State Responses to Rx Drug and Heroin Abuse

1. State Responses to
Rx Drug and Heroin Abuse
Presenters:
• Dean Wright, RPh, PMP Director, Arizona State Board of Pharmacy
• Ralph Orr, Director, Virginia Prescription Monitoring Program, Virginia
Department of Health Professions
• Michael Landen, MD, MPH, State Epidemiologist, New Mexico
Department of Health
• Maggie Hart Stebbins, County Commissioner, Bernalillo (NM) Board of
Commissioners
Advocacy Track
Moderator: Mark D. Birdwhistell, MPA, Vice President for
Administration and External Affairs, University of Kentucky
HealthCare

2. Disclosures
Maggie Hart Stebbins; Michael Landen, MD,
MPH; Ralph Orr; Dean Wright, RPh, PMP; and
Mark D. Birdwhistell, MPA, have disclosed no
relevant, real, or apparent personal or
professional financial relationships with
proprietary entities that produce healthcare
goods and services.

3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center

4. Learning Objectives
1. Outline how Virginia’s new Health and Criminal
Justice Data Committee is designed to respond
to concerns before they become crises.
2. Explain Arizona’s state-wide prescriber report
cards.
3. Describe New Mexico’s model for stakeholder
collaboration to reduce opioid overdose deaths.
4. Provide accurate and appropriate counsel as
part of the treatment team.

5. Advocacy Track:
State Responses to Rx Drug and
Heroin Abuse
Dean Wright, RPh
Director of Arizona’s Controlled
Substances Prescription Monitoring
Program

6. Disclosure statement:
Dean Wright, RPh, has disclosed no
relevant, real or apparent personal
or professional financial
relationships with proprietary
entities that produce health care
goods and services.

7. Learning Objective:
Explain Arizona’s state-wide
prescriber report cards.

8. The Strategies
1. Reduce Illicit Acquisition and Diversion of Rx Drugs
2. Educate Prescribers and Pharmacists about “Rx Drug Best
Practices” and emphasize responsible prescribing
3. Enhance Rx Drug Practice and Policies in Law
Enforcement
4. Increase Public Awareness about the Risks of Rx Drug
Misuse
5. Build Resilience in Children and Adults

9. Strategy #1: Reduce Acquisition
• Proper Disposal
• Permanent drop boxes
• Take-back events
• Community education and awareness
• Proper Storage
• Community education and awareness
• Increase the use of the PDMP
• More law enforcement, prescribers and dispensers signed up and using the
PDMP
• A data feedback system for prescribers to self-monitor prescribing practices

11. Specialty CountOfSpecialty
Pathology 21
Hospice 24
Addiction Medicine 33
Preventive Medicine 56
Physical Medicine & Rehab 104
Optometry 125
Podiatry-Surgical 130
Podiatry-General 141
Dentists-Orthodontics 145
Otolaryngology 148
Dentists-Surgical 155
Pain Medicine 164
Urology 167
Oncology 202
Radiology 285
Anesthesiology 305
Neurology 362
Naturopath 375
OBGYN 847
Psychiatry 1193
Pediatrics 1204
Other PA-APN 1426
Surgery 1519
Emergency Medicine 1543
Dentists-General 2709
Internal Medicine 4674
Family Medicine 5483
23552

