Addressing the Rural Opioid Crisis 2016 National Coalition of Black - - PowerPoint PPT Presentation
Addressing the Rural Opioid Crisis 2016 National Coalition of Black Lung and Respiratory Disease Clinics Conference Lexington, Kentucky September 15, 2016 3:20-4:20 p.m. Presenters Nisha Patel, FORHP Holly Andrilla, WWAMI Rural
2016 National Coalition of Black Lung and Respiratory Disease Clinics Conference
Lexington, Kentucky September 15, 2016 3:20-4:20 p.m.
Nisha Patel, MA, CHES Acting Associate Director/Senior Advisor Federal Office of Rural Health Policy
Black Lung Coalition Meeting September 15th, 2016
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79%, with 200% increase involving opioids
prescribe buprenorphine
buprenorphine treatment
rural areas
Though opioid abuse and opioid-related death has been on the rise nationally, rural communities are disproportionately affected
Drug-related deaths 45% higher in rural Rural communities have a history of substance abuse
and fewer options for treatment.
Rural residents are most likely to be prescribed opioid painkillers
increased over the past 15 years in both rural and urban, with exponential increases in rural areas from 2013-2014
rates of overdose death, particularly from prescription opiate overdose
women are dying more
>50% Rural <50% Rural Heroin Overdose Rate >2.9% in 2014 OH, WV, NH, NM, MO, IL, VT, MI, KY, WI, WA, PA, UT, AK, OR, ME CO, AZ CT, MA, RI, DE, DC, MD, NJ, NY, VA Heroin Overdose Rate <2.9% in 2014 NC, IN, AL, TN, LA, NV, MN, TX, GA, SC, IA, MS, OK FL, CA
>50% Rural <50% Rural Overdose Mortality >8.4% in 2014 WV, NH, NM, OH, KY, UT, OK, ME, TN, NV, MO, WI, SC, MI, VT, AK, NC, CO, WA, RI, MD, MA, CT, DE, DC Overdose Mortality Rate <8.4% in 2014 IL, WY, PA, AZ, OR, GA, IN, KS, AL, MN, AR, LA, MT, IA, ID, SD, TX, HI, MS, ND, NE VA, NY, NJ, FL, CA
Secretary’s Opioid Initiative (announced March 2015)
NIH FDA CDC HRSA SAMHSA AHRQ ACF
CMS IHS ONC
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the expansion of substance abuse services
management for primary care clinicians
"Catastrophic Consequences: The Rise of Opioid Abuse in Rural Communities”
reducing morbidity and mortality related to opioid overdoses
HIV care, as well as support services for patients who are homeless or unstably housed and those who are living with mentally illness or substance use disorders
professional and paraprofessionals across the country, and in particular, within underserved and rural communities (FY2014)
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Program Goals:
through purchase and strategic placement;
using the devices to recognize the signs of opioid overdose, administer naloxone, administer basic cardiopulmonary life support, report results, and provide appropriate transport to a hospital or clinic for continued care after administration;
centers where care coordination can be provided by team of providers;
measureable health outcomes, including reducing opioid
100 200 300 400 500 600
Number of Trainings Number Trained
47 586
Nasal Narcan Injectable Evzio
prescribed take home naloxone on how to respond to an
signs
drug users
like other health issues.
Reduce
misuse and
Telehealth Programs Rural Healthcare Outreach Program Rural Network Programs
manager (transportation, daycare, medical assistance, housing, employment)
Heroin addict arrived at hospital with suicide thoughts. She was admitted to hospital psychiatric, discharged home with a planned admission date for inpatient drug treatment, stayed in touch with case manager, changed her living environment and believes “this program saved my life”.
Patients
Families
Law Enforcement Policymaker
Providers
Toolkit-Updated-2016/SMA16-4742
Patients & Families
4742/Toolkit_Patients.pdf
https://www.ruralhealthinfo.org/community-health/services-integration
https://www.ruralhealthinfo.org/community-health/mental-health
proven to work
Pocket-Guide/Most-Popular/SMA16-4892PG?sortByValue=4
the-Treatment-of-Opioid-Addiction/SMA07-3939
resources/index.html
ne-Background
http://nashp.org/wp-content/uploads/2016/09/Rural-Opioid-Primer.pdf
http://nashp.org/wp-content/uploads/2016/09/Rural-Opioid- Infographic.pdf
“After doing a presentation at a local church, a mother and son came and talked to me afterwards. The son told me that he had been battling heroin addiction for several years, but was
He than thanked me for training him to carry and use Naloxone, and told me that he had many friends that still used heroin, and was glad he now had an alternative to death that he could carry in his pocket in case one of his friends
San Luis Valley AHEC, Colorado
Opioid Use Rates and Overdose Deaths
users
number of deaths.
