Prevalence of Prescription and Illicit Drugs in Pregnancy-Associated Non-natural Deaths of Florida Mothers, *

Size: px
Start display at page:

Download "Prevalence of Prescription and Illicit Drugs in Pregnancy-Associated Non-natural Deaths of Florida Mothers, 1999 2005*"

Transcription

1 PAPER J Forensic Sci, November 2013, Vol. 58, No. 6 doi: / Available online at: onlinelibrary.wiley.com PATHOLOGY/BIOLOGY; TOXICOLOGY Nancy Hardt, 1 M.D.; Tit D. Wong, 2 M.P.H.; Martha J. Burt, 3 M.D.; Ross Harrison, 4 B.S.; Will Winter, 5 M.P.H.; and Jeffrey Roth, 6 Ph.D. Prevalence of Prescription and Illicit Drugs in Pregnancy-Associated Non-natural Deaths of Florida Mothers, * ABSTRACT: Abuse of prescription and illicit drugs has been rapidly increasing. This study examines the prevalence of drug use in the nonnatural deaths of pregnant or recently pregnant women. Records from Florida s Pregnancy Associated Mortality Review conducted between 1999 and 2005 (n = 415) were linked to 385 toxicology reports obtained from Florida medical examiners offices. The final study sample consisted of 169 drug-positive, pregnancy-associated non-natural deaths. Of these, 86 were positive for both blood and urine, 64 were positive for blood only and five for urine only, and the remainder were positive for some other specimen. Among these deaths, 91 cases (54%) involved prescription drugs, 78 cases (46%) involved illicit drugs, and 69 cases (41%) involved alcohol. Opioids constituted the majority of deaths associated with prescription drugs. Substantial co-use of opioids and benzodiazepines was seen. Pregnant or recently pregnant women may have more interactions with healthcare providers, which may present more opportunities for intervention and prevention. KEYWORDS: forensic science, pregnant women, substance abuse, opioid, prescription drugs/poisoning, overdose/mortality With the exception of alcohol and marijuana, prescription drugs are now the most commonly abused psychotropic agents in the United States (1). Opioid painkillers have been identified as a major driver of the observed increase in prescription drugrelated mortality (2 9). In one study, opioids were encountered in 93.2% of pharmaceutical drug overdose fatalities (4). In at least one state, the majority of drug overdose-related deaths were attributable to the abuse of prescription opioids (10). Unlike the illicit drug epidemics of the 1970s that were seen as concentrated in urban centers, the rate of increase in drug poisoning mortality in rural areas is three times greater than what has been observed in metropolitan areas (5). Prescription drug abuse also has significant associated morbidity that has also seen a sharp increase recently (11). Between 2004 and 2009, the number of 1 Departments of Pathology and Obstetrics/Gynecology, University of Florida, Box , Gainesville, FL Infectious Disease Epidemiology Program, Division of Surveillance and Disease Control, West Virginia Bureau for Public Health, 350 Capitol Street, Room 125, Charleston, WV Department of Pathology, University of Florida, Box , Gainesville, FL College of Medicine, University of Florida, Box 10081, Gainesville, FL Department of Pediatrics, Shands Teaching Hospital, University of Florida, Box , Gainesville, FL Department of Pediatrics, University of Florida, Box , Gainesville, FL *Presented in part at the 17th Annual Maternal and Child Health Epidemiology Conference, December 14 16, 2011, in New Orleans, LA; and the 35th Annual Conference of the Association for Medical Education and Research in Substance Abuse, November 3 5, 2011, in Arlington, VA. Received 4 Dec. 2011; and in revised form 19 July 2012; accepted 25 Aug emergency department visits related to misuse or abuse of prescription drugs surpassed the number of visits related to illicit drug use, with the largest increases in drug abuse or misuse coming from opioids and anxiolytics (12). Overdose deaths have important public health implications: for every one overdose death, there are nine abuse treatment admissions, 35 emergency room visits for misuse or abuse, 161 people with abuse/dependence, and 461 nonmedical users (13). A pattern of multiple drug abuse has been noted among prescription drug abusers, with opioid abusers being more likely to abuse other medications such as benzodiazepines (4,6). In Florida, similar trends are being observed (14 16). From 2003 to 2009, the annual number of deaths in Florida involving lethal drug concentrations increased 61.0%, while the death rate increased from 10.6 to 15.7 per 100,000 individuals a 47.5% increase (14). This observed trend is almost entirely attributable to prescription drugs. During the same period, the prescription drug overdose death rate increased by 84.2%, while the illicit drug over dose death rate decreased by 21.4% (14). Other studies from Florida support this shift from illicit to prescription drugs as a significant source of mortality (15). By 2009, the deaths involving prescription drugs were four times as common as deaths involving illicit drugs such as heroin and cocaine (14) (See Fig. 1). Inappropriate prescribing practices at pain clinics commonly referred to as pill mills are contributing to the prescription drug abuse epidemic in Florida (15 22). The increases observed in the overdose death rates of the commonly abused opioid oxycodone and the benzodiazepine alprazolam 264.6% and 233.8% between 2003 and 2009, respectively seem to indicate that pill mills are a contributing factor to the situation in Florida (14). Until recently, the state lacked both a prescription drug American Academy of Forensic Sciences

2 HARDT ET AL.. DRUGS IN PREGNANCY-ASSOCIATED UNNATURAL DEATHS 1537 FIG. 1 Annual drug overdose death rates for selected prescription and illicit drugs - Florida, Source: Centers for Disease Control and Prevention (CDC) (14). monitoring program and legislation against inappropriate prescribing practices (22,23). According to data supplied to Florida s Department of Children and Families by Florida s Agency for Health Care Administration, there has been more than a 500% increase in newborns treated for drug withdrawal between 2005 and 2010 that has been anecdotally attributed to maternal use of prescription drugs (24,25) (See Fig. 2). Given the rise in prescription drug abuse and infants requiring treatment for drug withdrawal, there is reason to believe that Florida s pregnant women are abusing prescription drugs. The purpose of this study was to examine the role of prescription drug abuse in the non-natural deaths of Florida s pregnant or recently pregnant women. While there has been substantial investigation into the relationship between substance abuse and pregnancy outcome, there is limited research into how drug abuse, especially prescription drug abuse, may be related to pregnancy-associated non-natural death. Methods Case Identification and Inclusion Criteria Florida s Department of Health has conducted a Pregnancy- Associated Mortality Review (PAMR) since 1996 (26). Pregnancy-associated death is defined by PAMR as a woman s death from any cause, while she is pregnant or within 1 year of termination of the pregnancy, regardless of duration, outcome, and site of the pregnancy. of pregnancy-associated death were identified by linking maternal death certificates, Healthy Start Prenatal Risk screenings, birth certificates, and fetal death records by Florida Department of Health (DOH), Bureau of Vital Statistics. The PAMR team provided researchers at the University of Florida with a dataset of all pregnancy-associated deaths between 1999 and 2005 where the manner of death was anything but natural (homicide, suicide, accident or undetermined, herein referred to as non-natural ). Medical examiners reports, including toxicology, autopsy, and case history information, were obtained through requests to district medical examiner. Each case of a pregnancy-associated death was matched to a medical examiner s report and then entered into Microsoft Office Access 2007 database. Complete information on all variables of interest was available for 415 pregnancy-associated non-natural deaths between 1999 and Three cases were identified as natural deaths and removed from the dataset. where a toxicology report was unavailable were also removed from the cohort (n = 27). that had a negative toxicology report (n = 167) were also removed. Positive toxicology reports that contained only caffeine, carbon monoxide/carboxyhemoglobin, or atropine/lidocaine were also excluded (n = 31). Positive toxicology for carbon monoxide or carboxyhemoglobin is not considered indicative of drug abuse, but rather is commonly associated with fire-related accidents. Caffeine is ubiquitous throughout our culture and was not considered a drug that generally poses serious harm to health. Atropine/lidocaine is used in resuscitation and usually administered as part of a resuscitation protocol. These deletions reduced the dataset to 187 cases of a pregnancy-associated death with a positive toxicology report. Eighteen additional exclusions were made for toxicology reports indicating the presence of only over-the-counter medications, including nicotine, acetaminophen, salicylates (aspirin), and diphenhydramine (antihistamine). Two cases with negative toxicology were included because they were delayed deaths from acetaminophen toxicity. The final cohort consisted of 169 drugpositive, pregnancy-associated non-natural deaths. The construction of the study sample is summarized in Fig. 3. Case History Review For cases that matched the inclusion criteria for our cohort, the following information was extracted from medical examiners reports: age, race, cause of death, manner of death, and drugs found in toxicology analyses. Information was unavailable on the socioeconomic status of the women. Similarly, in cases of positive toxicology involving prescription drugs, the source of the drugs was not indicated. FIG. 2 of neonatal withdrawal syndrome in Florida, Source: Florida Agency for Health Care Administration and Florida Department of Children and Families. Toxicologic Testing The postmortem toxicology data collected for this study were obtained from the toxicology reports submitted by the individual medical examiner offices and included quantitative drug data for

