Annual Harold Rogers Prescription Drug Monitoring Program onitoring. Commissioner Cheryl Bartlett, RN Massachusetts Department of Public Health

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1 Annual Harold Rogers Prescription Drug Monitoring Program onitoring Commissioner Cheryl Bartlett, RN Massachusetts Department of Public Health

2 Current Substance Use: Massachusetts vs. Northeast Region and National, ages 12 and older Northeast region includes New England and Middle Atlantic states. Source: SAMHSA, National Survey on Drug Use and Health,

3 Past Month Alcohol Use in US & Select States, Source: SAMHSA, National Survey on Drug Use and Health,

4 Past Month Illicit Drug Use in US & Select States, Illicit Drugs include nonmedical marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescriptiontype psychotherapeutics used nonmedically. Source: SAMHSA, National Survey on Drug Use and Health,

5 Past Year Nonmedical Pain Reliever Use in US & Select States, Illicit Drugs include nonmedical marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescriptiontype psychotherapeutics used nonmedically. Source: SAMHSA, National Survey on Drug Use and Health,

6 Past Year Nonmedical Pain Reliever Use by Age Group in US & Select States, Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs. Source: SAMHSA, National Survey on Drug Use and Health,

7 Number of Deaths Massachusetts Unintentional Opioid Overdose Deaths (est.) Est. = Estimate This is the projected number for 2013 based on the first six months of preliminary data Source: Registry of Vital Records and Statistics, MDPH

8 Number of Nonfatal overdoses Massachusetts Nonfatal Opioid-related Overdoses ,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1, ,864 4,684 Sources: MA Inpatient Hospital Discharge Database, MA Outpatient Emergency Department Discharge Database, and MA Observation Stay Database, Center for Health Information and Analysis (CHIA).

9 Prescription opioid sales, deaths and treatment: National Vital Statistics System, ; Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), ; Treatment Episode Data Set,

10 Four-part Strategy Being Applied in Massachusetts 1. Promote safe opioid prescribing through education and the use of the PMP 2. Provide help if someone becomes addicted to prevent sickness, injury or death 3. Treat the person s addiction 4. Provide recovery support to both the person and their families

11 State Indicators The Trust for America s Health Prescription Drug Abuse: Strategies to Stop the Epidemic 2013 provides a snapshot of the range of evidence-informed policies in place in different states. Zero is the lowest possible overall score (no policies in place), and 10 is the highest (all the policies in place)

12 INDICATORS 1. Prescription Drug Monitoring Program: Does the state have an operational Prescription Drug Monitoring Program? 2. Mandatory Use of PDMP: Does the state require mandatory use of PDMPs by providers? (any form of mandatory use requirement) 3. Doctor Shopping Law: Does the state have a doctor shopping statute? 4. Support for Substance Abuse Services: Has the state expanded Medicaid under the Affordable Care Act, thereby expanding coverage of substance abuse treatment? 5. Prescriber Education Requirement: Does the state require or recommend education for prescribers of pain medications? 6. Good Samaritan Law: Does the state have a law in place to provide a degree of immunity from criminal chargers or mitigation of sentencing for an individual seeking help for themselves or others experiencing an overdose? 7. Support for Naloxone Use: Does the state have a law in place to expand access to, and use of, naloxone for overdosing individuals given by lay administrators? 8. Physical Exam Requirements: Does the state require a healthcare provider to either conduct a physical exam of the patient, a screening for signs of substance abuse or have a bona fide patient-physician relationship that includes a physician examination, prior to prescribing prescription medications? 9. ID Requirement: Does the state have a law requiring or permitting a pharmacist to ask for identification prior to dispensing a controlled substance? 10. Pharmacy Lock-In Program: Does the state s Medicaid plan have a pharmacy lock-in program that requires individuals suspected of misusing controlled substances to use a single prescriber and Pharmacy?

13 Scores By State 10 (2 states) 9 (4 states) 8 (11 states) 7 (5 states) 6 (11 states & D.C) New Mexico Vermont Kentucky Massachusetts New York Washington California Colorado Connecticut Delaware Illinois Minnesota North Carolina Oklahoma Oregon Rhode Island West Virginia Florida Nevada New Jersey Tennessee Virginia Arkansas D.C. Georgia Hawaii Iowa Louisiana Maryland Michigan North Dakota Ohio Texas Utah 5 (8 states) 4 (6 states) 3 (2 states) 2 (1 state) Alaska Idaho Indiana Maine Mississippi Montana New Hampshire South Carolina Alabama Arizona Kansas Pennsylvania Wisconsin Wyoming Missouri Nebraska South Dakota

14 Emergency Actions On March 27, 2014, Governor Deval Patrick declared a public health emergency in response to the growing opioid addiction epidemic and established an Opiate Task Force Subsequent to this declaration, Commissioner Bartlett requested and received the approval of the Public Health Council to take the following actions: Order expanded access to naloxone for individuals in a position to assist a person experiencing an opioid-related overdose. Prohibit the prescribing and dispensing of hydrocodone-only medication until adequate measures are in place to safeguard against the potential for diversion, overdose and misuse. Issue emergency regulations to permit first responders to carry and administer naloxone (Narcan), a safe and effective opioid antagonist. Work with staff to develop a proposal to the Council on accelerating the mandatory use of prescription monitoring by physicians and pharmacies. Convene a taskforce through the Interagency Council on Substance Abuse Slide 14