12. Arizona State Board of Pharmacy
Controlled Substances Prescription Monitoring Program
1616 W. Adams, Suite 120
Phoenix, AZ 85007
February 18, 2016
«Prescriber_Name» «Degree»
«Address»
«City», «State» «Zip»
Dear «Prescriber_Name» «Degree»:
The Arizona State Board of Pharmacy, in collaboration with the Arizona Substance Abuse Partnership, is participating
in an initiative to address the growing concern over prescription drug misuse and abuse in Arizona. The Rx Initiative
involves stakeholders from the Arizona Department of Health Services, the Arizona Criminal Justice Commission,
the Governor’s Office of Youth, Faith and Family, and local substance abuse prevention coalitions.
A major focus of the Rx Initiative involves promoting responsible prescribing and dispensing practices among
medical professionals in Arizona. In an effort to help you monitor your own prescribing habits, please find an
attached report card that details your prescribing patterns related to the types of prescription medications of
interest to the Initiative. These medications were chosen based on data that identified them as the most commonly
prescribed and the most commonly misused by youth and adults. Additionally, these drugs account for the majority
of drug-related Emergency Department visits and poisoning deaths in Arizona.
The data provided by the report card is for your information only.
Please take a moment to review the report card to compare your prescribing practices to those of your colleagues,
and help us promote responsible prescribing in Arizona. If you are an outlier (i.e., prescribing at least 1 Standard
Deviation above the mean compared to your colleagues), we encourage you to consider if your prescribing practices
follow best practice guidelines for your medical specialty. You can find the Arizona Opioid Prescibing Guidelines on the
Arizona Department of Health Services website at http://azdhs.gov/audiences/clinicians/index.php#guidelines-
recommendations-rx-guidelines. We also encourage you to educate your patients about the risks of Rx drug misuse and
proper storage and disposal methods. Locations of permanent drop boxes can be found at www.dumpthedrugsaz.org .
If you have not yet done so, please go to the website below to sign up for access to the Prescription Drug Monitoring
Program (PDMP) database: https://pharmacypmp.az.gov/. The PDMP is an essential tool for checking your
patient’s medication history, for monitoring their drug therapy, and for minimizing misuse. If you have any
questions, please do not hesitate to call the Arizona State Board of Pharmacy at 602.771.2748 or 602.771.2732.
______________________________ ______________________________
Debbie Moak John A Blackburn Jr
Arizona Substance Abuse Partnership Executive Director,
The Governor’s Office of Youth, Faith and Family Arizona Criminal Justice Commission
______________________________ ______________________________
Cara M. Christ, MD Dean Wright
Director, Monitoring Program Director,
Arizona Department of Health Services Arizona State Board of Pharmacy

13. CSPMP Report Cards
Report cards for the 3rd Quarter of 2015
1543 mailed on 12/28/15
8429 emailed on 1/4/16 to 1/5/16
So far:
66 returned envelopes
935 bounced emails

14. CSPMP Report Cards
Next set of report cards for the 4th
Quarter 2015 will go out the 1st week
of March 2016.

15. QUESTIONS?
Arizona State Board of Pharmacy
Web page: https://pharmacypmp.az.gov
Dean Wright, CSPMP Director
Arizona State Board of Pharmacy
1616 W. Adams, Suite 120
P.O. Box 18520
Phoenix, AZ 85005
602-771-2744
Fax: 602-771-2748
dwright@azpharmacy.gov

16. Advocacy Track: State Responses
to Rx Drug and Heroin Abuse
Ralph Orr
Director, Virginia’s Prescription
Monitoring Program

17. Disclosure Statement
• Ralph Orr has disclosed no relevant, real or
apparent personal or professional financial
relationships with proprietary entities that
produce health care goods and services.”

18. Objectives
• Discuss recommendations of the Virginia
Governor’s Task Force on Prescription Drug
and Heroin Abuse
• Outline how Virginia’s new Health and
Criminal Justice Data Committee is designed
to respond to concerns before they become
crises.

19. Task Force
Establishment & Structure
19
• Healthy VA Plan: Executive Order 29
• Co-chaired by Secretary Hazel & Secretary Moran
• Five meetings between November 2014 and September
2015, resulting in 51 recommendations
• 32 members, 5 workgroups
 Education
 Treatment
 Storage & Disposal
 Data & Monitoring
 Law Enforcement
2 Co- chairs
32 multi-
disciplinary,
bipartisan
members
5 workgroups

20. Recommendations: Major Themes
20
Access to Naloxone
Maximization of
Prescription
Monitoring Program
Provider education
and proper
prescribing/dispensing
Access to and
availability of
treatment
Drug courts and
incarceration-based
programs; further
support for law
enforcement
Information and Data

21. Maximizing the
PMP
Using the Prescription
Monitoring Program to its
maximum benefit to decrease
overdose and promote legitimate
use of controlled substances.
21
Access to and Availability of
Treatment
Treating opioid and heroin addiction
requires a complex and individualized
set of services, including Medically
Assisted Treatment, group and individual
counseling, and peer supports.

