Prescription Drug Abuse: Colorado and Nationwide
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1 Prescription Drug Abuse: Colorado and Nationwide Eric Lavonas, MD Associate Director, Rocky Mountain Poison and Drug Center Associate Professor, University of Colorado School of Medicine 1
2 What s the Problem? CDC NCHS Data Brief,
3 What s the Problem? CDC, MMWR,
4 What s the Problem? CDC graphic 4
5 Opioid Pain Relievers Active Ingredient Hydrocodone Oxycodone Morphine Oxymorphone Hydromorphone Tapentadol Tramadol Buprenorphine Fentanyl Methadone Common Brand Names Vicoden, Lortab, Norco OxyContin, Tylox, Percocet MS Contin Opana Dilaudid, Exalgo Nucynta Ultram Subutex, Suboxone Duragesic, Actiq, Fentora Methadose 5
6 Benzodiazepines Active Ingredient Alprazolam Clonazepam Diazepam Lorazepam Temazepam Chlordiazepoxide Clorazepate Common Brand Names Xanax Klonopin Valium Ativan Restoril Librium Tranxene 6
7 Stimulants Active Ingredient Amphetamine / dextroamphetamine Methylphenidate Common Brand Names Adderall Concerta, Ritalin, Daytrana 7
8 Let s Not Forget Active Ingredient Dextromethorphan Bupropion Quetiapine Zolpidem Zopiclone / Eszopiclone Common Brand Names Coricidin, Robitussin Wellbutrin Seroquel Ambien, Intermezzo, Lunesta 8
9 The RADARS System Operated by Rocky Mountain Poison and Drug Center Denver Health Measures rates of abuse, misuse, and diversion of prescription opioids and stimulants Also street price Product-specific Geographic (3 digit Zip code level) Timely 9
10 1 0 RADARS System Mosaic Approach College Survey Early Experimenters
11 1 1 RADARS System Mosaic Approach College Survey Early Experimenters Poison Center Acute Events
12 1 2 RADARS System Mosaic Approach College Survey Early Experimenters Poison Center Acute Events OTP Opioid Tx Program Patients in Treatment SKIP Survey of Key Informant Pts Patients in Treatment
13 RADARS System Mosaic Approach College Survey Early Experimenters Poison Center Acute Events OTP Opioid Tx Program Patients in Treatment SKIP Survey of Key Informant Pts Patients in Treatment Drug Diversion Criminal Justice/ Law Enforcement 13
14 RADARS System Mosaic Approach College Survey Early Experimenters Poison Center Acute Events OTP Opioid Tx Program Patients in Treatment SKIP Survey of Key Informant Pts Patients in Treatment Drug Diversion Criminal Justice/ Law Enforcement Street Price Users/Buyers 14
15 RADARS System Denominators COUNTS BY SYSTEM UNITED STATES POPULATION = POPULATION RATE Tried and true Disease burden on whole population Does not account for drug availability COUNTS BY SYSTEM URDD = UNIQUE RECIPIENTS OF DISPENSED DRUG (URDD) RATE Number of unique people filling prescription for drug Accounts for availability of drug in community Relates events to corresponding patient benefit 15
16 RADARS System Colorado Data Prescription Opioids 16
17 17
18 18
19 Poison Center Oxycodone Signals 3 rd Quarter nd Quarter
20 Drug Diversion Oxycodone Signals 3 rd Quarter nd Quarter
21 Poison Center Hydrocodone Signals 3 rd Quarter nd Quarter
22 Drug Diversion Hydrocodone Signals 3 rd Quarter nd Quarter
23 RADARS System Colorado Data Stimulants 23
24 24
25 25
26 Opioid abuse Colorado Summary Poison Center calls related to abuse are similar to or lower than national rates Drug diversion investigations are similar to or higher than national rates Oxycodone signals are detected in several Colorado regions Minimal signals related to hydrocodone abuss 26 26
27 Colorado Summary: Opioids Poison center call rates are similar to or below national rates Drug diversion investigation are similar to or slightly higher than national rates Oxycodone signals are detected in several regions Few hydrocodone signals 27
28 Colorado Summary: Stimulants Poison center call rates are consistently at or below national rates Drug diversion investigation rates have increased rapidly in the past 12 months, and now greatly exceed national rates 28
29 Prescription Drug Monitoring Programs Intentional Abuse Reports Poison Center Program 29
30 Prescription Drug Monitoring Programs Prescription Opioid Abuse Mentions Treatment Programs 30
31 Abuse Deterrent OxyContin + = + = 31
32 Sales Decreased 15% 32
33 Intentional Abuse Calls to Poison Centers Down 42% 33
34 More Decrease by Non-Oral Routes than Oral Routes 54% vs35%; interaction p =
35 Drug Diversion Cases Down 60% 35
36 ADF is Worth Less on the Street Product Street Price Median (IQR) $US / mg OxyContin OC (non-adf) $1.00 ($0.63, $1.25) OxyContin OP (ADF) $0.63 ($0.50, $1.00) 36
37 Endorsements by Patients Entering Treatment Down 24% 37
38 Squeezing the Balloon The RADARS System Poison Center Program Intentional Abuse Cases: Opana ER Rate per 1,000 URDD 38
39 ADFs and PDMPs Work Here Image source: 39
40 Other Interventions Community awareness Provider education Resilience training Enhanced PDMPs Improved access to treatment Drug courts 40
41 Eric Lavonas, MD Image credit: Washingtonpost.com 41
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Richard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA
*We are not accepting any New Patients who are currently taking any controlled pain medications *We are *Note: not completion accepting of the any following New Patients paperwork who and Initial are Screening
Drug poisonings in Southern Nevada,
Drug poisonings in Southern Nevada, 2001-2012 By Jing Feng, Ph.Dc, MS Nancy Williams, MD, MPH Cassius Lockett, Ph.D Joseph P. Iser, MD, DrPH, MSc Abstract Objective This report presents recent trends relating
Opioid Prescribing Guidelines for Patients in the Emergency Department
Opioid Prescribing Guidelines for Patients in the Emergency Department and Immediate Care Centers These guidelines are meant to assist clinicians in treating patients with acute and chronic pain in the