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BUT…..I GOT A SCRIPT FOR IT!
“But I Got A Script For It”
Presented by: Vanessa Price
October 18, 2011
© Vanessa Price, October 18, 2011The following presentation may not be copied in whole or in part without the written permission of the author or the National Drug Court Institute. Written permission will generally be given without cost, upon request.
BUT…..I GOT
A SCRIPT FOR IT!
HOW PRESCRIPTION DRUG ABUSE
AND ADDICTION
CAN IMPACT THE DRUG
COURT SETTING
OBJECTIVES • Identify trends in prescription medication use, abuse, and dependence
• Discuss how the trends may impact your specialty court
• Utilize information discussed to improve service delivery
Legitimate Usage• Acute medical paint
treatment and humane hospice care for cancer patients (opioids)
• Serious anxiety disorders (benzodiazepines)
• Stimulants have a range of valuable uses in the medical field
Challenges• Development of
national policy that balances efforts:– to minimize abuse of
prescription drugs– need to ensure access for
their legitimate useDevelopment
of Specialty Court
Responses
• Prescription drug abuse and addiction has traditionally been overlooked when considering its impact on criminal justice
• National studies and published reports indicated that the abuse of prescription and over-the-counter (OTC) drugs is a growing concern
• The impact of prescription drug abuse and addiction on the criminal justice system must be considered in the design of, target population, and service delivery in specialty courts
National PerspectivesLocal Impact
• Yahoo – 9,360,000• Lost talents
– Freddie Prinze @ 22– Howard Hughes @ 70– Elvis Presley @ 42– Russell T. Jones @ 35– Dinah Washington @ 29– Chris Benoit @ 40– Anna Nicole Smith @ 39– Keith Moon @ 32– Dana Plato @ 34– Judy Garland @ 47– Jimi Hendrix @ 27
January 2007January 2007
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
Rogue Internet Pharmacy Avg*U.S. Pharmacy Avg Excluding (34) Rogue Internet Pharmacies
DO
SA
GE
UN
ITS
Comparison of CY2006 Purchases of Comparison of CY2006 Purchases of Hydrocodone by PharmaciesHydrocodone by Pharmacies
*Based on 34 Suspected Rogue Pharmacies (Operating via the Internet)(as of 3/7/2007) Date Prepared: 03/07/2007
Source: ARCOS
2.9 million 88,000
January 2007January 2007
Cyber vs. Brick & Mortar SalesCyber vs. Brick & Mortar Sales
*SOURCE: 2003 NCPA-Pfizer Digest New York, New York - June 26, 2003
Average Independent ‘Brick & Mortar’
Pharmacy*
‘Cyber’ Pharmacy
Pre
scri
ptio
ns
Fill
ed P
er
Da
y
Noncontrolled RXs(89%)
Noncontrolled RXs (5%)
Controlled Substance RXs
(95%)
Controlled Substance RXs (11%)
Sources of Pain Relievers/Nonmedical Use
• 56% free from friend or relative
• 19% from one doctor• 7% other source• 4% bought from
drug dealer• 5% took from friend
or relative without asking
• 9%Bought from friend or relative
Drug Involved Impact
• More than 50% of violent crimes
• 60-80% of child abuse and neglect cases
• 50-70% of theft and property crimes
• 75% of drug dealing• 1.5 million prison-bound
arrestees at risk for drug abuse or dependenceBelenko and Pough, 1998; National Institute of Justice 1999Urban Institute Report, April 2008
National Picture 11 million people pass through American jails each year
• 46% were on probation/parole at the time of arrest
• 41% had current or prior violent offenses
• 46% were nonviolent repeat offenders
• 13% had a current or prior drug offense only
77% of convicted jail inmates were alcohol or drug-involved at the time of their current offense
www.ojp.usdoj.gov
DEA 2010 Data • Narcotic analgesics were the third most frequently prescribed class of drugs– 244 million prescriptions
• 12 or OLDER, the proportion that reported pain reliever abuse increased more than fourfold between 1998 and 2008– From 2.2% to 9.8%
Prescription Percentages
Analgesics Reports137,670
• Oxycodone 41.36%• Hydrocodone 31.95%• Buprenorphine 7.10%• Methadone 6.03%• Morphine 5.05%• Codeine 2.50%• Hydromorphone 1.79%• Propoxyphene 1.50%• Tramadol (uncontrolled)
1.01%• Oxymorphone 0.50%• Opium 0.42%• Fentanyl 0.42%• Meperidine 0.16%• Other narcotics 0.11%
Regional Reporting Trends
• Northeast– 54% Oxycodone– 17% Buprenorphine
• West– 38% Hydrocodone
For practioners living in these regions…how can these trends impactTreatmentSupervision Drug Testing
Tranquilizers and Depressants
• 4% of all drug reports in 2010– Alprazolam accounted for
52%• 59% in South• 50% Midwest
– Clonazepam accounted for 18% in Northeast
– Diazepam accounted for 13% in the West
For practioners living in these regions…how can these trends impactTreatmentSupervision Drug Testing
My First Time • 2010 SAMHSA Survey– 12-49 years of age
• 21.0 years for pain relievers• 21.2 years for cocaine and
stimulants• 24.6 years for tranquilizers• 22.8 years for OxyContin
Juvenile Specialty CourtsFamily Specialty CourtsAdult Specialty CourtsDWI Specialty CourtsVeterans Specialty Courts
At Risk Populations
• Adolescents• College Students• Elderly• Chronic Pain Sufferers• Physical Laborers• VeteransTarget Population?Monitoring Resources?Service Delivery?Eligibility
Requirements
Speaking of EducationAdderalland the
College Student
– Full time student 18-22 were twice as likely to use adderall
– 3 times more likely to use THC
– 8 times more likely to use cocaine
– 8 times more likely to use tranquilizers
– 5 times more likely to use prescription pain relievers
POLY-DRUG USE ISSUES
Older Adults • Nonmedical use of prescription type drugs was as common as use of marijuana among adults aged 60 or older
• Among adults aged 50 or older who used illicit drugs in the past year 31.5% used only prescription type drugs non-medically
Veterans• Illicit drug use
increased from 5% to 12%– Activity duty service
members– 3 year period (2005-2008)– Primarily attributed to
prescription drug abuse
Recovery Field Response
• Only 12.5 percentof those with a prescription drug use disorder in the past year received specialty treatment for drug problems in that period
• You don’t know what you don’t know
The ExcusesWhere did that new
bottle of pills come from?
