RADARS R SYSTEM INTERNATIONAL PRE-SYMPOSIUM. International Landscape of Prescription Medication Misuse
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2 RADARS R SYSTEM INTERNATIONAL PRE-SYMPOSIUM International Landscape of Prescription Medication Misuse
3 WELCOME 3 The Global Mosaic: Is Prescription Drug Misuse Really Different Among Countries? Janetta Iwanicki, MD Associate Medical Director RADARS R, Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority The Growing Nexus Between NARCOS and Counterfeit Medicines J. Aaron Graham Executive Director - Brand Safety & Security, Boehringer Ingelheim Pharmaceuticals, Inc. John J. Burke President, Pharmaceutical Diversion Education Inc., President and Co-Founder, International Health Facility Diversion Association
4 WELCOME 4 Acute Harms of Prescription Drug Misuse: What Can We Learn from the European Drug Emergencies Network (Euro- DEN) Plus Project David Wood, MD Consultant Physician and Clinical Toxicologist, Guy s and St Thomas NHS Foundation Trust and King s Health Partners Reader in Clinical Toxicology, King s College London Understanding the Evolution of the Opioid Epidemic in Canada, and the Risks of Poly-Substance Use Tara Gomes, PhD Scientist, St. Michael s Hospital Panel Discussion Networking Welcome Reception
5 The Global Mosaic: Is Prescription Drug Misuse Really Different Among Countries? Janetta Iwanicki, MD RADARS R, Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority
6 The Global Mosaic: Can We Compare Apples and Oranges? 6 Prescription medications vary widely across countries Prescribing patterns Medication availability Cultural and social trends Each country measures the impacts of nonmedical use differently Nationwide surveys National databases How can we transition to comparing apples to apples?
7 WHO: Total Opioid Consumption (Morphine Equivalence Mg/Capita), Canada US
8 Global Mosaic: Canada IQVIA, Standard Units per Population 8
9 Global Mosaic: UK IQVIA, Standard Units per Population 9
10 Global Mosaic: France IQVIA, Standard Units per Population 10
11 Global Mosaic: Germany IQVIA, Standard Units per Population 11
12 Global Mosaic: Italy IQVIA, Standard Units per Population 12
13 Global Mosaic: Spain IQVIA, Standard Units per Population 13
14 RADARS R International Program Development : Global Toxicosurveillance Network (GTNet) Program 2012: StreetRx (CA) 2012: EUROPAD 2013: StreetRx (UK, EU) 2014: Survey of Non-Medical Use of Prescription Drugs (UK) 2014: Web Monitoring 2015: SKIP (CA) 2014: Drug Diversion (CA) 2016: Survey of Non-Medical Use of Prescription Drugs (US, CA) 2017: Survey of Non-Medical Use of Prescription Drugs (EU) 2018: Canadian Poison Centre Network (CA)
15 RADARS R International Program: Canadian Consumer Products & Pharmaceutical Safety, Inc. 15
16 RADARS R International Program: European Mosaic 16
17 Canadian Poison Centre Network and Global Toxicosurveillance Network (GTNet) Methodology Standardized data are collected during routine daily management of acute medical events then queried for cases involving drugs of interest Date of event Key Measures? Demographics (gender, age, postal code) Reason for exposures (e.g. intentional abuse, misuse, unintentional, suicide) Drugs/drug products involved in the exposure (product-specific) Routes of abuse Outcome (e.g. death) 17
18 Global Mosaic: GTNet, France Exposures per 100,000 Population 18
19 Global Mosaic: GTNet, Germany Exposures per 100,000 Population 19
20 Global Mosaic: GTNet, Italy Exposures per 100,000 Population 20
21 Global Mosaic: GTNet, UK Exposures per 100,000 Population 21
22 Canadian Opioid Depedence Treatment and European Opioid Treatment Patient Survey Program (EUROPAD) Methodology Patients entering treatment for opioid addiction are asked to voluntarily complete the questionnaire Questionnaires are sent to central data coordination site for quality review and data entry Key Measures Gender, age, substance abuse treatment history, primary drug used to get high, source of primary drug acquisition and routes of abuse Endorsement of prescription drugs to get high in the past 30 or 90 days (productspecific) Route of abuse (chewed, snorted, smoked, injected) 22
23 Opioid Dependence Treatment Program, Canada Quarterly Rates per 100,000 Population 23
24 Opioid Dependence Treatment Program, Canada Cumulative Rates per 100,000 Population 24
25 Opioid Dependence Treatment Program, Canada Routes of Opioid Misuse % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Distribution of Route of Abuse Chew Smoke Snort Inject References: 9 pt.
