Idaho Opioid Misuse And Overdose Strategic Plan 2017 - 2022
Idaho Opioid Misuseand OverdoseStrategic Plan2017 - 20222019 Update (Abridged)Prepared on Behalf of the Strategic Planning Stakeholder Group by:Monica G. Revoczi, MAInteraction International, Inc.This project is supported by Funding Opportunity CDC-RFA-CD16-1606 from the Centers for DiseaseControl and Prevention (CDC). Its contents are solely the responsibility of the authors and do notnecessarily represent the official views of the IDHW or CDC.
Table of ContentsIntroduction . 1Planning Process . 3Vision . 4Goals, Strategies, and Performance Measures . 5Goals and Strategies .5Performance Measurement Plan . 8
IntroductionIn April 2017, the Governor’s Office of Drug Policy convened a planning group to create astatewide, multi-stakeholder opioid misuse and overdose prevention strategic plan. A broadgroup of stakeholders met over two days and developed the “2017 – 2022 Idaho Opioid Misuseand Overdose Strategic Plan.” Subsequent meetings were held in person and by phone tofurther refine the goals and strategies. The workgroup held its third annual retreat in May 2019.This strategic plan identifies four key goal areas that address the epidemic in a comprehensive,multi-faceted approach to support the plan’s 2022 vision of “A safe and healthy Idaho, free ofopioid misuse and untreated opioid use disorders.”Drug overdose deaths in the United States continue to increase, with overdose deaths fromopioids increasing almost six times since 19991. In 2017, 70,237 Americans died from a drugoverdose and nearly 68% of those deaths involved an opioid2. Like the rest of the country, Idahois struggling with the opioid epidemic and has seen an increasing number of drug overdosedeaths since 20003. In 2018, 248 Idahoans died from a drug overdose and at least 125 of thosedeaths reported an opioid3. The age adjusted mortality rate has increased from 11.9 per100,000 Idaho residents in 2009 to 14.5 per 100,000 Idaho residents in 20183. Among the drugslisted on death certificates from drug overdoses in 2018, opioids were reported in more than half(125 out of 217 deaths with one or more drugs reported)3. Despite these increases, the burdenof opioid abuse in overdose deaths is likely underestimated. Due to the lack of requirementamong certifiers to report specific drugs on death certificates and lack of funding for toxicologytests, in 2018, about 13% of drug-overdose deaths did not specify the drugs involved3.Males appear to be at particular risk for drug overdose deaths3. Though Idahoans aged 25-34have the highest drug overdose death rate by age group3, the rate for those aged 55-64increased by 18%3. Public Health District 5 has the highest drug overdose mortality rate bydistrict (17.1), with the rate increasing by 35% between 2017 and 20183. Although Public HealthDistrict 5 has the highest drug overdose death rate, Public Health District 3 has seen the largestdrug overdose death rate increase, 42%, from 2017 to 20183.Idaho ranks 25th among the states and D.C. for past year pain reliever misuse4. 4% of Idahoansaged twelve and older reported misusing pain relievers in the past year, but adults aged 18 to25 are at particular risk; 7.2% reported misusing pain relievers in the past year4. Among youth,approximately 1 in 12 Idaho students have misused a prescription pain reliever in their lifetime5.At the outset of the Strategic Plan, access to opioid medications in Idaho had increased;between 2011 and 2016 the retail distribution of oxycodone to pharmacies, hospitals, andphysicians increased from over 13,000 grams per 100,000 population to over 16,000 grams per100,000 population6. From 2016 to 2017, Retail distribution of oxycodone decreased by 1000grams per 100,000 population6.Although less often used, heroin is also becoming an increasing concern. Between 2014 and2017, drug overdose deaths reporting heroin increased by almost 3-fold3. The arrest rate forheroin increased from 0.05 arrests per 1,000 population in 2013 to 0.40 arrests per 1,000population in Idaho in 20177. In 2018, heroin use was more prevalent than prescription opioiduse among the Idaho Department of Correction’s supervised population, which includes thecommunity population as well as the incarcerated population and those in the presentencephase8. More than 15% of IDOC’s supervised population reported heroin as a drug of choice,compared to 8.6% that reported opioid analgesics8. Females are more likely to use both opioid1