15 Expanded Access to Naloxone Expand Naloxone to Bystanders $300,000 added to Bystander Naloxone Program agencies statewide to increase capacity to do training in overdose prevention, recognition and response including administration of intra-nasal naloxone. The Board of Pharmacy is drafting a letter providing guidance to licensees and other stakeholders regarding the Commissioner s Order and access to Naloxone. The letter outlines and explains protocols and procedures for obtaining a standing order so all pharmacies have the ability to participate and make Naloxone available to patients and bystanders Once completed the letter will be posted on the Board s website, disseminated by to the Board s regular distribution list, and be presented and reviewed at upcoming scheduled outreach meetings Slide 15

16 Naloxone for First Responders First Responder Regulations Changes to the First Responder regulations were distributed to all regional EMS offices, regional medical directors, state EMS director, EMS agencies, EMCAB members and training institutions OEMS also reached out to police training Council as they are responsible for training approximately 30,000 first responders, to advised them of the emergency regulation changes OEMS has prepared information, as well as the new protocol, which now applies to first responders and this was posted to the OEMS website OMES has circulated the administrative requirement pertaining to first responder training which will also be posted Slide 16

17 Prohibition of New Medication Prohibit Hydrocodone in Hydrocodone-Only Extended-Release Formulation (Non-abuse deterrent) On April 15, 2014, there was a federal district court decision enjoining the ban prohibiting the prescribing and dispensing of any hydrocone product in hydrocodone-only extended-release formulation On June 16, 2014 the Board of Registration in Medicine (BORIM) approved amendments to the emergency regulations to retain the expectation that physicians will thoroughly assess a patient prior to prescribing a hydrocodone-only extended release medication that is not in an abuse deterrent form. The required assessment includes an evaluation of the patient s risk factors and presenting conditions and a requirement that the physician check the patient s prescription data through the online PMP. Slide 17

18 Task Force Inter-Agency Council on Substance Abuse (IACSA) Opioid Task Force Purpose: The Task Force will investigate all aspects of opioid abuse including but not limited to: how to better coordinate services, ensure a full range of treatment regardless of insurance, and how to divert non-violent criminal defendants struggling with addiction into treatment programs. Convened members from various sectors across the Commonwealth including providers, family members, community leaders and members of the Executive Committee of the IACSA, with first meeting held April 7. Task Force to make recommendations within 60 days. On June 10, the Governor approved recommendations of the Task Force and DPH to reduce overdose events, prevent opioid misuse and addiction, increase the numbers of persons seeking addiction treatment, support persons recovering from addiction in our communities and map a long term solution to address opioid abuse in the Commonwealth Slide 18

19 Prevention Finding: There is a need for increased education for youth, families and prescribers Education and Awareness campaign for targeting youth and families Enhanced education to prescribers through CME requirements Add up to five new Opioid Overdose Prevention Coalitions in high need areas Slide 19

20 Intervention Finding: Opportunities exist to improve safe prescribing and dispensing Work with boards of registration to minimize diversion and misuse Require all prescribers to utilize the PMP more frequently Develop regulations and policies through health professional licensure Adopt Joint Policy Working Group recommendations Slide 20

21 Treatment Finding: There is need for centralized services Coordinated referral through central navigation system Establishing regional walk in assessment centers that could coordinate with central navigation as needed Develop and implement a public facing dashboard Finding: Individuals and families report challenges in accessing services Prioritize treatment for underserved populations Families Youth Hispanics Address the geographic gap in Franklin County MATs- Expand OBOTS to include vivitrol at CHC s Add more CSS beds Slide 21

22 Treatment Finding: Providers and Consumers express concerns about barriers to access DPH and the Division of Insurance, in consultation with the Health Policy Commission, should conduct a comprehensive review of medical necessity criteria and utilization review guidelines for opiate abuse and addiction treatment Interagency Council on Substance Abuse and Prevention should expand its review of substance abuse issues to review interagency regulatory and operational barriers to treatment Finding: Correctional facilities are an important site of care for opioid addiction Enhance the DOC s and Sheriff Offices' continuum of care by increasing the availability of treatment for offenders at designated DOC facilities. Support the expansion of the use of injectable naltrexone for persons re-entering the community from correctional facilities Slide 22

23 Recovery Finding: There is a need for peer support in the recovery process. Develop a peer to peer support network Finding: There is a need for expanded recovery services across the state. Augment the capacity of Recovery Support Centers by expanding hours to include nights and weekends and by adding new Recovery Support Centers Add a Recovery High School in Worcester area Add Learn to Cope chapters across the Commonwealth DPH also recommends developing and implementing a voluntary accreditation program for Alcohol Drug-Free Living housing, also known as sober homes. Slide 23

24 Community Education Commissioner Actions Participated with Hilary Jacobs, BSAS Director, in training video for first responders usage of Narcan Spoke at the Addiction Nurses Conference Attended MOAR (Massachusetts Organization for Addiction Recovery) Statewide Alcohol Awareness Town Hall Meeting Attended the National Prescription Take Back Press Conference with Mayor Marty Walsh and Congressman Joe Kennedy Meeting with Federal agencies Communicating with mayors, law enforcement, stakeholders and convening round tables Public Health Advisory A Public Health Advisory has been issued on the DPH website to the public and providers on opioid overdose Slide 24

25 NE Governor s Task Force On June 17, 2014, the New England Governor s met at Brandeis University for a round table on opioids. The Governor s developed 5 goals for a regional response to opioid use: Prescription Monitoring Program (PMP) Data Sharing Safe Opioid Prescribing Practices Shared Treatment Resources Regional Prevention Campaign Align Law Enforcement Activities August 18- North Eastern states met to develop a work plan to address the Governor's concerns Final report to Governors anticipated October, 2014 Slide 25

26 Thank you Slide 26

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