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BRINGING NALOXONE TO VIRGINIA Yesterday, Today, and Tomorrow Jason Lowe, MSW From Research to Rehab: A Town Hall Meeting College Behavioral and Emotional Health Institute Virginia Commonwealth University April 15, 2016 BRINGING NALOXONE TO VIRGINIA Yesterday - How did we get here? Today – Where are we? Tomorrow – What can we do? How Did We Get Here? PAIN BECOMES PRIMARY. PAIN BECOMES PRIMARY 1980’s - Pain drives decision making Patient satisfaction joins the group of prime metrics for quality assurance Opioids are very effective at providing quick relief, and therefore Increased computing ability, data mining, and algorithm development drives health care analytics Healthcare accreditation – Joint Commission created pain management standards in 2001 1996 - American Pain Society introduces the phrase “pain as the fifth vital sign” Claims that pain assessment is as important as assessing four vital signs “Clinicians need to take action when patients report pain” How Did We Get Here? BIG PHARMA BIG PHARMA Pharmaceutical Companies Actively and misleadingly marketing opioids as effective for pain management at unprecedented levels Purdue Pharma spent six to twelve times as much on promoting OxyContin as it had on other opioids (ER morphine sulphate) Claimed that extended-release formulation had a lower threat of abuse than shorter-acting opioids on the market at that time BIG PHARMA Pharmaceutical Companies Supporting pain advocacy groups AstraZeneca Super Bowl Commercial BIG PHARMA Did you notice the credits at the end of the commercial? BIG PHARMA American Chronic Pain Association AstraZeneca [Movantik for OIC] (Champion) Teva Pharmaceuticals [fentanyl] (Ambassador) Creaky Joints Abbvie [Vicodin, hydrocodone] AstraZeneca [Movantik] Bristol-Myers Squibb [Percocet, oxycodone] For Grace Pfizer Pharmaceuticals [oxycodone/naltrexone, not to market] (Glass-Wing Contributor) Teva Pharmaceuticals (Glass-Wing Contributor) US Pain Foundation Endo Pharmaceuticals [Opana, oxymorphone] Pfizer Pharmaceuticals Purdue Pharma [OxyContin, oxycodone] To understand how this epidemic has unfolded, we must separate fact from fiction. How Did We Get Here? OPIOIDS ARE NOT BEST-PRACTICE TREATMENT FOR MOST CHRONIC PAIN MANAGEMENT. OPIOIDS AND CHRONIC PAIN Research indicates that opioids have utility for pain sufferers, but it is limited to post-trauma and end of life situations. A George Washington University study in 2014 found opioid prescriptions in emergency rooms rose drastically between 2010 and 2014, while the number of patients presenting with pain complaints only rose slightly. A Dartmouth study in 2014 concluded the increase in opioids prescribed was not associated with improvements in health status commensurate with well-documented risks of these drugs. OPIOIDS AND CHRONIC PAIN When weighing risks, opioids are not best treatment for chronic pain. Franklin G M Neurology 2014; 83:1277-1284 HOW DID WE GET HERE? When weighing risks, opioids are not best treatment for chronic pain. 2015 National Safety Council Report How Did We Get Here? PATIENT SATISFACTION IS NOT AN EFFECTIVE INDICATOR OF QUALITY OF CARE. PATIENT SATISFACTION AND QUALITY OF CARE A 2013 Thomas Jefferson University study found that high caseloads are a much better indicator of quality of care. How Did We Get Here? PAIN IS NOT AN EFFECTIVE VITAL SIGN. PAIN IS NOT AN EFFECTIVE VITAL SIGN A 2015 Veteran’s Health Administration study found that routine documentation of pain intensity, while necessary for quality care, may not be sufficient by itself to improve the quality of pain management. A 2016 study in the Journal of the American Board of Family Medicine study found that: Accuracy of pain as a vital sign is moderate, but much lower in practice than under research circumstances; Nurses do not always use 0-10 scale to properly quantify pain; and More efforts to link fifth vital sign to clinician action for better pain management. THE BOTTOM LINE Pain is real and needs to be