analgesics and heroin than their male counterparts8. Among Idaho’s incarcerated populationcurrently with drug dependence, over 8% indicated opioid analgesics as a drug of choice, andover 18% indicated heroin as a drug of choice8.1Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center forHealth Statistics; 2018. Available at http://wonder.cdc.gov.2 Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — UnitedStates, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419–1427.3 Idaho Department of Health and Welfare, Division of Public Health, Bureau of Vital Records and HealthStatistics, July 2018.4SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,2016 and 2017.5Office of Drug Policy, Idaho Healthy Youth Survey, 2017.6United State Department of Justice, Drug Enforcement Agency, Diversion Control Division, Datadownloaded from the Automated Reports and Consolidated Ordering System (ARCOS), 2017.7Idaho State Police, Idaho Statistical Analysis Center, National Incidence-Based Reporting System, 20072017.8Evaluation and Compliance, Idaho Department of Correction, 2018.2
Planning Process“The greater danger for most of us lies not in setting our aim too high and falling short,but in setting our aim too low and achieving our mark.”- MichelangeloA strategic plan provides a powerful roadmap to align and navigate efforts in pursuit of an impactfuland inspiring future vision. In April of 2017, the Idaho Office of Drug Policy and the IdahoDepartment of Health and Welfare’s Division of Public Health convened a strategic planning teamcomprised of diverse statewide stakeholders connected to the opioid crisis to determine how toaddress this serious issue and achieve significant positive impact in the next five years. Attendingstakeholders included persons and family members directly affected by opioid misuse, addiction, oroverdose; the Idaho Office of Drug Policy; the Idaho Department of Health and Welfare; publichealth districts; Idaho State Senators and Representatives; mental health providers; physicians;treatment and recovery support providers; law enforcement jurisdictions and criminal justiceprofessionals; medical associations and state licensing boards; the Coroner’s Office; and others.1First, the group came to consensus on a collective vision for the ideal future impact on the opioidepidemic in Idaho. Every participant’s input was considered in the process, culminating in a concise,compelling vision to serve as the point of alignment for the rest of the plan.Next, the group conducted an environmental assessment: an analysis of all factors that have thepotential to either help or hinder achievement of the vision. The assessment was informed bybusiness intelligence generated and distributed in advance of the planning retreat, including currentIdaho best practices and programs in opioid misuse prevention and control, Idaho’s Opioid NeedsAssessment (updated annually), the CDC Opioid Prescribing Guidelines, and the SAMHSA OpioidPrevention Toolkit.The results of the environmental assessment were synthesized into critical success factors: the mostimportant areas of focus to achieve significant progress toward the vision. SMART goals weredeveloped to address each of the critical success factors. Strategies were created to define howeach goal would be attained. Performance measures were established to guide evaluation ofprogress toward reaching the goals. An accompanying performance measurement plan was createdto define the timeframes, responsibilities, and audience for each measure. Finally, action plans weredeveloped, detailing the steps and responsibilities for carrying out each strategy; they will serve asthe primary tool for strategic plan implementation.This plan reflects the results of the strategic planning process, and represents Idaho stakeholders’commitment to aligning efforts to significantly move the needle on this serious issue.Consistent strategic plan review and follow-up will continue to be key to success. Strategic planningstakeholders are convened quarterly to report progress on action plans and performance measures,share agency updates, and collaborate on any challenges that arise. In addition, in the spring of2018 and 2019, the group, along with new members, met to review and update the plan. Thesemeetings include presentations from several subject matter experts on new and emerging topicscritical to the opioid crisis, and opportunities to determine how best to refine the existing plan andincorporate new information. The group will continue to meet in-person annually to review andupdate the strategic plan, optimizing its relevance and effectiveness.1A detailed list of planning retreat participants and meeting details can be found in the Appendix.3
