NYC RxStat: A Collaborative Approach to Surveillance of Prescription Drug Misuse and Associated Consequences

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1 NYC RxStat: A Collaborative Approach to Surveillance of Prescription Drug Misuse and Associated Consequences National Governor s Association Institute for Governors Criminal Justice Policy Advisors Washington, DC May 1,

2 Introduction Chauncey Parker Director of New York/New Jersey High Intensity Drug Trafficking Area (HIDTA) Steven Newmark Sr. Policy Advisor & Counsel to the Deputy Mayor for Health and Human Services, New York City Office of the Mayor Denise Paone Director of Research & Surveillance, Bureau of Alcohol & Drug Use Prevention, Care & Treatment, New York City Department of Health & Mental Hygiene 2

3 Outline NYC RxStat Overview Public Health Data Sources Data Driven Opioid Policies and Strategies in New York City 3

4 Steven Newmark, JD/MPA, Sr. Policy Advisor & Counsel to the Deputy Mayor for Health and Human Services New York City Office of the Mayor RXSTAT OVERVIEW 4

5 Opioid Analgesics Are a Public Health Crisis in New York City 5 *Paone D, Bradley O Brien D, Shah S, Heller D. Opioid analgesics in New York City: misuse, morbidity and mortality update. Epi Data Brief. April Available at

6 RxStat: Central Focus and Unifying Goal Reduce Overdose Deaths 6

7 RxStat: Four Core Principles Timely, accurate analysis of drug misuse indicators from multiple sources (e.g., mortality, EDs, PMP, drug treatment, law enforcement, etc.) Develop strategies based on analysis of existing and newly available data Rapid deployment of public health and public safety resources to high priority areas Rigorous follow-up to ensure strategies are effective 7

8 RxStat Public health & public safety collaboration Housed at NYC Department of Health & Mental Hygiene (DOHMH) leverages expertise and infrastructure Real-time (enhanced) surveillance Participants and stakeholders at city, state, and federal organizations Monthly RxStat Data Meetings 8

9 Layering and Reporting Data Reduce Overdose Deaths 9

10 Data Sources Price/Purity Qualitative Research Mortality Medicaid Fraud Data PMP Data Drug Prosecutions Reduce Overdose Deaths Hospitalizations Syndromic Poison Control Pharmacy Crime 10 DEA ARCOS Treatment Admissions Jail Data

11 Denise Paone, EdD, Director of Research & Surveillance Bureau of Alcohol & Drug Use Prevention, Care & Treatment New York City Department of Health and Mental Hygiene PUBLIC HEALTH DATA SOURCES 11

12 Number 900 Opioids Were Involved In 73% of Overdose Deaths in NYC Total Opioids Heroin NOTE: Drugs not mutually exclusive Opioid Analgesics Year of Death 12 Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene

13 Number Age-adjusted rate per 100,000 Opioid Analgesic Overdose Deaths Increased 233% from 2000 to 2012, NYC Number of unintentional opioid analgesic poisoning deaths Age-adjusted rate per 100, Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene

14 Age-Adjusted Rate per 100,000 Staten Island residents had the highest rate of opioid-analgesic overdose death Staten Island Manhattan Bronx Brooklyn Queens Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene

15 Number Age-adjusted rate per 100,000 Heroin Overdose Deaths Increased 84% from 2010 to 2012, NYC Number of unintentional heroin poisoning deaths Age-adjusted rate per 100, Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene

16 Age-Adjusted Rate per 100,000 Staten Island residents had the highest rate of heroin overdose death Bronx Staten Island Manhattan Brooklyn Queens Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene

17 PRESCRIPTION MONITORING PROGRAM 17

18 Number of Prescriptions 2,500,000 Opioid analgesic (OA) prescriptions NYC, Opioid analgesic prescriptions 2,000,000 Note: Schedule II opioid analgesics 1,500,000 1,000,000 Oxycodone Hydrocodone 500, Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, Year

19 Age-adjusted rate of prescriptions filled per 1,000 residents Staten Islanders filled OA prescriptions 500 at higher rates in Opioid Analgesics Oxycodone Hydrocodone Note: Schedule II opioid analgesics NYC Bronx Brooklyn Manhattan Queens Staten Island Rates are adjusted to 2000 US Standard population Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2012 Borough of Residence

20 Median Supply, Days OA prescriptions filled by Staten Islanders have longer median day supply 30 Note: Schedule II opioid analgesics Median day supply is calculated from day supply of each prescription filled in the year NYC Bronx Brooklyn Manhattan Queens Staten Island Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2012 Borough of Residence

21 Age-adjusted rate of prescriptions filled per 1,000 residents OA prescriptions filled by Staten Islanders are more frequently high dose (>100 MED) Note: Schedule II opioid analgesics High dose is any opioid analgesic prescription with a calculated morphine equivalent dose (MED) greater than 100. Among patients receiving opioid prescriptions, overdose rates increase with increasing doses of prescribed opioids NYC Bronx Brooklyn Manhattan Queens Staten Island Rates are adjusted to 2000 US Standard population Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, Borough of Residence

