Transcript (PPTX, 389KB)

Opioid Dependence
in Missouri
Cheryl Marcum, Missouri State Opioid Treatment Authority
AATOD 2015
Total of 13 OTP’s in MO: 9
Non- Contracted:
• Nine non-contracted, private-pay clinics
• Located in mostly rural areas with exception to
one private clinic in St. Louis and Kansas City
• Currently have three applications to initiate
OTP’s in more rural areas
• Hope to have 16 in MO by 2016
DMH contracted Comprehensive Substance
Treatment and Rehabilitation (CSTAR) Opioid
Providers
• Missouri has four contracted Opioid Treatment
Providers
• Two in Kansas City and two in St. Louis
• Current Wait List
• Approximately 550 consumers waiting for
treatment
• Priority Populations
• Pregnant Women
• IV Drug Users
• Individuals who are HIV positive
*
1
3
*
1
3
*
1
1
1
1
1
Geographic Distribution of heroin
users who enter treatment
Large
Population in
Eastern Region
Counties
Notes: Served between 2008 and 2010 (N=6,710).
Data source: Missouri Department of Mental Health, Division of Alcohol and Drug Abuse
Medications for Treatment
• Methadone - When properly prescribed:
•
•
•
•
•
•
Agonist: Compound that activates brain receptors
Should not be intoxicating or sedating on stabilizing dose
Does not interfere with ordinary activities
Relieves cravings associated with heroin addiction
Medically safe
Approved for treatment for more than 30 years
• Buprenorphine / Suboxone
• Partial Agonist: Compound that partially activates receptors and blocks further
activation
• Causes weaker opiate effects
• Less risk for overdose
• Not all patients respond to buprenorphine
• Approved for treatment of narcotic addition in 2002
• Physician limited to 100 patients
• Naltrexone
• Antagonist: Compounds that block activation of receptors.
• (Poor patient compliance)
• Vivitrol (injectable naltrexone)
• Approved for treatment of narcotic addiction in October 2010
Data source: National Institute on Drug Abuse
Percent of Treatment
Admissions
• United States
• Heroin: Stable
• 14% of all treatment admissions
• Other opiates: Increasing
• 1% of all treatment admissions in 1999 to 7% in 2009
• Missouri
• Heroin: Increasing
• 4.6% of all treatment admissions in 1999 to 7.4% in 2009
• Other opiates: Increasing
• <1% of all treatment admissions in 1999 to 5.5% in 2009
Data source: Substance Abuse and Mental Health Services Administration. Treatment Episode Dataset
(TEDS)
Demographics at Treatment
Admission
Other Opiates
Heroin
• Gender:
• Male: 59%
• Female: 41%
• Race:




• Caucasian: 62%
• African-American: 37%
• Average Age: 33
• Legal Status:
• On Parole: 11%
• On Probation: 31%
• Injection Use: 66%
• Referral Source:
• Self: 51%
• Criminal Justice: 34%
Gender:
Race:






Caucasian: 93%
African-American: 6%
Average Age: 32
Legal Status:


Male: 51%
Female: 49%
On Parole: 8%
On Probation: 34%
Injection Use: 25%
Referral Source:


