FMCC 2016 Curbing Rx Drug Abuse Plenary by Daniel Blaney-Koen

The nation’s opioid epidemic:

State legislative perspective

AMA Task Force to Reduce Opioid Abuse

© 2015 American Medical Association. All rights reserved.

• AMA Task Force to Reduce Opioid Abuse

– Increase registration and use of PDMPs

– Ensure safe, evidence-based prescribing

– Support comprehensive pain care; reduce the stigma of pain

– Reduce the stigma of substance use disorder; increase access to treatment

– Increase access to naloxone, co-prescribing, Good Samaritan protections

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Drug Poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 1999–2013

Sources: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury

Prevention

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

opioid analgesics 4030 4400 5528 7456 8517 9857 10928 13723 14408 14800 15597 16651 16917 16007 16235 18893

heroin 1960 1842 1779 2089 2080 1878 2009 2088 2399 3041 3278 3036 4397 5925 8257 10574

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

http://www.cdc.gov/

http://www.cdc.gov/

http://www.cdc.gov/injury




4

Number and age-adjusted rates of drug

overdose deaths by state, US 2013-2014


National prescribing trends

• Overall utilization of opioids

– 2013: 251,814,805

– 2014: 244,462,567

– 2015: 227,780,915

• Rate of change, 2013-2015

– 2013-14: -2.9%

– 2014-15: -6.8%

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2015-16 state legislative trends

• 2015: 600+ individual pieces of state legislation

– New York e-Rx for all prescriptions

– Mandates to register and use PDMPs, delegate access

– Increased naloxone access

• 2016: 1,000+ individual pieces of state legislation

– Mandates to register and use PDMPs

– Prescribing thresholds

– Standing orders for naloxone

– Maine, Massachusetts, Pennsylvania, Tennessee and California

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PDMPs

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States w PDMP

mandate 2013 Rx Total 2014 Rx Total 2015 Rx Total

Rate of change

2013-2015

Kentucky 4,997,389 4,900,964 4,471,521 -11.8%

New York 10,957,729 10,450,786 10,164,060 -7.8%

Ohio 11,261,528 10,794,842 9,955,858 -13.1%

Tennessee 8,525,017 8,239,110 7,800,947 -9.3%

States w/o mandate 2013 Rx Total 2014 Rx Total 2015 Rx Total Change: 2013-15

Alabama 6,814,305 6,393,791 5,840,754 -16.7%

Florida 13,636,391 13,413,544 12,708,441 -7.3%

Georgia 8,643,869 8,305,929 7,880,524 -9.7%

Vermont 418,161 415,687 388,108 -7.7%

Oregon 3,456,129 3,389,575 3,145,023 -9.9%

States w no PDMP 2013 Rx Total 2014 Rx Total 2015 Rx Total Change: 2013-15

D.C.* 530,757 520,817 462,789 -14.7%

Missouri 5,755,659 5,602,998 5,217,577 -10.3%

Pennsylvania* 11,330,259 11,031,159 10,394,466 -9.0%


Physicians say that PDMPs can help provide important

information about a patient’s prescription history

10

4% 3%

8% 10%

45% 43%

42% 44%

Agree completely

Agree somewhat

Disagree somewhat

Disagree competely

Perceptions of state PDMPs in helping physicians to …

Be fully informed about your

patients’ prescription history

Identify when patients

receive multiple prescriptions

Agree

87%

Agree

87%

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Turning Data Into Information • Push reports

▫ Upon login to the PDMP,

prescriber’s patients who

meet risk thresholds are

visible on the main screen

▫ Prescriber then

acknowledges viewing the

patient alert

ALERTS: Female and child bearing age (15-45 years of age)

“Please remember that narcotic prescriptions for women of child bearing age could result in Neonatal Abstinence Syndrome (NAS) should pregnancy occur; please discuss with your patient methods to prevent unintended pregnancy.”

Education and

treatment

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Total Primary care Specialists

(2130)

(1219)

(911)

Safe opioid prescribing 69% 68%

Pain management with opioid alternatives 54% 56%

Treatment and prevention of substance use disorder 45% 35%

Prevention of diversion 30% 22%

PDMPs 17% 17%

Naloxone 16% 17%

Medication assisted treatment 14% 15%

Other 5% 5%

68%

55%

40%

26%

17%

17%

15%

5%

7 in 10 physicians took education on safe opioid prescribing, and

more than half on pain management with alternatives.

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Education taken by physicians


Reduce the stigma of substance use disorder;

increase access to treatment

1. Stigma – misunderstanding of the disease

2. Capacity – lack of trained and willing providers

3. Access – treatment limits imposed by policymakers & insurers

“Over the last decade, the vast

majority ― about 8 in 10 ― of

all individuals with an opioid

use problem were not receiving

any treatment at a given point

in time, and rates of treatment

did not improve over the

decade despite a dramatic

increase in deaths related to

prescription drugs.”

- Brendan Saloner, PhD

Saloner B and Karthikeyan S. Changes in Substance Abuse Treatment Use Among Individuals With Opioid Use Disorders in the

United States, 2004-2013. JAMA. 2015; 314(14):1515-1517.

Stigma

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“For many years, we thought of addiction as a

bad choice people make. We thought of it as a

moral failing. But now, we have to start seeing it

for what it is, which is a chronic illness that we

have to treat with the same skill, compassion

and urgency that we would treat diabetes or

heart disease,”

U.S. Surgeon General Vivek Murthy, MD

2016 National Rx Drug and Heroin Abuse Summit

Naloxone

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Patient has prior history of overdose

Patient is on a high opioid dose

Patient has a history of substance use disorder

Patient has a co-morbid condition that might make him or her more

susceptible to opioid toxicity or respiratory distress

Patient has used or is at risk for using heroin

Patient has an underlying mental health condition that might make him or her

more susceptible to overdose

Patient’s family member or friend might be in a position to help save the

patient from an overdose

Patient injects drugs

Patient recently released from jail, prison, house arrest or other incarceration

and misused or abused opioids

Patient is on a concomitant benzodiazepine

Patient receiving opioids for pain

Which of the following clinical variables or indications

would indicate that naloxone should be co-prescribed?

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64%

58%

56%

52%

49%

45%

44%

42%

37%

31%

24%


• AMA Task Force to Reduce Opioid Abuse

– Increase registration and use of PDMPs

– Ensure safe, evidence-based prescribing

– Support comprehensive pain care; reduce the stigma of pain

– Reduce the stigma of substance use disorder; increase access to treatment

– Increase access to naloxone, Good Samaritan protections

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For more information:

Daniel Blaney-Koen, JD

Senior Legislative Attorney

Advocacy Resource Center

(312) 464-4954

[email protected]

mailto:[email protected]





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FMCC 2016 Curbing Rx Drug Abuse Plenary by Daniel Blaney-Koen

Health & Medicine