George Pro, PhD, MPH February 22, 2020 Age Agenda Opioid epidemic - - PowerPoint PPT Presentation

▶
george pro phd mph february 22 2020 age agenda
SMART_READER_LITE
LIVE PREVIEW

George Pro, PhD, MPH February 22, 2020 Age Agenda Opioid epidemic - - PowerPoint PPT Presentation

May 16, 2023 42 likes •419 views

National Perspective on the Ep Epidemiology of of Opi pioi oid Addiction on and Treatment George Pro, PhD, MPH February 22, 2020 Age Agenda Opioid epidemic background Treatment Services Research at NAU Future Research at NAU

slide-1
SLIDE 1

National Perspective on the Ep Epidemiology

  • f
  • f Opi

pioi

  • id Addiction
  • n and Treatment

George Pro, PhD, MPH February 22, 2020

slide-2
SLIDE 2

Age Agenda

  • Opioid epidemic background
  • Treatment Services Research at NAU
  • Future Research at NAU
slide-3
SLIDE 3

Background nd

slide-4
SLIDE 4

Op Opio ioid id types

Background | Treatment Services | Future NAU Research

slide-5
SLIDE 5

Ra Racial/ethnic disparities

Background | Treatment Services | Future NAU Research

slide-6
SLIDE 6

Di Differences by state and region

Background | Treatment Services | Future NAU Research

slide-7
SLIDE 7

Converging epidemi mics

Background | Treatment Services | Future NAU Research

National Survey on Drug Use and Health

slide-8
SLIDE 8

Converging epidemi mics

Background | Treatment Services | Future NAU Research

National Survey on Drug Use and Health

slide-9
SLIDE 9

Converging epidemi mics

Background | Treatment Services | Future NAU Research

National Survey on Drug Use and Health

slide-10
SLIDE 10

Treatment nt Services Research at NAU

slide-11
SLIDE 11

Me Medicati tion-as assisted ed ther erap apy

Empty opioid receptor Methadone Full agonist Buprenorphine Partial agonist Naltrexone Antagonist

Background | Treatment Services | Future NAU Research

slide-12
SLIDE 12

MA MAT tr trends

Background | Treatment Services | Future NAU Research

Treatment Episode Dataset-Discharges

slide-13
SLIDE 13

MAT outcome mes

Background | Treatment Services | Future NAU Research

Pr Pro G G, Utter J, Cram J, Baldwin J (2019) Racial/ethnic and gender differences in associations between medication-assisted therapy and reduced opioid use between

  • utpatient treatment admission and discharge

Journa nal of Psychoactive Drugs Accepted/in press

slide-14
SLIDE 14

Re Research study background

  • Definitions of MAT success vary
  • Reducing opioid use improves health and safety
  • Tolerating some continued opioid use is a harm reduction strategy

Background | Treatment Services | Future NAU Research

slide-15
SLIDE 15

Re Research study background

RE RESE SEARCH CH QUE UESTIONS To what extent nt does MAT effect a reduction n in n opioid use?

Background | Treatment Services | Future NAU Research

MAT receipt A reduction in opioid use

total effect

Race/ethnicity Gender

moderation

And nd does the MAT effect chang nge based on n racial/ethni nic and nd gend nder group?

slide-16
SLIDE 16

Data source and me methods

Treatment Episode Dataset-Discharges (2015-2017) Restricted to those in treatment with heroin or other opioids indicated at outpatient admission n=232,547 Statistical modeling to predict the probability of clinical improvement

Background | Treatment Services | Future NAU Research

slide-17
SLIDE 17

De Descriptive fi findings gs

Gr Greater MA MAT receipt Le Less MA MAT receipt

Background | Treatment Services | Future NAU Research

slide-18
SLIDE 18

De Descriptive fi findings gs

Gr Greater re reduction in use Le Less re reduction in use

Received MAT Did not receive MAT

Background | Treatment Services | Future NAU Research

slide-19
SLIDE 19

Measuring group differences using statistical mo models

3.79

Background | Treatment Services | Future NAU Research

MAT receipt A reduction in opioid use

to total effect

aO aOR=3 =3.79 Race/ethnicity Gender

1

Differences in clinical improvements using statistical modeling mo moderation

slide-20
SLIDE 20

Di Discussion

Background | Treatment Services | Future NAU Research

slide-21
SLIDE 21

Fu Future NAU NAU research

slide-22
SLIDE 22

MAT me medications

Methadone, buprenorphine (Suboxone), and naltrexone (Vivitrol) have similar ef effic icac acy Effectivene ness differs based on client characteristics and preferences OUD treatment services that offer all three are optimal

Background | Treatment Services | Future NAU Research

slide-23
SLIDE 23

MA MAT availability ty and uti tilizati tion

The majority of treatment service providers do not offer MAT ≈1/3 of individuals with a need for MAT receive it Insurance coverage for each medication varies widely Fewer than n 15% 15% of addiction service physicians have applied for a license to prescribe buprenorphine

Background | Treatment Services | Future NAU Research

slide-24
SLIDE 24

Me Medicaid exp xpansions under th the ACA

Medicaid Expansion Decisions

– as of Nov. 2019 –

Adopted and implemented Adopted but not implemented Not adopted

Background | Treatment Services | Future NAU Research

slide-25
SLIDE 25

Substance abuse and me mental health parity

Ment ntal Health Parity and nd Addiction n Equity Act

Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report

Background | Treatment Services | Future NAU Research

slide-26
SLIDE 26

Substance abuse and me mental health parity

United States, Color Coded by Statutory Grades A-B C D F

Statutory grades

Background | Treatment Services | Future NAU Research

slide-27
SLIDE 27

Re Relevance to Arizona and nei neighbor

  • ring

ng stat ates es

n=138,000 n=3,061 n=1,438 n=2,045

Background | Treatment Services | Future NAU Research

slide-28
SLIDE 28

Relevance to Arizona and Native Ame merican states

Arizona Rank #12 New Mexico Rank #34 Oklahoma Rank #49 Background | Treatment Services | Future NAU Research

slide-29
SLIDE 29

Conc nclusion

slide-30
SLIDE 30

Co Conclusio sion

  • Prevention + MAT
  • A complex issue with many intersecting parts
  • Progress will be driven by interdisciplinary efforts
  • Importance of interprofessional education
slide-31
SLIDE 31

Thank nk you

slide-32
SLIDE 32

Ex Extr tra sli lides

slide-33
SLIDE 33

0.25 0.5 0.75 1 MAT, no alcohol MAT + alcohol No MAT, no alcohol No MAT + alcohol

Group proportions

AI/AN men AI/AN women Black men Black women Latino men Latina women White men White women

Group differences in reduced opioid use between outpatient admission and discharge

slide-34
SLIDE 34

Referenc nces

slide-35
SLIDE 35

Slide – Opioid types

National Institute on Drug Abuse. (January 2019). Overdose Death Rates. Trends and Statistics. National Institutes of Health. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Slide – Racial/ethnic disparities

Henry J. Kaiser Family Foundation. (2018). Opioid Overdose Death Rates by Race/Ethnicity. Health Status: Opioid Overdose Deaths. https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D Parkhurst ND, Burke A, Montiel A, Davis J, Ritchey J. (2018). The Opioid Epidemic in Indian Country. Indian Health Service Cooperative Agreement. Public Health Emergency and Preparedness Technical Assistance. Inter Tribal Council of Arizona, Inc. Tribal Epidemiology Center. https://itcaonline.com/wp-content/uploads/2018/10/ITCA-TEC-Opioid-Report-2018.pdf

Slide – Difference by state and region

Henry J. Kaiser Family Foundation. (2018). Opioid Overdose Death Rates by Race/Ethnicity. Health Status: Opioid Overdose Deaths. https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Slide – Study Background