Self: 47%
Criminal Justice: 35%
Data source: Missouri Department of Mental Health, Division of Alcohol and Drug Abuse
Average Length of Treatment
Engagement
For Individuals Receiving Medication Treatment
for Opioid Addiction in 2010
1200
1000
1,002
days
800
600
400
200
76
67
29
67
Suboxone
Vivitrol
Naltrexone
No Medication
0
Methadone
N=1,698
N=325
N=80
N=55
Note: Individuals placed on Medication Assisted Treatment tend to have greater severity of addiction.
Data source: Missouri Department of Mental Health, Division of Alcohol and Drug Abuse
N=4,687
Number Served in Treatment for
Opioid Dependence
Number Served in Calendar Year 2010
By Primary Substance Problem
Other Opiates
and Synthetics,
2068, 29%
Hydrocodone
(Vicodin), 381,
5%
Oxycodone
(Oxycontin), 663,
9%
Heroin, 4182,
57%
Data source: Missouri Department of Mental Health, Division of Alcohol and Drug Abuse
Percent of treatment
Admissions
• United States
• Heroin: Stable
• 14% of all treatment admissions
• Other opiates: Increasing
• 1% of all treatment admissions in 1999 to 7% in 2009
• Missouri
• Heroin: Increasing
• 4.6% of all treatment admissions in 1999 to 7.4% in 2009
• Other opiates: Increasing
• <1% of all treatment admissions in 1999 to 5.5% in 2009
Data source: Substance Abuse and Mental Health Services Administration. Treatment Episode Dataset
(TEDS)
Methadone Maintenance treatment
Outcomes
• In FY 2010:
• 78% of the random drug tests administered to
individuals in treatment were clean of illegal
drugs
• Missouri’s four publicly-funded Opioid
Treatment Clinics had 83 babies born free of
illegal drugs
Data source: Missouri Department of Mental Health, Division of Alcohol and Drug Abuse
Age at Death for Heroin-Related
Deaths 2010
Age at Death
Significant Impact on
Young Adults
90
60
30
0
<20
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
age
Data source: Missouri Department of Health and Senior Services, Section of Epidemiology for Public
Health Practices, Bureau of Health Informatics
60+
Regional Differences
2009 Heroin-Related Deaths per 100,000 population
8
7.06
High rates in
Eastern Region
1.30
0.64
0.33
0.07
0
Central
Eastern
Northwest
Southeast
Southwest
20
Includes nonurban areas
12.90
9.38
8.67
6.91
5.74
6.35
3.66
0
St Louis
Co
St Louis Jefferson St Charles Franklin
City
Lincoln
Warren
Data source: Missouri Department of Health and Senior Services, Section of Epidemiology for Public
Health Practices, Bureau of Health Informatics
Missouri Division of Alcohol and Drug Abuse
OPIOID TREATMENT PROGRAM MONTHLY REPORT
The information on this form is required by the Certification Standards for Alcohol and Drug Abuse Programs.
Please complete and submit by the 5th of every month
NAME OF PROGRAM:
Month:
Year:
Consumers in Treatment
For each item below, provide data for each of the
four treatment lengths listed in the columns.
CENSUS DATA
Number:
DRUG SCREEN DATA (reduction of illicit drug use)
Random drug screens conducted:
Number of drug screens positive for any drug:
Percent positive for any drug:
Less Than
3 Months
3-6
Months
6-12 Months
More Than 12
Months
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Number of consumers with a medically documented disability:
Percent disabled:
ADMINISTRATIVE WITHDRAWAL & PHASE VI
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Number of consumers undergoing administrative withdrawal:
Percent administrative withdrawal:
Number undergoing voluntary withdrawal:
Percent voluntary withdrawal:
CENSUS BY CONSUMER PHASE
Number of consumer in Phase I:
Percent Phase I:
Number of consumers in Phase II:
Percent Phase II:
Number of clients in Phase III:
Percent Phase III:
Number of consumers in Phase IV:
Percent Phase IV:
Number of consumers in Phase V:
Percent Phase V:
Number of consumers in Phase VI:
Percent Phase VI:
PREGNANCY CENSUS & DRUG FREE BIRTH DATA
Number of pregnant consumers in OTP treatment only
Number of births by consumers in OTP treatment only
Number of drug free births in OTP treatment only
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Number of drug screens positive for opiates:
Percent positive for opiates:
Drug screens positive for marijuana & methadone only
Percent positive for marijuana and methadone only
PERFORMANCE OUTCOMES
Number of consumers employed full or part time:
Percent employed:
Number of consumers attending job training or school:
Percent in school:
Number of consumers who are homemakers:
Percent homemakers:
Total
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Other Recovery Supports/Options in
MO
All of Missouri substance use disorder treatment programs must provide for medicationassisted recovery, either on-site or with a referral process…
