issues and impacts related to opioid treatment programs in florida
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Issues and Impacts Related to Opioid Treatment Programs in Florida. Agency for Health Care Administration Briefing Friday, March 16, 2012 Holly Hills, Ph.D. Overview. Three areas of investigation were undertaken in FY 10-11: Analyses examining costs An examination of the role of pain - PowerPoint PPT PresentationTRANSCRIPT
Issues and Impacts Related to Opioid Treatment Programs in Florida
Agency for Health Care Administration Briefing
Friday, March 16, 2012
Holly Hills, Ph.D.
Louis de la Parte Florida Mental Health Institute
Overview
Three areas of investigation were undertaken in FY 10-11:
♦ Analyses examining costs
♦ An examination of the role of pain
♦ An evaluation of factors that impact treatment retention
Louis de la Parte Florida Mental Health Institute
Population Changes
There has been a shift in “Primary Problems” among those entering MAT.
A comparison of two cohorts of individuals entering MAT, demonstrates a shift over the five-year period with regard to the primary problems prompting admission to treatment, from illicit drugs (i.e., heroin, cocaine/crack) in 2002-2003 to prescription drugs (Oxcodone, Hydrocodone / Acetaminophen) in 2007-March 2008.
Louis de la Parte Florida Mental Health Institute
Most Frequently ReportedPrimary Problems
Figure 1: Most Frequently Reported “Primary Problems” Prompting Admission to MAT for Opioid Dependence in 2002-2003 (N=537).
Other Opiates * Heroin Cocaine/Crack Alcohol Non-Prescription Methadone
0
50
100
150
200
250
300
Primary Problems
• * This includes codeine, Dilaudid, morphine and any other non-prescription drug with morphine-like effects.
Louis de la Parte Florida Mental Health Institute
Most Frequently ReportedPrimary Problems
Figure 2: Most Frequently Reported “Primary Problems” Prompting Admission to MAT for Opioid Dependence in 2007-2008 (N=465).
Other Opiates * Oxycodone Heroin Hydrocodone/ Acetaminophen
Methadone0
50
100
150
200Primary Problems
• * This includes codeine, Dilaudid, morphine and any other non-prescription drug with morphine-like effects.
Louis de la Parte Florida Mental Health Institute
Analysis of service costs, demonstrated a cost offset related to emergency room costs for those engaged in MAT and this offset increased as time in treatment increased:
♦ $69 at 90 days
♦ $95 at 180 days
♦ $399 at 365 days
Cost Impacts
Louis de la Parte Florida Mental Health Institute
MAT and Pain
Approximately one-half of those entering MAT in 2007-2008 had been prescribed opioids for pain:
♦ Among the 412 persons admitted to MAT in 2007-2008 that had not been previously admitted in years 2002-2007, more than half (n=214) received a prescription for opioids due to a diagnosis of illness or injury in the five years prior to entering MAT.
Louis de la Parte Florida Mental Health Institute
Of the 4,239 individuals who sought MAT through Medicaid in years 2002-2008, 3,713 individuals had co-occurring physical health problems:
♦ 1265 were diagnosed with ‘Lumbago’ (low back pain resulting from a variety of illnesses or injuries)
♦ 912 were diagnosed with abdominal pain
♦ 900 were diagnosed with back pain
Physical Health and MAT
Louis de la Parte Florida Mental Health Institute
Greater numbers of psychotherapeutic counseling sessions were associated with retention in treatment:
♦ Associated with a decrease in the odds of dropping out of treatment before 90 days
♦ Associated with a decrease in the odds of treatment drop out before 180 days
♦ Associated with a decrease in the odds of dropping out of treatment before 1 year
Improving Outcomes
Louis de la Parte Florida Mental Health Institute
Greater engagement with, and training of, primary and specialty care physicians, led by substance abuse treatment providers, is necessary to provide education as to the risk of extended or excessive prescription of narcotic painkillers especially to those with a history of substance use disorders.
Policy Recommendations
Louis de la Parte Florida Mental Health Institute
♦ Since 2003, the AMA has offered a 12-module continuing medical education (CME) series on pain management.
♦ The AMA has certified more than 20,000 physicians upon successful completion of these online courses.
♦ In February 2011, the AMA created an online CME called “Prevention of Prescription Drug Misuse and Diversion” which provides an overview on prescription drug abuse information for patient education.
Training Physicians: Resources
Louis de la Parte Florida Mental Health Institute
Many prescriptions for opioids could not be associated with a diagnosis.
♦ Policies related to associating a diagnosis with any billed interaction should be evaluated, as tracing the history of prescriptions and prescriptive practice would be made more interpretable.
Policy Recommendations
Louis de la Parte Florida Mental Health Institute
Psychotherapeutic counseling is associated with treatment retention and better long term outcomes.
♦ Utilization of allowable funding categories to support greater psychotherapeutic interventions should be targeted to those most vulnerable to treatment drop out – individuals that identify significant stressors or histories of polysubstance dependence.
Improving Outcomes
Louis de la Parte Florida Mental Health Institute
Investigations in FY 2011-12
Three studies have been initiated:• An evaluation of client satisfaction
with the treatment experience • An examination of professional
use of buprenorphine • Analyses of administrative data
examining the diagnosis and treatment of co-occurring disorders
Louis de la Parte Florida Mental Health Institute
Evaluation of opioid prescription practices among primary and specialty care physicians
Evaluation of the specific types of psychotherapeutic interventions offered to clients in OTP care
Development of a whitepaper / policy forum to identify and remedy impediments to adoption of innovation / buprenorphine variants
Recommendations for Research: FY2012-2013
Louis de la Parte Florida Mental Health Institute
Implementation of physician training programs to improve identification of SA/SD history and modified prescriptive practice
GIS study investigating MAT clients’ access to treatment sites
Recommendations for Research: FY2012-2013
Louis de la Parte Florida Mental Health Institute
Adoption of Innovation:
♦ Modified clinical strategies to encourage treatment engagement
♦ Improved integration of primary care into OTP settings
♦ Improving pain management in MAT populations
Recommendations for Research: FY2012-2013