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Opioids and Older Minnesotans:

What to Know and What to Do

Aaron Leppin, MD, MSc, Assistant Professor-Researcher,

Division of Health Care Policy and Research, Mayo Clinic; Aging

Policy Fellow, Minnesota Board on Aging

Kate Erickson, MSW, \Opioid Overdose Prevention Director,

Minnesota Department of Health

Jodie Dvorkin, MD, MPH, Associate Medical Director, Institute

for Clinical Systems Improvement – ICSIHandouts:

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FREE WEBINAR

July 18, 2018

12 – 1:30 pm

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Opioids and Older Minnesotans: What to Know and What to Do

Kate Erickson, MSW; Minnesota Department of Health

Jodie Dvorkin, MD, MPH; Institute for Clinical Systems Improvement

Aaron Leppin, MD, MSc; Mayo Clinic and Minnesota Board on Aging

Learning Objectives

1. Provide overview of the opioid epidemic and its impact on older adults

2. Describe the State’s approach to addressing the epidemic in Minnesota

3. Describe healthcare’s efforts to addressing the epidemic in Minnesota

4. Outline specific actions you can take to support these efforts

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Why this webinar?

• Older adults are a population of increasing priority

• Baby boomers have aged into this demographic

• Older adults commonly have chronic pain

We need a workforce and society that can support older adults’ efforts to maintain function and quality of life while appropriately weighing the risks and benefits of opioid medications and identifying and addressing signs of an opioid use disorder.

Opioid Dashboard: one-stop shop for opioid-related data and information in MN

Kate S. Erickson| Opioid Overdose Prevention Director

Injury and Violence Prevention Section | MN Department of Health (MDH)

www.health.state.mn.us/opioiddashboard

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Emergency Response: Overdose

Signs of overdose

• Sleepiness/loss of consciousness

• Slow, shallow breathing

• Pale, blue, or cold skin

• Choking/gurgling sounds

• Constricted, “pinpoint” pupils

Emergency Response: Overdose

What to do

• Call 911/get help!

• Call MN poison control 24/7 at 1-800-222-1222

• Provide rescue breaths

• Administer naloxone (Narcan) if available

https://www.youtube.com/watch?v=GPbqPDOol14&feature=youtu.be

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Emergency Response: Obtaining Naloxone

Pharmacies: can dispense to at-risk individuals or people that know at-risk individuals on request if enrolled in appropriate program

Community Organizations (provide free training and kits)

• Steve Rummler Hope Network

• Rural AIDS Action Network

• Valhalla/Meridian

**Opioid Dashboard: Nonfatal Overdose → Naloxone

Intervention and Treatment: Person-Centered Care Plans

Review pain symptoms, impact on function/quality of life

Review pain medications, look for interactions (benzos), contraindications

Assess for opioid use disorders (CAGE-AID)

Consider and integrate non-opioid pain management strategies (e.g. physical activity, mind-body, non-opioid treatments, group-based self-management support/training)

Biophysical Approaches

Psychological Intervention

Social Issues

Person-Centered Pain Management

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CAGE-AID7/9/2018 11

https://www.integration.samhsa.gov/images/res/CAGEAID.pdf

Intervention and Treatment: Opioid Use Disorder Assessment

Get a Rule 25 chemical dependence (CD) assessment (anyone can request for self or someone else)

• Determines eligibility for publicly-funded chemical dependency treatment

• Contact health plan or county/tribe for all MNCare/MA individuals (list of contacts maintained on DHS website)

Diagnostic assessment (DA) is for co-occurring disorders and must be completed by mental health specialist

**Opioid Dashboard: Prescription Opioid Misuse→ Resources

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Intervention and Treatment: Opioid Use Disorder Treatment

MAT (suboxone/buprenorphine) increasingly outpatient primary care

Chemical Treatment Programs

• Primarily outpatient programs (less intensive, for people with social supports)

• Primarily inpatient programs (12 step/short programs for 3-8 weeks)

• Extended care (24/7 long-term residential setting for 6-12 months)

• Halfway house (transitional living focused on independence and recovery)

