Federal Drug Control Policy and Priorities: Prescription Drugs: Disposal, Overdose Prevention and Other Emerging Issues

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1 Federal Drug Control Policy and Priorities: Prescription Drugs: Disposal, Overdose Prevention and Other Emerging Issues September 15, 2014 National Governor s Association Policy Academy on Prescription Drug Abuse Prevention Cecelia Spitznas, Ph.D., Senior Science Policy Advisor Office of National Drug Control Policy

2 Office of National Drug Control Policy Component of the Executive Office of the President Coordinates drug-control activities and related funding across the Federal Government Produces the annual National Drug Control Strategy

3 Main ONDCP Priorities Non-medical prescription drug use and heroin use Overdose & medical consequences Marijuana issues Supply-related measures focusing on heroin Treatment access (MAT)

4 Prescription Drug Abuse Coordinated effort across the Federal Government Prevention Plan Four focus areas: 1) Education 2) Prescription Drug Monitoring Programs 3) Proper Disposal of Medication 4) Enforcement

5 Source of Prescription Pain Relievers Source: Special Tabulations for ONDCP. SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

6 Controlled Substance Disposal To find a collection receptacle location near you: Call the DEA s Registration Call Center at Contact your local DEA office Visit the DEA website at takeback/index.html

7 Number of Users (Thousands) Heroin Use or Non-Medical Use of Pain Relievers in the Past Year among Persons Aged 12 or Older: Persons Aged 12 or Older 14,000 12,000 1,400 1,200 10,000 8,000 6,000 4,000 2,000 0 Non-medical users of pain relievers Heroin users , Source: SAMHSA, 2013 National Survey on Drug Use and Health (September 2014). 9/2014

8 Non-medical Prescription Opioid Users Who Try Heroin Prescription opioid use is a risk factor for heroin use. Approximately 4 out of 5 of heroin users ages used prescription opioids before heroin initiation. 1 Among nonmedical prescription opioid users, heroin use is relatively rare; across a five year period following initiation, only 3.6% of people who used prescription opioids non-medically tried heroin. 2 Injection-drug users report tolerance motivates them to try heroin. 3 New research shows heroin effects, price, availability and ease of use motivate heroin users who formerly used prescription opioids Muhuri, P.K. Gfroerer, J., Davies, C. (2013). Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. SAMHSA CBHSQ Data Review (August). 2. Ibid 3. Lankenau SE, et al. (2012). Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy Jan;23(1): Epub 2011 Jun Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry. Published online May 28, doi: /jamapsychiatry

9 Overdose Prevention and Education The National Drug Control Strategy supports comprehensive overdose prevention efforts, to include: More extensive public education campaigns about overdose, including the signs of overdose, emergency interventions, information about Good Samaritan laws where they exist, and the importance of connecting people to substance use disorders treatment. Expanded training and availability of emergency interventions, such as naloxone for first responders (including campus police). Increased education among health care providers about informing patients using opioids (and their family members/caregivers) about potential for, signs of, and interventions in case of overdose. Naloxone co-prescribing.

10 Myth or Fact? Pain Patients are the Main Concern All opioid users are at risk, not just chronic pain patients. In one large claims database study, daily users (e.g. people under treatment chronically with opioids) accounted for 25 percent of the overdoses. Other users people who used on average around 10 days accounted for 43.6 percent of overdoses. People who did not fill a prescription at all accounted for 31.4 percent of the overdoses. Patients with acute pain and patients who may not be under treatment for pain are also vulnerable. Source: Paulozzi LJ, Zhang K, Jones CM, Mack KA. Risk of adverse health outcomes with increasing duration and regularity of opioid therapy. J Am Board Fam Med May- Jun;27(3): doi: /jabfm PMID: [PubMed - in process]

11 Promising Practice: Naloxone Pharmacy Collaborative Practice Agreements Under collaborative practice agreements pharmacies can stock and dispense naloxone to the public for use by patient caregivers during an opioid overdose without a prescription by their primary care provider. State laws vary. Examples include: Rhode Island in partnership with CVS and Walgreens Washington state

12 High Utilizers Declined When Prescribers Required to Consult PDMPs Tennessee s PDMP Law went into effect at the start of Prescribers now must access the PDMP before prescribing opioids to a new patient. High utilizer defined as a person who used 5 prescribers and 5 pharmacies in a 90-day period. High utilizers decreased 47 percent from 2011 to the fourth quarter of Source: Tennessee Department of Health Controlled Substance Monitoring Database Committee. Controlled Substance Monitoring Database 2014 Report to the 108 th Tennessee General Assembly, February 1, Page 5. Available at Linked to

13 Prevention of Opioid Use Consequences and Treatment As Prevention Consequence Prevention Naloxone and overdose education Needle exchange Warnings and provider notification of risks for women who may become pregnant HIV and Hepatitis C testing and treatment Treatment As Prevention Screening and identification and referral to treatment for opioid use disorders Integrated treatment in general medical settings Medication-Assisted Treatment, including for pregnant women Treatment may need to be chronic or indefinite to include treatment and recovery services and supports

14 Perceived Need for and Effort Made to Receive Specialty Treatment Among Persons Aged 12 or Older Needing But Not Receiving Treatment: 2013 Did Not Feel They Needed Treatment (5,731,000) 75% 3% 2% Felt They Needed Treatment and Did Not Make an Effort (247,000) Felt They Needed Treatment and Did Make an Effort (148,000) 19% Received Specialty Treatment (1,483,000) 7,608,000 Needing Treatment for Illicit Drug Problem Source: SAMHSA, 2013 National Survey on Drug Use and Health (September 2014).

15 Medication-Assisted Treatment (MAT) Formulary Options Medication-assisted treatment (MAT) using an FDA-approved medicine and psychosocial treatment is highly effective. Detoxification and psychosocial treatment alone without medication show high rates of relapse. The medicines are not interchangeable, Massachusetts ensured patient insurance coverage for full array of medicines, including: Injectable naltrexone (Vivitrol); Methadone; and Medicines combining buprenorphine and naloxone.

16 For More Information: WHITEHOUSE.GOV/ONDCP DISPOSAL REGULATION LINK: Strategy Input: