Substance Abuse Prevention and Treatment Agency 2012 Community Profile

Transcription

1 Substance Abuse Prevention and Treatment Agency 2012 Community Profile Nevada Division of Mental Health and Developmental Services Department of Health and Human Services Brian Sandoval, Governor Michael J. Willden, Director Department of Health and Human Services Richard Whitley, MPH, Acting Administrator Division of Mental Health and Developmental Services May 2012

2 Nevada Division of Mental Health and Developmental Services Department of Health and Human Services 2012 Community Profile Prescription Drug Abuse In Nevada: Overdose Deaths and Emergency Room Visits Deborah McBride, MBA, Agency Director Nan Kreher, M.Ed., Health Program Specialist I

3 ACKNOWLEDGEMENTS Thanks to the following individuals for their contributions: William Bailey, Data Team Supervisor for technical assistance. Darla Beers, Data Team Administrative Assistance, for proof reading.

4 Table of Contents TABLE OF CONTENTS I. Introduction... 1 II. Data Sources and Key Indicators III. Community Profile Section I - Key Prescription Drug Abuse Consequences and Consumption Consequences, Adults & Youth Consumption, Adults Consumption, Youth Section II - Key risk/protective/intervening/social and other indicators Risk Factors, Adults Risk Factors, Youth Risk Factors, Supply IV. Conclusion i

5 Table of Contents (cont.) TABLE OF CONTENTS List of Maps Map 1. Map 2. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages based on 2008 and 2009 NSDUHs Nonmedical Use of Pain Relievers in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs List of Charts Table 1. Controlled Substance Table 2. Dosage Units Table 3. Prescription Schedule List of Charts Chart 1. Nevada Prescription Drug Overdose Deaths 2009 to Chart 2. Nevada Prescription Drug Overdose Deaths Ages Chart 3. Causes of Death in Nevada Overdoses... 5 Chart 4. Ages of Prescription Drug Overdoses, Clark County Chart 5. Percentage of Male/Female Prescription Drug Overdose Deaths, Chart 6. Washoe County Prescription Drug Overdose Deaths... 7 Chart 7. Prescription Drug Poisonings by Gender, Chart 8. Percentage of People Using Drugs... 8 Chart 9. Ages Drug Dependent Poisoning ER Visits... 9 Chart 10. Poisonings by Analgesics, Antipyretics and Antirheumatics, Chart 11. Percentages of Ages of ER Visits for Sedative and Hypnotic Poisonings Chart 12. Nevada Poisonings by Psychotropic Agents, Chart 13. Poisonings by Central Nervous System (CNS) Stimulants, ii

6 Table of Contents (cont.) TABLE OF CONTENTS Chart 14. NV Poisonings by CNS Depressants and Anesthetics, Chart 15. NV Adults Admitted for Prescription Drug Abuse Treatment Chart 16. NV Adolescents Admitted for Prescription Drug Abuse Treatment Chart 17. Pain and Mental Illness in Drug Overdose Decedents, West Virginia, 1999 to Chart 18. Past Year Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: Chart 19. Past Year Substance Use among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: Chart 20. Suicide Thoughts, Plans, and Attempts in the Past Year among Adults Aged 18 or Older, by Substance Dependence or Abuse: 2010 Chart 21. MTF Availability of Oxycontin, Vicodin Chart 22. Percentage of 12th Graders Saying that Using Narcotics Puts Users at Great Risk Chart 23. MTF Twelfth Graders OxyC and Vicodin Use Chart 24. MTF Any Prescription Drug Use in Past Year Chart YRBSS High School Suicide Questions Chart 26. Past Year Substance Dependence or Abuse among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: Chart 27. Past Year Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: Chart 28. Dosage Units of Prescription Drugs Prescribed in Chart 29. Prescriptions in Nevada PDMP iii

