Current A&D Conditions in lane County: And why we need prevention. Guest lecturer: Julie Hynes, MA, RD, CPS - PreventionLane at Lane County Public Health

1. (and why we need prevention)
CURRENT A&D CONDITIONS
IN LANE COUNTY
Julie Hynes, MA, CPS – Guest Lecturer
LCC HS 102 – Psychopharmacology
May 12, 2017

2. Today’s objectives:
BROAD BRUSH /
PREVENTION PART I
1. Defining prevention & why it matters
2. Current conditions on addictions
3. Opioids
COMPLETE, CLICKABLE SLIDE DECK:
www.preventionlane.org/lcc

3. QUICK INTROS

5. contribute

6. IF, FOR NO OTHER REASON, WHY WE
$HOULD WE CARE ABOUT PREVENTION:
Health Care Overall
Year
Estimate
Based On
Tobacco
1,2
$168 billion $300 billion 2010
Alcohol
3
$27 billion $249 billion 2010
Illicit Drugs
4,5
$11 billion $193 billion 2007
Prescription
Opioids
6 $26 billion $78.5 billion 2013
Source: National Institute on Drug Abuse (NIDA);click references above for each research study.
https://www.drugabuse.gov/related-topics/trends-statistics

7. WHAT
ACCOUNTS
FOR
DIFFERENCES
IN HEALTH?
McGinnis, JM, et al., “The Case for More Active Policy Attention to Health Promotion,” Health
Affairs (2002)
Schreoeder, SA “We Can Do Better—Improving the Health of the American People” New England
Journal of Medicine (2007)
Social & Environmental
Conditions and Related
Behaviors
(60-70%)
Genetics
(20-30%)
Health Care
(10%)

9. “What
problems
have the
biggest
impact on
health in
your
community
(choose 3)?”
n=2,298 – Fall 2015 0 200 400 600 800 1000 1200 1400
Alcohol & drug abuse
Child abuse/neglect
Chronic diseases
Conditions of aging (e.g., arthritis, hearing/vision
loss)
Discrimination and racism
Hunger
Lack of access to health care (e.g., mental,
medical, dental, primary care)
Lack of affordable housing and homelessness
Lack of services for people with disabilities
Other
Pollution
Poverty
STDs (e.g., HIV/AIDS)
Suicide
Tobacco use
Violent crime, domestic violence, rape/sexual
assault
Online Responses Paper Responses

10. of Americans who meet the
medical criteria for
addiction started
smoking, drinking, or using other
drugs
before age 18.

11. of Americans who meet the
medical criteria for
addiction started
smoking, drinking, or using other
drugs
before age 18.

12. The top two
drugs used by
high school
students in
Lane County…

15. Source: https://oregon.pridesurveys.com/dl.php?pdf=Lane_Co_2016.pdf&type=county
GRADE 8 USE – ATOD,
2016 (LANE COUNTY)

16. GRADE 11
USE –
ATOD,
2016
(LANE
COUNTY)
Source: https://oregon.pridesurveys.com/dl.php?pdf=Lane_Co_2016.pdf&type=county

17. SO WHY DO WE
FOCUS ON YOUTH
MOST?

18. Prefrontal
Cortex
25

19. Most critical “risk
factor”:
TRAUMA

20. ACES – ADVERSE
CHILDHOOD EXPERIENCES
Growing up (prior to age 18) in a
household with:
 Physical abuse
 Emotional abuse
 Sexual abuse
 Emotional or physical neglect
 Loss of parent due to divorce,
abandonment, or death
 Substance use
 Mental illness
 Incarcerated household member
ACE points are
attributed for
exposure to each
type of adverse
event (0 to 10).
Centers for Disease Control and Prevention: http://www.cdc.gov/ace

21. ACEs & ADDICTIONS
Poole, J.C., Kim, H.S., Dobson, K.S., & Hodgins, D.C.(2017, March). Adverse childhood experiences and
disordered gambling: Assessing the mediating role of emotion dysregulation. Journal of Gambling
Studies, DOI 10.1007/s10899-017-9680-8
Adverse
Childhood
Experiences
(ACEs)
Emotional
disregulation
Self-
medicating
w/substance
use, eating,
gambling, etc.
Substance use
disorders,
eating
disorders,
disordered
gambling,
mental health
issues

22. ASSOCIATION BETWEEN ACEs & HEALTH
OUTCOMES IN OREGON, 2011-2013

23. ACES OFTEN LAST A LIFETIME…
BUT THEY DON’T HAVE TO
Healing can occur
The cycle can be broken
Safe, stable, nurturing
relationships heal both
parent and child

24. HISTORICAL APPROACHES
Were they
effective?

25. If these programs continue to
be shown as not
effective, why do we
continue
funding them?

27. FOCUS ON OPIOIDS

28. A NATIONAL EPIDEMIC
0
4000
8000
12000
16000
20000
1999 2001 2003 2005 2007 2009
US Opioid Analgesic Deaths, 1999-2010
CDC, National Center for Health Statistics, Multiple Cause of Death 1999-2010, CDC
WONDER database, released 2012

29. A NATIONAL EPIDEMIC
• From 2000-2015 more
than half a million people
died from drug overdoses
• 6 in 10 drug overdose
deaths in the US involve
an opioid

30. NOT JUST MORTALITY
• In 2014, almost 2 million
Americans abused or were
dependent on prescription
opioids
• 1 in 4 people who receive
opioid prescriptions for long-
term, non-cancer pain
struggles with addiction

