Primary Prevention ofRx Opioid Abuse or Misuse
14 percent of U.S. residents- an estimated 35 million people age 12 and older -report the nonmedical use of Rxpain relieversU.S. consumes 80% of opioidsworldwideSOURCE: 2009 National Survey on Drug Use and Health (NSDUH). SAMHSA and the Division ofPharmacologic Therapy, Center for Substance Abuse Treatment, SAMHSA,
PRESCRIPTION OPIOIDS (PAINKILLERS)Opioids are drugs that contain opium or are derived fromand imitate opium:• Are used for pain relief and are available only byprescription.• Are non-refillable and when used properly under amedical doctor's supervision, are safe and effective.They effectively change the way a person experiencespain.Users experience a general sense of well-being by reducedtension, anxiety, and aggression.
Illicit drug use initiates age 12 or older by drugSOURCE: Past year illicit drug initiates, 2010 National Survey on Drug Use and Health, SAMHSA.
All opiates:• High abuse potential• High addictive potential• High overdose potential• Feel good• Block pain• Depress breathing
Drug-related emergency department visits in U.S. involving the non-medicaluse pharmaceuticals and abuse of illicit drugs: 2004 - 20101,400,0001,345,645Misuse or Abuse ofPharmaceuticals1,200,0001,000,000991,6401,171,024Misuse or Abuse ofIllicit Drugs800,000626,472600,000400,000200,00002004 2005 2006 2007 2008 2009 2010SOURCE: Center for Substance Abuse Research (CESAR), University of Maryland , adapted from the Substance Abuse and Mental HealthServices Administration (SAMHSA), “Highlights of the 2010 Drug Abuse Warning Network (DAWN) Findings on Drug-Related EmergencyDepartment Visits,” The DAWN Report, July 2, 2012. Available online athttp://www.samhsa.gov/data/2k12/DAWN096/SR096EDHighlights2010.pdf.
Drug abusers will usewhatever’s available.Rx opiates and heroinare now part of the mixeven in Minnesota.
Prescription painkillers sold by state per 10,000 population (2010)12.6 = Florida11.8 = Tennessee, Nevada11.6 = Oregon10.2 = Delaware9.8 = Maine9.7 = Alabama9.2 = Washington, Oklahoma9.0 = Kentucky8.1 = Michigan7.9 = Ohio7.5 = Idaho7.2 = Missouri6.5 = Wisconsin6.2 = California5.5= South Dakota5.0 = North Dakota4.6 = Iowa4.2 = Minnesota3.9 = District of Columbia3.7 = IllinoisUS overall = 7.1SOURCE: Automation of Reports and Consolidated Orders System (ARCOS) , US Drug Enforcement Administration (DEA), 2010
exhibit 11Prescription painkillers sold in Minnesota - 2011SOURCE: Automation of Reports and Consolidated Orders System (ARCOS), U.S. Drug Enforcement Administration, 2012. Prescription opiateanalgesics (painkillers) include: codeine, morphine, fentanyl (brand names: Sublimaze, Actiq, etc), hydrocodone (brand names: Vicodin,Lortab), hydromorphone (brand names: Dilaudid, Palladone), meperidine, pethidine (brand name: Demerol), and oxycodone (brand names:OxyContin, Percodan, Percocet).
Law enforcement seizures of heroin and prescription opiatescontinue to escalate.Opiate Summary 2010 - 2011: Minnesota Drug Task ForcesHeroin seized(grams).Heroin arrestsOxycodone seized(dosage units)2010 2011percent change2010 to 2011Heroin seized228 406 78(grams)108 206Heroin arrests 108 196 81.5 90.7Oxycodone seized(dosage units)2010 2011percent change2010 to 2011228 40678944 3,409 261944 2,586173.9Pill arrests 483 531 10% of total arrests that14.3 14.9 --Pill arrests involve pills483 502 3.9SOURCE: Minnesota Office of Justice Programs, Minnesota Department of Public Safety, audited and updated June 20, 2012. As of January 2012, there are 23multijurisdictional law enforcement drug and violent crime task forces operating throughout Minnesota, staffed by over 200 investigators from over 120agencies.
