Evergreen Treatment Services (ETS) CPAA Council Learning Session - - PowerPoint PPT Presentation

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Evergreen Treatment Services (ETS) CPAA Council Learning Session - - PowerPoint PPT Presentation

Jan 21, 2024 190 likes •549 views

Evergreen Treatment Services (ETS) CPAA Council Learning Session Prescription Opioids Distributed in WA State The total number of daily doses of opioids sold to hospitals and pharmacies in WA State peaked in 2011 at 112 million. The increase

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Evergreen Treatment Services (ETS)

CPAA Council Learning Session

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Prescription Opioids Distributed in WA State

http://adai.washington.edu/wadata/ARCOSopiates.htm

The total number of daily doses of

  • pioids sold to hospitals and pharmacies

in WA State peaked in 2011 at 112

  • million. The increase over time was

enormous, it has since declined modestly.

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http://adai.washington.edu/wadata/ARCOSopiates.htm

Prescription Opioids Distributed in WA State

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Drug Overdose Rates

4/25/2017 3

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WA Heroin vs Rx Opioid Deaths Over Time

4/13/17 4

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WA Drug Overdoses vs Motor Vehicle Accidents

4/25/2017 5

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WA Deaths by Race/Ethnicity

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WA Unintentional Deaths

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Center for Disease Control

4/25/2017 8

Since 1999, the number of

  • verdose deaths involving
  • pioids (including prescription
  • pioids and heroin)

quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses. WA State: 1 person dies from drug OD every 1.5 days

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Police Evidence Testing- What’s on “the street”

Data source: WA State Patrol Forensic Laboratory Services Bureau Data analysis: Alcohol and Drug Abuse Institute, UW http://adai.washington.edu/WAdata/cases.htm

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WA State Data – Treatment Admissions: Opioids

4/25/2017 10

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Treatment Admissions

4/25/2017 11

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Regional Data

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Mapping of Opioid Deaths

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Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin San Juan Kitsap Wahkiakum 42 37

# All Controlled Substances Rx by County, 2014: Recipients per 1,000 Residents (Age-Gender adjusted)

Statewide Rate = 296

  • 336–377
  • 317–335
  • 293–317
  • 174–293

Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin 350 312 325 301 354 338 307 321 318 377 293 336 270 294 281 291 276 174 358 344 319 303 327 333 317 282 324 309 317 335 357 293 292 294 304 276 321 267 352 Island

Source: WA Dept of Health

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Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin San Juan Kitsap

# Opioids Rx by County, 2014: Recipients per 1,000 Residents (Age-Gender adjusted)

Statewide Rate = 232

  • 274–302
  • 252–273
  • 227–252
  • 136–227

42 37 Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin Wahkiakum 272 252 261 237 284 273 249 273 257 302 240 279 210 231 210 226 218 136 291 289 263 252 274 282 249 207 253 238 251 268 299 227 227 222 227 210 269 215 287 Island

Source: WA Dept of Health

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Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin San Juan Kitsap

# Hydrocodone Rx by County, 2014: Recipients per 1,000 Residents (Age-Gender adjusted)

Statewide Rate = 143

  • 181–214
  • 154–181
  • 144–152
  • 78 –142

42 37 Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin Wahkiakum 177 149 151 147 198 166 149 192 168 210 152 176 124 144 120 135 142 78 181 192 164 154 181 200 149 126 160 148 148 195 214 142 136 157 148 140 169 129 213 Island

Source: WA Dept of Health

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Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin San Juan Kitsap

Methadone Rx by County, 2014: Recipients per 1,000 Residents (Age-Gender adjusted)

Statewide Rate = 2.6

  • 4.4 – 7.5
  • 3.1 – 4.3
  • 2.3 – 2.8
  • 1.4 – 2.1

42 37 Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin Wahkiakum 2.0 2.6 7.5 2.1 1.4 3.8 2.8 4.5 1.5 4.6 2.4 3.8 3.1 4.8 2.0 2.3 2.3 1.6 3.2 2.0 4.3 3.5 2.6 6.3 3.1 2.3 4.4 4.8 3.9 2.6 4.4 2.1 2.1 3.5 3.1 2.5 2.0 2.8 7.3 Island

Source: WA Dept of Health

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Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin San Juan Kitsap

(Preliminary) Buprenorphine Rx by Waivered Prescribers by County, 2015Q4 Recipients per 1,000 Residents (Age-Gender adjusted) (n=10,433) Statewide Rate = 1.5

2.3 – 4.4

  • 1.5 – 2.2
  • 1.1 – 1.5
  • 0.3 – 1.1

42 37 Clallam Jefferson Grays Harbor Pacific Whatcom Skagit Snohomish King Pierce Lewis Mason Cowlitz Thurston Clark Skamania Klickitat Yakima Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane Lincoln Adams Whitman Franklin Benton Walla Walla Columbia Garfield Asotin Wahkiakum Kitsap 2.1 1.5 3.3 1.1 * 1.8 1.9 2.3 1.1 * 1.3 3.5 1.4 0.6 1.3 1.5 1.1 0.5 1.5 * 2.1 1.4 2.7 1.7 1.7 2.9 2.9 * 2.2 1.7 4.4 1.5 * 1.5 2.9 0.3 1.0 * 1.1 Island * Rates based on fewer than 10 recipients are suppressed.

Data Source: Prescribers waivered to prescribe buprenorphine for medication assisted treatment, DEA. Waivered prescribers include those identified in July or December 2015 file. (Source WA DOH PMP)

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Models of Care

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Nurse Care Manager Model (Massachusetts) Primary Care Model (Bup)

  • MD admits/initial
  • RN manages most visits thereafter
  • Under supervision of MD
  • Rx renewals
  • Coordination of care
  • Intensity of visit needs
  • UAs every visit
  • MD sees every 1-3 months
  • 1 full time RN: 100 patients
  • MD: 4 hrs/week

4/25/2017 20

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Hub and Spoke Model (Vermont) Partners Primary Care with OTPs (Bup)

  • Patients inducted/stabilized at OTP
  • Transferred to Primary Care clinic after stabilized
  • Bup Rx continued with PCP
  • Refer back to OTP as needed for restabilization

4/25/2017 21

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Cooperative Opioid Prescribing (CoOP) - Maryland Partners Primary Care with OTP (Bup)

  • Patients inducted/stabilized at either OTP or PCP
  • Remain with PCP if stable
  • Refer to OTP as needed for restabilization

4/25/2017 22

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WA Models Currently Being Tested

  • SAMHSA MAT-PDOA grant
  • Nurse Care Mgr Model + CoOP Model
  • Tested at ETS and HMC (OTP and Primary Care

settings)

  • ETS sites in Grays Harbor and Olympia
  • Using telehealth for MD
  • First year outcome results have been published
  • People are desperate for treatment options

4/25/2017 23

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Addiction is a brain disease:

Management of a chronic medical condition

Prevention, Intervention, Education Prescribers and users Medication Assisted Treatment Works:

People do recover

Treatment Benefits Society:

Crime rates decline, costs decline

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Medication Assisted Treatment

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Acute to chronic opioid use

Withdrawal Normal Euphoria Chronic use Acute use Tolerance and Physical Dependence

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Pills to IV drug use

4/25/2017 27

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Need and interest in treatment in WA State

  • Most drug injectors in WA State reported they

would like help stopping or reducing their drug use

  • based on the 2015 WA State Syringe Exchange Survey

http://adai.uw.edu/pubs/infobriefs/SEPoverview2015.pdf

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Medication Assisted Treatment

  • Addiction is a chronic, relapsing medical disorder
  • Disease of the brain’s reward system
  • Similar to hypertension and diabetes
  • Medication helps stabilize the disorder
  • Addiction doesn’t get cured. It gets managed.

4/25/2017 29

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Medication Assisted Treatment: Goals

  • Stabilize the body
  • Alleviate withdrawal
  • Alleviate craving
  • Normalize brain functioning
  • Engage the patient in recovery
  • Understand chronic, relapsing medical disorder
  • Medication is life-saving: 50% lower OD risk when in MAT
  • Duration of treatment is unknown

4/25/2017 30

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How do the medications work?

4/25/2017 31

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Drug Use & Length of Time in Methadone Treatment

Evergreen Treatment Services 57.4% 42.9% 33.8% 26.5% 16.4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

< 90 days 91 - 180 days 181 days - 1 year 1 - 2 years > 2 years % of Time Cohort with a positive U.A. during month

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Relapse After MAT: Leaving AMA

2/24/16 33

N=104 men who left methadone treatment against medical advice

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One man’s story

4/25/2017 34