31. OPIOID DEATHS IN LANE COUNTY
• Higher overall rate of death
due to pharmaceutical
opioids than heroin
• Overdose deaths seen across
the lifespan but age groups
most impacted:
• 45-64 years old (9.5 per
100,000)
• 18-44 years old (7.3 per
100,000).
5.9
2.8
8.3
4.3
2.8
6.8
Rx Opioid Heroin Any
opioid
Rateper100,000
Lane
Oregon
Opioid Deaths, 2010-2014
Source: Oregon Health Authority

32. OPIOID HOSPITALIZATION IN LANE
COUNTY
• More people hospitalized
for overdose from
pharmaceutical opioid
(7.9 per 100,000) than
heroin (1.4 per 100,000)
• Hospitalization due to
pharmaceutical opioid
overdose tends to be
older adults, ages 45-75+
1.6
5.7
14.8
13.2
14
0-18
18-44
45-64
65-74
75+
Rate per 100,000
Opioid Hospitalization Rate (per 100,000),
2010-2014
Source: Oregon Health Authority

33. STRATEGIES TO ADDRESS THE
EPIDEMIC
• Prevent abuse
• Provide Treatment
• Prevent Death

34. PRESCRIPTION DRUG OVERDOSE
PREVENTION
• Oregon is one of 16 states
selected for CDC Prescription Drug
Overdose: Prevention for States
funding for 2015-2019, to
advance prevention in key areas:
– Enhancing and Maximizing State
Prescription Drug Monitoring
Programs (PDMPs)
– Implementing Community & Health
Systems Interventions
• Lane & Douglas counties selected
as one of 4 pilot regions

35. DRIVER DIAGRAM: PDO PREVENTION, 2015 - 2019
Staff
Katrina Hedberg, State Health Officer Lisa Millet, Principal Investigator
Lisa Shields, Program Coordinator Matt Laidler, Research Analyst
Josh van Otterloo, Research Analyst
1. Implement opioid prescribing guidelines for pain management
Engage CCOs, Emergency Departments, health systems, pharmacies, and
insurers to expand uptake and use of evidence-based opioid prescribing and
management guidelines
Fund five high- burden county regions to form and convene regional pain
guidance groups (PGGs) and interdisciplinary action teams (IATs) to expand
uptake of model opioid prescribing guidelines
Aim Primary Drivers Secondary Drivers
5. Increase access to naloxone
Establish a standing order for Naloxone distribution at pharmacies
Increase access to Naloxone through community-based programs
Include co-prescribing of naloxone in model guidelines when prescribing
opioids for at-risk patients
3. Provide reimbursement for non-opioid pain treatment therapies
Require insurers to pay for non-opioid care for chronic non-cancer pain
treatment
Encourage CCOs and other prescribers to increase the use of non-opioid pain
management
6. Evaluations of policy and programs
Evaluate the public health impact of removing methadone as a preferred pain
treatment drug from the state Medicaid drug formulary
Evaluate the impact of 72-hour or “real time” PDMP reporting
Reduce deaths,
hospitalizations, and
emergency
department visits
related to drug
overdose
Increase and improve the
infrastructure of naloxone
rescue
Provide Medication
Assisted Treatment (MAT)
for opioid use disorder
Reduce problematic
prescribing practices
Increase access to and
reimbursement for non-
opioid treatments for
chronic non-cancer pain
2. Enhance and maximize the Oregon Prescription Drug Monitoring Program
(PDMP)
Reduce barriers and increase PDMP registration and use
Reduce data reporting interval
Increase PDMP reporting, surveillance, and data sharing
Establish messaging to PDMP users
Authorize PDMP to share identified data with researchers, public health, and
health systems
Use data to target
interventions to populations
at highest risk
4. Increase the number and geographic distribution of primary care physicians
certified to provide MAT for chronic opioid dependency

36. PREVENT DEATH
Improve Naloxone
distribution
– Train opioid users in
delivery in an
emergency
– Make available
through pharmacies
– Provide insurance
coverage

37. PROVIDE TREATMENT
• Expand access to
medication-assisted
therapy (MAT)
• Increase screening to
identify patients at-
risk

38. PREVENT ABUSE
• Insurance strategies
– Prior authorization, quantity
limits
• Community substance
abuse prevention programs
– Lane County Public Health
Prevention strategies
• Patient education
– Risks of opioid use
– Storage and disposal
• Prescribing practices

39. PRESCRIBING OPIOIDS:
BEST PRACTICE
• Implement clinical practice
guidelines
– When to initiate or continue opioids
– Opioid selection, dosage, duration,
follow-up, and discontinuation
– Assessing risk and addressing harms
of opioid use
• Regular use of the Prescription
Drug Monitoring Program (PDMP)
– Provides information to the prescriber
on
• Patient history using controlled substances
• Current prescriptions of controlled
substances
– Helps to identify patients who may be
at risk of abuse/overdose

40. WHAT IS THE PRESCRIPTION DRUG
MONITORING PROGRAM (PDMP)?
• Web-based system for tracking
prescriptions for schedule II-IV drugs in
Oregon
• Only licensed healthcare providers &
pharmacists (and their delegates) with
authenticated accounts can access
PDMP data
• Data includes:
– Patient name, address, DOB & sex
– Pharmacy
– Prescriber
– Drug name and quantity
– Date prescribed / date dispensed

41. Allow
pharmacies
to collect
unused Rx.
Currently in 2017
Oregon legislative
session
(HB 2645)
Find this bill at: https://olis.leg.state.or.us/liz/2017R1/Measures/Overview/HB2645

42. BROAD BRUSH /
PREVENTION PART I
We covered:
1. Defining prevention & why it matters
2. Current conditions on addictions
3. Opioids
NEXT WEEK: HOPE!
WHAT WE’RE DOING
IN LANE COUNTY,
w/ MARIA KALNBACH.

43. hynes@preventionlane.org
facebook.com/
preventionlane
THANK YOU!
Connect :
@ preventionlane
@ hynesUO