K e ntuc ky s Opio id Use Diso rde r Crisis: A F o c us o n Rura - - PowerPoint PPT Presentation

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K e ntuc ky s Opio id Use Diso rde r Crisis: A F o c us o n Rura l Po pula tio ns Alle n J. Bre nze l, M.D.,MBA Me dic a l Dire c to r, DBHDI D, CHF S Asso c ia te Pro fe sso r o f Psyc hia try a nd Pe dia tric s Unive rsity o f K e

SLIDE 1

K e ntuc ky’ s Opio id Use Diso rde r Crisis: A F

c us o n Rura l Po pula tio ns

Alle n J. Bre nze l, M.D.,MBA Me dic a l Dire c to r, DBHDI D, CHF S Asso c ia te Pro fe sso r o f Psyc hia try a nd Pe dia tric s Unive rsity o f K e ntuc ky

SLIDE 2

K e ntuc ky - Co nte xt

Po pula tio n 4.4 millio n
E

c o no mic Sta tus

– 47th in a ve ra g e a nnua l inc o me ($41,141)

Rura l Sta te

–

Mo re tha n 50 pe rc e nt live in rura l se tting

Me dic a id E

xpa nsio n Sta te

– 1.4 millio n K

e ntuc kia ns o n Me dic a id

– 500 tho usa nd o f tho se a re E

xpa nsio n

Ce nte r o f the Opio id Crisis

SLIDE 3

AGE-ADJUSTED OVERDOSE DEATH RATE BY STATE, 2016

State Deaths Population Crude Rate per 100,000 Age-Adjusted Rate per 100,000

West Virginia 884 1,831,102 48.3 52.0 Ohio 4,329 11,614,373 37.3 39.1 New Hampshire 481 1,334,795 36.0 39.0 Pennsylvania 4,627 12,784,227 36.2 37.9 Kentucky 1,419 4,436,974 32.0 33.5 Maryland 2,044 6,016,447 34.0 33.2 Massachusetts 2,227 6,811,779 32.7 33.0 Rhode Island 326 1,056,426 30.9 30.8

SLIDE 4

KY RESIDENT DRUG OVERDOSE DEATHS (all drugs)

197 241 345 426 560 526 638 728 708 764 769 10071058107810191077 1273 1419 1565

200 400 600 800 1000 1200 1400 1600 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Year

Numb e r o f De a ths

10.3% increase

SLIDE 5

Composite Risk Index for Opioid Overdose

SLIDE 6

Numb e r o f Opio id-Re la te d Ove rdo se De a ths in K e ntuc ky

2017 Synthetic opioids increased to 763

SLIDE 7

E / D Ove rdo se Visits All Drug s

K e ntuc ky I njury Pre ve ntio n a nd Re se a rc h Ce nte r Da shb o a rd

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Ne o na ta l Opio id Withdra wa l

19 46 69 98 123 133 179 209 251 327 379 522 632 756 1,060 1,043 1,115 725 982 890 934

200 400 600 800 1,000 1,200

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Number NAS Hospitalizations NAS Paid by Medicaid

SLIDE 9

Crisis in numb e r o f individua ls

inc a rc e ra te d in sta te c o rre c tio na l syste m (25,000)

Mo re tha n 9600 c hildre n in sta te c usto dy
E

xplo ding he a lthc a re c o st fo r OUD re la te d he a lth c a re c o mplic a tio ns

– OD E

/ R a nd a dmissio ns

– He pa titis/ HI

V Risk

– Ce llulitis/ e ndo c a rditis/ b ra in a b sc e sse s

Consequences of Opioid Crisis

SLIDE 10

Counties most vulnerable to rapid HIV spread if HIV introduced: 220 counties in 26 states

Van Handel et al. Journal of AIDS epub ahead of print DOI: 10.1097/Q AI.0000000000001098

SLIDE 11

Over 50 counties in KY vulnerable to rapid Hep C/HIV spread

Van Handel et al. Journal of AIDS epub ahead of print DOI: 10.1097/Q AI.0000000000001098