7 Introduction Introduction The abuse and misuse of prescription pain medications has become increasingly prevalent in Nevada. In , Nevada, Kentucky, Oregon, Oklahoma, and Washington ranked in the top one fifth of states for this measure in all three age groups on the National Survey on Drug Use and Health (NSDUH). A direct consequence of abuse and misuse is overdose deaths due to prescription drugs. The population that overdoses on prescription medications was chosen for the Nevada Community Profile with the intention to learn more about this group of people in order to develop prevention efforts focused on this population. Nearly 7 million Americans are abusing prescription drugs more than the number who are abusing cocaine, heroin, hallucinogens, ecstasy, and inhalants, combined. That 7 million was just 3.8 million in 2000, an 80% increase in just twelve years. Prescription pain relievers are new drug users drug of choice, vs. marijuana or cocaine. Opioid painkillers now cause more drug overdose deaths than cocaine and heroin combined. The U.S. Centers for Disease Control and Prevention says in the past decade, the number of annual deaths from painkillers has quadrupled to roughly 15,000. Read more: Nearly 1 in 10 high school seniors nationwide admits to abusing powerful prescription painkillers. Forty percent of teens and an almost equal number of their parents think abusing prescription painkillers is safer than abusing "street" drugs. Misuse of painkillers represents three-fourths of the overall problem of prescription drug abuse; hydrocodone is the most commonly diverted and abused controlled pharmaceutical in the U.S. Twenty-five percent of drug-related emergency department visits are associated with abuse of prescription drugs. Methods of acquiring prescription drugs for abuse include getting them from friends or relatives (57%), doctor-shopping (18%), from one physician (18%), traditional drug-dealing (5%), and, illicitly acquiring prescription drugs via the internet (2%). (Drug Enforcement Administration Brief, December, 2010) 1

8 Data Sources and Indicators Data Sources Clark County Coroner s Office The Clark County Office of the Coroner/Medical Examiner (CCOCME) investigates all deaths by violence, criminal means, suicide, or any unattended death whatever the cause. The Coroner s office provides SAPTA with comprehensive data on prescription drug overdose deaths. NSDUH The National Survey on Drug Use and Health is the primary source of information on the prevalence, patterns, and consequences of alcohol, tobacco, and illegal drug use and abuse in the general U.S. civilian non institutionalized population, age 12 and older. It is currently conducted by SAMHSA's Office of Applied Studies (OAS). Correlates in OAS reports include the following: age, gender, pregnancy status, race/ ethnicity, education, employment, geographic area, frequency of use, and association with alcohol, tobacco, and illegal drug use. Monitoring the Future Monitoring the Future (MTF) is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately fifty thousand 8th, 10th and 12th grade students are surveyed (12th graders since 1975, and 8th and 10th graders since 1991). The survey includes detailed questions regarding drug and alcohol use. Prescription Drug Monitoring Program, Nevada Prescription drug monitoring programs are helping states address prescription drug abuse, addiction and diversion. As of July 2009, a total of forty states have laws allowing for a prescription drug monitoring program (PDMP). PDMPs gather information that may include: patient name, date of birth, address; drug name, strength, and quantity; doctor name and Drug Enforcement Agency number; and other prescription information, date written, refills, and day supply. The Nevada program was started in 1995 and was one of the first in the country. Results form the 2010 National Survey on Drug Use and Health: Mental Health Findings This report presents results pertaining to mental health from the 2010 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, non-institutionalized population of the United States aged 12 years old or older. This report presents national estimates of the prevalence of past year mental disorders and past year mental health service utilization for youths aged 12 to 17 and adults aged 18 or older. Among adults, estimates presented include rates and numbers of persons with any mental illness (AMI), serious mental illness (SMI), suicidal thoughts and behavior, major depressive episode (MDE), treatment for depression (among adults with MDE), and mental health service utilization. 2

9 Data Sources and Indicators SAMHSA The Substance Abuse and Mental Health Services Administration provides statistical information and does research of the population to develop policies and programs that address substance abuse and mental health issues in the U.S. YRBSS The Youth Risk Behavior Surveillance Survey is conducted by the Centers for Disease Control and Prevention (CDC). The survey monitors six categories of priority health-risk behaviors among youth and young adults, including behaviors that contribute to unintentional injuries and violence and alcohol and other drug use. YRBSS includes a national school based survey conducted by CDC and state and local school based surveys conducted by state and local education and health agencies. Washoe County Medical Examiner - Coroner s Office The mission of the Washoe County Medical Examiner and Coroner's Office is to investigate unexpected and unexplained deaths in order to identify and report on the cause and manner of death. Scientific investigative techniques and medical procedures are used to serve families and public agencies impacted by sudden unexpected death. 3

