggregate nonfatal opioid overdose reporting.
Increase the timeliness of fatal opioid overdose and associated risk factor reporting.
Disseminate surveillance findings to key stakeholders working to prevent or respond to opioid overdoses.

10. Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality
Key Partnerships
BPH/Office of the Chief Medical Examiner (OCME)
BPH/Health Statistics Center (HSC)
BPH/Office of Emergency Medical Services (OEMS)
BPH/Office of Epidemiology and Prevention Services (OEPS)

11. Cooperative Agreement for Emergency Response: Public Health Crisis Response
Purpose: To “advance the understanding of the opioid overdose epidemic and scale up prevention activities across all 50 States and Washington, D.C.”
Must be coordinated with all other CDC-funded and federally funded opioid prevention activities to ensure alignment and reduce duplication.
Project Period: 12 Months (This is one-time funding)
Funding for approved activities will be available to recipients until August 31, Therefore, the period of performance and the budget period are approximately one year.
CDC will issue Notices of Award (NOAs) after approving final work plans and budgets.

12. Public Health Crisis Response Proposed Activities
Develop and implement “Levels of Care” for West Virginia Emergency Departments and Hospitals to standardize humane, evidence-based care of patients with opioid use disorder in the state’s emergency and hospital institutions.
Develop recommendations based on research. Explore feasibility of requiring ESSENCE submission as part of level of care (Qtr. 1).
Establish an advisory committee, which will include ED personnel (Qtr. 1).
Develop 1st draft of the guidance document. (Qtr. 2)
Disseminate and receive feedback to incorporate into the document (Qtr. 2).
Disseminate the draft document to stakeholders (Qtr. 2).
Convene advisory meeting for deliberation (Qtr. 3).
Incorporate feedback and disseminate to stakeholders (Qtr. 3).
Develop a training plan for EDs and dissemination plan for the guidance document (Qtr. 3).
Convene advisory meeting for approval or revision based on feedback (Qtr. 3).
Implement dissemination and training plans (Qtr. 4).
Establish protocols and policies in EDs to guide referrals and linkages to care for persons who have experienced overdose.

13. Public Health Crisis Response Proposed Activities
Enhance linkages to care for those with an opioid use disorder (OUD) or at risk of an overdose by implementing emergency department interventions in ten counties (excluding Cabell, Monongalia and Kanawha Counties) to create post-overdose protocols, policies, and procedures in EDs to ensure that vulnerable patients are receiving naloxone, being referred to MAT, provided “warm hand- offs” to community-based recovery organizations, and are linked to patient navigators at this critical time of care.
Emergency department interventions will include but not be limited to:
Staffing EDs with peer navigators to connect directly with individuals who have experienced an overdose (or their family/friends/community as appropriate) to ensure awareness of and connection to treatment and other services.
Implementing ED-initiated buprenorphine induction.

14. Public Health Crisis Response Proposed Activities
Work with five local health departments to deploy five Quick Response Teams (QRTs).
Local Health Departments have credibility with local and state-level stakeholders, and hold surveillance and evaluation capacity.
Each QRT will consist of one Paramedic, one Police Officer, one Health and Human Services Aide who meets West Virginia’s certification requirement for Peer Recovery Support Specialist (PR), and one Health and Human Resources Specialist Senior whom will provide administrative coordination and necessary technical assistance.
Once a person has an opioid overdose and is revived by first responders, the QRT will initiate contact within hours to discuss treatment options.

15. Public Health Crisis Response Proposed Activities
Hire a physician to facilitate the development of a sustainable model for “rapid medical response teams” that respond as needed to enforcement actions in West Virginia.
Comprised of an appropriate combination of clinicians, case managers, peer navigators, and community health workers, the “rapid medical response team” would be able to triage patients and link them (as necessary) to treatment, work with insurers (including Medicaid), and facilitate training for providers who are willing to accept new patients.

16. Public Health Crisis Response Proposed Activities
Hire a Coordinator to engage law enforcement agencies for the purpose of increasing the utilization of ODMAP.
Utilize ODMAP data to formulate a comprehensive communication response protocols.
To improve the timeliness of actionable data, interdisciplinary communication and data sharing, recruit and hire an Epidemiologist to direct the collection and analysis of data pertinent to the statutory requirements of West Virginia Code §16-5T-3.

17. Thank You
Questions?

18. Contact
James E. Jeffries Bureau for Public Health Office of Maternal, Child and Family Health 350 Capitol Street, Room 427 Charleston, West Virginia Phone: