In a recent court filing in Delaware’s ongoing civil lawsuit against the pharmaceutical industry over the prescription opioid crisis, the State asserts Walgreens’ liability for its role in the addiction epidemic as both a pharmacy and a distributor and seeks to add Walgreens to the list of manufacturer and distributor defendants.

An amended complaint filed April 2 argues that two Walgreens entities, Walgreen Co. and Walgreen Eastern Co., Inc., distributed and filled prescriptions for large amounts of prescription opioids in Delaware between 2006 and 2014, controlling a substantial portion of the Delaware wholesale prescription opioid market during that time. Walgreens was an original defendant in the suit filed last year and was dismissed from the lawsuit in February 2019, but the court’s order allowed for additional information to be provided to argue that Walgreens should be added back in as a defendant.

The suit contends Walgreens failed in its duty to use due diligence to avoid filling orders for prescription opioids that could be diverted into illicit markets. The amended complaints also adds Walgreens to its Distributor Claims, which consist of negligence and consumer fraud claims.

The inclusion of pharmacies in Delaware’s suit makes it one of the nation’s only legal actions that targets every level of the prescription opioid distribution system for its alleged failure to meet legal obligations that have contributed to Delaware’s opioid addiction epidemic.

The suit in Delaware Superior Court names Purdue Pharma L.P., Purdue Pharma Inc., The Purdue Frederick Company, Endo Health Solutions Inc., Endo Pharmaceuticals Inc., McKesson Corporation, Cardinal Health, Inc., Amerisourcebergen Drug Corporation, Anda Pharmaceuticals, Inc., H. D. Smith, LLC, Walgreen Co., and Walgreen Eastern Co., Inc. as defendants. Delaware is represented in this litigation by the law firms of Gilbert LLP, Fields PLLC, Connolly Gallagher LLP, and Cross & Simon, LLC.

DOVER — The Delaware Division of Public Health (DPH) is engaging dental providers in the launch of a statewide campaign directed at increasing awareness about the addictive nature of opioid medications used after dental procedures. Dentists are among the leading prescribers of opioid medications, particularly for surgical tooth extractions. In fact, dentists and oral surgeons are commonly in a position to prescribe adolescents their first opioid prescription after the removal of the third molars, also known as “wisdom teeth.” The highest number of dental-related opioid prescriptions are for teenagers ages 14 to 17, followed closely by young adults ages 18 to 24.

DPH has begun distributing a toolkit to every dental office in the state with resources for both dentists and patients to encourage safe and healthy pain management. Included is a provider letter and fact sheet, a patient brochure, and posters for display in dental offices. The campaign drives home the message that “all pain is not the same,” and therefore should be treated effectively without opioids whenever possible. The American Dental Association (ADA) strongly recommends considering non-steroidal anti-inflammatory drugs (NSAIDs) such as Motrin or Aleve as the first-line of therapy for acute pain management.

“Dental professionals have a unique opportunity to help curtail the opioid epidemic by suggesting opioid alternatives for pain management when possible, counseling patients on the risks of opioid use, and educating on proper disposal procedures,” said Dr. Nick Conte, Director of the DPH Bureau of Oral Health and Dental Services (BOHDS).

A 2011 study in the Journal of the American Dental Association (JADA) estimated that dentists are responsible for 12 percent of prescriptions for fast-acting opioid pain relievers, just below general practitioners and internal medicine doctors. The opioid drugs most commonly prescribed by dentists are hydrocodone and oxycodone, which are highly addictive and have the highest potential for abuse.

This statewide campaign supports a larger state initiative to lower the rate of opioid prescriptions, with the ultimate goal to reduce opioid-related overdoses and deaths. In 2018, DPH launched an expanded section on HelpIsHereDE.com for health care providers, loaded with information; tools, such as forms and screening templates; and resources, including patient materials. Patient and dental provider materials from the oral health toolkit have now been added to the health care provider section of the website. HelpIsHereDE.com is a website providing addiction prevention, treatment, and recovery resources and information for individuals, families and health care providers in Delaware.