10 Consequences, Adults & Youth Prescription Drug Overdose Deaths in Nevada, 2009 to 2011 Data from the Office of Vital Statistics in Nevada shows that between 2009 and 2011, 2,082 people died from prescription drug overdoses. The chart below shows that the majority of those dying from prescription drug overdoses were men (58%). Chart 1. Chart 2. The chart above shows that 69% of those who die of prescription drug overdoses are between 35 and 64 years old. 4

11 Consequences, Adults & Youth Causes of Death, 2011 Nevada Office of Vital Statistics Chart 3. Cause of death is listed on the death certificates using ICD 10 codes. Deaths referred to in this section were assigned one of four codes: T36 T50, poisoning by drugs, medicaments and biological substances, X40 X49, accidental poisoning by and exposure to noxious substances not including alcohol, X60 X84, intentional self harm due to poisoning, and Y10 to Y34, death due to drug poisoning of unknown intent. The majority of overdose deaths were caused by accidental poisoning by and exposure to noxious substances not including alcohol (83%). 5

12 Consequences, Adults & Youth Consequences of Prescription Drug Abuse Prescription Drug Overdoses, Clark County, NV The Coroner s Office in Clark County, Nevada (Las Vegas) reported that in 2010 there were 288 deaths as a result of prescription drug overdoses. In 2007 and 2008, the number was 344 and 349 people, respectively. Two-thirds of those dying from prescription drug overdoses in 2010 were between 36 and 64. Decedents had an average of four different substances in their systems at the time of death and 95% of them had at least one indicator of substance abuse. Eighty-five percent of the deaths were ruled accidents and not suicides. Sixtyseven percent of people who overdose on prescription drugs are male. (Clark County Coroner, 2010) Chart 4. Chart 5. 6

13 Consequences, Adults & Youth Prescription Drug Overdose Deaths, Washoe County Nevada Chart 6. Clark and Washoe Counties are the two largest population centers in Nevada, making up about 88% of the state s population. Thus, prescription drug overdose deaths in these counties would make up the majority of those deaths in the state. 7

14 Consequences, Adults & Youth Nevada 2010 ER Visits for Prescription Drug Overdose In 2010, there were 3,983 emergency room visits in Nevada for overdoses of prescription medications. The first chart below shows that 60% of those who went to an emergency room with drug poisoning were women. It is interesting that the majority of people who seek care for an overdose are women but the majority of those who die of prescription drug overdoses are men. Chart 7. Chart 8. The chart above shows that almost 80% of emergency room visits for prescription drug overdoses are due to abuse of analgesics (pain relievers) or psychotropics (anti-depressants). 8

15 Consequences, Adults & Youth Drug Dependent Overdose Poisonings Seventy-one percent of those admitted to emergency rooms for prescription drug overdose involved people diagnosed with drug dependence. The percentage of men to women in this group was 50/50. Seventy-seven percent of those in this group were White, eleven percent were Black and seven percent were Hispanic. The chart below shows that the majority (69%) of those in this group were between ages 25 and 54. Chart 9. 9

16 Consequences, Adults & Youth Nevada Poisonings by Analgesics, Antipyretics and Antirheumatics, 2010 In 2010, 1,571 people visited Nevada emergency rooms having been poisoned by analgesics, such as aspirin or ibuprofen, antipyretics, which are used to lower fevers or antirheumatics which are used to treat pain caused by arthritis. Women represented 56% of this group and the majority of people poisoned by this group of drugs were between 15 and 54 years old. Caucasians made up 67% of this group flowed by Hispanics, 14% and Black people, 11%. Chart 10. Nevada Poisonings by Sedatives and Hypnotics Sedatives are a group of drugs used to reduce anxiety or irritability and includes barbiturates, and benzodiazepines such as Valium and Klonopin. The majority of the people in this group were between 15 and 64 years old and 65% of them were women. Seventy-two percent of this group were White, 13% were Black and 8% were Hispanic. Chart

17 Consequences, Adults & Youth Poisonings by Psychotropic Drugs Chart 12. Psychotropic drugs alter chemical levels in the brain and can cause a variety of changes in behavior and perception. These drugs have many uses and can be divided into four major groups: hallucinogens, antipsychotics, depressants, and stimulants. The majority of people in this group were between the ages of 15 and 54 and 61% of them were women. Seventy-three percent of this group were White, 10% were Black, and 11% were Hispanic. 11

