Opioids

The State Interagency Opioid Response Plan provides recommended actions and a 2017 progress report. 

Efforts supporting the plan include:

• Medicaid Transformation projects through Accountable Communities of Health to address opioid misuse disorder in their regions.
• Recommendations from the Bree Collaborative established by the Washington State Legislature, including opioid use disorder treatment recommendations, opioid prescribing guidelines for dental practitioners, pain guidelines and prescribing metrics. Also see the Bree Collaborative’s Working Together to Impact the Opioid Epidemic.
• Provider access to patient prescription history through Washington State Prescription Monitoring Program.
• Grant-funded efforts to expand treatment, social support, and chronic pain management for opioid use disorder, including the state targeted response to opioid crisis grant and the Prescription Drug Overdose Prevention for States.
• Public awareness campaign through Department of Social and Health Services, including downloadable media tools, available at GetTheFactsRx.com.

The 2017 progress report includes recommended actions.

Additional information and resources may be found on the Department of Health opioids web page.

• Synthetic opioids including illicit fentanyl and fentanyl-type drugs have been appearing in other drugs sold as pain pills or heroin, contributing to fentanyl overdose deaths in Washington State.
• Jail and prison inmates with opioid use disorder often lack access to Medication Assisted Treatment (MAT) and social services while incarcerated.
• There is a need to transform care for pregnant and new mothers with opioid use disorder, including stigma reeducation.
• Rising rates of homelessness are creating a crisis in many communities. Trying to address housing and opioid issues is putting great stress on limited resources.

• Washington State rates of opioid overdose death vary by race and ethnicity. Data indicate American Indian/Alaska Native rates were highest, Hispanic and Asian populations were lowest. (2011-15)*
• Those who die from heroin overdose tend to be younger than those who die from prescription opioids.*
• Low-wage workers in physically demanding jobs may use opioids so they can avoid missing work.*
• Rural communities are challenged by a shortage of treatment providers and counseling infrastructure.*
• Access to alternative pain treatments such as physical therapy or acupuncture is limited for some populations. Factors include insurance coverage, sick leave, transportation, and childcare.*

*Sources:

DOH death certificates, includes all intent of drug-related deaths with the additional ICD-10 codes of T40.0, T40.1, T40.2, T40.3, T40.4, or T40.6

DOH Death Certificates, methodology identifies opioid deaths using both ICD-10 codes and the literal text on the death certificate, and excludes intentional deaths due to opioid overdose

HRSA 2016

HRSA 2016

NIH Mar 2017

• The rate of prescription opioid overdose deaths has declined, while the rate of heroin overdoses has increased.*
• About 330,000 persons 12 years and older in Washington State are estimated to misuse pain relievers.*
• Nearly 60 percent of those who inject heroin said they were hooked on prescription opiates before they began using heroin.*
• 66 percent of drug injectors in Washington reported they would like help stopping or reducing their drug use.*

Sources used:

• Washington State Health Assessment, Drug Overdose and Nonmedical Use of Pain Relievers
• University of Washington Alcohol & Drug Abuse Institute Interactive Data
• Washington State Healthy Youth Survey
• Health of Washington State, including Drug Abuse and Overdose and Social and Economic Determinants of Health

* Sources:

DOH Death Certificates

National Survey on Drug Use and Health, 2015-2016

2015 Drug Injector Health Survey, University of Washington and Public Health-Seattle & King County

UW Alcohol and Drug Abuse Institute 2015 WA State Syringe Exchange Survey

Strategies for opioids include, but are not limited to:

• Reduce stigma around substance abuse disorders.
• Screen for opioid misuse/opioid use disorder.
• Follow Center for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain.
• Implement Prescription Monitoring Program
• Implement Medication-Assisted Treatment (MAT).
• Reduce insurance coverage barriers.
• Develop training for providers at all levels.
• Increase support services, including housing.

Resources and tools:

Frameworks and Strategies

• Opioid Misuse Strategy, Center for Medicare and Medicaid Services.
• Social-Ecological Model: A Framework for Prevention, CDC.
• Prevention Approaches, Substance Abuse and Mental Health Services Administration (SAMHSA)

Screening Tools

• Screening, Brief Intervention, and Referral to Treatment SBIRT), including available reimbursement codes, SAMHSA.
• Chart of Evidence-Based Screening Tools for Adults and Adolescents, National Institute on Drug Abuse (NIDA).

Prescribing Guidelines, Prescription Monitoring

• Guideline for Prescribing Opioids for Chronic Pain, CDC.
• Guidelines for Prescribing Opioids and Prescribing Guidelines for Dental Practitioners
• TelePain audio and video-based resource for providers treating chronic pain, University of Washington.

Treatment Recommendations, Overdose Reversal

• Medicated Assisted Treatment information and guidelines, SAMHSA.
• Opioid Overdose Reversal information, NIDA. 

Trauma Informed Approaches

• Policy Brief on ACEs and Opioid addiction, Campaign for Trauma Informed Policy & Practice.

Strategies for Tribal, Rural, and Homeless Populations

• Treating the Rural Opioid Epidemic, National Rural Health Association (NRHA).
• Strategies to Address the Intersection of the Opioid Crisis and Homelessness, Interagency Council on Homelessness.