Addressing the Opioid Epidemic New York State Department of Health - PowerPoint PPT Presentation

Addressing the Opioid Epidemic New York State Department of Health Work presented was supported by 1 NU17CE002742, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. Kitty Gelberg, Ph.D., MPH Director, Bureau of Occupational Health & Injury Prevention

September 20, 2017 2 County of Death due to Opioids Rate per 100,000 Residents

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September 20, 2017 5 Opioid-related Overdose Deaths vs. Motor Vehicle Deaths, NYS, 1999-2015 2500 2000 1500 1000 500 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Opioid-related Overdose Deaths Motor vehicle-related Injury Deaths

September 20, 2017 6 NYS – Opioid Epidemic 3500 3000 Number of Deaths 2500 2000 1500 1000 500 0 2010 2011 2012 2013 2014 2015 Year NYC ROS NYS

September 20, 2017 7 Epidemic #1: Prescription Opioids Number of Prescription Drug Deaths, NYS 1400 1200 Number of Deaths 1000 800 600 400 200 0 2010 2011 2012 2013 2014 2015 Year NYC Rx ROS Rx NYS Rx

September 20, 2017 8 Epidemic #2: Heroin Number of Heroin Deaths, NYS 1200 1000 Number of Deaths 800 600 400 200 0 2010 2011 2012 2013 2014 2015 Year NYC ROS NYS

September 20, 2017 9 Epidemic #3: Synthetic Drugs (Fentanyl) Number of Synthetic Drug Deaths, NYS 800 700 Number of Deaths 600 500 400 300 200 100 0 2010 2011 2012 2013 2014 2015 Year NYC ROS NYS

September 20, 2017 10 Lethal dose of Fentanyl

September 20, 2017 11 Burden on Coroners/Medical Examiners • Large number of deaths requiring autopsies – Time and expense • Responding to Information Requests – Law enforcement, NYS, DAs, Press

www.health.ny.gov/Opioids September 20, 2017 12

September 20, 2017 13 Build Local Health Department Capacity • Funding 4 counties based on opioid burden, size of county and geographic location • Erie, Onondaga, Sullivan, Broome • Identifying strategies to implement through broad-based County coalitions

September 20, 2017 14 Prescriber Education • Aims to prevent poisonings, overdoses and addictions before they occur – Reduce opioid use in the general population • Engage providers in improving opioid prescribing practices

September 20, 2017 15 Opioid-Related Data • Develop/Distribute County Level Reports (NYS Legislation) • Analyze multiple new datasets • Develop Data Dashboard

September 20, 2017 16 Opioid-Related Data http://www.health.ny.gov/statistics/opioid/

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September 20, 2017 20 Other Factors Influencing Opioid Trends Event Implementation Date Risk Evaluation and Mitigation Strategy (REMS) for long-acting July 9, 2012 opioids received FDA approval I-STOP legislation signed by Governor Cuomo (Bill S7637) August 27, 2012 Updates to the Controlled Substance Schedule February 23, 2013 I-STOP Registry Review Mandated August 27, 2013 Opioid Prescriber Education Program September 1, 2013 Electronic Prescribing of all Controlled Substances March 27, 2015 CDC Guideline for Prescribing Opioids for Chronic Pain – March 15, 2016 United States – 2016 released Governor Cuomo signs legislation to combat the heroin and June 22, 2016 opioid crisis 7-day opioid supply limit for opioid naïve patients July 22, 2016 20

September 20, 2017 21 A Multi-Systemic Approach to Address Opioid Overdose Community Programs Law Enforcement Firefighters Basic Life Support EMS School Settings Corrections & Parole Pharmacy

September 20, 2017 22 Drug User Health Hubs Established 2016 • Outpatient ambulatory care programs for drug users • Enhance local providers understanding and ability to provide services to substance • Provide on-site medically assisted treatment – buprenorphine. • Prevent overdoses; provide care post overdose. • Law Enforcement Assisted Diversion (LEAD): Low level offenders are diverted to SEP for care services instead of being arrested.

September 20, 2017 23 Drug User Health Hubs Core Elements Syringes Buprenorphine Naloxone Hepatitis C Care

September 20, 2017 24 Drug User Health Hubs

September 20, 2017 25 What is Naloxone? • Naloxone is an emergency medicine that can reverse an opioid overdose.

September 20, 2017 26 October 28, 2015 Overdose Responders Trained: Oct 1, 2014-Sept 30, 2016 25,000 21,411 Community Responders 82,922 20,000 3,563 16,609 School 15,677 14,142 3,532 EMS 15,000 12,724 2,622 11,202 Fire Fighters 8,358 8,651 16,045 Law Enforcement 10,000 108,684 TOTAL Note: Data reported by 5,000 registered programs. 0 2014 2015 2015 2015 2015 2016 2016 2016 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

September 20, 2017 27 Total Naloxone Administration for NYS, by Responder Type 20,000 17,307 18,000 2015 2016 16,000 14,595 14,000 12,659 11,033 12,000 10,000 8,000 6,000 4,000 1,575 1,137 968 2,000 658 0 Total EMS Law Enforcement Community opioid overdose prevention (COOP) programs Source: NYSDOH, AIDS Institute and Bureau of EMS and Trauma Systems Note: Data as of June 2017. EMS totals represent only naloxone encounters that were reported in Regional Medical Control Data for Suffolk County, or electronically for other counties; therefore, the actual numbers of events may have been higher. Law enforcement totals do not yet comprehensively include reports from law enforcement agencies in New York City and Nassau County. Law enforcement and COOP program totals represent only naloxone administration reports submitted by law enforcement and registered COOP programs to the NYSDOH AIDS Institute. The actual numbers of naloxone administration events may have been higher.

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September 20, 2017 29 Rationale for Creating the Naloxone Co-payment Assistance Program (N-CAP) • Increasing pharmacy access will allow more naloxone to get into the hands of people who need it: State resources can be devoted to covering naloxone for individuals not eligible for N- CAP • Uninsured; • Individuals using it in the line of duty; • Vulnerable individuals: • individuals being released from prison; • syringe exchange program participants.

September 20, 2017 30 Getting the Word Out Information will be available at pharmacies, registered programs, homeless shelters, LGBT centers

September 20, 2017 31 To find the nearest participating pharmacy or registered program, please visit:

September 20, 2017 32 Syndromic Surveillance • Working to use Emergency Department real-time data to identify unusual clusters of overdoses • Planning use of the syndrome – Alert community partners to enhanced overdose risk – Identify communities needing increased training, access to naloxone/buprenorphine

September 20, 2017 33 Also provided with: • Observed # vs. Expected # for each zip code • Details on each SatScan case including results hospital, day, age, provided to sex and chief program complaint

September 20, 2017 34 QUESTIONS? Kitty Gelberg, Ph.D., MPH Kitty.Gelberg@health.ny.gov 518-402-7900