3 1538 JOURNAL OF FORENSIC SCIENCES blood, vitreous humor, and/or urine. Because this study s aim was evaluating the prevalence of use (and not dose/concentration), a case was considered positive for a drug/toxin if it was detected in any body fluid sample, whether or not it was quantified. Toxicology reports with presumptively positive (nonconfirmed) results were not included. The toxicology data were collected from the reports generated by a number of different laboratories. The state of Florida is divided into 23 Medical Examiner Districts; each has its own policies and procedures regarding how toxicology testing is performed, but in general, most offices utilize an accredited toxicology laboratory, such as UF and Wuestaff, and others utilize local or regional hospital laboratories for screening, with confirmation and quantification performed selectively at a specialized laboratory. Several large medical examiner districts have their own, in-house accredited laboratories, such as Miami-Dade County. The methodologies used were also varied and included gas chromatography, gas chromatography mass spectrometry, high-performance liquid chromatography, thin-layer chromatography, ELISA, and immunoassays. For these reasons, the toxicology data are heterogeneous in the manner in which they were reported and included confirmed positive, presumptive positive, and quantified drugs. Because we are interested in exposure of this population to drugs, both illicit and prescription, we chose to include cases with both quantified and nonquantified, but confirmed positive results. For the purposes of this paper, this is the definition of a positive toxicology report. Of the 169 cases included in this study, 86 had both blood and urine positive for drug(s), 64 had 415 Pregnancy Associated Mortality Review (PAMR) Records PAMR records Linkage of PAMR records to Medical Examiner (ME) Reports 385 Linked PAMR+ME Reports 3 Natural deaths removed 27 No toxicology report 167 Negative toxicology report only blood positive for drug(s), and five had only urine positive for drug(s). The remainder (14) had some other specimen positive for drug(s), such as vitreous humor, gastric contents, bile, brain, liver, or decomposition fluid. Classification of Drugs Drugs encountered in this study were broadly classified as either prescription or illicit. Prescription drugs were subcategorized as opioids (morphine, hydrocodone, methadone, hydromorphone, oxycodone, propoxyphene, fentanyl, tramadol, and codeine), benzodiazepines (oxazepam, nordiazepam, temazepam, alprazolam, diazepam, midazolam, benzodiazepine, and clonazepam), and antidepressants (sertraline, venlafaxine, nortriptyline, citalopram, amitriptyline, doxepin, wellbutrin, and fluoxetine). A general other category was also used to group lessfrequently encountered prescription drugs in the toxicology reports (gabapentin, promethazine, barbiturate, butalbital, olanzapine, phenytoin, benzonatate, cyclobenzaprine, cimetidine, and anxiolytic not otherwise specified). Morphine is difficult to categorize as prescription or illicit, given that morphine is the major metabolite of heroin. Without either substantial investigative information indicating heroin use, or the detection of heroin and/or 6-monoacetylmorphine in postmortem samples, the source of the morphine cannot be definitively ascertained. For the purposes of this study, we chose to place those positive for morphine without heroin or heroin metabolites in the prescription drug category because of the far greater accessibility to prescription opioids and the relatively low availability of heroin. Results Table 1 lists the major groups of causes of death for the 169 decedents included in this study. These were grouped into categories based on mechanism of death, such as drug toxicity, motor vehicle crash, and sharp force injury. The largest groups of causes of deaths were drug toxicity (both single and mixed) and motor vehicle crashes, each accounting for approximately one-third of the deaths. Gunshot wounds were listed as the cause of death in 24 of the 169 deaths, or 14%. The remainder of the causes of death each accounted for <10%. Table 2 indicates that at least one prescription drug was found in 91 of the 169 cases (54%) of drug-positive, pregnancy-associated non-natural deaths; 78 cases (46%) were positive for at least one illicit drug, and alcohol, whether detected alone or in combination with other substances, was detected in 69 cases (41%). 218 Linked PAMR+ME Reports 187 Linked PAMR+ME Reports 169 Final study sample 31 Positive toxicology report for caffeine, carbon monoxide, or atropine 18 OTC drug findings FIG. 3 Construction of final study sample: 169 pregnant or recently pregnant women who died and who had a positive toxicology report. TABLE 1 Causes of death as reported by the medical examiner on the death certificate. Cause of Death Number % Drug toxicity Single drug toxicity Mixed drug toxicity Motor vehicle crash Gunshot Blunt trauma NOS Hanging Strangulation/asphyxia Sharp force injury Other* Total *Other: Homicide NOS (2), carbon monoxide (1), drowning (1).

