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11/29/2016
1
It Takes A Village to Curb the Prescription Opioid Epidemic:
CDC EffortsJan Losby, PhDTeam Lead, Overdose Prevention Health Systems TeamDivision of Unintentional Injury PreventionCenters for Disease Control and Prevention
Session L6This presenter has
nothing to disclose
December 4, 20161:00-4:30
28thIHIFORUM
Supply healthcare providers with resources to improve patient safety
Strengthen state efforts by scaling up effective public health interventions
Improve data quality and track trends
Pillars of CDC’s Overdose
Prevention Work
P2
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2
Patients 18 years or older with chronic pain
Outpatient settings
Outside of active cancer, palliative, and end of life care
Primary care providers
CDC Guideline for Prescribing
Opioids for Chronic Pain
P3
Organization of Guideline
Recommendations
12 recommendations are grouped into three
conceptual areas:
• Determining when to initiate or continue opioids for chronic pain
• Opioid selection, dosage, duration, follow-up, and discontinuation
• Assessing risk and addressing harms of opioid use
P4
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3
Dissemination & Implementation
Approach
Translation & Communication
Clinician Education &
Training
Health Systems
Interventions
Insurer
Interventions
P5
Translation & Communication
Checklist
Tapering
Nonopioid Treatments
Pharmacists on the Front
Lines
Assessing Benefits and
Harms of Opioid Therapy
Prescription Drug
Monitoring Programs
(PDMPs)
Calculating Total Daily Dose
of Opioids for Safer
Prescribing
P6
11/29/2016
5
Patient Materials
• Graphics and messages
• Fact Sheets
• Prescription Opioids:
What You Need to Know
• Pregnancy and Opioids
• Posters
• Podcasts
• Infographics
P9
Clinician Education & TrainingP10
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6
Clinician Outreach and Communication
Activity (COCA) Webinars
Earn CMEs/CEs:
1. Overview of Guideline
2. Nonopioid Treatments for
Chronic Pain
3. Assessing Benefits and Harms
of Opioid Therapy
4. Dosing and Titration of Opioids
5. Opioid Use Disorder—
Assessment and Referral
6. 12/6: Risk Mitigation Strategies
7. 12/13: Effective
Communication with Patients https://emergency.cdc.gov/coca/calls/2016/index.asp
P11
Coming Soon
• Mobile “app” with
morphine milligram
equivalent (MME)
calculator
• Videos
• Brochures and pocket
guides
• Online training for
providers
P12
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7
Training Resources: Online Course
eLearning
• Web-based training
• Modules that can be completed
in 30 minutes or less
• Learner-directed content
• Scenario-based interactions
• Mini-lessons on implementing
the guideline
• Short videos
P13
Health Systems InterventionsP14
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8
Quality Improvement (QI) Initiative
Create QI measures
Create QI implementation guide
Launch & support Opioid QI Collaborative in 6 health care systems
Clinical Decision Supports
CDC & ONC collaborating
Create sharable EHR code/artifacts
Clinical sites to implement guideline & track outcomes
P15
Coordinated Care Plan
Created the Chronic Pain Care Involving Opioids: A Coordinated Care Plan for Safer Practice
Informed by Group Health and VA
Rigorous evaluation underway at MedStar in Maryland (9 clinical intervention sites & 9 clinical comparison sites)
Broad dissemination following evaluation conclusion
P16
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9
Coverage for non-pharmacologic therapies
Improve ease of prescribing non-opioid pain medications
Reimbursement for patient counseling, care coordination, & checking PDMP
Promote more judicious use of high dosages of opioids outside of palliative care, active cancer or end-of-life care, using mechanisms such as drug utilization review
Remove barriers to evidence-based treatment of opioid use disorder, such as eliminate lifetime limits on buprenorphine
Insurer InterventionsP17
PDMPs System-Level Evaluate Policy Rapid Response
Five Components
Funded State
Unfunded State
Surveillance
CDC Funded StatesP18
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10
P19Guideline Dissemination & Implementation:
State Examples
Translation & Communication
• Disseminating Materials to stakeholders
Clinician Education & Training
• Academic Detailing
Health Systems
• EHR & PDMP (Prescription Drug Monitoring Program) Integration
Insurers
• Workers’ Compensation
• Medicaid
U.S. Health and Human Services
Secretary’s Opioid Initiative
Focus on three priority areas that tackle the opioid crisis and significantly
impact those struggling with substance use disorders to help save lives
Providing training and educational resources to assist health professionals in making informed prescribing decisions
1
Increasing use of Naloxone
Expanding the use of Medication-Assisted Treatment
2
3
P20
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11
P21
Resources & Contact Information
CDC Opioid Overdose Prevention Website: www.cdc.gov/drugoverdose
HHS Prescription Drug & Heroin Overdose Epidemic: www.hhs.gov/opioids
Turn the Tide (Surgeon General’s website): http://turnthetiderx.org/#
Presenter Contact
Information:
Jan Losby
770-488-8085
Disclaimer:
The findings and conclusions of this
presentation are those of the
presenter and do not necessarily
represent the official position of the
Centers for Disease Control and
Prevention.