22. Drug Courts & Law
Enforcement Support
“We cannot arrest
our way out of
this problem.”
22
Provider education and proper
prescribing/dispensing
• Students:
– Medical School curricula
– Social Work curricula
• Medical residents:
– Loan forgiveness for Addiction
Medicine residency program
– Grand Rounds inclusion
• Practicing Providers:
– Mandate and/or incentivize
Continuing Medical Education
(CME) for current providers

23. Continuing Action
23
Leadership on
cross-
secretariat
coordination
efforts
Engagement
from agencies
(VDH, DBHDS,
DHP, DCJS)
and
legislature
Health and
Criminal
Justice Data
Committee
Development
of Website

24. PMP
Med Examiner
ED
Data
State Police
Forensics
Corrections
Juvenile Justice
Workforce
data
PROBLEM: LACK OF COORDINATED
ANALYSIS OF DATA

25. HEALTH AND CRIMINAL JUSTICE DATA
COMMITTEE: PROVIDES MECHANISM
FOR COORDINATED ANALYSIS

26. Virginia Prescription Opioid Data
Comparing Hospitalizations to Fatal Overdoses
0
100
200
300
400
500
600
700
800
900
1000
FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015
CountofHospitalizationsandFatalOD
Hospitalizations Fatal OD
Data Sources: OCME Fata Drug Overdose Quarterly Report (2015 data are projected, preliminary figures); OFHS response to data request 12/30/2015.

27. Virginia Heroin Data
Comparing Hospitalizations to Fatal Overdoses
0
50
100
150
200
250
300
350
FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015
CountofHospitalizationsandFatalOD
Hospitalizations Fatal OD
Data Sources: OCME Fatal Drug Overdose Quarterly Report (2015 data are projected, preliminary figures); OFHS response to data request 12/30/2015

28. Submissions to Virginia Department of Forensic
Science: Prescription Opioids and Heroin
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
CY2002
CY2003
CY2004
CY2005
CY2006
CY2007
CY2008
CY2009
CY2010
CY2011
CY2012
CY2013
CY2014
CasesSubmitted
RxOpioids Heroin
Data Source: DFS monthly submission to the National Forensic Laboratory Information System (NFLIS), shared with DCJS

29. Opioids Prescribed in Virginia
Six Drugs Represent 90% of Opioid Prescriptions in First
Half of 2015
0%
10%
20%
30%
40%
50%
60%
Hydrocone SA Oxycodone SA Tramadol SA Buprenorphine Codeine Hydromorphone
2010JanJunPct 2011JanJunPct 2012JanJunPct 2013JanJunPct 2014JanJunPct 2015JanJunPct
Data Sources: Brandeis University report, 11/23/2015. That report used Virginia Prescription Monitoring Program database as its source.

30. TASK FORCE WEBPAGE:
Virginia Governor's Task Force on Prescription Drug and
Heroin Abuse
• CONTACT INFORMATION
– Phone #: 804-367-4566
– Fax 804-527-4470
– Email- ralph.orr@dhp.virginia.gov
– Virginia's Prescription Monitoring Program

31. Advocacy Track: State Response to
Rx Drug and Heroin Abuse
Michael Landen
State Epidemiologist
New Mexico Department of Health

32. Disclosure
Michael Landen, MD, MPH, has disclosed no
relevant, real or apparent personal or
professional financial relationships with
proprietary entities that produce health care
goods and services.

33. Approved Learning Objectives
Describe New Mexico’s model for stakeholder
collaboration to reduce opioid overdose deaths.

34. 0
5
10
15
20
25
30
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
Deathsper100,000persons
Year
Drug Overdose Death Rates
New Mexico and United States,
1990-2014
New Mexico
United States
Rates are age adjusted to the US 2000 standard population
Source: United States (CDC Wonder); New Mexico (NMDOH BVRHS/SAES, 1990-1998,2014 ; NM-IBIS, 1999-2013)

35. Drug Overdose Death Rates
Leading States, U.S., 2014
Rank State Deaths per 100,000
1 West Virginia 35.5
2 New Mexico 27.3
3 New Hampshire 26.2
4 Kentucky 24.7
5 Ohio 24.6
U.S. 14.7
Sources: CDC Wonder
Rates are age-adjusted to the 2000 US Standard Population.

