Prescription Drug Abuse National Perspective

Transcription

1 Prescription Drug Abuse National Perspective Timothy P. Condon, Ph.D. Science Policy Advisor Office of the Director White House Office of National Drug Control Policy

2 Commonly Abused Prescription Drugs

3 The Prescription Drug Abuse Problem 3.99 billion prescriptions dispensed in U.S. in million Americans reported non-medical use of psychotherapeutics in in 3 people using drugs for first time in 2009 began by using a psychotherapeutic nonmedically 6 of top 10 abused substances among high school seniors are prescription drugs

4 Number of New Users (Thousands) New Users in the Past Year of Specific Illicit Drugs among Persons Aged 12 or Older, ,000 2,567 2,500 2,000 2,361 2,179 Note: The specific drug refers to the drug that was used for the first time, regardless of whether it was the first drug used or not. 1,500 1,226 1,110 1, * *Includes pain relievers, tranquilizers, stimulants, and sedatives Source: SAMHSA, 2009 National Survey on Drug Use and Health (September 2010).

5 Millions of Persons Persons Classified with Substance Abuse/Dependence on Psychotherapeutics * * Results from the 2009 National Survey on Drug Use and Health (NSDUH): National Findings, SAMHSA (2010). *Number in 2009 is statistically significantly higher than in 2003.

6 Prescription Drug Abuse Consequences Unintentional deaths Emergency Room visits Treatment admissions Economic Costs

7 Public Health Impact of Opioid Analgesic Use For every 1 overdose death there are Abuse treatment admissions 9 ED visits for misuse or abuse 35 People with abuse/dependence 161 Nonmedical users 461 Treatment admissions are for primary use of opioids from Treatment Exposure Data set Emergency department (ED) visits are from DAWN,Drug Abuse Warning Network, Abuse/dependence and nonmedical use in the past month are from the National Survey on Drug Use and Health

8 Drug-Induced Deaths vs. Other Injury Deaths, Causes of death attributable to drugs include accidental or intentional poisonings by drugs, drug psychoses, drug dependence, and nondependent use of drugs. Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Not all 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 2007 (2001 to 2010).

9 Death rate per 100,000 Unintentional Drug Overdose Deaths United States, ,658 unintentional drug overdose deaths Heroin Cocaine 0 '70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06 Year National Vital Statistics System,

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11 Economic Costs $180.9 billion in economic costs for drug abuse in the U.S. in 2002 $55.7 billion in costs for prescription drug abuse in $24.7 billion in direct healthcare costs Opioid abusers generate, on average, annual direct health care costs 8.7 times higher than nonabusers 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: 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):

12 Unique Aspects of Prescription Drugs Perceived Risk Accessibility and Supply

13 Perceived Risk Perceived Risk Because prescription drugs are manufactured by pharmaceutical companies, prescribed and dispensed by healthcare providers, they are often perceived as safer than street drugs Studies show that teens perceive prescription medication abuse as safer, less addictive, and less risky than using illegal or illicit drugs, and that drugs obtained from a medicine cabinet or pharmacy were not the same as drugs obtained from a drug dealer 1,2 1. Wu L, Pilowsky DJ, Patkar AA. Non-prescribed use of pain relievers among adolescents in the United States. Drug Alcohol Depend. 2008;941(1-3): Generation Rx. National study confirms abuse of prescription and over the counter drugs. 18 th Annual Study of Teen Abuse by the Partnership for a Drug Free America

14 Accessibility and Supply Abused prescription drugs like painkillers and anxiety medications are often taken as needed and dispensed in quantities larger than necessary They are kept in the medicine cabinet long after therapy has been completed and are easily available to others who may abuse them 2009 NSDUH found that 70 percent of people who abused prescription pain medications got them from friends or relatives 1 Prescriptions for controlled substances and opioid pain relievers in particular have increased in the last decade 1. Results from the 2009 National Survey on Drug Use and Health (NSDUH): National Findings, SAMHSA (2010)

15 Source of Pain Relievers for Most Recent Nonmedical Use Among Past Year Users 70% obtained from friend or relative* Bought from friend or relative Took from friend or relative w/o asking Bought from drug dealer Other source Free from friend or relative From one doctor *Percentage from friend or relative is derived before rounding of individual components. Source: SAMHSA, 2009 National Survey on Drug Use and Health (September 2010).