4 HARDT ET AL.. DRUGS IN PREGNANCY-ASSOCIATED UNNATURAL DEATHS 1539 TABLE 2 Incidence of prescription and illicit drugs, plus alcohol detected and frequency co-detected with other substances in pregnant and recently pregnant women who died, Florida, (N = 169). Substance(s) Detected Positive Toxicology Reports Percentage Among Pregnant and Recently Pregnant Women Who Died Prescription drugs, +/ other Prescription drugs, alone Prescription drugs and illicit drugs Prescription drugs and alcohol 14 8 Prescription drugs, alcohol, 12 7 and illicit drugs Illicit drugs, +/ other Illicit drugs, alone Illicit drugs and prescription drugs Illicit drugs and alcohol 11 6 Illicit drugs, alcohol, and 12 7 prescription drugs Alcohol, +/ other Alcohol Alcohol and illicit drugs 11 6 Alcohol and prescription drugs 14 8 Alcohol and illicit drugs 12 7 Table 3 indicates that prescription opioids were detected alone or in conjunction with other drugs in 50 cases (30% of toxicologypositive cases). Table 4 indicates that benzodiazepines were the second most frequently detected class of prescription drug with 42 cases (25%) positive for benzodiazepines alone or in conjunction with other drugs. Evidence of co-use/co-abuse with other drugs was detected. Twenty cases (12%) were positive for both opioids and benzodiazepines. Of cases involving benzodiazepines, 18 were also positive for illicit drugs. Table 5 lists the type and frequency of illicit drugs detected with/without involvement of other drug types. Illicit drugs were involved in 69 (41%) of the 169 cases of pregnancy-associated non-natural deaths. Table 6 indicates that 32 of the 55 toxicology-positive decedents (58%) were pregnant at the time of their death. Toxicology reports indicated that 11 of the 32 decedents (34%) had prescription drugs in their systems at the time of their death. Sixteen cases (50%) showed evidence of illicit drug use, and twelve cases (32%) evidence of alcohol use. Because there are numerous challenges in determining intent in cases of overdose, accidental and suicidal overdoses were considered together. Table 7 indicates that 47 of the 169 deaths (28%) were identified as due to the direct toxic affect of drugs. Of these, single or multiple prescription drugs were attributed as the cause of overdose in 33 cases (70%). In six additional cases, involvement of illicit drug use was also detected. Single or multiple illicit drugs alone accounted for 18 cases of overdose (38%). Two other cases of overdose were detected; one overdose was attributed to alcohol toxicity. The other cause of overdose was determined to be acetaminophen toxicity, although opioids were also detected. Table 8 indicates that alcohol was the drug most commonly found in the toxicology reports of pregnant or recently pregnant women who died from non-natural manners (69 of 169 cases or 41%). Approximately two-thirds of those involved the admixture of alcohol with prescription drugs and one-third with illicit drugs. Discussion Our study represents the first investigation exploring the relationship between prescription and illicit drug use and, TABLE 3 Frequency of cases involving prescription opioids with/without involvement of other drug types. Prescription Opioids Detected, with/without Other Substances Percentage of Opioids, without other drugs Opioids, with benzodiazepines* Opioids, with antidepressants* Opioids, with >1 other type of drug 8 16 Opioids, with illicit drugs* Opioids, total cases involving *With/without involvement of other prescription drugs. TABLE 4 Frequency of cases involving benzodiazepines with/without involvement of other drug types. Benzodiazepines Detected, with/without Other Substances Percentage of Benzodiazepines, without other drugs Benzodiazepines, with opioids* Benzodiazepines, with antidepressants* 7 17 Benzodiazepines, with >1 other type of drug 7 17 Benzodiazepines, with illicit drugs* Benzodiazepines, total cases involving *With/without involvement of other prescription drugs. TABLE 5 Type and frequency of illicit drugs detected with/without involvement of other drug types. Illicit Drugs Detected* Percentage of Cocaine Cannabis Methamphetamine/amphetamine 4 6 Heroin 4 6 Phencyclidine 1 1 c-hydroxybutyric acid 1 1 Illicit drugs, with alcohol Illicit drugs, with prescription drugs Illicit drugs, total cases *Single case may be positive for >1 drug/group of drugs. TABLE 6 Substances detected in women who were pregnant at the time of their death (N = 32). Substance(s) Detected in Pregnant Decedents * Percentage of Prescription drugs Opioids 4 13 Benzodiazepine 2 6 Antidepressants 4 13 Other 4 13 Illicit drugs Cocaine 8 25 Cannabis 8 25 c-hydroxybutyric acid 1 3 Alcohol Total pregnant decedents *Single case may be positive for >1 drug/group of drugs. pregnancy-associated non-natural death, keeping in mind that pregnancy-associated death indicates a death in a woman who was pregnant or recently pregnant at the time of her death. Also important to note is that just because a drug is categorized in the

5 1540 JOURNAL OF FORENSIC SCIENCES TABLE 7 of pregnancy-associated accidental and intentional overdose (N = 47). Drug Type Attributed to Overdose Percentage of Prescription drugs Single prescription drug class Multiple, with other classes of prescription drugs Multiple, with illicit drugs 6 13 Single or multiple illicit drugs* Other 2 4 Total Overdoses use. *Includes cases where toxicology report also indicated prescription drug TABLE 8 Frequency of cases involving alcohol with/without involvement of other drug types. Alcohol Detected, with/without Other Substances Percentage of Alcohol, without other drugs Alcohol, with opioids* Alcohol, with benzodiazepines* Alcohol, with antidepressants* 8 12 Alcohol, with other prescription drugs* 4 6 Alcohol, with >1 type of prescription drugs 9 13 Alcohol, with illicit drugs* Alcohol, total cases involving *With/without involvement of other prescription drugs. prescription drug group does not mean it was prescribed to the decedent. Prescription drugs were detected in a majority (91 of 169 or 54%) of toxicology-positive cases of pregnancy-associated nonnatural death from Florida between 1999 and Opioids and benzodiazepines were the most frequently encountered prescription drug classes: 50 total cases were positive for opioids, and 42 total cases were positive for benzodiazepines. In cases of drug-positive overdose, without regard to overdose intent, prescription drugs were the most common drugs encountered. Substantial co-use of opioids and benzodiazepines was seen. Sixteen cases were positive for both benzodiazepines and opioids. There are several significant limitations in the ascertainment of prescription and illicit drug abuse during and in the year after pregnancy. Most notably, this study investigated a very narrowly defined population: cases of pregnancy-associated non-natural death with positive postmortem toxicology or investigative information directly linking the death to a specific drug or toxin. This study is not able to capture those individuals whose bodies may have completely metabolized any recently ingested drugs, nor able to identify occasional or binge use of drugs and medications. It is possible that some of those cases positive for morphine (without detectable heroin and/or 6-MAM) were from exposure to heroin rather than a prescription opioid. However, given the historically low use of heroin throughout the general population and the easy access to prescription forms, we chose to group morphine-positive cases with prescription opioids. Even if we took the opposite approach and assumed that ALL morphine detected in our population sample originated from heroin, a staggering number of cases positive for some other opioid remain. This method of categorizing heroin and morphine deaths is similar to that of the Florida Medical Examiner Commission in their annual drug surveillance reports (\www.fameonline.org) such that our data can be directly compared and correlated with statewide medical examiner data. The statewide data reported by medical examiners show that within the group of all opioids, heroin and morphine together make up a small fraction of opioid-positive deaths, both in this study and across the state of Florida: in 2005, 369 of 1747 opioid-positive deaths, or 21% of opioid-positive deaths, were positive for heroin or morphine combined, as compared to 1378 of 1747 opioid-positive deaths, or 79% that were positive for any other opioid drug. For 2010, the numbers are even more staggering: 699 of 6358 opioid-positive deaths (11%) were positive for heroin or morphine, compared with 5659 of 6358 deaths (89%) that were positive for an opioid other than morphine or heroin. This represents a more than 300% increase in prescription drug exposure in the entire, statewide medical examiner population. The data in our study sample of pregnant and recently pregnant women are similar to that reported by the Florida Medical Examiner Commission: of the 50 cases that were positive for any opioid, only 8 deaths, or 14%, were positive for morphine without any other prescription opioid. Thus, even if we assumed all the morphine detected in these decedents came from heroin, it would not change the bottom line prescription opioid use and abuse is epidemic in our population. The prevalence of opioid exposure in our study population of non-natural deaths in mothers is similar to that in the general medical examiner population. In this comparison of two groups suffering non-natural deaths during the same time frame, roughly 12% were opioid positive. Of note, in 2010, the proportion of opioid-positive non-natural deaths in Florida was 44.5%. This is consistent with the observed overall increase in use and misuse of opioids. Based both on this data and on the rising incidence of neonatal abstinence syndrome, we infer that women are continuing to use opioids during pregnancy. Further study of the more recent time period may be of interest. The Centers for Disease Control recently reported that the number of deaths related to prescription opioids rose nearly fourfold between 1999 and 2008 (27). Comparison studies in states with prescription drug control legislation would be useful to evaluate the efficacy of prescription drug monitoring programs and establish best practices. Other limitations of this study include sparseness of socioeconomic data. Most of the women in the study population were White; however, their socioeconomic status was not reported. Ethnic or socioeconomic difference in drug use may limit the applicability of these data to non-white women, even those who are or recently were pregnant. Limited data prevented the ascertainment of the source of prescription drugs detected. There was no way of determining the extent of prescription drug diversion from Florida s pain clinics in the study population. Some medical examiners reporting on cases of homicide during the study period were not made available to the investigators because they are currently under criminal investigation and access to these files was very limited. One factor worth emphasizing is that this study population is quite unique in that it is composed of relatively young women (of reproductive age), and because they were pregnant or recently pregnant at the time of their death, they would have been expected to have more interactions with healthcare providers and more opportunities for intervention and prevention of high-risk behaviors. However, as shown in this study, they have very similar exposures to both prescription and illicit drugs and are dying from their toxic effects. These cases may represent missed opportunities for counseling and prevention. Another possibility is that women who die of trauma are frequently