18 Consequences, Adults & Youth Poisonings by Central Nervous System (CNS) Stimulants and Depressants The majority of people admitted to emergency rooms for CNS stimulant poisoning were men (63%). Stimulants used include Adderall, Ritalin and MDMA or Ecstasy. Stimulants increase alertness and awareness and improve concentration. Chart 13. Chart 14. Poisonings by CNS Depressants and Anesthetics The majority of those who overdose on central nervous system depressants and anesthetics were women (61%). Benzodiazepines, such as Valium and Xanax are sometimes prescribed to treat anxiety, acute stress reactions, and panic attacks. The more sedating benzodiazepines are prescribed for short-term treatment of sleep disorders. Usually, benzodiazepines are not prescribed for long term use because of the risk for developing tolerance, dependence, or addiction. 12

19 Consumption, Adults Consumption Data National Survey on Drug Use and Health According to results from the National Survey on Drug Use and Health (NSDUH), Nevada ranked in the top one-fifth of the states in all four age groups (12 and older, 12 to 17, 18 to 25 and 26 and older) of the percentage of people who reported using prescription medications non-medically in the past year. Map 1. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs In Nevada 5.8% of those 12 and older who responded to the NSDUH in survey reported using prescription drugs non-medically in the past year. This represents 118,338 people statewide. Nevada ranked in the top 20% among the states in all four age groups for the percentage of respondents who reported using prescription drugs non-medically. 13

20 Consumption, Adults Nevada Adults Admitted for Prescription Drug Abuse Treatment Chart 15. The data displayed in the chart above is from the Nevada Health Information Provider Performance System for The system creates client records for people treated for substance abuse in Nevada. In 2011, 9,605 adults 19 and older were admitted for substance abuse treatment at a SAPTA funded treatment program. Thirteen percent of the clients were treated for addiction to prescription opiates or synthetic opiates such as meperidine or fentanyl. Three percent of adult clients were treated for benzodiazepine addiction. (The majority of people treated for substance abuse in Nevada (58%) and nationwide are treated for alcohol abuse.) 14

21 Consumption, Youth Nevada Adolescents Admitted for Prescription Drug Abuse Treatment Chart 16. In 2011, 1,585 adolescents (ages 10 to 18) were treated for prescription drug abuse in Nevada. The chart includes the primary and secondary prescription drugs of choice for those clients. Eleven percent of the adolescents treated in SAPTA funded programs were treated for prescription drug abuse. Map 2. Nonmedical Use of Pain Relievers in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs Nevada youth ages 12 to 17 rank in the top twenty percent of youth nationwide reporting non-medical use of prescription drugs. 15

22 Risk Factors, Adults Risk Factors for Prescription Drug Overdose Death Although studies examining risk factors for prescription drug abuse are limited, one recent study published in journal Pain Medicine examined characteristics of a series of cases of overdose deaths in individuals prescribed controlled substances. (Paulozzi, L., Kilbourne, E., Shah, N., Nolte, K., Desai, H., Landen, M., Harvey, W., & Loring, L. (2011). A History of Being Prescribed Controlled Substances and Risk of Drug Overdose Death Pain Medicine ) Individuals who died of an unintentional drug overdose in the state of New Mexico over an 18 month period were identified. A control group of individuals were identified based on recently receiving prescriptions utilizing a state prescription monitoring database. This case control study found some interesting risk factors associated with unintentional drug overdose deaths including: Male gender Older age Sedative/hypnotic prescriptions Multiple prescriptions for controlled substances Prescriptions from multiple providers and multiple pharmacies Specific prescriptions for buprenorphine, fentanyl, hydromorphone (Dilaudid), methadone, or oxycodone (Oxycontin) Daily opioid prescription dose greater than the equivalent of 40 mg of morphine This study found prescriptions for at least one controlled substance was found in 44% of all individuals 10 years and older during the study period. The authors conclude their study supports the potential for centralized state pharmacy controlled substance databases to reduce the numbers of unintentional overdose deaths. Such databases could alert providers and pharmacies to high-risk individuals who may be abusing the medical system. Such programs would not address other potential access routes such as purchase of controlled prescription drugs off the street or via internet orders. Abundance of Supply of Prescription Opiates In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade. Drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg of morphine per person in 1997 and approximately 700 mg per person in 2007, an increase of more than 600% (6). That 700 mg of morphine per person is enough for everyone in the United States to take a typical 5 mg dose of Vicodin (hydrocodone and acetaminophen) every 4 hours for 3 weeks. Persons who abuse opioids have learned to exploit this new practitioner sensitivity to patient pain, and clinicians struggle to treat patients without overprescribing these drugs. 16

