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Technology as a Weapon in the
Opiates Crisis
1
Shifting gearsTechnology as a Weapon in the Opiates Crisis
Moderator: Paul Dommel, IBM Corp
Agenda
Why it’s important
What’s being done
Perspectives from Virginia
Next steps
Mr. Frederick Isasi
Director, NGA Center for Best Practices
Healthcare
• Does not represent the official position of the Governors or NGA;
• I will be speaking from direct experience of working with Governors and
state leaders; and
• My comments are off-the-record and not for attribution.
Today’s discussion
Brief overview of the National Governors Association
Brief overview of the national opioid crisis
Brief summary of NGA’s work with states
Highlight sections from Finding Solutions to the Prescription Opioid
and Heroin Crisis: A Road Map for States
My comments
• Nation’s oldest organization serving the needs of governors and their staff (founded
in 1908)
• Bipartisan Leadership: Chair Gov. McAuliffe (D-VA) and Vice-Chair Gov. Sandoval
(R-NV)
• NGA Office of Government Relations (OGR): serves as the collective voice of the
nation’s governors in Washington, DC
• NGA Center for Best Practices: a hybrid think thank/consultancy that works to
surface evidence-based practices, works directly with governors on specific policy
projects, and provides support to OGR. The NGA Center divisions are:
• Health
• Education
• Energy, Environment, and Transportation
• Human Services and Workforce
• Homeland Security and Public Safety
The National Governor’s Association
• NGA Center Health Division:
• Work focuses on governors most pressing and important health care issues
• Typically, project-based through competitive RFA process to you and your
governors
• Our work is provided a service, free of charge –projects funded through
cooperative agreements with federal government, grants, and donations.
About the NGA’s health work
Continuum of Health Division activities
Target Audience
Most Focused
Most Broad
• Governor Healthcare Leadership
Retreats
• In-State Policy Retreats
• State-specific Technical Assistance
• Policy Academies
• Convenings of States
• Collaboration with NGA’s
Office of Federal Relations
• Medicaid Transformation
Toolkit, Opioid Roadmap
• Other Publications
Health Division Activities
Six current focus areas
U.S. Map of Opioid Death by State, 1999 - 20141999 DRUG OVERDOSE DEATH RATES2002 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2005 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2008 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2011 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2014 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES2014 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES
Source: Centers for Disease Control and Prevention
Spread of the opioid crisis
• In 2014, 28,647 people died of an opioid overdose, more than any other year on record.
• Over 1,000 people will be treated today in an ER for an overdose.1
• 78 people will die today of an overdose.2
• One person in the US will die from an opioid-related overdose roughly every 20 minutes.
• The Drug Enforcement Administration (DEA) expects overdose rates to increase in the next year as fentanyl
makes its way through the states.
• In addition to the human cost, the epidemic is having an impact on state budgets.
• Total inpatient charges for hospitalizations related to opioid abuse/dependence more than tripled between
2002 ($4.57 billion) and 2012 ($14.85 billion).3
• The financial burden for this cost largely falls on state budgets; Medicaid funds about 50% of
hospitalizations.
1 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The DAWN Report: Highlights of the 2011 Drug Abuse Warning Network
(DAWN) Findings on Drug-Related Emergency Department Visits.
2 R. Rudd, “Increases in Drug and Opioid Overdose Deaths.”
3 Matthew V. Ronan, and Shoshana J. Herzig “Hospitalizations Related To Opioid Abuse/Dependence And Associated Serious Infections Increased Sharply, 2002–12,” Health Affairs 35 no. 5
(May 2016)
Overview of the opiates crisis
• This crisis is impacting constituents lives:
• It is a bipartisan issue (impacting red, blue, and purple states)
• It is urban and rural
• It affects people of all ages
• It affects people of all income levels and socioeconomic status
• It is an economic issue, with consequences for health care costs, lost productivity, and
jobs and hiring within communities
• The solutions are not simple:
• Strategies may be slow to show results
• Several factors are compounding states’ progress
• Greater availability of heroin
• Spread of illicit fentanyl
• Data lag
• There is a lack of evidence for effective strategies
• Stigma surrounding opioid use disorder is changing
• States are viewing the problem as a public health crisis, rather than solely a public safety
issue
Reality of the opioid crisis
• Joint effort between Health and Homeland Security and Public Safety