36. Drug Overdose Death Rates for Selected Drugs, NM, 1990-2014
0
2
4
6
8
10
12
14
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Deathsper100,000population
Heroin Prescription Opioids Methamphetamine
Cocaine Sedative-hypnotics
Drug categories are not mutually exclusive. Source: Office of the Medical Investigator; UNM/GPS population

37. Drug Overdose Death Rates by Census
Tract Poverty Level*
New Mexico, 2009-2013
15.6
16.8
23.0
27.1
29.9
23.8
0
5
10
15
20
25
30
35
Less than 5% 5 - 9.9% 10 - 19.9% 20 - 29.9% 30% - 39.9% 40% or more
Deathsper100,000Population
*Poverty level is the percentage of persons of all ages in the decedent’s census tract living at or below 100% of Poverty.
Drug Overdose deaths are defined by ICD 10: X40-X44, X60-X64, X85, Y10-Y14.
Rates have been age-adjusted to the standard U.S. 2000 population.
Source: NM Vital Records and Health Statistics, U.S. Bureau of the Census, American Community Survey

38. 0.0
5.0
10.0
15.0
20.0
25.0
30.0
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
Overdosedeathsper100,000pop
MorphineEquivalents(kg)per10,000pop
MME of Opioids Sold and Overdose Death
Rates
NM, 2001-2014
Morphine equivalents sold
Drug OD Death Rate
Buprenorphine and Methadone excluded from total morphine equivalents; Source: DEA

39. New Mexico Mechanisms - 2011
• 7 licensing boards for each controlled
substance prescribers profession
• PMP in Board of Pharmacy with shared
access for Department of Health via
regulation
• Naloxone widely distributed alongside syringe
exchange

40. 2012 Legislative Session
• 3 bills introduced
– Opioid Prescribing Limits and PMP bills failed
• Pain Relief Act revised
– Mandatory continuing education for prescribers
– Required licensing boards to have chronic pain
management rules
– Established Governor’s Council on overdose
prevention and pain management

41. Council
• Meets every 1- 2 months
• Annual recommendations to Governor
• Voting members include Department of
Health, licensing boards, professional
associations, consumers, chronic pain
patients, pain management specialists
– Some licensing boards not voting members
– Many others attend and participate

42. Improving Prescribing
• Council recommended PMP move from data
within 7 days to within one day - implemented
• Reviewed licensing board chronic pain
management rules
• Reviewed overdose death – PMP linked data
• Reviewed prescriber report cards
• Reviewed quarterly prescribing measures
• Recommended PMP check with each opioid Rx

43. Percent of Patients with No PMP Review by Opioid Use
Category, NM, 2014
93
81
56
42
31
0
20
40
60
80
100
1 prescription < 90 days 90-180 days 180-330 days Full Time
Percentofpatients
1 year Opioid Use Category
Source: NM Prescription

44. Naloxone Access
• Council recommended Naloxone for Medicaid
formulary
• Brought Medicaid managed care
organizations together to work on
reimbursement
• Regular updates on naloxone availability
including availability by community/overdose
death rates
• Recommended standing order and statute

45. Naloxone Distribution and Reported Reversals,
NMDOH Programs, NM, 2010-2014
Source: NM DOH Harm Reduction Program and Co-Prescription Pilot Program
0
1000
2000
3000
4000
5000
6000
7000
2011 2012 2013 2014
Number
Doses dispensed
0
200
400
600
800
1000
2011 2012 2013 2014
Reported Reversals

46. Pharmacist Prescriptive Authority
• Based on 2002 law which provided pharmacists prescriptive
authority
– The Board of Pharmacy adopts regulations and protocols governing
certification for specified “dangerous drug therapies”
• Vaccinations, emergency contraception, tobacco cessation
drugs, and tuberculosis testing are allowed by certification
• Naloxone certification was established by regulation in 2014
– Training is provided by the NM Pharmacist’s Association and certification
is maintained by completing 2 hours of CE every 2 years
– About 180 pharmacists have been certified to date
• Reporting system in place
– About 200 reports of persons prescribed naloxone by pharmacists

47. Medicaid Claims for Naloxone from Outpatient
Pharmacies, NM January 2013- June 2015
Source: NM HSD Medicaid Claims; NM PMP
0 1
17
66
100
0
20
40
60
80
100
120
Jan-Jun 2013 Jul-Dec 2013 Jan-Jun 2014 Jul-Dec 2014 Jan-Jun 2015
Numberofclaims
Six month time period

