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It Takes A Village to Curb the Prescription Opioid Epidemic:

CDC EffortsJan Losby, PhDTeam Lead, Overdose Prevention Health Systems TeamDivision of Unintentional Injury PreventionCenters for Disease Control and Prevention

Session L6This presenter has

nothing to disclose

December 4, 20161:00-4:30

28thIHIFORUM

Supply healthcare providers with resources to improve patient safety

Strengthen state efforts by scaling up effective public health interventions

Improve data quality and track trends

Pillars of CDC’s Overdose

Prevention Work

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Patients 18 years or older with chronic pain

Outpatient settings

Outside of active cancer, palliative, and end of life care

Primary care providers

CDC Guideline for Prescribing

Opioids for Chronic Pain

P3

Organization of Guideline

Recommendations

12 recommendations are grouped into three

conceptual areas:

• Determining when to initiate or continue opioids for chronic pain

• Opioid selection, dosage, duration, follow-up, and discontinuation

• Assessing risk and addressing harms of opioid use

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Dissemination & Implementation

Approach

Translation & Communication

Clinician Education &

Training

Health Systems

Interventions

Insurer

Interventions

P5

Translation & Communication

Checklist

Tapering

Nonopioid Treatments

Pharmacists on the Front

Lines

Assessing Benefits and

Harms of Opioid Therapy

Prescription Drug

Monitoring Programs

(PDMPs)

Calculating Total Daily Dose

of Opioids for Safer

Prescribing

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Provider MaterialsP7

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Patient Materials

• Graphics and messages

• Fact Sheets

• Prescription Opioids:

What You Need to Know

• Pregnancy and Opioids

• Posters

• Podcasts

• Infographics

P9

Clinician Education & TrainingP10

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Clinician Outreach and Communication

Activity (COCA) Webinars

Earn CMEs/CEs:

1. Overview of Guideline

2. Nonopioid Treatments for

Chronic Pain

3. Assessing Benefits and Harms

of Opioid Therapy

4. Dosing and Titration of Opioids

5. Opioid Use Disorder—

Assessment and Referral

6. 12/6: Risk Mitigation Strategies

7. 12/13: Effective

Communication with Patients https://emergency.cdc.gov/coca/calls/2016/index.asp

P11

Coming Soon

• Mobile “app” with

morphine milligram

equivalent (MME)

calculator

• Videos

• Brochures and pocket

guides

• Online training for

providers

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Training Resources: Online Course

eLearning

• Web-based training

• Modules that can be completed

in 30 minutes or less

• Learner-directed content

• Scenario-based interactions

• Mini-lessons on implementing

the guideline

• Short videos

P13

Health Systems InterventionsP14

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Quality Improvement (QI) Initiative

Create QI measures

Create QI implementation guide

Launch & support Opioid QI Collaborative in 6 health care systems

Clinical Decision Supports

CDC & ONC collaborating

Create sharable EHR code/artifacts

Clinical sites to implement guideline & track outcomes

P15

Coordinated Care Plan

Created the Chronic Pain Care Involving Opioids: A Coordinated Care Plan for Safer Practice

Informed by Group Health and VA

Rigorous evaluation underway at MedStar in Maryland (9 clinical intervention sites & 9 clinical comparison sites)

Broad dissemination following evaluation conclusion

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Coverage for non-pharmacologic therapies

Improve ease of prescribing non-opioid pain medications

Reimbursement for patient counseling, care coordination, & checking PDMP

Promote more judicious use of high dosages of opioids outside of palliative care, active cancer or end-of-life care, using mechanisms such as drug utilization review

Remove barriers to evidence-based treatment of opioid use disorder, such as eliminate lifetime limits on buprenorphine

Insurer InterventionsP17

PDMPs System-Level Evaluate Policy Rapid Response

Five Components

Funded State

Unfunded State

Surveillance

CDC Funded StatesP18

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P19Guideline Dissemination & Implementation:

State Examples

Translation & Communication

• Disseminating Materials to stakeholders

Clinician Education & Training

• Academic Detailing

Health Systems

• EHR & PDMP (Prescription Drug Monitoring Program) Integration

Insurers

• Workers’ Compensation

• Medicaid

U.S. Health and Human Services

Secretary’s Opioid Initiative

Focus on three priority areas that tackle the opioid crisis and significantly

impact those struggling with substance use disorders to help save lives

Providing training and educational resources to assist health professionals in making informed prescribing decisions

1

Increasing use of Naloxone

Expanding the use of Medication-Assisted Treatment

2

3

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P21

Resources & Contact Information

CDC Opioid Overdose Prevention Website: www.cdc.gov/drugoverdose

HHS Prescription Drug & Heroin Overdose Epidemic: www.hhs.gov/opioids

Turn the Tide (Surgeon General’s website): http://turnthetiderx.org/#

Presenter Contact

Information:

Jan Losby

JLosby@cdc.gov

770-488-8085

Disclaimer:

The findings and conclusions of this

presentation are those of the

presenter and do not necessarily

represent the official position of the

Centers for Disease Control and

Prevention.