VisionA vision describes the ideal future impact of an organization or collaboration of stakeholders. Itis the guiding force that inspires stakeholders to take action in influencing success, and providesa point of alignment for all associated efforts. This vision is intended to drive significant positiveoutcomes with regard to opioid misuse and overdose over the duration of the strategic plan andbeyond.Idaho’s 5-Year Vision (2022)“A safe and healthy Idaho,free of opioid misuse and untreated opioid use disorders.”4
Goals, Strategies, and Performance MeasuresThis section outlines the goals, strategies, and performance measures of the strategic plan.Goals articulate the outcomes that will be achieved to realize the vision. Strategies define howthe goals will be accomplished. Strategy implementation, including process, timing, responsibleparties, and resulting outputs, is detailed in accompanying action plans (please see nextsection). Performance measures are designed to assess the impact of plan activities.Measurement data is translated into intelligence that informs progress toward achieving thegoals, and guides any course adjustments needed to maximize success at reaching the vision.Goals and StrategiesCRITICAL SUCCESS FACTOR 1:EDUCATE PROVIDERS, PATIENTS, AND THE PUBLICGOAL 1ABy December 2021, using Idaho’s 2017 number of 645.2 as a baseline,reduce the annual amount of opioids prescribed in Morphine Milligram Equivalents (MME)per person in all ages, to 512.6 (the current U.S. average).Strategies:1) Research and standardize toolkits to ensure they are Idaho-based and electronic2) Public Health Districts to continue peer-to-peer educational approach with Prescriber Championsand implement quality improvement projects to improve clinical workflow to incorporatePrescription Monitoring Program (PMP) checking3) Implement a dissemination plan for provider toolkits and other educational materials4) Explore linking controlled substance licenses with continuing medical education5) Provide information related to opioid stewardship and the state strategic plan to Idaho healtheducation programs6) Ensure sustainability of and increase engagement in the Extension for Community HealthOutcomes (ECHO) program in IdahoGOAL 1BBy December 2019, reduce the past year pain reliever misuse among Idahoans 12 years andolder from 4.25% to 4.0%, as measured bythe National Survey on Drug Use and Health (NSDUH).Strategies:1) Expand Idaho branded patient education information for distribution to prioritized communities2) Expand distribution of a patient friendly variation on the Brief Opioid Knowledge test rack cardfor patients3) Develop patient education tools to implement at pharmacies4) Develop or adopt a web-based opioid education program for patients5
CRITICAL SUCCESS FACTOR 1:EDUCATE PROVIDERS, PATIENTS, AND THE PUBLIC (continued)GOAL 1CBy December 31, 2020, 85% of Idaho's adult population (as measured by the Behavioral RiskFactor Surveillance System (BRFSS)) will be aware that using prescription painkillersmore frequently or in higher doses than directed by a healthcare provider,or using prescription painkillers not prescribed by a healthcare provider,holds great risk.Strategies:1) Implement and expand evidence-based substance use prevention education programs forstudents2) Provide information dissemination through adult-focused education campaign3) Provide information dissemination through community statewide prevention education efforts4) Continue information dissemination about the availability of local prescription take-backprogramsCRITICAL SUCCESS FACTOR 2:IMPROVE OPIOID PRESCRIPTION PRACTICESGOAL 2By December 31, 2019, the percent of Idaho prescribers issuing controlled substanceprescriptions who checked the Idaho PMP at least once during calendar year 2019will be at least 10% greater than the percentwho checked during calendar year 2016 (baseline rate).Strategies:1) Encourage prescribers and healthcare systems to adopt PMP integration into electronic medicalrecords (EMRs)2) Educate prescribers on access to and use of PMP, including use of delegates3) Educate prescribers and administrators about safe opioid prescribing in general4) Help make Idaho PMP data more accessible to public/interested parties5) Coordinate with Medicaid on provisions of SUPPORT Act that involve the Idaho PMP6) Research and consider implementation of best practices to maximize effectiveness of the PMP6
