Role of PMPs in Preventing Substance Abuse National Conference of State Legislatures December 6, 2006 San Antonio, Tx

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1 Role of PMPs in Preventing Substance Abuse National Conference of State Legislatures December 6, 2006 San Antonio, Tx Nick Reuter Division of Pharmacologic Therapy Substance Abuse and Mental Health Services Administration 1

2 Overview Prescription Drug Abuse- nature and extent of problem Methadone Mortality Treatment Options NASPER Described

3 Fig 2.2 Illicit Drug Use, Ages 12+: Percent Using in Past Month Marijuana Psychotherapeutics Cocaine Hallucinogens Inhalants + Difference between estimate and the 2005 estimate is statistically significant at the.05 level.

4 Fig 7.2 Dependence on or Abuse of Illicit Drugs in the Past Year, Ages 12+: 2005 Marijuana 4,090 Cocaine Pain Relievers 1,549 1,546 Tranquilizers Stimulants Hallucinogens Heroin Inhalants Sedatives ,000 2,000 3,000 4,000 5,000 Numbers Center in for Thousands Substance Abuse Treatment

5 Non-medical Use of Prescription Drugs, Percent Using in Past Month Ages 12+: Any Psychotherapeutics Pain Relievers Stimulants Sedatives Tranquilizers + Difference between estimate and the 2005 estimate is statistically significant at the.05 level.

6 Fig 5.1 Past Year Initiates for Specific Illicit Drugs, Ages 12+: 2005 Numbers in Thousands 2,500 2,193 2,114 2,000 1,500 1,286 1, Pain Relievers Marijuana Inhalants Tranquilizers Cocaine Stimulants Ecstasy Sedatives LSD Heroin PCP

7 Types of Drugs Used by Past Month Illicit Drug Users: Age 12 to 49 and 50+, Annual Averages Percent of Current Users All Other Marijuana & Prescription Drugs Only Prescription Drugs Only Marijuana Only 0.0 Age 12 to 49 Age 50+

8 Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on Performance Measure???

9 Source Where Pain Relievers Were Obtained for Most Recent Non-medical Use among Past Year Users Aged 12 or Older, by Age: 2005 Percent Using in Past Year or Older* * All estimates for persons aged 50 or Older are reported with low precision. Age in Years Other Bought on Internet Drug Dealer/ Stranger 1 or More Doctors Bought/Took from Friend/ Relative Free from Friend/Relative

10 Source Where Tranquilizers Were Obtained for Most Recent Non-medical Use among Past Year Users Aged 12 or Older, by Age: 2005 Percent Using in Past Year * or Older* Other Bought on Internet Drug Dealer/ Stranger 1 or More Doctors Bought/Took from Friend/ Relative Free from Friend/Relative * Estimates for "Bought on Internet" for persons aged and all estimates for persons aged 50 or Older are reported with low precision. Age in Center Years for Substance Abuse Treatment

11 Past Year Non-medical Psychotherapeutic Use Among Adults Age 60+: Age 60+, 2000 and Projected % Increase Population 42m 72m 71% % Using 0.8% 2.0% 138% # Users 0.34m 1.40m 307% Source: Computed from Colliver et al, Annals of Epidemiology, 2006.

12 Characteristics of Prescription Pain Reliever Misuse Perception that prescription medications are not dangerous Iatrogenic dependence/addiction Detoxification and relapse Continuation to I.V. opioid abuse

13 Methadone Mortality Methadone used in addiction and pain relief. Methadone in opioid treatment programs stable. Prescriptions, abuse, and mortality increase over the last 5 years National assessment calls for expanded use of PMPs.

14

15 Pain Reliever Cost Comparison Estimated Monthly Drug Costs Agent Dosage Cost* Methadone 90 pills $ 8.00 SR morphine 60 pills MS Contin 60 pills Oxycontin 60 pills Duragesic 10 patches * -Estimated cost to the pharmacist based on average wholesale prices, rounded to the nearest half dollar, in Red book. Montvale, N.J.: Medical Economics Data, Cost to the patient will be higher, depending on prescription filling fee.

16 NASPER National All Schedules Prescription Electronic Reporting Act of 2005

17 NASPER - P.L Intent 1. to foster the establishment or enhancement of State-administered controlled substance monitoring systems in order 2. to ensure that health care providers have access to accurate, timely prescription history information. 3. for assisting in the early identification of patients at risk for addiction. Early identification will lead to enhanced substance abuse treatment interventions.