According to the CDC, Delaware is ranked first in the nation for prescribing high-dose opioids, and is also ranked first for prescribing long-acting opioids. DPH Director Dr. Karyl Rattay says that while a small percentage of providers (1 percent) are writing 32 percent of opioid prescriptions, almost all providers are struggling with how to better help their patients.

“This isn’t just about telling providers what they need to do,” said Dr. Rattay of the expansion of the health care provider section of the website. “It’s about motivating them by telling them why they need to do it. It’s also about providing comprehensive, evolving support to the trusted caregivers in our community. Certainly, the entire crisis surrounding opioid addiction and drug-related deaths doesn’t lie solely in the hands of health care providers, but they are the critical starting point, and offer the greatest potential for impacting our state’s continual move toward safer use of opioids.”

Preliminary estimates for 2018 indicate 419 overdose deaths across the state, an increase of 21 percent from the 2017 total of 345 deaths, according to the Division of Forensic Science. The CDC ranked Delaware number six in the nation for overdose mortality rate in 2017.

If you or a loved one is struggling with addiction in Delaware, call DHSS’ 24/7 Crisis Hotline to be connected to treatment and recovery options. In New Castle County, call 1-800-652-2929. Or in Kent and Sussex counties, call 1-800-345-6785. To search online for treatment and recovery services in Delaware or nearby states, visit www.HelpIsHereDE.com.

A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing person’s spoken words back to the TTY user. To learn more about TTY availability in Delaware, visit http://delawarerelay.com.

The Department of Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. DPH, a division of DHSS, urges Delawareans to make healthier choices with the 5-2-1 Almost None campaign: eat 5 or more fruits and vegetables each day, have no more than 2 hours of recreational screen time each day (includes TV, computer, gaming), get 1 or more hours of physical activity each day, and drink almost no sugary beverages.

GEORGETOWN (March 1, 2019) – In an effort to reduce the number of individuals dying from drug overdoses in Delaware, the Division of Public Health (DPH) will hold Community Naloxone Distribution events in each county throughout the month of March. DPH will distribute free naloxone kits to members of the general public from 10 a.m. to 2 p.m., on Saturday, March 9, 2019, at Delaware Technical Community College, Owens Campus, 21179 College Drive, Georgetown, DE 19947. The distribution event will be held in the Theater Lobby and Rooms 344A/B in the Arts and Sciences Center. DPH is holding its first distribution event Saturday, March 2, 2019, in coordination with the atTAcK addiction 5K race in New Castle.

In addition, a third distribution event will be held in Kent County, from 5:30 p.m. to 8:30 p.m., Wednesday, March 20, 2019, at Delaware Technical Community College, Terry Campus, 100 Campus Drive, Dover DE 19904, Corporate Training Center Rooms 408 and 412.

Each naloxone kit will contain two doses of naloxone, and members of the community who attend these events will receive one-on-one training on how to administer the overdose-reversing medication. The Division of Substance Abuse and Mental Health (DSAMH) also will have representatives on hand to answer any questions about access to treatment for those struggling with substance use disorder.

“It is critically important for family and friends of loved ones struggling with addiction to have access to naloxone,” said DPH Director Dr. Karyl Rattay. “The data are telling us that 80 percent of overdoses happen in a residence. If family or friends of someone overdosing have naloxone immediately accessible, it can mean the difference between life or death for that person.”

Within three to five minutes after administration, naloxone can counteract the life-threatening respiratory depression of an opioid-related overdose and stabilize a person’s breathing, which buys time for emergency medical help to arrive. DPH recommends calling 9-1-1 immediately if you find someone in the midst of a suspected overdose, starting rescue breathing, and then administering naloxone. Naloxone is not a replacement for emergency medical care and seeking immediate help and follow-up care is still vital.

There were at least 291 deaths last year in Delaware from suspected overdoses. Tragically, the final number is expected to exceed 400 after all toxicology screens are finished (they take six-eight weeks) and final death determinations are made on outstanding cases by the Division of Forensic Science. The Centers for Disease Control and Prevention ranked Delaware as number six in the nation for overdose deaths in 2017.

