PRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE May 19, 2012 National Association Boards of Pharmacy Annual Meeting Gil Kerlikowske, Director White House Office of National Drug Control Policy
ONDCP s Authority Established by the Anti-Drug Abuse Act of 1988 Principal purpose: Establish policies, priorities, and objectives for the nation's drug control program Goals: Reduce illicit drug use, manufacturing, and trafficking, drug-related crime and violence, and drugrelated health consequences 2
National Drug Control Strategy Science-based, public health approach to drug policy Guided by three principles: 1) Addiction is a disease that can be treated 2) People with substance use disorders can recover 3) Criminal justice reforms can stop the revolving door of drug use and crime 2012 Coordinated federal effort on 115 action items Signature initiatives: Prescription Drug Abuse Prevention Drugged Driving
The Prescription Drug Abuse Problem 478 million prescriptions for controlled-substances dispensed in U.S. in 2010 7 million Americans reported current non-medical use of prescription drugs in 2010 1 in 4 people using drugs for first time in 2010 began by using a prescription drug non-medically Nearly 15,600 overdose deaths involving opioid painkillers in 2009 (vs. 4,000 for cocaine and 3,000 for heroin)
Number of Prescriptions Prescriptions Dispensed for Select Opioids in U.S. Outpatient Retail Pharmacies, 2000-2009 140,000,000 120,000,000 100,000,000 80,000,000 60,000,000 40,000,000 20,000,000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Hydrocodone Oxyocodne Oxycodone methadone Methadone buprenorphine Buprenorphine Tramadol tramadol Source: SDI, Vector One: National. Extracted June 2010.
Number of New Users (Thousands) Past Year New Users of Specific Drugs, Persons Aged 12 or Older, 2010 2,500 2,000 2,426 2,417 2,004 Note: The specific drug refers to the drug that was used for the first time in the past year, regardless of whether it was the first drug ever used or not. 1,500 1,238 1,000 937 973 624 637 500 0 Marijuana Psychotherapeutics* Ecstasy Pain Relievers* Tranquilizers* Inhalants Stimulants* *Includes pain relievers, tranquilizers, stimulants, and sedatives 377 252 Cocaine LSD Sedatives* 140 Heroin 45 PCP Source: SAMHSA, 2010 National Survey on Drug Use and Health (September 2011)
Emergency Department Visits, 2004-2009
Death rate per 100,000 Unintentional Drug Overdose Deaths United States, 1970 2009 10 9 8 28,754 unintentional drug overdose deaths in 2009 Rx 7 6 5 4 3 2 1 Heroin Heroin Cocaine Cocaine 0 '70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06 08 Source: National Vital Statistics System, http://wonder.cdc.gov (May 2012).
NUMBER OF DEATHS Drug-Induced Deaths vs. Other Injury Deaths, 1999 2009 50,000 45,000 40,000 Injury by firearms Drug-induced Homicide Suicide Motor vehicle accidents 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Causes of death attributable to drugs include accidental or intentional poisonings by drugs and deaths from medical conditions resulting from chronic drug use. Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Not all injury cause categories are mutually exclusive. Source: National Center for Health Statistics, Centers for Disease Control and Prevention. National Vital Statistics Reports Deaths: Final Data for the years 1999 to 2009 (January 2012).
