Opioids: A Regional Perspective on a National Epidemic Ed Heidig - - PowerPoint PPT Presentation

Opioids:

A Regional Perspective on a National Epidemic

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Ed Heidig

Regional Director HHS Region IX @HHSRegion9

Region IX

The U.S. Department of Health & Human Services

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Region IX

The U.S. Department of Health & Human Services

Divisions

Administration for Children and Families Administration for Community Living Assistant Secretary for Preparedness and Response Agency for Toxic Substances Disease Registry Centers for Disease Control and Prevention Centers for Medicare and Medicaid Services Food and Drug Administration Health Resources Services Administration Indian Health Service Office of the Assistant Secretary for Health Office of Civil Rights Office of the Inspector General Substance Abuse and Mental Health Services Administration

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HHS Top Priorities

Enhance and Protect the Health and Well-Being of All Americans

• Goal 1: Prevent & Treat Opioid Abuse
• Goal 2: Reduce Prescription Drug Prices
• Goal 3: Increase Accessibility & Affordability of Health

Insurance

• Goal 4: Pay for Value & Outcomes in Healthcare Delivery
• Goal 5: Reduce New HIV/AIDS Infections by 90% by 2030

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HHS Top Priorities

Enhance and Protect the Health and Well-Being of All Americans

• Goal 1: Prevent & Treat Opioid Abuse
• Goal 2: Reduce Prescription Drug Prices
• Goal 3: Increase Accessibility & Affordability of Health

Insurance

• Goal 4: Pay for Value & Outcomes in Healthcare Delivery
• Goal 5: Reduce New HIV/AIDS Infections by 90% by 2030

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Presentation Overview

• Scope of the Opioid Epidemic
• Our National Strategy at HHS
• From Policy to Practice
• The Region IX Approach to Collaboration
• Where Do We Go From Here?

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Scope of the Opioid Epidemic

Scope of the Problem

Source: HHS: HHS.gov/opioids/about-the-epidemic/index.html Source: SAMHSA: SAMHSA.gov/sites/default/files/aatod_2018_final.pdf

The Opioid Epidemic in Context

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Estimated Age-Adjusted Death Rates for Drug Poisoning by County 2006 2016

Source: CDC/NCHS

The Opioid Epidemic in Context

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Drug Overdose Deaths, 1970 - 2015

Source: CDC/NCHS

The Opioid Epidemic in Context

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Nonmedical use of Rx Opioids: A significant risk factor for heroin use

Source: Chris Jones/SAMHSA

3 out of 4 people who used heroin in the past year misused opioids first 7 out of 10 people who used heroin in the past year also misused opioids in the past year

Risk Factors for Heroin Misuse

Epidemic Is Driving Increased Healthcare Utilization

Source: AHRQ-HCUP

The National Response

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A Comprehensive Strategy

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Prevent the health, social, and economic consequences associated with

• pioid addiction and enable individuals to achieve long-term recovery

Supporting Services Targeting Populations Providing Education Strengthening Collaborations

Improving Access to Prevention, Treatment & Recovery Services

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Targeting the Distribution & Availability of Overdose-Reversing Drugs

Ensure the broad provision of overdose-reversal drugs to people likely to experience or respond to an overdose, with a particular focus on targeting high-risk populations

Building Capacity Providing Education

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Advancing the Practice of Pain Management

Enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of

• pioids and opioid-related harms

Developing Policies Providing Education

Former CMO Dr. Vanila Singh, Chair of the Inter-Agency Pain Management Task Force

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Improve the timeliness and specificity of data to inform a real- time public health response as the epidemic evolves

Enhanced Surveillance Data Sharing

Strengthening Timely Public Health Data & Reporting

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Advance our understanding of pain and addiction, support the development of new treatments, and identify effective public health interventions to reduce opioid-related harms

Understanding Pain Addiction & Overdose Epidemiology & Policy

Supporting Cutting-Edge Research

From Policy to Practice

The 2018 Omnibus

Substance Abuse & Mental Health Services Administration

• State Opioid Response Grants: Authorized $1 billion in new funding

for grants to States to address the opioid crisis

– In addition to the $500M provided in the 21st Century Cures Act – $50M for grants to Indian tribes and tribal organizations

• Medication-Assisted Treatment for Prescription Drug and Opioid

Addiction: $84M authorized for MAT expansion

– $5M set-aside for Indian tribes, tribal organizations, or consortia

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The 2018 Omnibus

Health Resources & Services Administration

• National Health Service Corps: $105M ↑ to expand/improve access to

quality opioid & substance use disorder treatment in rural & underserved areas nationwide

• Rural Communities Opioids Response: $100M initiative to support

treatment for & prevention of substance use disorder

– 8 counties in Nevada covered by grantees

• Telehealth Centers of Excellence: $4M for technical assistance

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The 2018 Omnibus

Centers for Disease Control & Prevention

• Opioid Prescription Drug Overdose (PDO) Prevention Activity:

$475,579,000 to advance the understanding of the opioid overdose epidemic and scale up prevention activities

– CDC shall use $10M of the funds provided to conduct an opioid nationwide awareness and education campaign

• Promote the use PDMPs, including making them more interconnected,

real-time, and usable for public health surveillance and clinical decision making at State and local level

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The 2018 SUPPORT Act

• Treatment and Recovery
• Prevention
• Protecting Communities
• Fighting Fentanyl