23 Risk Factors, Adults Risk Factors for Prescription Drug Overdose Death A study of prescription drug overdose deaths done in West Virginia found that the majority of the decedents were men. Over 56% of the decedents had previously been diagnosed with a mental illness and over 42% of them had been prescribed medications for chronic pain. Psychoactive drugs such as stimulants, depressants, and hallucinogens contributed to 49% of the deaths. Benzodiazepines or sedatives and anti-anxiety medications contributed to 37% of the deaths. Chart 17. Source: Mental Illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review, Toblin et.al, J of Clinical Psychology, April 7,

24 Risk Factors, Adults Chart 18. Major Depressive Episode and Substance Abuse, Adults in the U.S. Past Year Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2010 Adults aged 18 or older who had MDE in the past year were more likely to have substance dependence or abuse than adults who did not have past year MDE (22.0 vs. 7.9%) The percentage meeting criteria for illicit drug dependence or abuse was greater among adults aged 18 or older who had MDE in the past year than for adults without MDE in the past year (8.8 vs. 2.1%). Also, the percentage meeting criteria for alcohol dependence or abuse in the past year was greater among adults with MDE in the past year than for adults without MDE in the past year (17.1 vs. 6.6%). In 2010, 3.4 million adults aged 18 or older (16.9%) with past year substance dependence or abuse had MDE in the same time period. (Source: Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings.) 18

25 Risk Factors, Adults Chart 19. Past Year Substance Use among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2010, U.S. Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used non-medically. In 2010, adults aged 18 or older who had past year MDE were more likely than those without past year MDE to have used illicit drugs in the past year (28.6 vs. 13.8%). A similar pattern was observed for specific types of past year illicit drug use, such as the use of marijuana, cocaine, hallucinogens, inhalants, or heroin and the nonmedical use of prescription-type psychotherapeutics. People who have mental illness use drugs and alcohol to feel normal. (Source: Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings.) 19

26 Risk Factors, Adults Chart 20. Suicide Thoughts, Plans, and Attempts in the Past Year among Adults Aged 18 or Older, by Substance Dependence or Abuse: 2010, U.S. Adults aged 18 or older with past year illicit drug or alcohol dependence or abuse were more likely than those without dependence or abuse to have had serious thoughts about suicide in the past year (12.2 vs. 3.0%). Adults with substance dependence or abuse also were more likely to make suicide plans compared with adults without dependence or abuse (3.1 vs. 0.9%) and were more likely to attempt suicide compared with adults without dependence or abuse (1.7 vs. 0.4%). Percentages of adults aged 18 or older in 2010 who made suicide plans were similar for those who had cooccurring Serious Mental Illness (SMI) and substance dependence or abuse in the past year (13.6%) and those with SMI alone (10.6%). Adults with co-occurring SMI and substance dependence or abuse were approximately twice as likely as those with SMI but no substance use disorders to have attempted suicide in the past year (7.3 vs. 3.8%). Among adults aged 18 or older with substance dependence or abuse, the percentages who attempted suicide differed by level of mental illness. Among those with SMI, 7.3% attempted suicide compared with 2.4% of those with moderate mental illness, 1.1% of those with low (mild) mental illness, and 0.4% of those with no mental illness. (Source: Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings.) 20

27 Risk Factors, Youth Risk Factors, Adolescents Chart 21. This Monitoring the Future (MTF) survey question asked students about their perception of the availability of narcotics other than heroin and now lists Oxycontin, Vicodin and Percocet as examples of narcotics. The list of examples was changed in 2010 from methadone, and opium to Oxycontin, Vicodin and Percocet. The clarification of the types of drugs being asked about likely explains the discontinuity in the 2010 results, according to MTF. Students in 10th and 12th grade reported that availability of narcotics was fairly easy or easy to get much more often after narcotics were defined using terms with which they were familiar. Availability and supply are risk factors for adolescents using these drugs at a young age. Chart 22. Twelfth graders were asked how harmful taking Vicodin, Oxycontin, or Percocet would be with these levels of use. 21

