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1 September 20, 2017
THOUGHTS ON A MARKET APPROACH TO CURBING SUBSTANCE USE DISORDER
John J. Dreyzehner, MD, MPH Commissioner
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THOUGHTS ON A MARKET APPROACH TO CURBING SUBSTANCE USE DISORDER - - PowerPoint PPT Presentation
THOUGHTS ON A MARKET APPROACH TO CURBING SUBSTANCE USE DISORDER - - PowerPoint PPT Presentation
THOUGHTS ON A MARKET APPROACH TO CURBING SUBSTANCE USE DISORDER John J. Dreyzehner, MD, MPH Commissioner 1 September 20, 2017 Cumberland Plateau Health District, Southwest Virginia 2 3 3 Back in 2005 Accidental Prescription Drug
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“Society doesn’t have all the answers for people bent on abuse and not caring enough about who they harm − at some point it is about a personal decision.”
Back in 2005…
Accidental Prescription Drug Deaths SW Virginia 2003 (n=168)
- 70.8% were male
- Average Age 36.8 Years
- 40.5% were married
- 67.3% had a history of drug abuse
- 53.0% had a history of pain
- 39.9% had a history of chronic illness
- 39.9% had a history of mental illness
- 22.0% were in the construction/extraction occupations
- 19.0% were disabled
- 10.1% were homemakers
- 7.1% had a previous overdose
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Supply Drives the Market…
Potential Buyers
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…And the Market Can be Constrained
Prevention
Potential Buyers
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The Dopaminergic Reward Center
Endorphins
(Endogenous Opiates)
THC Physical Activity Glucose Sex Nicotine
Yeah!
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Ab Abuse se Misuse se Misuse se Ab Abuse se Misuse se Ab Abuse se Ab Abuse se Ab Abuse se Misuse se Misuse se Misuse se Ab Abuse se- Pregnancy ancy NAS Over erdo dose se Resis sistant tant (Relig eligio ious) Resis sistant tant (Rec ecovery) Resis sistant tant (Bad ad Relati lationsh ship) ip)
A simplified schematic of “transmission” in the substance abuse epidemic:
- Social networks can mitigate or create risk
- Not everyone who misuses will abuse
- Not everyone who overdoses will die
- Not all misuse/abuse with pregnancy will result in NAS
- Resistance/Immunity-some have innate or acquired “resistance”
What does “epidemic” really mean?
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Public Health Approach to the Opioid Abuse Epidemic Tennessee Department of Health Strategic Map, 2016
Expand efforts to reduce NAS Actively support community coalitions Expand use of optimal prescribing guidelines Provide prescriber/ dispenser education on regulation & enforcement
Improve collaboration with law enforcement
Expedite investigations supporting Board oversight
- f prescribers
Adopted 1/11/16
Expand treatment alternatives to incarceration Partner with Mental Health to expand treatment
- ptions for opioid misuse
Optimize use of the CSMD Improve the high risk patient model Link other data sources to the CSMD Destigmatize & approach addiction as a treatable chronic illness Eliminate “Pill Mills” Develop a high risk prescriber model for individuals and practices Improve legislation to allow proactive regulation
Reduce Opioid Misuse, Abuse & Overdose
Improve Primary Prevention Improve Regulation and Enforcement Increase Utilization
- f Treatment
(2º Prevention) Improve Monitoring and Surveillance A B D C
Secure/Realign Resources and Infrastructure to Implement Comprehensive Approaches
Facilitate community interventions, including safe disposal of drugs Expand appropriate use of MAT Expand SBIRT training and use Advocate for Prescription for Success including treatment and care
Expand and Strengthen Key Partnerships and Collaborative Infrastructure Use Data, Evaluation and Research to Inform Interventions and Continuous Improvement
Improve education for consumers, families & HCWs Develop a high risk dispenser model Reduce harm from needle use
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Improve proactive use of clinical monitoring tools Work with academic partners to improve training of prescribers Describe how patient care is impacted by sudden clinic closure Require pain management clinic physicians to have specialty certification
Increase Access to Appropriate Pain Management E
Increase access for uninsured Develop a model for desirable integrated pain practices Expand the availability and use of Naloxone
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Some Bright Spots in Tennessee
333 180 50 100 150 200 250 300 350 2014 2017
Pain Clinics in TN
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…Constraining the Market
Prevention
Potential Buyers
Medication Assisted Therapy, Inpatient, Outpatient, 12 Step, Etc. Law Enforcement, PDMPs, Preventing Pill Mills, Regulatory Board Investigations, Etc. Fulfilling The Brain’s Reward Center, Working Upstream to Keep the Brain from being Hijacked
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