• Detox centers (medically managed withdrawal)

**Opioid Dashboard: Prescription Opioid Misuse→ Resources

Intervention and Treatment: Co-Occurring Disorder

After receiving diagnostic assessment (DA) for co-occurring disorder, individual may receive a variety of integrated therapy supports

• Can be outpatient or inpatient

• Ultimately focused on paying equal attention to psychiatric and substance use issues

• May offer specialized treatment plans, support groups, peer counseling, dual medication strategies for psychiatric illness and addiction

Bridgingthegapofamerica.org

Mental Disorder

Addiction

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Intervention and Treatment: Opioid Use Disorder Treatment

Can find and explore treatment centers and connect directly for services in many ways (if privately insured, best to go through insurer)

• www.fast-trackermn.org

• www.minnesotahelp.info

• DHS Licensing Lookup: https://licensinglookup.dhs.state.mn.us/

• SAMHSA treatment center locator: https://findtreatment.samhsa.gov/

**Opioid Dashboard: Prescription Opioid Misuse→ Resources

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Intervention and Treatment: Caregiver and Recovery Support

Do not forget that the people you interact with may be caring for someone with an opioid use disorder!!!

• Families anonymous (12 step)

• Co-dependents anonymous

Narcotics Anonymous (naminnesota.us)

Minnesota Recovery Connection (www.minnesotarecovery.org)

**Opioid Dashboard: Prescription Opioid Misuse→ Resources

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Intervention and Treatment/Primary Prevention

Promoting Safe Use, Safe Storage, Safe Disposal of opioids

• Safe Use: always use as prescribed, dispose of extra

• Safe Storage: secure location, disguised

• Safe Disposal: designated location (pollution control agency) https://www.pca.state.mn.us/living-green/managing-unwanted-medications

• Earth 911 to find drop-off locations

**Opioid Dashboard: Pharmaceuticals Distributed→ Resources

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Primary Prevention: Promoting Non-opioid Pain Management

Physical Activity Modalities: exercise, walking, swimming, yoga, tai chi, physical therapy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534717/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461882/

Primary Prevention: Promoting Non-opioid Pain Management

Non-Opioid Treatment Modalities: Tylenol (acetaminophen), NSAIDS (aspirin, ibuprofen), steroids (injections), acupuncture

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Primary Prevention: Promoting Non-opioid Pain Management

Mind-body Modalities: cognitive behavioral therapy (CBT), prayer, meditation, guided imagery

https://www.ncbi.nlm.nih.gov/pubmed/17610459

Primary Prevention: Promoting Non-opioid Pain Management

Group-based Self-Management Support/Training Programs

• Chronic Pain Self-Management Program

• Chronic Disease Self-Management Program

• Evidence-based exercise programs (including tai chi) https://www.ncoa.org/resources/issue-brief-implementing-

evidence-based-programs-address-chronic-pain/

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Primary Prevention: Promoting Non-opioid Pain Management

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http://www.wellconnectsemn.org/https://yourjuniper.org/

(SE MN Only)

Primary Prevention: Promoting Healthy Communities

• Change the narrative about pain and the relationship with opioids

• Fight to address disparities, build community capacity

• Focus on social determinants and upstream predictors

• Build partnerships with community stakeholders

**Opioid Dashboard: Social Determinants of Health

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”What to Do” In Summary

• In case of overdose: 911, poison control, naloxone

• For people with opioid use disorder: support treatment plan and recovery, support caregivers/family

• For folks on opioids: assess for use disorder frequently; encourage safe use, storage, and disposal; connect to wrap-around services when needed

• For folks with pain: develop/participate in person-centered care plans

• Always: change the narrative and culture around pain; promote physical activity and positive, non-opioid pain management; address social determinants

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Questions?

contact

info@mngero.org

Beyond Diagnosis: Rehabilitation Aspects in Dementia

Ed Ratner, MD, Associate Professor of Medicine, University of Minnesota;

Associate Director for Education and Evaluation, Minneapolis VA Medical Center.

NEXT WEBINAR

August 16, 2018

noon – 1:00 pm