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Reducing Drug Overdose Death in New Mexico

Posted By Michael Landen, Friday, February 20, 2015
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New Mexico has led the nation in drug overdose deaths for most years over the past two decades. However, in 2011 NM dropped from this position to number two and in 2012 to number three because of a 16% decrease in drug overdose death from 2011 to 2013. This decrease has been largely due to a decrease in prescription drug overdose death that has followed a decrease in the amount of opioids prescribed in NM. Despite this improvement NM’s drug overdose death rate remains substantially higher than the U.S. rate.

In 2011 state legislation created a governor’s advisory council on drug overdose prevention and pain management, which formalized a process for bringing stakeholders together. This legislation also required that each of the seven healthcare provider entities that license providers who can prescribe controlled substances promulgate new regulations for treating chronic pain and providing mandatory continuing education on chronic pain. As a result, all licensing entities require registration and use of the prescription monitoring program. The Board of Pharmacy and the Department of Health routinely analyze prescription opioid and benzodiazepine prescribing data and provide reports to the licensing entities on outliers. The Council also recommended removing the preauthorization requirement around Medicaid suboxone prescribing, and this was removed.

Additionally, NM has built on the highly successful syringe exchange based naloxone program by adding co-prescription pilots in several communities where naloxone is provided along with chronic opioid prescriptions. NM also allows pharmacists to prescribe naloxone and has been working with pharmacies to stock naloxone so that it is available around the state. Medicaid also reimburses for naloxone and the accompanying education.

NMDOH has three substance abuse epidemiologists who are critical to the drug overdose prevention effort in NM. They collaborate with the Office of the Medical Investigator and the Board of Pharmacy to track drug overdose deaths and prescribing patterns. These data are disseminated both locally and statewide. Particularly useful are presentations of county-level overdose death and prescribing patterns that have been provided to community groups and local provider organizations. They have also led the process for tracking naloxone distribution to assure it is available in areas with the highest drug overdose death rates.

Despite being one of two states with all 10 prescription drug overdose prevention policies in place tracked by the Trust for America’s Health, NM has a long way to go to adequately address the drug overdose epidemic. The prescription drug monitoring program needs to move closer to real-time prescribing data – currently it requires data from pharmacies within seven days. Licensing entities need to better enforce their own rules on prescription monitoring program use. And naloxone needs to be far more widely available like most prescription drugs are. In the 1990s heroin was driving the NM epidemic, and more recently prescription opioids have been. This means that many of our original naloxone programs, originally directed at heroin users, now accommodate persons at high risk because of prescription opioid use. While many states have seen heroin overdose death rates increase in recent years, New Mexico hasn’t witnessed the same trend. However, one possible explanation for NM’s relatively stable heroin overdose death rate is that New Mexico already had a high prevalence of heroin drug overdose death.

The drug overdose epidemic is different in each state. Having an adequate epidemiologic infrastructure to track the epidemic in each state is critical. The CSTE Overdose Subcommittee has done critical work in developing practical approaches that can be employed in states, taking into account state-specific differences. Fellow CSTE members provide good approaches to state-specific surveillance that is the foundation for reducing inappropriate prescribing and drug overdose.

Michael Landen, MD, MPH is co-chair of the Substance Abuse Subcommittee. NM’s substance abuse epidemiology section includes Laura Tomedi, PhD, MPH, the chair of the Alcohol Subcommittee, and Jim Davis, MS a member of the Overdose Subcommittee, and Luigi Garcia-Saavedra, MPH. To find out more about substance abuse, visit the subcommittee pages and read CSTE’s 2008 State-Level Substance Abuse Epidemiology Capacity position statement. A unique, new fellowship opportunity is now available for substance abuse or mental health fellowships: Applied Epidemiology Fellowship applications will be open soon.

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