Transcript Prescription Drug Abuse EPI Profile Presentation

An Epidemiological Overview
of Nonmedical Prescription
Drug (Rx) Use in Indiana
Eric R. Wright, PhD
Director, Center for Health Policy
SPF SIG
Funding was provided by the U.S. Department of
Health and Human Services’ Center for Substance
Abuse Prevention, as part of the Strategic Prevention
Framework State Incentive Grant (SPF SIG) Program,
and by the Indiana Family and Social Services
Administration/Division of Mental Health and Addiction
through the SAMHSA Substance Abuse Prevention and
Treatment (SAPT) Block Grant CFDA 93.959. The SPF
SIG program sponsors initiatives to encourage states to
engage in data-based decision-making for substance
abuse prevention planning and grant making.
SPF SIG
The Center for Health Policy and the State of Indiana,
represented by the Family and Social Services
Administration (FSSA), Division of Mental Health and
Addiction (DMHA), formed a formal partnership to provide
support in executing the SPF SIG, for the period 2006-2010.
The Center for Health Policy’s role is to provide leadership
and technical support for the State Epidemiology and
Outcomes Workgroup (SEOW), and to develop, implement,
and coordinate a statewide program evaluation initiative to
assess the impact of new prevention programs funded as
part of Indiana's SPF SIG program.
State Epidemiological Profiles
• Annual publications (2006-2009) – currently working on
2010 report
• Available at www.healthpolicy.iupui.edu
• Review of alcohol, tobacco, marijuana, cocaine, heroin,
meth, Rx drugs, and polysubstance abuse
• Companion documents
 Drug Fact Sheets
 English
 Spanish
 Chart Pack (CD)
Recent ATOD Issue Briefs
 What’s Cooking? Meth Use in Indiana (2010)
 An Epidemiological Overview of Alcohol, Tobacco, and Other
Drug Use in Indiana (2010)
 Injection Drug Use In Indiana (2010)
 Economic Impact of Substance Abuse and Misuse in Indiana
(2010)
 Underage Drinking: A Culture of Drinking on Indiana’s College
Campuses? (2009)
 Prescription Drug Abuse Is a Growing Problem in Indiana
(2008)
 Fatal Drug Overdoses: A Growing Concern in Indiana (2008)
Most Commonly Abused Rx Drugs
• Pain relievers (opioids, narcotics)
 Oxycodone (e.g., OxyContin, Percocet), hydrocodone,
codeine, and morphine
• Central nervous system depressants (sedatives,
tranquilizers, hypnotics)
 Barbiturates (e.g., Mebaral, Nembutal) and
benzodiazepines (e.g., Valium, Xanax)
• Stimulants (used to treat attention deficit disorders,
narcolepsy, and weight loss)
 Dextroamphetamine (e.g., Dexedrine, Adderall) and
methylphenidate (e.g., Ritalin, Concerta) 1
The INSPECT Program
• INSPECT: Indiana Scheduled Prescription
Electronic Collection & Tracking Program
• Indiana’s Rx drug monitoring program
• Collects information on all controlled substances
(schedules II-V) dispensed in Indiana
• Maintained by the Indiana Professional Licensing
Agency/Board of Pharmacy
Rx Drugs Dispensed in Indiana
(INSPECT, 2008)
In 2008, almost 11.5 million controlled
substances were dispensed to Indiana
residents
53.2% pain relievers
30.9% CNS depressants
9.9% stimulants
6.2% others
Source: Indiana State Board of Pharmacy, 2010 2
Rx Drugs Dispensed, by Gender
Male
Female
Opioids
54.6%
52.3%
CNS
Depressants Stimulants
25.7%
13.7%
34.3%
7.4%
Note: results were significant, P < .001.
Source: Indiana State Board of Pharmacy, 20102
Rx Drugs Dispensed, by Age Group
Age
Group
0-17
18-25
26-35
36-45
46-55
56-65
65+
Opioids
23.3%
61.6%
61.2%
56.0%
54.3%
53.4%
52.4%
CNS
Depressants Stimulants
5.7%
68.6%
17.6%
17.3%
27.1%
7.4%
32.1%
6.1%
34.6%
4.3%
35.9%
2.9%
39.3%
1.1%
Note: results were significant, P < .001.
