The Opioid Epidemic & HHS Response

Christopher M. Jones, PharmD, MPH CDR, US Public Health Service

Director, Division of Science Policy

Office of the Assistant Secretary for Planning and Evaluation

Overview

• Brief epidemiology update

• HHS Secretary’s Opioid Initiative

• Emerging successes

Rx opioids mostly commonly abused prescription drug, US, 2014

Source: SAMHSA National Survey on Drug Use and Health, 2014

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500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

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Rx Opioids Tranquilizers Stimulants Sedatives

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Initiation Dependence or Abuse Past Month Nonmedical Use

Past year opioid use disorders, US, 2003-2014

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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Any Opioid Use Disorder Prescription Opioid Use Disorder Heroin Use Disorder

Source: SAMHSA, NSDUH 2003-2014 PUF

Opioid-related overdose deaths, US, 1999-2014

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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All Opioids Heroin Natural/Semi-Sythetic Opioids Methadone Synthetic Opioids

Nonmedical use of Rx opioids significant risk factor for heroin use

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

Source: Jones, C.M., Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States,

2002–2004 and 2008–2010. Drug Alcohol Depend. (2013). Slide credit – Grant Baldwin, CDC

Emerging issues

HHS Opioid Initiative

• Launched by Secretary Burwell in March 2015

• Three focus areas

– Improve opioid prescribing

– Increase use of naloxone to reverse opioid overdose

– Expand use of Medication-Assisted Treatment (MAT) for opioid use disorders

Improve opioid prescribing

• CDC opioid prescribing guidelines

• CDC Prevention for States funding – Funding and Technical Assistance to

enhance PDMPs

• Educational opportunities

– FDA ER/LA Opioid Analgesic REMS

– NIDAMED and NIH Centers of Excellence in Pain Education

– SAMHSA programs – PCSS-O and PCSS-MAT

• EHR/Clinical decision support

Expand access to and use of MAT

• Buprenorphine rule-making

• NIDA supported research to optimize MAT delivery

• FDA incentives to spur product development

• SAMHSA grants to states to support uptake of MAT

• SAMHSA-funded SBIRT programs

• HRSA up to $100 million for MAT in Community Health Centers

Increase use of naloxone

• FDA and NIDA support to develop new formulations

• SAMHSA overdose toolkit

• July 1-2, 2015 public meeting on naloxone –http://www.fda.gov/Drugs/NewsEvents/ucm442236.htm

• Funding for states and communities to purchase, train, and distribute naloxone

– HRSA funding to 18 rural communities in 2015

– $12 million for SAMHSA grants in FY16

Partnership with health professional societies

• Have more than 540,000 health care providers complete opioid prescriber training in the next two years

• Double the number of physicians certified to prescribe buprenorphine for opioid use disorder treatment, from 30,000 to 60,000 over the next three years

• Double the number of providers that prescribe naloxone

• Double the number of health care providers registered with their State PDMP in the next two years

• Reach more than 4 million health care providers with awareness messaging on opioid abuse, appropriate prescribing practices, and actions providers can take to be a part of the solution in the next two years

12

Washington

• Implemented a multi-faceted approach – State-wide chronic pain and ED guidelines – Prescription drug monitoring program – Medicaid innovations and Patient Review and

Coordination program – Naloxone law – Expansion of MAT

• Decline in opioid overdose death rate since 2008 • Decline in opioid hospitalizations since 2012

THANK YOU

QUESTIONS?

CHRISTOPHER.JONES@HHS.GOV