• Baseline Assessment: Alaska's Capacity and Infrastructure for Prescription Opioid Misuse Prevention

      Elkins, Amanda; Barnett, Jodi; Hanson, Bridget; Smith, Oliver (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-08-01)
      The State of Alaska Department of Health and Social Services (DHSS), Division of Behavioral Health (DBH) was awarded the Partnerships for Success (PFS) grant by the Substance Abuse and Mental Health Services Administration (SAHMSA) in 2015. DBH contracted with the Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA) to conduct a comprehensive project evaluation. As part of the evaluation, CBHRS performed a baseline assessment of the state’s capacity and infrastructure related to prescription opioid misuse prevention. Researchers conducted interviews with key stakeholders representing state government, healthcare agencies, law enforcement, substance abuse research, and service agencies. Interviews were semistructured, with questions addressing five domains of interest: (1) state climate and prevention efforts; (2) partnerships and coordinated efforts; (3) policies, practices, and laws; (4) data and data monitoring; and (5) knowledge and readiness. Thirteen interviews were conducted and analyzed using a qualitative template analysis technique combined with a SWOT analysis (i.e. strengths, weaknesses, opportunities, and threats). Emergent themes are displayed in Table 1 below. Table 1. Emergent themes from SWOT analysis Strengths Weaknesses Opportunities Threats (1) New and revised policies and guidelines (2) Activities and partnerships between state agencies and communities (3) Knowledge and awareness of state leadership (1) State policy limitations (2) Insufficient detox, treatment, and recovery support resources (3) Lack of full coordination within state agencies and with communities (1) Education enrichment (2) Policy improvements (3) Expansion of treatment, recovery, and mental health support (1) State fiscal crisis (2) Prescribing practices (3) Complexity and stigma of addiction (4) Legislative support Despite limitations in sample representativeness and interview timing, participants agreed that agencies, communities, and organizations across Alaska have demonstrated great concern about the opioid epidemic and that this concern has translated into considerable efforts to address and prevent opioid misuse. Participants also noted a variety of opportunities as targets for future work, many of which would address some of the current weaknesses that exist. Results yielded clear recommendations for increasing awareness and providing education to a variety of groups, further improving relevant policies to promote prevention, and expanding services for prevention and treatment.
    • Baseline Opioid Survey: Access, Consumption, Consequences, and Perceptions among Young Adults in Alaska

      Barnett, Jodi; Hanson, Bridget; Smith, Oliver (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-05-01)
      In September of 2015, SAMHSA awarded the Partnerships for Success (PFS) grant to the State of Alaska  Department of Health and Social Services, Division of Behavioral Health (DBH). The PFS grant program is  a five‐year effort that focuses on preventing and reducing substance use and building prevention  capacity at both the state and community levels. DBH provides leadership for the project and facilitates  the conduct of project activities by community‐level coalitions. Additionally, DBH contracted with the  Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA)  to conduct a comprehensive evaluation of the PFS project.   Using a data‐informed prioritization process to narrow the substance abuse focus of the grant, the State  Epidemiological Outcomes Workgroup chose two PFS priority areas: 1) non‐medical use of prescription  opioids among 12‐25 year olds; and 2) heroin use among 18‐25 year olds. Data on the use of and  consequences related to prescription opioids and heroin in Alaska are described below.  Partnerships for Success (PFS) Priority Area: Non‐Medical Use of Prescription Opioids  Data from the National Survey on Drug Use and Health (NSDUH) indicate that young adults aged 18‐25  consistently have the highest percentage of non‐medical use of prescription pain relievers in Alaska  compared to youth aged 12‐17 and adults aged 26 and older (see Figure 1).1,2,3 While small decreases in  use were observed among all age groups from 2009 to 2014, the age‐specific pattern remained  consistent.   Figure 1. Past year non‐medical use of prescription pain relievers in Alaska from 2009 to 2014 by age  Additional data requested from NSDUH (see Table 1) indicated no significant change in non‐medical use  of prescription pain reliever estimates among 12‐25 year olds in Alaska between years 2007‐2010 and  2011‐2014 but a decreasing trend was observed for past year use and past year prescription pain  reliever dependence or abuse.4 0 5 10 15 2009-2010 2011-2012 2013-2014 Percentage 12-17 years 18-25 years 26+ years 4 Table 1. Past year non‐medical use of prescription pain reliever estimates among individuals aged 12  to 25 in Alaska from 2007 to 2014  1 Dependence/abuse is based on definitions found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV)  Estimates of past year non‐medical use of prescription pain relievers among individuals aged 12 and  older in Alaska are slightly higher than national estimates but both follow a small decreasing trend in use  from 2009 to 2014 (see Figure 2).1,2,3 Figure 2. Past year non‐medical use of prescription pain relievers among individuals aged 12 and older in  the U.S. and Alaska from 2009 to 2014  Other indicators related to non‐medical use of prescription opioids in Alaska have also decreased slightly  or stabilized in recent years. Treatment admissions for synthetic opiates (opiates or synthetics including  Methadone, Oxycodone, or Oxycontin) as a primary, secondary, or tertiary substance of abuse have  stayed relatively stable from 2013 to 2015 (1,052 to 1,011 treatment admissions), according to the  Alaska Automated Information Management System (AKAIMS).5  Age‐adjusted overdose death rates in  Alaska have decreased from 11.2 per 100,000 in 2009 to 8.5 per 100,000 in 2015. Although overdose  deaths from prescription opioids are decreasing, Alaska still has higher rates of overdose deaths from  prescription opioids than the nation overall (7.3 vs. 5.1 per 100,000 in 2012).6 
    • Medicaid Policies for Alcohol SBI Reimbursement

      Porter, Rebecca R.; Hanson, Bridget; Smith, Oliver (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-08-01)
      The purpose of this report was to review existing reimbursement policies by state Medicaid agency, including the District of Columbia (D.C.), in order to understand similarities and differences associated with financial compensation for alcohol screening and brief intervention (SBI) services. Alcohol SBI is an evidence-based practice known to help reduce atrisk alcohol consumption among patients who drink too much. 1 Although alcohol SBI was designed to be a population-based approach to address unhealthy alcohol consumption, its current utilization is limited. 2 Implementation of the practice into routine clinical care remains a challenge at the health system level even with support from federal resources (e.g., SBIRT: Screening, Brief Intervention, and Referral to Treatment). One way to encourage the uptake of alcohol SBI/SBIRT among providers is to ensure that the service is reimbursable by third-party payers. However, reimbursement opportunities vary by state and payer, and in some locations are non-existent. Information about the current status of policies will assist in the development of policies and incentives to encourage healthcare providers and systems to submit claims for alcohol SBI/SBIRT and potentially increase the routine uptake of the service in clinical care