Those are not mine?My car was broken into?
Those are for my dog?I got a prescription
though!My doctor knows about
this….Really.
Signs of addiction and abuse
• Doctor Shopping• Rapid Increase in the
amount of medicine needed
• Frequent, unscheduled refill request
• Continually losing prescriptions
• Taking higher doses despite warnings
• Stealing, forging or selling prescriptions
• Excessive mood swings
PHYSICIANS • Research shows that by discussing problems, physicians can have a powerful effect on a patient’s willingness to address addiction
• Educating community physicians about drug court and its purpose to gain support
Physicians • Help to identifying prescription drug abuse when it exists
• Helping the patients recognize abuse problems
• Supporting the patients in seeking appropriate treatment
• Patient Accountability
Collaborations• Screening about AOD
Abuse, current prescriptions and OTC use and reasons
• Prescribing Physicians Forms
• Non-Narcotic Options, when appropriate
• Utilizing Resources –PDMP website (doctor shopping)
PMDP • Prescription Drug Monitoring Programs
• DEA• Electronic database • Collects electronic data
on substances dispensed in a state
• 37 states operational• 8 states have enacted
legislation but not yet operational
• 5 states have legislation pending
Key Community Stakeholders
• PDMP (Prescription Drug Monitoring Program)– assist law
enforcement in the collection and analysis of data related to controlled substances
– centralized database administered by an authorized state agency.
– activities related to the illegal prescribing, dispensing and procuring of controlled substances
COLLABORATE • Judicial Intervention• Specialized Treatment
Plans• Supervision• Physician Support• Participant Involvement
Positive OutcomesPain Management
ContractsYou are FIRED!
TEAM APPROACH • Look at program policy regarding prescription drugs
• How is team monitoring and sharing information
• What type of boundaries exist to maintain accountability and protect privacy of participant
• ALWAYS ALWAYSALWAYS FACTOR IN HIPPA RESTRICTIONS
Recovery Based Care
• Recovery-based care refers to a philosophy of how systems should operate to provide support to individuals with substance use problems and disorders
• Recovery-oriented systems are a holistic, public health approach, focusing on the physical, mental, spiritual and social wellness of the individual
• SAMHSA Standards
Goals and Outcomes of
working together• To intervene earlier• To respond
appropriately• To improve treatment
outcomes• To support long-term
recoveryIf I were suffering from
heart disease would you just address that issue for 28 days, 6 months, a year?
National Support • White House Position Paper– Epidemic: Responding
to America’s Prescription Drug Abuse Crisis
– Critical role of• Parents• Patients• Healthcare Providers• Manufacturers
Suggested Reading and
Resources
• Harrison narcotics Act 1914• Federal Pure Food Drug Act of 1906• Comprehensive Drug Abuse Prevention
and Control Act of 1970• Drug Court 10 Key Components• DEA State Prescription Drug Monitoring
Programs Q&A• Epidemic: Responding to America’s
Prescription Drug Abuse Crisis• Prescription for Disaster: How teens abuse
medicine• NSDUH Report (Sept 2011 & April 2009)• SAMHSA – Results from the 2010 National
Survey on Drug Use and Health: Summary and national findings
• NFLIS 2010 Annual Report• SAMHSA KAP Series TIP 13, 28, 30, 33, 40,
43, 42, 43, 44, 45, 49• www.dea.gov• www.allrise.org• www.samhsa.gov• www.nida.nih.gov• www.nlm.nih.gov
Questions?
Thank YouInspector Vanessa Price
Law Enforcement Consultantcoreinc05@cox.net
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