Prescription Drugs In Utah. Fall Substance Abuse Conference St. George, Utah September 24, 2014 Anna Fondario, MPH Injury Epidemiologist

Transcription

1 Prescription Drugs In Utah Fall Substance Abuse Conference St. George, Utah September 24, 2014 Anna Fondario, MPH Injury Epidemiologist

2 Objectives Explore the types of data used to identify Utah s prescription drug problem Explain Utah s multi-faceted approach in addressing the problem Identify strategies that bring together state and local agencies to address the prescription drug overdose epidemic

3 National Data Each day, 46 people die from an overdose of prescription pain medications in the U.S. Health care providers wrote 259 million prescriptions for pain medications in 2012, enough for every American adult to have a bottle of pills. 2 million Americans addicted to opioid pain relievers.

4 National Data

5 National Data

6 National Data The number of opioid prescriptions per 100 people increased by 35.2% from in 25 adults are receiving treatment of chronic pain with opioid pain relievers.

7 National Data

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9 National Data

10 Utah Data Prescription drug overdose deaths has been a growing problem in Utah. In the past decade, Utah has experienced a more than 400% increase in deaths associated with misuse and abuse of prescription drugs. Poisoning is the number ONE cause of injury deaths in Utah.

11 Utah Data 30.0 Drug Poisoning Firearm Rate per 100,000 population Fall Motor Vehicle Crash Year

12 Poisoning Deaths (n=661) 10.9% non-drug Poisoning (n=72) 89.1% Drug Poisoning (n=589) Healthiest People Strategic Goal Measure 17.7% Intentional Drug Poisoning (n=104) 82.3% Accident/Undetermined Drug Poisoning (n=485) 74.8% Opioids (n=363) 25.2% Other and Unspecified Drugs (n=122) 73.8% non-illicit Opioids (n=268) 26.2% Illicit and non- Illicit Opioids (n=95)

13 Utah Data 900 Number of drug related hospitalizations by type and year, Utah Hospitalizations Rx opioid overdose Neonatal abstinence syndrome Drug-dependent mothers $15 million $13 million Year $1.8 million

14 Utah Data Number of prescription pain medication deaths per 100,000 adults by sex, Utah, Male Female 25.1 Rate per 100,000 adults * Total Age group

15 Utah Data 60% Percentage of occurrent deaths by top three contributing prescription pain medication deaths, Utah % 40% 30% Indicated Drug Only Other Drugs Involved 20% 10% 0%

16 Utah Data Rate of deaths per 100,000 prescriptions Rate of occurrent deaths per 100,000 prescriptions by year and prescription type, Utah, Methadone Fentanyl Oxycodone Hydrocodone Year

17 Utah Data 35 Percent change in the rate of occurrent prescription pain medication deaths by drug type, Utah % Change Methadone Fentanyl Oxycodone Hydrocodone

18 Utah Data Benzodiazepene Decedents by Selected Benzodiazepene COD No. of decedents Year Alprazolam Chlordiazepoxide Clonazepam Diazepam Nordiazepam Temazepam

19 Utah Data Number Of Illicit Drug Deaths By Selected Drug And Year, Utah Number Year Cocaine Heroin Methamphetamine Marijuana

20 Where you live makes a difference

21 Click to edit Master title style Approximately 3,000 Utah students in grades 8, 10, and 12 reported that they had used prescription drugs in the past 30 days not prescribed to them by a doctor. Students in the Weber-Morgan Local Health District reported the highest rate of prescription drug misuse.

22 Utah Data

23 Utah Data

24 A public health approach to preventing prescription drug abuse, misuse, and overdose death needs to be reestablish and maintained. Utah s previous experience has proven that prescription drug overdose deaths are preventable through targeted interventions and stakeholder coordination. Since 2010, there has been no concerted public health effort to address the issue of opioid abuse, misuse, and death.

25 Utah Data Number of occurrent prescription opioid deaths by year, Utah % 250 Deaths % Program Funded Funding Eliminated Year

26 Utah Data 5th Highest drug overdose death rate in the U.S. in 2011 % Increase or Decrease by Sex Men 271% 28% 21% Women 483% 27% 2% Overall 293% 28% 11%

27 Public Health Approach Define the Problem Identify Risk and Protective Factors Develop and Test Prevention Strategies Ensure Widespread Adoption

28 Call to Action: Promoting a Comprehensive Approach State taskforce or workgroup addressing prescription drug misuse and overdoses State plan addressing prescription drug misuse and overdoses

