PRESCRIPTION DRUG ABUSE:THE NATIONAL PERSPECTIVEMay 19, 2012National Association Boards of Pharmacy Annual MeetingGil Kerlikowske, DirectorWhite House Office of National Drug Control Policy
National Drug Control Strategy• Science-based, public health approachto drug policy• Guided by three principles:1) Addiction is a disease that can be treated2) People with substance use disorders can recover3) Criminal justice reforms can stop the revolvingdoor of drug use and crime2012• Coordinated federal effort on 115action items• Signature initiatives:– Prescription Drug Abuse– Prevention– Drugged Driving
The Prescription Drug Abuse Problem• 478 million prescriptions for controlled-substancesdispensed in U.S. in 2010• 7 million Americans reported current non-medical use ofprescription drugs in 2010• 1 in 4 people using drugs for first time in 2010 began byusing a prescription drug non-medically• Nearly 15,600 overdose deaths involving opioid painkillersin 2009 (vs. 4,000 for cocaine and 3,000 for heroin)
Number of PrescriptionsPrescriptions Dispensed for Select Opioids in U.S.Outpatient Retail Pharmacies, 2000-2009140,000,000120,000,000100,000,00080,000,00060,000,00040,000,00020,000,00002000 2001 2002 2003 2004 2005 2006 2007 2008 2009Hydrocodone Oxyocodne Oxycodone methadone Methadone buprenorphine Buprenorphine Tramadol tramadolSource: SDI, Vector One: National. Extracted June 2010.
Number of New Users (Thousands)Past Year New Users of Specific Drugs,Persons Aged 12 or Older, 20102,5002,0002,426 2,4172,004Note: The specific drug refers to the drugthat was used for the first time in the pastyear, regardless of whether it was the firstdrug ever used or not.1,5001,2381,000937 973624 6375000MarijuanaPsychotherapeutics*EcstasyPainRelievers*Tranquilizers*InhalantsStimulants**Includes pain relievers, tranquilizers, stimulants, and sedatives377252Cocaine LSD Sedatives*140Heroin45PCPSource: SAMHSA, 2010 National Survey on Drug Use and Health (September 2011)
Emergency Department Visits, 2004-2009
Death rate per 100,000Unintentional Drug Overdose DeathsUnited States, 1970–2009109828,754 unintentional drug overdose deaths in 2009Rx7654321HeroinHeroinCocaineCocaine0'70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06 08Source: National Vital Statistics System, http://wonder.cdc.gov (May 2012).
NUMBER OF DEATHSDrug-Induced Deaths vs. Other Injury Deaths,1999–200950,00045,00040,000Injury by firearms Drug-induced Homicide Suicide Motor vehicle accidents35,00030,00025,00020,00015,00010,0005,00001999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009Causes of death attributable to drugs include accidental or intentional poisonings by drugs and deaths from medical conditions resulting from chronic drug use.Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Not all injury cause categories are mutually exclusive.Source: National Center for Health Statistics, Centers for Disease Control and Prevention. National Vital Statistics Reports Deaths: Final Datafor the years 1999 to 2009 (January 2012).
