Grant Baldwin, PhD, MPH
December 1, 2015
CDC Initiatives & Priorities to Address the
Prescription Drug Overdose Crisis
National Center for Injury Prevention and ControlDivision of Unintentional Injury Prevention
HHS Secretary’s Opioid Initiative
Focus on three priority areas that tackle the opioid crisis and significantly impact those struggling with substance use disorders to
help save lives
Providing training and educational resources to assist health professionals in making informed prescribing decisions
1
Increasing use of Naloxone
Expanding the use of Medication-Assisted Treatment
2
3
Three Pillars of CDC’s Work Improve data quality and track trends Strengthen state efforts by scaling up
effective public health interventions Supply healthcare providers with resources
to improve patient safety
Improving the quality & timeliness of opioid overdose surveillance
WHAT WE’RE DOING Generate near real-time surveillance
of emergency department visits related to drug overdoses
Improve surveillance of EMS transports related to drug overdoses
WHY WE’RE DOING IT An early warning of large increases or
decreases of drug overdoses to better target prevention efforts
Better understand changing demographic patterns of drug overdoses
Prevention for States (PfS) Provides states guidance and
resources to prevent prescription drug overdoses by addressing problematic opioid prescribing
Builds on the success of the Prevention Boost – Funding Opportunity
16 states funded with average award ranging from $750K to $1M
Funding to states with high burden and readiness to act
Focus on high impact, data driven activities and give states flexibility to tailor their work
Expand or improve proactive PDMP reporting
Expand/maximize PDMPs as a surveillance system
Implement mandatory PDMP registration or use
Reduce PDMP data collection interval
Evaluate existing PDMP practices*
Enhance Patient Review and Restriction (PRR) capacity
Enhance other health insurer/system practices*
Develop and apply metrics for inappropriate prescribing
Identify high-risk groups among the insured
Conduct cost analyses
Identify effective benefit design strategies
Disseminate best practices info for insurers
Provide technical assistance to high burden communities and counties*
Evaluate laws/policies/regulations implemented in states, including their impact on heroin and
prescription drug abuse/overdose
Disseminate information on effective laws/policies/regulations
Funding
Surveillance expertise
TA on policy & program
development
Evaluation guidance
Dissemination of best
practices
Short (1 year)Policy/Program Development
Medium (1−3 years)Behavior Change
Authority to send proactive reports
Mandatory registration & use
Reduced data collection interval (e.g., real time reporting)
Increased use of standard PDMP reports for surveillance and
other purposes
Long (3−5 years)Health Outcomes
Increase enrollment in PRR programs
Implemented robust drug utilization review programs
Implemented enhanced drug formularies
Revised policy on Medication Assisted Treatment (MAT)
Evidence of effectiveness for pain clinic laws
Evidence of effectiveness for clinical guidelines/rules
Evidence of effectiveness for licensure boards enforcement
policies and practices
Evidence of effectiveness for immunity/naloxone laws
Increased use of PDMPs
Decreased rate of high-dose (>100 MME/day) opioid Rxs
Decreased rate of dangerous drug combinations
Decreased prescribing patterns inconsistent with guidelines/rules
Increased # of patients on MAT
Decreased use of methadone for pain
Increased law enforcement and licensure boards using PDMP data
Increased enforcement actions against outlier providers
Decreased number of pill mills
Fewer drug diversion cases
Increased opioid substance abuse
treatment admissions (ultimately want
decrease)
Improvement in treatment of pain
Decreased drug overdose death rate
Decreased rate of ED visits due to controlled
prescription drugs
Decreased doctor shopping rate
Reduced barriers to seeking help and responding with naloxone to
an overdose
Enhanced adoption of opioid prescribing guidelines*
Increased number of patients enrolled in PRR programs
Reduced number of providers and MME/day among PRR enrollees
Increased use of claims reviews to identify outlier providers
**High-Risk Prescribing/
Patient Behaviors
• High-dose opioids (>100 MME/day)
• Multiple providers• Co-prescribing of
opioids and benzodiazepines
• Lack of access to substance abuse treatment
Enhance and Maximize PDMPs
Improve Insurer/Health System Mechanisms
Evaluate Laws/Policies/Regulations
PDMPS
Insurers/Health Systems
Strengthened Evidence
Providers
Insurers/Health Systems
Oversight/Enforcement
LOGIC MODEL Prescription Drug Overdose: Prevention for States and Prevention Boost*
Targeting High-Risk Prescribers and High-Risk Patients**
Patients
State-Level OutcomesOutputs/Strategies***Inputs
*These activities are being conducted through PFS only – all other activities are conducted through both Boost and PFS.***Through PFS, states can propose Rapid Response Projects that break new ground in any of these areas.
Enhance and Maximize
PDMPs
Community or Health System Interventions
State Policy Evaluation
Rapid Response Projects
Move toward universal PDMP registration and use
Make PDMPs easier to use and access
Move toward a real-time PDMP
Expand and improve proactive reporting
Conduct public health surveillance with PDMP
Implement or improve opioid prescribing interventions for insurers, health systems, or pharmacy benefit managers. This includes:
Prior authorization, prescribing rules, academic detailing, CCPs, PRRs,
Enhance adoption of opioid prescribing guidelines
Allow states to move on quick, flexible projects to respond to changing circumstances on the ground and move fast to capitalize on new prevention opportunities.
Build evidence base for policy prevention strategies that work like pain clinic laws and regulations, or naloxone access laws
Prevention for States ProgramCOMPONENTS
1 2
34
Opioid Prescribing Guidelines for Chronic Pain
Outside of Active Cancer, Palliative, & End-of-life Care
PRIMARY CARE
LeveragingAHRQSystematic Review
Sept 2014
Process Used to Develop the Guidelines GRADE Method Multi-staged development with stakeholder
input Projected release in January 2016
Opioid Prescribing Guideline
Intended for primary care providers.
Will apply to patients >18 years old in chronic pain outside of end-of-life care
Clinical Practices Addressed in the Guidelines
Determining when to initiate or continue opioids for chronic pain
Opioid selection, dosage, duration, follow-up, and discontinuation
Assessing risk and addressing harms of opioid use
Research priorities: Insurer, health system, and pharmacy benefit manager
strategies
Which insurance and pharmacy benefit manager interventions change prescribing behaviors most effectively (e.g., drug utilization review, patient review and restriction, prior authorization)?
Which of these interventions are most cost-effective?
What are the effective ways that state public health departments can engage insurers and pharmacy benefit managers to foster adoption of these interventions?
Research priorities: State policies and strategies
What are the impacts of innovative, untested policies and strategies at the state level?
Which PDMP strategies (e.g., mandatory registration) enhance use and produce the greatest impacts?
What are the cost implications and cost savings of identified policy changes?
How can communications campaigns influence physician opioid prescribing and patient opioid use?
Research priorities: Risk and protective factors for prescription drug
and heroin mortality
How can PDMP, coroner, medical examiner, and law enforcement data be used to identify risk and protective factors for drug overdose?
What are the patterns of co-use of prescription opioids and heroin, injection of opioids, and overdose?
Does controlled substance prescribing, including opioid pain reliever prescribing, increase risk for heroin overdose?
Research priorities: Clinical practice guidelines and coordinated care plans
What are the clinical decision support needs, barriers, and effective approaches to promoting guideline adherence in primary care?
What factors facilitate adoption of coordinated care plans in health systems?
What are the patient and health system impacts of guideline, clinical decision support, and coordinated care plan implementation?
http://www.cdc.gov/injury/researchpriorities/
More Information:
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.