The Prescription Drug Abuse and Heroin Crisis: New York s Response Joshua S. Vinciguerra, Director Bureau of Narcotic Enforcement October 28, 2015
October 28, 2015 2 The Connection
States with more opioid pain reliever sales tend to have more drug overdose deaths Death rate, 2013, National Vital Statistics System. Opioid pain reliever sales rate, 2013, DEA s Automation of Reports and Consolidated Orders System
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October 28, 2015 5 Bureau of Narcotic Enforcement Responsibilities: 1. Prevent Diversion Through Investigation & Enforcement 2. Data Collection, Analysis, & Reporting -- PMP 3. Licensing/Regulation/Help Desk 4. Medical Marijuana Program 5. Policy Initiatives, Outreach, Education
October 28, 2015 6 Early PMP Usage In February 2010, BNE implemented a PMP that provided secure, online access to patients recent controlled substance prescription histories. Available to practitioners only, 24 hours a day/7 days a week and was underused. From February 16, 2010 to June 16, 2013, 5,087 (of over 100,000 practitioners) conducted only 465,639 searches.
October 28, 2015 7 Prescription Drug Reform Act 2012 Part A: Part B: Part C: Part D: Part E: I-STOP Electronic Prescribing Controlled Substance Schedule Changes 3309 Work Group Safe Disposal Program
October 28, 2015 8 Updated PMP (I-STOP) On August 27, 2013, the updated PMP and the mandatory duty to consult was officially implemented (Schedules II-IV). Since then, over 34 million PMP searches on more than 12 million patients by over 96,000 searchers have been performed.
October 28, 2015 9 Max Numbers Searches per second Date/Time Searches Patients Searchers 2015-04-01 09:38:32 AM 47 47 5 Searches per minute Date/Time Searches Patients Searchers 2014-10-14 09:26 AM 297 296 83
October 28, 2015 10 Changes in Prescribing Behavior Comparison of opioid prescribing during the year prior to mandated PMP use and year post implementation: 8.72% decrease in total prescriptions; 10.4% decrease in patients w/ a prescription; 10.3% decrease in total quantity dispensed; Largest decreases in prescriptions were codeine 5 (-24%), hydrocodone (-17.7%) and codeine 3 (-14.3%); Increases in prescriptions for fentanyl (3.5%), morphine (2.2%) and oxycodone (0.2%).
October 28, 2015 11 Changes in Prescribing Behavior Hydrocodone 17.7% decrease in prescriptions; 16.3% decrease in patients with a prescription; 16.44% decrease in total doses dispensed. Oxycodone 0.2% increase in prescriptions; 1.6% increase in patients with a prescription; 2.98% decrease in total doses dispensed.
October 28, 2015 12
October 28, 2015 13 Doctor-Shopping In the first year of the mandated use of the PMP, the number of doctorshoppers decreased by 75% That trend has continued with a further drop from 4Q2012 to 3Q2015 to 86%
October 28, 2015 14 Other Law Enforcement Uses of Data Doctors in pill mills, who knowingly prescribe medically unnecessary drugs for extra income; Locate sold/stolen/forged prescriptions; Dishonest pharmacists who take advantage of access to controlled substances.
October 28, 2015 15 Next Steps Interstate data sharing with other PMPs E-Prescribing (March 27, 2016) Expanded Data Analytics EHR Integration Pilot/Proof of Concept (SAMSHA Grant) Multi-Agency Efforts
October 28, 2015 16 The New York State Office of Alcohol and Substance Abuse Services (OASAS) Oversees one of the nation s largest addiction services systems. Nearly 1,600 prevention, treatment and recovery programs. Chemical dependence treatment programs assist about 100,000 people a day and about 240,000 individuals every year.
October 28, 2015 17 June 2014: Combat Heroin Launched awareness campaign using social media, advertising and other outlets to teach youths, parents, health care professionals and others about the risks of heroin and opioids. Includes a new website that s easy to navigate and geared toward parents, adults, and young people looking for help and information. Ran PSA s in Movie theaters (PG-13 and R) and added Real Story videos to site; a month straight of billboards, mass transit posters, online and on-air commercials.
October 28, 2015 18 Combat Heroin For help 24 hours a day, 7 days a week call 1-877-8-HOPENY (1-877-846-7369) or visit oasas.ny.gov/accesshelp
October 28, 2015 19 Combat Heroin -- Naloxone Expanded DOH s community-based opioid overdose prevention program, a program that s been growing steadily since it began in 2006, especially in the last two years. Since 2013, the DOH has doubled the number of registered opioid overdose prevention programs in New York State. In December 2013, there were approximately 100 registered programs, today, there are over 215 registered programs. Since the program s inception in 2006, more than 55,000 individuals have been trained as opioid overdose responders and equipped with naloxone.
October 28, 2015 20 Combat Heroin Naloxone II Since 2006: >1,600 lifesaving administrations of naloxone have been reported to DOH. Includes approximately 400 attributed to law enforcement officers who were trained as part of a public safety-oriented initiative launched in 2014. 2013: >170 reversals. 2014: Nearly 400 reported reversals. Expansion of the State s community overdose programs is being accompanied by new efforts in 2015 to place naloxone in the hands of individuals being released to the community from correctional settings, firefighters and school personnel.
October 28, 2015 21 Combat Heroin Gave BNE access to the criminal backgrounds of people under investigation. Imposed higher penalties on health care professionals who sell controlled substances for diversion under the guise of legitimate medical practice. Improved access to care by requiring insurers to consistently cover the appropriate level of treatment for patients with substance use disorders.
October 28, 2015 22 Bureau of Narcotic Enforcement Joshua S. Vinciguerra, Director (518) 408-0248 Toll Free (866) 811-7957 joshua.vinciguerra@health.ny.gov narcotic@health.ny.gov Website: www.health.ny.gov/professionals/narcotic Riverview Center 150 Broadway, 6 th Floor Albany, New York 12204