1. The Opioid Crisis – State Perspectives and Approaches for Prevention
Adrienne Hearrell, MPH, CPTA
Program Coordinator
Prescription Drug Overdose: Data-Driven Prevention Initiative (DDPI)
Kansas Department of Health and Environment
Our Mission: To protect and improve the health and environment of all Kansans.

2. Background
Our Mission: To protect and improve the health and environment of all Kansans.

3. Background
In 2016, there were 63,632 drug poisoning deaths in the United States
Provisional data – 68,400 deaths from 10/2016 – 10/2017
Drug poisoning is the leading cause of unintentional injury death in the U.S.
Unintentional injuries became the 3rd leading cause of death in 2016
U.S. life expectancy decreased in 2015 and 2016
In 2016, there was a total of 63,632 drug overdose deaths in the United States. (One death every 8 minutes).
Unintentional drug poisonings are the number one cause of unintentional injury death nationwide, ahead of motor vehicle deaths and firearms deaths.
Unintentional injuries became the 3rd leading cause of death in 2016, right behind cancer and cardiovascular disease
Life expectancy decreased 0.1 year in both 2015 and 2016 because of this influx in drug OD deaths.
Public health emergency
Our Mission: To protect and improve the health and environment of all Kansans.

4. ~11.0/100,000
National Center for Health Statistics Data
This map reflects age adjusted drug overdose death rates from all drugs and compares it to the national average
In 2016, the death rate was 19.8 deaths per 100,000 population, which reflects a 21% increase from 2015 (16.3 per 100,000)
Looking at KS – our drug poisoning death rate is 11.1 deaths per 100,000 population. KS is statistically below the U.S. average in terms of drug poisoning mortality from all drugs.
Note: Look at OK and MO. Wouldn’t be surprised if we see something different in 2017.
Our Mission: To protect and improve the health and environment of all Kansans.

5. Drug Overdose Mortality Rates
Gender – Males (26.2 deaths per 100,000)
Age – (35.0 deaths per 100,000)
Race – Non-Hispanic whites ( deaths per 100,000)
Image source: National Center for Health Statistics
Drug overdoses affect those of all ages, races, and socioeconomic statuses.
Certain populations are affected by fatal drug overdoses at disproportionate rates as compared to others.
Based on 2016 data, the age-adjusted mortality rate for non-Hispanic whites was 25.3 deaths per 100,000 U.S. population, 17.1 deaths per 100,000 U.S. population for non-Hispanic blacks, and 9.5 deaths per 100,000 U.S. population for Hispanics.
Based on 2016 data, persons aged had the highest mortality rate from drug poisonings (35.0 deaths per 100,000), followed by adults aged (34.6 deaths per 100,000) and (34.5 deaths per 100,000). This reflects a 29%, 24%, and 15% increase in drug overdose death rates from 2015 to 2016 per each respective cohort.17 However, the drug poisoning mortality rate also increased in persons aged 15-24, 55-64, and 65 and over – 28%, 17%, and 7%, respectively.17
Males are significantly more likely to die from drug poisonings as compared to females, though the gender gap is closing.
In 2016, the drug poisoning mortality rate for males was 26.2 deaths per 100,000, compared to 13.4 deaths per 100,000 for females.17
In summarizing these data, the demographics of those who died from drug poisonings in the United States are mainly white non-Hispanic males between the ages of 25 to 54. This demographic remains consistent in focusing on opioid-related mortality specifically – though, the younger cohort (ages 25-34) are more likely to die from illicit opioid overdoses as opposed to the older cohort (ages 45-54).
Our Mission: To protect and improve the health and environment of all Kansans.

6. This graph breaks down the U. S
This graph breaks down the U.S. drug overdoses by type of drug from
Over the past years, the U.S. sets a new record for drug poisoning deaths every year, and each successive year that record is broken.
In looking at the drugs that are implicated in U.S. overdose deaths, prescription and illicit opioids are the most prevalent, and deaths involving opioids continue to increase.
In 2016, opioid OD deaths accounted for 66% of all the drug overdose deaths.
Essentially, opioids are driving the U.S. drug overdose epidemic.
Our Mission: To protect and improve the health and environment of all Kansans.