SLIDE 12

K e ntuc ky Opio id Re spo nse E ffo rt

Go ve rno r’ s Offic e He a lth a nd F a mily Se rvic e s Justic e a nd Pub lic Sa fe ty E duc a tio n a nd Wo rkfo rc e De ve lo pme nt L a b o r Administra tive Offic e o f the Co urts

BHDI D DPH DMS DCBS OCSHN OI G (K ASPE R) OHDA Offic e o f Drug Co ntro l Po lic y (ODCP)

SLIDE 13

Building Blocks of the Action Plan

SLIDE 14

Prevention

Prevent initiation of use Prevent misuse Prevent related harm

SLIDE 15

Opio id Re spo nse – F

c us o n Rura l
Rura l o pio id pre sc rib ing tre nds
Ha rm re duc tio n/ e ng a g e me nt
Ac c e ss to q ua lity tre a tme nt

SLIDE 16

Opio id Pre sc rib ing

SLIDE 17

SLIDE 18

Stra te g ie s

Ma nda to ry utiliza tio n o f PDMP (K

ASPE R)

Re g ula tio n o f pa in c linic (“pill mills”)
Pro vide r/ Pub lic E

duc a tio n

Drug ta ke b a c k a nd pill dispo sa l
E

nha nc e d PDMP

hre e da y limit fo r a c ute pa in

Opio id Ste wa rdship

SLIDE 19

Quesinberry, D. KASPER Quarterly Threshold Analysis Report, Fourth Quarter 2017. Kentucky Injury Prevention and Research Center, 2018.

Prevent Initiation of Use

SLIDE 20

13.91 14.93 14.54 14.42 14.65 14.63 14.69 16.16 16.62 16.01 16.38 16.03 15.85 16.69 12.00 12.50 13.00 13.50 14.00 14.50 15.00 15.50 16.00 16.50 17.00 De c 2016 Ja n 2017 F e b 2017 Ma r 2017 Apr 2017 Ma y 2017 Jun 2017 Jul 2017 Aug 2017 Se p 2017 Oc t 2017 No v 2017 De c 2017 Ja n 2018

PERCENT OF TOTAL: THE PERCENTAGE OF ALL DISPENSED C-II OPIOID ANALGESIC DRUG PRESCRIPTIONS WHERE DAY'S SUPPLY IS ≤ 3

Proportion (%)

H O U S E B I L L 3 3 3

SLIDE 21

Treatment

Improve early identification of intervention need Build pathways to treatment Support utilization of a full treatment continuum Integrate and coordinate service delivery

SLIDE 22

T re a tme nt Rura l F

c us
T

re a tme nt L

c a to r a nd Ca ll L

ine

nc re a se d Ac c e ss to MAT

mpro ve me nt o f Ne two rk Ade q ua c y

Wo rkfo rc e
T

e le he a lth

1115 Wa ive r

SLIDE 23

Increase access to and awareness of treatment resources for clients and providers

findhelpnowky.org

Pathways to treatment

SLIDE 24

I mpro ve d Ac c e ss to Me dic a tio n Assiste d T he ra py (MAT )

Me tha do ne
Bupre no rphine
Na ltre xo ne

Me dic a tio ns in c o mb ina tio n with e vide nc e b a se d the ra pie s a nd psyc ho so c ia l suppo rts

SLIDE 25

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SLIDE 28

Medicaid 1115 Waiver – SUD components

Grant exceptions to 15 bed limit for SUD residential
Develop quality and outcome standards
Consider SUD status in determining medically frail

determinations

Count “Recovery” activities toward Community

Engagement Requirements

Enhance access to employment resources

SLIDE 29

RECOVERY

Expand transitional care services such as housing, transportation, employment Expand community support services to support long-term recovery

SLIDE 30

EMPLOYMENT SUPPORT

Employment supports through the Department of

Corrections for individuals re-entering the community

Employer toolkit to guide employers’