3/27/2012. Supply and Demand: The Substance Abuse/Misuse Market Triangle

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1 Substance Abuse and Misuse: A Tragic Market That Can Be Curtailed Tennessee Department of Health Protect, promote, and improve the health and prosperity of persons in the State of Tennessee. John J. Dreyzehner, MD, MPH, FACOEM ETSU, March 3 rd Supply and Demand: The Substance Abuse/Misuse Market Triangle 1

of persons in the State of Tennessee. John J.

2 Substance Abuse/Misuse Constraining the Market OxyContin Manufacturer Deceived Public; Ordered to Pay $600 Million ABINGDON, VA May 18, 2007 Purdue Frederick Co., the manufacturer of the painkiller OxyContin, pleaded guilty to felony charges of misbranding the drug and misleading people about its addictive properties No matter the addiction pathway Footer Text 3/27/2012 It s about Dopamine Evolutionary Changes in Dopaminergic Modulation of Courtship Behavior in Cnemidophorus Whiptail Lizards Tennessee resident deaths from drug overdoses: , No. of Deaths from Drug Overdoses Year *Source: Office of Policy, Planning and Assessment, Tennessee Department of Health Death Certificates 2

Text 3/27/2012 It s about Dopamine Evolutionary Changes in Dopaminergic Modulation of Courtship Behavior in Cnemidophorus Whiptail Lizards Tennessee resident deaths from drug overdoses: 1999-2010

3 Note: 3-Year moving average is based on a backward moving average calculation. For example, 2002 target year represents mortality rates for 2000, 2001 and 2002 added together and divided by 3. Source: Tennessee Department of Health, Division of Health Statistics Drug Overdose Deaths vs. Motor Vehicle Traffic Deaths 2 Death Rates per 100,000 population Tennessee vs. US Motor Vehicle Traffic Deaths US Motor Vehicle Traffic Deaths TN Drug Overdose Deaths US Drug Overdose Deaths TN Source: Office of Policy, Planning and Assessment, Tennessee Department of Health Death Certificates Source: NCHS Data Brief, No. 81, December 2011, Drug Poisoning Deaths in the United States, , Data table for Figure 1 8 State funded treatment admissions in Tennessee for prescription opioids (pain relievers): ,000 2,717 2,00 2,333 No. of Consumers 2,000 1,00 1, ,044 1,362 1,281 1,74 1,32 1,737 2, * Year Projected Number Admissions Number of Admissions * Projected Number of Admissions Source: Treatment Episode Data Set Admission (TEDS-A)

US 20 1 10 Motor Vehicle Traffic Deaths US Motor Vehicle Traffic Deaths TN Drug Overdose Deaths US Drug Overdose Deaths TN 0 1999 2000 2001 2002 2003 2004 200 2006 2007 2008 2009 2010 Source: Office

4 More people will seek treatment for prescription opioids than alcohol by Source: Treatment Episode Data Set Admission (TEDS A) Facts About The Supply and Demand of Prescription Drugs and Patient Safety SUPPLY: An analysis of national prescribing patterns shows that more than half of patients, who received an opioid prescription in 2009 had filled another opioid prescription within the previous 30 days. ( 0.htm) 20% of drug overdose deaths are patients on a low dose opioid from a single prescriber. 80% of drug overdose deaths are patients prescribed high doses of opioids. 10% of patients who seek care from multiple doctors and are prescribed high daily doses, are not only at high risk for overdose themselves (40% of opioid overdose deaths), but are also likely to be diverting or providing drugs to others who are using them without prescriptions. ( 6101a3_w ) DEMAND: Patient Safety: PMP can improve patient and family safety through careful design and implemented programs. PMP will assist a targeted strategy that includes: Providing clinicians access to data in order to make informed decisions; Permitting prescribers to continue to provide pain management for their patients, yet limiting the amount of drugs for diversion or potential overdose. (Gugelmann, H and Perrone, J: JAMA. 2011;306(20): ) 11 Prescription Drug Abuse In TN Opioids (methadone, oxycodone, and hydrocodone) are by far the most abused prescription drugs Prescription drug abuse in the U.S. has increased so rapidly that the CDC calls the problem an "epidemic Huge economic impact National cost of opioid abuse is estimated to be > $70 B Lost productivity: $42 billion Criminal justice: $8.2 billion Doctor shopping costs $10,000 to $1,000 per person per year "Prescription drug abuse is claiming too many lives, threatening public safety, and placing unnecessary obstacles in the way of economic prosperity in Appalachia." US National Drug Control Policy Director Gil Kerlikowske 4

prescription in 2009 had filled another opioid prescription within the previous 30 days. (http://www.nih.gov/news/health/apr2011/nida 0.

5 Will We Move Decisively? Curtail prescription drug abuse Curtail supply stop overprescribing of opioids and benzodiazepines Curtail demand treatment of addiction Address potential demand education concerning real dangers of abuse Will Professionals Lead? Three Prong Prescription Drug Initiative Prevention Increase public awareness about prescription drug abuse. Increase data sharing among departments. Treatment Expand treatment options for people addicted to prescription drugs. Control Support health care providers in becoming champions for the prevention and treatment of drug abuse. Strengthen law enforcement tools to fight prescription drug abuse. 1 4 Prescription Safety Act: Patient Safety If utilized, prescription databases can help to reduce patient drug interactions, prescription abuse and potential misuse. Patient Safety is a community effort. Presently 1/3 of pharmacists use the PMP. Most prescription painkillers are prescribed by primary care physicians, internal medicine doctors, and dentists--not specialists. (CDC Prescription Painkillers Overdoses) % of abused painkillers are obtained from a friend, only 17.3% of painkillers are prescribed by a doctor. (CDC Prescription Painkillers Overdoses) The Prescription Drug Database will decrease factors that can have an adverse affect on patient safety outcomes: Poor patient or family member comprehension, Ineffective medical professional drug usage communication, Medical professional s lack of knowledge of other prescribing or updated drug interactions, The intentional abuse by the patient or patient s family of the prescription medication. 1 Source: CDC Policy Impact: Prescription Painkiller Overdoses

abuse Will Professionals Lead? Three Prong Prescription Drug Initiative Prevention Increase public awareness about prescription drug abuse. Increase data sharing among departments.

6 Thank you for your attention Tennessee Department of Health 16 6

Presentation by: Commissioner E. Douglas Varney

Presentation by: Commissioner E. Douglas Varney Prescription Drug Abuse Affects Everyone Families as a whole Women Children The abuse of prescription drugs, particularly opioids, is costly not only for