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Key Strategies to Address the Drug Epidemic Region VIII Opioid Summit Denver, Colorado August 15-16, 2017 Anna Fondario, MPH Violence and Injury Prevention Program Epidemiology Manager
Key Strategies to Address the Drug Epidemic Region VIII Opioid Summit Denver, Colorado August 15-16, 2017 Anna Fondario, MPH
Violence and Injury Prevention Program Epidemiology Manager
HOW DID WE GET HERE?
Drug poisoning is the
leading cause of injury deaths in Utah 3
Firearm, 12.4
Motor Vehicle Crash, 8.6
Fall, 8.5
Drug Poisoning, 22.8
0.0
5.0
10.0
15.0
20.0
25.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rat
e pe
r 100
,000
pop
ulat
ion
Rate of deaths per 100,000 population by injury type, Utah 1999-2015
Data Source: Utah Department of Health Indicator Based Information System for Public Health (IBIS-PH). CDC WISQARS.
From 2013-2015, Utah ranked 7th highest in the U.S.
Rate of Drug Poisoning Deaths per 100,000 Population, Utah 1999-2015
Data Source: Web-based Injury Statistics Query and Reporting System, US Census Bureau.
0-2 >30
1999 2000 2001 2002 2003 2004
2005 2006 2007 2008 2009 2010
2011 2012 2013 2014 2015
Number of drug poisoning deaths by manner of death, Utah, 2000-2015
Data Source: Utah Department of Health Indicator Based Information System for Public Health (IBIS-PH).
0
50
100
150
200
250
300
350
400
450
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Num
ber
Year
Accidental
Undetermined
Suicide
Rx No Heroin
Heroin No Rx
All Opioids
0
50
100
150
200
250
300
350
400
450
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016*Year
Accidental and Undetermined Drug Poisoning Deaths by Select Categories, Utah 2000-2016
Exec
utiv
e Co
mm
ittee
(P
olic
y Pr
iorit
izat
ion)
Stee
ring
Com
mitt
ee
Access to Treatment*
Advocacy
Data and Evaluation
Harm Reduction
Provider Training and Patient Education*
Public Awareness
Use Only As Directed*
Stop the Opidemic
Public Safety
Work Groups
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Uta
h D
epar
tmen
t of H
ealth
Mission Statement
Prevent and reduce
opioid abuse, misuse, and overdose deaths
in Utah through a coordinated response.
(Bac
kbon
e Ag
ency
)
*Efforts align with Intermountain Healthcare’s Opioid Community Collaborative Steering Committee.
Health Priority: Prescription Drug Misuse and Overdose Prevention • Decrease high risk prescribing • Decrease opioid overdoses • Increase access to naloxone
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Utah Health Improvement Plan
*Efforts align with Intermountain Healthcare’s Priorities.
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Outcome Goals
Goal Measures Baseline
Decrease high risk prescribing
1. Average number of opioid prescriptions per person
2. Rate of opioid prescriptions dispensed per 1,000 population
3. Percent of opioid prescriptions with a daily MME > 90
1. 2014: 5.0 Rxs / person 2. 2015: 888.5 per 1,000
population 3. 2015: 15.9% dispensed
with daily MME > 90
Decrease opioid overdoses
1. Rate of drug overdose deaths involving opioids per 100,000 population
2. Rate of drug overdose ED visits / hospitalizations involving opioids per 10,000 population
1. 2015: 15.8 per 100,000 population
2. 2014: 1.6 / 0.98 per 10,000 population
Increase access to naloxone
1. Number of pharmacies participating in Utah’s Statewide Standing Order
2. Number of naloxone doses dispensed
1. 2016: 87 pharmacies
2. 2016: 3503 naloxone doses
Goal Measures
• Utah Clinical Guidelines on Prescribing Opioids • Controlled substance prescriber training education
modules – Update data, information on naloxone, benzodiazepines,
urine drug screening, MAT • Academic detailing – peer to peer education • Provider Survey • Develop PDMP patient, provider and community
dashboards • Intermountain Healthcare – Providers / UOAD • Partnership with Arthritis Program for CPSMP
Provider Training and Patient Education
Opioid prescriptions dispensed per 100 population, Utah 2006-2016
Data Source: Web-based Injury Statistics Query and Reporting System, US Census Bureau.
2006 2007 2008 2009 2010 2011
2016 2012 2013 2014 2015
Rx No Heroin
Heroin No Rx
All Opioids
0
50
100
150
200
250
300
350
400
450
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016*Year
Unintentional and Undetermined Drug Poisoning Deaths by Select Categories, Utah 2000-2016
Public Awareness
Use Only As Directed • Safe Storage, Use,
Disposal • Opt Out, Speak
Out, Throw Out • Intermountain
Drop Box Locations
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Public Awareness Stop the Opidemic Media Campaign • Increase awareness of the risks of opioids • Increase awareness of the signs of an overdose • Increase awareness of naloxone
Research Conducted Message Testing Conducted
Billboards Posters Brochures Testimonial Videos Website Social Media TV / Radio Spots Talk to Your Pharmacist Month
Public Awareness
Impressions 70 million
Views 3 million
Reactions / Clicks 70,000
Printed Materials 200,000 (170,000 distributed)
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Overdose Outreach Pilot Program 1,599 purchased / 757 distributed / 617
individuals • 6 local health departments (50%) • 9 direct service agencies (44%) • 17 law enforcement agencies (6%)
Community-level Grantees 512 naloxone kits disseminated
• 5 local health departments • 3 local substance abuse authorities
Emergency Provisions 180 naloxone kits disseminated
• Law enforcement agencies
Standing Order (Dec 8-Dec 31) 17% of Utah pharmacies distributed 140 kits Current enrollment: 21% of pharmacies
Disease Intervention Specialist
Harm Reduction Naloxone Distribution via UDOH Efforts
18 reversals reported
Public Safety
Substance Use Disorder • 13,743 Adults; 1,306 Youth
• 85% below Federal Poverty Level
• Urban: 74%, Rural: 26%
• Male: 61%, Female: 39%
• Largest Referral Source–Courts
• Medicaid: 28%
Mental Health
• 31,742 Adults; 19,273 Child/Youth
• 80% Below Federal Poverty Level
• Urban: 72%, Rural: 28%
• Male: 48%, Female: 52%
• Largest Referral Source–Self
• Medicaid: 67%
State contracted local mental health and substance abuse treatment providers have increased services to
almost 8,000 individuals and families, from 2010 to 2015
DSAMH – Who We Serve
Opioid Treatment Programs and Initiatives • Fifteen opioid treatment programs (OTP’s) in Utah provide medication-
assisted treatment (MAT) for persons diagnosed with opioid-use disorder.
• Serve 3495 individuals a year. • Opioid Community Collaborative: IHC, Davis and Weber County
• Interdisciplinary approach. • Project targets Pregnant women , women between 20-35 and
individuals who are homeless. • Salt Lake County Extended Release Naltrexone Pilot
• Salt Lake County, Midtown health Clinic, Utah Department of Corrections
• One of the largest jail MAT programs in Country (248 Participants).
• First shot administered within County jail
Access to Treatment
Utah Opioid State Targeted Response Grant • Utah Received $5.5 million • Completed required needs assessment and developed a
strategic plan • Funding provided to high need communities • Continuum of evidence-based prevention, treatment, and
recovery services for unfunded, underserved youth (age 12-17) and adults (18+) at risk, or with an opioid use disorder.
• Project goals are to: – prevent/ reduce opioid misuse, reduce overdose deaths, – expand access to evidence-based treatment, – increase partnerships with physical health and promote recovery.
Access to Treatment
2017 Legislation • Limiting opioid prescriptions for acute, non-complex, non-chronic
conditions to seven days (2017 HB 50, Ward) • Requiring prescribers to check the prescription drug monitoring program
data prior to issuing a first opioid prescription unless it is only for three days or less or for a 30-day post-surgery supply (2017 HB 50, Ward)
• Screening, brief intervention, and referral to treatment training and provider reimbursement for services (2017 HB 175 Eliason)
• Adoption of opioid risk-reduction policies, such as clinical guidelines on prescribing opioids by insurers (2017 HB 90, Ward).
• Establishing a process for court-ordered essential treatment and intervention for individuals suffering from a substance use disorder (2017 HB 286, Christensen).
• Establishing co-prescribing guidelines for naloxone (2017 SB 258, Mayne).
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