1. Strategic Initiatives to Address Opioid Overdose & Addiction
David A. Fiellin, M.D.
Director, Program in Addiction Medicine
Professor of Medicine, Emergency Medicine and Public Health
Yale School of Medicine

2. Outline National State Connecticut Opioid REsponse (CORE) Initiative
White House
National Governor’s Association
State
Strategic plans
Legal
Connecticut Opioid REsponse (CORE) Initiative

3. WH Commission Report Prescriber education Medication treatment
Naloxone
Law enforcement (fentanyl)
Prescription Monitoring Programs
42 CFR Part 2, align with HIPAA
Parity
State waivers from federal Institutes for Mental Diseases (IMD) exclusion in the Medicaid
Others

4. WH Commission Report Others to include:
Prevention using big data analytics
Prevention programs for schools and youth
Address CMS use of satisfaction with pain to evaluate health care providers
Workforce access and training
Improvement in treatment programs – evidence based care
Research
Incentivize screening and referral
Patient education regarding opioid risks
Supply reduction

5. National Governor’s Association
Released, July 7, 2016

6. National Governor’s Association
Step 1

7. National Governor’s Association
Step 2

8. National Governor’s Association
Step 3

9. State Responses

10. State Responses

11. CORE

12. CORE Initiative Process
June – August, 2016
Consulted with local and national experts
Met representative of > 50 stakeholder CT groups
Evaluated Connecticut data
Developed a succinct, prioritized, 3-year strategy for the state on opioid addiction and overdose
6 strategies, >20 tactics and methods
Took public comments on a draft report
Revised and submitted to Governor
CORE

13. Connecticut Data
CORE
CORE

14. Demographic and Clinical Characteristics
Mean age:
Male: %
White: %
Injection: %
House/apartment: 81%
Opioids
Heroin/morphine alone: 38%
Prescription opioids alone: 24%
Fentanyl alone: 9%
Combination of opioids: 30%
Benzodiazepines: 42%
Alcohol: %
CPMRS contact, past year
No contact: %
Opioids and benzodiazepines: 39%
CORE
CORE

15. Overdose deaths by town, 2015 top 25th percentile
CORE
CORE

16. Opioid-related death in relationship to opioid agonist treatment
CORE
CORE

17. Opioid-related overdose death in relationship to naloxone-prescribing pharmacists
CORE
CORE

18. Connecticut Opioid REsponse
Increase Access to Methadone or Buprenorphine
Address OD Risk
Reduce Stigma
Connecticut Opioid REsponse
CORE
Increase Access to Naloxone
Data Sharing
Responsible Prescribing

19. Benefits of buprenorphine and methadone for opioid use disorder
Increased
Retention in treatment
Social functioning
Decreased
Drug use
Overdose death
HIV transmission
HCV transmission
Criminal behavior
Endorsed by
American Bar Association, World Health Organization, White House Office of National Drug Control Policy, President’s Commission on Combatting Drug Addiction and the Opioid Crisis, Surgeon General, NIH, Substance Abuse and Mental Health Administration, National Governor’s Association, many others
“These medications coupled with psychosocial support are the current standard of care for reducing illicit opioid use, relapse risk, and overdoses, while improving social function. However, limited access to providers and programs can create barriers to treatment.”
Volkow, Collins – NIDA/NIH, New England Journal of Medicine, June 2017

20. Increase data sharing across relevant agencies and organizations
Tactic
Create memorandum of understandings across relevant agencies to allow for data sharing and protection
Prescription? Overdose Treatment?
CORE
CORE

21. Increase community understanding of opioid use disorder, treatment, decrease stigma
Tactic
Educational efforts with media, agencies, healthcare and public health personnel
CORE
CORE

22. Increase community understanding of opioid use disorder, treatment, decrease stigma
Yale media symposium – 6/13/17
CORE

23. Words matter Avoid these terms… Use these instead…
Addict, user, drug abuser, junkie
Person with opioid use disorder or person with opioid addiction, patient
Opioid abuse or opioid dependence
Opioid use disorder
Problem
Disease
Habit
Drug addiction
Clean or dirty urine test
Negative or positive urine drug test
Opioid substitution or replacement therapy
Opioid agonist treatment
Relapse
Return to use
Treatment failure
Treatment attempt
Being clean
Being in remission or recovery

24. Progress
DMHAS SAMHSA grant incorporated ED-initiated buprenorphine in 10 EDs
DPH CDC grant aligned with CORE
DATA 2000 training events
“FDA Blueprint” trainings
Increased number of PCSS-MAT mentors from 5 to 11
Integration of PDMP into Electronic Medical Records
Worked with Connecticut Overdose Workgroup to standardize naloxone reporting
Working with DPH to access EMS naloxone data
Legislation passed (6/6/17): House Bill 7052, An Act Preventing Prescription Opioid Diversion and Abuse: Increases data sharing between state agencies regarding opioid abuse and opioid overdose deaths
FDA funding to link DPH, DCP, DOC, OCME, Hospital, DMHAS, EMS data
DOC to assess criminal justice treatment efforts and strategic plan
CORE

25. How to help? Read the CORE initiative Work with CORE
Work with CORE
CORE
CORE