CRITICAL SUCCESS FACTOR 3:STRENGTHEN AND SUPPORT FAMILIESGOAL 3By December 2021, reduce Idaho youth opioid misuse by 10% as measured by theIdaho Healthy Youth Survey.Strategies:1) Collect resources supporting all groups (such as patient, parents, family, friends) affected byopioid misuse or in crisis and coordinate dissemination to established public resource outlets(e.g., 211, Idaho Wellness Guide, Live Better Idaho)2) Create a county resource map to include validated resources collected in Strategy 1, and makeavailable to all stakeholders3) Increase family recovery support services in each county/region (e.g., Narcotics Anonymous andNar-Anon Family Groups, Family Strong, etc.)4) Educate parents about the signs of drug use, destigmatize, disseminate resourcesCRITICAL SUCCES FACTOR 4:EXPAND AWARENESS OF, AND ACCESS TO, TREATMENTGOAL 4By December 2021, decrease the number of Idahoans with untreated opioid use disorder(OUD) from 12,117 (2015/2016 baseline) to 7,368,as calculated by the Idaho Office of Drug Policy based on results fromthe National Survey on Drug Use and Health (NSDUH).Strategies:1)2)3)4)Increase the number of treatment providersIncrease payment options for treatment by identifying and removing financial barriersReduce stigma around opioid treatment modalitiesImprove pathways to treatment for all populations7
Performance Measurement PlanGOAL #1AMEASURE AND DESCRIPTION(i) Prescribing Rate per 100 IdahoansFREQUENCY OFMEASUREMENTRESPONSIBLEPARTY(IES)METHOD FORCOMMUNICATINGRESULTSAUDIENCEAnnuallyMegan Hearn, DOPPPresent at thequarterly strategic planreview meeting afterthe annual results arereleased.Strategic PlanningGroup 2This figure, reported annually by the CDC, willtrack the trend/decrease in Idaho andcomparison to the national average.1A(ii) Percentage of Opioid Naïve PatientsWho are Prescribed a Long-Acting orExtended Release (LA/ER) OpioidQuarterlyMegan HearnPresent at eachquarterly strategic planupdate meeting.Strategic PlanningGroup1A(iii) Percentage of Opioid Naïve PatientsWho Took Opioids for Longer than ThreeDaysQuarterlyMegan HearnPresent at eachquarterly strategic planupdate meeting.Strategic PlanningGroup1A(iv) Percentage of Opioid PrescriptionsDispensed that have Daily MME Dosesunder 50 MME, Between 50 and 90 MME,and Over 90 MMEQuarterlyMegan HearnPresent at eachquarterly strategic planupdate meeting.Strategic PlanningGroupThis data, obtained from the PMP, will trackchanges in proportion for each MME category.2Strategic Planning Group refers to the participants of the 2017 Idaho Opioid Strategic Planning Retreat, and other parties actively involved in planimplementation since then.8
GOAL #1BMEASURE AND DESCRIPTION(i) Statewide Patient Education CampaignEvaluationFREQUENCY OFMEASUREMENTRESPONSIBLEPARTY(IES)(ii) Expansion of Full Hospital CampaignODPReport andpresentation ofevaluation results atthe quarterly strategicplan update meetingfollowing the end ofthe campaign.Strategic PlanningGroupQuarterlyODPReport and presentnumbers at eachquarterly strategic planreview meeting.Strategic PlanningGroupSemiannually: Januaryand JulyBoard of Pharmacy(BOP)Report results at theimmediately followingquarterly strategic planreview meetings.Megan to updateOpioid NeedsAssessment(annually).Strategic PlanningGroupReport andpresentation ofevaluation results atthe end of thecampaign at the nextquarterly strategic planupdate meeting.Strategic PlanningGroupNumber of locations to which the full hospitalcampaign extends. Number of pharmacyparticipants.1B(iii) Average Daily Supply DispensedTrack data via PMP.Megan HearnIC(i) Statewide Adult Education CampaignEvaluationAUDIENCECollected duringcampaign, reportedimmediately afterBehavioral intent is measured by patientexperience surveys in initial hospitals. Reachnumbers during period of campaignimplementation.1BMETHOD FORCOMMUNICATINGRESULTSAnnually: AugustThe evaluation will assess campaign reach,engagement and earned media. Additionally,the evaluation will measure change inknowledge, attitudes, behaviors, and how wellthe CDC campaign materials resonate withIdaho residents.9Kristen Raese, DHW
