The Changing Face of Heroin Use in the US: A Retrospective Analysis of the Past 50 Years 100 Heroin 90 Prescription opioids

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1 Total Sample, % Total Sample, % The Changing Face of Heroin Use in the US: A Retrospective Analysis of the Past Years Heroin 9 Prescription opioids s 97s 98s 99s s s (n = 88) (n = ) (n = ) (n = 8) (n =,6) (n = 86) Decade of First Opioid Use (no. of abusers) 9 8 Nonwhite 7 White 6 96s 97s 98s 99s s s Decade of First Regular Opioid Use Total Sample, % Mean Age, y Decade of First Regular Opioid Use Men Women 96s 97s 98s 99s s s 96s 97s 98s 99s s s Decade of First Opioid Use Cicero TJ, et al. JAMA Psychiatry. ;7:8 6.

2 Age Adjusted Rates of Death Related to Prescription Opioids and Heroin, Between and, the rates of death from prescription opioid overdose nearly quadrupled In, drug overdoses accounted for, US deaths, 6.% (,9) of which involved any type of opioid In, heroin death rates were highest among those to years of age (./,), increasing.% from to No. of Overdose Deaths per, People Heroin.9 Prescription opioids Year Compton WM, et al. N Engl J Med. 6;7: 6; Rudd RA, et al. MMWR Morb Mortal Wkly Rep. 6;6: Metropolitan vs Nonmetropolitan Areas Age Adjusted Death Rate Females Large central metro Large fringe metro Medium metro Small metro Micropolitan (nonmetro) Noncore (nonmetro) Age Adjusted Death Rate Males Large central metro Large fringe metro Medium metro Small metro Micropolitan (nonmetro) Noncore (nonmetro) Year Year Mack KA, et al. MMWR Surveill Summ. 7;66:.

3 Drug Overdose Deaths Involving Opioids, by Type of Opioid: US, Drug Overdose Deaths (per, people) Heroin Any opioid Natural and semisynthetic opioids (eg, oxycodone, hydrocodone) Other synthetic opioids (eg, fentanyl, tramadol) Methadone 6 8 Frank RG, Pollack HA. N Engl J Med. 7;76:6 7. Number and Age Adjusted Rates of Drug Overdose Deaths by State: US, From to, the death rate from synthetic opioids other than methadone, which includes fentanyl, increased by 7.%; heroin death rates increased by.6% Natural/semisynthetic opioid death rates increased by.6%, whereas methadone death rates decreased by 9.% WA OR NV CA AK ID AZ UT MT WY CO NM HI ND SD NE KS OK TX MN WI IA IL MO AR MS LA NY MI PA IN OH WV VA KY NC TN SC GA AL FL VT DE MD ME NH MA CT RI NJ.8 to.. to..6 to to to.. to. CDC. Drug overdose death data. Rudd RA, et al. MMWR Morb Mortal Wkly Rep. 6;6:.

4 Drug Overdose Death Rate (8) and Opioid Pain Reliever Sales Rate () WA ME MT VT ND MN OR NH ID WI NY SD WY MA MI RI IA NE PA NV IN IL VA KS MO DE WV CO Kilograms of NPR used per M NJ OH UT CA CT MD KY NC AZ TN OK NM AR SC MS TX GA AL Age adjusted rate per, people LA AK FL HI National Vital Statistics System. 8; Automated Reports Consolidated Orders System.. Twelve States Have More Opioid Prescriptions Than People Alabama:.9 per people Tennessee:.8 West Virginia: 7.6 Kentucky: 8. Oklahoma: 7.8 Mississippi:. Louisiana: 8 Arkansas:.8 Indiana: 9. Michigan: 7 South Carolina:.8 Ohio:. Opioid Pain Reliever Prescriptions by State WA MT ME VT ND MN OR ID NH WI SD CT IA NE NJ IL UT IN OH DE WV KS CA MO VA KY NC AZ OK NM TN AR SC MS TX AK AL GA LA FL HI RI PA NV CO MA NY MI WY MD Prescriptions per adults National Vital Statistics System. 8; Automated Reports Consolidated Orders System..

5 Challenges in Reaching Rural Patients Dispersed and hidden populations Medically underserved Gaps and lacks in services and providers Poverty Cultural differences Stigma Fear of mistreatment and criminalization Lack of waivered physicians Lack of training in addiction medicine Lack of resources/capabilities/ addiction specialists Bias against MAT Insurance/reimbursement issues Patient related barriers (poor treatment adherence, etc) Slide courtesy of Dr. Patrick Milligan. DSM Substance Use Disorder Loss of Control More than intended Amount used Time spent Unable to cut down Giving up activities Craving Formerly Dependence Physiology Tolerance Withdrawal Consequences Unfulfilled obligations Work School Home Interpersonal problems Dangerous situations Medical problems Formerly Abuse A substance use disorder is defined as having or more of the above characteristics in the past year resulting in distress or impairment Tolerance and withdrawal alone don t necessarily imply a disorder Severity is rated by the number of symptoms present: = mild = moderate 6+ = severe American Psychiatric Association. (). DSM (th ed.). Arlington, VA: American Psychiatric Association.

6 SAMHSA/Center for Substance Abuse Treatment Distribution of Opioid Treatment Programs in the US WA MT OR ND ID WI SD WY NY IA PA 7 IL 66 UT CO CA 7 AZ KS 8 OH 6 WV 9 VA NC 6 TN AR SC AL GA LA 8 AK MA RI 7 CT NJ DE KY MS TX 8 IN MO OK NM NH 8 MI NE NV ME VT 7 MN MD 6 DC 6 Number of OTP doctors or more 7 to to 6 7 to to 6 FL HI Puerto Rico 6 & US Virgin Islands Acknowledgment of Commercial Support This activity is supported by an educational grant from Indivior, Inc. Contact Information Call (toll free) info@med iq.com Please visit us online at IQ.com for additional activities provided by Med IQ. 6

7 To receive credit, click the Get Credit tab at the bottom of the webcast for access to the evaluation, attestation, and post test. 7 Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors. 7

8 Abbreviations/Acronyms DSM- = Diagnostic and Statistical Manual of Mental Disorders Fifth Edition ER = extended release LA = long acting MAT = medication-assisted treatment MI = motivational interviewing NPR = narcotic pain reliever OTP = Opioid Treatment Program OUD = opioid use disorder SAMHSA = Substance Abuse and Mental Health Services Administration SMART = Specific, Measurable, Attainable, Realistic, Time-Related US = United States