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ArizonaState Office of Rural

Health Webinar Series

http://crh.arizona.edu/


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http://www.crh.arizona.edu/

ArizonaState Office of Rural Health

Monthly Webinar Series

Focused on providing technical assistance to rural stakeholders to disseminate research findings, policy updates, best-practices and other rural health issues to statewide rural partners and stakeholders throughout the state.



Arizona’s Opioid Epidemic:

Understanding the Problem and Finding Solutions

1. Understand the ontology of the rising rates of opioid use nationally and in Arizona

2. Understand the deleterious consequences occurring as a result of the rising

trends in opioid use

3. Identify solutions that individuals can take across healthcare, substance abuse

treatment and the general community



© 2015 UA Board of Regents

Today’s presenter:

Shana MaloneClinical Initiatives Project Manager

AHCCCS - Office of the Director

Shana Malone is a Clinical Initiatives Project Manager in the Office of the Director at the Arizona Health Care

Cost Containment System. Shana oversees the agency initiative to reduce the effects of the opioid epidemic in

Arizona. Shana has an M.S. in Human Development with a clinical specialty in family systems therapy and

completed her doctoral coursework in the School of Social and Family Dynamics at Arizona State University.

Her academic work focused on computational social science, social and emotional development and dynamical

systems applications. Prior to coming to AHCCCS, Shana was the Director of the Statistical Analysis Center at

the Arizona Criminal Justice Commission where she developed the original pilot model for the Arizona

Prescription Drug Misuse and Abuse Initiative. Shana has worked on several local and national multi-systemic

prevention and evaluation health outcome projects, and she has experience as a therapist in Arizona.

Arizona’s Opioid Epidemic

Understanding the Problem and Finding Solutions

The National Opioid Influx

• A 4 fold increase in the quantity of Rx Opioids sold in the U.S.

• The U.S. makes up 4.6% of the world’s population, but consumes 80% of its Rx opioids

• 91 opioid deaths every day!

8

Past 30 Day Rx Drug Misuse Among Arizona Youth (AYS)

Reaching across Arizona to provide comprehensive quality health care for those in need

*Y-axis altered for visual purposes; accurate representation is out of 100%

10.4%

7.9%

6.3%6.6%

0.8%0.4% 0.3% 0.3%

0%

2%

4%

6%

8%

10%

12%

2010 2012 2014 2016

Pe

rce

nt

(%)

of

You

th R

ep

ort

ing

Mis

use

/Use

AnyRx Heroin

9

Past 30 Day Youth Rx Drug Misusers Reporting “Cocktailing” (AYS, 2016)


*Y-axis altered for visual purposes; accurate representation is out of 100%

33.4 31.6

0

10

20

30

40

50

60

70

80

90

100

Alcohol+Rx Opioids Rx Opioids+Rx Sedatives

Pe

rce

nt

(%)

You

th R

ep

ort

ing

Mis

use What puts our kids at elevated risk even though

we only have 6.6% misusing Rx Drugs?

Arizona Adult Rx Drug Misuse (BRFSS, 2014)

10Reaching across Arizona to provide comprehensive quality health care for those in need

19.6%

32.5%

56.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Past 30 Days Past 12 Months but Not Past 30 Days

Lifetime but NotPast 12 Months

Per

cen

t (%

) R

epo

rtin

g M

isu

se

Emerging Heroin Trends


Fentanyl


What the Opioid Epidemic is Costing Arizona


Arizona Opioid-Related ED Encounters and Hospital Admissions


0

50

100

150

200

250

300

350

2010 2011 2012 2013 2014 2015

Eve

nt

Rat

e P

er

10

0,0

00

Po

pu

lati

on

EMERGENCY ENCOUNTERS

HOSPITAL ADMISSIONS

114.5% Increase

91.6% Increase

15

Neonatal Abstinence and Newborn Drug Exposure Rates per 1,000 Births


0

1

2

3

4

5

6

7

8

9

2008 2009 2010 2011 2012 2013 2014

Neonatal Abstinence Syndrome (779.5) Narcotic Exposure (760.72) Cocaine Exposure (760.75)

Fetal Alcohol Syndrome (760.71) Hallucinogen Exposure (760.73)

218% Increase

245% Increase

AHCCCS represented 51% of Arizona hospital births between 2008 and 2014, but was the payer for 79% of the NAS cases

Number of Drug Overdose Deaths Involving Opioids, Arizona 2005-2015 (ADHS)

0

50

100

150

200

250

300

350

400

450

500

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

mb

er

of

dru

g p

ois

on

ing

de

ath

s

Year

Opioid pain relievers*(T40.2-T40.4)

Heroin (T40.1)693.3% Increase

44.2% Increase

*includes methadone

Finding a Solution

3 Groups to Target

1. Opioid-Naïve Individuals

2. The Chemically Dependent

3. Diverters

3 Strategies to Implement

1. Harm Reduction

2. Prescribing/Dispensing Practices and Patient Ed

3. Access to MAT

Why Naloxone?

• The obvious – it saves lives! Reversals between Jan-March 2017

• Creates awareness

• Community distribution Someone understands and cares

Access to additional services and resources

Pipeline to treatment referral


Strategic Plan

• STRATEGY #1: Enhance Harm Reduction Strategies to Prevent Overdose

o GOAL #1: Provide education and training on Naloxone to prescribers, pharmacists and AHCCCS members

o GOAL #2: Increase member access to Naloxone.


