​​Prescription Drug Overdose Prevention Initiative

PRESCRIBER GUIDANCE LETTER

California Department of Public Health Director and State Health Officer, Dr. Karen Smith, in conjunction with the Prescription Opioid Misuse and Overdose Prevention Workgroup, has developed an opioid resource letter for providers who see patients and write prescriptions for pain management. The letter specifically offers resources for health care providers to assist them with patients who may need special medical guidance due to opioid addiction.  This letter is issued in the hope that it benefits prescribers with patients needing assistance around opioid use.  Efforts to prevent opioid addiction and overdose in California are appreciated.

BACKGROUND

The opioid epidemic is a dynamic multi-factorial problem with several rapidly changing components, including changing prescribing/dispensing patterns and changing availability of low cost heroin.  In the past, prescription opioids (such as hydrocodone, oxycodone, morphine and codeine) were prescribed for relieving short-term (acute) pain. Today, they are increasingly being used to treat chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness. Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there was not an overall change in the amount of pain Americans reported during that same time period.  See the number of opioid prescriptions sold in California from 2006-2014.

The magnitude of legal and illegal opioid usage and related negative consequences (e.g., addiction) is high in terms of health impact to California residents. However, there is wide variation across the counties within California with some counties having much higher rates than others.  The most recently available California data (2014) indicates: 1) Prescription opioid related overdose deaths peaked in 2009 and have leveled off in the last two years; 2) Heroin related overdose deaths and ED visits have sharply increased since 2011 (54% and 52% respectively); and 3) The number of prescriptions filled per 1,000 residents has leveled off and the morphine milligram equivalent (MME) per resident per year has actually decreased. The decrease in MMEs may reflect a decrease in the number of pills per prescription.

CALIFORNIA ADDRESSES THE OPIOID EPIDEMIC

The State of California is leveraging a multi-sector collaboration at both the state and local levels to build a comprehensive approach to address the Opioid Epidemic. The statewide overarching strategy includes five main components: 1) Safe Prescribing; 2) Access to Treatment; 3) Naloxone Distribution; 4) Public Education Campaign; and 5) Data Informed/Driven Interventions. Grants from the Centers for Disease Control and Prevention (CDC) - Prescription Drug Overdose Prevention (PDOP) for States (PfS) are the glue through which this multi-pronged initiative is united, aligned, and coordinated.

The Statewide Prescription Opioid Misuse and Overdose Prevention Workgroup - In response to the national Opioid epidemic, the California Department of Public Health (CDPH) Director and state partners launched a state agency Prescription Opioid Misuse and Overdose Prevention Workgroup in 2014 to share information and develop collaborative prevention strategies to curb prescription drug overdose deaths and addiction in California. Additionally, the Workgroup provides a platform for state entities working to address opioid overdose and addiction to improve coordination and expand joint efforts.  The Prescription Drug Overdose Prevention (PDOP) Initiative funded by the CDC grants supports and facilitates the statewide Workgroup and four Taskforces.  

Prescription Drug Overdose Prevention Initiative (PDOP) – In addition to supporting the work of the Statewide Workgroup and five Task Forces, PDOP staff engages with an array of local and state partners working on the opioid overdose epidemic. Current PDOP Initiative activities include:

• Promoting the CDC and Medical Board of California Prescriber Guidelines and registration and use of California’s Prescription Drug Monitoring Program – CURES;
• Providing education and support to health payers and providers on best institutional prescribing policies and practices;
• Conducting a “Policy” Environmental Scan to identify current laws, regulations, and policies that best address opioid overdose and addiction prevention;
• Contracting with the San Francisco Department of Public Health and Keck School of Pharmacy to develop Opioid Stewardship Curriculums to be rolled out in early April 2017 in three northern California counties: Humboldt, Lake, and Shasta. The curriculums will be utilized to train professionals to conduct “academic detailing” (or educational outreach) with prescribers (physicians, physician assistants, and nurse practitioners) and pharmacists on safe opioid prescribing practices;
• Providing funding to support thirteen Opioid Safety Coalitions;
• Developing a statewide media education campaign for California patients and consumers;
• Providing data, technical assistance, and support to local health departments, coalitions, and community members in translating overdose and related data into actionable information to address the opioid prescription/illicit drug problem locally; and,
• Convening a taskforce to address maternal and neonatal opioid exposure issues. 