7. 42,249 of the 63,632 U.S. drug overdose deaths involved a prescription or an illicit opioid
This chart shows U.S. opioid overdose deaths specifically from
Opioids were involved in 42,249 of the 63,632 deaths in 2016 (that includes any opioid – heroin, rxs, legal and illegal fentanyl)…that’s about 66% of the total
Equivalent to 116 opioid-overdose deaths every day in 2016…staggering statistic
Doesn’t account for number of non-fatal opioid ODs
The arrows reflect the 3 waves of the opioid epidemic:
Natural and semi-synthetic – rises in 1999 and persists.
Caused by influx of prescriptions in the 1990s
Deaths caused by semi-synthetic opioids remained higher than deaths attributed to heroin and synthetic opioids in the 1990s-2000s
2. Heroin – rises sharply in 2010 – those younger individuals addicted to rxs switch to heroin because it’s cheap, accessible, and effects are virtually indistinguishable from prescription opioids
Rx opioid exposure is a risk factor for heroin use as 8/10 heroin users report that their addiction began with rxs
Have to maintain opioid supply once addicted
Heroin use may be an outcome of OUD that started with rx opioids; especially after having no or difficulty with rehab
3. Synthetic – (fentanyl and >1400 analogs) sharply rises in 2013, and death rate actually doubled between 2015 and 2016
Causes the majority of opioid-overdose deaths in 2016!!!
Fentanyl is x stronger than morphine, and up to 50x more potent than heroin so it is easy to OD on. Fentanyl overdoses have a fast onset (O2 deprivation), and are more difficult to reverse with narcan
Illicitly manufactured in China and then shipped to the U.S. and cut into the heroin supply. Even cheaper than heroin.
Also, fentanyl is also frequently involved in overdose deaths involving non-opioids drugs
40.3% of cocaine-involved overdose deaths
31.0% of benzodiazepine-involved overdose deaths
20.8% of antidepressant-related deaths
Recently being mixed into methamphetamine, further increasing OD deaths
Our Mission: To protect and improve the health and environment of all Kansans.

8. In considering everything, in 2016:
More than 19,000 died from overdosing on synthetic opioids
More than 17,000 Americans died from prescription opioid overdoses
More than 15,000 died from heroin overdoses
Economic burden of the opioid epidemic is estimated at 504 B.
Health care costs
Criminal justice system
Largest cost was to the workplace due to decreased labor force participation among prime working-age men and women
Our Mission: To protect and improve the health and environment of all Kansans.

9. Kansas Data
Our Mission: To protect and improve the health and environment of all Kansans.

10. Kansas Drug Poisoning Death Rates/Counts 2005-2016
Now we will shift to Kansas data – this chart shows the age-adjusted mortality rates and counts for drug poisoning among Kansans from 2005 to 2016
Rate was ~11 deaths per 100,000 Kansans in 2016, 8% decrease from 2015
Peak death rate was in 2013 with 330 deaths total
2017 data is TBD.
Our Mission: To protect and improve the health and environment of all Kansans.

11. Drug Poisoning Mortality in Kansas
310 drug poisoning deaths in 2016
104 caused by natural or semi-synthetic opioids
36 caused by heroin
Drug poisoning death rate decreased 8% in compared to 2015
Chart shows KS drug overdose mortality counts by type of drug from
In 2016, there were 310 deaths in Kansas caused by drug poisonings
104 – natural or semi-synthetic opioid
36 – heroin
Opioid-involved deaths have remained steady
Deaths from methamphetamine have increased significantly in recent years as well
Count doubled in
Our Mission: To protect and improve the health and environment of all Kansans.

12. Visit www.preventoverdoseks.org for additional Kansas data
This map shows Kansas’s age-adjusted drug poisoning mortality rate from by county
Higher burden in SE region
Counties were excluded if fewer than 5 deaths occurred in that time period
Visit for additional Kansas data
Our Mission: To protect and improve the health and environment of all Kansans.

13. Prevention Strategies
Our Mission: To protect and improve the health and environment of all Kansans.

14. Prevention Strategies
A multi-faceted problem requires a multi-disciplinary approach!
Primary prevention – Prevent opioid use disorder
Secondary prevention – Surveillance and early detection of OUD
Tertiary prevention – Prevent mortality
Access to treatment
Harm reduction
Primary - Unnecessary exposure to prescription opioids must be reduced to prevent opioid use disorder in the first place.
Try alternative therapies/modify prescribing guidelines for pain management
Change policies
Decrease availability of opioids – use PDMP to make informed clinical decisions
Deeper rooted causes – ACEs and mental health
Secondary – surveillance
Screening tools and early detection to prevent worsening of OUD and to prevent poisoning
Tertiary - Goal is to prevent death
Increase access to treatment – whether counseling or MAT
NALOXONE! Education, availability, how to use it etc.
Our Mission: To protect and improve the health and environment of all Kansans.

15. John’s Hopkins and Clinton Foundation Report
Top Ten Recommendations for action…
1: Optimizing Prescription Drug Monitoring Programs (PDMPs)
2: Standardizing Clinical Guidelines
3: Engaging Pharmacy Benefits Managers And Pharmacies
4: Implementing Innovative Engineering Strategies
5: Engaging Patients and the General Public
6: Improving Surveillance (i.e. before having to count vital stats)
7: Treating Opioid-Use Disorders
8: Improving Naloxone Access and Use
9: Expanding Harm Reduction Strategies
10: Combating Stigma – non-constructive
Federal Response to the Opioid Epidemic – HHS priorities
In response to the opioid crisis, HHS is focusing its efforts on 5 priorities:
1. Better addiction prevention, treatment and recovery services
2. Better targeting of overdose reversing drugs
3. Better data
4. Better pain management
5. Better research
Our Mission: To protect and improve the health and environment of all Kansans.

