Revisiting The Opioid Epidemic and its Unintentional Consequences

drug overdose death rates in US

Source: Centers for Disease Control and Prevention

PHILADELPHIA—Americans represent 4.6% of the world’s population, yet we consume more than 97% of all the hydrocodone produced worldwide. In 2012, the CDC reported health care providers wrote 259 million prescriptions for painkillers, which is enough for every American adult to have a bottle of pills.

The Center for Public Health Initiatives dedicated a week in November to focus on the opioid epidemic and how to reduce the level of prescribing these drugs. In her talk, “From the Streets to the ER,” Dr. Jeanmarie Perrone from the University of Pennsylvania’s Department of Emergency Medicine proposed that health care providers should begin to focus on patient education, “It takes 30 seconds to prescribe and 30 minutes to educate.” So which one is a more viable option?

The fine line between compassionate pain management and encouraging addiction is often hard to distinguish when prescribing opioid medications. Larger patient loads and shorter doctor-patient visits (average, 7-9 minutes) may encourage physicians to prescribe chronic non-cancer patients opioids instead of spending time to educate them on alternative options.

Is the solution to the opioid epidemic as simple as a half hour of education? A team approach to patient education has consistently worked well. Dr. Perrone and her colleagues conducted a study involving two urban emergency departments in Philadelphia and investigated the use of a multidisciplinary team approach to decrease the amount of opioid packs dispensed at discharge. The interventions included educating a multidisciplinary team of nurses, residents, nurse practitioners, and attending physicians. The number of opioids dispensed at discharge for individuals who were at risk for opioid dependence decreased significantly from 21.8% to 13.9% in the primary ER investigated.

Studies involving a multidisciplinary approach and state regulations implementing prescription drug monitoring programs led to a successful reduction in rates of opioid abuse.

State Successes After Implementing Prescription Drug Monitoring Programs

Sources: NY, TN: DMP Center of Excellence at Brandeis University, 2014. FL: Vital Signs Morbidity and Mortality Weekly Report, July 1, 2014.

Sources: NY, TN: DMP Center of Excellence at Brandeis University, 2014. FL: Vital Signs Morbidity and Mortality Weekly Report, July 1, 2014.

Unintentional Consequences

With strong policies that have made it more difficult to obtain prescription pills, some argue that these regulations have only shifted the type of opioids being used.

Emerging research shows that the increased opioid regulations may be linked to the increase in heroin use. Over the past three years, opioid related fatalities in New York City have leveled off, while deaths involving heroin use have increased by 44%.

unintentional overdose deaths

As opioid regulations increase across the nation, public health practitioners should pay close attention to an unintended rise in heroin use, particularly in areas where heroin is readily accessible.

Written by: Amy Rajan, RN, MSN/MPH Candidate, Class of 2016

Penn’s Dominating MPH Presence at APHA’s 142nd Annual Meeting & Expo

The University of Pennsylvania’s Master of Public Health Program made a strong showing at this year’s APHA meeting in New Orleans. This year’s conference theme was “Healthography: How Where You Live Affects Your Health and Well-Being.” Six alumni, four current students, and many faculty presented their work. The Penn MPH booth at the Public Health Expo was also very popular!APHA_2014_Annual_Meeting


Alumni:

Noel Harbist, MD, MPH

Primary care pediatricians identify barriers to recommended care

With the establishment of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program (PQMP), there is increased attention to the measurement and delivery of recommended care. Primary care pediatricians identify time, payment issues, and family issues to be significant barriers to delivery of recommended care.  Enhancements in QI processes, such as the design of electronic medical records, may improve the documentation of care, but may not alleviate the obstacles pediatricians identified in the delivery of recommended care. QI strategies for delivery of recommended care should consider pediatricians’ perspectives and the possible role public health initiatives.

Jordan Price, MPH

Barriers and facilitators influencing inconsistent condom use in young adults in Philadelphia

Rates of chlamydia and gonorrhea in Philadelphia are three to four times higher the national rates, respectively, and clients served by Planned Parenthood of Southeastern Pennsylvania (PPSP) have the highest rates in the city. Though it is well known that condoms are one of the most effective ways to prevent sexually transmitted infections (STIs), reasons behind inconsistent condom use are not fully understood. This study aims to identify the barriers and facilitators that influence

Jane Seymour, MPH

Literacy and fertility: Lifecourse evidence from the National Longitudinal Survey of Youth (NLSY)

Literacy is associated with many health outcomes among US adults, but little is known about its relationship with reproductive outcomes. This study assessed the link between literacy and fertility outcomes for US women.

