7 page grant proposal and power point

Request for Applications – Application Narrative

Regional Opioid Safety Coalitions: Bringing Communities Together to Prevent Overdose Deaths

Introduction

The Orange County Collaborative on Prescription Drug Abuse (OCCPDA) is committed to developing a

county wide initiative to reduce opioid-related overdose deaths. This county plan is closely aligned with

the national plan, Epidemic: Responding to America’s Prescription Drug Abuse Crisis, and identifies

specific recommendations for action. Prescription drug abuse is Orange County’s fastest growing drug

problem and impacts our county in multiple ways. Parents suffering from drug addiction can compromise

the health and well-being of their families, often leading to greater social services agency involvement.

Young people may view prescription drugs as a “less harmful” drug of choice, derailing healthy

development and their ability to succeed. Workers who abuse prescription drugs contribute to poor work

performance, injuries, absenteeism, and lack of economic productivity. Prescription painkillers (opioids)

are now the most commonly involved drugs in unintentional overdose deaths.

A study done in collaboration with the Orange County Health Care Agency and Orange County Sheriff-

Coroner Department found that the overall rate of drug/alcohol overdose deaths in the County increased

by 51% between 2000 and 2012. Key findings of the report include:

• Drug/alcohol overdoses, or poisonings, resulted in over 5,000 hospitalizations and nearly 600

deaths among Orange County residents each year.

1. More than half (54%) of all such hospitalizations involved drugs, most of which were

poisonings due to benzodiazepine tranquilizers (e.g., Xanax, Valium) or opioid substances

(e.g., OxyContin, heroin). Coroner investigations found that prescription medications were

the most frequently used substances, the majority of which involved opioid pain medications

(e.g., OxyContin, Hydrocodone).

What does this coalition aim to accomplish during the grant period?

ORANGE COUNTY COLLABORATIVE ON PRESCRIPTION DRUG ABUSE (OCCPDA) is

a coalition designed to promote coordinated planning, implementation, and evaluation of quality

prevention services to reduce the impact of prescription drug abuse epidemic on children, youth,

and families of Orange County. The goals of the OCCPDA are to (1) Identify opportunities for

coordination and collaboration on prevention initiatives serving the same populations, utilizing

common strategies, or aiming for similar outcomes; (2) Promote implementation of evidence-

based prevention practices at the county level.

a. Supporting safe prescribing practices:

i. Establishing safe opioid-prescribing guidelines across OC hospitals and clinics.

Standardize the evaluations of patients who are at risk of abuse using standardized

opioid-risk stratification tools prior to initiation or continuation of chronic opioid

treatment.

ii. Use prescription drug monitoring programs.

iii. Prescribe the lowest effective dose and only the quantity needed for each patient.

iv. Link patients that have substance use disorders to effective substance abuse treatment

services.

v. Improve surveillance to better track trends, identify high-risk communities at risk, and

target prevention strategies.

vi. Look at the data and practices of state Medicaid and worker’s compensation programs to

identify and reduce inappropriate prescribing.

vii. Reducing inappropriate access by monitoring hospitals for drug diversions, increasing

take back days, increasing the number of prescription drug drop boxes for public

medication disposal

viii. Use of local media to disseminate information on the locations and proper use of drop

boxes for public medication disposal

ix. Engage pharmacies, prescribers, and nursing staff statewide to promote proper

medication storage to customers/patients, including the use of personal medication lock

boxes for opioids.

x. Education on proper disposal of excess medication.

b. Expanding access to medication-assisted treatment (MAT):

i. Work with Medicaid and other insurance companies to expand coverage for MAT

ii. Support adoption of MAT in community settings.

iii. Screen and evaluate patients for potential substance abuse disorders and provide them

with effective substance abuse treatment services

c. Increasing naloxone access:

i. Help local jurisdictions to implement effective strategies to increase naloxone access in

communities where drug addiction is common.

ii. Educate communities at high risk on the availability of naloxone without prescription at

local pharmacies.

iii. Create protocols for co prescription/availability of naloxone for patients on oral morphine

equivalence of over 100mg per day.