In 2018, first responders administered 3,728 doses of naloxone, compared to 2,861 in 2017, a 30 percent increase.

Funding for the Community Naloxone Distribution Initiative comes from state funding built into DPH’s budget for the first time in state fiscal year 2019, thanks to the advocacy of Lt. Governor Bethany Hall-Long and the Behavioral Health Consortium. In October, DPH also announced the agency was awarded federal funds to support the purchase of naloxone and other programs for first responders.

Community access to naloxone has increased significantly since 2014 when legislation was enacted making it available to the public. In 2017, Governor John Carney signed additional legislation ensuring pharmacists had the same legal protections as doctors, peace officers and good Samaritans when dispensing the medicine without a prescription.

Information on community training and pharmacy access to naloxone, along with resources regarding prevention, treatment and recovery are available on HelpIsHereDE.com.

A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing person’s spoken words back to the TTY user. To learn more about TTY availability in Delaware, visit http://delawarerelay.com.

Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. DPH, a division of DHSS, urges Delawareans to make healthier choices with the 5-2-1 Almost None campaign: eat 5 or more fruits and vegetables each day, have no more than 2 hours of recreational screen time each day (includes TV, computer, gaming), get 1 or more hours of physical activity each day, and drink almost no sugary beverages.

NEW CASTLE (Oct. 15, 2018) – Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician, has been elected as a member of the prestigious National Academy of Medicine (NAM), Academy President Victor Dzau announced today during the organization’s annual meeting in Washington.

Secretary Walker is one of 75 new members this year from across the country and 10 international members. Membership in the National Academy of Medicine is considered one of the highest honors in the fields of health and medicine, and recognizes individuals who have demonstrated outstanding professional achievements and commitment to service.

“I congratulate Dr. Walker on being elected to the National Academy of Medicine,” Governor John Carney said. “Dr. Walker uses her problem-solving, outreach and leadership skills to take on such complex issues in our

state as the opioid epidemic and the rising growth in health care spending. She doesn’t back way from these issues. She leans in, bringing people together, using data and other resources to assess situations, and changing systems to better serve the people of our state.”

Secretary Walker was sworn in as Cabinet Secretary for DHSS in February 2017, leading the principal agency charged with keeping Delawareans healthy, ensuring they get the health care they need in a fast-changing world, and providing children, families and seniors with essential social services including food benefits, disability-related services, and mental health and addiction treatment. She oversees one of the largest departments in Delaware’s government with an annual budget of more than $2 billion. As Cabinet Secretary, her priorities include:

• Slowing the growth of health care spending, increasing the transparency of health care costs and improving patient outcomes.
• Bolstering the state’s response to the opioid epidemic with increased resources for treatment, harm reduction and prevention.
• Reducing gun violence in Wilmington by meeting the social services needs of high-risk young people and their families.
• Maintaining a strong safety net for those in need.
• Providing more community-based services for seniors, people with disabilities and individuals who are homeless.

Prior to being nominated to head DHSS by Governor Carney, Secretary Walker worked as the Deputy Chief Science Officer at the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit, nongovernment organization in Washington that is authorized by Congress to improve evidence available to help patients, caregivers, employers, insurers and policymakers make informed health care decisions. She managed the Institute’s research investments, which totaled $1.6 billion in 2016, toward a planned total of $2.5 billion by 2019.

“Those of us who had the great pleasure to work with Kara during her four and a half years at PCORI are thrilled with her well-earned election to the National Academy of Medicine,” said Joe V. Selby, MD, MPH, Executive Director of the Patient-Centered Outcomes Research Institute. “It recognizes the diligent work and exceptional contributions she’s made at every stop throughout her training and career. She brings tremendous knowledge and insight to the Academy as it pursues its mission of improving health for all.”

Background in teaching, serving

Secretary Walker formerly taught Family and Community Medicine at the University of California, San Francisco, as an Assistant Clinical Professor, and has worked with several national organizations to advocate for health equity and for access to quality health care in minority and underserved populations, including the National Medical Association, the Student National Medical Association and the American Medical Association. Dr. Walker has been recognized for leadership by Harvard Business School’s Program for Leadership Development, the American Medical Association and the National Medical Association.

