Jeff Coady, PsyD SAMHSA Region V Administrator - PowerPoint Presentation

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Jeff Coady, PsyDSAMHSA Region V Administrator

Rx Drug Abuse Prevention Strategies:  Building the Infrastructure to Stem the Flow of Rx Drugs & Preventing Addiction

Indiana 5th Annual Prescription

Drug Abuse Symposium

October 17, 2014 Indianapolis, IN Slide3

SAMHSA’s VisionBehavioral health is essential to health.Prevention works.Treatment is effective.People recover.

America is a nation that understands and acts on the knowledge that …Slide4

Presentation OverviewData PreventionTreatmentRecoveryBehavioral Health as Public HealthSlide5

Prescription Drug Abuse Affects EveryonePrescription medications are among the top substances abused by 12th graders in the past year. In 2011, more than 4,500 young people per day abused a prescription drug for the first time.

All ages are affected.Older Americans2009: approximately 1 U.S. infant born per hour with signs of drug withdrawal.55 to 94 percent of neonates exposed to opioids in utero experience withdrawal.Slide6

U.S. Opioid Related Emergency Department VisitsLarge increase in the number of ED visits involving nonmedical use of pharmaceuticals observed between 2004 and 2011.Percentage change for opioid involved visits =183% increase.Oxycodone had the largest impact = 263% increase.Short term trend: 15% increase from 2009-2011.Pain relievers were involved in 38.0 % of drug-related suicide attempts.

SAMHSA DAWN 2013Slide7

Specific Illicit Drug Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2013

7Numbers in ThousandsSlide8

Non Medical Rx Pain Reliever Use in the Past Year among Persons Aged 12 or Older

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2006-2010 (Revised March 2012), 2011STATENon medical Rx Pain Reliever Use %

CI

Indiana

5.68

4.68-6.89

Illinois

4.07

3.58-4.59

Michigan

5.11

4.57-5.72

Minnesota

4.57

3.79-5.49

Ohio

5.0

4.49-5.56

Wisconsin

4.51

3.68-5.52Slide9

Heroin Use in the Past Year among Persons Aged 12 or OlderSource: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2006-2010 (Revised March 2012), 2011

STATEPast Heroin Use

Percentage

Indiana

9,000

.2

Illinois

41,000

.4

Michigan

21,000

.3

Minnesota

5,000

.1

Ohio

21,000

.2

Wisconsin

6,000

.1Slide10

Identify needs and resourcesEstablishing networks Accessing resources and programsSharing lessons learnedExpanding Pilot ProgramsDistributing Scientific InformationDeveloping the Infrastructure:Collaboration and PartnershipSlide11

Developing the Infrastructure:Identifying Needs and ResourcesSchoolsEAPsTelephone LinesTreatment ProgramsCourtsCommunity Health Centers Mortality ReportsUniversitiesPolice DepartmentsJailsHospitalsFaith BasedSlide12

http://hopeandrecovery.org/resources/

Developing the Infrastructure: Establishing NetworksSlide13

Developing the Infrastructure: Accessing Resources and ProgramsSlide14

Developing the Infrastructure:

Sharing Lessons LearnedSlide15

Lazarus Project: ResultsSlide16

Developing the Infrastructure:

Expanding Pilot Programs

Currently serves Cuyahoga, Montgomery, and Scioto counties, and the city of Cleveland.

ODH has plans to expand to three

additional Project DAWN sites. Slide17

Developing the Infrastructure:

Distributing Scientific InformationSlide18

5 modules, each one customized to address the specific needs of target audiences:Facts for Community MembersFive Essential Steps for First RespondersSafety Advice for Patients & Family MembersInformation for PrescribersResources for Overdose Survivors & Family Members

*

August 2013

Toolkit ModulesSlide19

State Naloxone and Good Samaritan LegislationSlide20

Prescriber EducationOpioidPrescribing.comCME granting trainings in collaboration with Boston UniversityHow to accurately assess the person for pain.Strategies to find the most appropriate treatment for each person, including drug-free approaches.Time-efficient ways to monitor a person’s progress (including person’s use of pain medications).How to identify medication misuse or abuse and specific actions to take when it occurs.Slide21

Treatment is PreventionTreatment reduces demand and diversionTreatment for emerging and/or parenting adults will reduce the risk of addiction for following generationsTreatment reduces negative social behaviorsTreatment reduces morbidity and mortalitySlide22

