stepping up to take on the opioid epidemic cheac annual ... · california health care foundation 8...
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1www.chcf.orgCalifornia Health Care Foundation 1www.chcf.orgCalifornia Health Care Foundation
Stepping Up to Take On the Opioid Epidemic
Kelly Pfeifer, MDOctober 18, 2018 CHEAC Annual Meeting
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2www.chcf.orgCalifornia Health Care Foundation 2www.chcf.orgCalifornia Health Care Foundation
Presenters
John Connolly, PhD Kelly Pfeifer, MD Carmen Nevarez, MD, MPH
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3www.chcf.orgCalifornia Health Care Foundation
STAT Special Report: 52 Weeks, 52 Faces Obituaries Narrate Lives Lost to the Opioid Epidemic
More people die from alcohol and tobacco use, but neither is likely to kill you tonight.
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4www.chcf.orgCalifornia Health Care Foundation
California statewide opioid strategy
PREVENTnew starts through safer pain prescribing
MANAGEpain safely: work with
patients to find safer regimens
TREATaddiction effectively with medications, at all points in the health care system
STOPdeaths through harm reduction (naloxone,
needle exchange)
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5www.chcf.orgCalifornia Health Care Foundation 5www.chcf.orgCalifornia Health Care Foundation
MANAGEPREVENTCalifornia is making progress
Source: www.cdph.ca.gov/opioiddashboard
High-dose prescribingTotal opioid prescribing(morphine mg equivalents)
Patients using5+ prescribers/pharmacies Use of benzos and opioids
NA
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6www.chcf.orgCalifornia Health Care Foundation 6www.chcf.orgCalifornia Health Care FoundationSource: www.cdph.ca.gov/opioiddashboard
Rising buprenorphine prescribing
However, access to SUD treatment still not adequate to meet demand.
Dropping overall opioid OD deaths
Rising heroin and fentanyl OD deaths
TREAT STOP DEATHSCalifornia is making progress, but we still have work to do
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7www.chcf.orgCalifornia Health Care Foundation
“Kelly Coltrain, 27, of Austin, was found dead in her cell in Nevada's Mineral County Jail on July 23, 2017, after suffering a seizure related to drug use . . .”
“Coltrain was a heroin user since 2008 and had been jailed because of traffic violations . . .”
People DO die from withdrawal, MAT is lifesaving
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8www.chcf.orgCalifornia Health Care Foundation
Deaths won’t stop until treatment is easier to get than street drugs
Brain in a tempest: day-to-day survival
Impact on long-term overdose death rate (in large real-world studies)
MAT stabilizes brain chemistry: can focus on recovery
Sordo et al., Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies, BMJ 2017; 357;j1550; Larochelle, et al. Ann Intern Med. 2018;169(3):137-145; DOI: 10.7326/M17-3107
MethadoneBuprenorphine (Suboxone)Naltrexone (Vivitrol)
Drug-free (detox)
➢ Cuts death by 67%➢ Cuts death rates by 50%➢ Long-term large trials: no
impact on death rate➢ 2-3x OD death rates
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9www.chcf.orgCalifornia Health Care Foundation
Diabetes vs. AddictionTreatment
Custody of children
Freedom (probation)
Housing
Family
Work
Identity
No Yes
No
No
No
No
Yes
Yes
Yes
YesNo
Yes
No Yes
You Make a Mistake: what could you lose?
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10www.chcf.orgCalifornia Health Care Foundation 10www.chcf.orgCalifornia Health Care Foundation
Vision: MAT at all points of care in the health system
EDs, hospitals, primary care, mental health, residential treatment, jails….
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11www.chcf.orgCalifornia Health Care Foundation 11www.chcf.orgCalifornia Health Care Foundation
Buprenorphine prescribing rates nearly doubled in coalition counties
CHCF launched local coalitions and pulled them together into a statewide network, now 40 counties strong.
Greater drops in prescribing rates in coalition counties
2015
2018
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12www.chcf.orgCalifornia Health Care Foundation 12www.chcf.orgCalifornia Health Care Foundation
Smart Care California: leveraging power of purchasers and plans.
0% 20% 40% 60% 80%
Limit new starts
Limit concurrent prescriptions for opioidand benzodiazepines
Help providers develop taper plans forpatients on high opioid doses
Health Plan Approaches: PREVENT new starts and MANAGE pain 2017 2018
0% 50% 100%
Develop action plan to meet demand forMAT (buprenorphine)
Support provider education: buprenorphineprescribing
Remove PA for buprenorphine (for addiction)
Offer provider education: co-prescribingnaloxone
Health Plan Approaches: TREAT addiction and STOP deaths 2017 2018
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13www.chcf.orgCalifornia Health Care Foundation
What Can We Learn from Another Epidemic?
Source: Centers for Disease Control, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
US AIDS Deaths, 1981-2007
--- AIDS deaths
Effective medications.Massive effort to increase access.Anti-stigma campaign.
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14www.chcf.orgCalifornia Health Care Foundation
The French Experience: 80% Drop in Deaths
Heroin OD deaths
Methadone treatment
Buprenorphineprescriptions
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15www.chcf.orgCalifornia Health Care Foundation
Additional Resources
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16www.chcf.orgCalifornia Health Care Foundation
California Opioid Overdose Surveillance Dashboard
https://discovery.cdph.ca.gov/CDIC/ODdash/
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17www.chcf.orgCalifornia Health Care Foundation
Understanding addiction: how opioids change the brain
Addiction Neuroscience 101 https://youtu.be/bwZcPlRRcc