48. Treatment Availability
• Chronic pain patient presentations
– Chronic pain survey process developing
• Buprenorphine barriers and access reviewed
• Recommended end to Medicaid pre-
authorization
• Tracked opioid treatment need and actual use
disparity

49. 0 2000 4000 6000 8000 10000 12000
Methadone
Buprenorphine/Naloxone
Heroin
Prescription Pain Relievers
Treatment
Abuseor
Dependence
Number of People
Estimated Number of People with
Abuse/Dependence on Opioids and Numbers of
People in Treatment, NM, 2014
Source: NM Treatment Need Estimates, NMDOH; NM Prescription Monitoring Program; NM Behavioral Health

50. 2016 Legislative Session
• Naloxone
– Standing order and storage bills passed
– Special meeting of council to implement standing
order process
• Prescription Monitoring Program
– Floated every check for every opioid Rx,
– initial bill had check for initial and q 3 month
– ended up with 4 day short prescription exception
– Council will lead joint process to revise 7 licensing
board chronic pain management rules

51. Recommendations
• Develop and maintain a state-level overdose
prevention policy group
– Transparency particularly around legislation
– Hope to add a smaller, parallel state agency group
• Develop indicators for the group with regular
data updates
• Establish a regular cycle for developing
recommendations
• Don’t get complacent – the overdose epidemic
and interventions constantly change

52. Advocacy Track: State Response to
Rx Drug and Heroin Abuse

53. Disclosure
Maggie Hart Stebbins, Bernalillo County
Commissioner, has disclosed no relevant, real or
apparent personal or professional financial
relationships with proprietary entities that
produce health care goods and services.

54. Approved Learning Objectives
Describe New Mexico’s model for stakeholder
collaboration to reduce opioid overdose deaths.

55. Maggie Hart Stebbins, Bernalillo
County Commissioner
• Joined the Bernalillo County Commission in
2009.
• Actively engaged in efforts related to
behavioral health, including:
– Bernalillo County Opioid Accountability Initiative.
– Bernalillo County Criminal Justice Review
Commission
– Bernalillo County Behavioral Health Initiative

56. Bernalillo County
• Located along the
middle Rio Grande of
New Mexico
• Largest population in
the State of New
Mexico, with more than
675,000 residents
• Includes the City of
Albuquerque
Images courtesy of marblestreetstudio.com

57. 19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
Bernalillo Co. 11. 11. 14. 15. 15. 16. 17. 15. 23. 20. 20. 20. 23. 24. 19. 26. 26. 27. 34. 26. 26. 29. 28. 22. 28.
New Mexico 7.6 7.8 8.9 10. 9.6 11. 11. 11. 15. 15. 15. 14. 16. 19. 16. 19. 21. 22. 26. 21. 23. 25. 24. 21. 26.
0
5
10
15
20
25
30
35
40
Deathsper100,000pop
Total Overdose Death Rate, Bernalillo
County and New Mexico, 1990-2014
Bernalillo Co.
New Mexico
Rates age adjusted to the US 2000 standard population
Source: Bureau of Vital Records and Health Statistics, UNM/GPS population est.

58. Source: New York Times: How the Epidemic of Drug Overdose Deaths Ripples Across America. January 19, 2016
New Mexico Overdose Deaths, 2003-2014

59. Bernalillo County Metropolitan Detention Center (MDC)
• Bernalillo County is responsible for the operations and maintenance of the MDC, which
comes at a cost of $84M for fiscal year 2016 and represents 30% of the County’s General
Fund budget of $281M.
• Under court order to reduce jail population, which in 2012 was at 2800, and today is at
approximately 1400, a 50% reduction.
• Accomplished as result of Bernalillo County Criminal Justice Review Commission, and
Bernalillo County Adult Detention Reform team.
• Their efforts have highlighted the need for increased and better coordinated behavioral
health services in our community, along with judicial reforms to make the system more
efficient.
• 60% of MDC inmates with mental health, substance use or co-occurring
• disorders
• MDC is the largest behavioral health care provider in NM.