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The SUPPORT Act

Medicaid Provisions to Address the Opioid Crisis

• Section 1001: Prohibits termination of Medicaid eligibility for juveniles

who are inmates of public institutions

• Section 1005: Requires HHS Secretary to issue guidance within 1 year
• f enactment to improve care for infants with neonatal abstinence

syndrome and their families

• Section 1006: Temporarily requires coverage of MAT under Medicaid

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The SUPPORT Act

Medicare Provisions to Address the Opioid Crisis

• Section 2001: Exempts SUD telehealth services from specified

requirements, such as geographic restrictions, under Medicare

• Section 2002: The initial exam of new enrollees and annual wellness

visits under Medicare must include SUD screening and a review of any current opioid prescriptions

• Section 2004: Medicare prescription drug sponsors must establish

drug-management programs for at-risk beneficiaries

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The SUPPORT Act

FDA and Controlled Substance Provisions

• Section 3014: The FDA must coordinate with the DHS and USPS to

improve screening & identification of unlawful controlled substances at international drug import facilities

• Section 3201: Increases the maximum number of patients that health

care practitioners may initially treat with MAT (i.e., under a buprenorphine waiver)

– This provision codifies the ability for qualified physicians to prescribe MAT for up to 275 patients

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The SUPPORT Act

Other Medicaid Provisions

• Section 5052: Allows states to apply to receive federal Medicaid

payment for specified services provided in IMDs for enrollees (aged 21 to 64) with substance-use disorders, through FY2023.

– Medicaid programs may receive federal reimbursement for up to 30 total days

• f care in an IMD during a 12-month period for eligible individuals

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The SUPPORT Act

Other Medicare Provisions

• Section 6001: CMS Innovation Center may test models to provide

incentive payments to behavioral health providers for adopting electronic health records technology and for using said technology to improve the quality and coordination of care

• Section 6065: CMS must identify outlier prescribers of opioids under

Medicare Part D and Medicare Advantage plans, based on specialty and geographic area, and annually notify such prescribers of their status

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The Region IX Approach

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How Region IX Approaches the Opioid Epidemic

• Federalism: Support state and local innovation to meet the needs of

their communities

• Collaboration: breaking down bureaucracy both internally and

externally brings the best information and resources to the epidemic the fastest

• Active Listening: States have been bold in their strategies, and asking

the right questions allows all parties to learn and inform

We Are Turning The Tide

Centers for Medicare & Medicaid Services

We Are Turning The Tide

Centers for Medicare & Medicaid Services

During last week’s National Health Center Week, HRSA awarded:

– ~ $70M for Opioid Workforce Expansion Programs for Professionals & Paraprofessionals – ~ $17M for Graduate Psychology Education Program – ~ $200M in Integrated Behavioral Health Services grants to health centers

• $668K to 4 centers in Nevada

– ~ $111M for the Rural Communities Opioid Response Program initiative

• $1M to Community Chest in Virginia City, NV

Learn more: http://www.hrsa.gov/opioids

We Are Turning The Tide

Health Resources & Services Administration

*Definition of MAT providers expanded to include physician assistances, certified nurse practitioners in 2017 Source: Uniform Data System (UDS) - Table Other Data Elements 2017. UDS 2016 Health Information Technology (HIT) Information

39,375 64,597 10,000 20,000 30,000 40,000 50,000 60,000 70,000 2016 2017

Patients

Patients Receiving MAT

64 % 1,700 2,973 500 1,000 1,500 2,000 2,500 3,000 3,500 2016 2017

Providers

Providers* Eligible to Prescribe MAT

75 % 376 472 50 100 150 200 250 300 350 400 450 500 2016 2017

Health Centers

Health Centers Providing MAT

26 % 35

We Are Turning The Tide

Increasing Access to MAT in Health Centers

Locator Tools

• Behavioral Health Treatment Services
• Buprenorphine Practitioner & Treatment Programs
• Opioid Treatment Programs

Practitioner Training

• Technology Transfer Centers
• State Targeted Response Technical Assistance Consortium
• Providers’ Clinical Support System for Medication Assisted Treatment
• Rural Opioid Technical Assistance

We Are Turning The Tide

Substance Abuse & Mental Health Services Administration

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We Are Turning The Tide

Other Regional Initiatives

• HHS Office for Civil Rights: Undertaking increased trainings on HIPAA

regulations

• U.S. Attorney’s Office Collaborations: sharing best practices for

educating law enforcement on public health components

• HUD Collaborations: working on joint ventures to support

wraparound services and tackle social determinants

• All HHS Divisions: continued engagement with State Health Officers

and STR/SOR grantees to facilitate communication between our states and between the states and the Federal government

The HIV/AIDS Initiative

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Understanding the Goal

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Understanding the Why

Target Populations

• Men having sex with men
• The Southern United States
• Minorities
• African-American
• Hispanic/Latinx
• Native populations

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Understanding the Why

Considerations

• 1:10 new infections among those who inject drugs
• ~80% of new infections were transmitted from those

who didn’t know they were positive

• Stigma still surrounds HIV/AIDS

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Understanding the Path

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Understanding How This Affects The Region

• Arizona: Maricopa
• California: Alameda, Los Angeles,

Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco

• Nevada: Clark

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Ending the HIV Epidemic

Health Center Program

• Nearly 2 million HIV tests conducted annually

nationally

• More than 165,000 patients with HIV receive medical

care services at health centers, including many sites co-funded by the Ryan White HIV/AIDS Program

• More than 600 health centers purchase Pre-Exposure

Prophylaxis (PrEP) through the 340B Program

• FY2020: $50 million to support increased outreach,

testing, care coordination, and HIV prevention services, including PrEP, in targeted counties/cities and States.

Where Do We Go From Here?

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Contact Us

Join Our Mailing List By Sending An Email To: Region9ORD@hhs.gov Follow Us on Twitter @HHSRegion9 Stay up to date on the national strategy