6 HARDT ET AL.. DRUGS IN PREGNANCY-ASSOCIATED UNNATURAL DEATHS 1541 women who engage in high-risk behaviors including drug use and unprotected sex resulting in pregnancy. Despite these caveats, this study does provide an important snapshot of the trends in drug use and misuse in a unique population, that is, women who were pregnant or recently pregnant at the time of their death. Acknowledgments The authors thank Rajeeb Das, M.S.P.H., at the UF Family Data Center and P.V. Rao, Ph.D., for their assistance with the study s data collection and analysis. References 1. Office of Applied Studies. Results from the 2007 national survey on drug use and health: national findings (NSDUH Series H-34, DHHS Publication No. SMA ). Rockville, MD: Substance Abuse and Mental Health Services Administration, Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf 2006;15(9): Compton WM, Volkow ND. Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend 2006;81(2): Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 2008;300(22): Paulozzi LJ, Xi Y. Recent changes in drug poisoning mortality in the United States by urban-rural status and by drug type. Pharmacoepidemiol Drug Saf 2008;17(10): Green TC, Grau LE, Carver HW, Kinzly M, Heimer R. Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: Drug Alcohol Depend 2011;115(3): Rintoul AC, Dobbin MD, Drummer OH, Ozanne-Smith J. Increasing deaths involving oxycodone, Victoria, Australia, Inj Prev 2011;17(4): Centers for Disease Control Prevention (CDC). Overdose deaths involving prescription opioids among Medicaid enrollees Washington MMWR 2009;58(42): Paulozzi LJ, Logan JE, Hall AJ, McKinstry E, Kaplan JA, Crosby AE. A comparison of drug overdose deaths involving methadone and other opioid analgesics in West Virginia. Addiction 2009;104(9): Hernandez SH, Nelson LS. Prescription drug abuse: insight into the epidemic. Clin Pharmacol Ther 2010;88(3): Centers for Disease Control and Prevention (CDC). Emergency department visits involving nonmedical use of selected prescription drugs - United States, MMWR 2010;59(23): Office of Applied Studies. Drug abuse warning network, 2009: national estimates of drug-related emergency department visits. HHS Publication No. (SMA) , DAWN Series D-35. Rockville, MD: Substance Abuse and Mental Health Services Administration, Baldwin G, Paulozzi L, Franklin G, Kerlikowske G. Prescription drug overdoses: an American epidemic. Public Health Grand Rounds, Office of the Director, Centers for Disease Control and Prevention February 17, 2011; \http://www.cdc.gov/about/grand-rounds/archives/2011/01-february.htm 14. Centers for Disease Control Prevention (CDC). Drug overdose deaths Florida, MMWR 2011;60(26): Graham NA, Merlo LJ, Goldberger BA, Gold MS. Methadone- and heroin-related deaths in Florida. Am J Drug Alcohol Abuse 2008;34 (3): Rigg KK, March SJ, Inciardi JA. Prescription drug abuse & diversion: role of the pain clinic. J Drug Issues 2010;40(3): Manchikanti L. Prescription drug abuse: what is being done to address this new drug epidemic? Testimony before the Subcommittee on Criminal Justice, Drug Policy and Human Resources. Pain Physician 2006;9 (4): LaMendola B. Profiting from pain: Clinics face scrutiny. South Florida Sun-Sentinel 2009 April 7; \http://articles.sun-sentinel.com/ / news/ _1_pill-trade-pain-drugs-clinics (accessed July 19, 2012). 19. Santana S. Broward leads state in Rx pill overdose deaths. South Florida Sun Sentinel 2009, November 24; \http://www.sun-sentinel.com/news/ palm-beach/fl-florida-drug-overdoses ,0, story (accessed July 19, 2012). 20. Hiaasen S. Sunny Isles doctor sentenced in pill-mill case. Miami Herald 2012 February 2; \http://www.miamiherald.com/2012/02/03/ / sunny-isles-doctor-sentenced-in.html#storylink=cpy (accessed July 19, 2012). 21. LaMendola B. How the George brothers made millions with pill mills. South Florida Sun-Sentinel 2011 August 25; \http://www.sun-sentinel. com/health/fl-hk-george-pill-mill ,0, story?page=1 (accessed July 19, 2012). 22. LaMendola B. Governor signs law to rein in pain clinics. New database aims to curb pill shopping. South Florida Sun-Sentinel 2009 June 19; \http://articles.sun-sentinel.com/ /news/ _1_pill-clinics-database 23. LaMendola B. Florida pain-pill database launches finally. South Florida Sun Sentinel 2011 October 17; \http://www.sun-sentinel.com/health/ fl-pain-clinic-database ,0, story. (accessed July 19, 2012). 24. Pavuk A, Alanez T. Florida newborns treated for drug withdrawal skyrocketing. South Florida Sun-Sentinel 2011 February 12; \http://articles.sun-sentinel.com/ /health/fl-prescription-drugs-bornaddicted _1_newborns-prescription-drug-winnie-palmer-hospital 25. Florida Department of Children and Families. Florida trends in drug withdrawal syndrome in newborns by county and DCF region, [Data source: Inpatient hospital discharge data, , Florida Agency for Health Care Administration]. Tallahassee, FL: Substance Abuse and Mental Health Program Office, \http://www.dcf.state.fl. us/programs/ samh/substanceabuse/docs/countynewbornwithdrawaldiagnoses2010.pdf 26. Hernandez L, Sappenfield W, Burch D Florida pregnancyrelated mortality report: why are Florida mothers continuing to die? Tallahassee, FL: Florida Department of Health, Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers United States, MMWR 2011;60(43): Additional information and reprint requests: Nancy Hardt, M.D. Professor, Pathology and Obstetrics/Gynecology College of Medicine University of Florida PO Box Gainesville, FL

Prescription Drug Abuse and Overdose: Public Health Perspective

Prescription Drug Abuse and Overdose: Public Health Perspective Prescription Drug Abuse and Overdose: Public Health Perspective [Residency educators may use the following slides for their own teaching purposes.] CDC s Primary Care and Public Health Initiative October

More information

Populations at risk for opioid overdose

Populations at risk for opioid overdose Populations at risk for opioid overdose Len Paulozzi, MD, MPH Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention April

More information

Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2014

Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2014 Maryland Department of Health and Mental Hygiene Larry Hogan, Governor Boyd Rutherford, Lt. Governor Van Mitchell, Secretary May, 215 Drug- and Alcohol-Related Intoxication Deaths in Maryland, 214 Table

More information

Part 1: Opioids and Overdose in the U.S. and New Mexico. Training: New Mexico Pharmacist Prescriptive Authority for Naloxone Protocol 7/15/2015

Part 1: Opioids and Overdose in the U.S. and New Mexico. Training: New Mexico Pharmacist Prescriptive Authority for Naloxone Protocol 7/15/2015 Training: New Mexico Pharmacist Prescriptive Authority for Naloxone Protocol New Mexico Pharmacists Association & Project ECHO 2014 This training fulfills the educational requirement for pharmacists in

More information

PRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE

PRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE PRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE May 19, 2012 National Association Boards of Pharmacy Annual Meeting Gil Kerlikowske, Director White House Office of National Drug Control Policy ONDCP

More information

PRESCRIPTION PAINKILLER OVERDOSES

PRESCRIPTION PAINKILLER OVERDOSES IMPACT{ POLICY PRESCRIPTION PAINKILLER OVERDOSES National Center for Injury Prevention and Control Division of Unintentional Injury Prevention What s the Issue? In a period of nine months, a tiny Kentucky

More information

Presentation to Senate Health and Human Services Committee: Prescription Drug Abuse in Texas

Presentation to Senate Health and Human Services Committee: Prescription Drug Abuse in Texas Presentation to Senate Health and Human Services Committee: Prescription Drug Abuse in Texas David Lakey, MD Commissioner, Department of State Health Services Lauren Lacefield Lewis Assistant Commissioner,

More information

Drug Testing to Support Pain Management

Drug Testing to Support Pain Management NATIONAL REFERENCE LABORATORY Drug Testing to Support Pain Management 500 Chipeta Way, Salt Lake City, UT 84108 (800) 522-2787 (801) 583-2787 www.aruplab.com www.arupconsult.com ARUP is an enterprise of

More information

DUI in Southern Ohio MATT 2006

DUI in Southern Ohio MATT 2006 DUI in Southern Ohio MATT 2006 Laureen J. Marinetti, M.S., Ph.D. Chief Toxicologist Montgomery County Coroner s s Office & Miami Valley Regional Crime Lab (MVRCL) Dayton, Ohio Region The MVRCL is a regional

More information

Table of Contents. I. Introduction... 2. II. Summary... 3. A. Total Drug Intoxication Deaths... 5. B. Opioid-Related Deaths... 9

Table of Contents. I. Introduction... 2. II. Summary... 3. A. Total Drug Intoxication Deaths... 5. B. Opioid-Related Deaths... 9 Table of Contents I. Introduction... 2 II. Summary... 3 III. Charts A. Total Drug Intoxication Deaths... 5 B. Opioid-Related Deaths... 9 C. Heroin-Related Deaths... 11 D. Prescription Opioid-Related Deaths...

