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Opioid Data Sharing

Opioid Data Sharing. Open Forum March 23, 2017. Objectives. Build upon the panel presentation from last year’s conference Identify steps that have been taken by federal, state, and local governments in the past year

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Opioid Data Sharing

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  1. Opioid Data Sharing Open Forum March 23, 2017

  2. Objectives • Build upon the panel presentation from last year’s conference • Identify steps that have been taken by federal, state, and local governments in the past year • Review trends in more recent data and areas of the state that are most impacted • Discuss health issues related to the opioid epidemic

  3. Last Year’s Conference

  4. Last Year’s Data Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services

  5. What steps is the national government taking?

  6. HIV/HCV Outbreak Vulnerability Assessment • Released June 2016 in Journal of Acquired Immune Deficiency Syndromes (JAIDS) • Prompted by 2015 Indiana outbreak of HIV (human immunodeficiency virus) and HCV (hepatitis C virus) • Identified 220 vulnerable counties across 26 states

  7. Source: CDC, County-level Vulnerability to Rapid Dissemination of HIV/HCV Infection Among Persons Who Inject Drugs [PowerPoint slides], March 8, 2016

  8. Variables Used in Model • Insurance coverage • Vehicle access • Education • Income • Poverty • Race/ethnicity • Unemployment • Population density • Drug overdose deaths • Prescription opioid sales • Mental health services • Urgent care facilities • Access to interstate • Buprenorphine prescribing potential • Urban/rural status Source: CDC, County-level Vulnerability to Rapid Dissemination of HIV/HCV Infection Among Persons Who Inject Drugs [PowerPoint slides], March 8, 2016

  9. Best Predictors of Acute HCV Infection • Percent White/Non-Hispanic population • Drug overdose deaths • Per capita income • Percent unemployed population • Prescription opioid sales per population • Buprenorphine prescribing potential Source: CDC, County-level Vulnerability to Rapid Dissemination of HIV/HCV Infection Among Persons Who Inject Drugs [PowerPoint slides], March 8, 2016

  10. CDC Recommendations • Assess for evidence of risk(i.e., evidence of injection drug use) using CDC’s analysis as the starting point and examining local data that is likely very informative; • Increase the ability to detect a potential outbreakby ensuring venues likely to encounter persons who inject drugs (PWID), such as substance use disorder treatment facilities, jails/prisons, and emergency departments, offer HIV and HCV testing; and • Prepare an outbreak response action plan, if the assessment indicates the need. Source: CDC, County-level Vulnerability to Rapid Dissemination of HIV/HCV Infection Among Persons Who Inject Drugs [PowerPoint slides], March 8, 2016

  11. What has the Missouri Department of Health and Senior Services Done?

  12. Bureau of HIV/STD/Hepatitis (BHSH) Response • Facilitated calls with impacted LPHAs • Plan to convene workgroup with a regional/statewide focus • Draft outbreak response plan developed

  13. Missouri’s Vulnerable Counties • Crawford • Hickory • Bates • Ripley • Ozark • Wright • Reynolds • Madison • St. Francois • Cedar • Iron • Wayne • Washington Source: CDC, County-level Vulnerability to Rapid Dissemination of HIV/HCV Infection Among Persons Who Inject Drugs [PowerPoint slides], March 8, 2016

  14. Audience Question: Are these county selections surprising?

  15. Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services

  16. Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services

  17. Enhanced State Surveillance of Opioid Involved Morbidity and Mortality (ESOOS) Grant Overview This 3-year grant from the CDC supports states with a high burden of drug overdoses to quickly improve the timeliness of fatal and nonfatal opioid overdose surveillance, including overdoses related to opioid pain relievers and heroin (CDC, 2016). • Strategy 1 – Increase the timeliness of aggregate nonfatal opioid overdose reporting. • Strategy 2 – Increase the timeliness of fatal opioid overdose and associated risk factor reporting. • Strategy 3 – Disseminate surveillance findings to key stakeholders working to prevent or respond to opioid overdoses.

