Transcript Current and Emerging Policy Overview

Prescription Drug Abuse in
Vermont:
The Problems and our Response
NASADAD Public Policy Committee
October 17, 2011
Barbara Cimaglio, Deputy Commissioner, ADAP
Prescription Drug Misuse in
Vermont
The Epidemiological Data
BRFSS Rx Misuse
25
Ever used Rx Drug
w/o Own Rx
Percent
20
Ever used Rx Drug
in Grtr Amts or More
Often
Past 30 Days Rx
Drug w/o Own Rx
15
10
5
Past 30 Days Rx
Drug in Grtr Amts or
More Often
0
2007
2008
2009
2010
Prescription Drug Misuse
YRBS
25
Percent
20
15
*
10
Males
Females
Total
5
0
2007
2009
2011
*2011 significantly lower than 2009 & 2007
Pain Relievers or Stimulants, 2009
16
Stimulants
only, 1
14
12
Percent of all
students who
ever used
prescription
drugs
Both, 6
10
8
6
4
Pain relievers
only, 9
2
0
Lifetime prescription drug use 2009
Source: VT YRBS
Prescription Drug Use in the
Treatment System
Admissions to Publicly-Funded Treatment
among All Vermonters
Alcohol
Marijuana
Heroin
Other Opiates
9000
People
6000
3000
0
2000
2001
2002
2003
2004
2005
State fiscal year
2006
2007
2008
2009
Admissions to Publicly-Funded Treatment
among All VT Adolescents
Alcohol
Marijuana
Heroin and Other Opiates
1000
People
750
500
250
0
2000
2001
2002
2003
2004
2005
State fiscal year
2006
2007
2008
2009
Number of People Abusing Prescription Drugs Treated by
State Fiscal Year
Substance
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Barbituates
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
Benzodiazepine
16
15
11
20
18
22
30
32
33
40
41
Non-prescription
Methadone
<5
<5
<5
8
15
26
36
57
53
69
53
Other Amphetamines
6
16
15
19
7
11
5
13
12
8
16
Other Hallucinogens
9
16
7
7
7
<5
<5
10
5
7
7
Other Opiates/ Synthetics
140
156
219
340
513
719
1139
1425
1602
1867
1946
Other Sedatives/hypnotics
6
7
8
12
8
9
15
11
12
12
11
Other Stimulants
<5
14
16
5
6
<5
5
8
5
6
5
Other Tranquilizers
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
Opiates are the Main Prescription Drug Category Seen in
the Treatment System
2500
People
2000
1500
Heroin
1000
Other Opiates/
Synthetics
Non-prescription
Methadone
500
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
State Fiscal Year
Data on Prescriptions in VPMS
Vermont Prescription Monitoring
System*
“VPMS”
Timely and easily accessed patient information for both
licensed prescribers and pharmacists to assist with
patient clinical management
*Launched by Dept of Health in 2009, as established under Act 205.
The VPMS
:
• Is an online, clinical tool for reviewing patients’ complete
schedule II-IV drug history.*
• Helps track the prescribing and dispensing of controlled
substances — those drugs most likely to lead to abuse, addiction
or patient harm if not used properly.
• May help identify and manage patients who are in need of
substance abuse treatment.
• Is a venue for coordination of care and medication prescribing
between health providers, patients and pharmacists through
increased clinical information.
• Provides useful feedback to prescribers on their own
prescribing trends
• Alerts providers to their patients whose total prescription use
for a given time period exceeds pre-determined threshold
levels through quarterly mailings
• Database contains prescriptions dispensed on or after July 1,
2008.
• May become an expected part of best practice
• *Pharmacies are required by law to report their data every
seven (7) days to the VPMS.
Vermont Prescription Monitoring System (VPMS)
7 / 1 / 2009 – 6 / 30 / 2010
Total Number of Persons Receiving Schedule II – IV Prescriptions and
Total Number of Schedule II – IV Prescriptions by Age
Number of people by age
10-19
2,452
<10
14,502
20-39
54,220
40-59
68,128
60-79
80+
39,736
11,762
Number of prescriptions by age
<10
10-19
12,701
56,621
20-39
255,220
40-59
60-79
80+
393,335
202,198
59,343
Vermont Prescription Monitoring System (VPMS)
7 / 1 / 2009 – 6 / 30 / 2010
Total Number of Schedule II – IV Prescriptions By DEA Schedule
•
Schedule II drugs are those with high abuse
potential. Such drugs are filled with a written
prescription and no refills. Examples include drugs
containing amphetamine/ ethamphetamine
(Dexedrine, Ritalin, Concerta) or drugs containg
codeine, hydrocodone, methadone, morphine,
oxycodone, opium (Percocet, OxyContin).
•
Schedule III drugs are those with moderately high
abuse potential. Such drugs are filled with a written
or telephone prescription with refills. Examples
include: Tylenol with codeine; buprenorphine;
hydrocodeine combination products (Vicodin,
Lortab); opium combination products; anabolic
steroids.
•
Schedule IV drugs are those with moderate abuse
potential. Such drugs are filled with a written or
telephone prescription with refills. Examples
include: sedatives (Xanax, Valium, Ambien,
Sonata); anticonvulsants.
•
Pain relievers containing opiates fall into each
Schedule depending upon the amount of opiate in
the dosage.
