Addiction amp Medication Assisted Treatment Andrew Kolodny MD Chief Medical Officer Phoenix House Foundation Inc Executive Director Physicians for Responsible Opioid Prescribing Senior Scientist Heller School for Social Policy and Management ID: 613401
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The Prescription Opioid & Heroin Crisis:
Addiction & Medication Assisted Treatment
Andrew Kolodny, M.D.
Chief Medical Officer, Phoenix House Foundation Inc.Executive Director, Physicians for Responsible Opioid PrescribingSenior Scientist, Heller School for Social Policy and Management, Brandeis UniversityTwitter: @andrewkolodnySlide2
Conflict of Interests
2I have no relevant financial relationships to disclose.Slide3
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Incidence of non-medical
use of pain relievers has been declining since 2002Source: Kolodny et al. The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction. Annu Rev Public Health. 2015: 36:559-574Slide4
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2002
2014Estimated Age-adjusted Death Rates for Drug Poisoning by CountySOURCE: CDC/NCHS, National Vital Statistics System; Tom Frieden Presentation at the Opioid Summit, Atlanta, April 2016Slide5
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Source: Kolodny et al. The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction.
Annu Rev Public Health. 2015: 36:559-574Non-medical Rx opioid use vs. opioid Rx OD deaths by age groupSlide6
Three Opioid-Addicted Cohorts
20-40 y/o, disproportionately white, significant heroin use, opioid addiction began with Rx use40 y/o & up, disproportionately white, mostly Rx opioids, opioid addiction began with Rx use
50 y/o & up, disproportionately non-white, mostly heroin users, opioid addiction began with heroin use6Slide7
Heroin
treatment admissions :
2003-2013SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 01.23.15.Slide8
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Mortality by cause, white non-Hispanics ages 45–54
Source: Anne Case, Angus Deaton. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences. November 2, 2015 (online ahead of print).Slide9
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Rate of hospital inpatient stays related to
“opioid overuse”, 1993 and 2012Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS), 1993 and 2012Slide10
Heroin admissions, by gender, age, and race/ethnicity: 2013
SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 01.23.15.Slide11
Opioid Related Overdose Deaths United States, 1999-
2014Slide12
Buprenorphine Experience in France
Introduced in the mid 90s
79% decline in OD deaths in 6 yearsUse of mono product (not formulated with naloxone) associated with diversion and injection useSource: Auriacombe et al. French field experience with buprenorphine. Am J Addict. 2004Slide13
Heroin
treatment admissions with
planned medication-assisted opioid therapy 2003-2013SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 01.23.15.Slide14
Barriers to Buprenorphine
IdeologicalFederally imposed patient capsFederally imposed ban on NP and PA prescribingLimited integration of addiction treatment in primary carePrior authorization requirementsSlide15
Questions?