Legislation Includes Creating the Nation’s first Overdose System of Care

NEW CASTLE, Del. – On Monday, Governor Carney joined Lt. Governor Hall-Long, members of the Behavioral Health Consortium, first responders, and advocates to sign three bills into law aimed at fighting the addiction epidemic and saving lives in Delaware. All three bills, HS #1 for House Bill 440,Senate Bill 206 and Senate Bill 225, are first year priorities of the Behavioral Health Consortium‘sThree Year Action Plan.

“Today, Delaware became the first state in the nation to enact an Overdose System of Care to improve our state’s care and treatment for Delawareans and families affected by the opioid crisis,” said Governor Carney. “We strengthened our Prescription Monitoring Program and we encouraged prescribers and patients to consider using non-opioid methods when treating back pain. These steps will help build on our system of support for those families and individuals dealing with the opioid crisis personally or professionally. Thank you to the members of the General Assembly, advocates and law enforcement for their tireless work on this epidemic affecting far too many Delaware families.”

The package of legislation addresses critical gaps identified by Delaware’s Behavioral Health Consortium which will tackle a range of issues including the creation of the nation’s first Overdose System of Care model to better transition individuals after an overdose or crisis from an emergency room setting to more comprehensive treatment for their addiction. Additional legislation also creates better access and education to alternative therapies to opioids and improved data sharing of health information between agencies to better assess and analyze prescribing patterns.

All three bills are year one priorities of the Behavioral Health Consortium, chaired by Lt. Governor Hall-Long.

“The addiction crisis ignores income, race, and geography,” said Lt. Governor Hall-Long.Delawareans deserve a treatment system that works for them when they need it most. With today’s bill signing, Delaware is another step closer to creating a more comprehensive, integrated, and timely treatment system from initial contact with first responders through the entire continuum of care.”

The legislative package received widespread support from many in Delaware’s General Assembly, most of whom see the devastating impacts of addiction in their communities.

“In Delaware, we are blessed to have a small, tight-knit community that can respond quickly to challenges as daunting as the current opioid epidemic,” said Sen. Bryan Townsend. “The bills that we have signed today are the result of that spirit of partnership and cooperation. They are a positive sign for the future of addiction and chronic pain treatment in our state. Our constituents deserve this kind of responsive government and I am as proud to be a part of today’s signing ceremony as I will be to keep the ball rolling next year.”

SB 225 encourages prescribers and patients to consider the use of proven alternative therapies instead of opioids and requires continuing education to prescribers about the risks of opioids and benefits of alternative treatments.

“Few Delawareans have made it through the last few years without being affected by the opioid crisis in some way,” said Sen. Stephanie Hansen. As elected officials, we are duty-bound to respond with every ounce of energy, creativity, and dedication we have to find solutions and make much-needed changes to our system of care, treatment methods, and prescription practices. As we continue to spend long hours poring through the data, news articles, and legislative documents trying to come up with new solutions, I am encouraged to see these bills passed today. They represent the combined efforts of an incredible team of people from all corners of this state and it has been a privilege to do my part in the Senate to get these bills drafted and passed. With the governor’s signature now affixed to these new laws, I am looking forward to carrying the momentum into the 150th General Assembly.”

“Combatting the addiction epidemic takes a collaborative approach, with many stakeholders coming to the table. The legislation we are signing into law today helps to establish wrap-around systems of care for overdose patients, better identify prescribing patterns and support alternative treatments to opioids,” said Rep. Helene Keeley, D-Wilmington South. “I was proud to be the prime sponsor of SB 225, and raise awareness about alternative pain care such as physical therapy and chiropractic care. Delawareans who struggle with back pain deserve all options at their disposal. I hope we can build on this legislation and continue the push for access for alternative pain treatments.”

Last year, nearly 2,000 individuals in Delaware suffered a non-fatal overdose, yet many continued to be prescribed opioids or did not receive treatment for substance use disorder. This prompted the need for SB 206, to better coordinate data sharing between state agencies and the Delaware Prescription Monitoring Program to study overdose data and create recommendations around safer prescribing and best practices.

“It seems like every day we hear about another overdose, another tragic death or another family struggling to beat addiction. Addiction doesn’t discriminate, and our policies should address the wide-ranging impacts of the disease,” said Rep. David Bentz, D-Christiana. “It has been an honor to work with the Behavioral Health Consortium and Lt. Governor Hall Long to address this systematic issue. The bills signed into law today by Governor Carney help continue to move Delaware forward and help the many families that struggle with addiction.”

Dr. Sandy Gibney, an emergency department physician at St. Francis Hospital was a leading advocate for legislation forming the nation’s first Overdose System of Care.

“The importance and impact this legislation cannot be understated, said Dr. Sandy Gibney, St Francis Hospital. “Utilizing the ‘system of care’ approach for substance use disorder and overdose care will ensure that an effective and collaborative statewide treatment and intervention plan will be put in place. The Systems of Care that are already established in Delaware for trauma, pediatric emergencies, and stroke have paved the way for an Overdose System of Care. All have demonstrated to be a highly effective and collaborative method for statewide patient care and treatment.”