Zhang Z, Friedmann P, Gerstein D. (2003). Does retention matter? Treatment duration and improvement in drug use. Addiction, 98(5), 673-684. Brugal M, Dennis B, Bhalerao A, Plater C, et al. (2002). Factors associated with non-fatal heroin overdose: Assessing the effect of frequency and route of heroin administration. Addiction, 97(3)319-327. Macmadu, A., Carroll, J., Hadland, S., Green, T., & Marshall, B. (2017). Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically. Addictive Behavior, 68, 35-38. Bruneau, J., Roy, E., Arruda, N., Zang, G., & Jutras-Aswad, D. (2012). The rising prevalence of prescription opioid injection and its association with hepatitis C incidence amongstreet-drug users. Addiction, 107(7), 1318-1327. Young, A., & Havens, J. (2012). Transition from first illicit drug use to first injection drug use among rural Appalachian drug users: A cross-sectional comparison and retrospective survival analysis. Addiction, 107(3), 587-596. Veilleux, J., Colvin, P., Anderson, J., York, C., & Heinz, A. (2010). A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction. Clinical Psychology Review, 30(2), 155-166.

slide-36
SLIDE 36

Slide – MAT Medications

Volkow N, Jones E, Einstein E, Wargo E. Prevention and treatment of opioid misuse and addiction: A review. JAMA Psychiatry. 2019;76(2):208-216. Connery HS. Medication-assisted treatment of opioid use disorder: Review of the evidence and future directions. Harvard Review of Psychiatry. 2015;23(2):63-75. Burns L, Gisev N, Larney S, et al. A longitudinal comparison of retention in buprenorphine and methadone treatment for opioid dependence in New South Wales, Australia. Addiction. 2015;110(4):646-655. Yarborough B, Stumbo S, McCarty D, Mertens J, Weisner C, Green C. Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis. Drug Alcohol Depend. 2016;160:112-118. Jarvis B, Holtyn A, Berry M, et al. Predictors of induction onto extended-release naltrexone among unemployed heroin-dependent adults. Journal of Substance Abuse Treatment. 2018;85:38-44. Mojtabai R, Mauro C, Wall M, Barry C, Olfson M. Medication treatment for opioid use disorders in substance use treatment facilities. Health Affairs. 2019;38(1):14-23.

Slide – MAT Availability and Utilization

Mojtabai R, Mauro C, Wall M, Barry C, Olfson M. Medication treatment for opioid use disorders in substance use treatment facilities. Health Affairs. 2019;38(1):14-23. Volkow N, Frieden T, Hyde P, Cha S. Medication-assisted therapies - Tackling the opioid-overdose epidemic. New England Journal of Medicine. 2014;370:2063-2066. Vestal C. In fighting an opioid epidemic, medication-assisted treatment is effective but underused. Health Aff (Millwood). 2016;35(6):1052-1057. Fiscella K, Wakeman SE, Beletsky L. (2018). Buprenorphine deregulation and mainstreaming treatment for opioid use disorder: X the X Waiver. JAMA Psychiatry, 76(3): 229-230. Rosenblatt RA, Andrilla HA, et al. (2015). Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Annals of Family Medicine, 13(1):23-26.

Slide – Medicaid Expansions under the ACA

Henry J. Kaiser Family Foundation. (2019). Status of State Action on the Medicaid Expansion Decision. State Health Facts. Medicaid and Health Reform. https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?activeTab=map&currentTimeframe=0&selectedDistributions=status-of-medicaid-expansion- decision&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Slide – Substance Abuse and Mental Health Parity

Douglas M, Wrenn G, Bent-Weber S, Tonti L, et al. (2018). Evaluating State Mental Health and Addiction Parity Statutes: A Technical Report. Kennedy-Satcher Center for Mental Health Equity at Morehouse School of Medicine. The Kennedy Forum. https://chp-wp-uploads.s3.amazonaws.com/www.paritytrack.org/uploads/2018/09/KF-Evaluating-State-Mental-Health-Report-0918_web.pdf

slide-37
SLIDE 37