April 10-12, 2012 Walt Disney World Swan Resort

Examining What’s Happening Across America

 Accepted  Learning  Objec1ves:  

1.  Analyze  the  characteris1cs  of  effec1ve  programs  designed  to  reduce  the  growth  of  prescrip1on  drug  abuse  and  provide  evidence-­‐based  programs  that  can  be  replicated  in  rural  and  urban  communi1es.  

2.  Iden1fy  common-­‐interest  issues  related  to  grassroots  preven1on  and  treatment  programs.  

3.  Describe  resources  to  advocate  for  change,  with  specific  focus  on  model  state  drug  laws.  

Disclosure  Statement  

All  presenters  for  this  session,  Sherry  Green,  Robert  I.L.  Morrison,  and  Steve  Pasierb,  have  disclosed  no  relevant,  real  or  apparent  personal  or  professional  financial  rela1onships.  

State  Substance  Abuse  Agencies  and  Prescrip2on  Drug  Abuse  

Ini1al  Results  from  a    NASADAD  Membership  Inquiry  

Robert  Morrison,  Execu1ve  Director  

Cliff  Bersamira,  Research  Analyst  

Na1onal  Associa1on  of  State  Alcohol  and  Drug  Abuse  Directors,  Inc.  (NASADAD)  April  2012  

Na1onal  Associa1on  of  State  Alcohol  and  Drug  Abuse  Directors,  Inc.  

• State  Substance  Abuse  Agency  Directors  (SSAs)  manage  the  publicly-­‐funded  State  substance  abuse  preven1on,  treatment,  and  recovery  systems.  

• NASADAD  established  in  1971  in  Washington,  DC.  

• Component  Groups:  Na1onal  Preven1on  Network  (NPN)  and  Na1onal  Treatment  Network  (NTN).  

Poisoning  is  the  Leading  Cause  of  Death  from  Injury  in  30  States  (CDC,  2011)  

Warner  M,  Chen  LH,  Makuc  DM,  Anderson  RN,  Miniño  AM.  Drug  poisoning  deaths  in  the  United  States,  1980–2008.  NCHS  data  brief,  no  81.  Hya`sville,  MD:  Na1onal  Center  for  Health  Sta1s1cs.  2011.  

Opioid  Analgesics  Involved  in  More  Than  40%  of  Drug  Poisoning  Deaths  in  2008  (CDC,  2011)    

Number  of  drug  poisoning  deaths  involving  opioid  analgesics  and  other  drugs:  United  States,  1999–2008  

Warner  M,  Chen  LH,  Makuc  DM,  Anderson  RN,  Miniño  AM.  Drug  poisoning  deaths  in  the  United  States,  1980–2008.  NCHS  data  brief,  no  81.  Hya`sville,  MD:  Na1onal  Center  for  Health  Sta1s1cs.  2011.  

NASADAD  Membership  Inquiry:  Primary  Objec1ves  

• Understand  how  States  Substance  Abuse  Agencies  are  addressing  prescrip1on  drug  abuse.  

• Iden1fy  effec1ve  prac1ces  and  challenges/barriers.  

• Iden1fy  training,  technical  assistance,  and  resource  needs.  

Membership  Inquiry:  Overview  

• Web  survey  conducted  in  March  2012.  • Invited  State  Directors  (SSAs),  Treatment  Leads  (NTNs),  and  Preven1on  Leads  (NPNs)  to  par1cipate.  • 46  States,  2  Territories,  and  the  District  of  Columbia  responded.  • Analysis  includes  46  States  and  the  District  of  Columbia  (N  =  47  States).  