GOAL #1CMEASURE AND DESCRIPTION(ii) Evidence-Based Program (EBP)EvaluationFREQUENCY OFMEASUREMENTRESPONSIBLEPARTY(IES)(iii) Perceived Risk of Opioid MisuseThe source of this data is the 2018 IDHWadded BRFSS question: “How much do youthink people risk harming themselves in anyway when they use prescription painkillersmore frequently or in higher doses thatdirected by a healthcare provider or whenthey use prescription painkillers NOTprescribed by a healthcare provider?”AUDIENCEAnnually, startingSeptember 2018Marianne King, ODPReport andpresentation of resultsat the end of theprogram at the nextquarterly strategic planupdate meeting.Strategic PlanningGroupAnnually: startingAugust/September2018ODP/Marianne KingReport results at theimmediately followingquarterly strategic planupdate meetings.Strategic PlanningGroupThis will be a pre and post survey evaluationof the program aimed at middle schoolstudents.1CMETHOD FORCOMMUNICATINGRESULTS2(i) Number of Unique Providers Checkingthe PMP in a Calendar Year AND Numberof Unique Providers Who Wrote aControlled Substance Prescription thatwas Filled in the Same Calendar YearAnnuallyBOPData report to GoalTeam 2 andpresentation at annualstrategic plan updateretreatStrategic PlanningGroup2(ii) Number of Patients GeneratingUnsolicited Reports from the Board ofPharmacyAnnuallyBOPData report to GoalTeam 2 andpresentation at annualstrategic plan updateretreatStrategic PlanningGroup10
FREQUENCY OFMEASUREMENTRESPONSIBLEPARTY(IES)MEASURE AND DESCRIPTION2(iii) Number of Prescribers Using Gatewayor NarxCare to A
opioid misuse and untreated opioid use disorders.” Drug overdose deaths in the United States continue to increase, with overdose deaths from opioids increasing almost six times since 1999. 1. In 2017, 70,237 Americans died from a drug overdose and nearly 68% of those deaths involved an opioid2. Like the rest of the country, Idaho
Opioid overdose was the main cause of the estimated 99,000-253,000 deaths worldwide related to illicit drug use in 2010.1 Opioid overdose is both preventable and, if witnessed, treatable (reversible). In its resolution 55/7 on promoting measures to prevent drug overdose, in particular opioid overdose, the
Look for obvious indications of an opioid overdose Always request Seattle Fire and Medics Supporting an opioid overdose patient’s breathing is the most important treatment Naloxone (Narcan) administration is a secondary treatment Many other conditions appear similar to opioid overdose but will
Missouri Opioid Overdose and Bloodborne Infection Vulnerability Assessments 2020 3 Introduction Opioid misuse is a growing problem in Missouri as well as throughout the nation. In 2017, 1 out of every 65 deaths in Missouri was due to an opioid overdose.2 From 2001 to 2015, Missouri
Naloxone for Opioid Overdose: FAQs Background Opioid prescribing doubled from the late 1990s to 2012, when pain treatment became the subject of several quality initiatives and practice guidelines.1-3 Prescription opioid overdose deaths quadrupled between 1999 and 2010, while heroin overdoses increased by 50%.4 Now, opioid
NSDUH, the opioid misuse (heroin use and prescription opioid misuse) rate among Hispanic/ Latinos is similar to the national population rate, about 4 percent. In 2018, 1.7 million Hispanic/ Latinos and 10.3 million people nationally, ged 12 and older, were estimated to have engaged in opioid misuse in the past year. Opioid and other substance .
Opioid Overdose Deaths by Drug Type In 2019, synthetic opioids were involved in the greatest proportion of opioid overdose deaths. Type of Opioid Number of Deaths Commonly-prescribed opioids* 143 Heroin 106 Synthetic opioids 309 Note: overdose deaths may involve more than one drug. They also include unintentional
The rate of fatal opioid overdose varied significantly by industry and occupation of the decedents. Construction and extraction workers had both a high rate (150.6 deaths per 100,000 workers) and a high number of opioid-related overdose deaths (n 1,096). The opioid-related death rate for those
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