Mental Health Roundtable October 6 2017 Last year 1138 Virginians died from an opioid overdose Profile of Opioid Addiction Opioids are natural and synthetic compounds that bind to the brains opioid receptors and trigger the release of dopamine ID: 724903
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Slide1
Opioid Addiction in Virginia
Mental Health RoundtableOctober 6, 2017Slide2
Last year, 1138
Virginians died
from
an opioid overdose. Slide3
Profile of Opioid Addiction
Opioids are natural and synthetic compounds that bind to the brain’s opioid receptors and trigger the release of dopamine.
Opioids
block pain, slow breathing, and for new users,
create a calm, happy high.
Opioids
include pain relievers that
medical providers prescribe
for acute pain post-surgery, palliative care and non-cancer chronic pain like back pain or joint or connective tissue disease (
Vicodin, Percocet, OxyContin, codeine, morphine, fentanyl and others). Heroin is also an opioid. Slide4
Profile of Opioid Addiction
Opioid addiction affects people from all walks of life.
Opioid
misuse and addiction problem is a result of excess
prescribing.
In 2012, 259 million opioid prescriptions were written – more than
enough for every American adult to have his/her own bottle of pills (
American Society of Addiction Medicine
). Slide5
Profile of Opioid Addiction
Virginia’s 2016 opioid prescribing rate, 63.2 opioid prescriptions/100 people is lower than the overall national 2016 prescribing rate of 66.5 opioid prescriptions/100 people.
The 2016 opioid prescribing rate in contiguous states, KY, TN and WV ranges from 96 to 107.5 prescriptions/100 people.
In 2016, 71 (
53%
) Virginia localities had prescribing rates higher than the state average. Slide6
Profile of Opioid Addiction
The five Virginia localities with the
highest opioid-prescribing rates are:
Virginia Locality
Opioid Prescriptions/100 People
Norton
470.3
Martinsville
399.9
Galax
394.4
Emporia
283.1
Franklin City
268.2Slide7
Causes of the Opioid Addiction Epidemic
Experts trace the opioid epidemic to the 1990s when there was an increase in the prescribing of opioid painkillers, resulting from several factors:
P
ublications in professional journals suggesting that opioids were an effective way to treat pain with a
low risk of addiction.
Emphasis on the importance of recognizing and
managing
pain in
the health care provider community . In 1995, the Food and Drug Administration (FDA
) approved the OxyContin, which it has described as “a focal point of opioid abuse issues”. Purdue Pharma knowingly publicized that OxyContin was less addictive than other pain medicines. Slide8
Opioid Addiction Epidemic
More
than a quarter of the general public
knows
someone close to them who has an opioid addiction
or has been addicted (27%
).
National Institute on Drug Addiction reports that 21% - 29% of patients prescribed opioids for chronic pain misuse them
8% - 12% develop an opioid addictionSlide9
Opioid Addiction EpidemicSlide10
Opioid-related Deaths in VirginiaSlide11
Opioid-related Deaths in VirginiaSlide12
Opioid-related Deaths in VirginiaSlide13
Opioid-related Deaths in VirginiaSlide14
Opioid-related Deaths in VirginiaSlide15
Opioid-related Deaths in Virginia Compared to USSlide16
Opioid-related Deaths in Virginia Compared to US
Opioid Overdose Death Rates & All Drug Overdose Death Rates per 100,000 Population
2011 - 2015 (Age-Adjusted)
The Henry J. Kaiser Family Foundation
Location
2011 Opioid Overdose Death Rate
(Age-Adjusted)
2012 Opioid Overdose Death Rate
(Age-Adjusted)
2013 Opioid Overdose Death Rate
(Age-Adjusted)
2014 Opioid Overdose Death Rate
(Age-Adjusted)
2015 Opioid Overdose Death Rate
(Age-Adjusted)
United States
7.3
7.4
7.9
9.0
10.4
West Virginia
31.5
27.1
27.9
31.6
36.0
Maryland
9.1
10.9
12.3
15.0
17.7
Tennessee
10.1
11.4
11.9
13.4
16.0
Washington,
DC
8.0
7.3
8.6
9.4
14.5
North Carolina
8.6
8.6
8.7
10
11.9
Virginia
7.1
6.5
7.6
9.1
9.9Slide17
Public Health Impact of Opioid Addiction
Neonatal Abstinence Syndrome (
NAS
)
NAS occurs
when a newborn withdraws from drugs s/he was exposed to in utero. Virginia’s NAS rate doubled between 2011 and 2015 (
2.9
per 1,000 live
births to 6.1
per 1,000 live births in 2015)In 2016, 771 Virginia babies were born with NAS.