29 Utah Pharmaceutical Drug Community Project

30 What is needed? What are we going to do? What are our products? Performance Measures Short-term Intermediate Long-term Funding Staff time Community partners Stakeholders Utah Legislature Data collected, analyzed, disseminated Educate on risks and warning signs, safe use, storage, and disposal Develop provider / prescriber materials and training Training on naloxone use and access for first responders Develop targeted education initiatives with coalition support Enhance clinical decision support tools Number of brochures, fact sheets, pamphlets, web hits, reports, conference presentations, social media Number of educational materials developed and distributed Number and types of providers and first responders trained Number of tools integrated into electronic health records, guidelines updated, referral directory developed and disseminated Increase in data reports to inform prevention efforts Increase in number trained on naloxone use and overdose prevention Increase in public awareness exposure Increase in number of providers educated Increase awareness of abuse risks and warning signs Increase proportion of prescribers following guidelines Change in rate of prescribing of opioids per year Decrease opioid overdose hospitalizations Decrease deaths due to opioid overdoses

31 Strengthen Surveillance Systems and Capacity Controlled Substance Database (Prescription Drug Monitoring Program) Utah Violent Death Reporting System Technical assistance support

32 Education Activities Use Only as Directed Media Campaign Community Profile and Toolkit Drug Overdose Prevention Pocketcards

33 Use Only as Directed Prescription Drug Public Awareness Campaign Safe USE Safe STORAGE Safe DISPOSAL Ad Agency Banner Ads CCJJ Subgrantee Salt Lake City Police Department Website TV Radio Two Face Bear Trap Badger Keeping Track Goodbye FY 2011 Funding FY 2012 Funding FY 2013 Funding FY 2014 Funding Billboards Angie s Story On December 5, 2010, 13-year-old Connor Watson died from an overdose of prescription pills he found on a neighbor s kitchen counter in Cottonwood Heights. Pharmacy Stickers Safe Disposal Posters Radio Underwear Final Breath Shouldn t Be Shared Billboards Bus Bus Board Board $250,000 CCJJ Grant $450,000 DSAMH SPF Grant $250,000 CCJJ Grant $300,000 CCJJ Grant $357,000 CCJJ Grant Current campaign: Flight dates: July December 2014 Extended through February 2015 with additional funds Media Mix: Broadcast Radio Outdoor Bus and TRAX Online

34 SAFE USE In 2011, only 31% of Utahns believe that prescription pain medication is a major problem in Utah.

35 SAFE STORAGE In 2011, 60% of Utahns report keeping leftover prescription pain medications.

36 SAFE DISPOSAL In 2011, only 26% of Utahns know how to properly dispose of leftover prescription pain medications.

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41 ONLINE BANNER ADS: USEONLYASDIRECTED.ORG

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43 PLEASE VISIT

44 Area resources Prevention tips Community Health care Law enforcement Schools Parents

45 Utah Prescription Drug Overdose Prevention WHAT CAN YOU DO? Recognize Warning Signs If a person has any of these signs and can t respond to you, he/she may be experiencing an overdose. Very limp body and very pale face Blue lips or blue fingertips Choking sounds or a gurgling, snoring noise No response when you yell the person s name or rub hard in the middle of the chest (sternal rub) Slowed breathing (less than 1 breath every 5 seconds) or no breathing What To Do After Calling Try to wake the person up by yelling his/her name and rubbing hard in the middle of the chest (sternal rub). 2. Try rescue breathing (see below). 3. Administer naloxone, if available. More than one dose may be needed (see back). 4. Put the person on his/her side so they don t choke. 5. Stay until the ambulance arrives. Make sure nothing is in his/her mouth. Tilt his/her head back, lift chin, pinch nose shut. Give 1 slow breath every 5 seconds until he/she starts breathing.

46 What is Naloxone? Naloxone is a drug that can reverse overdoses from prescription opioids or heroin. When administered, it blocks the effects of opiates on the brain and restores breathing. There is no potential for abuse and side effects are rare, it is legal and FDA-approved. How is Naloxone Administered? Naloxone may be injected in the muscle, vein, under the skin, or sprayed into the nose. Talk to your doctor about which type is available to you. It may work immediately, but can take up to 8 minutes to have an effect. The effect will last for about 30 to 90 minutes in the body, however, most opioids may last longer than this and the naloxone may wear off causing the person to go into an overdose again.

47 How Do I Get Naloxone? The Utah State Legislature passed two bills in 2014 to help reduce the number of prescription drug overdose deaths. H.B. 11 Overdose Reporting Amendments (Good Samaritan Law) Enables bystanders to report an overdose without fear of criminal prosecution for illegal possession of a controlled substance or illicit drug. H.B. 119 Emergency Administration of Opiate Antagonist Act Permits physicians to prescribe naloxone to third parties.* Permits individuals to administer the medication without legal liability. *A third party is someone who is usually a caregiver, or a potential bystander, to a person at risk for overdose.

48 Public Health Approach Define the Problem Identify Risk and Protective Factors Develop and Test Prevention Strategies Ensure Widespread Adoption

49 Questions? Thank You For more information, please contact: Anna Fondario, MPH Injury Epidemiologist