Public Health Impact of Opiate Analgesic Abuse For every 1 unintentional opioid overdose death in 2009, there were Abuse treatment admissions ED visits for misuse or abuse 11 41 People with abuse/dependence 148 Nonmedical users 419 Mortality figure is for unintentional overdose deaths due to opioid analgesics in 2009, from CDC/Wonder Treatment admissions are for with a primary cause of synthetic opioid abuse in 2009, from TEDS Emergency department (ED) visits related to opioid analgesics in 2009, from DAWN Abuse/dependence and nonmedical use of pain relievers in the past month are from the 2009 National Survey on Drug Use and Health
Source of Prescription Pain Relievers Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2009-2010
Economic Costs $55.7 billion in costs for prescription drug abuse in 2007 1 $24.7 billion in direct healthcare costs Opioid abusers generate, on average, annual direct health care costs 8.7 times higher than non-abusers 2 1. Birnbaum HG, White, AG, Schiller M, Waldman T, et al. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. Pain Medicine. 2011;12:657-667. 2. White AG, Birnbaum, HG, Mareva MN, et al. Direct Costs of Opioid Abuse in an Insured Population in the United States. J Manag Care Pharm. 11(6):469-479. 2005
Economic Costs Maternal opioid dependence can affect birth costs A recent study showed in 2009, the average hospital stay for opioid exposed infants with neonatal abstinence syndrome (NAS) was 16 days 1 The hospitalization cost of treating each baby with NAS averaged $53,400 2 State Medicaid programs paid for 77.6% of these births 3 1. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012 May 9;307(18):1934-40. Epub 2012 Apr 30 2. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012 May 9;307(18):1934-40. Epub 2012 Apr 30 3. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal Abstinence Syndrome and Associated Health Care Expenditures: United States, 2000-2009.. JAMA. 2012 Apr 30. Epub ahead of print
Prescription Drug Abuse Prevention Plan Coordinated effort across the Federal government Four focus areas 1) Education 2) Prescription Drug Monitoring Programs 3) Proper Medication Disposal 4) Enforcement
Education Gaps Health Care Providers o 2000 survey: 56 % of residency programs required substance use disorder training, median number of curricular hours ranged from 3 to 12 hours 1 o 2008 follow-up: Although the education of physicians on substance use disorders has gained increased attention, and progress has been made to improve medical school, residency, and post-residency substance abuse education since 2000, these efforts have not been uniformly applied. 2 Pharmacists 3 o 67.5% report receiving two hours or less of addiction or substance abuse education in pharmacy school o 29.2% reported receiving no addiction education o Pharmacists with greater amounts of addiction-specific education: Higher likelihood of correctly answering questions relating to the science of addiction and substance abuse counseling Counseled patients more frequently and felt more confident about counseling 1. Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A National Survey of Training in Substance Use Disorders in Residency Programs. J Stud Alcohol. 61(6):912-915. 2000. 2. Polydorou S, Gunderson EW, Levin FR. Training Physicians to Treat Substance Use Disorders. Curr Psychiatry Rep. 10(5):399-404. 2008. 3. Lafferty L. Hunter TS, Marsh WA. Knowledge, attitudes and practices of pharmacists concerning prescription drug abuse. J Psychoactive Drugs. 2006 Sep:38(3):229-232.
Education Education Goals o Knowledge on appropriate prescribing o Effectively identifying patients at risk for abuse o Screening, intervention, and referral for those misusing or abusing prescription drugs o PDMP use in everyday clinical practice o Ensure community leader, parents, and young people understand the dangers of prescription drug misuse. Main Actions o Legislation requiring mandatory education for all clinicians who prescribe controlled substances o Increased substance abuse education in health profession schools, residency programs, and continuing education o Expedited research on the development of abuse deterrent formulations
Prescription Drug Monitoring Programs Source: Alliance of States with Prescription Monitoring Programs, 2012
Proper Medication Disposal Goals o Easily accessible, environmentally friendly method of drug disposal that reduces the amount of prescription drugs available for diversion and abuse Main Actions o Publish and implement regulations allowing patients and caregivers to easily dispose of controlled substance medications o Once regulations are in place, partner with stakeholders to promote proper medication disposal programs
Enforcement Goals o Increase law enforcement and prosecutor training around prescription drug diversion and abuse o Assist states in addressing pill mills and doctor shopping Main Actions o Provide technical assistance to states on model regulations/laws for pain clinics o Encourage High-Intensity Drug Trafficking Areas (HIDTAs) to work on prescription drug abuse issues o Support prescription drug abuse-related training programs for law enforcement
Conclusions Prescription drug abuse is one of the fastest growing drug problems in the U.S. No simple solution, we all have a role to play Success will come from coordination and collaboration at the Federal, state, local, and tribal levels
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