Medication Assisted Treatment: Facts and MythsMedication-Assisted Treatment is an evidence-based treatment for opioid addiction; however, it is not a stand-alone treatment choice. MAT has proven to be very effective as part of a holistic evidence-based treatment program that includes behavioral, cognitive, & other recovery-oriented interventions, treatment agreements, urine toxicology screens, and checking of PDMP.Slide23

NIDA Principles of Drug Addiction Treatment 3rd Edition

http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatmentSlide24

MAT: One Size Does Not Fit AllIndividuals have varied responses to different medications. Effectiveness of medications vary among individualsSide effects vary among individualsAdherence constraints vary by individual; and for a given individual these constraints may vary over time/personal circumstance These individual-specific responses to medications hold true for MAT when it is used to treat SUDs & addictions.Slide25

NIDA Principles of Drug Addiction Treatment 3rd Edition

http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatmentSlide26

Medication Assisted Treatment: Benefits Lifestyle stabilization Improved health and nutritional status EmploymentDecrease in criminal behavior Decrease in injection drug use/shared needles: reductions in risk for HIV and viral hepatitis/medical complications of injection drug use Slide27

MAT with Methadone is the Gold-standard for treatment in pregnancyBirth outcomes are comparable to other obstetric patientsCompared to untreated substance user:Fewer pre-term birthsLess intrauterine growth retardationFewer low birth-weight babiesLess maternal drug use = less antenatal fetal stressImproved compliance with prenatal care

The use of MAT by opioid-dependent women with children is an effective treatment that help women in parenting their childrenSlide28

Target High-Risk/High-Cost Populations:

Federal and State Inmates

Alcohol or Drug Related offense

Intoxicated at the time of offense

Offended to get money to support the addiction

History of alcohol abuse or dependence and/or regular drug useSlide29

Treatment Capacity Recommendations Medical DetoxificationOutpatient Psychoeducation & Relapse PreventionResidential Therapeutic TreatmentFamily TherapySelf-Help Support Systems (e.g., 12 Step Programs)Toxicology Screens/abstinence monitoringMedication Assisted Treatment (MAT)Slide30

Treatment Capacity RecommendationsCoordinate with federally funded health care providers to provide servicefederally qualified health centersIndian Health ServiceForm partnerships with academic institutions to provide treatment service which would also serve to train physicians and other providersPhysician Clinical Support SystemsPCSS-buprenorphinePCSS-opioidsSlide31

Treatment Capacity RecommendationsOptimize Medicaid reimbursement by bundling services; include a rate for buprenorphine services at Opioid Treatment Programs (OTPs)Create service delivery definitions and billing rates forPhysician tele-health visitsPhysician-NP “supervision” via tele-healthSpecialist consultation via tele-healthExpand use of long-acting injectable naltrexone.Slide32

SAMHSA Certification of U.S. OTPsSlide33

Assure QualityRevise or adopt state regulations/guidelines for methadone and buprenorphineTIP 1 State Methadone Treatment Guidelineshttp://www.fsmb.org/pdf/2013_model_policy_treatment_opioid_addiction.pdfCollect data on Neonatal Abstinence Syndrome (NAS)promote state-wide clinical guidelines for NAS screening and managementRequire OTPs and buprenorphine prescribers to check PDMPSlide34

http://162.99.3.213/products/manuals/tips/pdf/TIP43.pdf

http://162.99.3.213/products/tools/keys/pdfs/KK_43.pdf Science-Based Treatment Improvement ProtocolsSlide35

Health—overcoming or managing one’s disease(s) or symptomsHome—having a stable and safe place to live

Purpose—conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in societyCommunity—having relationships and social networks that provide support, friendship, love, and hope

Four Dimensions of RecoverySlide36

Treat the Whole Person in Their Social Context

Recovery Oriented Systems of Care (ROSC) for Chronic Disorders

Medication Assisted Treatment

(MAT)

