Safe Med LA Los Angeles Countys Prescription Drug Abuse Coalition - - PowerPoint PPT Presentation
Safe Med LA Los Angeles Countys Prescription Drug Abuse Coalition Gary Tsai, MD, FAPA, FASAM Medical Director and Science Officer Substance Abuse Prevention and Control County of Los Angeles Department of Public Health Outline Opioid
Gary Tsai, MD, FAPA, FASAM Medical Director and Science Officer Substance Abuse Prevention and Control County of Los Angeles Department of Public Health
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United States 80% Rest 20%
Global Opioids
United States 5% Rest 95%
World Population
Manchikanti, L (2010). Therapeutic Use, Abuse, Nonmedical use of Opioids: A Ten‐Year Perspective, Pain Physician, 13, 401‐435 United States 99% Rest 1%
Hydrocodone
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4 Emergency Department and Inpatient Discharge Data Set. Office of Statewide Health Planning and Development. California Department of Public Health.
2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 ED Visits Hospitalizations
31%
From 2005‐2014
217%
From 2005‐2014
100 200 300 400 500 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
34%
From 2005‐2014
72%
From 2005‐2014
Rx Opioid‐related Heroin‐related
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469 410 424 434 360 386 381 377
2006 2008 2010 2012
Emergency Department and Inpatient Discharge Data Set. Office of Statewide Health Planning and Development. California Department of Public Health.
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(per 100,000 pop)
6 Emergency Department and Inpatient Discharge Data Set. Office of Statewide Health Planning and Development. California Department of Public Health.
50 100 150 200 250 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 3 6 9 12 15 18 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Rx Opioid‐related Heroin‐related
Men Women White Black Latino Other
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N = 9,605,765
OTHER 4.2 HORMONES 3.2 MUSCLE RELAXANTS 1.9 STIMULANTS 6.6
SEDATIVES 40.3
HYDROCODONE 67.0 OXYCODONE 10.9 CODEINE 10.6 MORPHINE 3.9 FENTANYL 2.1 OTHER 5.6
OPIOIDS 43.9 Department of Justice, California Prescription Drug Monitoring Program (PDMP)/Controlled Substance Utilization Review and Evaluation System (CURES) data.
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multi‐pronged approach to comprehensively address prescription drug abuse in Los Angeles County www.SafeMedLA.org
– Given that the reasons for prescription drug abuse are complex, multi‐factorial, and involve numerous entities, the solution will need to be similarly broad and inclusive. – “Blanket approach” Addressing complex problems along the full continuum of interventions to avoid the phenomenon of addressing one aspect of the issue only to lead to worsening of another, interconnected aspect of the problem. – Organize and coordinate various concurrent projects that involve prescription drug abuse into a unified effort
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‐ Health Providers (LAC DHS, UCLA Health System, KP, HealthCare Partners, LA LGBT Center, Exer Urgent Care, Venice Family Clinic, Synovation Medical Group, AltaMed, Facey, Providence, US HealthWorks, etc.) ‐ Behavioral Health Providers (Tarzana Treatment Centers, Behavioral Health Services, Prototypes, JWCH Institute, LA Community Health Project, Homeless Health Care Los Angeles, etc) ‐ Others (Pharmacist Associations, City of Long Beach, City of Pasadena, etc)
‐ County Departments (Health Services, Mental Health, Public Health, Public Works, Sheriff’s) ‐ Health Plans (LA Care, Health Net, Kaiser Permanente, Blue Shield of California, Care 1st, Molina, Anthem Blue Cross, Cigna, etc.) ‐ Healthcare Organizations (Community Clinic Association of Los Angeles County, LA County Medical Association, Hospital Association of LA County, LA Dental Society, Health Services Advisory Group, etc.)
