Project Lazarus 2014 Health Expo Presentation

Preventing opioid poisonings Promoting responsible pain management Fred Wells Brason II .rason@projectlazarus.org Who is Project Lazarus? •  Non-­‐profit organiza<on •  Provides training and technical assistance •  Using experience, data, and compassion we empower communi<es and individuals to prevent drug overdoses and meet the needs of those living with chronic pain •  Believes that communi<es are ul<mately responsible for their own health and that every drug overdose is preventable. Prescrip<on Drug Misuse Overdose Defined: Accidental Poisoning – Uninten<onal Overdose Overdose – WHO? Pa<ent misuse Family/Friends sharing to self medicate Recrea<onal User Substance Use Disorder/Treatment/Recovery CDC Policy Impact: Prescrip?on Painkiller Overdoses Source: CDC-www.cdc.gov/homeandrecreationalsafety/rxbrief/
The Project Lazarus Model Project Lazarus Model Community Educa-on
Addic-on Treatment
Harm Reduc-on
Public
Awareness
Provider Educa-on
Coalition Action
Data &
Evaluation
Pain Pa-ent Support
Hospital ED Policies
Diversion Control
The Project Lazarus Model can be conceptualized as a wheel, with three core components (The Hub) that must always be present, and seven components (The Wheel) which can be ini<ated based on specific needs of a community. THE HUB I.  Public Awareness – is par<cularly important because there are widespread misconcep<ons about the risks of prescrip<on drug misuse and abuse. It is crucial to build public iden<fica<on of prescrip<on drug overdose as a community issue. That overdose is common in the community, and that this is a preventable problem must be spread widely. II.  Coali?on Ac?on -­‐ A func<oning coali<on should exist with strong <es to and support from each of the key sectors in the community, along with a preliminary base of community awareness on the issue. Coali<on leaders should also have a strong understanding of what the nature of the issue is in the community and what the priori<es are for how to address it. Data & Evalua<on – The Hub cont. •  Data & Evalua?on •  Using data to understand community problems and poten<al priori<es •  Evalua<on of coali<on ac<on, events, and trainings Epidemiologic Profile of Uninten?onal Poisonings: Cabarrus, Rowan and Stanly Coun?es, N.C. A decade of fatal uninten?onal* poisonings: Cabarrus, Rowan and Stanly Coun?es, NC, 2000-­‐2012 35 Number of Annual Deaths 30 29 25 25 21 20 20 17 15 10 5 10 8 6 4 8 1 0 2000 2004 Cabarrus 2008 Rowan Stanly 2012 Uninten?onal* Poisoning Mortality Rates: Cabarrus, Rowan and Stanly Coun?es, NC-­‐ 2009-­‐2012 Mortality rates per 100,000 residents 25 21 19.2 20 16.5 15.1 15 11.2 10 State Average Rate, 11.8 10.4 5 0 Cabarrus Rowan 2009 2012 Stanly Uninten?onal Poisoning* Related ED Visits (2009-­‐2012) ED visit rates/100,000 pop. NC state average ED visit rate=743.8 visits 1000 900 899.3 825.1 800 812.2 722.3 700 618.8 600 598.8 500 400 300 200 100 0 Cabarrus Rowan Stanly *Sources: NCDETECT for ED and NCSCHS for Hospitaliza<ons, based on ICD-­‐9-­‐CM codes=292.0, 977.9, E850-­‐E858.9, 960-­‐969.9, E980-­‐E980.9, 304-­‐304.9, 305.2-­‐305.93, Records must 2009 960-­‐969.9, 2012 NOT also have one of the following E-­‐codes: between 'E950' and 'E959.99‘. Report prepared by K. Harmon, NC-­‐DPH Injury and Violence Preven<on Branch, Jan. 2011. Hospitaliza?on Rates: Cabarrus, Rowan, Stanly (2008) Hospitaliza?on rates/100,000 pop. NC state average hospitaliza<on rate=433.6 hospitaliza<ons 900 800 700 613.2 600 500 469.3 440.8 400 300 200 100 0 Cabarrus Rowan Stanly *Sources: NCDETECT for ED and NCSCHS for Hospitaliza<ons, based on ICD-­‐9-­‐CM codes=292.0, 960-­‐969.9, 977.9, E850-­‐E858.9, 960-­‐969.9, E980-­‐E980.9, 304-­‐304.9, 305.2-­‐305.93, Records must NOT also have one of the following E-­‐codes: between 'E950' and 'E959.99‘. Report prepared by K. Harmon, NC-­‐DPH Injury and Violence Preven<on Branch, Jan. 2011. Venues to help build coali?ons Rela?onal Diagram among All Components of the Coali?on Community Awareness
Risk Reduction – Community Education