More information

Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER

Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER November 17, 2015 Today s Speakers Karmen Hanson, Program Manager, NCSL Cynthia Reilly, Director,

More information

Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008

Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008 PRESCRITPION DRUG ABUSE: AN EPIDEMIC What is Addiction? By: Lon R. Hays, M.D., M.B.A. Professor and Chairman Department of Psychiatry University of Kentucky Healthcare Addiction is a primary, chronic disease

More information

2013 Annual Toxicology Report

2013 Annual Toxicology Report 213 Annual Toxicology Report Department of Justice Forensic Science Division Toxicology Department 2679 Palmer Street Missoula, MT 5988 DOJTOX@mt.gov Personnel Phil Kinsey Scott Larson Scott Schlueter

More information

Introduction to Neonatal Abstinence Syndrome

Introduction to Neonatal Abstinence Syndrome Introduction to Neonatal Abstinence Syndrome Cara Christ, MD Director, Arizona Department of Health Services Learning Objectives 1.Define Neonatal Abstinence Syndrome 2.Describe Neonatal Abstinence Syndrome

More information

Trends of Nonmedical Prescription Drug Misuse in Miami-Dade, Broward, Palm Beach Counties, and the State of Florida: 2010

Trends of Nonmedical Prescription Drug Misuse in Miami-Dade, Broward, Palm Beach Counties, and the State of Florida: 2010 Miami-Dade, Broward and Palm Beach Counties, Florida Trends of Nonmedical Prescription Drug Misuse in Miami-Dade, Broward, Palm Beach Counties, and the State of Florida: 2010 James N. Hall 1 ABSTRACT The

More information

Federal Response to Opioid Abuse Epidemic

Federal Response to Opioid Abuse Epidemic Healthcare Committee Federal Response to Opioid Abuse Epidemic On May 1, 20215 the Energy and Commerce Subcommittee on Oversight and Investigations held a hearing entitled What is the Federal Government

More information

EMERGENCY DEPARTMENT VISITS INVOLVING NARCOTIC PAIN RELIEVERS

EMERGENCY DEPARTMENT VISITS INVOLVING NARCOTIC PAIN RELIEVERS Relievers Pain Narcotic Involving Visits Department Emergency Drug Abuse Warning Network Short Report November 05, 2015 EMERGENCY DEPARTMENT VISITS INVOLVING NARCOTIC PAIN RELIEVERS AUTHORS Elizabeth H.

More information

Flagship Priority: Mental Health and Substance Abuse

Flagship Priority: Mental Health and Substance Abuse 10 Colorado s winnable battles Flagship Priority: Mental Health and Substance Abuse ELEVATING HEALTH AND ENVIRONMENT Mental and emotional well-being is essential to shaping a state of health for Coloradans.

More information

Substance Abuse During Pregnancy: Moms on Meds. Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates

Substance Abuse During Pregnancy: Moms on Meds. Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates Substance Abuse During Pregnancy: Moms on Meds Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates 2010 National Survey on Drug Use and Health An estimated 4.4% of pregnant women reported

More information

9. Substance Abuse. pg 166-169: Self-reported alcohol consumption. pg 170-171: Childhood experience of living with someone who used drugs

9. Substance Abuse. pg 166-169: Self-reported alcohol consumption. pg 170-171: Childhood experience of living with someone who used drugs 9. pg 166-169: Self-reported alcohol consumption pg 170-171: Childhood experience of living with someone who used drugs pg 172-173: Hospitalizations related to alcohol and substance abuse pg 174-179: Accidental

More information

Prescription Opioid Overdose & Misuse in Oregon

Prescription Opioid Overdose & Misuse in Oregon Prescription Opioid Overdose & Misuse in Oregon Mel Kohn, MD MPH Public Health Director and State Public Health Officer Oregon Health Authority Oregon In-State Policy Workshop NGA Policy Academy: Reducing

More information

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths Joanna G Katzman, M.D., M.S.P.H Director, UNM Pain Center Associate Professor,

More information

A Review of the Impacts of Opiate Use in Ontario: Summary Report

A Review of the Impacts of Opiate Use in Ontario: Summary Report A Review of the Impacts of Opiate Use in Ontario: Summary Report A Provincial Summary Report of the Impacts of the Discontinuation of Oxycontin in Ontario: January to August 2013 December 2013 This report

More information

Trends of Opioid Misuse and Diversion: Lessons from the United States

Trends of Opioid Misuse and Diversion: Lessons from the United States Trends of Opioid Misuse and Diversion: Lessons from the United States 31 October 2012 Richard C. Dart, MD, PhD Director Rocky Mountain Poison and Drug Center Professor - University of Colorado, Department

More information

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome Neonatal Abstinence Syndrome Effective Prevention Strategies Division of Prevention and Health Promotion Injury Prevention Program Objectives Characterize PDA as a public health problem Detail the impact

More information

This is the written version of our Hot Topic video presentation available at: MayoMedicalLaboratories.com/hot-topics

This is the written version of our Hot Topic video presentation available at: MayoMedicalLaboratories.com/hot-topics This is the written version of our Hot Topic video presentation available at: MayoMedicalLaboratories.com/hot-topics Welcome to Mayo Medical Laboratories Hot Topics. These presentations provide short discussion

More information

Patterns of Heroin and Other Substance Use in Youth and Young Adults in Suburban Cook County

Patterns of Heroin and Other Substance Use in Youth and Young Adults in Suburban Cook County Patterns of Heroin and Other Substance Use in Youth and Young Adults in Suburban Cook County 2014 School Nurse Conference Steven M. Seweryn, EdD, MPH April 24, 2014 Learning Objectives To become familiar

More information

Opioid/Opiate Dependent Pregnant Women

Opioid/Opiate Dependent Pregnant Women Opioid/Opiate Dependent Pregnant Women The epidemic, safety, stigma, and how to help. Presented by Lisa Ramirez MA,LCDC & Kerby Stewart MD The prescription painkiller epidemic is killing more women than

More information

Drugged Driving. What is Drugged Driving? How Many People Take Drugs and Drive?