Elizabeth Stelson, LSW, MSW, MPH

Reentry and reunification: Investigating the influence of children in the reentry experience of mothers released from short-term jail stay

The incarceration rate of women has increased 800% in the last 30 years, and 80% of incarcerated women are mothers of children (<18 years of age). Research on community reentry for mothers released from prison has shed light on how social determinates of health—such as social support, housing, and employment—relate to successful reunification with children. Successful prison reentry has been linked to improved health and social outcomes for both the mother and child. However, little is known about maternal reentry following release from jail, which is markedly different from prison, characterized by a shorter stay, uncertainty awaiting sentence, and access to fewer resources.

Resources for reentry: Investigating the biopsychosocial needs of mothers of young children released from jail

The vast majority of incarcerated women (80%) are mothers of children (<18 years). Research on community reentry for mothers released from prison has identified significant barriers to health care services (HCS) and unmet social health needs. However, little is known about the reentry barriers experienced by mothers released from jail, characterized by shorter stays and fewer HCS compared to prison.

Samantha Gross, JD, MPH

Medical legal partnership education: A survey of existing programs and recommendations for national curriculum

Medical-Legal Partnership (MLP) is an integrative and collaborative model that brings legal services directly into the health care setting to assist patients in maximizing health and social benefits.  Legal remedies can resolve many socioeconomic and environmental issues common to vulnerable and underserved populations.  Also MLPs vary in structure, three components are central to the model: (1) providing direct legal assistance, (2) transforming health and legal institutions, and (3) achieving policy-level change.  These partnerships are uniquely suited to address necessary social and legal needs in an accessible clinical setting. This research addresses the current MLP educational environment by conducting interviews with MLP educators throughout the country to better understand how health care and law students are prepared to work in this unique, collaborative setting and the current challenges to providing MLP education.

Kaitlyn Meirs, MPH

Investigatory research on the distribution and accessibility of physicians with environmental expertise in the Gulf of Mexico

Disparate access to health care has been well documented, however, little is known about access to providers trained in assessment of environmental exposure and related care. Industries depend on occupational clinics that employ physicians with environmental expertise to provide exposure care to industry employees. Physicians employed in this setting are generally unavailable to see patients other than those employed by contracted companies due to potential conflict of interest. Our project evolved from concerns related to a lack of access to physicians with environmental expertise in the Gulf of Mexico and is supported through the Community Outreach and Engagement Core (COEC) of the Center of Excellence in Environmental Toxicology (CEET) supported by NIEHS (P30ES013508).

Current students:

Natalie Stollon, MSW, MPH(c)

Transitioning from pediatric to adult services: A public health approach

Due to advances in neonatal and pediatric care, patients with chronic illnesses and disabilities are surviving well into adult life and are faced with needing to navigate the challenging transition to adult care. As with all medical transitions, there is valid concern that patient morbidity and mortality are adversely affected during this time. We carried out a pilot Primary Care Transition Program, a randomized controlled trial that evaluated whether participation in three different transition interventions increased transition readiness, successful transition to an adult care provider and patient, caregiver and provider satisfaction and systematically evaluated and implemented transition plans for CHOP patients and families as they transitioned from pediatric to adult care. At this point the RCT is ongoing. 6-month and 10-month post-intervention surveys are being collected. We have 33 young adults and 10 caregivers enrolled in the study. Analysis will be complete by May 2014.

Caren Steinway, MSW(c), MPH(c)

Transitioning from pediatric to adult services: A public health approach

Due to advances in neonatal and pediatric care, patients with chronic illnesses and disabilities are surviving well into adult life and are faced with needing to navigate the challenging transition to adult care. As with all medical transitions, there is valid concern that patient morbidity and mortality are adversely affected during this time. We carried out a pilot Primary Care Transition Program, a randomized controlled trial that evaluated whether participation in three different transition interventions increased transition readiness, successful transition to an adult care provider and patient, caregiver and provider satisfaction and systematically evaluated and implemented transition plans for CHOP patients and families as they transitioned from pediatric to adult care. At this point the RCT is ongoing. 6-month and 10-month post-intervention surveys are being collected. We have 33 young adults and 10 caregivers enrolled in the study. Analysis will be complete by May 2014.

