2016 All State Epidemiologists Conference Call

November 28, 2016

Agenda

  1. Welcome

New State Epidemiologists

  • Jenifer Layden, Illinois
  • Paul White, Como

CSTE is seeking a volunteer to serve and represent CSTE as a Journal Editor for the Public Health Reports The estimate time commitment is 3 hours per week, which includes a 45 minute weekly editorial Committee and time to screen submitted manuscripts for potential peer review.

  1. The Opioid Drug Epidemic: Presidential Priority

Jay Butler, AK ASTHO President* presentation slides included in email

Highlights

2017 Challenge: Public Health Approaches to Preventing Substance Misuse and Addictions

Scope of Substance Misuse and Addiction

  • Legal Substances
  • Illicit Substances
  • Therapeutic Substance and Prescription Drugs
  • Emerging Technologies

Substance Misuse and Addictions: Prevention Framework

  • Environmental Control and Social Determinants
  • Chronic Disease Screening and Management
  • Acute Health Event Control and Prevention

2016-2019 Strategic Map

Develop and Leverage Public Health Approaches to Prevent Substance Misuse, Addictions, and Related Consequences

  • Reduce Stigma and Change Social Norms
  • Increase Protective Factors and Reduce Risk Factors in Communities
  • Strengthen Multi-Sectoral Collaboration
  • Strengthen Prevention Infrastructure
  • Optimize the Use of Cross-Sector Data for Decision making

What Can We Do? Acute Health Event Control and Prevention

  • Increase access to naloxone
  • Support clean needle use
  • Reduce impaired driving

What Can We Do? Chronic Disease Screening and Management

  • Reframe “addictions”
  • Increase screening and diagnosis
  • Improve access to withdrawal symptom management and support for recovery

What Can We Do? Environmental Controls and Social Determinants

  • Promote health families and increase resiliency
  • Reduce the prescription supply of opioid in communities
  • Support safer pin management and judicious prescribing

What Can We Do? Use data for assessing the problem and measuring progress

  • Standardize and enhance post-mortem toxicological testing in investigation of suspected overdose and suicide deaths (e.g., testing for fentanyl)
  • Leverage Violent Deaths Reporting Systems to increase timeliness and accuracy of data collection and analysis
  • Develop syndromic surveillance methodology to identify clusters of overdose and substance toxicity
  • Increase capacity to determine risk factors for HCV infection
  • Establish access to and capacity to analyze PDMP data
  • Utilize BRFSS module assessing ACEs
  • Create lines of communication to assure cross-sectoral data sharing

What Will Success Look Like?

Near horizon (next 3 years)

  • Reduced deaths from drug overdose
  • Declines in motor vehicle crashes from impaired driving
  • Fewer self-injection related HIV and HCV infections
  • Less unintentional injuries and self-harm related to drugs and alcohol

Further horizons

  • Lower rates of drug misuse and addiction, including underage use
  • Reduce drug- and alcohol- related incarceration and re- incarceration of persons with addictions
  • Lower rates of crime and referrals to child protective services
  • Less interpersonal violence, self-harm, and child neglect
  • Prevention of excessive prescriptions for controlled substance while improving wellness and function

Debra Houry, MD, MPH Director National Center for Injury Prevention* presentation slides included in email

The Opioid Drug Crisis

Highlights

  • Nearly a half million: people have died from drug overdoses in the United States from 2000-2014
  • 78 Americans die every day from an opioid overdoses
  • 249 million prescription were written in 2013- enough for every adult American to have a bottle of pills.
  • The amount of opioid prescriptions dispensed has Quadrupled since 1999
  • But the pain that American report remains Unchanged

States with more opioid pain reliever sales tend to have more drug overdose deaths

Purpose of CDC’s Guideline for Prescribing Opioid for Chronic Pain

  • Reduce the number of patient exposed to opioids
  • Support primary care providers in addressing and treating patients with chronic pain
  • Improve patient-provider conversations about the risks and benefit of opioids
  • Not intended for patients undergoing active cancer treatment, palliative care ,or end –of –life care

The Evidence

  • Lack of evidence that opioids control pain effectively long term.
  • Risk of serious harm increases with opioid dose.
  • Up to a quarter of patients receiving opioids long-term in a primary care setting struggles with addiction.

What can providers do?

  • First, do no harm. Opioids are not first line or routine therapy for chronic pain.
  • When opioids are used, prescribe the lowest effective dosage.
  • Exercise caution when prescribing opioids and monitor all patients closely.

Implementation

  • Improve Data & Surveillance
  • Strengthen State Efforts
  • Support Healthcare Providers

Strengthening State Efforts

  • State Prevention Programs
  • Equip states with resource and scientific assistance to prevent prescription opioid overdoses
  • Maximizing PDMPs
  • Improving public insurance mechanism
  • Providing technical assistance to communities
  • Policy Evaluation to identify what works

CSTE President Priorities – Joe McLaughlin, AK

2016-2017 President Priorities

  • Primary priority involves in collaborating with SAMSA, CDC and ASTHO and others on improving epidemiological capacity nationwide to address emerging and the longstanding public health concerns around substance abuse
  • Brief Summary Of CSTE
  • Well-funded Corporative Agreement with SAMSA
  • Building behavioral health epidemiological capacity through CSTE applied fellowship
  • Supporting 12 short term pilot projects at state and local departments to utilized novel surveillance methods to address emerging behavioral health priorities
  1. Washington, D.C. Update
  2. National Office Update

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