Pa<ent opioid safety educa<on starts in the clinic and con<nues in the community. The SPOKES Community Educa?on – -­‐ efforts are those offered to the general public and are aimed at changing the percep<on and behaviors around sharing prescrip<on medica<ons, and improving safety behaviors around their use, storage, and disposal. “Prescrip)on medica)on: take correctly, store securely, dispose properly and never share.” The Spokes-­‐ Prescriber Educa<on •  Treatment of chronic pain •  Exploring op<ons instead/in addi<on to medica<ons •  Reduce risk of pa<ent medica<on diversion •  Reduce risk of pa<ent overdose •  Reached via trainings with Con<nuing Medical Educa<on Units (CME), lunch and learn, Grand Rounds, webinars •  Use of the Prescribers Toolkit •  Pa<ent Educa<on The Spokes-­‐ Hospital ED Policies •  Working with hospitals to develop a system-­‐wide standardiza<on with respect to prescribing narco<c medica<on •  Use of the Chronic Pain Ini<a<ve Tool Kit: Emergency Departments •  Dispensing naloxone THE SPOKES cont. Diversion Control Diversion Control -­‐ Suppor<ng pa<ents who have pain, par<cularly those who are treated with opioid analgesics, is an important form of diversion control: take correctly, store securely, dispose properly and never share. -­‐ Law Enforcement, Pharmacist and Facility training on forgery, methods of diversion and drug seeking behavior THE SPOKES cont. Pain Pa?ent Support Pain Pa?ent Support -­‐ In the same way that prescribers benefit from addi<onal educa<on on managing chronic pain, the complexity of living with chronic pain makes suppor<ng community members with pain important. “Proper medica)on use and alterna)ves” Take correctly, store securely, dispose properly and never share! The Spokes-­‐ Harm Reduc?on •  Overdose preven<on training •  Increasing access to naloxone (Narcan) •  Reverse opioid overdose •  Prescribetoprevent.org •  Distribu<ng a script that gives pa<ents specific language they can use with their family to talk about overdose and develop an ac<on plan, similar to a fire evacua<on plan •  Naloxone access to community in general, military and Tribal groups •  Opera<on OpioidSAFE Project Lazarus Model Community Educa-on
Provider Educa-on
Addic-on Treatment
Harm Reduc-on
NALOXONE
Pain Pa-ent Support
Diversion Control
Hospital ED Policies
Substance Abuse treatment and Recovery Addic?on treatment, especially opioid agonist therapy like methadone maintenance treatment or office based buprenorphine treatment, has been shown to drama<cally reduce overdose risk. Unfortunately, access to treatment is limited by two main factors: •  Availability and accessibility of treatment op<ons, •  Nega<ve antudes or s?gma associated with addic<on in general and drug treatment. !
Wilkes County NC RESULTS www.projectlazarus.org Fred Wells Brason II 28 The overdose death rate dropped 69% in two years aper the start of Project Lazarus and the Chronic Pain Ini<a<ve. Wilkes County Results • 
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Opera<on OpioidSafe, US Army Ft. Bragg, NC 15 OD’s per 400 soldiers to 1 per 400. • 
Wilkes Scripts related to overdose 2008 – 82%, 2011 – 0% School based SA incidences 7.3 per 1000 2011-­‐2012 to 4.9 2012-­‐2013 SA ED visits down 15.3 % Prescribing levels rela<vely the same OTP SA treatment admissions 2010 -­‐ 0, 2013 -­‐ 400+ Involuntary commitments reduced/Less SA calls Churches providing fundraisers for treatment Diversion Tips increased Can coali?ons help reduce Rx drug abuse? • 
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Counties with coalitions had 6.2% lower rate of ED visits for substance
abuse than counties with no coalitions (but this could be due to random
chance)
In counties with coalitions 1.7% more residents received opioids than in
counties without a coalition.
However, counties with a coalition where the health department was
the lead agency had a statistically significant 23% lower rate of ED
visits (X2=2.15, p=0.03) than other counties.
For every unit increase in county leadership there is a 2.7-fold
increase in the odds of having community forums & workshops,
after accounting for other prevention efforts and resources.
Level 3: "People have talked about doing something, but so far there isn’t anyone who has really taken charge. There may be a few concerned people, but they are not influen)al.
Information
projectlazarus.org communitycarenc.org Dr. Mike Lancaster mlancaster@N3CN.org Fred Wells Brason II FWBrason2@projectlazarus.org Robert Wood Johnson Community Health Leader Award 2012