Education and Advocacy Track Collaboration, Coordination & Data: Three Keys for State Progress Presenters: • Laurie Lovedale, MPH, CPS II, Manager, Prescription Drug Abuse Prevention Program, Peer Assistance Services, Inc. • Dwight Holton, JD, CEO, Lines for Life • E. Douglas Varney, Commissioner, Tennessee Department of Mental Health and Substance Abuse Services • Karen Edwards, PhD, Research Director, Tennessee Department of Mental Health and Substance Abuse Services Moderator: Regina M. LaBelle, JD, Chief of Staff, White House Office of National Drug Control Policy (ONDCP), and Member, Rx Summit
Transcript
1. Education and Advocacy Track Collaboration, Coordination
& Data: Three Keys for State Progress Presenters: Laurie
Lovedale, MPH, CPS II, Manager, Prescription Drug Abuse Prevention
Program, Peer Assistance Services, Inc. Dwight Holton, JD, CEO,
Lines for Life E. Douglas Varney, Commissioner, Tennessee
Department of Mental Health and Substance Abuse Services Karen
Edwards, PhD, Research Director, Tennessee Department of Mental
Health and Substance Abuse Services Moderator: Regina M. LaBelle,
JD, Chief of Staff, White House Office of National Drug Control
Policy (ONDCP), and Member, Rx Summit National Advisory Board
2. Disclosures Laurie Lovedale, MPH, CPS II; Dwight Holton, JD;
E. Douglas Varney; Karen Edwards, PhD; and Regina M. LaBelle, JD,
have disclosed no relevant, real or apparent personal or
professional financial relationships with proprietary entities that
produce health care goods and services.
3. Disclosures All planners/managers hereby state that they or
their spouse/life partner do not have any financial relationships
or relationships to products or devices with any commercial
interest related to the content of this activity of any amount
during the past 12 months. The following planners/managers have the
following to disclose: Kelly Clark Employment: Publicis Touchpoint
Solutions; Consultant: Grunenthal US Robert DuPont Employment:
Bensinger, DuPont & Associates-Prescription Drug Research
Center Carla Saunders Speakers bureau: Abbott Nutrition
4. Learning Objectives 1. Specify benefits of collaboration and
coordination among entities engaged in Rx drug abuse. 2. Describe a
method for empowering communities to tailor an effective local
response to Rx drug abuse. 3. Explain how data can be used to
mobilize the resources needed to combat Rx drug abuse.
5. Collaboration, Coordination and Data: Three Keys for State
Progress Laurie Lovedale, MPH, CPS II Manager, Prescription Drug
Abuse Prevention Program Peer Assistance Services
6. Disclosure Statement Laurie Lovedale, MPH, CPS II has
disclosed no relevant, real or apparent personal or professional
financial relationships with proprietary entities that produce
health care goods and services
7. Session Objectives Specify benefits of collaboration and
coordination among entities engaged in Rx drug abuse. Describe a
method for empowering communities to tailor an effective local
response to Rx drug abuse. Explain how data can be used to mobilize
the resources needed to combat Rx drug abuse.
