Prescriber Behavior, Pain Treatment and Addiction Treatment

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1 Prescriber Behavior, Pain Treatment and Addiction Treatment Mary Fleming, M.S. Director, Office of Policy, Planning, and Innovation Substance Abuse and Mental Health Services Administration NGA Policy Academy on Reducing Prescription Drug Abuse Lake Tahoe, NV September 15, 2014

2 SAMHSA: A Public Health Agency Mission: To reduce the impact of hazardous substance use and mental illness on America s communities Roles: Leadership and Voice Influencing Public Policy Data and Surveillance Clinical Education Public Education and Communications Regulation and Standard Setting Practice/Services Improvement Funding - Service Capacity

3 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: In 2013, 24.6 million Americans aged 12 or older were current (past month) illicit drug users. This represents 9.4% of the population aged 12 or older. 6.5 million (2.5%) nonmedical users of prescriptiontype drugs. 4.5 million of which were prescription pain reliever users. 289,000 current heroin users aged 12 or older (0.1% of population).

4 Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: Source Where User Obtained Other 1 (4.3%) Bought on Internet (0.1%) More than One Doctor (2.6%) One Doctor (21.2%) Drug Dealer/ Stranger (4.3%) Bought/Took from Friend/Relative (14.6%) Free from Friend/ Relative (53.0%) Source Where Friend/Relative Obtained One Doctor (83.8%) More than One Doctor (3.3%) Free from Friend/Relative (5.1%) Bought/Took from Friend/Relative (4.9%) Drug Dealer/ Stranger (1.4%) Bought on Internet (0.3%) Other 1 (1.2%) 1 The Other category includes the sources "Wrote Fake Prescription," "Stole from Doctor's Office/Clinic/Hospital/Pharmacy," and "Some Other Way." Note: The percentages do not add to 100 percent due to rounding.

5 Morbidity and Mortality with Prescription Pain Medication Abuse : Increases in Emergency Department visits related to opioid analgesic misuse: Men: 159% Women: 146% 2010: Deaths related to opioid analgesic use: 16,651 (313% increase over past decade); most deaths involved opioids + other drugs/alcohol For every death, there were: 11 treatment admissions 33 Emergency department visits 880 non-medical users CDC, 2013, SAMHSA TEDS, , SAMHSA/DAWN, 2011

6 SAMHSA s Efforts to Prevent Prescription Drug Abuse Partnerships for Success grants Prescription Drug Monitoring Program (PDMP) grants Prevention of Prescription Abuse in the Workplace (PPAW) Technical Assistance Center Promotion of DEA s national takeback day (April 26, 2014) Not Worth the Risk, Even If It s Legal (pamphlet series)

7 SAMHSA s Efforts to Curb Prescription Drug Abuse Prescriber Education Opioidprescribing.com: focus on CME accredited trainings on safe use of opioids PCSS-O: Focus on Safe Opioid Prescribing PCSS-MAT: Focus on Treatment of Opioid Use Disorders

8 SAMHSA s Efforts to Prevent Prescription Drug Overdose Opioid Overdose Prevention Toolkit - Overdose-Prevention-Toolkit/SMA Substance Abuse Prevention and Treatment Block Grant: Primary prevention funds can be used for overdose prevention education/training Treatment block grant funds can be used for purchase of naloxone and overdose kits.

9 Interventions to Address Misuse of Prescription Medications Prescription Drug Monitoring Programs Intrastate and interstate data Enforcement efforts Community outreach and education

10 Treatment Prescription pain medications and heroin are the same types of drugs: opioids Treatments are the same Medical Withdrawal ( Detoxification ) > 90% relapse rate in the year following treatment High risk for overdose when relapse occurs Should not be a stand alone treatment

11 Range or Continuum of Treatment MAT and Recovery Support Services Detoxification Inpatient Outpatient/Community Residential Services Intensive Outpatient Outpatient ACT, co-occurring Peer Services/Recovery Supports Case Management

12 Treatment MAT Plus Combination of FDA-approved medication: Naltrexone Methadone Buprenorphine/naloxone With psychosocial treatments and ancillary treatment components: Counseling: Coping skills/relapse prevention Education PDMP use Toxicology screening

13 Treatment MAT Plus In a 2004 Cochrane review, scientists found evidence from 12 of 77 studies that met their criteria that adding any psychosocial support to methadone treatment significantly reduced heroin use during treatment. Physicians working in opioid clinics found that counseling and case management varied widely in quality and comprehensiveness. Clinic-based buprenorphine treatment offers the same intensity of psychosocial interventions as methadone maintenance; however, most buprenorphine maintenance is carried out in non-clinic settings with variable availability of counseling. Integration of psychosocial care with buprenorphine maintenance medication has been shown to be beneficial in reducing drug abuse and improving retention, though the optimal intensity of care is harder to determine.

14 Medication Assisted Treatment (MAT) Benefits: Lifestyle stabilization Improved health and nutritional status Decrease in criminal behavior Employment Decrease in injection drug use/shared needles: reductions in risk for HIV and viral hepatitis/medical complications of injection drug use

15 Myths About MAT Detox is the best approach to treatment People only need a few weeks/months of treatment Opioid use disorders are chronic, relapsing conditions No different than other chronic conditions: diabetes, high blood pressure, obesity, depression Medication doses should be held low There is no medical basis for: arbitrary dosing limits use FDA and SAMHSA guidance for limiting treatment duration let patients and their doctors decide these issues

16 Challenges to Prevention, Treatment and Recovery Unwillingness to recognize problem Financing of prevention strategies Quick Access (on demand) Capacity Engagement Restrictions/Limits on treatment for what is a longterm disease Barriers to housing and employment Discrimination

17 Thank you!

18

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