Lexington Medical Society Opioid Symposium: Perspectives, Connections, & Strategies for Action October 16, 2019 Welcome & Introduction Charles Papp, M.D. President, Lexington Medical Society
LMS Opioid Symposium Thank you to our sponsors
LMS Opioid Symposium Lexington Medical Society Opioid Symposium: Perspectives, Connections, & Strategies for Action The opioid crisis has grown to the point where it penetrates all walks of life, all occupations, and is found in every neighborhood. The Opioid Symposium will provide physicians with tools and resources they can use in their practices. Objectives: ▪ Inform physicians & community leaders on: ▪ The background & scope of the opioid crisis in Lexington ▪ Perspectives from organizations on the front lines of the crisis ▪ Identify ways physicians and community leaders can connect patients and community members to support
LMS Opioid Symposium For CME credit: Sign-in • Turn in a survey •
Panel LMS Opioid Symposium Panel Podium Charles Papp, M.D. President, LMS Andrea James Community Response Strategist for Mayor Linda Gorton Tuyen Tran, M.D., MBA LMS Executive Board Chair Owner and CEO, 2 nd Chance P Danesh Mazloomdoost, M.D. Medical Director, Wellward Regenerative Medicine A Chad Traylor Battalion Chief, EMS Ryan Stanton, M.D. Emergency Medicine physician with Central Emergency Physicians at N Baptist Health Lexington & Chief Medical contributor for WKYT TV Kraig Humbaugh, M.D., MPH Commissioner of Health Lexington-Fayette County Health Department E Lou Anna Red Corn Fayette Commonwealth’s Attorney Michelle Lofwall, M.D., DFASAM L Professor of Behavioral Science & Psychiatry and Bell Alcohol & Addictions Chair at U.K. Center on Drug & Alcohol Research. Mark Jorrisch, M.D., DFASAM Immediate Past President Kentucky Society of Addiction Medicine Catherine Hines SUD Education and Outreach Coordinator Findhelpnowky.org
LMS Opioid Symposium 5 4 3 2 1 Community Resources P Dinner A Buffet N E L Sponsors 1. Health Department 2. Chrysalis House 3. Find Help Now KY.org 4. KORE (KY Opioid Response Effort) 5. Additional literature
LMS Opioid Symposium Please save your questions ▪ for the panel at the end We have distributed ▪ question cards at each table Make sure you have ▪ signed in and complete the survey in order to receive the CME credit
LMS Opioid Symposium Mayor’s Vision Andrea James Special Projects Coordinator, Mayor’s Office Andrea James serves as Community Response Strategist for Mayor Linda Gorton. Her emphasis is on the opioid crisis and its impact on the City of Lexington. She served on Lexington’s city council 2007 -2011 representing the First District and has the distinct honor of being the first black woman to serve as an elected city council member in Lexington. Andrea has worked in local government, philanthropy and various medical administrative roles. Outside of her work with Mayor Gorton, she is co-owner of S & A Strategies, a consulting firm specializing in intentional inclusion and equity.
LMS Opioid Symposium Personal Reflections Melissa Combs
LMS Opioid Symposium Setting the Stage of the Opioid Crisis Tuyen Tran, M.D., MBA Tuyen Tran, M.D. emigrated from South Vietnam after the war. He completed his undergraduate in biology/chemistry and medical school at the University of Missouri – Kansas City in a six-year program. He is currently boarded in internal medicine and addiction medicine.
