Reduce incidence of substance abuse disorder
Why is this important to Colorado?
- Drug abuse and deaths from drug overdose continue to be a serious problem in Colorado. In 2016, 912 people died of a drug overdose.
- The prescription opioid death rate stopped increasing in 2016. The number of prescription opioid overdoses in 2016 decreased to 300 deaths from a high of 338 in 2014. However, in 2017 overdoses rebounded past its 2014 high to 373 deaths.
- There were 228 heroin overdose deaths in 2016, an increase of 68 deaths in one year. The heroin death rate of 4.1 deaths per 100,000 persons in 2016 has doubled since 2012 (when 2.2 deaths per 100,000 persons occurred).
- Since 2013 when the Colorado Consortium for Prescription Drug Abuse Prevention started, non-medical use of prescription opioids among those age 12 and older dropped from 5.1 percent in 2013 to 4.9 percent in 2014. Among 18-25 year olds, non-medical use dropped from 10.7 percent to 9.3 percent in 2014.*
- Marijuana use among Colorado's youth is in line with national averages (19.4% of CO youth compared to 19.8% of national youth in 2017); however, due to increased access to marijuana by all Coloradans after legalization, and decreased perceptions of the substance as risky for youth use, many in Colorado are concerned that legalization of marijuana may lead to higher youth use in the future.
How do we measure success?
- Reduce self-reported, non-medical opioid (prescription drug) use.*
- Maintain the percent of high school students who used marijuana one or more times during the past 30 days at or below the 2013 level of 19.70 percent.**
*The National Survey on Drug Use and Health (NSDUH) changed the misuse question for the 2015 survey, making it impossible to compare the data on non-medical opioid use with previous surveys. The NSDUH did not release state-level data using the new question in 2015. As a result, the 2016 data will serve as the new baseline for this effort moving forward. Given the lack of data needed to identify whether misuse is declining, the change in prescription opioid overdoses was used as a proxy. As noted above, in 2017 deaths from prescription opioids reached an all time high.
** The Healthy Kids Colorado Survey is conducted every other year, with a reporting lag into the following year.
||Non-medical prescription drug use||N/A||N/A||N/A||5.2% (2016)||3.50%|
||High school students using marijuana||19.70%||21.20% (2015)||N/A||19.4% (2017)||19.70%|
Source: CDPHE, National Survey on Drug Use and Health, Health Kids Colorado Survey.
What actions are we taking?
- Colorado’s Department of Public Health and Environment (CDPHE) and the Colorado Department of Regulatory Agencies (DORA) are partnering with other members of the Colorado Consortium for Prescription Drug Abuse Prevention to conduct a series of pilot projects to make the Prescription Drug Monitoring Program (PDMP) easier to use and access in an effort to increase PDMP utilization rates. CDPHE is also funding local health agencies to conduct provider and prescriber education to increase the use of the PDMP.
- Colorado’s Department of Public Health and Environment is partnering with other members of the Colorado Consortium for Prescription Drug Abuse Prevention to expand the Colorado Household Medication Take-Back Program. Permanent collection locations are being established statewide at law enforcement agencies, pharmacies, hospitals, and clinics to provide all Colorado residents a safe and convenient way to rid their homes of unused medications, reducing the potential for misuse or abuse.
- Colorado Department of Health Care Policy and Financing (HCPF) implemented the Chronic Pain Management Program. This program uses interactive video technology to connect primary care providers with pain management specialists. The second phase of the program began in May 2016, and offers providers the current Chronic Pain Telehealth Program and the new Buprenorphine Telehealth Program, to assist providers with treating clients with opioid addiction.
- Colorado Department of Health Care Policy and Financing is working with the University of Colorado Skaggs School of Pharmacy on a number of initiatives designed to reduce inappropriate use of opioids. In 2017, letters documenting prescribing patterns of physicians compared to their peers will be evaluated for effectiveness in impacting prescribing behavior.
- Colorado Department of Health Care Policy and Financing implemented a new policy on August 1, 2017 limiting opioid naive members to a 7-day supply of opioids. The member can receive two additional prescriptions of 7 days and after that a prior authorization and possibly a pain consultation is required to continue to receive opioids.
- Colorado Department of Health Care Policy and Financing is reducing the Morphine Milligram Equivalent (MME) from 300 to 250 effective October 1, 2017. The Department implemented the 300 MME February 2016 to require a prior authorization for anyone receiving more than 300 MME per day. The Department’s goal is to ultimately reduce down to the current recommended dosing of 90-120 MME. The Department is taking a slow approach to this to allow tapering and appropriate reduction in use to reduce the danger of people using other sources of opioids.
- Colorado Department of Health Care Policy and Financing continues to provide a pain resources webpage for providers to obtain information about opioids including pain assessment charts, information about tapering, patient education, overdose information, and substance use disorder assistance/prevention.
- Colorado Department of Public Health and Environment launched the “Protect What’s Next” campaign in August 2015 to help prevent youth from using marijuana before age 21 by encouraging them to think about their goals and how marijuana could get in the way. Colorado also launched a complementary campaign in 2015 to encourage adults to have conversations with youth about marijuana. There were nearly 125,000,000 media impressions between the two campaigns in FY17 and just over 19,000,000 in FY18. In May and June of 2018, a new youth and complementary trusted adult campaign launched with refreshed creative and messaging to remind youth of their responsibility to their futures and adults of their responsibility to help prevent underage use. The youth campaign, "Find Your Moment," focuses on the important moments in life that help young people realize what it takes to achieve their goals. The trusted adult campaign was created to remind parents, teachers, coaches and other influential adults that their words have power, especially when it comes to talking to youth to prevent substance use. Both initiatives are part of the "Responsibility Grows Here" campaign, which aims to educate about legal, responsible, and safe marijuana practices to a variety of audiences across Colorado. From launch through September 2018, the youth prevention campaigns have garnered nearly 74 million impressions.
- The Colorado Department of Public Health and Environment is funding community mobilization efforts with $9 million in marijuana tax cash revenue to prevent substance abuse among young Coloradans using the Communities That Care model. Communities That Care is a proven community prevention model that has been studied across multiple randomized control trials with a well-documented return on investment. For every $1 spent, the program sees a $5.30 return on that investment. Currently, 47 communities across 43 counties are in their third year of Communities That Care implementation.
- Colorado Department of Human Service's Tony Grampsas Youth Services (TGYS) program continues to provide funding to to100 organizations throughout the state who provide prevention intervention services to children, youth, and their families. TGYS goals include reducing youth marijuana use, increasing protective factors, and improving opportunities for youth to succeed.
- Colorado is enforcing retail marijuana age restriction laws, including identification spot checks and cracking down on enforcement actions.