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Project Lazarus/CCNC

Project Lazarus/CCNC. A statewide initiative to prevent drug overdose. Dr. Robin Gary Cummings Deputy Secretary for Health Services State Health Director. Resources: Community Care of North Carolina. 1.4+ million Medicaid lives in CCNC Medical Homes in CCNC 14 Networks- local control

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Project Lazarus/CCNC

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  1. Project Lazarus/CCNC A statewide initiative to prevent drug overdose Dr. Robin Gary Cummings Deputy Secretary for Health Services State Health Director

  2. Resources: Community Care of North Carolina • 1.4+ million Medicaid lives in CCNC • Medical Homes in CCNC • 14 Networks- local control • 1600+ Practices • 4,500+ PCP providers • Behavioral Health • 19 Psychiatrists in the 14 Networks • 14 Full-time Behavioral Health Coordinators in the Networks • 44 Network pharmacists, now with Behavioral Health pharmacy training • 14 Identified Chronic Pain Coordinators • 14 Clinical Directors- MD, non-psychiatrists • Data Management Tools • CPI Flags • Pain Agreements Uploaded • BH Care Alerts • LME/MCO Priority Patients

  3. Each CCNC Network Has: A Clinical Director A physician who is well known in the community Works with network physicians to build compliance with CCNC care improvement objectives Provides oversight for quality improvement in practices Serves on the State Clinical Directors Committee A Network Director who manages daily operations Care Managers to help coordinate services for enrollees/practices A PharmD to assist with Medication Management of high cost patients Psychiatrist to assist in mental health integration Palliative Care and Pregnancy Home Coordinators

  4. Unintentional poisoning mortality rates by type of narcotic: North Carolina residents, 2000-2010* *Source: NC SCHS, annual poisoning report prepared for Project Lazarus, based on ICD-10 T codes that identify the five narcotic categories associated with unintentional/undetermined intent poisonings on death certificates.

  5. Number of Unintentional Drug-Related Overdose Deaths By Year, Robeson County, N.C., 2003-2012 (N=100)

  6. Rates of Hospitalizations Associated with Drug Withdrawal Syndrome in Newborns per 100,000 Live BirthsNorth Carolina, 2004-2011 355% Increase Source: N.C. State Center for Health Statistics, 2006-2011 Analysis by Injury Epidemiology and Surveillance Unit

  7. Where Pain Relievers Were Obtained Source Where Respondent Obtained Bought on Internet0.1% Drug Dealer/Stranger3.9% Other14.9% Source Where Friend/Relative Obtained More than One Doctor 1.6% More than One Doctor3.3% Free from Friend/Relative7.3% One Doctor 19.1% Bought/Took fromFriend/Relative4.9% OneDoctor 80.7% Bought/Took from Friend/Relative14.8% Drug Dealer/Stranger1.6% Free from Friend/Relative55.7% Other 12.2% Non-medical Use among Past Year Users Aged 12 or Older 2006 1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”

  8. Project Lazarus: A State Wide Response to Managing Pain • Based on pilot project from Wilkes County • Funding mechanism: • Kate B. Reynolds grant- $1.3 million • Matching funds from Office of Rural Health- $1.3 million • MAHEC grant for western counties • Total Funds available $2.6 million

  9. Areas of Focus • Clinical Education- tool kits and trainings focus on opioid prescribing for primary care docs, ED docs, and CCNC care managers • Community Involvement- Involvement of all levels of community to demonstrate the drug problem is a community problem • Outcome Study- evaluate the outcomes to assure the effectiveness of the interventions

  10. Partners • Partners in roll-out coordinated through CCNC: • Project Lazarus- Community Coalitions (funding for 100 counties) • Governor’s Institute/CCNC- 40 Clinical Trainings for all prescribers and dispensers • Local Mentor program through CCNC • Local TA and Consultation through CCNC • UNC Injury Prevention Research Center- report outcomes of project

  11. Areas of Focus for Project Lazarus • Safer Opioid Prescribing- decrease in unintentional poisonings • Increased enrollment and use of CSRS • Education on and dispensing of Naloxone as rescue medication • Special projects: • Dental Pain • Opioids in pregnant women • Sickle Cell disease and pain

  12. CCNC Infrastructure to Support Project Lazarus • Project Manager • Chronic Pain Initiative Coordinatorsin each of 14 Networks • Care Managersto support patients in connecting to and remaining in care • Network Psychiatriststo provide education and support to Primary Care Physicians • Informatics Centerto make available pain contracts and special treatment plans for patients

  13. Community Coalitions • Coalitions to be developed in each County • Involve local leaders from health departments, law enforcement, Public Health, school systems, advocate groups, local CCNC, and clinical leaders • Leadership of coalition to be determined by each county • Funding through Project Lazarus available to help support each county coalition

  14. Updates on Early Results since March 2013 • Eight trainings for prescribers and dispensers- average attendance 55-60 • Enrollment in CSRS: • Prescribers (MD, DO, PA, FNP) • 8/2012 30% • 9/2013 33% (increase over 2400 prescribers) • National average 28% • Pharmacists • 8/2012 17% • 9/2013 42%

  15. Legislative Support in 2013 • Supports for CSRS to enhance enrollment and use: • Delegate authority • Reporting time of 72 hours from 7 days • Reporting of aberrant patterns in patients and physicians for follow-up by physicians and licensing Boards • Passage of Good Samaritan Law • Supports distribution and use of Naloxone as rescue drug in overdose situations • Supports physician prescribing

  16. North Carolina’s Response:Coordinating with Many Partners

  17. North Carolina Injury and Violence Prevention Branch Epidemiology, Policy, Partners, Community North Carolina Opioid Death Task Force Poisoning Death Study Comprehensive Community Approach Chronic Pain Initiative Policy Substance Abuse SAC Poisoning Workgroup Prescription Drug Monitoring System Policy & Practice Research Enforcement SBI & Medical Board Div. of Public Health, Drug Take Back Div. Medical Assistance, Div. Mental Health/ DD/Substance Abuse

  18. Call to Action:What can the Division of Public Health do?

  19. ASTHO’s Presidential Challenge

  20. ASTHO’s Presidential Challenge Identify an area of concentration Improve Monitoring & Surveillance Expand Prevention Strategies Expand and Strengthen Enforcement Improve Access to Treatment & Recovery 18 states to date have signed on 15x15: Reduce prescription drug use by 15% by 2015

  21. ASTHO’s Presidential Challenge North Carolina’s Areas of Concentration Improve Monitoring & Surveillance Increase available data Continue & expand linkage projects Increase public health surveillance using CSRS Expand Prevention Strategies CCNC/ Project Lazarus Expand access to Naloxone Expand and Strengthen Enforcement Coordinate efforts with law enforcement

  22. Call to Action:What can Local Health Departments do?

  23. Local Health Department Actions Coordinate with your CCNC Regional Director Form or Join a Substance Abuse Coalition Request your Poisoning Data tables from CCNC or DPH Use NC DETECT to monitor your prescription drug ED visits Enhance your data from local sources Have a signed standing order for Naloxone by your Medical Director Take an active role to facilitate and coordinate with local groups Make presentations at local medical societies on your prescription drug prevention activities Advocate with local providers to register and use CSRS

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