In 2011 the Red Lake Nation, Leech Lake Band of Ojibwe,and the White Earth Band of Chippewa declared public healthemergencies due to prescription opiate and illegal drug abuseon their reservations.
Thefts of controlled substances, mostly prescription narcotics,from Minnesota pharmacies are increasing.Theft or loss of controlled substances inMinnesota reported to the DEA: 2006 - 2010SOURCE: Minnesota Department of Health from the U.S. Drug Enforcement Administration. Compiled from“Form DEA-106, Theft or Loss of Controlled Substances.” This form is filed to report a theft or loss ofcontrolled substances due to “employee pilferage” or “other” that occurred at a Minnesota hospitalpharmacy, clinic pharmacy, retail pharmacy physically co-located in a clinic or hospital, or practitioners whowere licensed to store controlled substances for use by patients (e.g., outpatient surgery center).
Admissions to addiction treatment for heroin and otheropiates are rising throughout the State.Minnesota statewide addiction treatment admissionsby primary substance of abuse excluding alcohol: 2007 – 201120Percent of admissions181614121086marijuanamethcocaineheroin/other opiatesother4202007 2008 2009 2010 2011SOURCE: Drug and Alcohol Abuse Normative Evaluation System, Minnesota Department of Human Services,Performance Measurement and Quality Improvement Division, 7/26/2012.
St. Paul Pioneer PressMay 26, 2012
The challenge:How to reduce the nonmedical abuse of Rxdrugs, while maintaining access tolegitimately used Rx medicationsRequires community collaboration and cooperation acrossmultiple levels of government and tribes.
The MinnesotaState Substance Abuse Strategy
The MinnesotaState Substance Abuse StrategyImmediate Policy Priorities:Prescription Opiate/Heroin Abuse and Addiction• Train Minnesota physicians in the basics of addiction, opiate prescribing and alternativeapproaches to pain management and require CME units in addiction, Rxing opiates andpain management.• Train a broad range of front-line professionals about prescription drug abuse, treatmentoptions for opiate addicts and how to reverse an opiate overdose, including licensedaddiction treatment providers, detox staff, law enforcement and first responders.• Accelerate efforts to increase participation by prescribers and pharmacists in thePrescription Monitoring Program and examine alternate methods for law enforcementaccess. As of March 2013: 40 percent of pharmacies and 30 percent of doctors use it.
MN PRESCRIPTION MONITORING PROGRAM (MN PMP)• Purpose: Promote public health and welfare by detecting diversion,abuse, and misuse for the prescription medications classifiedas controlled substances under the Minnesota statutes.‣ Designed to be a source of information for prescribers andpharmacists;‣ Also used as an investigative tool by law enforcement and medicalexaminers The PMP is not intended to:‣ Prevent people from obtaining needed drugs; or‣ Decrease the number of doses dispensed
WHO REPORTS THE DATA?• MN Licensed Pharmacies 1,890 In state Mail order• Prescribers Dispensing for outpatient use
ACCESS TO THE MN PMP DATAPrescribers of controlledsubstances with a valid DEAnumber who are prescribing orconsidering prescribing acontrolled substance for a currentpatient.• Agent or employee of theprescriber who has beendelegated by the prescribertasks related to accessing thedata.Pharmacists who aredispensing or consideringdispensing controlled substancesto an individual.• Agent or employee of thepharmacist who has beendelegated by the pharmacisttasks related to accessing thedata.
ACCESS THE MN PMP DATA-CONTINUEDThe law also provides access to the MN PMP data by thefollowing:Minnesota Restricted Recipient Program staff (MN Department ofHuman Services. MN Health Care Program)Medical Examiner/CoronerIndividual (request by mail only)Law Enforcement (search warrant required)
APPROVED ACCESS & VOLUME OF USE‣ 9,600+ Approved for Use• 6,317 Prescribers• 2,412 Pharmacists• 441 Delegates‣ 33,000 queries monthly