•
Source: Drug Enforcement Agency
II
344,826
35%
IV
378,146
39%
III
256,500
26%
Vermont Prescription Monitoring System (VPMS)
7 / 1 / 2009 – 6 / 30 / 2010
Total Number of Schedule II – IV Prescriptions By Selected Therapeutic Classes
422,000
Opiate agonists are pain relievers containing opiates. Benzodiazepine sedatives
are anti-anxiety medication while other sedatives include sleeping medications.
Anticonvulstants are used primarily to treat epilepsy and bipolar disorder. Stimulants
and amphetamines are used primarily to treat ADD/ADHD. Buprenorphine-containing
drugs comprise the majority of opiate partial agonists in VPMS.
180,012
es
et
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90,113
These 7 classes represent 98% of the total prescriptions in
VPMS. Androgens, antitussives, barbiturate sedatives, and
NSAIDs have between 1,000 - 10,000 prescriptions
representing 1.9% of the total. Ten classes have fewer than
1,000 prescriptions representing 0.1% of the total.
Strategic Directions
How are we addressing the
problems?
Strategic Plan for Prescription
Drug Abuse Prevention
Fall, 2011
• Education
– Medical School
– Primary Care Practices
• Tracking & Monitoring
– VPMS – best practice
Strategic Plan (con't)
• Proper Medication Disposal
– Patient Education
– Take Back events
• Enforcement
– Positive ID for controlled substance pick-up
– Training on diversion
Health Care Reform
• Behavioral health is central to health
• Screening, intervention and specialty
treatment will be components of enhanced
medical homes & community health teams
Prevention System:
• Community coalitions
• Youth serving organizations
• Vermont Alcohol and Drug Information
Clearinghouse
• Regional prevention consultant network
• Student Assistance Programs (early
intervention)
Screening, Brief Intervention & Referral to
Treatment (SBIRT)
Embedding screening, brief intervention, referral
& treatment of substance abuse problems within
primary care settings such as emergency centers,
community health care clinics, and trauma
centers helps to:
– Identify patients who don’t perceive a need for treatment,
– Provide them with a solid strategy to reduce or eliminate
substance abuse, and
– Move them into appropriate services.
25
Resiliency Recovery Oriented System
of Care (RROSC)
Specialty Treatment:
Changes to the system of care will improve access for
consumers in order to move them into long-term
recovery, with treatment being one avenue for success.
This systems transformation seeks to connect treatment
to the larger and more enduring process of recovery, to
transition from recovery initiation to stable recovery
maintenance, and to connect residential treatment to the
communities it serves.
Prescription Drug Abuse Work Group
– Started in October of 2008
– State level stakeholders meeting to share information on prescription
drug abuse
– Developing Vermont Prescription Drug Abuse Plan for Fall, 2011
• Partnership – US Attorney & VDH
• AHS Community Meetings
– AHS Field Directors and community stakeholders (e.g. local hospitals,
prescribing physicians, mental health and substance abuse providers,
Departments of Public Safety and Corrections), began hosting meetings
in March 2010 to identify ways communities can address prescription
drug abuse, including buprenorphine
ADAP Sponsored Hospital Grand Rounds Series
Universal Precautions for Addiction
Drug addiction is a disease for which anyone seeking medical
treatment may be at risk. Awareness and screening are
imperative.
Compassionate Clinical Approaches
• Some of the most difficult patients to manage may be those
struggling with both the disease of addictions as well as pain
management challenges. A variety of motivational and joining
skills have been presented.
Pain Management Strategies
• October 2009: Two Day Conference -Managing Chronic Pain
While Keeping the “Control” in Controlled Substances
• Online Pain Management Webinars:
• UVM Medical Student Summer Project: Evaluation of the
medication disposal projects in Vermont
Coordination of Office Based-Medication
Assisted Therapies II (COB-MAT II)
• Coordinated effort between DVHA and ADAP
• Provides care management services to physicians
involved in the Capitated Program for the Treatment
of Opiate Dependency.
• Pilot - DVHA Chronic Care Managers were placed in
four buprenorphine practices in Vermont to provide
guidance in the use of the Vermont Buprenorphine
Practice Guidelines.
• Promulgation of rule for practices treating opiate
dependent patients.
Redesign of MAT System
• Hub & Spoke Model
• Hub in 5 geographic locations:
– Induction, tapers, case management,
counseling, consultation
• Spokes – physician practices
Pharmacy Home
• The Pharmacy Home program, administered by the DVHA
(Medicaid) Program Integrity (PI) unit, is for beneficiaries in
the buprenorphine program.
• DVHA PI staff work with the beneficiary and their providers
to identify a pharmacy home and/or provider home.
• Beneficiaries choose a convenient pharmacy where they can
obtain medications that are prescribed by their primary care or
specialist provider in an effort to help receive consistent and
effective medication therapy.
• Exceptions exist to allow more than one provider when
applicable.
Resources:
www.communityofcompetence.com
http://www.mainebenzo.org/2009conference.htm
Vermont Medical Society
http://www.vtmd.org
From the home page, click on Education, then on Opioid Dependence, Information and
Links. That will bring you to Opioid Therapies for Patients with Chronic Pain (2008)
Managing Chronic Pain While Keeping Control Part 1
https://webdemo.ganconference.com/?meeting=7951532
Managing Chronic Pain While Keeping Control Part 2
https://webdemo.ganconference.com/?meeting=2840263
Managing Chronic Pain While Keeping Control Part 2
https://webdemo.ganconference.com/?meeting=9039293