CommStat 12/20/18 Monthly Data Reports from our Partners Kayla - PowerPoint PPT Presentation

CommStat 12/20/18

Monthly Data Reports from our Partners Kayla Donohue, MPH

Accidental or Undetermined Opioid-Related Fatalities Among Chittenden County Residents, 2010-2017 30 28 25 21 20 20 17 17 16 16 15 13 13 13 12 11 10 12 10 9 10 8 10 8 8 5 4 5 3 5 5 4 1 3 3 0 0 1 0 2010 2011 2012 2013 2014 2015 2016 2017 All Opioids Rx Opioid (No Fentanyl) Heroin Fentanyl Source: VDH

Accidental or Undetermined Opioid-Related Fatalities Among Chittenden County Residents, 2018 * Indicating preliminary data, with 25 pending cases statewide 4 2 2 2 1 1 1 1 0 0 0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct* Nov* Dec* Source: VDH

Source: SIREN, VDH

Source: SIREN, VDH

Source: Valcour

Monthly Surveillance of Opioid-Related Emergency Department Visits at UVMMC 30 25 23 20 16 15 15 11 11 10 10 9 11 8 7 8 5 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2018 2015-2017 Average 2015-2017 Min 2015-2017 Max Source: UVMMC

Individuals Enrolled, Admitted, and Waiting by Month at the Chittenden Clinic (Hub) 45 1020 40 35 1010 35 30 1000 994 25 990 20 15 980 10 970 5 0 960 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DOC 1 3 2 1 4 6 Waiting Admitted Census Data Source: Howard Center Chittenden Clinic

Number of Medicaid Beneficiaries Treated in Chittenden County Spokes, Sep 2013-Sep 2018 700 645 600 500 400 959 all payer patients 300 on MAT at spokes in Nov. 2018 200 100 0 Sep-13 Dec-13 Mar-14 Jun-14 Sep-14 Dec-14 Mar-15 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Dec-17 Mar-18 Jun-18 Sep-18 Source: http://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_OpioidUseDisorderTreatmentCensusandWaitList.pdf

Department of Corrections, September 15 – October 15 106 existing inmates 428 new intakes 534 total OUD requested to be screenings *all screened for OUD screened for OUD 2 on 374 on 60 on 436 on MAT Naltrexone Bupe Methadone 21 referrals to hubs

Substances Presenting in ED Recovery Coach Visit (n=172) 112 30 11 7 6 3 2 1

2018 Emergency Department Recovery Coach Follow-up (n=172) IOP 4 MAT 11 Outpatient/Counseling 13 Turning Point Center Access 20 Inpatient 23 Detox 24 Residential 24 Recovery Support 26 ED Recovery Coach Follow Up 97 *These categories are not mutually exclusive

Safe Recovery Low Barrier Buprenorphine Program Data (October 22, 2018 – December 14, 2018) • Number Currently Receiving Prescription – 30 clients • Number Transitioned to Hub and Spoke – 10 clients • Chittenden Clinic – 1 client • Pine Street – 7 clients • CHCB – 2 clients • Incarcerated – 1 client • Declined/Unreachable – 3 clients • Average Length of Time to Transition out of Safe Recovery – 27 days

Police Data for Property Crime & Drug-Related Incidents Valcour Agencies in Chittenden County Nancy Stetson

Source: Valcour

Source: Valcour

Source: Valcour

Source: Valcour

Source: Valcour

Source: Valcour

Source: Valcour

Amphetamine Positivity Rates Chittenden County VT, Apr – Sep 2018 For CCOA - CommStat, 12/19/18

Positivity Rate of Screen Tests, Chittenden County 2018 12% 11.5% 10.1% 9.7% 10% 8.7% 8.3% 8% 6.4% 6% 4% 2% 0% Apr May Jun Jul Aug Sep Amphetamine Opiates Fentanyl Heroin Cocaine Oxycodone

Positivity Rate of Amphetamine Confirm Tests, Chittenden Cty. 2018 69.1% 70% 59.4% 58.0% 57.4% 60% 56.3% 52.0% 50% 40% 30% 20% 13.7% 11.6% 10% 2.5% 0.0% 0.0% 0.0% 0% Apr May Jun Jul Aug Sep Amphetamine Methamphetamine

Literature Review, MAT Efficacy, Outcomes & Next Steps Dr. Rawson & Dr. Evans

A life course perspective to addressing opioid use disorders CommSTAT, Burlington, VT December 20, 2018 Liz Evans, PhD, MA Assistant Professor Department of Health Promotion & Policy School of Public Health and Health Sciences University of Massachusetts Amherst eaevans@umass.edu

1. When examined over many years, opioid use resembles a chronic disease 2. Over 10 years, there is persistent use, cycles of abstinence and use, poor treatment adherence 3. Hser YI, Huang D, Brecht ML, Li L, Evans E. Contrasting trajectories of heroin, cocaine, and methamphetamine use. J Addict Dis. 2008;27(3):13-21. n=1,797

