reducing the supply of illegal opioids · reducing the supply of illegal opioids in washington...

REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 1

REDUCING THE SUPPLY OF

ILLEGAL OPIOIDS IN WASHINGTON STATE

NOVEMBER 2017


Dear Washingtonians:

On average, two people die each day from opioid overdoses in our state. Tens of thousands of others

safe, and overwhelming our safety nets.

We partnered to convene the Summit on Reducing the Supply of Illegal Opioids in Washington, bringing together law enforcement, public health experts, prosecutors, and medical

As public safety professionals, we recognize that response to the opioid epidemic must include

Sincerely,

Bob Ferguson

Washington State Patrol

Bob Ferguson


•

GOALS & RECOMMENDATIONS

• •

•

• controlled substances.

• • •

•

•

• of overdoses.

•

•

2

1

3

5

6

7

• 4


REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE

Washington —more than six out of ten— involve an opioid.

born addicted to opioids.3

To be more successful at reducing the supply of illegal opioids in our state, we

to opioids.

80 PERCENT

started by using pain medication prescribed to them or someone they know

of heroin users

Attorney General Bob Ferguson provides introductory remarks at the Summit.


heroin

1.

371

694

176

446

61

281

0

100

200

300

400

500

600

700

800

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016*

Tota

l rep

orte

d dea

ths

Opioid Overdose Deaths in WashingtonAll Opioids Prescrip on Opioids Heroin

REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 5REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 5REDUCING THE SUPPLY OF ILLEGAL OPIOIDS IN WASHINGTON STATE 5

•

ADDRESS SIGNIFICANT GAPS IN PUBLIC AWARENESS ABOUT THE DANGERS OF OPIOIDS, AS WELL AS LESS RISKY ALTERNATIVES AVAILABLE

Youth hold these views, in part,

8

9

not only seen—but concentrated—among youth who have

views against illegal drug use.

1 in 4 teensbelieve there is

in using prescription pain relievers

without a prescription.

“LITTLE OR NO RISK”

1

Captain Juan Colon discusses New Jersey’s groundbreaking Drug Monitoring Initiative.


federal grant funds to conduct a statewide opioid misuse

increase awareness of appropriate opioid use, storage, and disposal, as well as how to respond to an overdose.

Washington, and transit ads in Southwest Washington.

will be accessible online and will include materials that

Due to the limited budget available, the campaign will introduce target audiences to the campaign messages

campaign going forward, such as tailoring outreach to

the Use Only As Directed

acetaminophen, ibuprofen, physical therapy, and

before they interacted with their doctor. Within four

Dose of Reality. This campaign also aims

disposal methods. The campaign includes radio and television commercials, digital online ads, print ads, and

Since the campaign launch, the Wisconsin Department

Wisconsin trailed only Texas in the amount of drugs collected. The Wisconsin materials have been adapted for and adopted by several other states.one of the states that adopted the Dose of Reality


••

•

2 PREVENT ADDICTION BY ADDRESSING OVERPRESCRIBING

By

– even though research has found that,

. This points to the need to change the protocols taught to medical and dental

Prescribing less

Guideline for Prescribing Opioids for Chronic Painbegins with the treatment of acute pain.

days will rarely be needed.

of opioids medical professionals may prescribe.

Drs. Amy Cook, Christopher Frank, and Sean Dobbin provide perspectives of dental, medical, and pharmacy providers.


Rates of Opioid Overdose Deaths, 2011-2015Rates Per 100,000 residents,

age-adjusted

Statewide Rate

9.7

*NR indicates data are not reliable

NR* 0 < 7

7 < 8.2 8.2 < 10.2

10.2 < 12.2 12.2 - 17

Whatcom 7.8

San Juan8.2

Island 11

Skagit 10.8

Snohomish 13.9

King 8.9

Pierce 10.2

Jefferson 8

Clallam 14.6

Thurston 8.4

Cowlitz 17

Klickitat 4.7

Skamania10.3

Yakima 5.4

Kittitas 9.3Grant 5.7

Adams 3.5 Whitman 7

Spokane 7.8Lincoln 12.4

Stevens 8.2

Chelan 11.2

Okanogan 7.8 Ferry 12.2

Douglas 10.2

Benton 8.6 Walla Walla 7.9

Garfield0

Wahkiakum 5.2Columbia 16.4

Asotin 10.7

Franklin 4.4

Clark 9.1

Lewis 10.9Pacific

6.8

GraysHarbor

10.5

PendOreille

14.3

Mason 14.1

Kitsap7.5

Rates of Opioids Prescribed, 2014

Whatcom 227

San Juan 207

Island 210

Skagit 253

Snohomish 251

King 210

Pierce 249

Jefferson 231

Clallam 261

Thurston 227

Cowlitz 273

Klickitat 136

Skamania 238

Yakima 269

Kittitas 218Grant 240

Adams 215 Whitman 210

Spokane 268Lincoln 289

Stevens 299

Chelan 252

Okanogan 252 Ferry 273

Douglas 249

Benton 272 Walla Walla 222

Garfield 302

Wahkiakum 274Columbia 284

Asotin 287

Franklin 257

Clark 237

Lewis 291Pacific

274

GraysHarbor

279

PendOreille

282

Mason 263

Kitsap226

Rates Per 1,000 residents, age & gender-adjusted

83-9874-82

60-7333-58

Statewide Rate

232


for acute pain, rather than chronic pain. Some states limit

The private sector has also imposed limits on opioid

opt out of these programs.