18 Alliance Goals for PMPs Education and information Public health initiatives Early intervention and prevention Investigations and enforcement Protection of confidentiality

19 How Formula grant, annual Establishes the authority for a grant program with the Secretary, HHS, wherein a State may submit an application to 1. implement a new controlled substance prescription monitoring system, or 2. to make improvements upon an existing State controlled substance monitoring system.

20 How Much?? Authorizations, Future appropriations - $15 million, no appropriation 06 Minimum Amount no less than 1% of the amount appropriated. Additional Amounts = appropriated amount x number of pharmacies in the state/total number of pharmacies in all approved states.

21 Who is Eligible-requirements D. To participate (1) The State shall require dispensers to report to such State each dispensing in the State of a controlled substance to an ultimate user not later than 1 week after the date of such dispensing. (2) The State may exclude from the reporting requirement of this subsection Direct administration to body of ultimate user Dispensing in quantity 48 hours or less Any other exclusion identified by the Secretary

22 What must be reported (3) The information to be reported under this subsection with respect to the dispensing of a controlled substance (II-IV) shall include the following: (A) DEA Number dispenser. (B) DEA Number and name of the practitioner who prescribed the drug. (C) Name, address, and telephone number of the ultimate user or such contact information of the ultimate user as the Secretary determines appropriate. (D) Identification of the drug by a national drug code number. (E) Quantity dispensed. (F) Number of refills ordered. (G) Whether the drug was dispensed as a refill of a prescription or as a first-time request. (H ) Date of the dispensing. (I) Date of origin of the prescription. (J) Other information as may be required by State law to be reported under this subsection. 4. Database State shall establish and maintain an electronic database containing the information reported to the State under subsection (d).

23 Other Requirements - 1 D. Electronic Standards i an agreement to adopt health information interoperability standards, including health vocabulary and messaging standards, that are consistent with any such standards generated or identified by the Secretary or his or her designee; ii. criteria for meeting the uniform electronic format requirement iii. criteria for availability of information and limitation on access to program personnel; iv. criteria for access to the database, and procedures to ensure that information in the database is accurate; v. criteria for the use and disclosure of information, including a description of the certification process to be applied to requests for information under subsection E. Electronic Format- The Secretary shall specify a uniform electronic format for the reporting, sharing, and disclosure of information under this section.

24 Disclosure Requirements A State may disclose only. Practitioner who certifies State, Local, Federal law enforcement who certifies Another state PMP with agreement Researchers

25 Drug Diversion States, after consultation with stakeholders : Shall establish a program to notify practitioners, dispensers with info to help identify and prevent unlawful distribution, and May notify drug diversion investigators.

26 WHY HHS?? Electronic Health Record Initiative CMS Utilization Public Health Unite with SA Treatment HHS/SAMHSA Drug Abuse Measurement Instruments

27 PMPs Intervention and Prevention Physician Education Prescribing practices Identifying dependence addiction Intervention Screening and referral Treatment

28 Substance Abuse Treatment Drug Free, Therapeutic Community In patient, ambulatory For opioids Opioid treatment programs 1149 programs, 241,000 patients Office-based buprenorphine 9,000 physicians, 130,000 patients

29 Treatment for Abuse/Dependence Last or Current Treatment in the Past Year Annual Averages Based on (in thousands, NSDUH) Any Pain Relievers Tranquilizers - 50 Stimulants - 64 Sedatives - 34

30 Fig 7.7 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12+ Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2005 Did Not Feel They Needed Treatment 94.4% 4.1% Felt They Needed Treatment and Did Not Make an Effort (865,000) 1.4% Felt They Needed Treatment and Did Make an Effort (296,000) 20.9 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use Note: Due to rounding, these percentages do not add to 100 percent.

31 Fig 7.8 Reasons for Not Receiving Substance Use Treatment among Persons Aged 12 or Older Who Needed and Made an Effort to Get Treatment But Did Not Receive Treatment and Felt They Needed Treatment: Combined Cost/Insurance Barriers 44.4 Other Access Barriers Not Ready to Stop Using Stigma Did Not Know Where to Go for Treatment Did Not Have Time Treatment Would Not Help Center Percent for Reporting Substance Reason Abuse Treatment

32 Conclusions SAMHSA recognizes the significant public health problem, current and future associated with prescription drug abuse. Agency is prepared, under NASPER framework, to work with States, other stakeholders to establish, advance PMPs.

33 Role of PMPs in Preventing Substance Abuse National Conference of State Legislatures December 6, 2006 San Antonio, Tx Nick Reuter Division of Pharmacologic Therapy Substance Abuse and Mental Health Services Administration 33

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