Missouri offers both social-setting detoxification and modified-medical detoxification
choices…
Outpatient detoxification is possible with correct medications…
Specialized treatment for women and children…
Utilize Residential Support with methadone or buprenorphine maintenance from an OTP…
Working with Drug Courts/Family Courts… Referring for treatment at OTP’s…
Educating more hospital, physicians and schools with training about opioid dependence…
Attending Health Fairs to address medical aspects of treatment at an OTP…
Finding MH treatment biggest barrier to fully addressing Disease Model… DBH working on
creating fidelity measurements for integrating SA/MH treatment at SA providers…
Comments From OTP’s
• St. Louis (East): “Seen an increase in prescription pill use, but heroin
remains the drug of choice…”; “…increase in female admissions… in
the 18-22 year group.”
• Columbia (mid-State): “…Older patients tend to struggle with pain
medication addiction, while our younger patients struggle with
heroin.”; “… more male patients…” 62% male/38% female…
• St. Joseph (Northwest): “… more prescription medication use than
heroin…”; “more male clients..”
• West Plains (South Central): “Prescription medication is more
prevalent than heroin…”; “…ages are primarily 22-49…”
• Kansas City (West): “…see a transition from prescription medication
to heroin…”;
“… a lot of poly-substance dependence… methamphetamines,
marijuana and K2”
Resources for Providers
Anti-Discrimination Resources - Medication-Assisted Treatment:
•
Educating Courts, Other Government Agencies and Employers About Methadone (2009) - This publication explains how individuals in
methadone maintenance programs and other forms of Medication Assisted Treatment, as well as their treatment programs and
advocates, can advocate for their rights so that they can get in or stay in the treatment they need – without discrimination. The focus is
on discrimination by the child welfare system and criminal justice system – including driving under the influence, jails and prisons, and
probation and parole.
Helpful Resources to Address Discrimination Against People in Medication-Assisted Treatment (2009) - List of useful resources for
educating employers, courts and others about Medication Assisted Treatment, including why methadone and buprenorphine do not
impair physical or mental functioning when provided to individuals stabilized on the appropriate dose.
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•
•
Know Your Rights: Are You in Recovery from Alcohol or Drug Problems? Rights for Individuals on Medication-Assisted Treatment (2009) This brochure is a companion piece to Know Your Rights: Are You in Recovery from Alcohol or Drug Problems? and describes the specific
legal issues faced by people in Medication-Assisted Treatment for opiate addiction. (Funded by Partners for Recovery, an initiative of the
Center for Substance Abuse Treatment of the U.S. Department of Health and Human Services).
Know Your Rights – Training Materials - The Legal Action Center has conducted numerous Know Your Rights trainings across the country
for people in the recovery and their allies. Funded by the Partners for Recovery Initiative of the U.S. Substance Abuse and Mental Health
Services Administration (SAMHSA), these trainings cover anti-discrimination laws that protect individuals with alcohol and drug problems
from discrimination in employment, housing, and elsewhere. They also cover anti-discrimination protections for individuals who also
have a criminal record. Click here for the materials distributed at these trainings.
Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System (2011) - A report that explains why criminal
justice agencies violate Federal anti- discrimination laws and the United States Constitution when they deny access to medications, such
as methadone and burprenorphine, to treat opiate addiction. The report was written at the request of the American Association for the
Treatment of Opioid Dependence (AATOD), who, along with the Center, has a longstanding interest in expanding the use of these
medications in criminal justice settings.
Methadone Maintenance Treatment: Memorandum of Driving & Psychomotor Studies and Background Information about Methadone
Treatment (April 2000) - This packet of information contains (1) a memorandum summarizing recent literature and studies about the
effect of methadone treatment on patients’ driving ability as well as psychomotor and intellectual functioning, (2) the actual articles and
studies referenced in the memorandum, and (3) background information about methadone treatment. It is a very useful resource for
people trying to combat discrimination based on participation in methadone treatment