Kevin Grumbach, MD, the Hellman Endowed Professor and Chair of the University of California, San Francisco (UCSF) Department of Family and Community Medicine, nominated Dr. Walker for the honor. “Dr. Walker’s election to the National Academy of Medicine recognizes her career-spanning roles as a family physician and community health leader in academic medicine, the Patient-Centered Outcomes Research Institute, and state government who has championed health equity and consumer and community engagement,” Dr. Grumbach said. “In her current role as Cabinet Secretary at the Delaware Department of Health and Social Services, she has addressed social determinants of health by making Delaware a state with one of the highest percentages of eligible families enrolled in the Supplemental Nutritional Assistance Program and fathers paying child support, and by launching new community-based violence prevention programs. She has rapidly emerged as one of her generation’s most influential family physicians.”

A Caravel Academy high school graduate, she earned her bachelor’s degree in chemical engineering from the University of Delaware and her medical degree from Jefferson Medical College in Philadelphia. She has a Masters of Public Health from the Johns Hopkins School of Public Health and a Masters in Health Services Research from the University of California, Los Angeles, School of Public Health, where she also completed a post-graduate fellowship in the Robert Wood Johnson Clinical Scholars program. As a family physician, Dr. Walker has provided direct patient care in many primary care settings, including those for uninsured and underserved populations. She has published research papers on physician workforce issues, health care organization and delivery.

“The College of Engineering at the University of Delaware would like to congratulate Dr. Walker for her well-deserved election to the National Academy of Medicine,” said Levi T. Thompson, Dean of UD’s College of Engineering and an alumnus of UD’s chemical engineering program. “Her studies in chemical engineering at UD were the starting point of an educational journey that prepared her well to tackle grand challenges in health and public policy. Now, she is using her skills and knowledge to improve the health, safety and quality of life for people in Delaware and across the nation. We could not be more proud of Dr. Walker and look forward to her continued successes.”

The National Academy of Medicine, established in 1970 as the Institute of Medicine, is an independent organization of eminent professionals from diverse fields, including health and medicine; the natural, social and behavioral sciences; and beyond. It serves alongside the National Academy of Sciences and the National Academy of Engineering as an adviser to the nation and the international community. Through its domestic and global initiatives, the Academy works to address critical issues in health, medicine and related policy, and inspire positive action across sectors.

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The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

NEW CASTLE (July 24, 2018) – Following a 14-month review of Delaware’s opioid use disorder treatment system, a research team from the Johns Hopkins Bloomberg School of Public Health and the Bloomberg American Health Initiative today recommended four major strategies to achieve the state’s goal of a system of care that is accessible, evidence-based, individualized, comprehensive and accountable.

Brendan Saloner, PhD, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, presented the findings today at a meeting of the Behavioral Health Consortium at Buena Vista. The report proposes four major strategies for the state to meet its treatment vision:

• Increase the capacity of the treatment system.
• Engage high-risk populations in treatment.
• Create incentives for quality care.
• Use data to guide reform and monitor progress.

In April 2017, Department of Health and Social Services Secretary Dr. Kara Odom Walker asked a team of researchers and clinicians from the Johns Hopkins Bloomberg School of Public Health to conduct the review by meeting with state officials representing multiple agencies, behavioral health organizations, treatment providers and patient advocates, and by studying data on Delaware’s epidemic, available literature, and the experiences of other states and localities.

“Families across the state have urged me to make changes to our public addiction treatment system,” Governor John Carney said. “This Johns Hopkins report is an important step forward in building a stronger treatment system so we can help more people get the access to care they need.”

“The recommendations from the Johns Hopkins team gives us a solid foundation in data, evidence and experiences from which to strengthen the opioid use disorder treatment system in our state,” said Secretary Walker, a board-certified family physician. “With almost one Delawarean dying each day from overdoses and thousands of more individuals and their families impacted by this epidemic, we need to meet people whenever and wherever they are ready for the most effective treatment we can provide.”