16 What is Being Done? Coordinated effort across the Federal government 4 focus areas Education Prescription Drug Monitoring Programs Proper Medication Disposal Enforcement

17 Top 10 prescribing specialties immediate-release opioids, 2009 Anesthesiologists, 3.2% Physical Med & Rehab, 2.7% Orthopedist, 7.4% Unspec., 4.5% General Practitioners/Family Medicine, 26.7% Other, 20.2% Internal Medicine, 15.4% Dentists, 7.7% Emergency Medicine, 4.7% Physicians Assistants, 4.0% Nurse Practitioners, 3.5% SDI, Vector One: National. Years Extracted June

18 Top 10 prescribing specialties extended-release/long acting opioids, 2009 Anesthesiologists, 13.8% Physical Med & Rehab, 9.3% Other, 11.8% General Practitioners/Famil y Medicine, 27.0% Internal Medicine, 16.8% Unspec., 4.9% Neurologist, 2.8% Orthopedist, 1.9% Hematology, 1.7% Nurse Practitioners, 5.7% Physicians Assistants, 4.3% SDI, Vector One: National. Years Extracted June

19 Education Education for parents, patients and healthcare providers Increasing public awareness of prescription drug abuse Safe and appropriate medication prescribing & use Potential adverse events and drug interactions Identifying those at risk for abuse Proper storage and disposal Screening, Intervention, Referral for those abusing prescription drugs

20 Specific Actions: Mandate Prescriber Education for all practiconers Link educational component to DEA registration (leg) Link mandatory prescriber education to FDA REMS authority Ensure educational component includes training on pharmacology, therapeutics, SUD, risk assessment, prescribing and tapering, SBIRT, proper use of a PDMP Certify competencies through assessment

21 Prescription Drug Monitoring Programs Used by healthcare providers and regulatory/law enforcement agencies to help prevent and reduce prescription drug abuse Goals All states have PDMPs Mechanisms in place for communication between states High utilization among healthcare providers

22 Prescription Drug Monitoring Programs

23 Prescription Drug Monitoring Programs

24 Specific Steps: Reauthorize NASPER, (include VA and DOD in PDMPs). Fully fund PDMPs. Increase cooperative agreements between states to share PDMP information. Increase prescriber use and usability of PDMPs Explore the intersection of EHR and PDMPs

25 Specific Actions: Link PDMPs with State Health Information Exchanges mandated and funded by ACA Explore making use of PDMP data real-time user friendly and part of normal Practicioners Workflow Explore incentives with private and public insurance Link VA and DOD facilities to state PDMPs (leg)

26 Proper Medication Disposal Secure and Responsible Drug Disposal Act 2010! Goals: Easily accessible, environmentally friendly method of drug disposal Should be cost-effective Cost burden should not be placed on consumers Reduce the amount of prescription drugs available for diversion and abuse Disposal needs to become the new norm

27 Proper Medication Disposal So how should this happen? Pharmacies/Pharmacists? Opportunity for clinical intervention Already have secure dispensing protocols Reverse distribution authority Who pays?

28 Enforcement Assist states in addressing pill mills and doctor shopping Fully leverage PDMPs Provide technical assistance to states on model regulations/laws for pain clinics Encourage High-Intensity Drug Trafficking Areas (HIDTAs) to work on prescription drug abuse issues Support prescription drug abuse-related training programs for law enforcement

29 Conclusions Prescription drug abuse and its consequences are the fastest growing drug problem in the U.S. No single solution We all have a role to play Success will come from coordination and collaboration at the Federal, state, local, and tribal levels All four components necessary

30 Thank you For more information: