human services programs and the opioid crisis · 2019-09-01 · office of the assistant secretary...
TRANSCRIPT
O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H
A D M I R A L B R E T T P. G I R O I R , M . D .A ss i s t a n t S e c re t a r y fo r He a l t h
S e n i o r Adv i se r, I m m e dia te O f f i ce o f t h e S e c re t a r y
Human Services Programsand the Opioid Crisis
2O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
THE STATE OF OPIOID MISUSE IN AMERICA (2018)
10.3 million people misused opioids in the past year
- 9.9 million misused pain relievers
- 808,000 used heroin
- 506,000 both misused pain relievers and heroin
from 11.4 million (2017)
NSDUH, 2018 Data; published Aug. 2019
Main reasons for opioid misuse: Pain 63.6%
2.0 million people had an opioid use disorder
- 1.7 million people with a prescription pain reliever use disorder
- 526,000 people with a heroin use disorder
- 226,000 had both pain reliever and heroin use disorders
51.3% obtained the last pain reliever they misused from a friend or relative
37.6% prescribed by a
healthcare provider. Only 2% received from >1 provider
2
3O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
PROPORTION OF DEATHS RELATED TO OPIOIDSBY AGE GROUP: 2001, 2006, 2011, and 2016
4O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
THE HUMAN SERVICES CRISIS: EXAMPLE, MIAMIOCTOBER 25, 2018
4
Orphaned by Opioids: The Silent Victims of the Crisis
“Right now, we have more children between birth and five in shelters and in group care than we’ve ever had… and that may very well be a function of opioids,” said Larry Rein, the Executive Director of ChildNet.
TANF, child support, and related programs can help families affected by OUD
find economic stability
https://www.nbcmiami.com/news/local/Orphaned-by-Opioids-The-Silent-Victims-of-the-Crisis.html
Head Start and child care providers can provide education to families and a safe, loving
environment for children
5O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
NEWBORN VICTIMS OF THE OPIOID EPIDEMIC
McQueen, NEJM 2016
Outcomes in the Fetus• Growth restriction• Prematurity• Death
Outcomes in the Newborn• Low birthweight• Small head circumference• Neonatal abstinence syndrome
Outcomes in the Child• Developmental disorders
0
5000
10000
15000
20000
25000
30000
2008 2009 2010 2011 2012 2013 2014 2015 2016
Source: AHRQ HCUP State Inpatient Databases
6O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
MENTAL DISORDERS AMONG CHILDREN BORN WITH NEONATAL ABSTINENCE SYNDROME (NAS) (%)
Sherman, Psychiatric Services 2018; 00:1; doi: 10.1176/appi.ps.201800341
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0
Any mental disorder
Specific delays in development
Disturbance of conduct
Hyperkinetic syndrome of childhood
Adjustment reaction
Acute reaction to stress
Neurotic disorders
Other Births (N=269,726) NAS Births (N=1,046)
7O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
INFECTIOUS CONSEQUENCES OF THE OPIOID EPIDEMIC
• HIV• Hepatitis C• Hepatitis B• Endocarditis• Skin, bone, and
joint infections
National Academies WorkshopSponsored by OASH, Report July 2018
8 8https://www.hhs.gov/opioids/
9O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
U.S. DRUG OVERDOSE DEATHS THE MOST CRITICAL PUBLIC HEALTH CHALLENGE OF OUR TIME
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
68,588
47,608
All Drug Overdoses
Opioid Overdoses
SOURCE: NCHS, National Vital Statics System, Mortality
Deaths Decreased 5% from 2017 to 2018
9
10O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
WHAT IS EVIDENCE-BASED TREATMENT?
• FDA-approved Medication (MAT)- Naltrexone: once a month injectable medication, blocks effects of opioids (any prescriber)- Buprenorphine (usually with naloxone): once daily/once monthly, partial agonist opioid from
prescribers (DATA 2000 waivered prescribers)- Methadone: long acting, once-daily, opioid from specially licensed programs (OTP programs only)
• Psychosocial Therapies- Contingency management, family therapy, cognitive behavioral therapy, others
• Recovery Services - Rebuilding One’s Life- Social supports to welcome into a healthy community: family, friends, peers, faith-based supports- Assistance with needs that can impact treatment - recovery housing, transportation and child care- Employment/vocational training/education
• Naloxone
10
11O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
TRANSFORM TO A SUSTAINABLE MODEL
Transition from a “crisis framework” into an integrated, sustainable, predictable, and resilient public health system for preventing and treating substance use and other behavioral health disorders.
11
12O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H 12
MATERNAL OPIOID MISUSE MODEL
The primary goals of the MOM Model are to:- Improve quality of care and reduce costs for pregnant and
postpartum women with OUD and their infants- Expand access, service-delivery capacity, and infrastructure
based on state-specific needs- Create sustainable coverage and payment strategies that
support ongoing coordination and integration of care
Requires- Comprehensive care management- Care coordination- Health promotion- Individual and family support- Referral to family and social services
Maternity and Infant Care
OUD Treatment
Behavioral Health and
Primary Care
State Medicaid Agency
Awards Anticipated December 2019
13O F F I C E O F T H E
A S S I S T A N T S E C R E T A R Y F O R H E A L T H
THE FUNDAMENTAL HUMAN SERVICE ISSUEWe must understand, engage, and remedy the underlying root causes of addiction, suicides, and other behavioral health issues.
Sept 21, 2018
14
WWW.HHS.GOV/ASH WWW.USPHS.GOV
@HHS_ASH
BRETT P. GIROIR, M.D.ADM, U.S. Public Health ServiceAssistant Secretary for Health,Senior Adviser, Immediate Office of the Secretary [email protected]