16. Kansas’s Prevention Efforts
Our Mission: To protect and improve the health and environment of all Kansans.

17. State of Kansas Opioid Grants
State Targeted Response to the Opioid Crisis (KDADS)
Partnerships for Success (KDADS)
Kansas Data-Driven Prevention Initiative (KDHE)
STR – prevention and increase access to treatment for OUD
PFS – decrease opioid abuse in year olds in high burden areas / safe use, storage, and disposal
DDPI – KDHE’s grant. Focuses on primary prevention of the opioid crisis

18. Kansas Data-Driven Prevention Initiative
Cooperative agreement with the CDC Prescription Drug Overdose: Data-Driven Prevention Initiative
Objective: decrease prescription and illicit opioid abuse, misuse, and dependence, to decrease rates of fatal and non- fatal poisoning deaths in Kansas
Implements a three-pronged approach to reach the initiative’s goals
Planning, Data, and “Prevention in Action”
Our Mission: To protect and improve the health and environment of all Kansans.

19. KDDPI – Planning
Established Kansas Prescription Drug and Opioid Advisory Committee Overdose
Development and implementation of a statewide strategic plan across multiple sectors to facilitate primary, secondary, and tertiary prevention activities for prescription and illicit drug abuse and overdose
Components: needs assessment, state plan, evaluation plan, and dissemination plan
Advisory Committee provides support to Governor’s Task Force on SUD
Strategic planning
Our Mission: To protect and improve the health and environment of all Kansans.

20. Committee’s priority areas and subcommittee chairs
Our Mission: To protect and improve the health and environment of all Kansans.

21. KDDPI – Data
Necessary to improve data collection/analysis, to better understand the epidemic and assess progress toward program goals
Sources
Drug-related mortality data
Syndromic surveillance drug poisoning data from EDs
K-TRACS dispensation data
Work with OVS and coroners to increase specificity of drug poisoning deaths
Behavioral Risk Factor Surveillance System
Our Mission: To protect and improve the health and environment of all Kansans.

22. KDDPI – Prevention in Action
Main focus: Enhance Kansas’s PDMP (K-TRACS) and increase its use by prescribers and dispensers
Aim – prevent diversion, misuse and abuse of controlled substances while protecting legitimate medical use
Strategies
Enable registration, use, and access of K-TRACS (EHR integration)
Expand proactive reporting
Public health surveillance with K-TRACS
Contracted with BoP/K-TRACS. Appriss is their vendor.
The Kansas State Board of Pharmacy is partnering with Appriss Health, the service provider of K-TRACS, to provide this integration option to all Healthcare providers in the State utilizing a service called PMP Gateway. PMP Gateway is a multi-state query system that provides access to a majority of state PDMPs. PMP Gateway facilitates communication, information transfer, integration, and support for the state approval process and the EHR vendor development process.
Integrating K-TRACS data within an EHR provides a streamlined clinical workflow for providers. The integration eliminates the need for providers to pull-up the K-TRACS browser, log-in, and enter their patient’s name and date of birth. Instead, the EHR or Pharmacy Management System automatically initiates a patient query, validates the provider’s credentials in K-TRACS and returns the patient’s prescription record directly within the provider’s EHR or Pharmacy Management System.
Our Mission: To protect and improve the health and environment of all Kansans.

23. KDDPI – Prevention in Action
Provide education and technical assistance to high-burden regions
Providers, pharmacists, students, LEOs, general public
CDC Clinical Guidelines
CDC Rx Awareness Campaign
Vermont Oxford Network (VON) Neonatal Abstinence Syndrome (NAS) Universal Training Program
Other 2018 grant activities that are addressed with supplemental grant funding.
Our Mission: To protect and improve the health and environment of all Kansans.

24. Future Directions DDPI in FY 2019
K-TRACS improvements
Data enhancements
Community-based prevention
Implementation of Kansas Prescription Drug and Opioid Misuse and Overdose Strategic Plan
Recruit additional stakeholders and communities
Our Mission: To protect and improve the health and environment of all Kansans.

25. Adrienne Hearrell, MPH, CPTA
Program Coordinator
Prescription Drug Overdose: Data-Driven Prevention Initiative (DDPI)
Kansas Department of Health and Environment
(785)
Visit our website!
Our Mission: To protect and improve the health and environment of all Kansans.