*Note: Above list of Safe Med LA participants is not exhaustive
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the work of Safe Med LA. – Overall goal Decrease prescription drug abuse deaths in LAC by 20%. – “9‐6‐10” Approach
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*More information on the Los Angeles County Prescription Drug Abuse Strategic Plan and Safe Med LA is available at: http://publichealth.lacounty.gov/sapc/Plan/StrategicPlan.htm
focusing on with
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with
Priority I: Education and Training Objective 1: Provide community education to increase public awareness of the risks of prescription drug abuse, safe use/storage/disposal, and available resources for help. Objective 2: Educate and train health care professionals (e.g., physicians and pharmacists) on best practice guidelines for safe prescribing and identifying prescription drug misuse through screenings. Objective 3: Provide training and education to help the criminal justice community (e.g., law enforcement, court, lawyers, etc.) better understand prescription drug abuse and navigate the interface between public health and law enforcement. Priority II: Treatment and Overdose Prevention Objective 4: Expand access to medication‐assisted treatment for individuals addicted to prescription drugs. Objective 5: Expand access to naloxone for overdose prevention. Priority III: Tracking, Monitoring, and Data Exchange Objective 6: Promote increased utilization of the statewide Prescription Drug Monitor Program (PDMP) in California, known as the Controlled Substance Utilization Review and Evaluation System (CURES), in order to decrease misuse and diversion of prescription drugs. Objective 7: Increase data collection and information sharing across agencies and organizations to enhance safe practices and reduce poor outcomes related to prescription drug abuse. Priority IV: Safe Drug Disposal Objective 8: Support convenient, safe, and environmentally responsible prescription drug disposal programs in Los Angeles County that are free to the public to help decrease the supply of unused prescription drugs in homes and the community. Priority V: Enforcement Objective 9: Collaborate with law enforcement to identify and address improper practices that threaten public health, such as indiscriminate prescribing by “pill mills” and inappropriate "doctor shopping" in order to secure prescription drugs. Priority VI: Community Trends and Policy Objective 10: Seize opportunities to positively influence policy, at the local as well as State and Federal levels, by identifying and communicating community factors that are contributing to prescription drug abuse.
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For more details: www.SafeMedLA.org
– Leverage learning collaborative model to expand access to MAT (buprenorphine, naltrexone, etc) within the primary care, mental health, and substance use settings. – Increase number of prescribers in LAC who are waivered to prescribe buprenorphine. – Increase number of buprenorphine prescriptions provided in LAC.
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to expand MAT:
referring and accepting providers to formalize processes.
inappropriate or unnecessary opioids.
plan formularies is critical.
(MDs/DOs/NPs/PAs) in all areas of the health sector, including physical and mental health, as well as the SUD community.
the culture change and knowledge transfer necessary to expand the number of MAT prescribers.
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– LA Overdose Prevention Task Force since 2006 focused on expanding naloxone access focused on direct service, policy, & research. – Small network of naloxone distribution programs based out of SUD treatment provider network.
– Expand naloxone access to those at highest risk for opioid overdoses.
increased access via the Drug Medi‐Cal Organized Delivery System Waiver
access across health systems (physical health, mental health, SUD)
– Ensure first responders, including law enforcement, have access to naloxone.
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– Increase number of naloxone kits provided to clients throughout LAC. – Work with Safe Prescribing Pharmacy Practice Action Team to ensure that pharmacists have the education and training necessary to furnish naloxone without a prescription. – Collaborate with the Law Enforcement Action Team to explore naloxone access in criminal justice settings.
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an individual before they obtain their prescription drugs, including
– Important educational opportunity safe opioid use and pain management, MAT, overdose prevention, alternatives to
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– Provide education for pharmacists about their critical responsibility and role in the dispensing of opioid pain relievers, particularly when prescribing practices are inconsistent with recommended safe prescribing practices.
– Education and training for the furnishing of naloxone, which can be provided by pharmacists in without a physician’s prescription (pharmacist’s prescription required) with certain training requirements (per regulations adopted by the CA State Board of Pharmacy effective January 2016).
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– Continue Safe Drug Drop‐Off Program within the Sheriff’s Dept. – Increase information‐sharing in
prescribers and instances of “doctor shopping.” – Collaborate with Naloxone Access Action Team to explore naloxone access in the criminal justice setting.
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epinephrine is to anaphylactic shock.
individuals who experience periods of reduced opioid tolerance (e.g., those leaving SUD treatment facilities, jail/prison).
cost often guides distribution strategy. – First responders only interested in intra‐nasal formulations.
such as fentanyl & carfentanil higher doses and multiple doses of naloxone will likely be necessary in the future in order to evolve with drug use trends.
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1. CULTURE CHANGE is necessary and will require time and significant outreach to engage a broad spectrum of stakeholders around:
considered “acceptable pain”
prescribers, and patients/families on safe prescribing and opioid use, MAT, and naloxone.
use communities.
2. Identification of opportunities to SYNERGIZE GOALS across stakeholders is critical leveraging overlap between Action Teams to maximize influence.
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health issues confronting American communities.
problem that will require a similarly comprehensive solution.
partners who are taking a multipronged and coordinated approach to address prescription drug abuse in LA County. – “9‐6‐10 Approach” 9 Action Teams focusing on different aspects of the prescription drug abuse epidemic via 6 Priority Areas and 10 Key Objectives. – Key Goal Reduce prescription drug abuse deaths in LAC by 20% by 2020
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Gary Tsai, MD, FAPA, FASAM Medical Director & Science Officer Substance Abuse Prevention and Control Los Angeles County Department of Public Health gtsai@ph.lacounty.gov
www.SafeMedLA.org