Medication Misuse and Abuse: A Growing Epidemic Colorado Providers Association Professionalizing Prevention June 19, 2015 Mancia Ko, PharmD, MBA Associate Director, Medical Affairs,, Ameritox Assistant Clinical Professor Skaggs School of Pharmacy, University of Colorado
Objectives Highlight the current state of prescription abuse in the US Discuss clinical recommendations from national organizations and on how to minimize this abuse Discuss the role of urine drug testing in minimizing abuse in patients with chronic pain Best practices in chronic pain management
Prescription painkiller overdoses are a public health epidemic - CDC CDC. POLICY IMPACT: PRESCRIPTION PAINKILLER OVERDOSES
New Illicit Drug Use United States, 2011 Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
Colorado is No. 2 in the Nation in Non-Medical Use of Rx Pain Reliever Prevalence for Non-Medical Use of Rx Pain Reliever SAMHSA 6.0% Colorado vs 4.6% National Ranked one of the top 5 states (OR, CO, WA, ID, IN) Combined 2010 and 2011 data among those aged 12 or older Trust for America s Health. Prescription Drug Abuse. http://healthyamericans.org/reports/drugabuse2013/release.php?stateid=co SAMHSA. The USDUH Report. State Estimates of Nonmedical Use of Prescription Pain Relievers. 2013. http://www.samhsa.gov/data/2k12/nsduh115/sr115- nonmedical-use-pain-relievers.htm
Sources of Non-medically Used Analgesics 1 71% of opioids used by non-patients are obtained from friends or family members Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services 6 Administration, 2012.
Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2010-2011 Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
Number of Benzodiazepine and Narcotic Pain Reliever Combination Admissions: 2000 to 2010 Annual Hospital Admission - 569.7 percent increase from 2000 to 2010 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (December 13, 2012). The TEDS Report: Admissions Reporting Benzodiazepine and Narcotic Pain Reliever Abuse at Treatment Entry. Rockville, MD.
Prevalence of Prescription Drug Misuse Ameritox National Prescription Drug Report. 2014/2015 Issue. Vol. 2
Top 10 States with Prescribed Drugs Not Found Ameritox National Prescription Drug Report. 2014/2015 Issue. Vol. 2 10
Top 10 States with Non-Prescribed Drugs Found Ameritox National Prescription Drug Report. 2014/2015 Issue. Vol. 2 11
Top 10 States with Illicit Drugs Found Ameritox National Prescription Drug Report. 2014/2015 Issue. Vol. 2 12
13 Medication Non-adherence is Critical Barrier in Mental Health
Strategies to Manage Opioid Risk in Chronic Pain Patients
A Need Exists to Balance Access to Pain Medications With Potential Risk Opioid pain relievers play an important role in the treatment of chronic pain, 1 but prescription pain relievers may be used inappropriately 2 1.Trescot AM, et al. Pain Physician. 2008;11(suppl):S5-S62. 2.EMBEDA prescribing information. Bristol, TN: King Pharmaceuticals, Inc.; 2009.
UDT Has Become a Standard of Care APS/AAPM 2009 COT Guidelines 1 Expanding State Regulations Expert Consensus Recommendations presented at AAPM in February 2012: Sponsored by Ameritox through an unrestricted grant to Thomas Jefferson University Monitoring Frequency by Patient Risk Level LOW Risk of Misuse MODERATE to HIGH Risk of Misuse May be periodically eligible for monitoring at each visit, with a minimum of one test conducted every six months (2x/year). May be periodically eligible for monitoring at each visit, with a minimum of one test conducted every three months (4x/year). 1 Chou R., Fanciullo G.J., et al., Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. The Journal of Pain, 2009, 10(2):113-130.
Aberrant Drug-Related Behaviors Purposeful over-sedation Negative mood change Appears intoxicated Increasingly unkempt or impaired Increase dose without authorization Changes route of administration Contact with street drug culture Police arrest Consumption in excess of prescribed dose Car or other accident involvement Reports of lost or stolen prescriptions Uses pain meds in response to situational stress Abuse of alcohol or illicit drugs Victim of abuse Multiple drug intolerances and allergies Frequent early renewals Obtain prescriptions from other doctors Insists on certain medications Hoarding medications Visits without appointments Frequent office calls and visits
Key Take-home Points The misuse and abuse of prescription drugs remains high This misuse and abuse spans many prescription products, ages, and payer types The consequences of this behavior can be devastating to the patient, clinician, and community Universal precautions to balance access to pain medications with potential risk Urine drug testing is an important part of risk assessment