Transcript Resource - Indiana Rural Health Association

Prescription Drug
Abuse in Indiana
Joan Duwve, M.D., M.P.H.
Indiana Rural Health Association
June 10, 2014
Drug Overdose Death Rates Versus Motor
Vehicle Accidents
Years 1980-2010
NCHS Data Brief, December, 2011, updated
with 2009 and 2010 mortality data
3
CDC. Death rates for drug poisoning, by state of residence,
United States, 2010.
Available at
http://www.cdc.gov/nchs/pressroom/states/drug_deaths_2
010.pdf
Opioid sales, opioid-related deaths and
opioid treatment admissions, U.S.
Source: Warner et al. 2011
Percent Change in Ten Leading Causes of Injury
Death* Indiana, 2000–2010
Unintentional Motor Vehicle Traffic-21.5%
Suicide Firearm
0.7%
Unintentional Poisoning
351.6%
Unintentional Falls
18.9%
Unintentional Unspecified -14.7%
Homicide Firearm
0.0%
Suicide Suffocation
48.0%
Unintentional Suffocation -17.4%
Suicide Poisoning
47.5%
Undetermined Poisoning
Source: WISQARS
135.6%
-50%
0%
50%
100%
150%
200%
250%
300%
350%
400%
*Age-adjusted rates
Number of Drug Deaths, Indiana
1200
1000
800
600
Number
400
200
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Drug Deaths, Indiana, Age-Adj. Rate
18.00
16.00
14.00
12.00
10.00
Age-Adj. Rate
8.00
6.00
4.00
2.00
0.00
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Source: Indiana State Department of Health, Epidemiology Resource Center, Data Analysis Team
Unintentional Poisoning Death Rates, AgeSpecific, Indiana, 2005 – 2010
18.0
17.1
16.1
16.1
16.0
14.0
Pate per 100,000
12.0
10.0
8.3
7.8
8.0
6.0
4.2
4.0
2.1
2.7
2.0
0.3
0.0
Age Group (Years)
* Rates based on 20 or fewer deaths may be unstable. Use with caution.
Source: Centers for Disease Control
and Prevention, WISQARS Database
Geographic Variation in Opioid Prescribing in the
U.S.
Journal of Pain, Volume 13, Issue 10, October 2012, Pages 988–996
Oxycodone Distribution to Indiana
Retail Registrants,
January 2007 through June 2008
Source: U.S. Drug Enforcement
Administration, 2008
Number of Prescription Drug
Overdose Deaths in Indiana, 20022011
Average Annual Accidental Poisoning by and Exposure to Drugs,
Medicaments, and Biological Substances by Indiana County (2009
and 2010) – Rates per 100,000
ICD‐10 Codes X40 – X44
Indiana State Department of Health Mortality Data;
Other Adverse Outcomes
http://www.cdc.gov/homeandrecreational
safety/rxbrief/
12
Neonatal Abstinence Syndrome and Associated
Health Care Expenditures: United States, 20002009
2009
NAS
vs. Other
LOS 16.4 d vs. 3.3d
Costs $53,400 vs. $9,500
Figure Legend:
NAS indicates neonatal abstinence syndrome. Error bars indicate 95% CI. P for trend < .001 over the study period. The unweighted sample sizes for rates of
NAS and for all other US hospital births are 2920 and 784 191 in 2000; 3761 and 890 582 in 2003; 5200 and 1 000 203 in 2006; and 9674 and 1 113 123 in
2009; respectively.
JAMA. 2012;307(18):1934-1940. doi:10.1001/jama.2012.3951
Date of download: 1/6/2013
Copyright © 2012 American Medical
Association. All rights reserved.
Percentage of College Students
Reporting Rx Misuse in the Past Six
Months in Indiana, 2013
Rx Drug
Adderall
Vicodin
Xanax
Codeine
Ritalin
Lortab
Percocet
Oxycontin
Morphine
Methadone
Steroids
Prevalence
10.1%
3.6%
3.5%
2.7%
1.7%
1.5%
0.9%
1.3%
0.4%
0.2%
0.1%
Source: Indiana College Substance Use Survey, 2013. Indiana Prevention
Resource Center.
