O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H

A D M I R A L B R E T T P. G I R O I R , M . D .A ss i s t a n t S e c re t a r y fo r He a l t h

S e n i o r Adv i se r, I m m e dia te O f f i ce o f t h e S e c re t a r y

Human Services Programsand the Opioid Crisis

2O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

THE STATE OF OPIOID MISUSE IN AMERICA (2018)

10.3 million people misused opioids in the past year

- 9.9 million misused pain relievers

- 808,000 used heroin

- 506,000 both misused pain relievers and heroin

from 11.4 million (2017)

NSDUH, 2018 Data; published Aug. 2019

Main reasons for opioid misuse: Pain 63.6%

2.0 million people had an opioid use disorder

- 1.7 million people with a prescription pain reliever use disorder

- 526,000 people with a heroin use disorder

- 226,000 had both pain reliever and heroin use disorders

51.3% obtained the last pain reliever they misused from a friend or relative

37.6% prescribed by a

healthcare provider. Only 2% received from >1 provider

2

3O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

PROPORTION OF DEATHS RELATED TO OPIOIDSBY AGE GROUP: 2001, 2006, 2011, and 2016

4O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

THE HUMAN SERVICES CRISIS: EXAMPLE, MIAMIOCTOBER 25, 2018

4

Orphaned by Opioids: The Silent Victims of the Crisis

“Right now, we have more children between birth and five in shelters and in group care than we’ve ever had… and that may very well be a function of opioids,” said Larry Rein, the Executive Director of ChildNet.

TANF, child support, and related programs can help families affected by OUD

find economic stability

https://www.nbcmiami.com/news/local/Orphaned-by-Opioids-The-Silent-Victims-of-the-Crisis.html

Head Start and child care providers can provide education to families and a safe, loving

environment for children

5O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

NEWBORN VICTIMS OF THE OPIOID EPIDEMIC

McQueen, NEJM 2016

Outcomes in the Fetus• Growth restriction• Prematurity• Death

Outcomes in the Newborn• Low birthweight• Small head circumference• Neonatal abstinence syndrome

Outcomes in the Child• Developmental disorders

0

5000

10000

15000

20000

25000

30000

2008 2009 2010 2011 2012 2013 2014 2015 2016

Source: AHRQ HCUP State Inpatient Databases

6O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

MENTAL DISORDERS AMONG CHILDREN BORN WITH NEONATAL ABSTINENCE SYNDROME (NAS) (%)

Sherman, Psychiatric Services 2018; 00:1; doi: 10.1176/appi.ps.201800341

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

Any mental disorder

Specific delays in development

Disturbance of conduct

Hyperkinetic syndrome of childhood

Adjustment reaction

Acute reaction to stress

Neurotic disorders

Other Births (N=269,726) NAS Births (N=1,046)

7O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

INFECTIOUS CONSEQUENCES OF THE OPIOID EPIDEMIC

• HIV• Hepatitis C• Hepatitis B• Endocarditis• Skin, bone, and

joint infections

National Academies WorkshopSponsored by OASH, Report July 2018

8 8https://www.hhs.gov/opioids/

9O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

U.S. DRUG OVERDOSE DEATHS THE MOST CRITICAL PUBLIC HEALTH CHALLENGE OF OUR TIME

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

68,588

47,608

All Drug Overdoses

Opioid Overdoses

SOURCE: NCHS, National Vital Statics System, Mortality

Deaths Decreased 5% from 2017 to 2018

9

10O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

WHAT IS EVIDENCE-BASED TREATMENT?

• FDA-approved Medication (MAT)- Naltrexone: once a month injectable medication, blocks effects of opioids (any prescriber)- Buprenorphine (usually with naloxone): once daily/once monthly, partial agonist opioid from

prescribers (DATA 2000 waivered prescribers)- Methadone: long acting, once-daily, opioid from specially licensed programs (OTP programs only)

• Psychosocial Therapies- Contingency management, family therapy, cognitive behavioral therapy, others

• Recovery Services - Rebuilding One’s Life- Social supports to welcome into a healthy community: family, friends, peers, faith-based supports- Assistance with needs that can impact treatment - recovery housing, transportation and child care- Employment/vocational training/education

• Naloxone

10

11O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

TRANSFORM TO A SUSTAINABLE MODEL

Transition from a “crisis framework” into an integrated, sustainable, predictable, and resilient public health system for preventing and treating substance use and other behavioral health disorders.

11

12O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H 12

MATERNAL OPIOID MISUSE MODEL

The primary goals of the MOM Model are to:- Improve quality of care and reduce costs for pregnant and

postpartum women with OUD and their infants- Expand access, service-delivery capacity, and infrastructure

based on state-specific needs- Create sustainable coverage and payment strategies that

support ongoing coordination and integration of care

Requires- Comprehensive care management- Care coordination- Health promotion- Individual and family support- Referral to family and social services

Maternity and Infant Care

OUD Treatment

Behavioral Health and

Primary Care

State Medicaid Agency

Awards Anticipated December 2019

13O F F I C E O F T H E

A S S I S T A N T S E C R E T A R Y F O R H E A L T H

THE FUNDAMENTAL HUMAN SERVICE ISSUEWe must understand, engage, and remedy the underlying root causes of addiction, suicides, and other behavioral health issues.

Sept 21, 2018

14

WWW.HHS.GOV/ASH WWW.USPHS.GOV

@HHS_ASH

BRETT P. GIROIR, M.D.ADM, U.S. Public Health ServiceAssistant Secretary for Health,Senior Adviser, Immediate Office of the Secretary ASH@hhs.gov