Drugged Driving. What is Drugged Driving? How Many People Take Drugs and Drive? Drugged Driving What is Drugged Driving? "Have one [drink] for the road" was, until recently, a commonly used phrase in American culture. It has only been within the past 20 years that as a Nation, we

More information

Toxicology CPT Code Changes for 2016

Toxicology CPT Code Changes for 2016 Beginning January 1, 2016, CMS deleted all 2015 drug testing G codes and will continue to not recognize the AMA CPT codes for drug testing. CMS created three G codes for presumptive testing and four G

More information

Massachusetts Substance Abuse Policy and Practices. Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District

Massachusetts Substance Abuse Policy and Practices. Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District Massachusetts Substance Abuse Policy and Practices Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District November 2014 Substance Abuse and Addiction National and State opioid abuse

More information

Testimony of. Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment

Testimony of. Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment Testimony of Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment New York City Department of Health and Mental Hygiene before the New York City

More information

Heroin in Snohomish County: Mortality and Treatment Trends

Heroin in Snohomish County: Mortality and Treatment Trends Heroin in Snohomish County: Mortality and Treatment Trends January 2015 This page left intentionally blank. Table of Contents Introduction and Acknowledgments 1 Executive Summary 2 Mortality Overdose Mortality

More information

Prescription Drugs: Impacts of Misuse and Accidental Overdose in Mississippi. Signe Shackelford, MPH Policy Analyst November 19, 2013

Prescription Drugs: Impacts of Misuse and Accidental Overdose in Mississippi. Signe Shackelford, MPH Policy Analyst November 19, 2013 Prescription Drugs: Impacts of Misuse and Accidental Overdose in Mississippi Signe Shackelford, MPH Policy Analyst November 19, 2013 Center for Mississippi Health Policy Independent, non-profit organization

More information

Treatment of Opioid Dependence: A Randomized Controlled Trial. Karen L. Sees, DO, Kevin L. Delucchi, PhD, Carmen Masson, PhD, Amy

Treatment of Opioid Dependence: A Randomized Controlled Trial. Karen L. Sees, DO, Kevin L. Delucchi, PhD, Carmen Masson, PhD, Amy Category: Heroin Title: Methadone Maintenance vs 180-Day psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Trial Authors: Karen L. Sees, DO, Kevin L. Delucchi,

More information

Maternal and Child Health Issue Brief

Maternal and Child Health Issue Brief Maternal and Child Health Issue Brief Substance Abuse among Women of Reproductive Age in Colorado September 14 9 Why is substance abuse an issue among women of reproductive age? Substance abuse poses significant

More information

Substance Abuse 2014-2015. Chapter 10: Substance Abuse

Substance Abuse 2014-2015. Chapter 10: Substance Abuse Substance Abuse 214-215 Chapter 1: Substance Abuse 265 214-215 Health of Boston Substance Abuse Substance abuse involves the excessive use of alcohol or illicit substances (e.g., marijuana, cocaine, heroin,

More information

Alcohol and Opiate Fatalities. Michael Bell, MD Chief Medical Examiner Palm Beach County Medical Examiner s Office

Alcohol and Opiate Fatalities. Michael Bell, MD Chief Medical Examiner Palm Beach County Medical Examiner s Office Alcohol and Opiate Fatalities Michael Bell, MD Chief Medical Examiner Palm Beach County Medical Examiner s Office Opiates Opiates-Heroin diacetylmorphine Opiates Opiates Drug-Related Death Overdose or

More information

Drug Overdose Deaths, Hospitalizations, Abuse & Dependency among Oregonians

Drug Overdose Deaths, Hospitalizations, Abuse & Dependency among Oregonians 214 Drug Overdose Deaths, Hospitalizations, Abuse & Dependency among Oregonians Oregon Health Authority Center for Prevention & Health Promotion, Injury & Violence Prevention Section 5/3/214 Drug Overdose

More information

Mental Health and Addiction

Mental Health and Addiction Mental Health and Addiction Ohio s community mental health and addiction services system includes both Medicaid and non Medicaid services coordinated through local boards of alcohol and drug addiction

More information

TRENDS IN HEROIN USE IN THE UNITED STATES: 2002 TO 2013

TRENDS IN HEROIN USE IN THE UNITED STATES: 2002 TO 2013 2013 to 2002 States: United the in Use Heroin in Trends National Survey on Drug Use and Health Short Report April 23, 2015 TRENDS IN HEROIN USE IN THE UNITED STATES: 2002 TO 2013 AUTHORS Rachel N. Lipari,

More information

Substance Use: Addressing Addiction and Emerging Issues

Substance Use: Addressing Addiction and Emerging Issues MODULE 6: SUBSTANCE USE: ADDRESSING ADDICTION AND EMERGING ISSUES Substance Use: Addressing Addiction and Emerging Issues Martha C. Romney, RN, MS, JD, MPH Assistant Professor Jefferson School of Population

More information

2013 OHIO DRUG OVERDOSE DATA: GENERAL FINDINGS 1

2013 OHIO DRUG OVERDOSE DATA: GENERAL FINDINGS 1 Number of Deaths Rate per 100,000 persons 2013 OHIO DRUG OVERDOSE DATA: GENERAL FINDINGS 1 Drug overdose deaths continue to be a public health crisis in Ohio with a 413 percent increase in the number of

More information

Macomb County Office of Substance Abuse MCOSA. Executive Summary

Macomb County Office of Substance Abuse MCOSA. Executive Summary Macomb County Office of Substance Abuse MCOSA Executive Summary This report marks the second data profile of alcohol and illicit drugs burden in Macomb County. The first report produced in 2007 detailed

More information

INFO Brief. Prescription Opioid Use: Pain Management and Drug Abuse In King County and Washington State

INFO Brief. Prescription Opioid Use: Pain Management and Drug Abuse In King County and Washington State ADAI-IB 23-3 INFO Brief Prescription Opioid Use: Pain Management and Drug Abuse In King County and Washington State O ctober 23 Caleb Banta-Green (Alcohol and Drug Abuse Institute, University of Washington),

More information

Harnessing National Data Sets to Measure Safety of Opioid Treatment: National Survey on Drug Use and Health (NSDUH) and VA Data

Harnessing National Data Sets to Measure Safety of Opioid Treatment: National Survey on Drug Use and Health (NSDUH) and VA Data Harnessing National Data Sets to Measure Safety of Opioid Treatment: National Survey on Drug Use and Health (NSDUH) and VA Data William C. Becker, MD Assistant Professor, General Internal Medicine VA Connecticut

More information

A Profile of Drug Overdose Deaths Using the Michigan Automated Prescription System (MAPS)

A Profile of Drug Overdose Deaths Using the Michigan Automated Prescription System (MAPS) A Profile of Drug Overdose Deaths Using the Michigan Automated Prescription System (MAPS) Behavioral Health and Developmental Disabilities Administration Office of Recovery Oriented Systems of Care A Profile

More information

The Cost of Prescription Drug Abuse: A Literature Review

The Cost of Prescription Drug Abuse: A Literature Review The Cost of Prescription Drug Abuse: A Literature Review Angela Baldasare, Ph.D. For ADAPTE International Of Strategic Applications International 1/6/2011 Introduction To gather information on the cost

More information

CDC s Prevention Efforts to Address Prescription Opioid Epidemic

CDC s Prevention Efforts to Address Prescription Opioid Epidemic CDC s Prevention Efforts to Address Prescription Opioid Epidemic Jan Losby, PhD, MSW Lead, Prescription Drug Overdose Health Systems and State Support Team Division of Unintentional Injury Prevention NASBO

More information

Magee-Womens Hospital

Magee-Womens Hospital Magee-Womens Hospital Magee Pregnancy Recovery Program: History Pregnancy Recovery Center A Medical Home Model Approach to Strengthen Families Bawn Maguire, MSN, RN Programmatic Nurse Specialist Stephanie

More information

Urine Drug Testing Methadone 101 Methadone for hospitalists

Urine Drug Testing Methadone 101 Methadone for hospitalists Urine Drug Testing Methadone 101 Methadone for hospitalists Dr. Patricia Mark MB, BCh LEARNING OBJECTIVES Clarify the purpose of urine drug testing Distinguish between UDT for detection of illicit drug

More information

DRUG AND ALCOHOL-ASSOCIATED INTOXICATION DEATHS BALTIMORE CITY

DRUG AND ALCOHOL-ASSOCIATED INTOXICATION DEATHS BALTIMORE CITY 2007-2012 DRUG AND ALCOHOL-ASSOCIATED INTOXICATION DEATHS BALTIMORE CITY Lead Authors: Aruna Chandran, Chief of Epidemiologic Services, Baltimore City Health Department Elizabeth Salisbury-Afshar, Medical

More information

Laboratory Insights into the New Drug Epidemic

Laboratory Insights into the New Drug Epidemic Health Trends Prescription Drug Misuse in America Laboratory Insights into the New Drug Epidemic Table of Contents Summary 2 Majority of Americans Misused Their Prescribed Medications 5 Anyone is at Risk

More information

Broward Barometer of Adult Drug Abuse Indicators Summer 2008

Broward Barometer of Adult Drug Abuse Indicators Summer 2008 Adult Summer 8 The chart below summarizes the severity and trends for indicators of drug use and abuse in Broward County, Florida. The Severity Index is based on the number of drug-related deaths, emergency

More information

Drugged Driving. What Is Drugged Driving?

