massachusetts responds to the opioid epidemic · 2018. 5. 10. · searches in q4 over q3 2017. •...
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Massachusetts Responds to the Opioid Epidemic Using Data To Inform Policy and Programs Monica Bharel, MD MPH Commissioner of Public Health
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Data For Massachusetts 2017 Q4 Quarterly Report and Chapter 55
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Opioid Related Overdose Deaths
379506 526 614
514 575 660 642 622 638 560656 742
961
1,352
1,648
2,083
1,501
1,768
2,1551,977
0200400600800
1,0001,2001,4001,6001,8002,0002,2002,400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Num
ber
of d
eath
s
Figure 2. Opioid1-Related Deaths, All IntentsMassachusetts Residents: 2000 - 2017
Confirmed Estimated
8.3% decline
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The rate of fentanyl present in the toxicology of opioid-related overdose deaths continues to rise, reaching 83 percent this year, while the rate of prescription opioids and heroin present in opioid-related overdose deaths continues to decline
0102030405060708090
100
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3
2014 2015 2016 2017
Perce
nt
Year and Quarter
Figure 4. Percent of Opioid Deaths with Specific Drugs PresentMA: 2014-2017
Fentanyl¹
Likely Heroin
Prescription Opioid²
Benzodiazepine
Cocaine
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Opioid Overdose Death Rates by County 2011 - 2013 2014 - 2016 vs.
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The age-adjusted opioid-related overdose death rate for Hispanics doubled over a three-year period (2014-2016)
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Prescription Monitoring Program – Data Trends
• Registered MassPAT providers conducted over 1.5 million searches. There was an increase of 35,000 searches in Q4 over Q3 2017.
• Approximately 594,000 Schedule II opioid prescriptions reported to the MA PMP in Q4 2017, which is a 30% decrease from Q1 2015 (n = 841,990 Schedule II opioid prescriptions)
• Approximately 268,000 people in Massachusetts received prescriptions for Schedule II opioids in Q4 2017, which is 30% less than Q1 2015, when there were 390,532 individuals receiving Schedule II opioids
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Chapter 55 of the Acts of 2015 • Signed into law in August 2015
• Required a comprehensive report to the state legislature and cross-agency collaboration to address 7 specific questions about opioid-related deaths
• Specified major data sets across government
• Overcame legal barriers for use of some data
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Data Mapping
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Chapter 55: Partners Coming Together Academic
•Brandeis University •Boston University •Brown University •Harvard Medical School •Harvard School of Public Health •Massachusetts College of Pharmacy and Health Sciences •Massachusetts Institute of Technology •Northeastern University •Tufts University •University of Massachusetts Amherst •University of Massachusetts Boston •University of Massachusetts Medical School
State and Federal Government Agencies
Hospitals & Private Industry
•Baystate Health •Beth Israel Deaconess Medical Center •Boston Medical Center •Brigham & Women’s Hospital •Children’s Hospital •GE •IBM •Liberty Mutual •Massachusetts General Hospital •Massachusetts League of Community Health Centers •McKinsey & Company •The MITRE Corporation •Partners Healthcare •PwC •Rand Corporation
• Boston Public Health Commission • Center for Health Information and Analysis • Department of Housing and Community Development • Department of Mental Health • Department of Correction • Department of Public Health • Executive Office of Health and Human Services • Executive Office of Public Safety and Security
• Federal Bureau of Investigation • High Intensity Drug Trafficking Area (NE) • Health Policy Commission • Massachusetts Sheriffs’ Association • MassIT • Office of the Chief Medical Examiner • State Auditor’s Office
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Chapter 55 Phase 1 Report – Key Finding
DRAFT - FOR POLICY DEVELOPMENT ONLY
0
0.5
1
1.5
2
2.5
Engaged in OAT Not Engaged in OAT
Cum
ulat
ive
Inci
denc
e of
Dea
th (%
)
Cumulative Incidence of Opioid-Related Death by OAT Status Following a non-fatal overdose,
patients treated with methadone and/or buprenorphine (Opioid Agonist Treatment or “OAT” that block the effect of opioids) were significantly less likely to die; however, very few patients (~5%) engage in OAT following a non-fatal overdose.
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Ch. 55 Phase 1 Report– Key Findings
DRAFT - FOR POLICY DEVELOPMENT ONLY 12
Statute Question Analytic Question Preliminary Findings
1. Instances of multiple provider episodes, meaning a single patient having access to opiate prescriptions from more than 1 provider
Does an abnormally high amount of prescribing physicians increase a patient’s risk of fatal overdose?