8. Strategic Planning Process in Colorado 1st NGA Policy
Academy CO Team includes representation from CDHS, CDPHE, DPS,
DORA, HCPF, AGs Office and Governors Office CO Team identifies
focus areas for state strategic plan CO Roundtables 185 experts and
stakeholders convene including state health officials, health
professionals, academics, professional membership organizations,
law enforcement representatives and policymakers Draft of initial
recommendations, expanding on major focus areas CO In-State Policy
Academy 40 decision-makers and stakeholders reconvene Initial
recommendations finalized and timeline established through May 2014
2nd NGA Policy Academy CO Team shares action plan and lessons
learned with the six other states participating in the NGA Policy
Academy CU School of Pharmacy recommendation to coordinate
consortium, house strategic plan, make and track progress
9. How will we do this ?
10. Prescriber and Provider Education Workgroup Agency
Co-Chair: Cathy Traugott, HCPF Univ Co-Chair: Lee Newman, MD PDMP
Workgroup Agency Co-Chair: Chris Gassen, DORA Univ Co-Chair: Jason
Hoppe, DO Safe Disposal Workgroup Agency Co-Chair: Shannon
Breitzman, CDPHE Univ Co-Chair: Sunny Linnebur, PharmD Public
Awareness Workgroup Agency Co-Chair: Stan Paprocki, OBH Univ
Co-Chair: Carol Runyan, PhD Treatment Workgroup Agency Co-Chair:
Denise Vincioni, OBH Univ Co-Chair: Paula Riggs, MD Data/Analysis
Workgroup Agency Co-Chair: Barbara Gabella, CDPHE Univ Co-Chair:
Ingrid Binswanger, MD Coordinating Center CU School of Pharmacy
+Coordinating Committee Governor Policy Lead CO Attorney General
Substance Abuse Trend & Response Task Force CO Legislature
Colorado Consortium for Prescription Drug Abuse Prevention A
coordinated, statewide, interuniversity/interagency network LEGEND
= New = Existing Subcommittee
11. Prescription Drug Abuse Prevention Program A State Priority
Initiative funded by the Colorado Office of Behavioral Health
5-year funding cycle Funded for over 20 years
12. 2010-2015 Program Objectives Increase awareness of the
problem Increase availability of medication disposal programs
statewide Encourage responsible prescribing practices Encourage
patient responsibility Track data and trends
13. Accomplishments of the Colorado Consortium for Prescription
Drug Abuse Prevention 1st Year
14. PDMP Work Group HB141283: PDMP Enhancement Bill Mandatory
PDMP registration for all CO DEA registered prescribing
practitioners & all CO licensed pharmacists Allows
PDMPregistered prescribing practitioners & pharmacists to
delegate access Allows the PDMP to send Unsolicited Reports (Push
Notices) to affected prescribing practitioners and pharmacies As
with outofstate prescribing practitioners in the past, it now
allows outofstate pharmacists to obtain patient information from
the PDMP;
15. Provides Colorado Department of Public Health and
Environment access to the PDMP for public health purposes Creates
of a PDMP Taskforce to further study the effectiveness of the
PDMP.
16. Public Awareness Work Group Statewide social marketing
campaign All adult Coloradoans 18+ Pre/post survey Safe Use Safe
Storage Safe Disposal Advocacy
17. Safe Disposal Work Group Developed guidelines for safe
disposal in Colorado Developed brochure to convey guidelines to
public Distributed brochure to major pharmacy chains in Colorado
and at multiple community events CDPHE expanded number of safe
disposal sites through grantfunded provision of lock boxes to law
enforcement agencies Created map of disposal sites
18. Providers Education Work Group Online Training &
Education for Providers Developed at the Colorado School of Public
Health in the Center for Worker Health & Environment Launched
in Fall 2012 Supported by an unrestricted educational grant from
Pinnacol Assurance WWW.PAINMANAGEMENTCME.ORG
19. Providers Education Work Group New Prescriber Education
Dentists Veterinarians Physicians Dr. Brett Kessler, President,
Colorado Dental Association
20. DORA Boards Nursing Medical Pharmacy Dental Nurse Physician
Advisory Taskforce (NPATCH)
21. Data Analysis Work Group Created a data inventory
Prioritized five indicators from the inventory to track over time
Specified a data dashboard
22. Naloxone Work Group Standing Orders Bill Explore
integrating EHR with PDMP Expanding public awareness campaign to
target certain populations
23. National Rx Drug Abuse Summit: Oregons Regional Summit
Agenda to Reduce Abuse, Misuse and Overdose Dwight Holton Chief
Executive Officer Lines for Life
24. Dwight Holton has disclosed no relevant, real or apparent
personal or professional financial relationships with proprietary
entities that produce health care goods and services
25. Lines for Life Team 14 Masters Level Counselors 120 Highly
Trained Volunteers 20 Teens on YouthLine Nationally Accredited
Suicide Line De-Escalate 98% of calls on LifeLine Trainers of
Trainers
26. Lines for Life Crisis Lines Overview
27. The Oregon Epidemic Oregon ranks #1 In Non-Medical Use of
Opioids (2010-2011, SAMSHA NSDUH) Over 3 million opioid
prescriptions in 2013 (54% of all Rx) (OHA Injury and Violence
Prevention Fact Sheet) 1.88 M hydrocodone 1.15 M oxycodone Over 100
million opioid pills every year Population: 3.9 million 25 pills
for every man, woman and child
28. Opioid Deaths 46 people die every day (Centers for Disease
Control) ~110 Oregonians in 2014 150 Oregonians in 2013 193 in 2011
170 in 2012
29. Source: SAMHSA Treatment Episode Data Set (TEDS), 2000-2010
28,326 37,649 45,882 52,664 60,824 71,048 82,359 98,386 122,185
142,124 157,171 0 20,000 40,000 60,000 80,000 100,000 120,000
140,000 160,000 180,000
20002001200220032004200520062007200820092010 More Than 5-Fold
Increase In Treatment Admissions For Prescription Painkillers In
the Past Decade 12 10 8 6 4 2 0 1990 1992 1994 1996 1998 2000 2002
2004 2006 2008 *Deaths are those for which poisoning by drugs
(illicit, prescription, and over-the-counter) was the underlying
cause. Drug OD in the US Have More Than Tripled since 1990 and
INCREASES Greater for Women (Five-FOLD) National Vital Statistics
System. Drug Overdose Death Rates by State 2008. 100 people die
from drug overdoses every day in the US CDC Vital Signs, July 2013.