Drugged Driving. What Is Drugged Driving? Drugged Driving What Is Drugged Driving? Have one [drink] for the road was once a commonly used phrase in American culture. It has only been within the past 25 years that as a Nation, we have begun to

More information

Drugged Driving. What Is Drugged Driving?

Drugged Driving. What Is Drugged Driving? Drugged Driving What Is Drugged Driving? Have one [drink] for the road was once a commonly used phrase in American culture. It has only been within the past 25 years that as a Nation, we have begun to

More information

Prescription for Danger

Prescription for Danger Prescription for Danger A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation s Teens OFFICE OF NATIONAL DRUG CONTROL POLICY EXECUTIVE OFFICE OF THE PRESIDENT

More information

Drug Abuse Patterns and Trends in the San Francisco Bay Area Update: June 2014

Drug Abuse Patterns and Trends in the San Francisco Bay Area Update: June 2014 Drug Abuse Patterns and Trends in the San Francisco Bay Area Update: June 24 Alice A. Gleghorn, Ph.D. ABSTRACT In San Francisco, increases in heroin consequence indicators (treatment admissions and Drug

More information

Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio

Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio Governor s Cabinet Opiate Action Team Promoting Wellness and Recovery John R. Kasich, Governor Tracy J. Plouck, Director Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio November 14,

More information

Testimony of The New York City Department of Health and Mental Hygiene. before the

Testimony of The New York City Department of Health and Mental Hygiene. before the Testimony of The New York City Department of Health and Mental Hygiene before the New York City State Assembly Committee on Alcoholism and Drug Abuse on Programs and Services for the Treatment of Opioid

More information

Medication Assisted Treatment

Medication Assisted Treatment Medication Assisted Treatment Tanya Hiser, MS, LPC State Opioid Treatment Authority Bureau Of Prevention, Treatment, & Recovery State of Wisconsin Elizabeth Collier, MSW, CSAC, ICS, LCSW TANF Best Practice

More information

Summary of Children s Safety Network Prescription and Over-the-Counter Drug Abuse Environmental Scan

Summary of Children s Safety Network Prescription and Over-the-Counter Drug Abuse Environmental Scan Summary of Children s Safety Network Prescription and Over-the-Counter Drug Abuse Environmental Scan Introduction Prescription and over-the-counter (OTC) drug abuse and its consequences are a fast growing

More information

Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery

Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery Marvin D. Seppala, MD Chief Medical Officer Hazelden Betty Ford Foundation This product is supported by

More information

Prescription Drug Monitoring Programs: A State Policy to Address Prescription Opioid Poisonings. Michael Kim, MPH April 30, 2012

Prescription Drug Monitoring Programs: A State Policy to Address Prescription Opioid Poisonings. Michael Kim, MPH April 30, 2012 Prescription Drug Monitoring Programs: A State Policy to Address Prescription Opioid Poisonings Michael Kim, MPH April 30, 2012 Overview 1. Prescription Opioid Abuse and Poisoning 2. Prescription Drug

More information

Opioids and the Injured Worker Tools for Successful Outcomes

Opioids and the Injured Worker Tools for Successful Outcomes Opioids and the Injured Worker Tools for Successful Outcomes Tim Pokorney, RPh Director, Clinical Express Scripts Workers' Compensation Division Goals and Objectives Alarming statistics for narcotic utilization,

More information

We re glad you are here! Agenda for the Day Breaks Lunch Q&A and note cards Phones

We re glad you are here! Agenda for the Day Breaks Lunch Q&A and note cards Phones We re glad you are here! Agenda for the Day Breaks Lunch Q&A and note cards Phones Learn about the history of opioid addiction and discuss what is happening today in Kentucky Learn about the disease of

More information

The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion. Angela Huskey, PharmD, CPE

The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion. Angela Huskey, PharmD, CPE The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion Angela Huskey, PharmD, CPE Case Bill is a 47 year old man with a history of low back pain and spinal stenosis Not a real

More information

Trends in the Abuse of Prescription Drugs

Trends in the Abuse of Prescription Drugs Trends in the Abuse of Prescription Drugs by Jane Carlisle Maxwell, Ph.D. The sale of narcotic analgesic pills is increasing, as is diversion and the non-medical use of prescription drugs. These drugs

More information

A Report on Marijuana and Prescription Drugs

A Report on Marijuana and Prescription Drugs Prescription Drug Misuse in America A Report on Marijuana and Prescription Drugs Table of Contents Summary 2 Prescription Drug Misuse is Prevalent 6 Marijuana: The Most Misused Drug 8 Recreational Marijuana

More information

Drug Abuse Trends in Miami-Dade and Broward Counties, South Florida: June 2013 James N. Hall 1

Drug Abuse Trends in Miami-Dade and Broward Counties, South Florida: June 2013 James N. Hall 1 Drug Abuse Trends in Miami-Dade and Broward Counties, South Florida: June 2013 James N. Hall 1 ABSTRACT Significant shifts in drug abuse patterns are underway. Cocaine consequences have stabilized or increased

More information

Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008

Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008 Treatment Episode Data Set The TEDS Report July 15, 010 Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 008 In Brief The proportion of all substance abuse treatment admissions

More information

Prescription Opioid Use and Opioid-Related Overdose Death TN, 2009 2010

Prescription Opioid Use and Opioid-Related Overdose Death TN, 2009 2010 Prescription Opioid Use and Opioid-Related Overdose Death TN, 2009 2010 Jane A.G. Baumblatt, MD Centers for Disease Control and Prevention Epidemic Intelligence Service Officer Tennessee Department of

More information

Appropriate Use of UDT to Improve Patient Care

Appropriate Use of UDT to Improve Patient Care Published on OpioidRisk (http://www.opioidrisk.com) Home > Urine Drug Testing Urine Drug Testing This guide provides: Download Entire Guide [1] Appropriate use of Urine Drug Testing (UDT) to improve patient

More information

3/27/2012. Supply and Demand: The Substance Abuse/Misuse Market Triangle

3/27/2012. Supply and Demand: The Substance Abuse/Misuse Market Triangle Substance Abuse and Misuse: A Tragic Market That Can Be Curtailed Tennessee Department of Health Protect, promote, and improve the health and prosperity of persons in the State of Tennessee. John J. Dreyzehner,

More information

Maximizing Use of Prescription Drug Monitoring Programs

Maximizing Use of Prescription Drug Monitoring Programs Maximizing Use of Prescription Drug Monitoring Programs Christopher M..Jones, PharmD, MPH Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease

More information

Appendix 14: Obtaining Data on Opioid Poisoning

Appendix 14: Obtaining Data on Opioid Poisoning : Obtaining Data on Opioid Poisoning Obtaining Hospital Data on Nonfatal Opioid Poisoning Data on the number of nonfatal opioid overdoses can often be obtained from hospitals serving your community. Forming

More information

PtProtect Pain Medication Management Program Monitors Patient Compliance

PtProtect Pain Medication Management Program Monitors Patient Compliance PHYSICIAN UPDATE 2013 Edition PtProtect Pain Medication Management Program Monitors Patient Compliance The PtProtect (Patient Protect) program offers pain medication management panels designed to improve