22 Concerns about initiation of heroin associated with opioid analgesic use NSDUH data show: Recent (12-months preceding interview) rate for new heroin initiates was 19 times higher among those who reported nonmedical opioid analgesic use than among those who did not use nonmedical opioids Four out of five heroin initiates (79.5%) had used nonmedical opioid analgesics whereas only 1% of recent opioid analgesic initiates had used heroin Source: CBHSQ Data Review, August

23 Denise Paone, EdD, Director of Research & Surveillance Bureau of Alcohol & Drug Use Prevention, Care & Treatment New York City Department of Health and Mental Hygiene USING DATA TO INFORM OPIOID POLICIES AND STRATEGIES IN NEW YORK CITY 23

24 Neighborhoods with high rates of OA prescriptions have high rates of unintentional (overdose) deaths involving opioid analgesics OA PRESCRIPTION RATES OA MORTALITY RATES *Paone D, Bradley O Brien D, Shah S, Heller D. Opioid analgesics in New York City: misuse, morbidity and mortality update. Epi Data Brief. April Available at

25 Opioid Prescribing Guidelines Less often: avoid prescribing opioids for chronic non-cancer, non-end-of-life pain e.g., low back pain, arthritis, headache, fibromyalgia Shorter duration: when opioids are warranted for acute pain, 3-day supply usually sufficient Lower doses: if dosing reaches 100 Morphine Milligram Equivalents (MME), reassess and reconsider other approaches to pain management Avoid whenever possible prescribing opioids in patients taking benzodiazepines Citation: Paone D, Dowell D, Heller D. Preventing misuse of prescription opioid drugs. City Health Information. 2011; 30(4): New York City Opioid Treatment Guidelines, Clinical Advisors: Nancy Chang, MD; Marc N. Gourevitch, MD, MPH; Mark P. Jarrett, MD, MBA; Andrew Kolodny, MD; Lewis Nelson, MD; Russell K. Portenoy, MD; Jack Resnick, MD; Stephen Ross, MD; Joanna L. Starrels, MD, MS; David L. Stevens, MD; Anne Marie Stilwell, MD; Theodore Strange; MD, FACP; Homer Venters, MD, MS

26 Emergency Department Guidelines Released January, 2013 Adopted by 38 NYC emergency departments 26 New York City Emergency Department Discharge Opioid Prescribing Guidelines Clinical Advisory Group: Jason Chu, MD, Brenna Farmer, MD, Beth Y. Ginsburg, MD, Stephanie H. Hernandez, MD, James F. Kenny, MD, MBA, FACEP, Nima Majlesi, DO, Ruben Olmedo, MD, Dean Olsen, DO, James G. Ryan, MD, Bonnie Simmons, DO, Mark Su, MD, Michael Touger, MD, Sage W. Wiener, MD.

27 Staten Island Public Health Detailing Campaign 1-on-1 detailing visits from Health Department representatives Deliver key prescribing recommendations, clinical tools, patient education materials ~1,000 Staten Island physicians, nurse practitioners, physicians assistants June August

28 28

29 Morphine Milligram Equivalent (MME) Calculator A tool to calculate total MME per day Gives alert for dosages >100 MME Quick and easy to use Web-based application Search for NYC MME Calculator Smartphone app 29

30 Media Campaigns Campaign One: Goal: Increase awareness of risk of opioid analgesic overdose Ran twice (2012, 2013) Campaign Two: Goal: Reduce stigma and raise awareness of opioid analgesic misuse 2 testimonials Mom lost son to opioid analgesic overdose NYC resident in recovery Ran 2013 and

31 Available at:

32 Overdose (OD) Prevention: Naloxone 32

33 In New York State, trained laypersons can legally administer naloxone for OD prevention Per NYS Public Health Law Opioid Overdose Prevention Program Effective April 1, 2006 Laypersons can become Trained Overdose Responders Trained Overdose Responders can legally carry and use naloxone 33

34 Intranasal Naloxone Distribution in NYC Since 2010 Drug Treatment Programs 13% Syringe Exchange Programs 73% Other (e.g., shelters, hospitals) 14% >25,000 kits distributed >200 reversals reported (underreporting) 34

35 NYC Department of Homeless Services (DHS) More than half DHS Peace Officers are trained and carry naloxone in all city shelters 35

36 NYPD Naloxone Project All NYPD officers in the 120 precinct on Staten Island (approximately 180) have been trained to carry and dispense naloxone Reported reversals 36

37 New York State Good Samaritan Law 37

38 Summary RxStat is a collaboration between NYC public health and public safety toward one unifying goal: Reduce overdose deaths in NYC Opioid overdose deaths are preventable Multi-pronged data driven approaches are needed 38