Stephen Wood: "The Role of Providers in the Opioid Epidemic"
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At the Seventh Annual Health Law Year in P/Review symposium, leading experts discussed major developments during 2018 and what to watch out for in 2019. Speakers covered hot topics including health policy under the current administration, pharmaceutical policy, and public health law. Featured panels explored "Challenges Facing Health Care General Counsels" and "AI in Health Care." For more, go to: http://petrieflom.law.harvard.edu/events/details/seventh-annual-health-law-year-in-p-review
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Stephen Wood: "The Role of Providers in the Opioid Epidemic"
- 1. The Role of Providers in the Opioid Epidemic Stephen P. Wood, MS, ACNP-BC
- 3. What happens to patients after overdose?
- 5. Weiner et al. Academic Emerg Med. 2016: 3(9) Cabpblell, et al, Ann Alergy Asthma Immunol, 2008:101(6)
- 6. Other Harm Reduction Opportunities • Syringe Exchange Programs • Consolidated Appropriations Act – 2016 Division H, Sec. 520 • Provides Federal funding to support SEPs EXCEPT to purchase needles • There is an exception however!
- 8. What about people looking for help?
- 9. Prescription Monitoring Programs • MGL c.94C s 24A • Tracks RX for Schedule II- V using pharmacy input data • Mandatory for providers to use PMP before prescribing schedule II-III • Mandatory for Rx of 1st time Benzodiazepine • Intended to enhance safe prescribing practices • Reduce diversion and questionable use • Provides reports to providers on their prescriptive practice
- 10. PMP: The Massachusetts Experience • 547,000 Schedule II Prescriptions in 2018 • This represents a 35% reduction since 2015 • Captures around 0.85 % of users considered “high risk” • Doesn’t necessarily capture illicit drug use • Overdose death in 2018 (3rd quarter): 1,518 • Expectations to meet if not exceed 2017 figures
- 12. What about MAT? • JAMA Psychiatry 2018 Study Rhode Island Prison System • All prisoners screened for OUD • All with OUD offered MAT • Discharged with Naloxone and MAT • Discharge to Sober Housing • Reduced post-incarceration mortality by 61%
- 13. Medication Assisted Treatment: Barriers • Federal regulation creates a significant barrier to access • Requires 8 – 24 hours of additional educational • Providers can only maintain a limited number of patients • Can be difficult for patients to access as well • Are rehabs using it? How about prisons? • Can EDs pull this off? • If they can’t who will?
- 14. Key point Summary • Patients often lack readiness for treatment in acute settings • Mandated evaluations aren’t being performed • Lack of in-patient and out-patient resources • Availability and use of discharge naloxone is low • Opportunity for SEP is underutilized • PMPs – Is there a potential for harm? • MAT isn’t legislated for use in EDs and PCPs are reluctant