Bridget Keogh, BS

Building a trauma-informed care peer workforce

This session provides a description of the implementation of a statewide, four year trauma-informed mental health (MH) and co-occurring disorders (COD) care systems change initiative. The goals of the systems change are to: 1) prepare outpatient mental health and co-occurring system providers and specialists to build a system of care based on a consumer-defined set of principles and values that integrate lived trauma experiences into MH and COD recovery services; 2) provide universal trauma screening and assessment to all individuals who enter the recovery system; and 3) to build a workforce of trauma peer specialists to provide trauma-informed recovery services across the service and provider network. The primary focus of this initiative is to change the culture of the treatment delivery system; incorporating a trauma-informed recovery philosophy and activities into all recovery services. This session will provide a description of the process of implementing universal screening and assessment and an analysis of the data of over 2,000 individuals who were screened for trauma experience at the onset of entering the recovery system over a three year period and on the design, implementation, and outcomes of trauma peer-delivered recovery services.

Ebony Easley

Psychosocial implications of uncertainty in genomic testing of children with autism

Chromosomal Microarray Analysis (CMA) is a genome-wide technology that enables identification of genomic alterations, many of which are of uncertain clinical significance. Clinical guidelines recommend CMA testing for children with Autism Spectrum Disorder (ASD), which occurs in approximately 1% of the US population. Increasingly, families are offered CMA testing, and many receive complex and uncertain results.  In this study we examined the psychosocial implications for parents of children with ASD who received uncertain results from CMA testing. We collected data using in-depth interviews and self-report questionnaires. We used purposive sampling to recruit 57 parents, including three subgroups with positive, negative and uncertain results. This presentation focuses on the uncertain subgroup (n=20).

Written by: Allison Golinkoff, MPH Candidate 2016

A Recap of Drs. Philippe Bourgois & Brian Work – Substance Abuse in Philadelphia

On Thursday, October 16, 2014, Philippe Bourgois, PhD, Professor of Anthropology and Family and Community Medicine at the University of Pennsylvania, and Brian Work, MD, MPH, Professor of Internal Medicine at the University of Pennsylvania and Director of Prevention Point Philadelphia, sat down with the CPHI’s Deputy Director, Sara Solomon, MPH, RD to talk about their experience and research in the field of substance abuse.

MPH Student Moderates Discussion on The Changing Roles of Pharmaceuticals

WUHC conference panel

First year MPH student, Matthew Kearney (far right), moderated the Wharton Undergraduate Healthcare Club’s first-ever conference on “The Changing Roles of Pharmaceuticals.”

On Saturday, November 8,2014 the Wharton Undergraduate Healthcare Club (WUHC) hosted its first-ever conference at the International House on Chestnut Street. The club’s stated goal is to improve healthcare and cultivate leadership, and the conference was intended to explore the future of the healthcare industry. The organizers of this event asked if I would be willing to moderate a panel on “The Changing Role of Pharmaceuticals” – one of four panels happening in the afternoon portion of the conference. As a first-year Master of Public Health student, I wanted to take advantage of the opportunity to learn more about the Wharton community’s perspective on health, as well as gain experience as a panel moderator. Thus, I accepted their offer.

The panel consisted of four current and former members of the pharmaceutical industry: Debbie Cooper, Ph.D., a former pharmacologist for Merck, Wyeth, and GlaxoSmithKline; Baali Musisi Muganga, US Development Director for Aesica Pharmaceuticals; Andrew Reaume, MBA, President and CEO for Melior Discovery; and Richard Hoddeson, MBA, former VP of Finance for Pfizer. The conference’s keynote speaker was Dr. Roy Vagelos, former CEO and president of Merck Pharmaceuticals as well as the former chairman of the board for the University of Pennsylvania. As someone at the conference put it, there were certainly several “heavy-hitters” in attendance. No big deal, right?

In a previous life (a.k.a. the last five years), I taught high-school level Biology. Believe it or not, moderating this panel was remarkably similar. First, I had to do my share of class prep before showing up. As a rule, I like to be over prepared, rather than run out of material halfway through a discussion. Therefore, I spent the weeks leading up the conference drumming up possible questions from various sources. Second, once I’d settled on several “juicy ones”, I practiced rephrasing them multiple different ways, in case anyone asked for clarification. I asked my friends and colleagues for advice, and for possible responses, so that I could better direct conversation on the day of the panel. Lastly, I wanted my lesson to be engaging for those involved, so I poured over the résumés of the panelists, and tried to imagine which questions would fit them best.

