CDC Initiatives & Priorities to Address the Prescription Drug Overdose Crisis

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1 CDC Initiatives & Priorities to Address the Prescription Drug Overdose Crisis Grant Baldwin, PhD, MPH February 2, 2016 National Center for Injury Prevention and Control Division of Unintentional Injury Prevention

2 2002 Rapid Increase in Drug Overdose Death Rates by County SOURCE: NCHS Data Visualization Gallery

3 2007 Rapid Increase in Drug Overdose Death Rates by County SOURCE: NCHS Data Visualization Gallery

4 2014 Rapid Increase in Drug Overdose Death Rates by County SOURCE: NCHS Data Visualization Gallery

5 Deaths per 100,000 population Rise in Rx overdose deaths since 2000 and recent increase in heroin & fentanyl deaths 5 4 Commonly Prescribed Opioids like oxycodone or hydrocodone 3 Heroin 2 Methadone 1 0 Synthetic opioids like fentanyl SOURCE: National Vital Statistics System Mortality File.

6 Quarter billion opioid prescriptions in 2012

7 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 1 Providing training and educational resources to assist health professionals in making informed prescribing decisions 2 Increasing use of Naloxone 3 Expanding the use of Medication-Assisted Treatment

8 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

9 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

10 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

11 LOGIC MODEL Prescription Drug Overdose: Prevention for States and Prevention Boost* Targeting High-Risk Prescribers and High-Risk Patients** Inputs Funding Surveillance expertise TA on policy & program development Evaluation guidance Dissemination of best practices Outputs/Strategies*** Enhance and Maximize PDMPs 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* Improve Insurer/Health System Mechanisms 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 Evaluate laws/policies/regulations implemented in states, including their impact on heroin and prescription drug abuse/overdose Disseminate information on effective laws/policies/regulations *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. Short (1 year) Policy/Program Development PDMPS 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 Insurers/Health Systems Increase enrollment in PRR programs Implemented robust drug utilization review programs Implemented enhanced drug formularies Revised policy on Medication Assisted Treatment (MAT) Strengthened Evidence 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 State-Level Outcomes Medium (1 3 years) Behavior Change Providers 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 Patients Decreased doctor shopping rate Reduced barriers to seeking help and responding with naloxone to an overdose Insurers/Health Systems 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 Oversight/Enforcement Increased law enforcement and licensure boards using PDMP data Increased enforcement actions against outlier providers Decreased number of pill mills Long (3 5 years) Health Outcomes Fewer drug diversion cases Increased opioid substance abuse treatment admissions (ultimately want decrease) Decreased rate of ED visits due to controlled prescription drugs Decreased drug overdose death rate Improvement in treatment of pain **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

12 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 1 2 Enhance and Maximize PDMPs Community or Health System Interventions 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 Prevention for States Program COMPONENTS Rapid Response Projects State Policy Evaluation 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. 4 3 Build evidence base for policy prevention strategies that work like pain clinic laws and regulations, or naloxone access laws

13 Opioid Prescribing Guidelines for Chronic Pain Outside of Active Cancer, Palliative, & End-of-life Care PRIMARY CARE

14 Leveraging AHRQ Systematic Review Sept 2014

15 Process Used to Develop the Guidelines GRADE Method Multi-staged development with stakeholder input Projected release in 2016

16 Clinical Practices Opioid Prescribing Addressed in the Guidelines Determining when to initiate or continue opioids for chronic pain Intended for primary care providers. Opioid selection, dosage, duration, follow-up, and discontinuation Will apply to patients >18 years old in chronic pain outside of end-of-life care Assessing risk and addressing harms of opioid use

17 For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Web: 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. Special thanks to Noah Aleshire for his assistance preparing this presentation

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