28 Risk Factors, Youth Risk Factors, Adolescents Chart 23. Chart 24. Monitoring the Future asks high school and college students about their use in the past 12 months of Vicodin, Oxycontin and Percocet and any Prescription Drug use. The data in the graphs is nationwide data. Almost 10% of students have reported using Oxycontin, Vicodin or Percocet, although the percentage has decreased slightly since High school students reporting any prescription drug use for non-medical reasons has remained at a little over 15% since

29 Risk Factors, Youth Risk Factors, Adolescents Suicide Chart YRBSS High School Suicide Questions Attempt using drugs, poison 3.6 Suicide attempt 10.2 Made a suicide plan 14.3 Seriously consider suicide 18 Felt sad or hopeless Suicide is the third leading cause of death for youth between the ages of 10 and 24. It results in approximately 4,400 lives lost each year. The top three methods used in suicides of young people include firearm (46%), suffocation (37%), and poisoning (8%). Deaths from youth suicide are only part of the problem. More young people survive suicide attempts than actually die. A nationwide survey of youth in grades 9th-12th in public and private schools in the United States (U.S.) found that 15% of students reported seriously considering suicide, 11% reported creating a plan, and 7% reporting trying to take their own life in the 12 months preceding the survey. Each year, approximately 149,000 youth between the ages of 10 and 24 receive medical care for self-inflicted injuries at Emergency Departments across the U.S. Suicide affects all youth, but some groups are at higher risk than others. Boys are more likely than girls to die from suicide. Of the reported suicides in the 10 to 24 age group, 84% of the deaths were males and 16% were females. Girls, however, are more likely to report attempting suicide than boys. Cultural variations in suicide rates also exist, with Native American/Alaskan Native and Hispanic youth having the highest rates of suiciderelated fatalities. A nationwide survey of youth in grades 9th-12th in public and private schools in the U.S. found Hispanic youth were more likely to report attempting suicide than their black and white, non-hispanic peers. (Source: YRBSS, CDC, Youth Suicide, 2010). 23

30 Risk Factors, Youth Chart 26. Major Depressive Episode and Substance Use Among Youth Past Year Substance Dependence or Abuse among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2010, U.S. In 2010, 20% of adolescents who had substance dependence or abuse also had a major depressive episode in the past year. Only 6.1 % of those who had substance dependence or abuse in did not have a major depressive episode in the past year. Youth who experience major depressive episode are three times more likely to become dependent upon or abuse drugs or alcohol, including prescription drugs. (Source: Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings.) 24

31 Risk Factors, Youth Chart 27. Past Year Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2010, U.S. (Source: Results of the 2010 National Survey on Drug Use and Health: Mental Health Findings) Illicit drugs include marijuana/hashish, cocaine, (including crack), heroin, hallucinogens, inhalants or prescription drugs used non medically. In 2010, youths aged 12 to 17 with past year MDE were almost twice as likely as those without to be dependent on illicit drugs, including prescription drugs. Adolescents with depression use drugs and alcohol to self medicate in an attempt to feel normal. (Source: Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings.) 25