• 2012 – 2015: NGA convened two prescription drug abuse policy academies with 13 states
• Round 1: Alabama*, Arkansas, Colorado*, Kentucky, New Mexico, Oregon and Virginia
• Round 2: Michigan, Minnesota, Nevada*, North Carolina, Vermont* and Wisconsin
*denotes policy academy co-lead governor
• February 2016: During the NGA Winter Meeting, governors agreed that collective action is needed to end
the opioid crisis
• Summer – Fall 2016:
• 46 governors sign Governors Compact to Fight Opioid Addiction
• NGA releases Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States
• Launches Learning Lab: Improving Information Sharing and Data Analysis Between Law
Enforcement and Public Health (Summer 2016)
• Launches Learning Lab: State Strategies for Combatting Heroin and Illicit Fentanyl (Fall 2016)
• Publications:
• Six Strategies for Reducing Prescription Drug Abuse. (September 2012)
• Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy (February 2014)
• Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. (July 2016)
Timeline of NGA activities
• Joint effort between Health and Homeland Security and Public Safety
• 2012 – 2015: NGA convened two prescription drug abuse policy academies with 13 states
• Round 1: Alabama*, Arkansas, Colorado*, Kentucky, New Mexico, Oregon and Virginia
• Round 2: Michigan, Minnesota, Nevada*, North Carolina, Vermont* and Wisconsin
*denotes policy academy co-lead governor
• February 2016: During the NGA Winter Meeting, governors agreed that collective action is needed to end
the opioid crisis
• Summer – Fall 2016:
• 46 governors sign Governors Compact to Fight Opioid Addiction
• NGA releases Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States
• Launches Learning Lab: Improving Information Sharing and Data Analysis Between Law
Enforcement and Public Health (Summer 2016)
• Launches Learning Lab: State Strategies for Combatting Heroin and Illicit Fentanyl (Fall 2016)
• Publications:
• Six Strategies for Reducing Prescription Drug Abuse. (September 2012)
• Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy (February 2014)
• Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. (July 2016)
Timeline of NGA activities
Finding Solutions to the Prescription Opioid and Heroin Crisis:
A Road Map for States
Road Map Highlights: Key Factors
Road Map Highlights: Comprehensive Policy Frameworks
• Prevention:
• Develop and update guidelines for all opioid prescribers
• Limit new opioid prescriptions for acute pain, with exceptions for certain patients
• Develop and adopt a comprehensive opioid management program in Medicaid and
other state-run programs
• Remove methadone for managing pain from Medicaid preferred drug list
• Treatment and Recovery:
• Change payment policies to expand access to evidence-based Medication Assisted
Treatment (MAT) and recovery services
• Increase access to naloxone
• Expand and strengthen the workforce and infrastructure for providing evidence-
based MAT and recovery services
• Create new linkages to evidence-based MAT and recovery services
Road Map Highlights: Select Healthcare Strategies
• Reducing Illicit Supply and Demand for Opioids:
• Establish a collaborative information sharing environment that breaks down silos
across state agencies to better understand trends
• Leverage assets from partner entities to improve data collection and intelligence
sharing to restrict the supply of illicit opioids
• Expand statutory tools for prosecuting major distributors
• Expand partnerships and data access to better target overprescribers
• Responding to the Crisis:
• Empower, educate and equip law enforcement personnel to prevent overdose
deaths and facilitate access to treatment
• Reinforce use of best practices in drug treatment courts
• Ensure access to MAT in correctional facilities and upon reentry into the community
• Strengthen pre-trial drug diversion programs to offer individuals the opportunity to
enter into substance use treatment
Road Map Highlights: Select Public Safety Strategies
• Reducing Illicit Supply and Demand for Opioids:
• Establish a collaborative information sharing environment that breaks down silos
across state agencies to better understand trends
• Leverage assets from partner entities to improve data collection and intelligence
sharing to restrict the supply of illicit opioids
• Expand statutory tools for prosecuting major distributors
• Expand partnerships and data access to better target overprescribers
• Responding to the Crisis:
• Empower, educate and equip law enforcement personnel to prevent overdose
deaths and facilitate access to treatment
• Reinforce use of best practices in drug treatment courts
• Ensure access to MAT in correctional facilities and upon reentry into the community
• Strengthen pre-trial drug diversion programs to offer individuals the opportunity to
enter into substance use treatment
Road Map Highlights: Select Public Safety Strategies
Road Map Highlights: Finalize, Implement, and Evaluate
The Honorable William A. Hazel, Jr., M.D.
