Spotlight on Health Policy Beyond the Clinical: The Opioid ...2001: New Mexico passes the first Naloxone Access Law (NAL) allowing trained responder to administer naloxone Sept 2014:

Spotlight on Health Policy

Beyond the Clinical: The Opioid Epidemic

October 25, 2017

Disclosures and Disclaimer

Neither the Institute for Health Policy and Leadership (IHPL) nor I have any relevant financial relationship to disclose. The views

expressed are those of the speakers and not necessarily those of Loma Linda University Health, the Institute for Health Policy &

Leadership, the Center for Christian Bioethics, or their staff.

Program Outline

• Background Info on the Opioid Epidemic by Wonha Kim, MD, MPH

• Moderated Panel Session •Moderator: Gerald Winslow, PhD

•Panelists:

• Justin Hata, MD

•Emily Hollinghurst, PharmD

•Gina Mohr, MD

•Greg Olson, DDS

• Audience Q/A

What Are Opioids?

• Any of various natural or synthetic compounds that bind to specific receptors in the central nervous system in the brain and the body, resulting in analgesic and narcotic effects

• Originally derived from the opium poppy

• Includes illegal forms as well as legal forms◦ Illegal: Heroin, opium

◦ Legal: Prescription opioids such as

◦ Codeine

◦ Morphine

◦ Oxycodone (OxyContin®)

◦ Hydrocodone (Vicodin®)

◦ Hydromorphone

◦ Fentanyl

Why Can Rx Opioids be Problematic?

• Opioids’ ability to produce euphoria can lead to abuse and misuse◦ Taken in a different way than prescribed

◦ Taken in a larger quantity than prescribed

◦ Taken without a doctor’s prescription

• Can lead to a spiral of negative consequences◦ Addiction

◦ Loss of jobs, house, etc.

◦ Alienation from friends and family

◦ Gateway to heroin use

◦ Death from overdose

What is this “Opioid Epidemic”?

• Nearly 2/3 of all recent drug deaths are attributable to opioid misuse

• About 2.5 million Americans now struggle with opioid dependence or use disorder

• 91 Americans die daily from opioid overdose

What is this “Opioid Epidemic”?

What is this “Opioid Epidemic”?

What Led to this Epidemic?• Significant increases in the number of opioid prescriptions

◦ 1980s: advocacy groups raise awareness about inadequate pain treatment in cancer patients

◦ 1996: The American Pain Society (APS) introduce the concept of “pain as the 5th vital sign”

◦ Increase in the number of opioid Rx (3x the rate in 1999; 4x European rate)

• Pharmaceutical companies increased the development of new opioid products◦ The FDA approved nearly two dozen new products between 1990 &

2017

• Aggressive marketing by pharmaceutical companies

• Greater social acceptability for using medications for different purposes

What Role do Healthcare Professionals Play?

• Healthcare professionals in the highest prescribing state (Alabama) wrote almost 3x as many of these Rx’s per person as those in the lowest prescribing state (Hawaii)

• The most common drugs involved in Rx opioid overdose deaths include: ◦ Methadone

◦ Oxycodone (OxyContin®)

◦ Hydrocodone (Vicodin®)

• Healthcare professionals wrote nearly a quarter of a billion opioid prescriptions in 2013

What is Being Done About It?

• The US Department of Health and Human Services (HHS) developed a five-point comprehensive strategy for the nation:

1. Better public health surveillance CDC

2. Better pain management practices Toolkits, Webinars

3. More addiction prevention, treatment, and recovery services

4. More overdose reverse drugs FDA

5. Better research on pain and addiction NIH

What is Being Done About It?

• Tighter restrictions on Rx opioids◦ Example: FDA placed hydrocodone combination products in a more

restrictive category of controlled substances

• Increased education and outreach efforts ◦ General public

◦ Healthcare professionals

• Increased surveillance (e.g., CA’s CURES database)

• Innovative approaches to treating addicts (e.g., Opiate Crisis Intervention Court in Buffalo, N.Y)

What is Being Done About It?

• Easier access to naloxone ◦ 2001: New Mexico passes the first Naloxone Access Law (NAL) allowing

trained responder to administer naloxone

◦ Sept 2014: Gov. Jerry Brown signs AB 1535 into law, permitting pharmacists to provide naloxone upon request w/o Rx

◦ March 2015: KY allows first responders or members of an opioid user’s family to receive naloxone w/o Rx

◦ July 2015: Ohio’s governor enacts emergency legislation to make naloxone available w/o Rx pharmacies can now offer naloxone OTC to individuals cleared by a doctor or health official

◦ Now 33 states and DC have similar law allowing naloxone w/o Rx

What Role can Healthcare Professionals Play?

• Consider non-opioid alternative to pain management

• When prescribing opioids, only prescribe the strength and quantity needed to treat the condition

• Be mindful of potential for opioid abuse/misuse

Image source: https://www.cdc.gov/drugoverdose/opioids/prescribed.html

What’s Happening at LLUH

• LLUHC Opioid Steering Committee◦ Consists of physician leaders from the primary care sites, pain

management, palliative care, and Riverside University Health System (RUHS)

◦ Currently developing a best practice guideline, pain/controlled substance agreement and working with IS department to develop Epic tools to support best practices

• Substance Use Recovery & Wellness program at the BMC◦ Provides inpatient detox services for opiates as well as an outpatient

rehabilitation program.

• IHPL Opioid Project◦ Looking at medical and dental prescription data to identify areas for

systematic improvement to help prevent potential for opioid addiction or abuse among patients

◦ Plan to survey LLUH healthcare professionals about opioids and pain management perspectives and practices

What is our Challenge?

Managing pain appropriately without adding to the national opioid epidemic

Moderated Panel Discussion and Audience Q/A

Thank You!

Questions or comments can be directed to [email protected] or [email protected]