Grant Baldwin, PhD, MPH

December 1, 2015

CDC Initiatives & Priorities to Address the

Prescription Drug Overdose Crisis

National Center for Injury Prevention and ControlDivision of Unintentional Injury Prevention

HHS 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

Three Pillars of CDC’s Work Improve data quality and track trends Strengthen state efforts by scaling up

effective public health interventions Supply healthcare providers with resources

to improve patient safety

Improving the quality & timeliness of opioid overdose surveillance

WHAT WE’RE DOING Generate near real-time surveillance

of emergency department visits related to drug overdoses

Improve surveillance of EMS transports related to drug overdoses

WHY WE’RE DOING IT An early warning of large increases or

decreases of drug overdoses to better target prevention efforts

Better understand changing demographic patterns of drug overdoses

Prevention for States (PfS) Provides states guidance and

resources to prevent prescription drug overdoses by addressing problematic opioid prescribing

Builds on the success of the Prevention Boost – Funding Opportunity

16 states funded with average award ranging from $750K to $1M

Funding to states with high burden and readiness to act

Focus on high impact, data driven activities and give states flexibility to tailor their work

Expand or improve proactive PDMP reporting

Expand/maximize PDMPs as a surveillance system

Implement mandatory PDMP registration or use

Reduce PDMP data collection interval

Evaluate existing PDMP practices*

Enhance Patient Review and Restriction (PRR) capacity

Enhance other health insurer/system practices*

Develop and apply metrics for inappropriate prescribing

Identify high-risk groups among the insured

Conduct cost analyses

Identify effective benefit design strategies

Disseminate best practices info for insurers

Provide technical assistance to high burden communities and counties*

Evaluate laws/policies/regulations implemented in states, including their impact on heroin and

prescription drug abuse/overdose

Disseminate information on effective laws/policies/regulations

Funding

Surveillance expertise

TA on policy & program

development

Evaluation guidance

Dissemination of best

practices

Short (1 year)Policy/Program Development

Medium (1−3 years)Behavior Change

Authority to send proactive reports

Mandatory registration & use

Reduced data collection interval (e.g., real time reporting)

Increased use of standard PDMP reports for surveillance and

other purposes

Long (3−5 years)Health Outcomes

Increase enrollment in PRR programs

Implemented robust drug utilization review programs

Implemented enhanced drug formularies

Revised policy on Medication Assisted Treatment (MAT)

Evidence of effectiveness for pain clinic laws

Evidence of effectiveness for clinical guidelines/rules

Evidence of effectiveness for licensure boards enforcement

policies and practices

Evidence of effectiveness for immunity/naloxone laws

Increased use of PDMPs

Decreased rate of high-dose (>100 MME/day) opioid Rxs

Decreased rate of dangerous drug combinations

Decreased prescribing patterns inconsistent with guidelines/rules

Increased # of patients on MAT

Decreased use of methadone for pain

Increased law enforcement and licensure boards using PDMP data

Increased enforcement actions against outlier providers

Decreased number of pill mills

Fewer drug diversion cases

Increased opioid substance abuse

treatment admissions (ultimately want

decrease)

Improvement in treatment of pain

Decreased drug overdose death rate

Decreased rate of ED visits due to controlled

prescription drugs

Decreased doctor shopping rate

Reduced barriers to seeking help and responding with naloxone to

an overdose

Enhanced adoption of opioid prescribing guidelines*

Increased number of patients enrolled in PRR programs

Reduced number of providers and MME/day among PRR enrollees

Increased use of claims reviews to identify outlier providers

**High-Risk Prescribing/

Patient Behaviors

• High-dose opioids (>100 MME/day)

• Multiple providers• Co-prescribing of

opioids and benzodiazepines

• Lack of access to substance abuse treatment

Enhance and Maximize PDMPs

Improve Insurer/Health System Mechanisms

Evaluate Laws/Policies/Regulations

PDMPS

Insurers/Health Systems

Strengthened Evidence

Providers

Insurers/Health Systems

Oversight/Enforcement

LOGIC MODEL Prescription Drug Overdose: Prevention for States and Prevention Boost*

Targeting High-Risk Prescribers and High-Risk Patients**

Patients

State-Level OutcomesOutputs/Strategies***Inputs

*These activities are being conducted through PFS only – all other activities are conducted through both Boost and PFS.***Through PFS, states can propose Rapid Response Projects that break new ground in any of these areas.

Enhance and Maximize

PDMPs

Community or Health System Interventions

State Policy Evaluation

Rapid Response Projects

Move toward universal PDMP registration and use

Make PDMPs easier to use and access

Move toward a real-time PDMP

Expand and improve proactive reporting

Conduct public health surveillance with PDMP

Implement or improve opioid prescribing interventions for insurers, health systems, or pharmacy benefit managers. This includes:

Prior authorization, prescribing rules, academic detailing, CCPs, PRRs,

Enhance adoption of opioid prescribing guidelines

Allow states to move on quick, flexible projects to respond to changing circumstances on the ground and move fast to capitalize on new prevention opportunities.

Build evidence base for policy prevention strategies that work like pain clinic laws and regulations, or naloxone access laws

Prevention for States ProgramCOMPONENTS

1 2

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Opioid Prescribing Guidelines for Chronic Pain

Outside of Active Cancer, Palliative, & End-of-life Care

PRIMARY CARE

LeveragingAHRQSystematic Review

Sept 2014

Process Used to Develop the Guidelines GRADE Method Multi-staged development with stakeholder

input Projected release in January 2016

Opioid Prescribing Guideline

Intended for primary care providers.

Will apply to patients >18 years old in chronic pain outside of end-of-life care

Clinical Practices Addressed in the Guidelines

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

Research priorities: Insurer, health system, and pharmacy benefit manager

strategies

Which insurance and pharmacy benefit manager interventions change prescribing behaviors most effectively (e.g., drug utilization review, patient review and restriction, prior authorization)?

Which of these interventions are most cost-effective?

What are the effective ways that state public health departments can engage insurers and pharmacy benefit managers to foster adoption of these interventions?

Research priorities: State policies and strategies

What are the impacts of innovative, untested policies and strategies at the state level?

Which PDMP strategies (e.g., mandatory registration) enhance use and produce the greatest impacts?

What are the cost implications and cost savings of identified policy changes?

How can communications campaigns influence physician opioid prescribing and patient opioid use?

Research priorities: Risk and protective factors for prescription drug

and heroin mortality

How can PDMP, coroner, medical examiner, and law enforcement data be used to identify risk and protective factors for drug overdose?

What are the patterns of co-use of prescription opioids and heroin, injection of opioids, and overdose?

Does controlled substance prescribing, including opioid pain reliever prescribing, increase risk for heroin overdose?

Research priorities: Clinical practice guidelines and coordinated care plans

What are the clinical decision support needs, barriers, and effective approaches to promoting guideline adherence in primary care?

What factors facilitate adoption of coordinated care plans in health systems?

What are the patient and health system impacts of guideline, clinical decision support, and coordinated care plan implementation?

http://www.cdc.gov/injury/researchpriorities/

More Information:

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.