Delaware’s first responders are often on the front lines of the addiction epidemic.

“Emergency medical services providers, such as emergency medical technicians and paramedics, are a vital component of the community health care system, said Larry Tan, Chief of Emergency Medical Services Division. “Our experience has demonstrated that leveraging their capabilities in defined ‘systems of care’ can have a significantly positive impact on survival and the quality of life in our communities.”

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Delaware one of 11 participating states vetting strategies around crises such as Hepatitis C and opioid use disorder

WILMINGTON, Del. — Delaware was one of 11 states that vetted potential strategies through the National Governors Association (NGA) Center for Best Practices to address public health crises such as Hepatitis C and opioid use disorder by improving access to evidence-based pharmaceutical interventions while ensuring the fiscal sustainability of public programs. The NGA released the report on the strategies today.

“Working with other states and the NGA, our Delaware team has found ways to address these public health crises that are having such a devastating impact on the people of our states, while still being able to effectively manage the cost of the medications we use to provide effective and life-saving interventions,” said Governor John Carney. “Giving states more options helps us make the right decisions on behalf of people in need.”

Across all states, specialty medicines – including treatments for Hepatitis C – have been a key driver in Medicaid spending, accounting for 0.9 percent of claims and 32 percent of Medicaid drug spending. A national study found that naloxone use in Medicaid increased 66 percent from 2013 to 2014, as compared with 12 percent for all drugs, and 101 percent from 2014 to 2015, compares with 10 percent for all drugs.

Delaware joined teams from 10 other states in coming up with the strategies: California, Louisiana, Massachusetts, New Mexico, New York, Ohio, Oregon, Rhode Island, Virginia and Washington. Beginning in November 2017, the NGA Center supported the states in generating ideas for governors across the country to consider as they balance access and cost concerns. The strategies include:

• Establish a Medicaid spending cap for pharmaceuticals.
• Pursue alternative payment mechanisms such as a subscription model with a pharmaceutical manufacturer.
• Consider options for excluding select drugs from Medicaid coverage.
• Engage in bulk and pooled purchasing.
• Determine and pay value-based prices for drug treatments by incorporating value assessments.
• Explore whether the federal government would allow nominal pricing for correctional facilities.

In Delaware, health care spending – including Medicaid, the Department of Correction and state employee health benefits – account for about 30 percent of the state’s total budget. About 225,000 Delawareans are served by Medicaid, the shared state and federal health insurance program for people from low-income households, seniors eligible for long-term care and individuals with disabilities.

Department of Health and Social Services Secretary Dr. Kara Odom Walker, who represented Delaware in the NGA vetting, said the strategies complement the work Governor Carney and she are leading to advance a health care spending benchmark and value-based care in Delaware. In February, Governor Carney signed Executive Order 19 creating a 13-member Advisory Group to make recommendations to Secretary Walker on health care cost and quality benchmarks across Delaware’s health care system, including employer-based coverage, Medicare and Medicaid. Secretary Walker will provide her formal recommendations to the Governor this summer. Beginning in 2019, Delaware will measure the total cost of health care, the first step in increasing transparency in how health care dollars are spent.

“Our Medicaid team has launched several initiatives to improve the quality of care for our Medicaid clients, to address the social determinants of health and to encourage value-based payments,” said Secretary Walker. “These NGA strategies involving evidence-based pharmaceutical interventions offer us options in balancing health care innovations, where appropriate, with the affordability of making those innovations available to the people we serve.”

The full report can be found here.

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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.

DOVER, Del. – The number of prescriptions for opioid medications in Delaware, as well as the total quantity of opioids dispensed, have dropped significantly in the 12 months since the Department of State enacted stricter prescribing regulations to help combat the opioid crisis statewide.

Statistics from the Division of Professional Regulation (DPR), which licenses controlled substance prescribers, show 14 percent fewer prescriptions for opioids were written by Delaware practitioners in the first quarter of 2018 compared to the first quarter of 2017. The Division also reports an 18-percent decline in the total quantity of opioids dispensed to patients over the same period.

“The opioid epidemic continues to ravage families across our state and our nation, but numbers like these show that the public policies we have put in place are having a positive impact,” said Gov. John Carney. “Health care practitioners in Delaware are partners in the shared effort to overcome this crisis, and we are seeing the results of changes in prescribing practices that will, without question, save lives across our state.”

The regulations, which took effect April 1, 2017, were designed to help prescribers more closely monitor and control the use of opioids by their patients. Six months after the regulations were implemented, statistics showed a 12-percent drop in opioid prescriptions and an 8-percent drop in the number of Delawareans receiving prescriptions.

“Fewer prescriptions written and fewer pills dispensed mean fewer chances for Delawareans to become addicted to opioids, or for these dangerous drugs to be diverted for illegal use,” said Secretary of State Jeff Bullock. “The regulations we enacted last year to put limits on opioid prescriptions seem to be working. We hope that in the long term these trends will mean a reduction in opioid addiction and deaths.”