Secretary of Health and Human Resources,
Virginia
Silos come in many forms
Policy, funding, workflow, people
Program and services mapVA Health and Human
Resources SecretariatSSA DOL AOA NIH
ACL ACF FNS CDC SAMHSA EPA CMS
DARS DBHDS DHP DMAS VDSS OCS VBPD VDBVI VDDHH VDH VFHY
• Vocational
Rehabilitatio
n
• Disability
Determinatio
n
• Community
Rehabilitatio
n for
Disabled
• Aging
Services
• Adult
Protective
Services
• Development
al Disability
Services
• Mental
Health
Services
• Substance
Abuse
Treatment
Services
• Behavioral
Health
Emergency
Response
Services
• Provider
Licensing
• Licensing
and Health
Profession
Regulation
• Prescription
Monitoring
Program
(PMP)
• Health
Practitioners
Data Center
• Medicaid
• Family
Access to
Medical
Insurance
Security
(FAMIS)
• Medicaid
Analytics and
Reform
• Supplement
al Nutrition
Assistance
Program
• Temporary
Assistance
for Needy
Families
• Child Care
• Energy and
Cooling
Assistance
• Eligibility
Determinatio
n
• Foster Care
and Adoption
Services
• Child
Support
Enforcement
• Child and
Adult
Protective
Services
• Licensure
• Community
Policy and
Managemen
t Teams
(CPMT)
• Family
Assessment
and
Planning
Teams
(FAPT)
• At-Risk
Youth and
Families
• Policy
Setting
• Grants for
Innovation
• Leadership
and
Advocacy
Training
Programs
• Disability
Services
Assessment
• Vocational
Rehabilitatio
n
• Randolph-
Sheppard
Vending
Program
(RSVP)
• Virginia
Industries for
the Blind
• General
Library
Services and
Education
Services
• Technology
Assistance
Program
(TAP)
• Virginia
Relay
• Outreach
and
Community
Services
• Interpreter
Services
• Family
Health
Services
• Emergency
Preparednes
s and
Response
• Environment
al Health
Services
• Licensure
and
Certification
• Epidemiology
• Virginia
Certificate of
Public Need
(COPN)
• Minority
Health and
Equity
• Drinking
Water
• Youth
Programs
• Youth
Tobacco
Use
Prevention
• Youth
Obesity
Prevention
IRS
A growing national issue
Silos come in many formsNumber of Fatal Prescription Opioid and
Heroin Overdoses in
Virginia Cities and Counties, CY2007-2014
Total drug overdoses
Emerging challenge: Fentanyl
Strategies
• Harm Reduction (naloxone, Suboxone, syringe exchange, NAS babies,
family breakup, and crime)
• Treatment (MAT, drug courts, peers, Medicaid Expansion)
• Prevention (legal opiate availability, better pain management, storage
and disposal, PMP)
• Prevention (illegal opiate interdiction, tracking and reducing supply)
• Culture change (removing youth belief that these drugs are harmless,
removing expectation of opiate pain management, removing stigma)
Challenges
• The nature of the drug is changing
• We are seeing an increase in synthetic fentanyl. Addicts often
believe they are buying heroin, but it is cut with fentanyl, which is
more deadly.
• The changing nature of the problem exacerbates the pressures
faced by first responders, hospitals, and law enforcement
Prevention
• Virginia has moved to limit legal opioids: greater reporting to PMP, increased medical education
• CDC is also recommending changes in how doctors treat pain and prescribe painkillers
• Full prevention efforts also involve public safety
• Need to share data and share information
• Center for Behavioral Health and Justice is part of Virginia’s response
Treatment
Substance Abuse Benefit
• $11 million in the first year
• Covers treatment, including medically assisted treatment
• Working to expand network of treatment providers
• Medicaid expansion would help provide this coverage to more who need it
Harm reduction
• Naloxone for first responders, family, etc
• MAT/Suboxone (with counseling)
– Need a better consensus. Without it, sheriffs are reluctant to try drug
courts with patients on Suboxone
2016 Medicaid benefit enhancement
Substance Use Disorder (SUD) Treatment Supports for Current Medicaid Members
Governance structure and information sharing
Executive Work Group
State Support Action Group: Focuses on: situational awareness and recommendation development
Primary PreventionSecondary Prevention/ Interdiction
Tertiary Prevention/
Incapacitation
Data and Surveillance
Local Support Action Group: Focuses on: Dissemination of information and
assisting local communities
Seven regions
Northern Shenandoah Valley Substance Abuse Coalition
• A dynamic, a multi-disciplinary collaboration of law enforcement
(prosecution and defense resources alike), public health, child
welfare, family courts, county and city leadership, and community
members impacted by the crisis of heroin and opiate addiction
• Has brought together a diverse set of local, community partners that
work collaboratively across disciplines to respond to a public health
crisis in the Valley contributing time, talent and treasure
• Working to develop a cost-effective drug treatment court as well as
compassionately and realistically expanding treatment options for
community members who need this service
Technology Implications
• Real-time information to direct resources– Where
– Effectiveness
• Collaboration: Health, Safety, Justice, Education
• Streamline access and simplify for addicts & families
39
Post Session Housekeeping
• RATE this session in the conference app• To download the conference app search for APHSA Events
• VISIT the vendors in the Exhibit Hall during Breakfast and
the Networking Breaks to learn more about the solutions
presented throughout the day.
• DONATE to Childhelp – the ISM Technology for a Cause
campaign to raise $10,000 to help stop child abuse in
Arizona and across the country.
40
See you again soon
THANKS FORCOMING