Slide from Presentation of Dr. Nora Volkow, Director, Natl
Institute of Drug Abuse, April 22, 2014 National Rx Summit
30. Regional Summit Objectives 1. Decrease pills in circulation
2. Promote PDMP 3. Patient education 4. Change attitudes &
perceptions 5. Reduce the volume of unwanted pills 6. Improve &
expand access to treatment services
31. Core Strategy Regional summits to develop regional action
plans to reduce abuse Include all relevant stakeholders CCO Third
party payers Hospitals/systems Treatment providers Prescribers
Prevention Public health Law enforcement
33. Regional Summit Agenda State of the state State of the
region PDMP data and survey data Highlight Key Initiatives in
Oregon Identify barriers to reducing abuse: Better Prescribing
Reducing Volume of Unwanted Pills Improving and Expanding Treatment
Expanded & Better Use of the PDMP
34. Regional Summit Outcomes Regional Plans to Reduce Misuse,
Abuse and Overdose Policy Recommendations to Governor and
Legislature Improved patient, provider and system education
35. Regional Survey Instrument Goals Identify existing regional
strategies that should be supported Establish a baseline regarding
use of evidenced based practices and standards to reduce abuse,
misuse and overdose Identify and understand unique regional
opportunities Identify and understand unique regional challenges
Participants Systems Clinics Public Health Officials Providers
36. Reducing the Pills in Circulation for each: Identify
Barriers and Solutions Prescribing Practices Rx Guidelines
Expanding use of guidelines Baseline components of effective
guidelines Use of the PDMP Expanding use Standard of Care? Other?
Reimbursement Strategies/Incentives Rx bias in reimbursement?
Reimbursement cap? Other?
37. Reducing the Pills in Circulation (2 of 2) for each:
Identify Barriers and Solutions Expanding Use of Non-Opioid
Therapies Non-opioid Therapies (movement, yoga, acupuncture)
Primary Care Provider education In practice today In medical
education Access/availability of providers Reimbursement incentives
Moving non-opioid therapies above the line Addressing any
reimbursement bias Alternative Pain Clinic Model
38. Improving Treatment and Access to Treatment Improving
access to medication assisted therapies Suboxone Reimbursement
strategies Improving provider access Expanded certification Hub
model Naloxone Co-prescription strategies Law enforcement / first
responder access Post Naloxone intervention strategies
39. ORCRM Oregon Coalition for Responsible Use of Meds Dwight
Holton CEO Lines for Life 971.244.1371
[email protected]
40. Collaboration, Coordination and Data: Three Keys for State
Progress Doug Varney, Commissioner Karen Edwards, Ph.D., Research
Director Tennessee Department of Mental Health and Substance Abuse
Services Tennessee Department of Mental Health and Substance Abuse
Services Varney & Edwards, 2/24/2015
41. Disclosure Statements Doug Varney, Commissioner, has
disclosed no relevant, real or apparent personal or professional
financial relationships with proprietary entities that produce
health care goods and services. Karen Edwards, Ph.D., has disclosed
no relevant, real or apparent personal or professional financial
relationships with proprietary entities that produce health care
goods or services. Tennessee Department of Mental Health and
Substance Abuse Services 2 Varney & Edwards, 2/24/2015
42. Learning Objectives 1. Specify benefits of collaboration
and coordination among entities addressing Rx drug abuse. 2.
