Transcript Bringing naloxone to virginia

BRINGING NALOXONE
TO VIRGINIA
Yesterday, Today, and Tomorrow
Jason Lowe, MSW
From Research to Rehab: A Town Hall Meeting
College Behavioral and Emotional Health Institute
Virginia Commonwealth University
April 15, 2016
BRINGING NALOXONE TO VIRGINIA
Yesterday - How did we get here?
Today – Where are we?
Tomorrow – What can we do?
How Did We Get Here?
PAIN BECOMES PRIMARY.
PAIN BECOMES PRIMARY
 1980’s - Pain drives decision making
 Patient satisfaction joins the group of prime metrics for quality assurance
 Opioids are very effective at providing quick relief, and therefore
 Increased computing ability, data mining, and algorithm development drives health
care analytics
 Healthcare accreditation – Joint Commission created pain management standards in
2001
 1996 - American Pain Society introduces the phrase “pain as the fifth
vital sign”
 Claims that pain assessment is as important as assessing four vital signs
 “Clinicians need to take action when patients report pain”
How Did We Get Here?
BIG PHARMA
BIG PHARMA
 Pharmaceutical Companies
 Actively and misleadingly marketing opioids as
effective for pain management at
unprecedented levels
 Purdue Pharma spent six to twelve times as
much on promoting OxyContin as it had on
other opioids (ER morphine sulphate)
 Claimed that extended-release formulation had
a lower threat of abuse than shorter-acting
opioids on the market at that time
BIG PHARMA
 Pharmaceutical Companies
 Supporting pain advocacy groups
 AstraZeneca Super Bowl Commercial
BIG PHARMA
 Did you notice the credits at the end of the commercial?
BIG PHARMA
 American Chronic Pain Association
 AstraZeneca [Movantik for OIC] (Champion)
 Teva Pharmaceuticals [fentanyl] (Ambassador)
 Creaky Joints
 Abbvie [Vicodin, hydrocodone]
 AstraZeneca [Movantik]
 Bristol-Myers Squibb [Percocet, oxycodone]
 For Grace
 Pfizer Pharmaceuticals [oxycodone/naltrexone, not to market] (Glass-Wing Contributor)
 Teva Pharmaceuticals (Glass-Wing Contributor)
 US Pain Foundation
 Endo Pharmaceuticals [Opana, oxymorphone]
 Pfizer Pharmaceuticals
 Purdue Pharma [OxyContin, oxycodone]
To understand how this epidemic has
unfolded, we must
separate fact from fiction.
How Did We Get Here?
OPIOIDS ARE NOT BEST-PRACTICE
TREATMENT FOR MOST CHRONIC PAIN
MANAGEMENT.
OPIOIDS AND CHRONIC PAIN
 Research indicates that opioids have utility for pain sufferers, but it is
limited to post-trauma and end of life situations.
 A George Washington University study in 2014 found opioid
prescriptions in emergency rooms rose drastically between 2010 and
2014, while the number of patients presenting with pain complaints only
rose slightly.
 A Dartmouth study in 2014 concluded the increase in opioids
prescribed was not associated with improvements in health status
commensurate with well-documented risks of these drugs.
OPIOIDS AND CHRONIC PAIN
 When weighing risks, opioids are not best treatment for chronic pain.
Franklin G M
Neurology
2014;
83:1277-1284
HOW DID WE GET HERE?
 When weighing risks, opioids are not best treatment for chronic pain.
 2015 National Safety Council Report
How Did We Get Here?
PATIENT SATISFACTION IS NOT AN
EFFECTIVE INDICATOR OF
QUALITY OF CARE.
PATIENT SATISFACTION
AND QUALITY OF CARE
 A 2013 Thomas Jefferson University study found that high caseloads are
a much better indicator of quality of care.
How Did We Get Here?
PAIN IS NOT AN
EFFECTIVE VITAL SIGN.
PAIN IS NOT AN EFFECTIVE VITAL SIGN
 A 2015 Veteran’s Health Administration study found that routine
documentation of pain intensity, while necessary for quality care, may
not be sufficient by itself to improve the quality of pain management.
 A 2016 study in the Journal of the American Board of Family Medicine
study found that:
 Accuracy of pain as a vital sign is moderate, but much lower in practice than under
research circumstances;
 Nurses do not always use 0-10 scale to properly quantify pain; and
 More efforts to link fifth vital sign to clinician action for better pain management.