HIV/AIDS and Hepatitis B and C
Infection rates are increasing due to needle sharing
28% increase in Hepatitis C between 2010 and
2015 in Virginia
New
cases of Hepatitis C are found primarily in young, white individuals with a history of injecting drugs, particularly
opioids.Slide18
Demographics of Adults with an Opioid Addiction
There is no specific profile for patients with an opioid addiction.
Interesting findings:
Adults ages 40 and older are mor
e
likely to use prescription opioids than those ages 20 – 39.
Women are more likely to use prescription opioids than men.
Whites are more likely to use prescription opioids.
Only 20
% of Americans with an opioid addiction are uninsured.Most uninsured adults with an opioid addiction work (62%), with
58% of those earning less than 200
% of the Federal Poverty
Level.
H
alf
to nearly two-thirds of adults with an opioid addiction have a mental
illness.
Adults with mental health issues are prescribed 51.4% of all opioid prescriptions
Current heroin users are more likely to be white and middle class.
11% of high school seniors report recreational use of opioids, including heroinSlide19
Opioid Addiction Treatment Available in Virginia
Medication
Assisted Treatment (
MAT
) – a combination of medicine and talk therapy – is the gold standard for opioid addiction
treatment.
Costs $400 - $1500 per month
for the medicine alone, not including the talk therapy.Slide20
Opioid Addiction Treatment Available in Virginia
Variety
of treatment sources in Virginia
:
Via private organizations, paid for by most private, employer-sponsored health insurance
New Medicaid benefit (
ARTS
)
Community Services Boards (
CSBs)Limited services at HSNsSlide21
Opioid Addiction Treatment Available in Virginia
April 2017 marked the start of a new benefit for Medicaid and FAMIS
with a substance use disorder, Addiction and Recovery Treatment Services (
ARTS
).
ARTS expanded services for all
Medicaid/FAMIS
enrollees and treatment networks; increased provider reimbursement; and expanded the number of medical providers prescribing buprenorphine.
It
is hoped that ARTS will help address the need for opioid treatment for many Virginians. In
the first quarter of availability, ARTS served nearly 2,800 enrollees with opioid addiction.Slide22
Opioid Addiction Treatment Available in Virginia
According to the Virginia Department of Behavioral Health and Developmental Services (
DBHDS
) in 2016 (
pre ARTS
), 10,953 people received opioid addiction treatment at a CSB.
The federal Substance Abuse and Mental Health Administration (
SAMHSA
) reported that in 2015:
5735 Virginians received methadone for an opioid addiction (up from 4799 in 2011)1319 Virginians were enrolled in opioid addiction treatment receiving buprenorphine (up from 726 in 2011)
DBHDS received federal funds to help 17 local CSBs expand opioid addiction treatment services.Slide23
Opioid Addiction Treatment Available in Virginia
HSNs primarily
refer patients to their local Community Services Board (
CSB
) for treatment
(52%).
FQHCs
Two FQHCs are Gold Standard providers for ARTS
21 FQHCs
(81%) received new federal funding to expand behavioral health or substance abuse staff in response to the opioid crisis in September 2017.
Free Clinic and Charitable Clinics
VAFCC obtained
200 units of free
Evzio
(
an injectable
Narcan
).
Twenty-three
clinics (
38%
)
requested
Evzio
. Interestingly, only 5
asked for 10
or more
units.Slide24
Virginia Initiatives to Address Opioid Addiction
In 2014, Governor McAuliffe established a Task Force on Prescription Drug and Heroin Abuse and in 2016, Commissioner Levine declared opioid addiction as a crisis in Virginia and a public health emergency.
Clinical/Treatment-Focused
Naloxone Statewide Standing Order (
Virginia Department of Health
)
State Targeted Response (
OTR
) to the Opioid Crisis (
Federal Substance Abuse and Mental Health Services Administration, SAMHSA) (DBHDS)Rescue Squad Assistance Fund (
RSAF
) Grant Program (
Virginia Office of Emergency Medical Services
)
Administrative/Regulatory
Regulations Governing Prescribing of Opioids and Buprenorphine (
Virginia Board of Medicine
)
Prescription Monitoring Program (
PMP
) Usage (
Virginia Department of Health Professionals
)
Dry Medication Disposal Bag (
Virginia Attorney General’s Office
)
Training/Resources
REVIVE! (
Virginia Department of Behavioral Health and Developmental Services
)
VAAware.com (
collaboration of state agencies
)Slide25
Summary
Opioid addiction impacts many
Virginians.
Virginia
is not as hard hit as many states.
Virginia’s opioid-related death rates and opioid-prescribing rates are lower than the U.S. rates.
Analog opioids, particularly illicit fentanyl (
alone or in combination with heroin
), are the primary cause of the increased opioid-related death rate in Virginia, not prescription opioids. Opioid addiction is not a notable issue in Virginia’s free and charitable clinics. There are a growing number of resources in Virginia to provide services to low-income individuals with an opioid addition, through ARTS and federal funds to CSBs and FQHCs.