To date, Washington has not imposed daily or dosage limits

Days’ supply of first opioid prescription

Prob

abili

ty o

f con

tinui

ng u

se (%

) Using opioids 1 year later

Using opioids 3 years later504540353025201510

50

0 5 10 15 20 25 30 35 40 45

Risk of prolonged opioid use increases with

each day of prescription after just 3 days

Chief John Batiste highlights Washington State Patrol’s role in

combatting the opioid epidemic.


has directed the various boards and commissions that regulate

number of people who become addicted.

opioid pain treatments, such as physical therapy and acupuncture.

means that though they are covered, they may remain out of reach

The audience engaged in a robust discussion with members of the Public Health and Medical Community Perspectives panel, moderated by Dr. Kathy Lofy.


REDUCE ILLICIT USE OF PRESCRIPTION OPIOIDS

• controlled substances.

• • •

3

for illicit purposes. One way that people obtain increasing

to treatment. In Washington, dispensers—generally

54%36%

5%5%

Source of Opioids Used

Non-Medically

Friend/Family Doctor Drug dealer/Stranger Other

Snohomish County panelists Commander Patric Slack, Sheriff Ty Trenary, and Mr. Hil Kaman discuss innovative approaches underway in their community.


name and dosage, and the prescribing and dispensing dates.

been accessible to many Washington providers through one of the most commonly used electronic health record

the convenience this adds for providers and the fact that

no cost, beyond the emergency departments described below, only one health system has fully implemented

F.

convenience, this eliminates bias, as providers do not

is suspicious. Based on the results demonstrated in

implement this capability to enable their providers to

30%Only about

of Washington’s

MEDICAL & DENTAL PROVIDERSwho prescribe controlled substances have registered for the

Prescription Monitoring Program

Emergency Departments Prescribers in

Other Medical Settings

2014 26,546 522,872

2015 2,222,446 958,246

2016 2,722,172 802,104

PMP Queries


other licensed health care providers, such as medical assistants.

Accordingly,

and other controlled substances.33

In both

electronically from medical providers to pharmacists. Rx Fraud Alert Report,

38

incidents may have also occurred.

39 According

community pharmacies across the country are enabled

an electronic health records system.

for other household members, guests, or criminals to

Impact of Prescription Monitoring Program Mandate

in New York

Num

ber o

f PM

P re

port

requ

ests

by

med

ical

pro

vide

rs

Num

er o

f pat

ient

s ex

hibi

ting

sign

s of

doc

tor s

hopp

ing

PMP reportrequests

Patients visting 5 or more prescribers and pharmacieswithin the month

1,800,000

1,600,000

1,400,000

1,200,000

1,000,000

800,000

600,000

400,000

200,000

450

400

350

300

250

200

150

100

50

Oct‘11

Jan‘12

Apr‘12

July‘12

Oct‘12

Jan‘13

Apr‘13

July‘13

Oct‘13

Jan‘14

Apr‘14

July‘14

Oct‘14

Jan‘15

Apr‘15

July‘15

Oct‘15


cabinets. A study exploring why parents of teens do not

and did not believe that they could be used to get high.

opioids securely. These conclusions support the need

unusable.

were collected at these events in Washington. A study

opioids originally dispensed were unused.

0

2,000

4,000

6,000

8,000

10,000

12,000

Po

un

ds

Me

dic

ine

Snohomish County Law Enforcement

Medicine Collection (pounds)

2010 2011 2012 2013 2014 2015 2016

Since passing a pharmaceutical stewardship ordinance,

the number of secure medicine drop boxes in

has increased from

KING COUNTY

10 to 99with 80%

now located at pharmacies.


medicine return systems, including a minimum number of secure drop boxes in each city or town, prepaid mailers for those who are homebound, and public

claims.

million annually.

pouches may be helpful.

pharmacies.

the vehicle. They contacted the Pharmacy Board and

revealed that a pharmacy technician used his access to

names, obtaining access to opioids with a high street value paid for by the government.


DISRUPT AND DISMANTLE DRUG TRAFFICKING ORGANIZATIONS RESPONSIBLE FOR BRINGING NARCOTICS INTO OUR STATE

•

4

Seizure by Grant County Taskforce - Oct. 2017

De

served on homes and storage units throughout the

Department, Ephrata Police Department, and WSP.