Cognitive &

Behavioral Therapies

Social Services

Whole Health

Medical Services

Adapted from NIDA Drug Abuse & Addiction

Prevention

Housing & Employment

Genetic & Environmental

Risk FactorsSlide37

Reduced

Criminal

Involvement

Stability in

Housing

Cost

Effectiveness

Perception

Of Care

Retention

Abstinence

Employment/

Education

Evidence-Based

Practice

Social Connectedness

Access/Capacity

Science and Community Working Together

Recovery

Health

Wellness

Outcomes

Mental Health

Primary Care

Child Welfare

Housing

Human Services

Educational

Criminal Justice

Employment

Private Health

Care

Systems of Care

Organized Recovery

Community

DoD &

Veterans Affairs

Indian Health

Service

Addictions

Tribes/Tribal Organizations

Bureau of Indian Affairs

Child Care

Housing/

Transportation

Financial

Legal

Case Mgt

Peer Support

Health Care

Mental Health

Alcohol/Drug

Vocational

Education

Spiritual

Civic Organizations

Mutual Aid

Services &

Supports

Community Individual Family

ROSC

Community Coalitions

Business CommunitySlide38

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Substance Abuse and Mental Health Disorders Are Common and CostlyAround 1 in 5 young people (14-20%) have a current disorder (MEB)Estimated $247 billion in annual costsCosts and savings to multiple sectors – education, justice, health care, social welfareCosts to the individual and familySlide39

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WHY FOCUS ON BEHAVIORAL HEALTH IN YOUNG PEOPLE?

Half of adult mental illness begins before age 14

Three-quarters

before age 24Slide40

BEHAVIORAL HEALTH IS PUBLIC HEALTH

Half of us will meet criteria for MI or SUD in life

Half

of us know someone in recovery from addiction now

In a given year:

1 in 4, if substance use disorders are includedSlide41

ACES: Adverse Childhood ExperiencesSlide42

How Do ACEs Affect Our Lives?

Source: CDC, Adverse Childhood Experiences Study. Available at:

http://www.cdc.gov/violenceprevention/acestudy

/

ACEs Can Have Lasting Effects on Behavior & Health (Infographic)Slide43

Prevention Strategies: U.S. Expanded Screening BenefitsChildren:Drug and alcohol use assessments for adolescentsBehavioral assessments for children of all agesDepression screening for adolescentsAdults:Alcohol misuse screening and counselingDepression screening for adultsTobacco use screening & cessation interventions for tobacco usersAnd more…Slide44

Behavioral Health Integration Public Health: http://store.samhsa.gov/product/A-Public-Health-Approach-to-Prevention-of-Behavioral-Health-Conditions/SMA12-PHYDE051512 Primary Care: http://www.integration.samhsa.gov/about-us/about-cihs Community Based: http://attcnetwork.org/regional-centers/content.aspx?rc=greatlakes&content=STCUSTOM1 Slide45

Public Health? Or Social Problem?

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BEHAVIORAL HEALTH AS SOCIAL PROBLEMPublic dialogue about behavioral health is in a social problem context rather than a public health contextHomelessnessCrime/jailsChild welfare problemsSchool performance or youth behavior problemsProvider/system/institutional/government failuresPublic tragediesPublic (and public officials) often misunderstand, blame, discriminate, make moral judgments, excludeAmbivalence about worth of individuals affected and about the investment in prevention/treatment/recoveryAmbivalence about ability to impact “problems”Slide47

LEADING TO INSUFFICIENT RESPONSESSlide48

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2/3 think treatment & support can help people w/MI leadnormal lives2/3 believe addiction can be prevented3/4 believe recovery from addiction is possible30% think less of person w/addiction20% think less of friend/relative in recovery38% unwilling to be friends w/a person with MI64% would not want person w/schizophrenia as co-worker

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68% would not want persons w/depression to marry into family

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Less willing to pay to ameliorate condition, even when understand implications

Don’t trust that BH treatment will help them

PUBLIC ATTITUDES CHANGING, BUT CHALLENGES REMAINSlide49

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OUT OF THE SHADOWSA NATIONAL DIALOGUE BEGINS

www.mentalhealth.govSlide50

Ending the Opioid Epidemic and…..Continue to train healthcare professionals in safe and appropriate use of opioids and alternatives to use of opioids for painContinue to educate the public about the dangers of misuse of pain medicationsUse PDMPs, treatment agreements and toxicology screens to increase safety Continue research efforts to find better approaches to containing opioid misuse/abuse Provide evidence-based treatment to all who need it for as long as it is clinically indicatedSlide51

Preventing Addiction

Opioid Epidemic

Behavioral Health Infrastructure

Behavioral Health as Public Health Slide52

Questions?Contact:SAMHSA Region V CAPT Jeffrey A. Coady, Psy.D 233 North Michigan Avenue, Suite 200 Chicago, IL 60601 Jeffrey.coady@samhsa.hhs.gov