Source: Indiana State Board of Pharmacy, 20102
The Growing Problem of Prescription
Rx Abuse
• Abuse of Rx drugs is a serious and growing
public health problem in Indiana and the U.S.
• Almost 52 million Americans (20.8%) ages 12+
have used Rx drugs nonmedically at least once
in their life; this includes pain relievers,
sedatives, tranquilizers, and stimulants (2008).
• In Indiana, over a million Hoosiers (20.7%)
reported that they misused Rx drugs at least
once in their life (2002-2004)3
Lifetime, Past Year, and Current Nonmedical Rx
Drug Use, Indiana and U.S. (National Survey on
Drug Use and Health)
Lifetime Use
Indiana
All Psychotherapeutics
Pain Relievers
OxyContin
Tranquilizers
Sedatives
Stimulants
Past Year
Past Month
Use
Use
U.S. Indiana U.S. Indiana U.S.
20.7% 20.8%
7.6% 6.1%
2.7% 2.5%
15.0% 14.0%
2.5%
1.9%
9.1%
8.6%
3.9%
3.6%
8.3%
8.5%
6.1%
0.8%
2.8%
0.4%
1.7%
2.0%
0.3%
0.8%
0.1%
0.8%
4.8%
0.6%
2.0%
0.2%
1.1%
1.9%
0.2%
0.7%
0.1%
0.4%
Note: Indiana data based on NSDUH averages from 2002-2004 (most recent estimates); U.S. data
based on 2008 results.
Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies,
n.d.3
Nonmedical Pain Reliever Use in the Past Year,
Indiana and U.S., by Age Group (NSDUH, 2008)
20%
15%
10%
5%
0%
Indiana
U.S.
12 -17
7.7%
6.6%
18-25
14.2%
12.1%
26 and older
4.4%
3.4%
Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, n.d.3
Youth Consumption Patterns
• Most 12th grade students received narcotics from a friend
or relative—given for free, purchased, or stolen
• Teenagers of middle- and upper-class socioeconomic
status are most likely to abuse these substances by
crushing and snorting the tablets1
• Pain relievers such as OxyContin and Vicodin are the
most commonly abused prescription drugs by teens
Image Source: http://www.visionsteen.com/blog/labels/East-Seattle.html
Special Focus: Oxycodone
• Oxycodone (and its forms) is one of the most
widely abused prescription pain relievers in
Indiana
Image Source: http://www.justice.gov/dea/photos/oxy/e710_pile.jpg
Oxycodone Distribution
• Oxycodone (e.g., OxyContin) distribution to
retail registrants in Indiana (pharmacies,
hospitals, and practitioners) nearly doubled
from about 29 million dosage units in 2002 to a
projected 54 million in 20074
Schedule II Narcotics
Oxycodone (and its forms) is listed as a Schedule II
Narcotic by the U.S. Drug Enforcement
Administration
(A) The drug or other substance has a high potential for
abuse
(B) The drug or other substance has a currently
accepted medical use in treatment in the United
States or a currently accepted medical use with
severe restrictions
(C) Abuse of the drug or other substances may lead to
severe psychological or physical dependence 5
Oxycodone Distribution to Indiana Retail
Registrants, January 1, 2007, through June 30, 2008
Source: U.S. Drug Enforcement Administration, 20084
Rx Use Reported at Admission (TEDS, 2009)
FREQUENCY
Indiana Family and Social Services Administration, Revenue Enhancement and Data, 20106
Rx Use Reported at Admission (TEDS, 2009)
PERCENTAGE
Indiana Family and Social Services Administration, Revenue Enhancement and Data, 20106
Rx Use Reported at Admission (TEDS, 2009)
RATE
Indiana Family and Social Services Administration, Revenue Enhancement and Data, 20106
Percentage of Indiana and U.S. Treatment Episodes
with Nonmedical Rx Drug Use (TEDS, 2008)
ALL RX USE
20%
15%
10%
5%
0%
Indiana
U.S.