  18. ESOOS Partners • 23+ County Medical Examiner and Coroner Offices • Hospital Industry Data Institute (HIDI), The Data Company of the Missouri Hospital Association • Midwest HIDTA (High Intensity Drug Trafficking Area) • Missouri Department of Mental Health, Division of Behavioral Health • Missouri State Registrar • National Council on Alcoholism and Drug Abuse- St. Louis Area • Regional Heroin and Opiates Steering Committee • Missouri Foundation for Health • Missouri Injury and Violence Prevention Advisory Committee • Missouri State Highway Patrol • Missouri Child Fatality Review Board • DHSS – Multiple Programs

  19. Audience Question: Any suggestions for additional stakeholders to contact?

  20. What are local communities doing?

  21. St. Louis County Prescription Drug Monitoring Program (PDMP) Participating Counties and Cities Source: http://www.stlouisco.com/HealthandWellness/PDMP

  22. Audience Question: What have you heard about PDMP in your area?

  23. Trends since Last Year …

  24. Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services

  25. Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services

  26. Related Issues

  27. Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services

  28. Naloxone (AKA Narcan) • HB 2040 (2014): Allows first responders to administer naloxone (http://www.moga.mo.gov/mostatutes/stathtml/19000002551.html) • First naloxone program in Missouri was started by the Pulaski County Sheriff’s Department in August 2015 (http://kbia.org/post/first-missouri-naloxone-program-and-running#stream/0) • HB 1568 (2016): Allows pharmacists to sell naloxone without a prescription (http://news.stlpublicradio.org/post/bill-expanding-use-overdose-fighting-drug-signed-law-missouri#stream/0)

  29. Audience Question: What has been your community’s experience with naloxone?

  30. The woman in this photo is six months pregnant. Photo by David Carson, St. Louis Post Dispatch, February 20, 2017

  31. NAS = Neonatal Abstinence Syndrome Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services

  32. Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services

  33. HIV/HCV Co-infections Of the 188 HIV infections diagnosed on February 1, 2016, in Scott County, Indiana, > 90% were coinfected with hepatitis C virus (HCV). Source: CDC, County-level Vulnerability to Rapid Dissemination of HIV/HCV Infection Among Persons Who Inject Drugs [PowerPoint slides], March 8, 2016

  34. Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services

  35. Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services

  36. Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services

  37. Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services

  38. Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services

  39. Audience Question: Based on what we know about the distribution of opioid overdoses, why aren’t we seeing the same distribution with hepatitis C?

  40. DHSS Steps to Address Hepatitis C • BHSH has been awarded CDC-RFA-PS17-1702, Improving Hepatitis B and C Care Cascades; Focus on Increased Testing and Diagnosis. • BHSH/BRDI have applied for CDC-RFA-PS17-1703, Strengthening Surveillance in Jurisdictions with High Incidence of Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) Infections. This grant will be awarded in May 2017. • BHSH/BRDI have been awarded the Building State/Territorial Health Department Capacity to Develop and Utilize Viral Hepatitis Epidemiologic Profiles grant from the Association of State and Territorial Health Officials (ASTHO).

  41. Contact Information:Section for Disease Prevention • Ken Palermo, Administrator, Section for Disease Prevention • Ken.Palermo@health.mo.gov • Nicole Massey, Chief, Bureau of HIV, STD, and Hepatitis (BHSH) • Nicole.Massey@health.mo.gov • Craig Highfill, Interim Assistant Bureau Chief, BHSH • Craig.Highfill@health.mo.gov • Becca Mickels, Chief, Bureau of Reportable Disease Informatics (BRDI) • Becca.Mickels@health.mo.gov • Angie McKee, Research Analyst IV, BRDI • Angela.McKee@health.mo.gov

  42. Contact Information: Section for Epidemiology for Public Health Practice • Loise Wambuguh, Chief, Bureau of Vital Statistics (BVS) • Loise.Wambuguh@health.mo.gov • Shilo Bender, Research Analyst III, BVS • Shilo.Bender@health.mo.gov • Wayne Schramm, BVS • Wayne.Schramm@health.mo.gov • Andrew Hunter, Chief, Bureau of Health Care Analysis and Data Dissemination (BHCADD) • Andrew.Hunter@health.mo.gov • Whitney Coffey, Research Analyst IV, BHCADD • Whitney.Coffey@health.mo.gov • Evan Mobley, Research Analyst IV, BHCADD • Evan.Mobley@health.mo.gov

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