Academic Detailing is an innovative method of educational outreach, which encourages providers to improve opioid prescribing behavior and integrates opioid safety into routine care. Through one-on-one visits, health care professionals (Academic Detailers) share the latest scientific evidence, using well-produced materials and setting accountable behavioral changes with the goal of improving outcomes. CDPH, in coordination with the San Francisco Department of Public Health (SFDPH) will implement Academic Detailing at the local level to improve prescribing practices and overall opioid stewardship among prescribers.
- CDPH/SFDPH has conducted three Academic Detailing training sessions to train new professional detailers throughout California to implement Academic Detailing sessions within their community. An additional training is planned for early 2020 to support Academic Detailing efforts within local opioid safety coalitions across the state.
- In addition, CDPH is identifying academic detailers to conducted detailing sessions within their communities to educate prescribers and dispensers on opioid stewardship and safe prescribing. CDPH is also working to incorporate academic detailing into health plans and health payer systems to improve prescribing practices among prescribers.
Implement Clinical Laboratory Services for Fentanyl and Fentanyl Analogs for Public Health Investigations, California Poison Control System (CPCS) and Emergency Medical Services in California (in case of a fentanyl outbreak anywhere in California).
CDPH’s Center for Environmental Health purchased the Q Exactive with Vanquish UHPLC and N2 Generator and the Biotage Extrahera SPE Workstation. This equipment is required for analysis of fentanyl and fentanyl analogs. CDPH LRN-C laboratory are working to develop the capability to analyze clinical and post mortem specimens for opioid drugs including fentanyl and fentanyl analogs (and emerging fentanyl analogs) and other emerging illicit drugs with abuse potential in the Richmond laboratory. Specimens will be analyzed at the LRN-C lab, a CA- licensed clinical laboratory, which is a supported by the federal Centers for Disease Control and Prevention (CDC) as a “Level 1” surge laboratory.
California Opioid Overdose Surveillance Dashboard
CDPH was tasked with including new data on the California Opioid Overdose Surveillance Dashboard. To date, four new data updates were made and a fifth update is planned for January 2020.
- Based on CDC case definitions, identify data sources and develop indicators for multiple drugs with abuse potential (e.g., cocaine, methamphetamines). CDPH added indicators for ‘Other Drugs’ Amphetamine and Cocaine to the Dashboard in June 2019:
- Deaths related to Amphetamines and Cocaine, 2006-2017
- Hospitalizations related to Amphetamines, 2006-2017
- Hospitalizations related to Cocaine, 2011-2017
- ED Visits related to Amphetamines, 2006-2018
- ED Visits related to Cocaine, 2011-2018
- CDPH added indicators for ‘Other Drugs’ Amphetamine and Cocaine as well as indicators for opioids in combination with amphetamines and opioids in combination with cocaine to the Dashboard in June 2019. Dashboard users can now select other drug indicators from the settings panel of each dashboard visualization box (Geographic Distribution, Time Trend, and Demographic Breakdown) by selecting the ‘Other Drugs’ radio button:
- Any Opioid and Benzodiazepines, 2006-2017
- Any Opioid and Amphetamines, 2006-2017
- Any Opioid and Cocaine, 2011-2017
Fund Opioid/Overdose Prevention Coalitions
CDPH is funding 12 Opioid Safety Coalitions to reduce opioid and other drug-related overdoses and deaths in California counties, from January 1, 2020 through August 31, 2022. A number of these Coalitions represent the northern region of California who continue to have the highest rates of non-fatal and fatal overdoses statewide. The Coalitions are focusing efforts on multiple program objectives that align with the following statewide strategies:
- Strengthen Statewide Collaboration
- Promote Safe Prescribing
- Build Community Capacity
- Expand Medication Assisted Treatment (MAT)
- Increase Access to Naloxone
- Reduce Access to and Negative Consequences of Illicit Drugs
- Address Priority Populations in High-Risk Settings
- Promote Public Education and Awareness
- Translate Data into Actionable Information
Public Health/First Responder Pilot Collaborations
This pilot project addresses the opioid epidemic by integrating three agencies/systems: public health department, EMS (Emergency Medical Services) Agency, and 911-transport provider agency. The Contra Costa County Public Health Department (CCCPHD) will test this novel EMS and public health integrated strategy to provide a foundational model for a proactive, public health approach. This replicable model can be used across the state with the current opioid crisis, as well as future epidemics. This effort will include the following three components:
- EMS agency will provide “leave behind” naloxone kits to individuals who survive an opioid overdose (with family members and friends);
- 911 responders will identify patients who are in acute withdrawal, administer a first dose of buprenorphine to these patients in the field, and transport them to an opioid receiving center designated by the county EMS agency; and
- EMS agency will provide a referral (“warm handoff”) of 911 patients to a public health outreach coordinator/intervention team, which will involve a data linkage between the 911-transport provider and the public health agency. Once this warm handoff occurs, the public health agency team will contact the patient to further assist enrollment in MAT programs and access to county services.
Single Room Occupancy (SRO) Overdose Prevention Pilot
CDPH is contracting with the San Francisco Department of Public Health (SFDPH) on the SRO pilot project, a replicable model to address opioid overdoses in SRO hotels in larger cities across California. SFDPH is collaborating with the DOPE (Drug Overdose Prevention Education) Project to:
- Develop agreements with building management of SROs (with high frequency of overdose);
- Recruit and train tenants at each SRO to be trained on naloxone overdose reversal skill training, strengthening knowledge and understanding of behavioral health issues and resources, how to train others in naloxone use, provision of naloxone, use and promotion of NaloxBoxes, and self-care to avoid burnout; and
- Install “NaloxBoxes” on each floor of the selected SROs. NaloxBoxes are transparent surface mounted boxes that contain naloxone, gloves, alcohol pads, a rescue-breathing device, and multilingual instructions.
For additional information on any of these CDPH projects, please contact OPI@cdph.ca.gov.