Prescription Drug Abuse National Perspective

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Prescription Drug Abuse National Perspective

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


Commonly Abused Prescription Drugs


The Prescription Drug Abuse Problem

• 3.99 billion prescriptions dispensed in U.S. in 2010

• 7 million Americans reported non-medical use of

psychotherapeutics in 2009

• 1 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


Number of New Users (Thousands)

New Users in the Past Year of Specific Illicit Drugs among Persons Aged 12 or Older,

2009

3,000

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

1,000

813

702

617

500

0

*

337

186 180

45

*Includes pain relievers, tranquilizers, stimulants, and sedatives

Source: SAMHSA, 2009 National Survey on Drug Use and Health (September 2010).


Millions of Persons

Persons Classified with Substance

Abuse/Dependence on Psychotherapeutics

2.4

2.3

2.2

2.1

2

1.9

1.8

1.7

2003 2004 2005 2006 2007 2008 2009

*

*

Results from the 2009 National Survey on Drug Use and Health (NSDUH): National Findings, SAMHSA (2010).

http://www.oas.samhsa.gov/nsduhLatest.htm.

*Number in 2009 is statistically significantly higher than in 2003.


Prescription Drug Abuse Consequences

• Unintentional deaths

• Emergency Room visits

• Treatment admissions

• Economic Costs


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, https://dawninfo.samhsa.gov/default.asp

Abuse/dependence and nonmedical use in the past month are from the National Survey on Drug Use and Health


Drug-Induced Deaths vs. Other Injury Deaths,

1999–2007

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).


Death rate per 100,000

Unintentional Drug Overdose Deaths

United States, 1970–2007

10

9

27,658 unintentional drug overdose deaths

8

7

6

5

4

3

2

1

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, http://wonder.cdc.gov


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 2007 1

– $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;12:657-667.

2. 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):469-479. 2005


Unique Aspects of Prescription Drugs

• Perceived Risk

• Accessibility and Supply


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):1-11.

2. 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. 2006.


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)


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).


What is Being Done

• Coordinated effort

across the Federal

government

• 4 focus areas

– Education

Prescription Drug

Monitoring Programs

– Proper Medication

Disposal

– Enforcement


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 2000 – 2009. Extracted June 2010.

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvisoryCommittee/UCM217510.pdf


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 2000 – 2009. Extracted June 2010.

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvisoryCommittee/UCM217510.pdf


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


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


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


Prescription Drug Monitoring Programs


Prescription Drug Monitoring Programs


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


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)


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”


Proper Medication Disposal

So how should this happen

– Pharmacies/Pharmacists

– Opportunity for clinical intervention

– Already have secure dispensing protocols

– Reverse distribution authority

– Who pays


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


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


Thank you

For more information:

www.WhiteHouseDrugPolicy.gov

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