After discussing the role of the moderator with my research mentor, and then attending the CPHI’s Peter Singer talk, I realized that the panelists were only part of the equation: the panel discussion would be followed by a “brief” Q&A from the audience. This turned out to be the most difficult component, particularly when one of the audience members interrupted the discussion to make a rather well rehearsed question (cough, statement), which I unfortunately had to cut off. During the post-discussion, official Q&A, I again had to facilitate some question clarification. Should I ever moderate another panel, it might be a good idea to collect questions ahead of time and screen/translate them.

Moderating this panel and attending the conference were excellent experiences, and I am thankful for the WUHC for making it all possible. Obviously, I learned a lot about pharmaceuticals and healthcare in the 21st century. Perhaps more importantly, I got to see the personal side to two industries that are often perceived as profit-driven. As a future public health worker, I have a better understanding of the necessary collaboration between the public and private sectors, and can better appreciate the process that drives innovation in healthcare. For those interested, more information can be found at www.uhcpenn.org. If anyone wants to hear more about the panel discussion, please contact me at kearnm@mail.med.upenn.edu.

Written by: Matthew Kearney, MPH Candidate 2016

A Vision on Building a Culture of Health

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PHILADELPHIA–The Center for Public Health Initiatives kicked off its seminar series with Dr. Risa Lavizzo-Mourey MD, MBA lighting a flame in the hearts of faculty and students here at the University of Pennsylvania.

Dr. Lavizzo-Mourey is the CEO and President of the Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted exclusively to health and health care. She holds more than 30 years of experience as a medical practitioner, professor, policy-maker, and non-profit executive.

Lavizzo-Mourey opened the seminar series with warm welcomes and thanks, expressing her delight to return to her alma mater; “It’s great to be home.”

Before sharing her foundation’s vision and charge for shifting our nation’s focus towards health, she first shed light on the stark realities we face.

Our Nation’s Current Health status

Approximately 75 percent of the country’s 17 to 24 year old youth are currently ineligible for military service, largely because of education, obesity, and physical ailments that make them unfit for the armed forces, according to a report recently presented to Congress by a group of retired military leaders.

She pointed out that improving quality of life and maintaining health starts at birth. Statistics show that the zip code where we are born in and reside may determine our life expectancy. She displayed a number of alarming U.S. statistics, highlighting in particular our nation’s capital, Washington D.C.. Metro area residents living in the predominantly affluent Montgomery County, Maryland, have an average life expectancy of 84 years whereas miles away in downtown D.C. the average life expectancy is seven years shorter.

Another troubling statistic is that 4 out of 5 physicians agree that addressing patient social needs are as important as dealing with medical conditions, yet an alarming majority of physicians admit they don’t know how to effectively address them.

Shifting Towards a Culture of Health

“A shift in this magnitude starts with an idea. Think back to the 1970’s, recycling was not part of our culture. Now it’s instinctive to recycle, because we made it easy. Recycling now is on every sidewalk and if we throw away a bottle in the trash, most of us feel guilty.” She also gave a great example of the 911 emergency response system and how years ago such a system never existed. Now, every child knows to dial 9-1-1 for an emergency.

Then Lavizzo-Mourey, turned to the faculty and students,

“We are the nation’s largest philanthropy dedicated to health. But we don’t make policy. We don’t sell anything. We don’t deliver any healthcare services; the only power we have is to invest in you.”

So how can we build a culture of health together? How can we ingrain healthy habits into our culture such that being healthy and staying healthy become instinctive? How can we turn around the stark reality that the zip code that we reside in may restrict our life expectancy? How can we create adequate social support systems to improve quality of life preventing re-admissions that plague hospitals throughout the nation? How do we start right here in the city of Philadelphia?

A vision this large will take a concerted effort from all members of the community, health care, social work, government, education, business, places of worship, and families to tackle the barriers to create an environment where a culture of health will thrive.

If each one of us does our part, small victories will turn into national success.

Written by: Amy Rajan, MSN/MPH Candidate 2016

Social Policy Researcher at Penn Honored With WOAR’s Bridge of Courage Award

CPHI Fellow and University of Pennsylvania School of Social Policy & Practice Professor, Susan B. Sorenson, will receive the 2014 Bridge of Courage Award from Women Organized Against Rape.  The Bridge of Courage Award recognizes exemplary leadership and commitment to promoting awareness, education, advocacy, and policy research to end sexual violence.

Congratulations, Susan!!

Sorenson 570x370_0

Full article: http://www.upenn.edu/pennnews/news/social-policy-researcher-penn-honored-woar-s-bridge-courage-award