OPIOID EPIDEMIC KENTUCKY UPDATE Tuyen T. Tran, MD, MBA
DISCLOSURES – NONE • Tuyen T. Tran, MD, MBA • Partner and CEO • 2 nd Chance – Addiction Treatment Center
OUTLINE • How did we get here? • Updates – Kentucky data • Impact of opioid epidemic
Chronic Pain – 20 th Century • We still do not quite understand chronic pain • AND we still do not have great treatment options for chronic pain • Physicians OVERPRESCRIBE opioids • But, physicians also overprescribe diagnostic evaluations, labs, imaging studies and antibiotics!! • Physicians do not want to miss a diagnosis which could harm patients • Physicians do not want patients to experience pain
Factors Contributing to the Opioid Epidemic • Physician overprescribing of opioids – Leftover pills are the problem • “pill mills” – Dr. David Proctor, the “Godfather of Pill Mills” – 1992- 2001, America’s first “pill mill” in South Shore, KY • Cultural change regarding opioids and pain – Too many patients are suffering unnecessarily because of inadequate pain management – Physicians needed education to dispel the concern for addiction – Insurances were not reimbursing for non-pharmacologic modalities for the treatment of chronic pain
Cultural Changes Regarding Pain and Opioids • 1980 NEJM one paragraph letter: Jane Porter and Hershel Jick, MD – Retrospective review of 11,882 hospitalized patients who received narcotics – Four patients were found to have “well documented addiction” • 1986 PAIN Doctors Kathleen Foley and Russel Portenoy – Iatrogenic risk was low in 38 chronic non-cancer pain patients treated with opioids • 1995 Dr. James Campbell, president of American Pain Society, promoted “Pain is the Fifth Vital Sign” • 1998 VHA incorporated pain as the “fifth vital sign” • JCAHO (Joint Commission on Accreditation of Healthcare Organizations) embraced the “Pain is the Fifth Vital Sign” • JCAHO issued standards requiring the use of a pain scale and treatment of pain, especially with opioids
Regulatory and Cultural Pressures • JCAHO referred to pain management as a patient’s rights issue – Inferred sanctions if pain was inadequately controlled • 1985 Press Ganey, a survey of patients’ hospital experiences – Collection of patient data was necessary for improvement – Distinction between patient satisfaction and quality of care BLURRED • CMS (Centers for Medicare and Medicaid Services) developed the value-based purchasing program – Patient experience collected via HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) – “Did hospital staff do everything they could to help you with your pain?”
Pressure on Physicians to Prescribe Opioids • Reimbursement to hospitals were tied to patient satisfaction • Hospitals coerced physicians (via withholding payment or bonuses) – CMS only required 300 surveys in a 12-month period – Only a small number of patients actually completed the surveys – A single poor survey could significantly impact whether the hospital achieved the required 90% percentile goal of patient satisfaction – Thus, every patient must be satisfied! • When patients requested/demanded opioid pain medications, physicians were often compelled to satisfy the patients, despite their reservations about the need for opioids
Kentucky Update - 2017 • Drug overdose deaths in the Commonwealth ranked 4 th highest among the 50 states • 1,565 Kentuckians died from a drug overdose (UP 11.5% from 2016) – Largest demographic: 35-44 y/o – Heroin: 22% of OD (DOWN from 34% in 2016) – Fentanyl: 52% of OD (UP from 47% in 2016) • Largest increase in OD were in counties: Jefferson, Fayette, Campbell, and Kenton • Largest decrease in OD were in counties: Madison, Bell, Knox, Breathitt, and Scott • Perspectives: 2017 – 782 died in traffic accidents – 263 people were murdered
Impact on Families and Children • Stress • Financial strains • Employment • Relationships • Co-dependency • Criminal justice system • Neonatal Abstinence Syndrome (NAS) – CDC: KY had 3 rd highest rate of opioid use at delivery among the 50 states
Impact on Criminal Justice System • Offenders imprisoned for drug offenses – 2000: 30% – 2009: 38% • Offenders sent to state prison for drug possession doubled from 2012 to 2016 • Offenders imprisoned for drug trafficking – 2012: 1,525 – 2016: 1,916 (25% increase) • Offenders jailed for drug possession – 2012: 911 – 2016: 1836 • Current cost to incarcerate a state inmate in KY: $18,406 per year • About 4,500 additional inmates (drug offenses) costed KY in 2016: $82M
Impact on the Workforce • Alan Krueger, Princeton economist, published 2016 – Strong link between RISING opioid prescriptions and DECLINING workforce participation rates (percentage of people employed or looking for work) – Half of men aged 25-54 who are not in the workforce take pain medication daily • 2018 Research by Federal Reserve Bank of Cleveland – Workforce participation rate was 4.6% LESS on average in counties with high rates of opioid prescribing
Impact on Kentucky Workforce • 2017 report by Kentucky Chamber of Commerce – Kentucky had one of the lowest workforce participation rates in the country – Contributing factors: • High levels of disability • High levels of poverty • High levels of incarceration • Low education attainment • High levels of substance abuse • Kentucky employers cannot fill available jobs!
Community Collaboration • Engage business leaders to discuss the opioid problem • Increase public education • Support efforts to hire people in recovery • Reclassify drug possession as a misdemeanor – Reduce number of offenders going to jail for drug possession – Remove barriers to people in recovery from acquiring employment
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