treated, especially chronic pain which can be debilitating. But, considering the risks, opioids are not the best available treatment for pain. Where are we now? DATA AND TRENDS DATA AND TRENDS Drug-Related Deaths in Virginia, 1999-2014 (2014 data is PROVISIONAL) DATA AND TRENDS National Opioid Prescribing Rates, 1991-2013 DATA AND TRENDS Virginia Drug-Related Death Rate superimposed over National Opioid Prescribing Rate DATA AND TRENDS Heroin overdoses by year, 2007-2014 DATA AND TRENDS Disproportionate Impact on Certain Populations DATA AND TRENDS Disproportionate Impact on Certain Populations Where are we now? WHY HEROIN? WHY HEROIN? Prescription opioid interdictions are working: Prescription Monitoring Programs High Intensity Drug Trafficking Areas and other law enforcement efforts Drug Courts But they have not been accompanied by detox, treatment, and recovery resources: Methadone clinics can require lots of travel time in some cases Lack of doctors offering suboxone alone or with wrap-around services WHY HEROIN? Without detox and treatment, those addicted to opioids will invariably turn to heroin to avoid withdrawal Today’s heroin: Mostly comes from Mexico, not Columbia Is cheaper than ever Is purer than ever Is deadlier than ever Is being adulterated not with benign substances like baking powder but with deadly substances like fentanyl Where are we now? WHY NALOXONE? 26,463 WHY NALOXONE? It is safe. No potential for abuse Accidental administration poses no threat Same dosage for adult or child Studies indicate laypersons can be effectively trained on administration It is proven effective and supported by: American Medical Association; Office of National Drug Control Policy; Substance Abuse and Mental Health Services Administration; and United States Attorney General. WHY NALOXONE? NALOXONE DOES NOT ENCOURAGE DRUG USE. Studies suggest that those who survive overdose emergencies are more likely to engage in treatment. Assumption that naloxone will encourage drug use is usually based on a lack of knowledge about the physical and chemical processes and effects of addiction. What can we do? ADVOCATE ADVOCATE Talk to all of your legislators about supporting efforts to fight the opioid epidemic: Federal – Increase SAMHSA SAPT Block Grant to support detox and treatment, allow SAPT dollars to fund needle exchange State – Expand Medicaid coverage, expand coverage of Good Samaritan law, and issue a statewide standing order for naloxone Local – Support judges in establishing drug courts, support equipping first responders with naloxone Petition the FDA to increase the 100-person suboxone limit for registered doctors Pressure naloxone manufacturers to make product more available and affordable ADVOCATE ADVOCATE What can we do? EDUCATE EDUCATE Drug courts work Nationwide, 75% of drug court participants remain arrest-free for two years, with longitudinal studies showing that this impact can persist for 10 years or more. One dollar invested in drug courts returns as much as $3.36 solely in avoided criminal justice costs. 2007 study in Multnomah County, Oregon showed drug courts lowered recidivism rates by 15-28% and lowered costs by $6,744 per participant. Combat stigma of addiction NOT A CHOICE Medication-assisted treatment is NOT substituting one drug for another. Long-term, sometimes permanent physical changes in brain make recovery exceptionally challenging and can necessitate lifetime medication-assisted treatment for some individuals. EDUCATE Increased media attention can cause fear and spread myths and misinformation What can we do? ORGANIZE AND PERSIST ORGANIZE AND PERSIST REVIVE! worked because of community champions like the McShin Foundation and OneCare of Southwest Virginia Virginia has no active statewide harm reduction organization focused on drug use Strength in Numbers! ORGANIZE AND PERSIST Use technology to your advantage. WHY DO WE DO IT? THANK YOU! Thank you for your attention! Jason Lowe, MSW [email protected] @ReviveVA To visit the REVIVE! Website, Simply search “DBHDS Revive”