All Prescription Drugs
18.9%
14.0%
Pain Relievers
13.7%
10.2%
Sedatives & Tranquilizers
7.3%
4.1%
Source: Substance Abuse and Mental Health Data Archive, n.d.7
Stimulants
1.0%
1.2%
Percentage of Indiana and U.S. Treatment Episodes
with Nonmedical Rx Drug Dependence (TEDS, 2008)
ALL RX DEPENDENCE
10%
8%
6%
4%
2%
0%
Indiana
U.S.
All Prescription Drugs
9.6%
7.1%
Pain Relievers
7.8%
5.9%
Sedatives & Tranquilizers
1.6%
0.8%
Source: Substance Abuse and Mental Health Data Archive, n.d.7
Stimulants
0.3%
0.4%
Number of Arrests for Possession and Sale/
Manufacture of “Other Drugs” (Barbiturates and
Benzedrine) in Indiana (Uniform Crime Reporting
Program, 1999–2007)
3,000
2,500
3,000
2,000
2,500
1,500
2,000
1,500
1,000
1,000
500
500
0
Possession
Sale
1999
0
1,617
Possession
316
Sale
2000
1999
1,255
1,617
528
316
2001
2000
1,493
1,255
537
528
2002
2001
1,621
1,493
476
537
2003
2002
1,688
1,621
556
476
2004
2003
2004
2,191
1,688
2,191
659
556
659
2005
2005
2,620
2,620
746
746
2006
2006
2,643
2,643
767
767
2007
2007
2,720
2,720
690
690
Source: National Archive of Criminal Justice Data, Inter-university Consortium for Political and Social
Research, University of Michigan, n.d.8
Arrest Rates, per 1,000 Population, for Possession
and Sale/Manufacture of “Other Drugs”
(Barbiturates and Benzedrine), Indiana and U.S.
(Uniform Crime Reporting Program, 1999–2007)
1.20
Per 1,000 Population
1.00
0.80
0.60
0.40
0.20
0.00
Indiana Possession
U.S. Possession
Indiana Sale
U.S. Sale
1999
0.27
0.52
0.05
0.13
2000
0.21
0.56
0.09
0.18
2001
0.24
0.59
0.09
0.17
2002
0.26
0.65
0.08
0.15
2003
0.27
0.76
0.09
0.17
2004
0.35
0.86
0.11
0.17
2005
0.42
0.95
0.12
0.22
2006
0.42
0.92
0.12
0.17
2007
0.43
0.86
0.11
0.15
Source: National Archive of Criminal Justice Data, Inter-university Consortium for Political and Social
Research, University of Michigan, n.d.8
How Do People Illegally Obtain Rx
Drugs?
• Receiving/purchasing/stealing medication from
family or friends
• Receiving extra amounts of a medication when
physicians overprescribe (either intentionally or
negligently)
• “Doctor Shopping”
• Illegal online pharmacies
• Theft and burglaries (from residences and
pharmacies)9
Estimated Costs/Allocations Attributable
to Substance Use (Indiana, FY 2008)
•
•
•
Funding to Reduce Substance Use
 Prevention, Intervention and Research: $70 million
Funding to Address Consequences of Substance Use
 Healthcare costs/Medicaid and Medicare: $4.8 billion
 Corrections and Judiciary: $1.3 billion
 Education: $621 million
 Child welfare: $685 million
 Income support: $133 million
 Mental health: $126 million
 Developmental disabilities/FASD: $11 million
 Public safety: $60 million
 State workforce: $7 million
Net Gain from Substance Use
 Excise taxes for alcohol, tobacco, and controlled substances: $567 million
Federal, State, and Local Spending/Funding (Per Capita)
Attributable to Substance Use in Indiana Compared to
Illinois, Michigan, Ohio, and Kentucky
Indiana
FY 2008
4-State Average
Adjusted for Inflation
FY 2008
Healthcare
$756.47
$830.74
Income Support, Child Welfare
$128.85
$197.52
Justice, Judiciary, Regulation + Compliance
$119.07
$290.79
Education
$97.87
$197.67
Mental Health, Developmental Disabilities
$21.62
$38.01
Prevention, Intervention, Research
$10.99
$35.67
Public Safety, Interdiction
$9.50
$88.37
Workforce
$1.09
$9.69
$1,145.46
$1,688.46
TOTAL
Note: 4-state average is based on 2005 data for Illinois, Michigan, Ohio, and Kentucky, as reported by CASA (2009). 10 We
then applied the CPI to adjust for inflation and improve comparability to Indiana.