Individuals who obtain prescriptions for opioids from more than one doctor may be at greater risk of death. Based on observed data, the use of 3 or more prescribers is associated with a 7-fold increase in risk of fatal opioid overdose.
2. Instances of poly-substance access, meaning a patient having simultaneous prescriptions for an opiate and a benzodiazepine or for an opiate and another drug which may enhance the effects or the risks of drug abuse or overdose
Does the addition of benzodiazepines to opioids increase the risk of fatal opioid overdose relative to taking opioids alone?
Preliminary findings support the hypothesis of increased risk of fatal overdose associated with concurrent use of opioids and benzodiazepines. Based on observed data, the use of benzodiazepines concurrent to opioids is associated with a 4-fold increase in risk of fatal opioid overdose. Future analysis should include other drugs.
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Year 2 Report Organization
Re-Estimating Baseline
Time line and Influences
At –Risk Populations
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Chapter 55 – Key Finding
DRAFT - FOR POLICY DEVELOPMENT ONLY
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
2011 2012 2013 2014 2015
% O
UD
in M
A Po
pula
tion
Estimated OUD Population Rises Significantly Between 2011-2015
• Approximately 4% of individuals age 11 and older have OUD in Massachusetts.
• There was a sharp increase in 2013.
• This estimate is more than double previously reported figures.
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Nonfatal Overdoses (NFO)
• Recorded nonfatal overdoses increased by about 200% between 2011 and 2015. • The total exceeded 65,000. It is probably an underestimate. • Multiple naloxone administrations up 27% since 2013.
-
10,000
20,000
30,000
2011 2012 2013 2014 2015
Estim
ated
# N
FOs
Total Nonfatal Opioid Overdoses Rise Sharply Between 2011 and 2015*
* MATRIS data only available from 2013 - 2015. EMS transports estimated.
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Time From Initial Rx to Overdose Death
0
20
40
60
80
100
% S
uviv
ing
of T
hose
W
ho D
ied
0 ------ Months from Initial Prescription ------ 60
Average Survival Time For Those Who Died of Opioid Overdose was 36 Months
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Persons with Histories of Incarceration
0.0
500.0
1000.0
1500.0
2000.0
Incarceration History No Incarceration HistoryDea
th R
ate
Per 1
00,0
00
Opioid Death Rate 120 Times Higher for Individuals with Histories of Incarceration
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Persons Experiencing Homelessness
0
100
200
300
400
Homeless (Modeled) Not HomelessDea
th R
ate
Per
100
,000
Opioid Death Rate 30 Times Higher
for the Homeless Individuals
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Individuals with Serious Mental Illness
30.3 34.1 37.0
86.1* 95.6
12.8 -
20
40
60
80
100
120
Anxiety Depression ADHD SMI Neuro Cog MADea
ths
Per 1
00,0
00
Very High Rates of Fatal Opioid Overdoses for Persons with Some Mental Health Diagnoses
*Among MassHealth members only
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Pregnant and Postpartum Risk
3.6 2.4 2.5
0.7 0.7
1.9 2.1
0 1 2 3 4 5
181—365 days after delivery
43—180 days after delivery
0—42 days after delivery
Third Trimester
Second Trimester
First Trimester
1 year before delivery, prior to conception
Overdose Events / 1 Million Person Days
Rate of Opioid Overdose Events Increase Sharply After Delivery for OUD Mothers
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Governor Baker’s Opioid Working Group
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Safe Prescribing
• Rx 7-day limit • Check Prescription Monitoring Tool
• Prescriber Education
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Core Competencies • Medical Schools • Dental Schools • Advance Practice Nursing
• Physician Assistants • Community Health Centers • Social Work Programs
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Parent Campaign Launched • Rx opioid misuse • Parents of middle and high school age kids
• Tips for how to start a conversation
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Access to Naloxone (Narcan®)
• First Responders • Bystanders • Pharmacies • Community Bulk Purchasing Program
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Treatment • >700 more Tx beds since 2015
• Ended use of prison for women with SUD
• Expanded Office Based Treatment
• Treatment for High-Risk Populations
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Recovery
• 2000 + sober home beds certified
• Recovery Coaches • Recovery Support in emergency rooms
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Additional Resources • Massachusetts Helpline:
• www.helplinema.org
• Massachusetts Responds to The Opioid Epidemic: • With links to current stats & Chapter 55 Report • Mass.gov/opioidresponse
• Stop Addiction Before It Starts:
• Mass.gov/stopaddiction