Opioid Epidemic as it Relates to Counties Ms. Jessica Cance Agency - - PDF document
89 TH A NNUAL W EST T EXAS C OUNTY J UDGES AND C OMMISSIONERS A SSOCIATION C ONFERENCE Wednesday, April 25, 2018 11:05 11:55 a.m. Opioid Epidemic as it Relates to Counties Ms. Jessica Cance Agency Analytics Unit Manager Ms. Kasey Strey
Jessica Duncan Cance, M.P.H., Ph.D.
Texas Departm ent of State Health Services
Kasey Strey, A.C.P.S.
Texas Health and Hum an Services Com m ission
in Texas
aspects of substance misuse/substance use disorders
designed to prevent opioid misuse and associated consequences
2 3
died due to drug overdose
cities and towns in Texas
Sources: Texas DSHS Provisional counts of drug overdose deaths, 2/15/2018. U.S. Census Bureau (2017). Annual Estimates of the Resident Population in Texas: April 1, 2010 to July 1, 2016. Available at: https://www.census.gov/data/datasets/2016/demo/popest/total-cities-and-towns.html 4
5 Source: National Institute on Drug Abuse
Type of Opioid Exam ples Natural opioids
(sometimes called opiates)
Morphine, Codeine, Thebaine Semi-synthetic Hydromorphone, Hydrocodone, Oxycodone, Heroin Fully synthetic Fentanyl, Methadone, Tramadol
addictive behaviors
activate opioid receptor proteins
response to pain
Source: Gutstein H, Akil H. Opioid Analgesics. In: Goodman & Gilman’s the Pharmacological Basis of
6
7 10.5 0.6 4.2 0.04 12.3 0.6 3.7 0.07
3 6 9 12 15 Marijuana Cocaine Pain Reliever Misuse Heroin
Past Year Substance Use among Youth Ages 12-17: TX vs. US
Texas U.S.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016. 8 10.1 1.5 4.5 0.22 13.9 2.0 4.5 0.36
3 6 9 12 15 Marijuana Cocaine Pain Reliever Misuse Heroin
Past Year Substance Use among Adults 18 or Older: TX vs. US
Texas U.S.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016. 9
10 Source: Texas Death Certificates Accidental Poisonings based on County of Occurrence Prepared by Texas Department of State Health Services, Center for Health Statistics 3/6/2018
2,226 1,174 500 1,000 1,500 2,000 2,500 1999 2003 2007 2011 2015 Number of Deaths Total Opioids Cocaine Psychostimulants Benzodiazepines Other Drugs
11
2,594 1,970 862 727 305
750 1500 2250 3000
Opioids Benzodiazepines Psychostimulants Cocaine Marijuana
12
Drug-Related Inpatient Emergency Department Visits: 2016
Source: Texas Hospital Inpatient Discharge Public Use Data Files, Q1 – Q4 2016. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. 3/7/2018.
Texas Health Data: Opioid-Related Inpatient ED Visits
13
Texas Poison Center Network Drug-Related Exposure Calls: 2000-2017
14 5265 1500 3000 4500 6000 7500 9000 2000 2002 2004 2006 2008 2010 2012 2014 2016
Antidepressants Benzodiazepines All opioids Stimulants
Source: Texas Poison Center Network, 2000-2017. Analyses include only those calls involving drug exposures; calls asking for information were not included.
Texas Health Data: Opioid-Related Exposure Calls
15
Rate of Opioid-Related Poison Center Network Calls, by County: 2011-2015
16
17
Psychological
Management
Biological
Social
Relationships
Status
18
five adults had chronic pain in the past six months
billion
recognized as “The Fifth Vital Sign”
Sources: QuickStats: Age-Adjusted Percentage of Adults Aged ≥18 Years Who Were Never in Pain, in Pain Some Days, or in Pain Most Days or Every Day in the Past 6 Months, by Employment Status — National Health Interview Survey, United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:796. Gaskin, D.J., & Richard, P. (2012). The Economic Costs of Pain in the United States. The Journal of Pain, 13 (8), 715. 19
20 Community Organizational Interpersonal Intrapersonal Sources: McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion
SAMHSA CAPT (2016). Preventing Prescription Drug Misuse: Understanding Who Is at Risk. Available at: https://www.samhsa.gov/capt/sites/default/files/resources/preventing-prescription-drug-misuse-understanding.pdf
Refusal Skills Risk Perception Caregiver Monitoring Communication Disapproval Peer Approval Number of Friends Using Retail Availability Prescriber Norms Social Availability Community Norms
4/11/2018 21
Public Health Approach to Preventing Substance Misuse and Addictions
Source: http://www.astho.org/addictions/ 22
Risk and Protective Factors
But why here?
Problems and Related Behaviors
What? And why?
Source: Luciani, N. (2016, September 26). Community-level Strategic Planning to Prevent Non-medical Use of Prescription Drugs in Texas. Lecture presented at CAPT Training - Fall Prevention Provider Meeting, Austin.
Prevention Strategies
What should we do? And how?
23
24
25
Source: 2017 Texas College Survey of Substance Use: Main Report. Available at: https://texascollegesurvey.org/wp-content/uploads/2017/08/CDAS_report_final_2017.pdf
5 5 3 8 2 7 2 0 9 4
20 40 60 Someone with a Prescription Personal Prescription Someone without a Prescription Home Medicine Cabinet Stealing It On-Line Percentage
Sources of Misused Prescription Medication among Texas College Students: 2017
26
Treatment, and Recovery Professionals
Other Health Care Professionals
Source: Shah, A., Hayes, C.J., & Martin, B.C. (2017). Characteristics of initial prescription episodes and likelihood of long-term opioid use: United States, 2006-2015. MMWR Morb Mortal Wkly Rep; 66:265-269. 27
Source: CDC Vital Signs, July 2017 Interactive maps: https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html 28
Source: www.cdc.gov/vitalsigns/opioids 29
Public Safety to the Texas Board of Pharmacy in 2016
2017 (House Bill 2561, 85th Regular Session)
prescribing opioids, benzodiazepines, barbiturates, or carisoprodol
30
31
and Referral Centers (OSARs)
32
Outreach, Screening, Assessment, and Referral Centers (OSARs)
Source: https://www.dshs.texas.gov/sa/OSAR/ 33
and professionals who do not specialize in addiction treatment
that uses motivational techniques based on the person’s readiness to change
recommendations respectfully, without judgment or accusations, in the form of useful information
34
35
36
Source: San Francisco Department of Public Health. Naloxone for Opioid Safety. San Francisco Health Network
37
Resources for academic institutions, community organizations, & healthcare providers Continuing education for pharmacists, prescribers, & social workers
38
Texas Health Data healthdata.dshs.texas.gov/Home Outreach, Screening, Assessment, and Referral Centers (OSARs) www.dshs.texas.gov/sa/OSAR/ Operation Naloxone www.OperationNaloxone.org CDC Opioid Overdose www.cdc.gov/drugoverdose/index.html Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities www.hhs.gov/about/agencies/iea/ partnerships/opioid-toolkit/index.html U.S. Surgeon General – Opioid Overdose Prevention https://www.surgeongeneral.gov/priorities/
39
DEATakeBack.com
Jessica.Cance@dshs.texas.gov Kasey.Strey@hhsc.state.tx.us