Importance  of  Prescrip1on  Drug  Abuse  to  State  Substance  Abuse  Agencies  

23%  

58%  

15%  4%   Most  Important  (11)  

Very  Important  (27)  

Important  (7)  

Moderately  Important  (2)  

Of  Li`le  Importance  (0)  

Unimportant  (0)  

State  Task  Force  Addressing  Prescrip1on  Drug  Abuse  

62%  15%  

19%  

4%   Yes,  currently  exists  (29)  

Yes,  once  existed  but  no  longer  ac1ve  (7)  No  (9)  

Unsure  (2)  

State  Task  Force  :  California  • State  Agency  Task  Force  established  in  2008.  • Task  Force  included:  Department  of  Jus1ce;  Department  of  Public  Health;  California  Universi1es;  Partnership  for  a  Drug-­‐Free  America;  AOD  workforce  professionals;  State  Substance  Abuse  Agency  • Summary  Report  and  Recommenda1ons  on  Prescrip1on  Drugs:  Misuse,  Abuse  and  Dependency  (2009)  h`p://www.adp.cahwnet.gov/Director/pdf/Prescrip1on_Drug_Task_Force.pdf    

State  Task  Force:  Iowa  • 370%  increase  (1999-­‐2009)  in  those  seeking  treatment  for  prescrip1on  drug  abuse  • 187  in  1999  to  878  in  2009  • Iowa  Prescrip1on  Drug  Abuse  Reduc1on  Task  Force  (PAR)  • Iowa  Plan  for  Reducing  Prescrip1on  Drug  Abuse  (2011)  h`p://nursing.iowa.gov/images/pdf/BM%20A`achments/ReducPresDrgAbuse.pdf    

• Educa1on/Interven1on;  Safe  Disposal;  Monitoring;  Enforcement  

State  Legisla1on  Addressing  Prescrip1on  Drug  Abuse  

Breakdown  by  Legisla2on  Focus  (N  =  47)  

79%  

19%  2%  

Yes  (37)  

No  (9)  

No  Response  (1)  

40%  

51%  

45%  

62%  

43%  

30%  

36%  

30%  

15%  

17%  

17%  

6%  

Focus  on  Prescriber  

Focus  on  Legal  Dispenser/Pharmacy  

Focus  on  Supply  

Focus  on  Demand  

Percent  of  States  

Yes   No   Unsure   No  Response  

Any  Legisla2on  (N  =  47)  

Educa1ng  the  General  Public  on  Prescrip1on  Drug  Abuse  

Any  Educa2on  (N  =  47)   By  Educa2on  Type  (N  =  47)  

83%  

17%  

Yes  (39)   No  (8)  

17%  

32%  

40%  

26%  

64%  

0%   20%   40%   60%   80%  

No  

Yes,  Other  

Yes,  Mul1media  (radio  or  television)  

Yes,  Internet  campaign  

Yes,  Printed  materials  

Percent  of  States  

Programs  or  Ini1a1ves  for  Target  Popula1ons  

•  Other  Popula1ons  Cited:  •  Na1ve  Americans  and  Tribes  (2)  

•  Pregnant  Women  (2)  

•  Those  with  Chronic  Health  Condi1ons  (1)  

•  Post-­‐Natural  Disaster  Communi1es  (1)  

19%  

23%  

53%  

55%  

47%  

34%  

13%  

13%  

6%  

13%  

17%  

6%  

Women  

Older  Adults  

Adolescent/  Young  Adults  

Percent  of  States  

Yes   No   Unsure   No  Response  

Addressing  Target  Popula1ons:  Mississippi  

• Development  of  print  materials  targeted  towards  adolescents.  • Trainings  for  care  givers  of  older  adults.  

Educa1onal  Ac1vi1es  for  Physicians,  Pharmacists,  and  Pa1ents  

53%  

38%  

51%  

34%  

32%  

28%  

11%  

17%  

15%  

13%  

6%  

Pa1ents/Families?  

Pharmacists?  

Physicians/Other  Prescribers?  

Percent  of  States  

Target  Group

 

Yes   No   Unsure   No  Response  

State  Substance  Abuse  Agency  Involvement  with  the  Prescrip1on  Drug  Monitoring  Program  (PDMP)  (N  =  28)  

11%  

11%  

32%  

43%  

3%  Directly  oversees  PDMP  (3)  

Part  of  commi`ee  that  oversees  PDMP  (3)  

Serves  in  an  advisory  capacity  (9)  

No  involvement  (12)  

Unsure  (1)  

Usefulness  of  PDMP  Data  to  State  Substance  Abuse  Agencies  

36%  

28%  

13%  

2%  4%  

11%  

6%  Very  Useful  (17)  

Useful  (13)  

Somewhat  Useful  (6)  

Not  Par1cularly  Useful  (1)  