32 Risk Factors, Supply Risk Factors for Prescription Drug Overdoses in Nevada Supply The Controlled Substances Act (CSA) was enacted into law by Congress as Title II of the Comprehensive Drug Abuse Prevention and Control Act of The legislation created five Schedules (classifications), with varying qualifications for a substance to be included in each. Two federal agencies, the Drug Enforcement Administration, and the Food and Drug Administration, determine which substances are added to or removed from the various schedules. Drugs are categorized in five schedules, with Schedule I including drugs that have a high potential for abuse, no currently accepted medical use in the U.S. and a lack of accepted safety for use of the drug under medical supervision. No prescriptions may be written for Schedule I drugs and heroin, marijuana, mescaline and strong opiates are included in this schedule. Schedule II drugs have a high potential for abuse, currently accepted medical use in the U.S. with severe restrictions and may lead to severe psychological or physical dependence. Oxycodone, fentanyl, morphine, codeine and hydrocodone are all Schedule II drugs. Drugs in Schedules III and IV are less likely to be abused and lead to physical and psychological dependence. Table 1. Controlled Substances Schedule II Schedule III Schedule IV Opioids: acetaminophen with codeine (Codalan, Phenaphen 2, 3, 4, Tylenol 2, 3, 4) aspirin with codeine (Empirin 2, 3, 4) hydrocodone hydrocodone w/ acetaminophen/aspirin (Anexsia, Azdone, Bancap, Co-gesic, Damason-P, Dolacet, Duocet, Endal-HD, Hyco-Pap, Hydrocet, Hyphen, Lorcet Plus, Lorcet HD, Lortab, Vicodin, Zydone) nalorphine paregoric. Opioids: codeine fentanyl (Sublimaze, Innovar) hydromorphone (Dilaudid) levorphanol (Levo-Dromoran) meperidine (Demerol) meperidine w/ Promethazine (Mepergan) methadone (Dolophine) morphine (MS Contin, MSIR, OMS, RMS, Roxanol) oxycodone oxycodone w/ acetaminophen/aspirin (Percocet, Percodan, Roxicet, Roxiprin, Tylox). Sedatives: amobarbital (Amytal)** secobarbital (Seconal)** pentobarbital (Nembutal)**. Sedatives: any compound containing an unscheduled drug and: amobarbital ** secobarbital** pentobarbital** glutethimide (Doriden) Non-narcotic Analgesic Combinations butalbital with acetaminophen/aspirin (fiorinal). Opioids: propoxyphene (Darvon) propoxyphene w/ acetaminophen/aspirin (Darvocet, Dolene, Wygesic) pentazocine (Talwin). Sedatives: chloral hydrate clorazepate (Tranxene) chlordiazepoxide (Librium) clonazepam (Klonopin) diazepam (Valium) ethchlorvynol (Placidyl) flurazepam (Dalmane) meprobamate (Equanil, Miltown) oxazepam (Serax) paraldehyde (Paral) phenobarbital ** prazepam (Centrax) triazolam (Halcion). 26

33 Risk Factors, Supply Risk Factors, Supply The Prescription Drug Monitoring Program (PDMP) in Nevada has been collecting data through pharmacies on prescriptions for Schedule II, III, and IV medications since When pharmacies fill prescriptions for drugs listed in these 3 schedules the information is logged in to a data base operated by the PDMP. Prescribers (physicians and dentists) are able to search for patients in the data base to check whether they are being prescribed medications by other prescribers. Data are collected twice per month, with information on over 3 million prescriptions collected annually. The monitoring program collects data on numbers of prescriptions filled and number of dosage units dispensed. The chart below shows that narcotics (OxyContin, oxycodone, hydrocodone, etc) represent the majority of dosage units dispensed in Nevada. Chart 28. Percentages of Dosage Units of Prescriptions Drugs Prescribed in Stimulants Tranquilizers Sedatives Narcotics Other 76.0 Table 2. Prescriptions, Dosage Units Schedule II Schedule III Schedule IV Stimulants 593, ,749 3,387,288 Tranquilizers ,193,424 Sedatives 1,241 75, ,350 Narcotics 158,810, ,289,789 40,969 Other ,795,305 Total 159,405, ,891,307 83,857,336 The Tables shows the total number of dosage units prescribed in Nevada in The total dosage units for all three Schedules was 356,154,498. The estimated population of Nevada in 2011 was 2,718,419. Thus, an average of 131 pills was prescribed for every citizen of Nevada, regardless of age. The volume of drugs that are in communities is a risk factor for abuse. 27

34 Risk Factors, Supply Prescriptions, Written Prescriptions Written for Schedule II, III and IV Medications by Percentage of Drug Type Chart 29. The pie chart shows that the majority of prescriptions listed in Schedules II, III, and IV were for narcotic pain drugs such as oxycodone and hydrocodone. Table 3. Schedule II Schedule III Schedule IV Stimulants 172,256 10,786 86,508 Tranquilizers ,968 Sedatives ,416 Narcotics 879, ,969 Other ,280 Total 1,051,049 12,067 1,355,141 28

35 Conclusion Conclusion Nationwide, the incidence of the abuse of prescription drugs has been increasing since the late 1990s. Many factors including the supply of prescription pain relievers and mental health issues such as anxiety and depression contribute to the abuse of prescription drugs. The Nevada Substance Abuse Prevention and Treatment Agency works with its coalitions to reduce the availability of these drugs in Nevada communities and provides treatment programs statewide for those needing help with substance abuse issues. 29