Preventing Prescription Drug Abuse: An Important Role for State Injury Prevention Programs

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1 Preventing Prescription Drug Abuse: An Important Role for State Injury Prevention Programs 2012 Joint tannual lmeeting of the Sf Safe States t Alliance and CDC Core Violence and Injury Prevention Program (Core VIPP) Wednesday, May 2, 2012 Cynthia Rodgers, MPH, Senior Technical Assistance Specialist, Children s Safety Network; RNL Coordinator, EDC Kathryn L. Santoro, MA, Director Maternal and Child Health Policy and Development, National Institute for Health Care Management (NIHCM) Foundation Holly Hackman, MD, MPH, Epidemiologist, Injury Prevention and Control Program, Massachusetts Department of Public Health Jennifer Sabel, PhD, Epidemiologist, Injury and Violence Prevention Program, Washington State Department of Health

Santoro, MA, Director Maternal and Child Health Policy and Development, National Institute for Health Care Management (NIHCM) Foundation Holly Hackman, MD, MPH, Epidemiologist,

2 Children s Safety Network Prescription Drug Abuse Efforts 2012 Joint Annual Meeting of the SafeStatesStates Alliance and CDC Core Violence and Injury Prevention Program May 2, 2012 Cynthia Rodgers

3 To understand the current level of involvement and interest in the topic To develop training, technical assistance and other resources September, 2011; all 50 state and District of Columbia MCH and IVP directors; all 50 state substance abuse services directors 45 states responded; 25 substance abuse and 43 MCH/IVP directors

50 state and District of Columbia MCH and IVP directors; all 50 state substance

4 : 1. Significant ifi interest in the issue 91% wanted to learn more; 79% wanted technical assistance 2. Majority of states include issue in prevention plan 63% MCH/IVP; 72% SAS 3. Most plans include youth and/or young adults 4. Majority are involved in prevention activities Data collection and reporting; training and technical assistance; participation in a collaboration; dissemination of information/materials 5. States are engaged in collaborations and cross agency work 42% MCH/IVP; 48% SAS participate ii in task force/committee 32% SAS; 21% MCH/IVP partnered with Medicaid or other health plan 28% SAS partnered with PDMP 6. Majority could identify community initiated prevention efforts Drug take back efforts; permanent kiosks; community forums

Majority are involved in prevention activities Data collection and reporting; training and technical assistance; participation in a collaboration; dissemination of information/materials 5.

5 Six session Learning Circle initiated in December, states currently participating Presenters have included ddr. Len Paulozzi of CDC, Mr. John Eadie of the PMP Center of Excellence and Melissa Heinen of Salus Consulting. Future sessions will feature a Principal of a Recovery High School, Pediatrician and Founder of a Family and Friends Support Group. To view additionaldetails details of the Environmental Scan, please go to the CSN website: p//

Future sessions will feature a Principal of a Recovery High School, Pediatrician and Founder of a Family and Friends

6 NIHCM FOUNDATION Why Are Health Plans Concerned About Preventing Adolescent Prescription & OTC Drug Abuse? Respondents generally indicated that prescription and OTC drug abuse is a priority for their health plan. Focus on adolescents varies some plans include adolescents in their overall efforts, some have adolescent-specific efforts Types of efforts vary, but include drug take-back days, addiction programs, restricting payments for inappropriate p use of medications and restricting patient to one provider & pharmacy to prevent doctor shopping Mainly working with states to disseminate information and materials, but indicated d further interest t in developing more in-depth collaborations with state public health & Medicaid agencies Barriers identified include lack of funding support for specific activities and a perceived lack of public support on this topic

Focus on adolescents varies some plans include adolescents in their overall efforts, some have adolescent-specific efforts Types of efforts vary, but include drug take-back days, addiction programs,

7 NIHCM FOUNDATION Health Plan Adolescent-Specific Efforts Cigna & Health Care Services Corporation Cigna developed a series of telephonic educational seminars to help members understand d physical, mental and emotional signs of individuals dealing with substance abuse disorders. There is a seminar specifically focused on Prescription and OTC drug abuse featuring The Partnership at DrugFree.org and a parent s story of losing a child to a accidental prescription p drug overdose Archived online and free to the general public ecenter/alcoholism/drugandalcoholawareness.jsp HCSC/BeSmart S BeWell Focus on Drug Safety Video: Katie s Story - Katie thought the pills were safe because they came from the medicine cabinet. Then she got addicted. She missed a lot of her childhood, and she wishes she could have it back. Prescription & OTC guide for parents describes commonly abused medications and teens nicknames for them developed by The Partnership at DrugFree.org Other items on the page include additional resources, more video accounts of medication addiction and what individuals can do to help reduce the risks related to the use of prescription and over-the-counter (OTC) drugs. Use social media to drive parent & teen members to the site

org and a parent s story of losing a child to a accidental prescription p drug overdose Archived online and free to the general public http://apps.cignabehavioral.

8 NIHCM FOUNDATION

9 Massachusetts Experience Holly Hackman, MD, MPH Massachusetts Department of Public Health

10 History - Massachusetts Poisoning the leading cause of injury death since 1990 s Opioids associated with ~2/3 Extensive programming within MA-DPH Bureau of Substance Abuse Services/Office of HIV/AIDS Injury Surveillance Prescription Monitoring Program Policy work

programming within MA-DPH Bureau of Substance Abuse

11 MA-DPH Injury Prevention Strategic Planning 2011/2012 Requirement of Core VIPP funding Review of surveillance data Poisonings identified as a priority area for prevention MassPINN (ICPG) Poisoning Workgroup Broad representation Focus area: prevention of fatal opioid overdose Reviewed evidence-base and best practice strategies Identified partners and resources for implementation Selected intervention for MDPH Injury Prevention and Surveillance to formally work on in Years 2-5 of Core VIPP

Focus area: prevention of fatal opioid overdose Reviewed evidence-base and best practice strategies Identified partners and

12 Poisoning Prevention Workgroup Participants Sarah Ruiz MDPH Bureau of Substance Abuse Services Michael Botticelli MDPH Bureau of Substance Abuse Services Adele Audet MDPH Drug Control Program Christine Farrell-O Reilly MDPH Division i i of Violence and Injury Prevention Holly Hackman MDPH Division of Violence and Injury Prevention Daniel Carr Tufts University Cindy Rodgers Educational Development Center Cathy Barber Harvard Injury Control Research Center John Eadie Brandeis Center of Excellence Jim Rathmell Massachusetts General Hospital Daniel Dooley Boston Public Health Commission Rahila Saeed Regional Poison Control Center

and Injury Prevention Daniel Carr Tufts University Cindy Rodgers Educational Development Center Cathy Barber Harvard Injury Control Research Center John Eadie

13 Implementation Plan Partner: Bureau of Substance Abuse Services Funding 10 community regions in MA to continue work of MassCALL2 (consequences of opioid use) Policy and program development Role of Injury Prevention/Injury Surveillance: provision of community level surveillance data assistance in formal evaluation (policy work and health outcomes) integration of MassPINN partners communication

Injury Prevention/Injury Surveillance: provision of community level surveillance data assistance

14 Strengths and Challenges Strengths: Many key partners within MA-DPH Strong surveillance and interest Close proximity of BSAS Challenges: Coordination of efforts - no multiagency task group making ongoing communication challenging ME data in separate agency PMP in separate Bureau and location Competing priorities within injury prevention Different funding requirements Data privacy Partner interest in having injury prevention at table

communication challenging ME data in separate agency PMP in separate Bureau and location Competing

15 Washington State s Efforts To Address Prescription Drug Abuse May 2, 2012 Jennifer Sabel, PhD 15

16 Surveillance of Unintentional Prescription Opioid Overdose Deaths Washington eaths Number of d Prescription Opioid + alcohol or illicit drug Prescription Opioid +/- Other Prescriptions Source: Washington State Department of Health, Death Certificates 16

05 06 07 08 09 10 Prescription Opioid + alcohol or illicit drug Prescription Opioid

17 Interagency Workgroup to Prevent Prescription Opiate Misuse, Abuse and Overdose Began quarterly meetings in June 2008 Includes representatives from: Workers Compensation System, Medicaid & Mental Health, Medical boards/commissions ss o s with prescriptive pesc p eauthority, health pa plans, emergency e room physicians, Washington Poison Control Center, Attorney General's Office & law enforcement, UW-Harborview and Alcohol and Drug Abuse Institute Developed short-term actions Increase provider and public education. Identify methods to reduce diversion through emergency departments. Increase surveillance. Support evaluation of practice guidelines for providers treating chronic, noncancer pain patients with opioids and the prescription monitoring program. 17

& law enforcement, UW-Harborview and Alcohol and Drug Abuse Institute Developed short-term actions Increase provider and public education.

18 Emergency Department Specific Activities Guidelines for Opioid Prescribing Adopted and distributed by WA chapter of American College of Emergency Physicians htm Accompanied by patient education poster Information Exchange Shares patient information between EDs, focus frequent ED visitors 18

htmorg/painmedication htm Accompanied by patient education poster http://here.doh.wa.

19 Statewide ED Visit Network (EDIE) 19

20 Chronic, Non-Cancer Pain Management Rules What was required by the law? Dosing criteria including a dosage threshold requiring pain management specialist consultation before it can be exceeded. Methods to increase consultation availability. Minimizing burden on practitioners and patients. Guidance on tracking clinical progress by using assessment tools focusing on pain interference, physical function, and overall risk for poor outcome. Guidance on tracking the use of opioids. 20

Methods to increase consultation availability. Minimizing burden on practitioners and patients.

21 Other Washington State Efforts Prescription Monitoring Program implemented October, 2011 Good Samaritan Law Overdose Prevention 21

22 Thank You! Contact Us! Cindy Rodgers: Kathryn L. Santoro: Holly Hackman: Jennifer Sabel:

Summary of Children s Safety Network Prescription and Over-the-Counter Drug Abuse Environmental Scan

Summary of Children s Safety Network Prescription and Over-the-Counter Drug Abuse Environmental Scan Introduction Prescription and over-the-counter (OTC) drug abuse and its consequences are a fast growing