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.
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)