60. Healing Addiction in
Our Community (HAC)
• Formed in April 2010
• To educate, advocate,
raise awareness
• 2014 opened Serenity
Mesa Youth Recovery
Center, providing
residential
rehabilitation services
to youth ages 14-21.

62. • Made up of community members, health and social service providers,
educators, and other private and public employees that serve County
residents
• History of bringing people together to explore public health concerns
• Until last year was an official part of BernCo Government, today is it’s
own non-profit.
• Experienced and highly skilled facilitator, Marsha McMurry Avila,
serves as the Executive Director.

63. bchealthcouncil.org
Collective Impact Initiatives
BERNALILLO COUNTY
OPIOID ACCOUNTABILITY INITIATIVE
“Turning the Curve on Opioid Abuse in
Bernalillo County”

64. SUMMIT PLANNING COMMITTEE
Focused on identifying recommendations, indicators,
panelists and format for first Summit , 20 multi-sectoral members representing:
• Advocates, community activists, drug policy analysts, data analysts
• Albuquerque Health Care for the Homeless
• Bernalillo County Community Health Council
• Bernalillo County Department of Substance Abuse Programs/MATS
• Bernalillo County Urban Health Extension
• City of Albuquerque Division of Health & Human Services
• Heroin Awareness Committee (Healing Addiction in Our Community)
• Molina Healthcare
• New Mexico Department of Health – Health Promotion
• New Mexico Department of Health – Office of Injury Prevention
• New Mexico Department of Health – Turquoise Lodge
• Presbyterian Healthcare Services
• UNM Prevention Research Center for Education Policy Research
• UNM Preventive Medicine
• UNM Urban Health Partners – Pathways to a Health Bernalillo County
• UNM Center for Alcoholism, Substance Abuse & Addictions (CASAA)
• UNM RWJF Health Policy Center

65. SUMMIT
PLANNING
COMMITTEE
SUMMIT #1
September
19, 2013
IMPLEMENTATION
TEAMS
PRIMARY
PREVENTION
NARCAN
TREATMENT
LAW
ENFORCEMENT/
CRIMINAL JUSTICE
COORDINATING
COMMITTEE
INTERIM
UPDATE
MEETING
June 2014
SUMMIT #2
January 2015
BERNALILLO COUNTY OPIOID ACCOUNTABILITY
INITIATIVE TIMELINE (Fall 2012 – Winter 2015)
August 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall
2014

66. Four Implementation Teams with
volunteers from Summit - plus others – have
met monthly to:
 strategize about recommendations for their
specific area, including identifying decision-
makers who are key players to bring to the
table
 select indicator(s) as target to measure
progress toward desired outcome(s)
 inventory available services/gaps in their
area, identifying need for additional
resources
 provide ideas for next Summit

67. PRIMARY PREVENTION
IMPLEMENTATION TEAM
What works or would work to "turn the curve" on this problem?
RECOMMENDATIONS FOR ACTION
• Expand access to drug counseling and prevention services for high school and
middle school students including appropriate referrals, working to gain
reimbursement coverage from Medicaid
• Support policies to expand evidence-based early childhood support programs,
including home visiting focusing first on low-income families
• For pain control, promote evidence-based alternatives for Rx opioids, such as
chiropractic or other physical medicine
• Reduce supply of Rx opioid pain medication by increasing access to and usage of
Prescription Monitoring Program database AND promoting prescribing guidelines
to limit over-prescription of opioids

68. What would work to "turn the curve" on this problem?
RECOMMENDATIONS FOR ACTION
•Distribute naloxone to persons being released from MDC and their families
•Restructure P&P policies to allow for parolees to have naloxone rescue kits while on
parole
•Assure all police officers are carrying naloxone and trained in its use
•Support implementation of authorization allowing pharmacists to prescribe naloxone
o Support development of MCO reimbursement mechanisms for kits and
education/consultation
o Assure naloxone rescue kits are stocked at all pharmacies
•Advocate for all providers to co-prescribe naloxone with opioid pain meds for chronic
pain management
•Make naloxone and training available to agencies with outreach programs for injection
drug users, treatment centers and methadone clinics
•Make naloxone available at all public health offices as walk-in sites
NARCAN
IMPLEMENTATION TEAM
Make availability of naloxone normal and universal