California Opioid Overdose Surveillance Dashboard – PDOP Initiative scientific staff has developed the California Opioid Overdose Surveillance Dashboard. The goal is to provide a data tool with enhanced data visualization and integration of statewide and geographically-specific non-fatal and fatal opioid-involved overdose and opioid prescription data. The dashboards and data available through the dashboard are the result of ongoing collaboration between the CDPH, Office of Statewide Health Planning and Development (OSHPD), Department of Justice (DOJ), and the California Health Care Foundation (CHCF).  Since November 1, 2016, there have been 1,031 users, 15,673 page views, and 373 files have been downloaded from the dashboard.

Partner Initiatives - In addition to the CDC original and supplemental grants awarded to CDPH, two other grants were awarded to California state agency partners along with seventeen coalition grants awarded to local communities to address the opioid crisis in California. The first is a Harold Roger Grant awarded to the California Department of Justice (DOJ) to upgrade the Prescription Drug Monitoring Program for the state. (DOJ sits on the Agenda Setting Team for the statewide Workgroup.) The second state agency grant is a Substance Abuse and Mental Health Services Administration (SAMSHA) grant recently awarded to the Department of Health Care Services (DHCS) – Substance Use Disorder Division. The grant focuses on infrastructure development and implementation of primary prevention strategies to address prescription drug misuse and abuse among youth. Finally, the California Health Care Foundation (CHCF) has awarded grants to seventeen local communities (in 24 counties) to create local opioid safety coalitions.

Naloxone Grant Program - Naloxone is a medication that works almost immediately to reverse opiate overdose. Naloxone is currently a prescription drug, but is not a controlled substance. Through a Request for Application (RFA) process, the CDPH Safe and Active Communities Branch (SACB) is offering grants of naloxone products (Narcan nasal spray) and funding to all 61 local health departments in California (LHDs) to conduct naloxone distribution projects.

Resource Links for Opioid Prescribers

To help address this crisis, PDOP staff has compiled a list of resources to assist health care professionals when prescribing opioids to patients.

• Prescribing Guidelines (PDF 72KB)
• CDC Tapering Pocket Guide (PDF 1.7MB)
• Opioid Prescribing and Treatment Resources (PDF 78KB)
• Prescription Drug Monitoring Program – CURES
• Referral and Treatment Services Locator (PDF 72KB)

• Related Publications (PDF 73KB)

• Full Resource Sheet which contains all resources listed above (PDF 92KB)
• CDC and MBC Guidelines Comparison (PDF 250KB)

AWARD ANNOUNCEMENT

The California Department of Public Health/Safe and Active Communities Branch is pleased to announce the twelve awarded recipients for the Request for Applications - Local Coalitions to Address Opioid Misuse and Abuse.  These awardees will be implementing comprehensive local opioid safety coalition activities beginning June 2017 through February 2019. 

Awardees

Health Improvement Partnership of Santa Cruz County

Mendocino County Health and Human Services

Siskiyou Community Services Council

County of San Luis Obispo Behavioral Health Department

San Diego County Medical Society

L.A. Care Health Plan

Sierra Sacramento Valley Medical Society

Plumas County Public Health Agency

California Health Collaborative

Butte County Public Health Department

Marin County Department of Health and Human Services

Alameda-Contra Costa Medical Association Community Health Foundation

Our thanks to all who applied.  We look forward to building agency partnerships as we continue our efforts to impact the opioid crisis.

Opioid Safety Coalitions - Funding Opportunity (Applications were due February 10, 2017)

Request for Application (RFA) – (Zip File 946 KB)