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

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1 Prescription drug abuse trends Minnesota s Prescription Monitoring Program Carol Falkowski Drug Abuse Dialogues Barbara Carter, Manager MN Board of Pharmacy Minnesota Rural Health Conference June 25, 2013 Duluth

2 Primary Prevention of Rx Opioid Abuse or Misuse

3 14 percent of U.S. residents - an estimated 35 million people age 12 and older - report the nonmedical use of Rx pain relievers U.S. consumes 80% of opioids worldwide SOURCE: 2009 National Survey on Drug Use and Health (NSDUH). SAMHSA and the Division of Pharmacologic Therapy, Center for Substance Abuse Treatment, SAMHSA,

4 PRESCRIPTION OPIOIDS (PAINKILLERS) Opioids are drugs that contain opium or are derived from and imitate opium: Are used for pain relief and are available only by prescription. Are non-refillable and when used properly under a medical doctor's supervision, are safe and effective. They effectively change the way a person experiences pain. Users experience a general sense of well-being by reduced tension, anxiety, and aggression.

5 Illicit drug use initiates age 12 or older by drug SOURCE: Past year illicit drug initiates, 2010 National Survey on Drug Use and Health, SAMHSA.

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8 All opiates: High abuse potential High addictive potential High overdose potential Feel good Block pain Depress breathing

9 Diversion

10 Drug-related emergency department visits in U.S. involving the non-medical use pharmaceuticals and abuse of illicit drugs: ,400,000 1,345,645 Misuse or Abuse of Pharmaceuticals 1,200,000 1,000, ,640 1,171,024 Misuse or Abuse of Illicit Drugs 800, , , , , SOURCE: Center for Substance Abuse Research (CESAR), University of Maryland, adapted from the Substance Abuse and Mental Health Services Administration (SAMHSA), Highlights of the 2010 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits, The DAWN Report, July 2, Available online at

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12 Drug abusers will use whatever s available. Rx opiates and heroin are now part of the mix even in Minnesota.

13 addiction Biology/Genes Environment DRUG Brain Mechanisms Addiction

14 Prescription painkillers sold by state per 10,000 population (2010) 12.6 = Florida 11.8 = Tennessee, Nevada 11.6 = Oregon 10.2 = Delaware 9.8 = Maine 9.7 = Alabama 9.2 = Washington, Oklahoma 9.0 = Kentucky 8.1 = Michigan 7.9 = Ohio 7.5 = Idaho 7.2 = Missouri 6.5 = Wisconsin 6.2 = California 5.5= South Dakota 5.0 = North Dakota 4.6 = Iowa 4.2 = Minnesota 3.9 = District of Columbia 3.7 = Illinois US overall = 7.1 SOURCE: Automation of Reports and Consolidated Orders System (ARCOS), US Drug Enforcement Administration (DEA), 2010

15 exhibit 11 Prescription painkillers sold in Minnesota SOURCE: Automation of Reports and Consolidated Orders System (ARCOS), U.S. Drug Enforcement Administration, Prescription opiate analgesics (painkillers) include: codeine, morphine, fentanyl (brand names: Sublimaze, Actiq, etc), hydrocodone (brand names: Vicodin, Lortab), hydromorphone (brand names: Dilaudid, Palladone), meperidine, pethidine (brand name: Demerol), and oxycodone (brand names: OxyContin, Percodan, Percocet).

16 Law enforcement seizures of heroin and prescription opiates continue to escalate. Opiate Summary : Minnesota Drug Task Forces Heroin seized (grams). Heroin arrests Oxycodone seized (dosage units) percent change 2010 to 2011 Heroin seized (grams) Heroin arrests Oxycodone seized (dosage units) percent change 2010 to , , Pill arrests % of total arrests that Pill arrests involve pills SOURCE: Minnesota Office of Justice Programs, Minnesota Department of Public Safety, audited and updated June 20, As of January 2012, there are 23 multijurisdictional law enforcement drug and violent crime task forces operating throughout Minnesota, staffed by over 200 investigators from over 120 agencies.

17 In 2011 the Red Lake Nation, Leech Lake Band of Ojibwe, and the White Earth Band of Chippewa declared public health emergencies due to prescription opiate and illegal drug abuse on their reservations.

18 Thefts of controlled substances, mostly prescription narcotics, from Minnesota pharmacies are increasing. Theft or loss of controlled substances in Minnesota reported to the DEA: SOURCE: Minnesota Department of Health from the U.S. Drug Enforcement Administration. Compiled from Form DEA-106, Theft or Loss of Controlled Substances. This form is filed to report a theft or loss of controlled substances due to employee pilferage or other that occurred at a Minnesota hospital pharmacy, clinic pharmacy, retail pharmacy physically co-located in a clinic or hospital, or practitioners who were licensed to store controlled substances for use by patients (e.g., outpatient surgery center).

19 Admissions to addiction treatment for heroin and other opiates are rising throughout the State. Minnesota statewide addiction treatment admissions by primary substance of abuse excluding alcohol: Percent of admissions marijuana meth cocaine heroin/other opiates other SOURCE: Drug and Alcohol Abuse Normative Evaluation System, Minnesota Department of Human Services, Performance Measurement and Quality Improvement Division, 7/26/2012.

20 St. Paul Pioneer Press May 26, 2012

21 The challenge: How to reduce the nonmedical abuse of Rx drugs, while maintaining access to legitimately used Rx medications Requires community collaboration and cooperation across multiple levels of government and tribes.

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23 The Minnesota State Substance Abuse Strategy

24 The Minnesota State Substance Abuse Strategy Immediate Policy Priorities: Prescription Opiate/Heroin Abuse and Addiction Train Minnesota physicians in the basics of addiction, opiate prescribing and alternative approaches to pain management and require CME units in addiction, Rxing opiates and pain management. Train a broad range of front-line professionals about prescription drug abuse, treatment options for opiate addicts and how to reverse an opiate overdose, including licensed addiction treatment providers, detox staff, law enforcement and first responders. Accelerate efforts to increase participation by prescribers and pharmacists in the Prescription Monitoring Program and examine alternate methods for law enforcement access. As of March 2013: 40 percent of pharmacies and 30 percent of doctors use it.

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27 MN PRESCRIPTION MONITORING PROGRAM (MN PMP) Purpose: Promote public health and welfare by detecting diversion, abuse, and misuse for the prescription medications classified as controlled substances under the Minnesota statutes. Designed to be a source of information for prescribers and pharmacists; Also used as an investigative tool by law enforcement and medical examiners The PMP is not intended to: Prevent people from obtaining needed drugs; or Decrease the number of doses dispensed

28 WHO REPORTS THE DATA? MN Licensed Pharmacies 1,890 In state Mail order Prescribers Dispensing for outpatient use

29 ACCESS TO THE MN PMP DATA Prescribers of controlled substances with a valid DEA number who are prescribing or considering prescribing a controlled substance for a current patient. Agent or employee of the prescriber who has been delegated by the prescriber tasks related to accessing the data. Pharmacists who are dispensing or considering dispensing controlled substances to an individual. Agent or employee of the pharmacist who has been delegated by the pharmacist tasks related to accessing the data.

30 ACCESS THE MN PMP DATA-CONTINUED The law also provides access to the MN PMP data by the following: Minnesota Restricted Recipient Program staff (MN Department of Human Services. MN Health Care Program) Medical Examiner/Coroner Individual (request by mail only) Law Enforcement (search warrant required)

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33 APPROVED ACCESS & VOLUME OF USE 9,600+ Approved for Use 6,317 Prescribers 2,412 Pharmacists 441 Delegates 33,000 queries monthly

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