Data-Driven Multi-Disciplinary Approaches to Reducing Rx Abuse, BJA Award FY 2014 Denise Paone and Alexandra Harocopos Bureau of Alcohol & Drug Use Prevention, Care & Treatment New York City Department of Health and Mental Hygiene
Central focus and unifying goal Reduce Overdose Deaths
RxStat Public health and 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
RxStat: Core principles Public health approach Track drug use and associated health consequences at a population level Timely, accurate analysis of drug misuse indicators from multiple sources (e.g., mortality, EDs, PMP, drug treatment, law enforcement, etc.) Data-driven initiatives Rapid deployment of public health and public safety resources to high priority areas Rigorous follow-up to ensure strategies are effective
Rates of unintentional drug poisoning (overdose) deaths involving opioid analgesics by neighborhood of residence Source: NYC Office of the Chief Medical Examiner and NYC DOHMH Bureau of Vital Statistics, 2012 and 2013
Rate of prescriptions filled per 1,000 residents Staten Island residents fill high dose prescriptions at the highest rates in NYC 160 140 120 100 Note: Schedule II opioid analgesics + hydrocodone 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. 2012 2013 80 60 40 20 0 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 and 2013 Borough of Residence
Rates of unintentional drug poisoning (overdose) deaths involving heroin by neighborhood of residence Source: NYC Office of the Chief Medical Examiner and NYC DOHMH Bureau of Vital Statistics, 2012 and 2013
Specific grant aims Develop data-driven multidisciplinary approaches to reduce overdose mortality Implement targeted naloxone interventions Utilize qualitative methods Provide a better understanding of prescribing practices and PMP Assess emerging drug issues
Naloxone pilot programs Primary care naloxone/opioid analgesic dual prescribing: 10 sites each in the Bronx and Staten Island Physicians prescribing high dose opioid analgesics will also prescribe naloxone Emergency Department naloxone/oa dual prescribing Non-fatal overdose victims will be prescribed naloxone following hospital visit
Naloxone pilot programs Pharmacy naloxone distribution Co-prescribing naloxone with high dose opioid analgesics in a pharmacy setting Naloxone distribution at Rikers Island visit house Training and dispensing naloxone to family and friends of individuals held at Rikers Island
Objectives of qualitative research In-depth understanding Focus on behaviors and practices Adds context Utilizes interviews and observational techniques
Prescriber study Since August 2013, I-STOP requires practitioners in NY to consult the PMP database before prescribing opioid analgesics Study will examine: (1) How do prescribers conceive of I-STOP and what are their experiences using the PMP? (2) How does using the PMP influence prescribing practices? (3) In what ways does using the PMP change prescriber-patient interactions? In-depth interviews with primary care prescribers across NYC
Rapid assessment and response (RAR) Real-time data presents new challenges RAR enables data to be gathered quickly in response to a question or crisis requiring a timely intervention Epidemiological investigation Qualitative investigation Public health response
Example of RAR Syndromic data identified increasing ED visits related to synthetic marijuana (K2) Reports of increased K2 use among certain populations Interviews conducted with K2 users and medical providers Issued a Health Alert Network (HAN) advisory to 14,000 NYC physicians Worked with multiple NYC agencies to remove product from store shelves Ongoing surveillance of ED visits
Current grant activities Staff hired Planning and inception of naloxone pilot designs Prescriber study in progress interviewing will start next month