Treatment Act (DATA 2000)
treat opioid use disorder
patients a physician can treat and to expand the option to get a waiver to nurse practitioners and physician assistants (both can prescribe
Kentucky
Tennessee
West Virginia
Virginia
Illinois
Indiana
Ohio
Pennsylvania
*of counties with at least one waivered provider Data Source: DEA Waivered Physician List, April 2016
Nevada
Utah
Colorado
Arizona
New Mexico
*of counties with at least one waivered provider Data Source: DEA Waivered Physician List, April 2016
Supply of Physicians with DEA DATA Waivers in US Counties, by Rural-Urban Status
Characteristic Metropolitana Adjacent to Metropolitanb Micropolitan, Not Adjacent to Metropolitanc Small and Remote Rural Countiesd Total UIC 1-2 UIC 3-7 UIC 8 UIC 9-12 US Population, No. (%) 260,479,400 (83.6) 33,691,096 (10.8) 9,677,339 (3.1) 7,744,082 (2.4) 311,591,917 (100.0) Counties with ≥1 physicians with waivers,
789 (72.4) 419 (39.6) 132 (46.8 125 (17.5) 1,465 (46.6) Counties with no physician with a waiver,
301 (27.6) 639 (60.4) 150 (53.2) 588 (82.5) 1,678 (53.4) Total counties, No. (%) 1,090 (34.7) 1,058 (33.7) 282 (9.0) 713 (22.7) 3,143 (100.0) Physicians with waivers per 100,000 residents, No. 6.3 3.3 4.2 3.1 5.8 Physicians with waivers, % 90.4 6.1 2.3 1.3 100.0
DATA = Drug Addiction Treatment Act; DEA = Drug Enforcement Administration; UIC = Urban Influence Code. Note: counties were classified as urban or into 1 of 3 categories of rural using the US Department of Agriculture UIC.
a Counties with an urban core with a population of at least 50,000. b Counties that are geographically adjacent to a metropolitan area whose largest town/urban cluster has 10,000-49,999 residents. c Counties that are not adjacent to a metropolitan area and whose largest town/urban cluster has 10,000-49,999 residents. d Counties whose largest town has fewer than 10,000 residents regardless of proximity to a micropolitan county.
US Counties with at least 1 DEA DATA Waivered Physician in US Counties, by Rural-Urban Status
Metropolitana Adjacent to Metropolitanb Micropolitan, Not Adjacent to Metropolitanc Small and Remote Rural Countiesd Total
Single Physician w/DEA waivere 14.5% 43.8% 44.1% 63.1% 29.9%
DATA = Drug Addiction Treatment Act; DEA = Drug Enforcement Administration; UIC = Urban Influence Code. Note: counties were classified as urban or into 1 of 3 categories of rural using the US Department of Agriculture UIC.
a Counties with an urban core with a population of at least 50,000. b Counties that are geographically adjacent to a metropolitan area whose largest town/urban cluster has 10,000-49,999 residents. c Counties that are not adjacent to a metropolitan area and whose largest town/urban cluster has 10,000-49,999 residents. d Counties whose largest town has fewer than 10,000 residents regardless of proximity to a micropolitan county. e Based on the July 2012 DEA Waivered Physician list
Mental Health Providers in US Counties, by Rural-Urban Status
Metropolitana Adjacent to Metropolitanb Micropolitan, Not Adjacent to Metropolitanc Small and Remote Rural Countiesd Total
Counties Lacking a Psychiatriste 27% 59% 39% 86% 51% Psychiatrists per 10,000 populatione 1.8 0.5 0.9 0.4 1.6
Note: counties were classified as urban or into 1 of 3 categories of rural using the US Department of Agriculture Urban Influence Codes.
a Counties with an urban core with a population of at least 50,000. b Counties that are geographically adjacent to a metropolitan area whose largest town/urban cluster has 10,000-49,999 residents. c Counties that are not adjacent to a metropolitan area and whose largest town/urban cluster has 10,000-49,999 residents. d Counties whose largest town has fewer than 10,000 residents regardless of proximity to a micropolitan county. e Based on the National Plan and Provider Enumeration System
Persistent Poverty Status and Median Household Income in US Counties, by Rural-Urban Status
Metropolitana Adjacent to Metropolitanb Micropolitan, Not Adjacent to Metropolitanc Small and Remote Rural Countiesd Total
Persistent Povertyf Countiese 4.5% 14.0% 14.1% 17.5% 11.2% Average County Median Household Incomee $52,204 $41,827 $44,201 $42,415
Note: counties were classified as urban or into 1 of 3 categories of rural using the US Department of Agriculture Urban Influence Codes.
a Counties with an urban core with a population of at least 50,000. b Counties that are geographically adjacent to a metropolitan area whose largest town/urban cluster has 10,000-49,999 residents. c Counties that are not adjacent to a metropolitan area and whose largest town/urban cluster has 10,000-49,999 residents. d Counties whose largest town has fewer than 10,000 residents regardless of proximity to a micropolitan county. e Based on the Health Area Resource File 2014-15 Release f 20 percent or more of the county population has lived in poverty over the past 30 years
community, others)
(45%)
About 1/3 of responding physicians indicated the following were barriers to incorporating Buprenorphine into their practice Financial/reimbursement concerns, Lack of specialty backup for complex problems, and Attraction of drug users to your practice
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