An Evidence-Based Response to Prescription Drug Abuse

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November 12, 2015

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Robert Pack, PhD, MPH & Stephanie Mathis, MPH

Overview

1. ETSU Prescription Drug Abuse and Misuse (PDA/M) Working Group
2. The PDA/M Epidemic in Brief
3. A Model for PDA/M Prevention
4. Medication-Assisted Treatment (MAT)

ETSU PDA/M Working Group

• Monthly meetings
• Since Spring of 2012
• 25-30 attend every month
• Inter-professional focus
• Research
• Community Outreach
• Education
• Resource development
• Systems thinking

PDA/M Working Group

*96 members included

The PDA/M Working Group

>100 members

NIH/NIDA-funded

DIDARP Research

Team

State-funded

NAS team

Carter County

Coalition team

NAS outcomes

team

Government &

Workforce

Engagement

CDC Prevention

Research Center

Proposal

NIH/NIDA proposal

- RX Stimulant Misuse in

College Students

October 2015

- Clinical Setting

Intervention to

reduce PDAM-

NIH/NIDA

Next new idea

TBR

RX Stimulant

Misuse

February 2016

- HCV and drug use-

NIH/NIDA

State-funded

Naloxone

training

Team Products 2013-15

• Proposal teams
• Evaluation activities with community partners
• Two dozen or more CE events
• More than 30 public presentations
• 8 peer reviewed publications or manuscripts in press & over 10 national presentations
• Inter-professional PDA/M Grand Rounds (7 so far)
• PDA/M Journal Club
• Interface with elected officials
• Social media & web presence
• Website, Facebook & Twitter
• Media:
• Cover of USA Today (Loyd), live chat on Huffington Post (Loyd), local TV, print and radio (Pack, Hagemeier, Gray, Tudiver, et al)

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PDA/M Publications

Regional Public Health Impact

• First drug-take back event on ETSU campus
• FTDD, Region 1:
• County-specific 1-pagers
• Workforce Investment Board
• Washington County partnerships, including workforce initiatives
• Carter County Coalition development and efforts
• Neonatal Abstinence Syndrome (NAS) Research Symposium and Toolkit
• ETSU hosted Trauma-Informed Informed Care Training
• ETSU PDA/M Website
• Additional activities of the ETSU PDA/M Working Group

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Source: Centers for Disease Control and Prevention (CDC)

Source: Warren MD, Miller AM, Traylor J, Bauer A, Patrick SW. Implementation of a statewide surveillance system for neonatal abstinence syndrome - Tennessee, 2013. MMWR Morb Mortal Wkly Rep. 2015;64(5):125-128.

Source: Hedegaard H, Chen LH, Warner M. Drug-poisoning deaths involving heroin: United States, 2000-2013. NCHS Data Brief. 2015(190):1-8.

A complex problem…

Levels of Evidence

Medication-Assisted Treatment (MAT):

The use of medications, in combination with counseling and behavioral therapies, to provide a comprehensive approach for the treatment of substance use disorders, including opioid use disorders

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Substance Abuse and Mental Health Services Administration. Medication-Assisted Treatment (MAT). 2015; http://www.samhsa.gov/medication-assisted-treatment.

“A key driver of the overdose epidemic is underlying substance-use disorder. Consequently, expanding access to addiction-treatment services is an essential component of a comprehensive response. Like other chronic diseases such as diabetes and hypertension, addiction is generally refractory to cure, but effective treatment and functional recovery is possible.”

Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic. New England Journal of Medicine. 2014;370(22):2063-2066.

Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic. New England Journal of Medicine. 2014;370(22):2063-2066.

Fullerton CA, Kim M, Thomas CP, et al. Medication-Assisted Treatment With Methadone: Assessing the Evidence. Psychiatric Services. 2014;65(2):146-157.

Thomas CP, Fullerton CA, Kim M, et al. Medication-assisted treatment with buprenorphine: assessing the evidence. Psychiatr Serv. 2014;65(2):158-170.

Connery HS. Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Harv Rev Psychiatry. 2015;23(2):63-75.

Degenhardt L, Randall D, Hall W, Law M, Butler T, Burns L. Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: risk factors and lives saved. Drug Alcohol Depend. 2009;105(1-2):9-15.

Treatment and Mortality

Schwartz RP, Gryczynski J, O'Grady KE, et al. Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009. Am J Public Health. 2013;103(5):917-922.

MAT Need Exceeds Capacity

• In Tennessee:
• Rate of past-year opioid abuse or dependence is 10.2 per 1,000 people, but buprenorphine treatment capacity is only 4.6 per 1,000 people
• 83.3% of opioid treatment programs are already operating at 80% or higher capacity

Jones CM, Campopiano M, Baldwin G, McCance-Katz E. National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment. American Journal of Public Health. 2015:e1-e9.

• Appalachian sample of prescription opioid abusers
• Lifetime use of buprenorphine “to get high” was 70%, but only 47% reported use of diverted buprenorphine over the 6-month period
• Most were sporadic users (1-2 times over the 6-month period) and daily use was not common
• “Attempting, but failing to access buprenorphine treatment was the strongest predictor of diverted buprenorphine use over the 6-month period, increasing the risk 7-fold.”

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Lofwall, M. R., & Havens, J. R. (2012). Inability to access buprenorphine treatment as a risk factor for using diverted buprenorphine. Drug and Alcohol Dependence, 126(3), 379-383. doi: 10.1016/j.drugalcdep.2012.05.025

Strong Support for Increasing MAT Access

• Department of Health and Human Services (DHHS)
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare and Medicaid Services
• National Institute on Drug Abuse (NIDA)
• Office of National Drug Control Policy (ONDCP)
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• World Health Organization (WHO)
• And many more…