Key elements of the regulations were aimed at controlling the amount of opioids given to new patients and aggressively monitoring their treatment. Except in special circumstances, first-time opioid prescriptions may not exceed a one-week supply under these rules. If further opioid prescriptions are deemed necessary, further action is required, including a physical exam with discussion of relevant patient history and the risks of opioids, and a check of the statewide Prescription Monitoring Program (PMP) database.

Data collected through the PMP is being used to track prescribing trends, document the impact of state efforts to address the opioid crisis, and identify practitioners whose prescribing histories send up red flags so that further outreach may be conducted.

“This is very good news. We hoped when we saw the first drop in opioid prescriptions after the new, more stringent regulations went into effect that those numbers would hold. This new report shows that they have not only held but improved,” said Attorney General Matt Denn. “This is further evidence that the Delaware regulations strike a good balance between making opioid drugs available to those who need them, and ensuring that they are prescribed in a responsible way and with appropriate monitoring and follow-up. Secretary Bullock deserves a lot of credit for investing the time to implement these new regulations, which will save lives.”

The regulatory reforms complement efforts organized across state government and in cooperation with Delaware’s community of public health organizations and anti-addiction advocates.

“There is no silver bullet for solving the addiction epidemic, but these new regulations give us one more tool to fight with,” said Lt. Governor Bethany Hall-Long. “Smarter prescribing practices undoubtedly save lives. As chair of Delaware’s Behavioral Health Consortium, I can promise we will continue to seek out approaches and use every tool we can to fight this epidemic and create stronger, healthier communities.”

The Behavioral Health Consortium, created last year by the General Assembly, is working to develop an action plan to prevent and treat substance use disorder, expand and improve mental health treatment and recovery and provide support for family members of loved ones who are battling addiction or coping with mental health issues.

The state’s Addiction Action Committee, also created by the General Assembly last year, is actively considering two other initiatives related to the prescription of opioid drugs: possible legislation requiring health insurance coverage of alternatives to opioids for pain management, and possible state responses to the co-prescription of opioids and benzodiazapenes.

“The regulations are an important component of the state’s overall plan to address the prescription opioid epidemic, and we are pleased to see the regulations are having the intended effect of reducing the number of prescriptions written,” said Division of Public Health (DPH) Director Dr. Karyl Rattay. “DPH and the Safe Prescribing Subcommittee of the Addiction Action Committee continue to partner with DPR to increase awareness among prescribers regarding the regulations, safe prescribing practices and alternatives to pain management.”

The Department of Health and Social Services also has boosted resources to help individuals struggling with addiction. Educational materials about identifying and fighting addiction can be found at HelpIsHereDE.com. Individuals who are suffering from addiction can also call DHSS’ 24/7 Crisis Hotline to be connected to treatment options. In New Castle County, call 800-652-2929; in Kent and Sussex counties, call 800-345-6785.

DOVER – Secretary of State Jeffrey Bullock has suspended the Delaware medical license and controlled substance privileges of Gregory Villabona, in light of allegations of unprofessional conduct related to the prescription and distribution of opioid medications.

In making this determination, Secretary Bullock considered the findings of two parallel complaints filed by the Delaware Department of Justice, which alleged that Mr. Villabona prescribed opioids to patients with little or no required documentation, failed to maintain effective controls against diversion of controlled substances, and exchanged guns and weapons with patients.

“The facts presented to me in this case demonstrate an immediate danger to public safety, which is the standard that an emergency suspension of this nature must meet,” said Secretary Bullock.

The order suspending Mr. Villabona’s medical license was signed by the secretary today with the concurrence of the president of the Board of Medical Licensure and Discipline. Secretary Bullock also signed a separate order suspending Mr. Villabona’s Delaware controlled substance registration.

Mr. Villabona is a psychiatrist with a practice in Dover and was previously disciplined by state licensing authorities in 2003 for unprofessional conduct arising from sex offenses in Maryland to which Mr. Villabona plead guilty. He was disciplined again in 2007 for violating the terms of a 2005 order, which, in part, prohibited Mr. Villabona from treating minor patients in unsupervised settings. In 2008, Mr. Villabona entered into a consent agreement with the state that placed certain permanent restrictions on his medical license, including limiting his practice to male patients over the age of 18.

Delaware Code Title 24 enables a temporary suspension pending a hearing to be issued upon the written order of the Secretary of State, if the activity of the licensee presents a clear and immediate danger to public health, safety or welfare.

The suspension of Mr. Villabona will remain in effect for a period of 60 days, during which time disciplinary hearings will be held or the final disposition for this individual will take place. As the result of a hearing, the Board of Medical Licensure and Discipline has the authority to impose disciplinary sanctions up to and including revocation of a practitioner’s license or certification.

The licensure status of Mr. Villabona will soon be updated on the Division of Professional Regulation’s online license verification service. Documentation of previous actions against Mr. Villabona’s medical license may also be viewed at this site.