Describe a method for empowering communities to tailor an effective
local response to Rx drug abuse. 3. Explain how data can be used to
mobilize the resources needed to combat Rx drug abuse. Tennessee
Department of Mental Health and Substance Abuse Services 3 Varney
& Edwards, 2/24/2015
43. Gov. Haslam announces Prescription for Success Varney &
Edwards, 2/24/2015 Tennessee Department of Mental Health and
Substance Abuse Services 4
44. Building an initiative: Prescription for Success Governor
focus on collaboration Public Safety Subcabinet Prescription for
Success Varney & Edwards, 2/24/2015 Tennessee Department of
Mental Health and Substance Abuse Services 5
45. Department of Safety and Homeland Security Department of
Mental Health and Substance Abuse Services Department of Childrens
Services Tennessee Bureau of Investigation Department of Correction
Board of Probation and Parole Military Department Department of
Health Governors Highway Safety Office (Department of
Transportation) Office of Criminal Justice Programs (Department of
Finance & Administration) Law Enforcement Training Academy
(Department of Commerce & Insurance) Additional Staff Support:
Tennessee Criminal Justice Coordinating Council National Governors
Association Center for Best Practices The Center for Non-Profit
Management PUBLIC SAFETY SUBCABINET WORKING GROUP Varney &
Edwards, 2/24/2015 Tennessee Department of Mental Health and
Substance Abuse Services 6
46. PUBLIC SAFETY ACTION PLAN Contains Three Key
Initiatives/Focus Areas to Curb Crime and Help Create a Climate for
Job Growth in Tennessee Communities. Violent Crimes Repeat
Offenders An Atmosphere that Encourages Investment And Job Growth
Tennessee Department of Mental Health and Substance Abuse Services
7 Varney & Edwards, 2/24/2015
47. o All prescribers must access the controlled substance
database prior to prescribing an opioid or benzodiazepine o
Dispensers must check the database if a person tries to obtain a
prescription for a controlled substance for fraudulent, illegal, or
medically inappropriate purposes o Increases penalties for doctor
shopping from a Class A misdemeanor to a Class E felony o Allows
data sharing from the prescription monitoring database Prescription
Drug Safety Act of 2012 Tennessee Department of Mental Health and
Substance Abuse Services 8 Varney & Edwards, 2/24/2015
48. o Neonatal Abstinence Syndrome Working Group o Substance
Abuse Data Task Force Agreement to share data Standard definitions
Footnote data source Review by data owner before sharing Safety
Subcabinet Working Groups Tennessee Department of Mental Health and
Substance Abuse Services 9 Varney & Edwards, 2/24/2015
49. Prescription for Success Statewide Strategies to Prevent
and Treat the Prescription Drug Abuse Epidemic in Tennessee
Prescription For Success Partners Tennessee Department of Health
Tennessee Department of Childrens Services Tennessee Department of
Correction Tennessee Department of Safety & Homeland Security
Tennessee Department of Health Care Finance Administration
(TennCare) Tennessee Bureau of Investigation U.S. Department of
Justice Drug Enforcement Administration Tennessee Department of
Mental Health and Substance Abuse Services 10 Varney & Edwards,
2/24/2015
50. PRESCRIPTION FOR SUCCESS Tennessee Department of Mental
Health and Substance Abuse Services 11 7 Goals 1. Decrease the
number of Tennesseans that abuse controlled substances. 2. Decrease
the number of Tennesseans who overdose on controlled substances. 3.
