Jane Maxwell, UT Addiction Research Institute, Prescription Pain Medications and Heroin: A Changing Picture

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1 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 activity received no commercial support. Disclosure of Conflict of Interest The speaker discloses no conflict of interest. Shifting Between Opiate Pills and Pollini et al. found high proportion of young heroin injectors reported problematic prescription type opioid use before initiating heroin use. NSDUH study from found 8% who began heroin use in past year (recent initiates) had previous non-medical use of pain relievers. Only 1% of recent initiates reported heroin use prior to using pain relievers. Pollini R. et al. Problematic use of prescription type opioids prior to heroin use among young heroin injectors. Sub Abuse and Rehab, , 211. Muhuri P. et al. Associations of Nonmedical Pain Reliever Use and Initiation of Use in the United States. CBMSQ Data Review, SAMHSA, August Jane Maxwell, UT Addiction Research Institute,

2 THE GOOD NEWS & BAD NEWS Most shifting from other opiates to heroin. Trends in demand, supply, and unintended consequences heading down (impact of actions by FDA and by manufacturers, and overdose campaigns). IDU risks heading up. Changes in users (young suburban heroin users and aging adults dependent on pain pills and benzos). Treatment need vs. capacity. Unresolved problems in increasing accessibility to treatment. Data Sources Deaths: CDC Wonder deaths categorized by ICD Code Treatment: admissions from SAMHSA s Treatment Episode Data Set Forensic Toxicology Labs: Items identified in labs which report to DEA s National Forensic Laboratory System Poison center cases: From American Association of Poison Control Center Annual Reports 5 Human Exposure Cases Reported by Poison Centers in the US: AAPCC # Cases Hydrocodone Oxycodone Cocaine Methadone Annual Reports of the American Association of Poison Control Centers Jane Maxwell, UT Addiction Research Institute,

3 Percentage of Items Identified in DEA s NFLIS Laboratory System: % of Items Seized Oxycodone Hydrocodone Methadone DEA s National Forensic Laboratory System, data retrieved 9/19/14 Grams of Selected Drugs Distributed per 1,: DEA ARCOS ,, 8 Hydrocodone, Oxycodone, Methadone 6,, 5,, 4,, 3,, 2,, 1,, Buprenorphine Hydrocodone Methadone Oxycodone Buprenorphine DEA Automation of Reports and Consolidated Orders System Number of Drug Poisoning Deaths: United States: CDC Other Opiates Methadone Other Synthetics Benzodiazepines Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File. Jane Maxwell, UT Addiction Research Institute,

4 Oxycodone Indicators of oxycodone use based on items distributed by manufacturer, items identified in forensic laboratories, and deaths due to other opiates 8,, 25 6,, 4,, 2,, Grams Distributed Tox Labs Deaths Treatment Source: NFLIS, NCHS, ARCOS, TEDS Hydrocodone (% of items identified in forensic laboratories and grams distribution by manufacturers) 5,, 25 4,, 2 3,, 15 2,, 1 1,, 5 Source: NFLIS,, ARCOS Grams Distributed Tox Labs Deaths Treatment (Deaths, % of Items Identified in NFLIS & Treatment Admissions) Deaths Tox Labs Treatment Source: NFLIS, NCHS, TEDS Jane Maxwell, UT Addiction Research Institute,

5 Methadone Items Identified in NFLIS, Deaths and ARCOS 1 2,, 8 16,, 6 12,, 4 8,, 2 4,, Tox Labs Deaths Grams Distributed Source: NFLIS, NCHS, ARCOS Admissions to Treatment Programs by Primary Substance of Abuse: TEDS % of All Admissions Alcohol Other Drugs Other Opiates SAMHSA Treatment Episode Dataset 1% 8% 6% 4% Changes in the Proportion of White Clients Entering Treatment: TEDS % 7% 84% 9% 2% % Other Opiates & Synthetics SAMHSA Treatment Episode Dataset 15 Jane Maxwell, UT Addiction Research Institute,

6 6% 5% 4% Proportion of Clients Under Age 3 Entering Treatment: TEDS % 52% 3% 2% 26% 2% 1% % Other Opiates & Synthetics SAMHSA Treatment Episode Dataset 16 Rates per 1, of Drug Poisoning Deaths Involving in the US: Rate per 1, years years years years years Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File Rate per1, Rates per 1, of Drug Poisoning Deaths Involving Other Opiates in the US: years years years years years years Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File, Jane Maxwell, UT Addiction Research Institute,

7 Estimated Number of Patients Receiving MAT: Buprenorphine (Duo) Methadone NSSATS Buprenorphine (Mono) Naltrexone (Oral) (Opiate Dep) 1,2, 1,, 8, 6, 4, 2, Source: IMS Total Patient Tracker, Sep 214. Buprenorphine data exclude forms indicated for pain. Oral naltrexone factored for opioid dependence use only (4% factor provided by Alkermes). Methadone patients, N-SSATS Opioid and Patients Receiving Methadone or Prescriptions for Buprenorphine or Naltrexone vs. Abuse/Dependent or Past Month Users of Pain Relievers Nonmedically or : 212 5,197, 1,462,69 Opioid and Patients Receiving MAT* Past Month Use of Pain Relievers or NSDUH 212 * Number of individuals receiving buprenorphine or naltrexone from IMS plus number of patients receiving methadone from NSSATS. Source: IMS Total Patient Tracker, Sept 214 and SAMHSA NSSATS. Buprenorphine data exclude forms indicated for pain. Oral naltrexone factored for opioid dependence use. Methadone patients from SAMHSA, N-SSATS 212. Additional Needs Consistent Prescription Monitoring Programs with real-time information across state lines. Current data to determine changes in trends. Use available data such as ARCOS and NFLIS data to pinpoint areas where prescribing practice rates do not show balance between pain relief and patient safety. Limits on size of patient loads? Increase the number of addiction specialists to treat patients on these new meds. Cost of buprenorphine & naltrexone and reimbursement? Jane Maxwell, UT Addiction Research Institute,

8 Questions for the Audience Are today s methadone programs easily accessible and attractive to new young suburban patients? Do we need new treatment modalities such as detoxification to attract aging Baby Boomers addicted to pain pill and benzos? Parallel prescribing of naloxone and pain pills for selected patients are non-compliant, on high daily doses, have been switched to another opioid, have COPD, sleep apnea, depression, or unable cognitively to manage their meds. Education for family on signs of overdose and use of naloxone. Lack of knowledge about new MATS and targets for use + stigma of and by users Jane C. Maxwell, Ph.D. Senior Research Scientist Addiction Research Institute Center for Social Work Research The University of Texas at Austin 1717 West 6th, Suite 335 Austin, Texas Jane Maxwell, UT Addiction Research Institute,

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