Not  Useful  (2)  

Not  Applicable  (5)  

Unsure  (3)  

Highlights  of  State  Programs  and  Ini1a1ves:  Themes  across  States  

•  Collabora'on  •  e.g.  across  State  agencies;  with  law  enforcement;  with  primary  care  providers;  across  States  

•  Educa'on  and  Preven'on  •  e.g.  provide  community  educa1on;  mobilize  preven1on  coali1ons;  educate  prescribers  and  pharmacists  

•  Early  Iden'fica'on  and  Referral  to  Treatment  

•  e.g.  SBIRT  training  for  physicians  •  Supply  Reduc'on  •  e.g.  take  back  ini'a'ves  

Highlights:  Ohio  •  In  2009,  opiates  were  primary  drug  of  choice  for  18%  of  all  clients  (up  from  7%  in  2001).  

• Top  priority  of  Governor  Kasich  –  includes  a  Task  Force  led  by  SSA.    

• State  conference  in  2011.  • “Recovery  2  Work”  Ini1a1ve  –  Led  by  SSA,  Rehabilita1on  Services,  and  County  Authori1es.  

•  Integrates  addic1on  treatment  with  voca1onal  rehab  services  –  focus  on  jobs.  

h`p://recovery2work.org    

Highlights:  Oregon  • In  2010,  the  State  Agency  developed  the  Prescrip1on  Opioid  Poisoning  Preven1on  (POP)  Ac1on  Plan  to  reduce  analgesic  overdose  deaths  in  the  State.  

• This  plan  took  a  mul1-­‐agency,  public-­‐private  collabora1on  approach  to  addressing  four  areas:  1)  communica1on;  2)  educa1on;  3)  clinical  prac1ce  and  policy;  4)  system  coordina1on  clinical  prac1ce  issues.  

Highlights:  Utah  • Legisla1on  requires  prescribers  to  a`end  four  hours  of  substance  abuse  classes.  

• April  is  designated  as  “Clean  Out  your  Medicine  Cabinet”  Month.  

h`p://www.medica1ondisposal.utah.gov/cleanoutcabinet.htm  

• Through  local  preven1on  coali1ons,  successful  take  back  events  have  collected  6,550  pounds  of  prescrip1on  drugs.  

Highlights:  Vermont  • 2nd  highest  State  per  capita  for  admissions  to  prescrip1on  opiates  treatment  in  2008.  

• Prescrip1on  Drug  Abuse  Work  Group.  

• State  Agency  sponsored  hospital  grand  rounds  –  call  a`en1on  to  awareness.  

• Conference  in  2009  on  Pain  Management.  

• Hub  and  Spoke:  5  loca1ons  with  specialty  treatment  /assessment/counseling  (hub)  monitoring/support/physician  prac1ces  (spoke).  

Highlights:  Arizona  

• State  Agency  collaborated  with  Poison  Control  Centers  to  iden1fy  repeat  poisonings  and  make  referrals  to  SUD  treatment  services.  

• Online  trainings  were  developed  for  Emergency  Department  doctors  to  increase  the  understanding  of  screening  and  referral  process.  

Highlights:  Connec1cut  

• Community  preven1on  coali1ons  are  priori1zing  prescrip1on  drug  abuse  and  misuse.  

• Drop  Boxes  are  installed  in  mul1ple  police  sta1ons  across  the  State.  

Remaining  Challenges:  Themes  across  States  

•  Easy  access  (high  supply)  of  prescrip1on  drugs.  •  Lack  of  funding.  •  Need  for  workforce  development  (lack  of  capacity  to  address  this  issue).  

•  Challenges  with  data  (lack  of  data;  data  that  doesn’t  capture  the  en1re  story).  

•  Need  to  priori1ze  the  issue.  •  Challenges  with  collabora1on.  •  Need  for  PDMP  improvement  (need  for  improved  collabora1on  with  PDMP  host  agency;  lack  of  funding  for  PDMP).  

Conclusion  

• This  is  a  complex  problem.  • Collaborate  with  your  State  Substance  Abuse  Agency.  

Contact  Informa2on:  Email:  rmorrison@nasadad.org  

Website:  www.nasadad.org