Decrease the amount of controlled substances dispensed in
Tennessee. 4. Increase access to drug disposal outlets in
Tennessee. 5. Increase access and quality of early intervention,
treatment and recovery services. 6. Expand collaborations and
coordination among state agencies. 7. Expand collaboration and
coordination with other states. 33 Strategies Measures of Success
Varney & Edwards, 2/24/2015
51. TELL THE STORY OF PRESCRIPTION DRUG ABUSE IN TENNESSEE
Using data to: Varney & Edwards, 2/24/2015 Tennessee Department
of Mental Health and Substance Abuse Services 12
52. Telling the Story of Prescription Drug Abuse in Tennessee
Identify the problem Answer questions Track success Tennessee
Department of Mental Health and Substance Abuse Services 13 Varney
& Edwards, 2/24/2015
53. IDENTIFY THE PROBLEM Use data to: Varney & Edwards,
2/24/2015 Tennessee Department of Mental Health and Substance Abuse
Services 14
54. Drug Overdose 342 391 422 484 660 753 868 963 972 924 929
1,059 1,062 1,094 0 200 400 600 800 1,000 1,200 1999 2000 2001 2002
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Drug overdose
deaths in Tennessee: 1999-2012 (Source: Office of Policy, Planning
and Assessment, Tennessee Department of Health - Death
Certificates) Tennessee Department of Mental Health and Substance
Abuse Services 15 Varney & Edwards, 2/24/2015
55. Admissions to Publicly Funded Substance Abuse Treatment TN:
Opioids TN: Alcohol US: Opioids Tennessee Department of Mental
Health and Substance Abuse Services 16 Varney & Edwards,
2/24/2015
56. Neonatal Abstinence Syndrome Tennessee Department of Mental
Health and Substance Abuse Services 17 Varney & Edwards,
2/24/2015
57. ANSWER QUESTIONS Use data to: Varney & Edwards,
2/24/2015 Tennessee Department of Mental Health and Substance Abuse
Services 18
58. How does substance abuse for young adults change over time?
How does Tennessee compare to the United States? United States
Tennessee *NOTE: Tennessee began disaggregating heroin admissions
from prescription opioids in July 2009. Substance abuse treatment
admissions among young adults, ages 18-24, by primary substance of
abuse: Tennessee and the United States from 2002 to 2011 (Data
source: TEDS-A) 28.5% 15.3% 16.8% 4.4% 24.7% 25.8% 0.0% 2.3%* 15.5%
41.4% 14.5% 10.9% 0% 25% 50% 75% 100% 2002 2003 2004 2005 2006 2007
2008 2009 2010 2011 34.6% 26.0% 7.4% 3.2% 30.3% 29.7% 13.5% 17.6%
2.4% 14.6% 11.9% 8.9% 0% 25% 50% 75% 100% 2002 2003 2004 2005 2006
2007 2008 2009 2010 2011 Tennessee Department of Mental Health and
Substance Abuse Services 19 Varney & Edwards, 2/24/2015
59. Where in Tennessee is prescription drug abuse a problem?
Percent of TDMHSAS funded treatment admissions by county when
prescription opioids are named as a substance of abuse (Data
Source: TDMHSAS, 2011-2014) Tennessee Department of Mental Health
and Substance Abuse Services 20 Varney & Edwards, 2/24/2015 FY
2011 FY 2014
60. TRACK SUCCESS Use data to: Varney & Edwards, 2/24/2015
Tennessee Department of Mental Health and Substance Abuse Services
21
61. Cumulative number of high utilization patients* by quarter
in the Controlled Substances Monitoring Database (CSMD): CY 2011 to
2014 1,950 2,246 1,785 1,374 2,413 2,218 1,533 1,404 2,515 2,261
1,533 1,278 2,352 1,940 1,335 1,307 0 2,000 4,000 6,000 8,000
10,000 CY2011 CY2012 CY2013 CY2014 CountofHighUtilizationPatients
Q1 Q2 Q3 Q4 *Note: Patients filled prescriptions from 5 or more
prescribers at 5 or more dispensers within 90 days. Source:
Tennessee Department of Health Decrease Doctor Shopping Tennessee
Department of Mental Health and Substance Abuse Services 22 Varney
& Edwards, 2/24/2015
62. Increase Disposal Boxes Tennessee Department of Mental
Health and Substance Abuse Services 23 Varney & Edwards,
2/24/2015 Source: Tennessee Department of Mental Health and
Substance Abuse Services January 2012 to December 2014
63. Increase Safe Housing Options for Individuals in Recovery
61 163 0 40 80 120 160 200 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14
Oct-14 Capacity(beds) Monthly capacity of Oxford Houses in
Tennessee: July 2013 to December 2014 Tennessee Department of
Mental Health and Substance Abuse Services 24 Varney & Edwards,
2/24/2015 Source: Tennessee Department of Mental Health and
Substance Abuse Services
64. Increase Access to Recovery Courts Varney & Edwards,
2/24/2015 Tennessee Department of Mental Health and Substance Abuse
Services 25 1,284 1,612 2,057 2,267 2,267 2,542 2,542 - 500 1,000
1,500 2,000 2,500 3,000 Q2 Q3 Q4 Q1 Q2 Q3 Q4 CY2013 CY2014 Capacity
Capacity of adult recovery (drug) courts: Q2 CY 2013 to Q4 CY 2014
Source: Tennessee Department of Mental Health and Substance Abuse
Services
65. Questions? Prescription for Success:
http://tn.gov/mental/prescriptionforsuccess/ For more information
contact: Karen Edwards, Ph.D. [email protected] 615-532-3648
Varney & Edwards, 2/24/2015 Tennessee Department of Mental
Health and Substance Abuse Services 26
66. Education and Advocacy Track Collaboration, Coordination
& Data: Three Keys for State Progress Presenters: Laurie
Lovedale, MPH, CPS II, Manager, Prescription Drug Abuse Prevention
Program, Peer Assistance Services, Inc. Dwight Holton, JD, CEO,
Lines for Life E. Douglas Varney, Commissioner, Tennessee
Department of Mental Health and Substance Abuse Services Karen
Edwards, PhD, Research Director, Tennessee Department of Mental
Health and Substance Abuse Services Moderator: Regina M. LaBelle,
JD, Chief of Staff, White House Office of National Drug Control
Policy (ONDCP), and Member, Rx Summit National Advisory Board