26 EUROPAD, GABA Analogues 26
27 EUROPAD, GABA Analogues & Polysubstance Misuse 27
28 StreetRx Program Methodology Street price information is voluntarily submitted to the open access websites Date of submission Key Measures Geographical locator (country, state/province, city) Drugs/drug products purchased (product, formulation and dosage strength specific) Amount purchased $ Price paid for purchase 28
29 Web Monitoring Program Key Measures? Number of monthly, weekly, daily mentions (product specific) Reason for use (e.g. abuse, misuse) Route of abuse Outcomes (e.g. addiction, overdose, death) # Frequency of pre-identified themes vs. Sentinel events, new trends 29
30 StreetRx, Canada Price per Milligram,
31 Global Mosaic: Web Monitoring, UK 31
32 Survey of Non-Medical Use of Prescription Drugs Program (NMURx) Gender, age, income, geographic location, veteran and student status Key Measures General use and non-medical use of prescription drugs by active pharmaceutical ingredient and by specific product Co-ingestants and use of illicit drugs and alcohol? Reason for non-medical use (e.g. treat pain, to get high, curiosity) $ Routes of non-medical use by product endorsed Source of drug acquisition and price paid if purchased through illegitimate channels History of chronic and acute pain and prescription drug therapy 32
33 The Global Mosaic: How Can We Compare Apples and Oranges? 33 NMURx Standardized survey across multiple countries Allows direct comparisons between countries Each country has a fingerprint of nonmedical use patterns
34 Global Mosaic: NMURx Around the World 34 References: 9 pt.
35 Global Mosaic: NMURx Around the World 35 References: 9 pt.
36 Global Mosaic: NMURx in USA 36 USA Percent of Respondents Benzos GABA Analogues Opioids Stimulants
37 Global Mosaic: NMURx Around the World 37 References: 9 pt.
38 Global Mosaic: NMURx in Canada 38 Canada Percent of Respondents Benzos GABA Analogues Opioids Stimulants
39 Global Mosaic: NMURx Around the World 39 References: 9 pt.
40 Global Mosaic: NMURx in UK 40 UK Percent of Respondents Benzos GABA Analogues Opioids Stimulants
41 Global Mosaic: NMURx Around the World 41 References: 9 pt.
42 Global Mosaic: NMURx in France 42 France Percent of Respondents Benzos GABA Analogues Opioids Stimulants
43 Global Mosaic: NMURx Around the World 43 References: 9 pt.
44 Global Mosaic: NMURx in Germany 44 Germany Percent of Respondents Benzos GABA Analogues Opioids Stimulants
45 Global Mosaic: NMURx Around the World 45 References: 9 pt.
46 Global Mosaic: NMURx in Italy 46 Italy Percent of Respondents Benzos GABA Analogues Opioids Stimulants
47 Global Mosaic: NMURx Around the World 47 References: 9 pt.
48 Global Mosaic: NMURx in Spain 48 Spain Percent of Respondents Benzos GABA Analogues Opioids Stimulants
49 Global Mosaic: NMURx Around the World 49 References: 9 pt.
50 The Global Mosaic: Conclusions 50 Comparisons between countries can be difficult NMURx allows for direct comparisons Each country has a fingerprint of patterns of misuse Misuse of prescription opioids is most common across all countries
51 Global Mosaic: NMURx Around the World 51 References: 9 pt.
52 The Global Mosaic: Conclusions 52 Each component of the global mosaic provides complementary data Codeine and tramadol are highly available in multiple countries GABA analogues are commonly misused by persons who abuse drugs, most often in setting of polysubstance misuse
53 The Global Mosaic: Conclusions 53 NMURx provides comparable data across countries Opioids are most commonly misused medications across all countries UK has the highest rate of lifetime opioid misuse, followed by Spain and France Spain has the highest rate of lifetime benzodiazepine misuse Italy has the highest rate of lifetime GABA analogue misuse
54 The Global Mosaic: Questions? 54 Questions?
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