Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008

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1 PRESCRITPION DRUG ABUSE: AN EPIDEMIC What is Addiction? By: Lon R. Hays, M.D., M.B.A. Professor and Chairman Department of Psychiatry University of Kentucky Healthcare Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is Characterized by: 1) Inability to consistently Abstain 2) Impairment in Behavioral Control 3) Craving; or increased hunger for drugs or rewarding experiences 4) Diminished recognition of significant problems with one s behaviors and interpersonal relationships 5) A dysfunctional Emotional response Prescription Drug Abuse: An Epidemic In 2010, >12,000,000 Americans (12 or older) reported non-medical use of prescription painkillers in the past year. 9.5% of Kentucky 12 th grades have used prescription narcotics in the last 30 days 1

2 Nearly 15,000 die annually from overdosing on pain pills, representing a three- fold increase from In 2010, enough pain pills were prescribed to medicate every American around the clock for one month. The quantity of pain pills sold to pharmacies, hospitals, and doctors offices was four times larger in 2010 than in Rates of Sales Rates of prescription painkiller sales, deaths and substance abuse treatment admissions ( ) SOURCES: National Vital Statistics System, ; Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), ; Treatment Episode Data Set, Amount of Prescription Pain Pills by State 2

3 Amount of prescription painkillers sold by state per 10,000 people (2010) SOURCE: Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), 2010 Drug Overdose Death Rates Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008 Treatment admissions for prescription drug abuse jumped 430% from , led by Kentucky and West Virginia DAWN: Hydrocodone, Oxycodone, and Methadone were most frequently reported from ED Visits sts Involving: Oxycodone Increased by 242% Hydrocodone Increased by 124% Alprazolam Increased by 145% Methadone prescriptions increased by 700% from

4 Methadone poisoning deaths increased by 468% from (West Virginia and Kentucky were #1 and #2 in the increases through 2004) Highest methadone related inpatient hospital rates and mortality rates were in the rural Appalachian area of Kentucky. DAWN Number of ED visits for nonmedical use of opioid analgesics increased 111% from Highest number were for Oxycodone, Hydrocodone, d and Methadone all of which showed increases during the five years Nonmedical use of benzodiazepines increased 89% from The amount of methadone distributed by manufacturers rose dramatically from with increases ranging from 9-22% annually. Tablets had the largest increase (pain clinics). In 2005, the methadone poisoning rate for Kentucky was 6 th highest in the U.S. and increased 17-fold from Poisoning deaths involving methadone increased 468% (to 4,462) from Increase of 4% of all poisoning deaths to 14% Since 1999, 73-80% of these deaths were listed as unintentional, 13% undetermined, and 5-7% suicide The highest rates were for those and Largest increase was for those

5 Figure 3. Emergency Department (ED) Visits Involving the Nonmedical Use of Selected Narcotic Pain Relievers: 2004 to 2008 Recent Newspaper Headlines Report Outlines Tennessee Judge s Addiction Three Men Charged with Murder in Death of Mt. Vernon Man New Powerful Painkiller has Abuse Experts Worried Up to 10x as much Hydrocodone as Vicodin ED Visits for Hydrocodone Abuse Increased from 19,221 in 2000 to 86,258 in 2009 The U.S. consumes 99% of the world s hydrocodone (and represent 4.6% of the world s population) Nearly 1/3 of Kentuckians report a friend/relative having problems due to abusing prescription pain medications. 43.2% of Eastern Kentuckians were aware of a friend/relative 5

6 Figure 1. Trends in Emergency Department (ED) Visits Involving the Nonmedical Use of Narcotic Pain Relievers: 2004 to 2008 Clay County Coroner Nearly every family I know in the area seems to have been affected one way or another. Identifying and Preventing Prescription Drug Abuse Medical vs. Non-Medical Use of Drugs Intent Effect Control Legality Pattern Warning Signs of Chemical Dependence Daily use above ceiling doses Use of alcohol or other drugs non- medically Addict behavior Poor therapeutic response 6

7 Source of Prescription Pain Relievers used Non-Medically Early onset of NMUPD was a significant predictor of prescription drug abuse and dependence. 55.7% friends or relatives 19.1% 1% from one M.D. 3.9% from drug dealers 0.1% from the Internet Protection for the Physician Investigations have illustrated drug abuse in 18-41% in patients receiving Opioids for chronic pain. Know the patient See the patient frequently Have contact with family members Urine tests Physicians are whipsawed between the imperative to treat pain with Opioids and the fear of producing addiction in some patients. Self-reported craving is a potential marker for identification of those at risk for Opioid medication misuse. 7

8 Medical use of Benzodiazepines 71% over 50 years of age 67% Female Non-Medical User 61% Male 74% less than 35 years old Benzodiazepine Checklist for Long-term Use: Diagnosis Drug and Alcohol Use Toxic Behavior Family Monitor Treatment for Chemically Dependent Patients: Don t use Benzodiazepines in outpatient treatment Refer patients to AA/NA Refer family members to AL-ANON Find Non-Benzo alternative Non-Addictive Alternativesti Anxiety Antidepressants Buspirone Hydroxyzine Biofeedback/Relaxation Techniques 8

9 Panic Disorder SSRI s TCA s Insomnia Hydroxyziney y Antidepressants Relaxation Tapes Pain Non-steroidal Anti-inflammatories Heat, cold Pain management Physical Therapy What Can Be Done? The US Government is: Tracking prescription drug overdose trends to better understand the epidemic. Educating healthcare providers and the public about prescription drug abuse and overdose. Developing, evaluating and promoting programs and policies shown to prevent and treat prescription drug abuse and overdose. States can: Start or improve prescription drug monitoring programs (PDMPs). Use PDMP, Medicaid, and workers compensation data to identify improper prescribing of painkillers. Set up programs for Medicaid, workers compensation programs, and state-run health plans that identify and address improper patient use of painkillers. Pass, enforce and evaluate pill mill, doctor shopping and other laws to reduce prescription painkiller abuse. Encourage professional licensing boards to take action against inappropriate prescribing. Increase access to substance abuse treatment. 9

10 Individuals can: Use prescription painkillers only as directed by a healthcare provider. Make sure they are the only one to use their prescription painkillers. Store prescription painkillers in a secure place and dispose of them properly. Health insurers can: Set up prescription claims review programs to identify and address improper prescribing and use of painkillers. Increase coverage for other treatments to reduce pain, such as physical therapy, and for substance abuse treatment. Healthcare providers can follow guidelines for responsible painkiller prescribing, including: Screening and monitoring for substance abuse and mental health problems. Prescribing painkillers only when other treatments have not been effective for pain. Prescribing only the quantity of painkillers needed based on the expected length of pain. Using patient-provider provider agreements combined with urine drug tests for people using prescription painkillers long-term. Use PDMPs to identify patients who are improperly using prescription painkillers. 10