Conclusions and Some
Final Thoughts
• Abuse of Rx drugs is a serious and growing public health problem in
Indiana and the U.S.
• Opioid-based pain medications (e.g., oxycodone) are the most
frequently abused Rx drug in Indiana.
• Pain medications in Indiana are most frequently abused by females,
whites, and young adults (18-25).
• Approximately 99% of public spending in Indiana is on the
consequences of the negative consequences of alcohol, tobacco, and
other drug use than on prevention.
• Studies suggest that if effective prevention policies and programs
were implemented nationwide, substance abuse initiation would
decline for 1.5 million youth and be delayed for 2 years on average.11
References
1. National Institute on Drug Abuse. (2005). Research report series: Prescription drugs abuse and addiction. Retrieved November 24,
2009, from http://www.nida.nih.gov/ResearchReports/Prescription/Prescription.html
2. Indiana Board of Pharmacy. (2010). 2008 INSPECT dataset. Received May 26, 2010, from Joshua Klatte, Program Director, INSPECT
Prescription Monitoring Program, Indiana Board of Pharmacy.
3. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (n.d.). National Survey on Drug Use and
Health. Retrieved September 15, 2009, from https://nsduhweb.rti.org/
4. U.S. Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and
Analysis Unit. (2007). State of Indiana oxycodone purchases 2002-2007. Received September 14, 2007 from Dennis Wichern, in
personal e-mail to IU Center for Health Policy
5. 21 USC Sec. 812 01/22/02. Title 21 - Food and Drugs Chapter 13 - Drug Abuse Prevention and Control Subchapter I - Control and
Enforcement Part B - Authority to Control; Standards and Schedules. Retrieved March 26, 2010, from
http://www.justice.gov/dea/pubs/csa/812.htm
6. Indiana Family and Social Services Administration, Revenue Enhancement and Data. (2009). Substance abuse population by county,
2008. Indianapolis, IN: Indiana Family and Social Services Administration
7. Substance Abuse and Mental Health Data Archive. (2009). Treatment Episode Data Set - Admissions (TEDS-A), 2008. Retrieved
September 23, 2009, from http://webapp.icpsr.umich.edu/cocoon/SAMHDA/STUDY/24280.xml
8. National Archive of Criminal Justice Data, Inter-university Consortium for Political and Social Research, University of Michigan. (n.d.).
Uniform Crime Reporting Program. Retrieved September 18, 2009, from http://www.icpsr.umich.edu/NACJD/
9. Office of National Drug Control Policy. (n.d.). Prescription drugs. Retrieved November 24, 2009, from
http://www.whitehousedrugpolicy.gov/drugfact/prescrptndrgs/index.html
10. National Center on Addiction and Substance Abuse at Columbia University. (2009). Shoveling Up II: The Impact of Substance Abuse
on Federal, State, and Local Budgets. Retrieved September 24, 2009, from
http://www.casacolumbia.org/absolutenm/articlefiles/380ShovelingUpII.pdf
11. Miller, T., & Hendrie, D. (2009). Substance abuse prevention dollars and cents: A cost-benefit analysis (Vol. DHHS Pub. No. (SMA)
07-4298). Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration
Center for Health Policy
The Center for Health Policy collaborates with state and local government, as
well as public and private healthcare organizations in health policy and
program development to conduct high quality program evaluation and applied
research on critical health policy-related issues.
Eric R. Wright, PhD
Director, Center for Health Policy
Professor and Division Director for Health Policy and Management
Department of Public Health, IU School of Medicine
Indiana University-Purdue University Indianapolis (IUPUI)
410 W. 10th St. Suite 3100
Indianapolis, IN 46202
317-274-3161
[email protected]
www.healthpolicy.iupui.edu