THE BOTTOM LINE
Pain is real and needs to be treated,
especially chronic pain which can be
debilitating.
But, considering the risks, opioids are not
the best available treatment for pain.
Where are we now?
DATA AND TRENDS
DATA AND TRENDS
Drug-Related Deaths in Virginia, 1999-2014 (2014 data is PROVISIONAL)
DATA AND TRENDS
National Opioid Prescribing Rates, 1991-2013
DATA AND TRENDS
Virginia Drug-Related Death Rate superimposed over
National Opioid Prescribing Rate
DATA AND TRENDS
Heroin overdoses by year, 2007-2014
DATA AND TRENDS
Disproportionate Impact on Certain Populations
DATA AND TRENDS
Disproportionate Impact on Certain Populations
Where are we now?
WHY HEROIN?
WHY HEROIN?
 Prescription opioid interdictions are working:
 Prescription Monitoring Programs
 High Intensity Drug Trafficking Areas and other law enforcement efforts
 Drug Courts
 But they have not been accompanied by detox, treatment,
and recovery resources:
 Methadone clinics can require lots of travel time in some cases
 Lack of doctors offering suboxone alone or with wrap-around services
WHY HEROIN?
 Without detox and treatment, those addicted to opioids
will invariably turn to heroin to avoid withdrawal
 Today’s heroin:
 Mostly comes from Mexico, not Columbia
 Is cheaper than ever
 Is purer than ever
 Is deadlier than ever
 Is being adulterated not with benign substances like baking powder but with
deadly substances like fentanyl
Where are we now?
WHY NALOXONE?
26,463
WHY NALOXONE?
 It is safe.
 No potential for abuse
 Accidental administration poses no threat
 Same dosage for adult or child
 Studies indicate laypersons can be effectively trained on administration
 It is proven effective and supported by:
 American Medical Association;
 Office of National Drug Control Policy;
 Substance Abuse and Mental Health Services Administration; and
 United States Attorney General.
WHY NALOXONE?
NALOXONE DOES NOT
ENCOURAGE DRUG USE.
 Studies suggest that those who survive overdose emergencies are more
likely to engage in treatment.
 Assumption that naloxone will encourage drug use is usually based on a
lack of knowledge about the physical and chemical processes and effects
of addiction.
What can we do?
ADVOCATE
ADVOCATE
 Talk to all of your legislators about supporting efforts to fight the opioid
epidemic:
 Federal – Increase SAMHSA SAPT Block Grant to support detox and treatment,
allow SAPT dollars to fund needle exchange
 State – Expand Medicaid coverage, expand coverage of Good Samaritan law, and
issue a statewide standing order for naloxone
 Local – Support judges in establishing drug courts, support equipping first responders
with naloxone
 Petition the FDA to increase the 100-person suboxone limit for
registered doctors
 Pressure naloxone manufacturers to make product more available and
affordable
ADVOCATE
ADVOCATE
What can we do?
EDUCATE
EDUCATE
 Drug courts work
 Nationwide, 75% of drug court participants remain arrest-free for two years,
with longitudinal studies showing that this impact can persist for 10 years or
more.
 One dollar invested in drug courts returns as much as $3.36 solely in avoided
criminal justice costs.
 2007 study in Multnomah County, Oregon showed drug courts lowered
recidivism rates by 15-28% and lowered costs by $6,744 per participant.
 Combat stigma of addiction
 NOT A CHOICE
 Medication-assisted treatment is NOT substituting one drug for another.
 Long-term, sometimes permanent physical changes in brain make recovery
exceptionally challenging and can necessitate lifetime medication-assisted
treatment for some individuals.
EDUCATE
 Increased media attention can cause fear and spread myths and
misinformation
What can we do?
ORGANIZE AND PERSIST
ORGANIZE AND PERSIST
 REVIVE! worked because of community champions like the McShin
Foundation and OneCare of Southwest Virginia
 Virginia has no active statewide harm reduction organization focused on
drug use
 Strength in Numbers!
ORGANIZE AND PERSIST
 Use technology to your advantage.
WHY DO WE DO IT?
THANK YOU!
Thank you for your
attention!
Jason Lowe, MSW
[email protected]
@ReviveVA
To visit the REVIVE! Website,
Simply search “DBHDS Revive”