Prescription Drug Abuse: It s Not What the Doctor Ordered. Wilson M. Compton, M.D., M.P.E. Deputy Director, National Institute on Drug Abuse

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1 Prescription Drug Abuse: It s Not What the Doctor Ordered Wilson M. Compton, M.D., M.P.E. Deputy Director, National Institute on Drug Abuse

2 Prescription Drug Abuse is a Major Problem in USA: Number of Current Drug Users, Ages 12+, 2013 Illicit Drugs Marijuana 19.8 Psychotherapeutics 6.5 Cocaine Hallucinogens Numbers in Millions Inhalants 0.5 Heroin Source: SAMHSA, 2013 National Survey on Drug Use and Health, released September Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically. 2

3 High Rates of Rx Abuse, especially Analgesics, : Past Month Psychotherapeutic Drug Use, Ages 12+ Percent Using in Past Month Pain Relievers Tranquilizers Stimulants Sedatives + Difference between this estimate and the 2013 estimate statistically significant at the.05 level. Source: SAMHSA, 2013 National Survey on Drug Use and Health, released September 2014

4 Medications Frequently Abused by U.S. Teens 12 th Grader Past Year Drug Use, 2013 Monitoring the Future Study Drug % Drug % Alcohol 62.0 Sedatives* 4.8 Marijuana/Hashish 36.4 Tranquilizers* 4.6 Hookah 21.4 Hallucinogens 4.5 Small cigars 20.4 MDMA (Ecstasy) 4.0 Amphetamines* 8.7 Hall other than LSD 3.7 Synthetic Marijuana 7.9 OxyContin* 3.6 Snus 7.7 Salvia 3.4 Adderall* 7.4 Cocaine (any form) 2.6 Narcotics o/t Heroin* 7.1 Inhalants 2.5 Vicodin* 5.3 Ritalin* 2.3 Cough Medicine* 5.0 LSD 2.2 * Nonmedical use Categories not mutually exclusive Source: Univ. of Michigan, Monitoring the Future Study

5 Rx Meds Commonly Abused by College Students, Past Year Opioids Tranquilizers Stimulants 2 0 Monitoring the Future, Volume 2: College Students and Adults, Ages 19-50, 2012

6 Rate Near Tripling in Opioid-related Deaths (in parallel with opioid sales and Rx opioid treatment admits) Opioid Sales (Kg/10,000) Opioid-Related Deaths/100,000 Opioid Treatment Admissions /10, OD Deaths: 41,340 Any Drug 22,810 Rx drug 16,917 Rx opioid 4,397 Heroin Year Sources: National Vital Statistics System, DEA Automation of Reports and Consolidated Orders System, SAMHSA TEDS

7 Prescriptions Overdose Deaths The Dynamic relationship between rates of opioid prescriptions and rates of opioid-related overdose deaths in the US 2002, 2006, Source: IMS Vector One National, CDC Wonder, & the US Census

8 # of Deaths USA Drug Overdose Deaths By Major Drug Type 18,000 Opioid Analgesic Cocaine Heroin Benzodiazepines 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, Source: CDC/NCHS National Vital Statistics System, CDC Wonder. Updated with 2011 mortality

9 % of Basal Release % of Basal Release Why Do People Abuse Prescription Drugs? These prescription drugs, like other drugs of abuse (cocaine, heroin, marijuana) raise brain dopamine levels Dopamine Neurotransmission AMPHETAMINE hr Time After Amphetamine Empty Box Feeding FOOD Time (min) Di Chiara et al.

10 What is the Difference Between Therapeutic Use and Abuse? Dose and Frequency of Dosing Lower, fixed regimes vs higher, escalating use Route of Administration Oral vs injection, smoking, snorting Expectation of Drug Effects Expectation of clinical benefits vs euphoria high Context of Administration School, clinic, home vs bar, party

11 People Abusing Analgesics DIRECTLY & INDIRECTLY Obtain Them by Prescription: Most Recent Pill Source Source Where Respondent Age 12+ Obtained Analgesics: More than One Doctor One Doctor (2.6%) (21.2%) Other 1 (4.3%) Bought on Internet (0.1%) Drug Dealer/ Stranger (4.3%) Bought/Took from Friend/Relative (14.6%) Free from Friend/ Relative (53.0%) 1 Other category includes Wrote Fake Prescription," "Stole from Doctor s Office/Clinic/Hospital/Pharmacy," and "Some Other Way." Source Where Friend/Relative Obtained One Doctor (83.8%) More than One Doctor (3.3%) Free from Friend/Relative (5.1%) Bought/Took from Friend/Relative (4.9%) Drug Dealer/ Stranger (1.4%) Bought on Internet (0.3%) Other 1 (1.2%) Source: SAMHSA, 2012 and 2013 National Survey on Drug Use and Health

12 Doctors (and other clinicians) Need to Know What Prescriptions Have Been Given to Their Patients By Other Practitioners This information should be: 1) included in the patients electronic health care records 2) accessible through a Prescription Drug Monitoring Program (PDMP) that provides immediate information

13 Overdose Intervention Naloxone Distribution for opioid overdose victims. The potential for direct intervention to save lives. Note the April 3, 2014 FDA approval of the naloxone auto-injector (called Evzio ) Naloxone Nasal Spray Development Needle-free, unit-dose, ready-to-use opioid overdose antidote. NIDA STTR Grantee AntiOp, Inc., Daniel Wermeling, CEO NIDA clinical study with Lightlake Therapeutics, Inc.

14 Overdose Deaths Patients Treated Medical Treatment May Reduce Deaths -10,000-8,000-6, ,000-2, Heroin OD Buprenorphine Treatment Methadone Treatment R Schwartz et al. American Journal of Public Health 2013

15 Additional Challenge Lack of uptake of medication-assisted treatment Addiction Specialty Programs Offering Services As % of all programs surveyed (N=345) Within adopting programs, % of eligible patients receiving Rx TOO FEW ARE TREATED Opioid Tx Med: Methadone Buprenorphine Tablet naltrexone Knudsen et al, 2011, J Addict Med; 5:21-27.

16 Summary: The Urgent Problem of Prescription Drug Abuse Coordinated national and local responses are necessary. Yet, when used properly opioid, sedative and stimulant medications have many benefits. Balancing therapeutic benefits versus risks is necessary and complicated.

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