69. TREATMENT
IMPLEMENTATION TEAM
What works or would work to "turn the curve" on this problem?
RECOMMENDATIONS FOR ACTION
• Increase MD participation in prescribing
• Continue MAT for MDC inmates already in treatment when incarcerated
• Offer pre-release MAT to MDC inmates not yet in treatment
• Assure access for uninsured populations, including those not eligible for coverage
• Expand buprenorphine beyond detox to ongoing maintenance treatment when appropriate
(Turquoise Lodge and MATS)
• Address issue of drug courts excluding people on MAT
• Address BHSD guidelines allowing only psychiatrists to prescribe buprenorphine and no
payment for methadone
• Address private insurance payment for methadone
• Address VA lack of provision and payment for methadone
• License mid-level practitioners to prescribe buprenorphine
• (issue of federal regulations)
1. Expand access to medication-assisted treatment (MAT)

70. TREATMENT continued
RECOMMENDATIONS FOR ACTION
• Expand number and capacity of residential and inpatient programs
o Work with Medicaid, Centennial Care MCOs and private insurance to provide
coverage/ reimbursement
o Assure access for uninsured populations, including those not eligible for coverage
• Duration of coverage for specific levels of intervention should be flexible and tailored
to patient needs
• Assure identification and treatment of co-occurring disorders
• Eliminate need for diagnosed co-occurring condition as a requirement for Medicaid
funding of treatment of alcohol/drug dependency
• Include wrap-around support services as integral part of funding for treatment
services, including assistance finding housing/jobs
• Identify and offer enrollment to all persons who are drug users or at risk for opioid
use and are eligible for Medicaid, especially persons being released from
incarceration
2. Expand full array of treatment services aligned with ASAM guidelines
TREATMENT
continued

71. TREATMENT continued
RECOMMENDATIONS FOR ACTION
• Develop a comprehensive inventory/mapping of current treatment services to
determine gaps in capacity and levels of care as basis for an effective, coordinated
system
• Develop current, consistently updated database of services accessible to providers
and community (including eligibility criteria and program capacity)
• Identify opportunities for enhanced linkages among different components of the
system
• Develop shared measurement criteria to allow for evaluation of system linkages and
accurate cost reports
• Propose realignment of resources to support prioritized services in alignment with
agreed-upon principles
• Explore feasibility and appropriately plan for expansion of County DSAP as nucleus of
a much-expanded integrated treatment system
• Assure integration of MDC into treatment system linked to community
providers/resources
3. Develop comprehensive and coordinated treatment system in Bernalillo County
TREATMENT
continued

72. LAW ENFORCEMENT/CRIMINAL JUSTICE
IMPLEMENTATION TEAM
What works or would work to "turn the curve" on this problem?
RECOMMENDATIONS FOR ACTION
• Increase programs offering alternatives to incarceration
• Increase capacity of court system to expedite proceedings and reduce time waiting for
verdicts and sentencing
• Assemble stakeholders to assess feasibility of LEAD pilot by either APD or County
Sheriff’s Department
1. Reduce the number of people with substance use disorders who are incarcerated

73. LAW ENFORCEMENT/CRIMINAL JUSTICE
continued
RECOMMENDATIONS FOR ACTION
• For persons already under medication-assisted treatment (MAT) at the time
of incarceration, continue methadone and Suboxone during incarceration
• Conduct a pilot for pre-release induction of Suboxone and treatment with
Vivitrol
• Prior to or upon release, arrange for Medicaid enrollment for those eligible
• Set up linkages between treatment providers and inmates
• Arrange for post-release social services and medical follow-up including
MAT, and distribute Narcan
• Make indicated prevention programs available for incarcerated individuals
with low-level substance abuse
• Increase amount of discharge prescriptions from 3 days to 30
2. Provide effective treatment services for those who are incarcerated and upon release

74. WHERE ARE WE NOW?
• Continued rise is opioid deaths in NM and Bernalillo County
• Numerous tragic encounters between law enforcement and people struggling with
substance use and mental health disorders that have heightened awareness of
community service needs.
• City of Albuquerque, U.S. Dept. of Justice Settlement Agreement includes several
provisions that will require an investment by the City into behavioral health
community resources, education and training for officers
• Bernalillo County 1/8 cent GRT for Behavioral Health & BC Behavioral Health
Initiative:
Connect the Dots
 Fill the Gaps
 Leverage Resources to Maximize Impact

75. WHERE ARE WE NOW?
Cont’d
Treatment -- Managing prescription opioids:
 Medicaid expansion has started targeting enrollment for persons at risk of
addiction: example incarcerated persons.
 MDC has turned around in terms of interest in helping with addiction,
including maintaining MAT for persons who are on methadone at time of
incarceration and active planning for drug treatment for persons being
released from incarceration.
 Medicaid has begun covering buprenorphine and clinician visits for
medication-assisted Treatment (MAT).