More information

Addressing Substance Use in Pregnancy

Addressing Substance Use in Pregnancy Addressing Substance Use in Pregnancy Stefan Maxwell, MD Director, NICU, CAMC Women and Children s Hospital Chair, Drug Use in Pregnancy Committee West Virginia Perinatal Partnership July 31, 2013 WV Early

More information

9/8/2014 EPIDEMIOLOGY PUBLIC HEALTH INTERVENTIONS FOR NEONATAL ABSTINENCE SYNDROME DISCLOSURE OBJECTIVES. No financial COI to disclose

9/8/2014 EPIDEMIOLOGY PUBLIC HEALTH INTERVENTIONS FOR NEONATAL ABSTINENCE SYNDROME DISCLOSURE OBJECTIVES. No financial COI to disclose PUBLIC HEALTH INTERVENTIONS FOR NEONATAL ABSTINENCE SYNDROME DISCLOSURE No financial COI to disclose Eric Reynolds MD MPH OBJECTIVES To discuss the epidemiology and current scope of the Neonatal Abstinence

More information

WHAT WE KNOW. Collective Action Issue Brief #2 Updated June 2014 PRESCRIPTION PAIN MEDICATION MISUSE

WHAT WE KNOW. Collective Action Issue Brief #2 Updated June 2014 PRESCRIPTION PAIN MEDICATION MISUSE Collective Action Issue Brief #2 Updated June 2014 PRESCRIPTION PAIN MEDICATION MISUSE WHAT WE KNOW The misuse and abuse of prescription drugs has become a leading cause of harm among New Hampshire adults,

More information

Outcomes for Opiate Users at FRN Facilities. FRN Research Report September 2014

Outcomes for Opiate Users at FRN Facilities. FRN Research Report September 2014 Outcomes for Opiate Users at FRN Facilities FRN Research Report September 2014 Introduction The illicit use of opioids has reached epidemic proportions in the United States (Alford, 2007; Meges et al,

More information

Drug Abuse Trends in Miami-Dade and Broward Counties, South Florida: June 2014

Drug Abuse Trends in Miami-Dade and Broward Counties, South Florida: June 2014 Drug Abuse Trends in Miami-Dade and Broward Counties, South Florida: June 2014 James N. Hall 1 ABSTRACT The key finding for this reporting period is that there has been substantial progress in reducing

More information

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Pik-Sai Yung, M.D. Staff Psychiatrist Center for Counseling at Walton Background and Rationale Alprazolam is

More information

Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth

Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth Prescription drug abuse trends Minnesota s Prescription Monitoring Program Carol Falkowski Drug Abuse Dialogues www.drugabusedialogues.com Barbara Carter, Manager MN Board of Pharmacy www.pmp.pharmacy.state.mn.us

More information

Drug Utilization Is On The Rise

Drug Utilization Is On The Rise Objectives Identify the clinical issues related to opioid prescribing for chronic pain indications Define the clinical needs and expectations of urine drug testing in pain management Address preanalytical

More information

Summit Spotlight Treatment Track breakout sessions announced

Summit Spotlight Treatment Track breakout sessions announced Volume 5, Issue 15, December 21, 2015 In This Issue: * Treatment Track breakout sessions announced 1. Drug overdose deaths reach all- time high 2. CDC releases draft opioid guidelines; seeks comments 3.

More information

Prescription Opioid Addiction and Chronic Pain: Non-Addictive Alternatives To Treatment and Management

Prescription Opioid Addiction and Chronic Pain: Non-Addictive Alternatives To Treatment and Management Prescription Opioid Addiction and Chronic Pain: Non-Addictive Alternatives To Treatment and Management Dr. Barbara Krantz Medical Director Diplomate American Board of Addiction Medicine 1 Learning Objectives

More information

Established in 1974 Non-Profit Federal Block Grant recipient Accept Medicaid, Private Insurance, and Self-Pay.

Established in 1974 Non-Profit Federal Block Grant recipient Accept Medicaid, Private Insurance, and Self-Pay. Established in 1974 Non-Profit Federal Block Grant recipient Accept Medicaid, Private Insurance, and Self-Pay. Patients are not denied treatment if they do not have the ability to pay for services Schedule

More information

Massachusetts Population

Massachusetts Population Massachusetts October 2012 POLICY ACADEMY STATE PROFILE Massachusetts Population MASSACHUSETTS POPULATION (IN 1,000S) AGE GROUP Massachusetts is home to more than 6.5 million people. Of these, more than

More information

Driving under the influence of alcohol or

Driving under the influence of alcohol or National Survey on Drug Use and Health The NSDUH Report December 9, 2010 State Estimates of Drunk and Drugged Driving In Brief Combined 2006 to 2009 data indicate that 13.2 percent of persons aged 16 or

More information

New Jersey Population

New Jersey Population New Jersey October 2012 POLICY ACADEMY STATE PROFILE New Jersey Population NEW JERSEY POPULATION (IN 1,000S) AGE GROUP New Jersey is home to nearly9 million people. Of these, more than 2.9 million (33.1

More information

Presentation by: Commissioner E. Douglas Varney

Presentation by: Commissioner E. Douglas Varney Presentation by: Commissioner E. Douglas Varney Prescription Drug Abuse Affects Everyone Families as a whole Women Children The abuse of prescription drugs, particularly opioids, is costly not only for

More information

Opioid Overdose in Western Massachusetts Springfield and Western Counties compared to statewide data

Opioid Overdose in Western Massachusetts Springfield and Western Counties compared to statewide data Volume #1 October 2015 PUBLIC HEALTH ISSUE BRIEF Opioid Overdose in Western Massachusetts Springfield and Western Counties compared to statewide data October 2015 Partners for a Healthier Community, Inc.

More information

Rural Substance Abuse Partnership (RSAP) State Profile: OKLAHOMA

Rural Substance Abuse Partnership (RSAP) State Profile: OKLAHOMA Rural Substance Abuse Partnership (RSAP) State Profile: OKLAHOMA Overview: The Rural Substance Abuse Partnership (RSAP), organized with the help of a U.S. Department of Justice, Office of Justice Programs

More information

The Prescription Opioid and Heroin Crisis: An Epidemic of Addiction

The Prescription Opioid and Heroin Crisis: An Epidemic of Addiction The Prescription Opioid and Heroin Crisis: An Epidemic of Addiction Andrew Kolodny, M.D. Chief Medical Officer, Phoenix House Foundation Inc. Executive Director, Physicians for Responsible Opioid Prescribing

More information

Cincinnati Christian University Drug Abuse Prevention Program

Cincinnati Christian University Drug Abuse Prevention Program Cincinnati Christian University Drug Abuse Prevention Program Cincinnati Christian University maintains that our bodies are created by God and should be used to glorify Him. The misuse or abuse of alcohol

More information

Prescription Drug Abuse in the US

Prescription Drug Abuse in the US TM The other epidemic: Prescription Drug Abuse in the US Ten prevention ideas from the states Len Paulozzi, MD, MPH National Center for Injury Prevention and Control Presented at the National Conference

More information

Jane Maxwell, UT Addiction Research Institute, 512 232-0610. Prescription Pain Medications and Heroin: A Changing Picture

Jane Maxwell, UT Addiction Research Institute, 512 232-0610. Prescription Pain Medications and Heroin: A Changing Picture Prescription Pain Medications and : A Changing Picture Jane Maxwell, Ph.D. Center for Social Work Research The University of Texas at Austin Disclosure to Participants Commercial Support: This educational

More information

Karol Kaltenbach, PhD Maternal Addiction Treatment Education and. Jefferson Medical College Thomas Jefferson University

Karol Kaltenbach, PhD Maternal Addiction Treatment Education and. Jefferson Medical College Thomas Jefferson University Benzodiazepines and the Pregnant Patient: Special Challenges Karol Kaltenbach, PhD Maternal Addiction Treatment Education and Research Jefferson Medical College Thomas Jefferson University Outline Introduction

More information