Public Health Impact of Opiate Analgesic AbuseFor every 1 unintentional opioid overdose death in 2009, there were…Abuse treatment admissionsED visits for misuse or abuse1141People with abuse/dependence148Nonmedical users419Mortality figure is for unintentional overdose deaths due to opioid analgesics in 2009, from CDC/WonderTreatment admissions are for with a primary cause of synthetic opioid abuse in 2009, from TEDSEmergency department (ED) visits related to opioid analgesics in 2009, from DAWNAbuse/dependence and nonmedical use of pain relievers in the past month are from the 2009 National Survey on Drug Use and Health
Source of Prescription Pain RelieversSource: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2009-2010
Economic Costs• $55.7 billion in costs for prescription drugabuse in 2007 1–$24.7 billion in direct healthcare costs• Opioid abusers generate, on average,annual direct health care costs 8.7 timeshigher than non-abusers 21. Birnbaum HG, White, AG, Schiller M, Waldman T, et al. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. PainMedicine. 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
Economic Costs• Maternal opioid dependence can affect birth costs• A recent study showed in 2009, the average hospital stay foropioid exposed infants with neonatal abstinence syndrome(NAS) was 16 days 1• The hospitalization cost of treating each baby with NASaveraged $53,400 2• State Medicaid programs paid for 77.6% of these births 31. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures:United States, 2000-2009. JAMA. 2012 May 9;307(18):1934-40. Epub 2012 Apr 302. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures:United States, 2000-2009. JAMA. 2012 May 9;307(18):1934-40. Epub 2012 Apr 303. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal Abstinence Syndrome and Associated Health CareExpenditures: United States, 2000-2009.. JAMA. 2012 Apr 30. Epub ahead of print
Prescription Drug Abuse Prevention Plan• Coordinated effort acrossthe Federal government• Four focus areas1) Education2) Prescription DrugMonitoring Programs3) Proper MedicationDisposal4) Enforcement
Education GapsHealth Care Providerso 2000 survey: 56 % of residency programs required substance use disordertraining, median number of curricular hours ranged from 3 to 12 hours 1o 2008 follow-up: “Although the education of physicians on substance usedisorders has gained increased attention, and progress has been made toimprove medical school, residency, and post-residency substance abuseeducation since 2000, these efforts have not been uniformly applied.” 2Pharmacists 3o 67.5% report receiving two hours or less of addiction or substance abuseeducation in pharmacy schoolo 29.2% reported receiving no addiction educationo Pharmacists with greater amounts of addiction-specific education:• Higher likelihood of correctly answering questions relating to the science of addictionand substance abuse counseling• Counseled patients more frequently and felt more confident about counseling1. Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A National Survey of Training in Substance Use Disorders in Residency Programs. J Stud Alcohol. 61(6):912-915. 2000.2. Polydorou S, Gunderson EW, Levin FR. Training Physicians to Treat Substance Use Disorders. Curr Psychiatry Rep. 10(5):399-404. 2008.3. Lafferty L. Hunter TS, Marsh WA. Knowledge, attitudes and practices of pharmacists concerning prescription drug abuse. J Psychoactive Drugs. 2006 Sep:38(3):229-232.
EducationEducation Goalso Knowledge on appropriate prescribingo Effectively identifying patients at risk for abuseo Screening, intervention, and referral for those misusing or abusing prescriptiondrugso PDMP use in everyday clinical practiceo Ensure community leader, parents, and young people understand the dangers ofprescription drug misuse.Main Actionso Legislation requiring mandatory education for all clinicians who prescribecontrolled substanceso Increased substance abuse education in health profession schools, residencyprograms, and continuing educationo Expedited research on the development of abuse deterrent formulations
Prescription Drug Monitoring ProgramsSource: Alliance of States with Prescription Monitoring Programs, 2012
Proper Medication DisposalGoalso Easily accessible, environmentally friendly method of drug disposalthat reduces the amount of prescription drugs available for diversionand abuseMain Actionso Publish and implement regulations allowing patients and caregivers toeasily dispose of controlled substance medicationso Once regulations are in place, partner with stakeholders to promoteproper medication disposal programs
EnforcementGoalso Increase law enforcement and prosecutor training aroundprescription drug diversion and abuseo Assist states in addressing “pill mills” and doctor shoppingMain Actionso Provide technical assistance to states on model regulations/lawsfor pain clinicso Encourage High-Intensity Drug Trafficking Areas (HIDTAs) towork on prescription drug abuse issueso Support prescription drug abuse-related training programs forlaw enforcement
Conclusions• Prescription drug abuse is one of the fastest growing drugproblems in the U.S.• No simple solution, we all have a role to play• Success will come from coordination and collaboration at theFederal, state, local, and tribal levels
For More Information:WHITEHOUSE.GOV/ONDCP