Why Access Matters?

• Enough Rx opioids were dispensed last year to medicate every Arizona adult around the clock for more than 2 weeks


How Access Translates into the Population

• 73.2% of Arizona youth who have misused Rx drugs in the past 30 days report getting them from friends, family or right out of the home


66

68

70

72

74

76

78

80

2010 2012 2014 2016

Pe

rce

nt

(%)

Yo

uth

Re

po

rtin

g S

ou

rce

Percentage of Past 30 Day Youth Rx Misusers Obtaining Rx Drugs on the "Friends and Family Plan" (AYS)

Note: Y-Axis altered for visual purposes; accurate depiction is out of 100%

The CSPMP:

Sign up here: https://pharmacypmp.az.gov/

25

Percentage of Arizona Pharmacists and Prescribers Signed Up to Use the CSPMP


0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

June 2012 December 2013 December 2014 December 2015 December 2016

Pe

rce

nt

(%)

Sign

ed

Up

to

Use

th

e C

SPM

P

Prescribers Pharmacists

338% Increase

334% Increase

WHY Opioid-Naïve Individuals?


CDC MMWR, March 2017

• Criminal Justice population

• American Indians

• Former users

• Veterans

• High MEDDs and Polypharm

• Trauma, depression, anxiety

• Rural communities/counties – why are they important?

High Risk Populations

28

Why Target Polypharm?


BMJ, March 2017

29

Elevated Misuse in MH Population (NSDUH, 2015)


30

Specifically Those with Depression…


31

And, Suicidal Thoughts


Strategic Plan

• STRATEGY #2: Promote responsible prescribing and dispensing policies and practices

o GOAL #1: Reduce the number of opioid-naïve AHCCCS members unnecessarily started on opioid treatment

o GOAL #2: Improve care processes for chronic pain and high-risk AHCCCS members.


Sign Up and USE the CSPMP

• Ensure Patient Safety

• Limit Liability

• Now Easier than Ever with Delegate Option

Facilitate Use of Best Practices

Register for FREE CMEwww.VLH.com/AZPrescribing

http://www.vlh.com/AZPrescribing

Educate Patientshttp://www.azcjc.gov/acjc.web/rx/default.aspx

Project ECHO


Screening and Assessment


• Substance Use

• Mental Health

Co-Prescribing Naloxone

• >90 MEDDs

• Any combination of opioids with benzos, muscle relaxers and sleep medication

• Education and instructions key


Why MAT?

• Improves treatment retention

• Decreases opioid use

• Reduces risk of mortality


Stigma and Access to Healthcare

• How we talk about things impacts the way we think about things and vice versa

• Improved understanding that opioid use disorder is a complex interplay of biology and environment will decrease stigma and increase access to healthcare

Reward Pathway


Opioid Withdrawal Symptoms

• Pupillary dilation

• Tachycardia

• Diaphoresis

• Gooseflesh skin

• Runny nose/tearing

• Tremor

• Yawning

• Anxiety/irritability

• Restlessness

• Bone/joint aches

• GI upset

Strategic Plan

• STRATEGY #3: Enhance Access to Medication Assisted Treatment

o GOAL #1: Assess statewide capacity of MAT providers available to AHCCCS members

o GOAL #2: Increase access to integrated MAT for AHCCCS members


Opioid STR Grant

• MAT education and outreach

• Increase peer support services

• MAT COE for 24/7 access to care

• Hospital and ED discharge projects

• Diversion and incarceration alternatives

• Early MAT ID for re-entry population

• Expand residential/recovery home services


Thank You

[email protected]


mailto:[email protected]

Additional AZ Resources:

Take the CME Safe & Effective Opioid Prescribing While Managing Acute & Chronic Pain-FREE for AZ only: http://www.vlh.com/AZPrescribing/-Non-AZ access here: http://www.vlh.com/

Use the AZ Prescription Drug Misuse & Abuse Initiative Toolkit here (scroll down to Strategies): http://www.rethinkrxabuse.org/. Order a physical copy from Lacie Ampadu, [email protected]

Sign up for the AZ Prescription Drug Monitoring Program here (FREE & required for licensing): https://pharmacypmp.az.gov/

Use the Arizona Opioid Prescribing Guidelines here: http://www.azdhs.gov/documents/audiences/clinicians/clinical-guidelines-recommendations/prescribing-guidelines/az-opiod-prescribing-guidelines.pdf. Request FREE physical copies from Lacie, [email protected].

Request a Naloxone training and receive free Naloxone. Contact Hayley Coles to schedule at [email protected].

View the recorded webinar here (will post soon): http://telemedicine.arizona.edu/webinar Connect w/ county organizations working on this issue. Email Lacie, [email protected] or Alyssa

Padilla, [email protected] to connect you.

http://www.vlh.com/AZPrescribing/

http://www.vlh.com/

http://www.rethinkrxabuse.org/


https://pharmacypmp.az.gov/

http://www.azdhs.gov/documents/audiences/clinicians/clinical-guidelines-recommendations/prescribing-guidelines/az-opiod-prescribing-guidelines.pdf



http://telemedicine.arizona.edu/webinar



This webinar is made possible through funding provided by Health Resources and Services Administration, Office for the Advancement of Telehealth (G22RH24749). Arizona State Office of Rural Health is funded granted through a grant from US Department of Health and Human Services. Grant

number H95RH00102-25-00 This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, DHHS or the U.S.

Government.

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