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Prescription Drug Misuse, Abuse, and Overdoses

Alcohol and Substance Abuse Council of Jefferson County, Inc.167 Polk Street, Suite 320Watertown, New York 13601Voice: 315-788-4660; Fax: 315-788-4922; Web: www.jcasac.com; Blog: www.jcasac.com/blog

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What is Prescription Drug Abuse? Use of a medication without a

prescription Use in ways other than as prescribed Use for the experience or feelings

elicited

Source: http://www.drugabuse.gov/publications/research-reports/prescription-drugs/what-prescription-drug-abuse

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Prescription Drug OverdoseDefinition Type of poisoning

Prescription drugs used in AMOUNTS or IN WAYS NOT recommended

No harm intended by user

Limited number of ingestions by young children or innocent mistakes by patientsSource: Public Health Grand Rounds, February 17, 2011, Center for Disease Control and Prevention

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Types of Drugs and Reasons for Use Types of Drugs

Drugs that depress breathing▪ Opioid pain medication▪ Sedative/hypnotics

Usually multiple drugs involved Frequently combined with illicit drugs

Reasons for use Original use: relief of pain and anxiety Development of tolerance Escalated use for “high”

Source: Public Health Grand Rounds, February 2011, Center for Disease Control and Prevention

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Most Commonly Abused Prescription DrugsOPIOIDS – INDICATED FOR PAIN Hydrocodone

(Vicodin) Oxycontin Propoxyphene

(Darvon) Diphenoxylate

(Lomotil) Fentanyl

DEPRESSANTS – INDICATED FOR ANXIETY AND SLEEP DISORDERS

Barbiturates Pentobartil sodium

(Nembutal) Benzodiazepines Diazepam (Valium) Alprazolam (Xanax) Corvalolum

Source: www.oasas.ny.gov/StopRxMisuse/comRX.cfm

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Increase of Total Number of Opioid Prescriptions, 1991-2010

Source: http://www.drugabuse.gov/publications/research-reports/prescription-drugs/what-are-some-commonly-abused-prescription-drugs

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Because of the increase in the number of prescriptions drugs, more medications are available for misuse/abuse and diversion

Prescription drug misuse/abuse and diversion have tremendous impacts on the individual, the community, and the healthcare and judicial systems

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Prescription Drug Overdoses - A Public Health Epidemic 2008 – 15,000 fatal

overdoses 1999 – 4,000 fatal overdoses

2010 - 1 in 20 people age 12> reported using prescription painkiller for nonmedical reasons in the past year

2009 – Approx. 500,000 ER visits due to misuse or abuse of prescription medication

1 Month – Enough prescription painkillers were prescribed in 2010 to medicate every American adult 24/7 for a month

More men than women die of overdoses from prescription painkillers

People in rural counties are 2 times as likely to overdose on prescription painkillers

Source: CDC Vital Signs, November 2011

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Implications of Pain Medication Deaths

In 2008, 14,800 prescription pain medication deaths

For every 1 death there are

▪ 10 treatment admissions for abuse

▪ 32 emergency department visits for misuse or abuse

▪ 130 people who abuse or are dependent

▪ 825 nonmedical users Source: http://www.questdiagnostics.com/dms/Documents/health-trends/PDF-MI3040_PDM-Report_24638_FIN_Digital_4-20-12/PDF%20MI3040_PDM%20Report_24638_FIN_Digital_4-20-12.pdf

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Impact of Opioid Pain Medication Abuse

Nonmedical users

People who abuse or are dependent

ED visits for misuse or abuse

Treatment admissions for abuse

825

130

32

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For every 1 overdose death there are

Source: http://www.questdiagnostics.com/dms/Documents/health-trends/PDF-MI3040_PDM-Report_24638_FIN_Digital_4-20-12/PDF%20MI3040_PDM%20Report_24638_FIN_Digital_4-20-12.pdf

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Projected Impact of Opioid Pain Medication Abuse Using CDC 2008 Death Methodology