2. Why is the lead organization well-positioned for this role?

As the county’s only academic medical center, the University of California, Irvine (UC Irvine Health)

has access to a large and diverse patient base where we have experience implementing standardized

prescribing guidelines through effective changes that lead to improved patient safety.

One in six UC Irvine Health admissions are opioid-tolerant (that is, on higher than 60mg of oral morphine

equivalents) prior to entering the hospital. An even larger proportion of patients are discharged from

another?? hospital on significant quantities of opioids from their inpatient stay or from emergency

department visits. This data can be replicated in most hospitals. (Gulur et al Opioid tolerance--a predictor

of increased length of stay and higher readmission rates. Pain Physician. 2014 Jul-Aug;17(4):E503-7.)

Project lead Dr. Example is the Director of UC Irvine Health Pain Management Services and has a

significant research background in opioid use and misuse. Although UCI has made strides in improving

the safety of our patients, we recognize the importance of leading this change into the community is

critical from a population health perspective. With partners such as the Orange County Health Care

Agency, Hospital Association of Southern California, CalOptima and the OC District Attorney’s Office,

we believe this coalition can result in the most effective reduction in prescription drug abuse in Orange

County.

3. How will you launch and support the coalition during the 18-month grant period?

An initial convening meeting will be required to determine the incipient agenda for the coalition and to

create the steering committee. Further task forces with all appropriate stakeholders including leaders

and representatives of local communities invited will be formed for the goals identified. Following that

the project manager will help coordinate quarterly meetings for the steering committee and all

taskforces, which will take place with all parties present to ensure that goals are met in a timely fashion

and to change protocols as necessary. We anticipate the need for a dynamic and flexible action plan,

therefore, we will increase the frequency of meetings to twice a quarter if we are not meeting targeted

goals in the first 6 months.

Goals will include the conduct of multiple community outreach programs, informationals and

interactive educational sessions to engage the community. These will be supported by the project manager

and administrative staff. Partners will promote the coalition’s work through their own traditional, online

and social media channels.

4. How will you measure the effects of the coalition’s work?

a. Reduce opioid prescription overdose deaths by 20% over the course of 18 months.

b. Decrease the amount of opioids not accounted for by regulated patient use by 20% over 18

months, thereby decreasing availability for recreational drug use.

c. Standardize opioid prescribing practices throughout the network of opioid prescribers,

e.g.prescription drug monitoring, use of opioid contracts, scheduled urine toxicology screening to

ensure not only the absence of drugs of abuse but also the presence of drugs that are being

prescribed, medication reconciliation through accurate pill counts to prevent pill hoarding.

d. Increase available disposal facilities for prescription drugs of abuse by 100%.

e. Surveys during educational/informational sessions.

5. How will you sustain progress after the collaborative is over?

a. Implement protocols that will become the standard of care for all opioid prescribers.

b. Engage local communities to continue to lead and monitor progress.

c. The agencies involved will continue to monitor the frequency of regional opioid prescription

deaths to ensure that the numbers do not trend negatively after dissolution of the collaboration.

d. Encourage ongoing communications amongst all coalition partners even after the coalition is

dissolved.

6. Describe any collaborative, multi-organization work on opioid safety that the region has done so

far (if any) and explain what the CHCF collaborative would enable your region to do that it has

not been able to achieve to date. How would in-kind support and the grant funds be leveraged to

advance this work?

While Orange County has seen multiple efforts to curb drug- and alcohol-related morbidity in our

community, this coalition will bring together major stakeholders that have individually launched

initiatives with the goal that increased collaboration, and sharing of experience and resources will help

make seamless gains in reducing prescription drug abuse and its resultant deaths in Orange County.

The coalition’s strength is the involvement and leadership of hospitals and their associated clinics, which

form the bulk of the county’s prescribers, as well as?? with public health, insurers and law enforcement.

The grant funds would help support the collaborative group through project management and

administrative support.