$1,626,421

$624,602

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

$1,800,000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

State Funding for

Washington's Drug-Gang Task Forces


$5,838,974(1990)

$5,478,148(2004)

$6,600,000(2010)

$3,144,091(2017)

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016

Federal JAG Funding for

Washington's Drug-Gang Task Forces

-


PREVENT FURTHER INCREASES IN OVERDOSE DEATHS FROM FENTANYL5

overdose deaths in our state.

In contrast,

fentanyl at all. This can result in an overdose when they use the same amount they normally would.

fentanyl for amounts greater than ten grams. Those convicted of this crime now face up to twenty years in state

substances. The lethality of fentanyl and fentanyl analogues

enhanced penalty when those substances are involved. This can

standard range. Such a provision may prevent Washington from experiencing the explosion of fentanyl deaths experienced by states in other parts of the country.

•

Amount of fentanyl that

can be deadly


IMPROVE OVERDOSE REPORTING AND INFORMATION SHARING

• • •

6

deaths in that brief period. Furthermore, many of the overdoses occurred in a single day, which could be due to

expedites the chemical analysis of any drug evidence gathered whenever heroin is suspected in an overdose.

seized throughout the region and the impact on public health outcomes.

Dr. Richard Harruff underscores the importance of creating a real-time drug overdose monitoring system.


statewide system. The Washington State Toxicology

impaired driving cases—has increased by more than

overdose cases can help the state recognize and respond to emerging threats.

and enhance response to public health threats, it does not capture overdoses not treated in the emergency department. Emergency medical service providers

emergency medical services. However, DOH recently

these funds will be used, in part, to build the capacity of emergency medical service providers to report these data, including care provided to people who have overdosed. DOH will also use the grant funds to improve

to prevent and respond to opioid overdoses. In contrast, the State does not have an electronic system for law

responders to report their response to an overdose in

geographic area.

8,000

9,000

10,000

11,000

12,000

13,000

14,000

15,000

16,000

17,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017*

*2017 projected based on actual January - June 2017 submissions.

WSP Toxicology Lab

Number of case submissions per year

9,575

15,710


nonfatal.

also allows the public health department to perform analyses and issue community opioid report cards to monitor

Clallam County Community

Opioid Report Card - 2016


EXPAND ACCESS TO TREATMENT7

with similar felonies, who demonstrated a need for substance abuse treatment and were otherwise considered

•

King County Prosecuting Attorney Dan Satterberg remarks on the changing role of a prosecutor’s office in responding to the opioid epidemic.


the program.

this tax. The federal government has also recognized the

it serves.

into treatment and support services, rather than the

such as medical needs, housing, and mental health

Department of Human Services have partnered to hire

the community. The purpose is to connect people on the streets—those facing chronic homelessness and mental illness—to treatment providers, housing, and

individuals were connected to treatment. The limited availability of treatment has presented a barrier to

possession cases have been treated as misdemeanors

criteria, including possessing seven grams or less of a controlled substance and showing no signs of dealing, are eligible to have their charges reduced to


NOTES

Opioid-related Deaths in Washington State, 2006-2016. Retrieved from .

opioid. See:

Morbidity and Mortality Weekly Report .

3

Morbidity and Mortality Weekly Report .

. Retrieved from .

. Retrieved from tanyl.html.

Fentanyl Overdose Deaths in Washington State. Washington State Department of Health. Retrieved from .

trieved from: .

8 . Retrieved from .

9 Pediatrics, 136

Ibid.

Dose of Reality campaign.

.

Morbidity and Mortality Weekly Report

linical Journal of Pain, 30


Pain Medicine

Morbidity and Mortality Weekly Re-port;60

Medscape. Retrieved from

NPR. Retrieved from

DOI: .

Interagency Guideline on Prescribing Opioids for Pain. Retrieved from .

Morbidity and Mortality Weekly Report, 66 .

prescribe an opioid to a minor is available at:

.

Opioid Clinical Policy—Medicaid. Retrieved from

.


. Retrieved from .

Washington.

33

ing, , is available at: .

Retrieved from .

. Retrieved from .

Ibid.

38 The latest Rx Fraud Alert report is available online: .

39

enforcement mechanism.

ONC Data Brief, no.18

.


Journal of .

Pediatrics, 139.

.

. For Walgreens store count by state, see .

-. Retrieved from

King

are not yet available.

. Retrieved from .

-. Retrieved from

.

Beshear, Partners Launch Kentucky Opioid Disposal . Retrieved from .

Ibid.

Washington. Retrieved from


Release: . Retrieved from .

Providence Journal. Retrieved from

.

. Retrieved from .

. Retrieved from: .

Data Analysis Division. Retrieved from .

. Retrieved from .

Costs

.

.

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