Key:
Opioid
Stimulant
CNS
Depressant
Other
Youth and Controlled Substances
0%
National Survey on Drug Use and Health 2011.
Bought on the Internet
From More Than One Doctor
Some Other Way
Bought from Drug Dealer or Other
Stranger
Bought or Took from Friend or
Relative
From One Doctor
Free from Friend or Relative
Narcotic Sources
60%
50%
40%
30%
20%
10%
Source Where Pain Relievers Were Obtained
for Most Recent Nonmedical Use among Past
Year Users Aged 12 or Older: 2010-2011
Source: SAMHSA, National Survey of Drug Use and Health, 2011
Number of Deaths with Heroin as Contributing Cause,
Indiana
120
100
80
60
Number
40
20
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
23
ONDCP's Prescription Drug Abuse
Prevention Plan
• Education
– Parents, youth, patients
– Prescribers
• Monitoring (INSPECT)
– Discourage “Doctor Shopping” and Diversion
– Interstate monitoring
• Proper Medication Disposal
– Take back programs
• Enforcement
– Identify and eliminate “Pill Mills” and unethical
prescribing practices
Indiana’s Prescription Drug Abuse
Prevention Plan
• Education
– Parents, youth, patients
– Prescribers
– Neonatal Abstinence Syndrome
• Monitoring (INSPECT)
– Discourage “Doctor Shopping” and Diversion
– Interstate monitoring
• Proper Medication Disposal
– Take back programs
• Enforcement
– Identify and eliminate “Pill Mills” and unethical prescribing
practices
• Treatment and Recovery
– Addiction treatment services
– Naloxone Rescue
The Indiana Prescription Drug Abuse
Prevention Task Force
Chair: Greg Zoeller, Indiana Attorney General
Co-chair: Joan Duwve, Indiana State Department of
Health
Committees
Education: Dr. Deb McMahan, LHO, Allen County
INSPECT: Greg Pachmayr, Director, Pharmacy Board
Take-Back: Representative Steve Davisson, Pharmacist
Enforcement: Tim McClure, OAG
Treatment and Recovery: Steve McCaffrey, MHA
Awareness
Accomplishments to Date
Education Committee
• Provider Education
– Provider Toolkit for management of chronic, non-terminal
pain
– Emergency rules for opioid prescribing for chronic nonterminal pain
– Annual symposium
– Public speaking
• Public Education
– Bitterpill.in.gov
– Pills of Peril PBS documentary
– Adult and adolescent education
http://www.in.gov/bitterpill/voices.html - meghan
“First Do No Harm”
Indiana’s Safe Prescribing
Recommendations
Accomplishments to Date
• NAS Committee formed to better support
families during pregnancy and after delivery
– Formalized as IPN committee by legislature
– make recommendations for screening pregnant
women for substance use
– identify and report infants with NAS to
understand incidence and improve
newborn care
Accomplishments to Date
• INSPECT
– Legislature authorized 100% of CSR fees to be
used to maintain and operate INSPECT
– Working with Health Information Exchange and
Indiana Network for Patient Care to integrate into
EHR systems
– Decreased reporting interval to INSPECT phased in
beginning July 2015
Accomplishments to Date
• Take-Back
– State-wide take-back
days
– Indiana law permits
pharmacy-based takeback (waiting for federal
DEA rule revision to be
published)
– Working with large
pharmacy in central
Indiana to develop a
pilot take-back program
Accomplishments to Date
• Enforcement
– Indiana Code now
requires owners of
clinics dispensing
controlled substances to
have a Controlled
Substance Registration
with Indiana Professional
Licensing Agency
Accomplishments to Date
• Treatment and Recovery
– Loan repayment programs for addiction
treatment training
– Naloxone rescue liability protection for first
responders and expansion of
life-line law
– Working with Indiana Medicaid
to ensure appropriate formulary
coverage for addiction treatment
medications
Joan Duwve, M.D., M.P.H.
Associate Dean for Public Health Practice
IU Richard M. Fairbanks School of Public Health
Chief Medical Consultant
Indiana State Department of Health
[email protected]
317-278-0754