“opioid epidemic as it relates to counties” prese… · • understand the bio-psycho-social...
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89TH ANNUAL WEST TEXAS
COUNTY JUDGES AND
COMMISSIONERS ASSOCIATION
CONFERENCE
Wednesday, April 25, 2018
11:05 – 11:55 a.m.
“Opioid Epidemic as it
Relates to Counties”
Ms. Jessica Cance
Agency Analytics Unit Manager
Ms. Kasey Strey
National Prevention Network -
Prevention Coordinator for
Texas, SPF-Rx Project Director
4/11/2018
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Opioids in Texas: The County Perspective
Jessica Duncan Cance, M.P.H., Ph.D.Texas Department of State Health Services
Kasey Strey, A.C.P.S.Texas Health and Human Services Commission
Objectives• Describe the opioid crisis nationally and in Texas
• Understand the Bio-Psycho-Social aspects of substance misuse/substance use disorders
• Define the role of prevention in the opioid crisis
• Discuss evidence-based strategies designed to prevent opioid misuse and associated consequences
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Drug Overdose in Texas
• In 2016, 2,790 Texans died due to drug overdose
• More than the population of a Texas 6A high school
• More than the population of nearly 60 percent of the cities and towns in Texas
Sources: Texas DSHS Provisional counts of drug overdose deaths, 2/15/2018. U.S. Census Bureau (2017). Annual Estimates of the Resident Population in Texas: April 1, 2010 to July 1, 2016. Available at: https://www.census.gov/data/datasets/2016/demo/popest/total-cities-and-towns.html
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What are Opioids?
5Source: National Institute on Drug Abuse
Type of Opioid Examples
Natural opioids (sometimes called opiates) Morphine, Codeine, Thebaine
Semi-synthetic Hydromorphone, Hydrocodone, Oxycodone, Heroin
Fully synthetic Fentanyl, Methadone, Tramadol
The Opioid System
• Controls pain, reward, and addictive behaviors
• Opioids attach to and activate opioid receptor proteins
• Opioids suppress perceptionof pain and calm emotional response to pain
Source: Gutstein H, Akil H. Opioid Analgesics. In: Goodman & Gilman’s the Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill; 2006:547-590. 6
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Data Trends
Understanding Opioid Misuse and Associated Consequences in Texas
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10.5
0.6
4.2
0.04
12.3
0.6
3.7
0.070
3
6
9
12
15
Marijuana Cocaine Pain RelieverMisuse
Heroin
Past Year Substance Use among Youth Ages 12-17: TX vs. US
Texas U.S.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016. 8
10.1
1.5
4.5
0.22
13.9
2.0
4.5
0.360
3
6
9
12
15
Marijuana Cocaine PainRelieverMisuse
Heroin
Past Year Substance Use among Adults 18 or Older: TX vs. US
Texas U.S.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016. 9
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Accidental Poisoning Deaths in Texas: 1999-2015
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Source: Texas Death CertificatesAccidental Poisonings based on County of OccurrencePrepared by Texas Department of State Health Services, Center for Health Statistics 3/6/2018
2,226
1,174
0
500
1,000
1,500
2,000
2,500
1999 2003 2007 2011 2015
Num
ber
of D
eath
s
Total
Opioids
Cocaine
Psychostimulants
Benzodiazepines
Other Drugs
Texas Health Data: Opioid-Related Deaths
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2,594
1,970
862727
305
0
750
1500
2250
3000
Opioids Benzodiazepines Psychostimulants Cocaine Marijuana
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Drug-Related Inpatient Emergency Department Visits: 2016
Source: Texas Hospital Inpatient Discharge Public Use Data Files, Q1 – Q4 2016. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. 3/7/2018.
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Texas Health Data:Opioid-Related Inpatient ED Visits
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Texas Poison Center Network Drug-Related Exposure Calls: 2000-2017
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5265
0
1500
3000
4500
6000
7500
9000
2000 2002 2004 2006 2008 2010 2012 2014 2016
Antidepressants
Benzodiazepines
All opioids
Stimulants
Source: Texas Poison Center Network, 2000-2017. Analyses include only those calls involving drug exposures; calls asking for information were not included.
Texas Health Data:Opioid-Related Exposure Calls
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Rate of Opioid-Related Poison Center Network Calls, by County: 2011-2015
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Why Do People Use?