76. WHERE ARE WE NOW?
Cont’d
Naloxone:
 NM pharmacists can have prescription authority for naloxone.
 2016 Legislative Session, HB 277, passed and is waiting for the Governors signature. If
signed, it will allow licensed prescribers new authority to provide standing orders for
unnamed persons to obtain naloxone. This will approximate OTC status naloxone
without losing third party coverage for it still being a prescription drug.

77. WHERE ARE WE NOW?
Cont’dPrevention:
• Focus on reducing supply of prescription opioids through take-backs, and control of
excess prescribing.
• NM was early in establishing its PMP; now fully running with required registration.
• Plans are underway to have face-to-face education encounters with prescribers who
are outliers at the high end of opioid volumes.
• Licensing boards requiring all prescribers to have pain management education and
to participate in the PMP.
• Focus on schools for education and early intervention.
• Focus on early childhood intervention (Nurse Family Partnership)
targeting high-risk families.

78. IMPLEMENTATION
TEAMS
PRIMARY
PREVENTION
NARCAN
TREATMENT
LAW
ENFORCEMENT/
CRIMINAL JUSTICE
ACTION
TEAM
C
O
O
R
D
I
N
A
T
I
N
G
C
O
M
M
A
L
I
G
N
E
D
A
C
T
I
O
N
S
U
M
M
I
T
#2
J
a
n
2
0
1
5
BERNALILLO COUNTY OPIOID ACCOUNTABILITY
INITIATIVE TIMELINE (as of Spring 2016)
PRIMARY
PREVENTION
NARCAN
TREATMENT
LAW
ENFORCEMENT/
CRIMINAL JUSTICE
STRATEGY
GROUPS
ACTION
TEAM
ACTION
TEAM
ACTION
TEAM
ACTION
TEAM
ACTION
TEAM
ACTION
TEAM
ACTION
TEAM
Jan 2015 (Jan 2015 to Jan
2013)
Jan 2016 Feb 2016

79. New Mexico Heroin and Opioid
Prevention and Education
(HOPE) Initiative
• Launched January 2015
• Collaboration between New Mexico Office of U.S. Attorney’s Office,
and
• University of New Mexico Health Science Center, in partnership with
the
• Bernalillo County Opioid Accountability Initiative
• Five Components:
– Prevention & Education
– Treatment
– Law Enforcement
– ReEntry
– Strategic Planning

80. Challenges Ahead
• Educating elected officials and government bureaucracies
• Poor drug treatment infrastructure, personnel, and insurance coverage
• Major issues with parity enforcement – Medicaid a particular concern
• Stigma of addiction
• Need to treat addiction as a chronic disease to shift from blame and
punishment
• The need to scale up. We have made progress in communication across
stakeholders, but the requirements for scaling up to impact the indicators
will require new tools to build systems of planning and collaboration. Our
agencies and bureaucracies are not prepared to accept a new set of
priorities that will compete for budget and disruption familiar alignments.
Ultimately it will depend on strong executive leadership.
• MAT-Induction at MATS & MDC?
• Add Buprenephorine to MDC MAT options?

81. State Responses to
Rx Drug and Heroin Abuse
Presenters:
• Dean Wright, RPh, PMP Director, Arizona State Board of Pharmacy
• Ralph Orr, Director, Virginia Prescription Monitoring Program, Virginia
Department of Health Professions
• Michael Landen, MD, MPH, State Epidemiologist, New Mexico
Department of Health
• Maggie Hart Stebbins, County Commissioner, Bernalillo (NM) Board of
Commissioners
Advocacy Track
Moderator: Mark D. Birdwhistell, MPA, Vice President for
Administration and External Affairs, University of Kentucky
HealthCare