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Overview
- Epidemiology crash course
- Policy and information sharing
A Brief Introduction to the Opioid Epidemic Christopher M. Jones, - - PowerPoint PPT Presentation
A Brief Introduction to the Opioid Epidemic Christopher M. Jones, - - PowerPoint PPT Presentation
A Brief Introduction to the Opioid Epidemic Christopher M. Jones, PharmD, MPH CDR, US Public Health Service Director, Division of Science Policy Office of the Assistant Secretary for Planning and Evaluation Overview Epidemiology crash
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Source: CDC/NCHS, National Vital Statistics System, Mortality File.
5 10 15 20 25 1980 1985 1990 1995 2000 2005 2010 2014
Deaths per 100,000 population
MV Traffic Drug Poisoning
Age-adjusted death rates for Motor Vehicle Traffic and Drug Poisoning, United States,1980-2014
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2002
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2003
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2004
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2005
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2006
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2007
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2008
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2009
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2010
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2011
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2012
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2013
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
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2002 2013
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2013 2002
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Rx opioids mostly commonly abused prescription drug, US, 2014
Source: SAMHSA National Survey on Drug Use and Health, 2014
500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 Rx Opioids Tranquilizers Stimulants Sedatives
Number of people reporting behavior (in thousands)
Initiation Dependence or Abuse Past Month Nonmedical Use
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Past year opioid use disorders, US, 2003-2014
18
500,000 1,000,000 1,500,000 2,000,000 2,500,000 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Number of Individuals
Any Opioid Use Disorder Prescription Opioid Use Disorder Heroin Use Disorder
Source: SAMHSA, NSDUH 2003-2014 PUF
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Opioid-related overdose deaths, US, 1999-2014
1 2 3 4 5 6 7 8 9 10 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Age Adjusted-Rate per 100,000 population All Opioids Heroin Natural/Semi-Sythetic Opioids Methadone Synthetic Opioids
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Increases in Rx opioid prescribing coincide with increases in Rx opioid overdose deaths
1 2 3 4 5 6 7 8 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Rate
Source: CDC/NVSS and DEA ARCOS. KG of morphine milligram equivalent per 10,000 population Opioid overdose deaths per 100,000 population
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Primary care physician’s views on Rx opioids
10 20 30 40 50 60 No problem at all Small problem Moderate problem Big problem Percent
Magnitude of Rx abuse in community
10 20 30 40 50 60 Strongly disagree Somewhat disagree Somewhat agree Strongly agree Percent
Opioids overused for pain
10 20 30 40 50 60 Not at all Slightly Moderately Very Percent
Confidence in clinical skills related to opioid prescribing
10 20 30 40 50 60 Not at all Slightly Moderately Very Percent
Comfort in prescribing opioids for chronic noncancer pain
Source: Hwang et al. Prescription drug abuse: a national survey of primary care physicians. JAMA 2015
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Increase in opioid prescribing dose for same conditions over time
Source: Wunsch et al. JAMA 2016
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Changing demographics of heroin use
Source: Jones CM et al. MMWR 2016; Cicero et al JAMA Psychiatry 2014.
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Multiple facets of the opioid epidemic
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Demographics
▪ Men ▪ 35-54 year olds (deaths) ▪ 18-35 (abuse) ▪ Whites ▪ American Indians/Alaska Natives
Socioeconomics and
Geography
▪ Medicaid, uninsured ▪ Rural
Clinical Characteristics
▪ Chronic pain ▪ Substance abuse ▪ Mental health ▪ Nonmedical use ▪ Multiple prescriptions ▪ Multiple prescribers ▪ High daily dosage ▪ Combination of opioids and benzodiazepines
Risk factors for Rx opioid abuse and overdose
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Use data to identify patients in need of treatment and improve continuity of information across information systems
- PDMPs
– Key piece of information in the clinical work flow – Starting point for a conversation with patients
- EHRs
– Like PDMPs, could provide full visibility on prior drug and treatment exposure, clinical conditions, risk factors – Clinical decision support can facilitate screening, assessment, intervention, and monitoring – Incorporate guidelines on appropriate prescribing for both acute and chronic pain conditions
- Insurer/PBM data/Claims data
– Examine utilization patterns to identify patients at risk or abusing substances – Academic detailing, alerts to providers, alters to patients, connection with employee assistance programs, etc.
- Connection with other information systems such as human and social services,
inpatient systems, etc., is needed
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HHS Opioid Initiative
- Launched by Secretary
Burwell in March 2015
- Three focus areas
– Improve opioid prescribing – Increase use of naloxone to reverse opioid overdose – Expand use of Medication- Assisted Treatment (MAT) for
- pioid use disorders
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