Some county initiatives include:

• National Council on Alcoholism and Drug Dependence - Orange County (NCADD – OC) /

Community Alliance Network (CAN)

CAN is the prevention arm of NCADD-OC and is dedicated to creating and implementing prevention

strategies that reduce underage drinking. Project staff provides education, training and technical

assistance in the cities of Costa Mesa, Tustin and Mission Viejo. Using mass media campaigns,

efforts focus on increasing adult awareness of the prevalence and consequences of underage drinking,

as well as identifying effective prevention strategies that address this problem.

• The Parenting Initiative’s mission is to increase parent involvement with their children and strengthen

their community ties in order to reduce alcohol and other drug (AOD) use among the youth of Orange

County. The Parenting Initiative uses a multi-pronged approach, which includes:

o Mass media campaigns to increase parents’ awareness of their roles in preventing AOD use in

their children, using banners, posters, and videos.

o Community networking to form partnerships with community organizations and schools that

share the same goal of youth AOD prevention by involving parents. Share parenting

resources, presentation curricula, newsletters, etc.

o Training and technical assistance for those seeking help in implementing a parenting program

of their own that addresses alcohol and other drug issues.

The Parenting Initiative offers many resources and services that can be incorporated into existing

programs for an effective, easy way to engage parents in AOD prevention.

• Community Service Programs: Positive Actions Toward Health (CSP/PATH)

CSP/PATH is a community-based prevention project that aims to create safe and healthy communities

by reducing problems associated with alcohol and other drug (AOD) impaired driving. Project staff

provides education, training, and technical assistance in the cities of Orange, Costa Mesa and Garden

Grove. Using mass media campaigns, efforts focus on increasing community awareness of driving

under the influence (DUI) enforcement operations conducted by local law enforcement. Services also

include providing responsible beverage service training for on-sale alcohol establishments. ADEPT’s

Impaired Driving Initiative consists of a comprehensive and multifaceted approach designed to

address alcohol and/or drug impaired driving in Orange County. ADEPT’s program staff coordinates

the AOD impaired driving prevention activities on a countywide level. In addition, staff serves as a

liaison between ADEPT and the California Strategic Highway Safety Plan (SHSP) committee and

provides assistance in developing statewide initiatives.

• The Orange County DUI Task Force is a countywide collaborative effort to address alcohol and/or

drug impaired driving in Orange County.

o The Task Force is comprised of 60+ agencies (representing law enforcement, traffic safety,

public health, local government, business, education, and private organizations) and is led by

the Automobile Club of Southern California and the Orange County Health Care Agency’s

Alcohol and Drug Education and Prevention Team.

Each of these program components utilizes multiple strategies to address AOD impaired driving issues at

the local level. Public information campaigns aim to increase community awareness on the dangers of

impaired driving and the risks of being arrested. Certified facilitators train alcohol servers (and related staff)

on serving alcohol responsibly. Local community groups receive education on the dangers, impact and

consequences associated with impaired driving. Law enforcement agencies receive support and assistance

with their impaired driving prevention activities.

7. What challenges do you expect to encounter? How do you anticipate mitigating or addressing

these challenges?

A major challenge in any prescription drug compliance plan is navigating patient reluctance for

increased monitoring. As an example, in many insurance plans, urine toxicology screenings

require a fairly significant co-payment by patients, which can be a deterrent for patient monitoring.

We would work with insurers to ensure monitoring is a covered expense.

Identifying patients with substance abuse disorders can be challenging in time constrained

healthcare visits. Our hope is to encourage implementation of standardized validated tools that will

help prescribers identify these patients and refer them to appropriate services for help.

8. What leaders or organizations have you not been able to engage thus far that you think are

important to the work? What prevented participation? How might you work to engage them

during the grant period?

We are working with commercial payers to engage them in the process. These insurers are at times

reluctant to endorse stricter compliance measures for their clients for fear of losing members in a

competitive market due to poor member satisfaction with stricter criteria. We met with major payers such

as Kaiser, Cigna, Anthem, etc. under the UCI health policy committee to begin the process of

engagement.