Patterns of opioid use do change over time Trajectories of Averaged Days of Opioid Use over 55 Months Hser YI, Huang D, Saxon AJ, Woody G, Moskowitz AL, Matthews AG, Ling W. Distinctive Trajectories of Opioid Use Over an Extended Follow-up of Patients in a Multisite Trial on Buprenorphine + Naloxone and Methadone. J Addict Med. 2017 Jan/Feb;11(1):63-69. n=795

Treatment with MOUD can be a turning point event

“Medications for Opioid Use Disorders (MOUD)” FDA-approved medications • Methadone (1972) • Buprenorphine (Suboxone, Subutex) (2002) • Extended release naltrexone (Vivitrol) (2006) Newer FDA-approved medications • Implantable buprenorphine (Probuphine) (2016) • Once-monthly injection buprenorphine (Sublocade) (2017) MOUD is the evidence-based gold standard of care. Being retained in MOUD is associated with lower mortality, less opioid use, less infectious disease risks (HIV, Hepatitis C), fewer arrests and incarcerations, and other positive outcomes. https://addiction.surgeongeneral.gov/

Risk of death is greatest when not receiving MOUD High mortality risk periods --When out of MOUD --When in detoxification, esp first 2 weeks --2 weeks after MOUD exit Women with fatal opioid overdose lose more years of potential life than men Evans et al., (2015). Gender differences in mortality among treated opioid dependent patients. Drug and Alcohol Dependence . 155:228-235. Evans et al., (2015). Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006 – 2010. Addiction , 110: 996 – 1005. Evans, E., Li, L., Min, J., Huang, D., Urada, D., Lei, L., Hser, Y.I., & Nosyk, B. (2015). Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006 – 2010. Addiction , 110: 996 – 1005.

Mortality among people with OUD On and off MOUD All-cause mortality is highest: Off MOUD --among people with other concurrent substance use disorders --in the first week following discontinuation from MOUD --in the year following the first record of OUD --after first drug-related hospitalization. On MOUD Nosyk et al., (2018). Mortality among a population-based cohort of people with opioid use disorders in British Columbia, Canada. In review.

Long-term Cohort Studies of Opioid Use Disorder Table 1. Long-term Cohort Studies BUP MMT HIV HAART 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Study #, Title/country 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 1. Bup vs. MM / Australia a 1996 - 2006 2. ATOS / Australia b 2001 - 2009 3. ORCHID / India d 2005 - 2009 4. Pakistan c 1992 - 1998 5. Copenhagen / Denmark c 1973 - 1984 6. Amsterdam / Netherlands b 1985 -2002 7. NTORS / UK b 1995 - 1999 8. Cohort 1 / England c 1963 - 1971 9. English Town / England c 1966 - 1999 London Cohort 2 / England c 10. 1969 - 1991 London Cohort 3 / England c 11. 1984- 1989 Edinburgh / Scotland c 1980 - 2007 12. Pregnant Women / Ireland a 13. 1985 - 2005 ROSIE / Ireland b 14. 2003 - 2007 MMT / Spain a 1980 - 2005 15. Vaillant 1 / US c 1952 - 1972 16. Tucson / US d 1955 - 1976 17. CAP / US d 1962 - 1997 18. San Antonio / US c 1964 - 1981 19. DARP / US b 20. 1969 - 1981 Santa Clara / US a 1970 - 1977 21. Vietnam / US d 1972 - 1997 22. CMC / US a 1976 - 2009 23. TOPS / US b 1981 - 1986 24. Parents – MMT / US b 1991 - 2006 25. ALIVE / US d 1988 - 2008 26. Albuquerque / US b 1991 - 2006 27. START / US a 28. 2005 - 2013 presen a Methadone/Buprenorphine, b Methadone and other treatment modalities, c Non-methadone treatment, d Non-treatment source. Hser YI, Evans E, Grella C, Ling W, Anglin D. Long-term course of opioid addiction. Harv Rev Psychiatry. 2015 Mar-Apr;23(2):76-89.

Methadone (MET) and buprenorphine (BUP) are each associated with a greater reduction of opioid use over 5 years (relative to no treatment) Estimated Days of Opioid Use by the Types of Treatment Based on Model 4 (N = 795) †† †† The number of participants in each type of treatment varied in each month and is therefore not indicated in the figure; on average over the follow-up period, each month there were about 14.2% of the participants in BUP treatment, 38.5% in MET treatment, and 46.9% in neither BUP nor MET treatment. Hser YI, Evans E, Huang D, Weiss R, Saxon A, Carroll KM, Woody G, Liu D, Wakim P, Matthews AG, Hatch-Maillette M, Jelstrom E, Wiest K, McLaughlin P, Ling W. Long-term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi-site trial. Addiction. 2016 Apr;111(4):695-705.