Risk Factors for Opioid Misuse
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BioPsychoSocialFramework
Psychological-Emotions -Thinking
-Attitudes -Beliefs-Stress
Management-Perceptions
Biological-Genetics
-Neurochemistry-Drug Effects
-HPA Axis
Social-Social Support
-Family Background-Interpersonal Relationships
-Cultural traditions-Socioeconomic
Status
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Pain in the United States
• In 2016, nearly one in five adults had chronic pain in the past six months
• Estimated cost of $635 billion
• Late 1990s, pain recognized as “The Fifth Vital Sign”
Sources: QuickStats: Age-Adjusted Percentage of Adults Aged ≥18 Years Who Were Never in Pain, in Pain Some Days, or in Pain Most Days or Every Day in the Past 6 Months, by Employment Status — National Health Interview Survey, United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:796.Gaskin, D.J., & Richard, P. (2012). The Economic Costs of Pain in the United States. The Journal of Pain, 13 (8), 715. 19
Correlates of Prescription Opioid Misuse
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Community
Organizational
Interpersonal
Intrapersonal
Sources: McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351-377.SAMHSA CAPT (2016). Preventing Prescription Drug Misuse: Understanding Who Is at Risk. Available at: https://www.samhsa.gov/capt/sites/default/files/resources/preventing-prescription-drug-misuse-understanding.pdf
Refusal SkillsRisk Perception
Caregiver MonitoringCommunicationDisapproval
PeerApproval Number of Friends Using
Retail AvailabilityPrescriber Norms
Social AvailabilityCommunity Norms
What Can We Do?
Strategies to Prevent Opioid Misuse and Associated Consequences
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Public Health Approach to Preventing Substance Misuse and Addictions
Source: http://www.astho.org/addictions/ 22
Evidence-Based Prevention Strategies
Risk and Protective
Factors
But why here?
Problems and Related Behaviors
What? And why?
Source: Luciani, N. (2016, September 26). Community-level Strategic Planning to Prevent Non-medical Use of Prescription Drugs in Texas. Lecture presented at CAPT Training - Fall Prevention Provider Meeting, Austin.
Prevention Strategies
What should we do? And how?
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What is Primary Prevention?
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Community Education
• Youth and Young Adults
• Communities
• Health Providers
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Disposal and Storage• Take-Back Events and Drop-Boxes• Individual Medication Disposal Pouches• Lock-Boxes
Source: 2017 Texas College Survey of Substance Use: Main Report. Available at: https://texascollegesurvey.org/wp-content/uploads/2017/08/CDAS_report_final_2017.pdf
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38
2720
94
0
20
40
60
Someonewith a
Prescription
PersonalPrescription
Someonewithout a
Prescription
HomeMedicineCabinet
Stealing It On-Line
Perc
enta
ge
Sources of Misused Prescription Medication among Texas College Students: 2017
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Workforce Development
• Prevention, Treatment, and Recovery Professionals
• Prescribers and Other Health Care Professionals
Source: Shah, A., Hayes, C.J., & Martin, B.C. (2017). Characteristics of initial prescription episodes and likelihood of long-term opioid use: United States, 2006-2015. MMWR MorbMortal Wkly Rep; 66:265-269. 27
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Prescribing Patterns, by County: 2015
Source: CDC Vital Signs, July 2017Interactive maps: https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html 28
Data Infrastructure• Prescription Monitoring Programs
• High Utilization• Consistent Reporting• Incorporate into Prevention Planning
Source: www.cdc.gov/vitalsigns/opioids 29
Texas Prescription Monitoring Program
• Moved from the Department of Public Safety to the Texas Board of Pharmacy in 2016
• Prescriber mandate passed Spring 2017 (House Bill 2561, 85th Regular Session)• Registration• Requires patient look-up prior to
prescribing opioids, benzodiazepines, barbiturates, or carisoprodol
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What is Secondary Prevention?
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Referrals and Resources
• Outreach, Screening, Assessment, and Referral Centers (OSARs)
• Treatment Centers• Peer Coaches• Recovery
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Outreach, Screening, Assessment, and Referral Centers (OSARs)
Source: https://www.dshs.texas.gov/sa/OSAR/ 33
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Screening & Brief Intervention (SBI)• Designed for use by counselors
and professionals who do not specialize in addiction treatment
• Person-centered methodology that uses motivational techniques based on the person’s readiness to change
• Gives feedback and recommendations respectfully, without judgment or accusations, in the form of useful information
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Treatment and Recovery• Medication Assisted Therapies
• Methadone• Buprenorphine• Naltrexone
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What is Tertiary Prevention?
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Source: San Francisco Department of Public Health. Naloxone for Opioid Safety. San Francisco Health Network Website. http://bit.ly/2t8GaKy
Naloxone
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Resources for academic institutions, community organizations, & healthcare providers
Continuing education for pharmacists, prescribers, & social workers
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Summary and Additional Resources
Texas Health Datahealthdata.dshs.texas.gov/Home
Outreach, Screening, Assessment, and Referral Centers (OSARs)
www.dshs.texas.gov/sa/OSAR/
Operation Naloxonewww.OperationNaloxone.org
CDC Opioid Overdosewww.cdc.gov/drugoverdose/index.html
Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities
www.hhs.gov/about/agencies/iea/ partnerships/opioid-toolkit/index.html
U.S. Surgeon General – Opioid Overdose Preventionhttps://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/index.html 39
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