Total number impacted

Nonmedical users

People who abuse or are dependent

ED visits for misuse or abuse

Treatment admissions for abuse

Overdose deaths

14,755,600

12,210,000

1,924,000

473,600

148,000

14,800

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Distribution of Narcotic Analgesics to Patients by Health Care Setting, National Percentages

Hospital outpatient departments

8%

Emergency departments

39%

Primary care of -

fices30%

Medical specialty offices13%

Surgical specialty of -fices 10%

Source: Center for Disease Control, Public Health Grand Rounds, National Center for Health Statistics. Vital Health Stat 13 (163). 2006; www.cdc.gov/nchs/data/series/sr_13/sr_13163.pdf

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Opioid Pain Medication Use: Sources for nonmedical users, United States, 2009

Prescribed to someone else

76%

Pre-scribed to user

20%

Other4%

Source: Public Health Grand Rounds, February 2011, National Survey on Drug Use and Health. Summary of national findings, 2008-2009, www.oas.samhsa.gov

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Total Numbers of Deaths from Overdoses, 2000-2012, Jefferson County (January – September 2012)

2000200120022003200420052006200720082009201020112012

1 1

4 3 2 2 3

8

5

8

4

15

6

3 35 5 4 3

6

108 9 8

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Opiate Overdoses Total Overdoses

Source: JEFFERSON COUNTY PUBLIC HEALTH SERVICE, MEDICAL EXAMINER PROGRAM, Numbers of Deaths from Total Overdoses; Opiates Overdoses, 2012:. Through September 2012, there have been 8 confirmed overdoses, with another 3 suspected (under review). Of the confirmed cases, 6 are opiates overdoses.

 

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Projected Impact of Opioid Abuse in Jefferson County Using CDC Death Methodology, Jefferson County

Nonmedical users

People with abuse/dependence

ED visits for misuse or abuse

Treatment admissions for abuse

4950

780

192

60

12375

1950

480

150

3330

520

128

40

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Estimated Number (in thousands) of Past Year Users of Prescription Drugs Used Nonmedically, U.S. Residents Ages 12 and Older, 2002-2011

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

400

800

1,200

1,600

2,000

TranquilizersStimulants

Pain Relievers*

Sedatives*

Number of Past Year Users

(in thousands)

SOURCE: Adapted by CESAR from Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Detailed Tables, 2012. Available online at http://www.samhsa.gov/data/NSDUH/2011SummNatFindDetTables/Index.aspx.

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Beginning to Address Prescription Drug Use, Abuse, and Overdoses

Education Increase Awareness Safe medication use, storage, and disposal

Education for health care providers Appropriate prescribing Adverse events and drug interactions Identifying those at risk for abuse Counseling on proper storage and disposal Screening, intervention, and referral for those

misusing or abusing prescription drugsSource: Source: Public Health Grand Round, February 17, 2011, Center for Disease Control and Prevention;

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Prescription Drug Monitoring Program (PDMPs) Tool to identify

Inappropriate prescribing, dispensing, and drug-seeking behavior

Drug interactions and therapeutic duplication

Goals All states have operational PDMPs Mechanisms in place for communication between

states High utilization among health care providers▪ Regular part of office visit like checking insurance

coverageSource: Public Health Grand Rounds, February 2011, Center for Disease Control and Prevention

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Proper Medication Disposal Goals

To be easily accessible and an environmentally friendly method of drug disposal

To be cost-effective and not a burden on consumers

To reduce the amount of prescription drugs available for diversion and abuseSource: Public Health Grand Round, February 17, 2011, Center for Disease Control and

Prevention

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Enforcement

Assist in addressing doctor and pharmacy shopping

Support prescription drug abuse-related training programs for law enforcement

Source: Public Health Grand Round, February 17, 2011, Center for Disease Control and Prevention

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911 Good Samaritan Law

Signed into effect on September 18, 2011

Rationale: To save lives; to grant limited shield from charge and prosecution

In 2008, 900 people died from accidental drug overdoses in New York State

www.drugpolicy.org http://www.ithaca.edu/sacl/healthpromotion/docs/nysgoodsamaritan.pdf

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Next Steps

Discussions

Who needs to be at the table but is not?

Who will invite that person or entity?

Other