In 2017, 345 Delawareans died from overdoses, according to the Division of Forensic Science (DFS). That total was up about 12 percent from 2016. In 2016, the report says, Delaware’s overdose rate tied for ninth (with Rhode Island) among all states at 30.8 deaths per 100,000. Through July 23 of this year, 145 people have died from suspected overdoses in Delaware, according to DFS.

“This report really helps to identify those priority areas we need to address to fix our broken system of treatment in Delaware,” said Lt. Governor Bethany Hall-Long. “These recommendations support the action items included in the Behavioral Health Consortium’s Three Year Action Plan. Implementing these recommendations will allow us to better serve our population and meet their needs most effectively.”

“We deeply appreciate the thoughtful recommendations from the Hopkins/Bloomberg Team to help us strengthen our response to this critical public health epidemic,” said Division of Public Health Director Dr. Karyl Rattay. “The recent passage of an Overdose System of Care bill will help us fulfill the recommendation to engage high-risk populations into treatment, through the creation of a statewide system to ensure that consistent, humane, evidence-based treatment and care is available and provided to those requiring acute management for overdose or substance use disorder.”

The Overdose System of Care will involve establishing consistent EMS and emergency department protocols to improve acute response, initiate medication-assisted treatment to manage withdrawal, and rapidly engage individuals into SUD treatment. Additionally, the bill enables the establishment of stabilization centers, which could provide medical management for individuals who have overdosed or who require acute management of SUD. The ultimate outcome of system implementation is a reduction in morbidity and mortality and improved engagement into SUD treatment.

In embracing another recommendation of the Johns Hopkins report, DHSS’ Division of Substance Abuse and Mental Health (DSAMH) will begin contracts this summer with providers to increase access to care, peer support and effective treatment for individuals living with substance use disorder. In addition to meeting individuals’ treatment needs, the new centers also will address needs for medical care, housing, vocational opportunities, education and other wraparound services.

“We need to treat each person with an opioid use disorder as a whole person,” DSAMH Director Elizabeth Romero said. “At the new centers, we will use certified recovery peers to help individuals navigate their way through both the treatment and the social services worlds. Being able to talk with someone with a similar lived experience will help individuals suffering from opioid use disorder to better coordinate their services and maintain their engagement with treatment.”

“Delaware’ leadership recognizes that the rising tide of overdoses is a public health crisis,” said Joshua Sharfstein, MD, Professor of the Practice and the Director of the Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health. “We are pleased to help the state save lives by expanding access to treatment.”

The Johns Hopkins report, available on DHSS’ website, includes details on each of the four strategies:

• Increasing treatment capacity: Recommendations include DHSS’ Division of Substance Abuse and Mental Health (DSAMH) implementing a Centers of Excellence-type program to provide rapid intake and assessment, treatment, peer services and access to chronic disease management; DSAMH creating an online inventory of all credentialed treatment providers; DHSS leading a campaign to increase the number of providers who prescribe buprenorphine; and DHSS developing a plan to support housing and employment for individuals in recovery.
• Engaging high-risk populations in treatment: Recommendations include the Department of Correction offering opioid use disorder treatment that includes all FDA-approved medications to all individuals in detention facilities; the state upgrading the three existing withdrawal management centers; and DHSS setting standards for hospital provision of SUD treatment for medication-assisted treatment and the use of peers.
• Creating incentive for quality care: Recommendations include DSAMH reviewing its current rates to ensure there is adequate and consistent reimbursement for high-quality care; DHSS’ Division of Medicaid and Medical Assistance (DMMA) ensuring that current value-based payment initiatives applied through Managed Care Organizations (MCOs) are extended to opioid use disorder treatment; and DHSS, in partnership with other state agencies, developing a compliance strategy.
• Using data to guide reform and monitor progress: Recommendations include DHSS developing a dashboard that collects and publicizes statewide data on treatment capacity, utilization and quality indicators; DHSS overseeing a linkage project that brings together multi-agency data for understanding system effectiveness and identifies opportunities for improvement; and DHSS evaluating program and policy changes and rapidly disseminating findings to facilitate continuous improvement.