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 • Review trends in more recent data and areas of the state that are most impacted • Discuss health issues related to the opioid epidemic
Last Year’s Conference
Last Year’s Data Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
What steps is the national government taking?
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
Source: CDC, County-level Vulnerability to Rapid Dissemination of HIV/HCV Infection Among Persons Who Inject Drugs [PowerPoint slides], March 8, 2016
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
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
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
What has the Missouri Department of Health and Senior Services Done?
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
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
Audience Question: Are these county selections surprising?
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
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.
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
Audience Question: Any suggestions for additional stakeholders to contact?
What are local communities doing?
St. Louis County Prescription Drug Monitoring Program (PDMP) Participating Counties and Cities Source: http://www.stlouisco.com/HealthandWellness/PDMP
Audience Question: What have you heard about PDMP in your area?
Trends since Last Year …
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
Related Issues
Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
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)
Audience Question: What has been your community’s experience with naloxone?
The woman in this photo is six months pregnant. Photo by David Carson, St. Louis Post Dispatch, February 20, 2017
NAS = Neonatal Abstinence Syndrome Source: Bureau of Health Care Analysis and Data Dissemination, Missouri Department of Health and Senior Services
Source: Bureau of Vital Statistics, Missouri Department of Health and Senior Services
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
Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services
Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services
Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services
Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services
Source: Bureau of Reportable Disease Informatics, Missouri Department of Health and Senior Services
Audience Question: Based on what we know about the distribution of opioid overdoses, why aren’t we seeing the same distribution with hepatitis C?
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).
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
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