Transcript September Presentation - The Roane County Anti

IS THERE A SOLUTION
TO THE PRESCRIPTION
OPIATES ABUSE
Drug Abuse
• According to the Centers for Disease Control and Prevention, the #1
cause of death in 17 U.S. states is prescription drug abuse, surpassing
motor vehicle accidents.
• Approximately 46,000 Americans died from overdose last year
• Half of which were due to improper use of legally owned prescriptions
• 56% of teens believe it is easier to get prescription drugs than illicit
substances
• Approximately 1 in 6 Americans have admitted to abusing
prescription drugs
2
The United States makes up only 4.6% of the world’s population,
but it consumes 80% of its opioids – and 99% of the world’s
hydrocodone supply
Hydrocodone, Oxycodone, Morphine, Fentanyl,
Buprenorphine(Suboxone), Methadone, Hydromorphone (Dilaudid),
Codeine
The solution involves many steps including
but not limited to the following:
• Prevention:
• Make the drugs less addictive $$
• Education $$
• Treatment:
• Rehabilitation Centers $$$$$
• Law Enforcement $$$$$?
• ~ 70% of drug rehabilitation programs result in failure.
• Adding naloxone or naltrexone to opiate products can be proactive
step that can prevent future addiction incidents from occurring.
• Costs approximately $1 more(drug company cost to be around 10
cents to 30 cents) per tablet to put naloxone or naltrexone in opiate
products and can have beneficial impact overall on patient quality of
health. Pay more no to save much more later. Also much less
emotional cost.
Targiniq (Oxycodone and Naloxone)
• Newer drug, Targiniq by Pardue
• Formulations:
• (10mg oxycodone/5mg naloxone, 20/10 and 40/20 extended release
tablets)
• Approved by FDA on July 13, 2014
• Not on the market at the present time.
DETERRENCE MECHANISMS — No opioid formulation prevents consumption of a large number of intact dosage units,
the most common method of abuse. Abuse-deterrent formulations have one or more properties that make their intentional
nontherapeutic use more difficult, less attractive, or less rewarding; examples of such properties are listed in the table.1
ABUSE-DETERRENT FORMULATIONS — OxyContin, an ER oxycodone tablet formulation, was reformulated in 2010
to deter abuse; the current product is more difficult to crush, break, or dissolve than the original, and when dissolved forms a
viscous gel that is difficult to inject through a hypodermic needle. In an intranasal administration trial in nondependent
opioid abusers, scores for "drug liking" and desire to "take drug again" were significantly lower with the newer
formulation than with original OxyContin or with oxycodone HCl powder.2
Embeda is formulated as capsules of ER morphine pellets that contain a sequestered core of the opioid antagonist naltrexone.
If the pellets are swallowed, the morphine is gradually released and absorbed, while the naltrexone core passes through the
gut intact. If the pellets are crushed, chewed, or dissolved, naltrexone is released, blocking morphine-induced euphoria.3 In
oral, intranasal, and IV administration trials in nondependent opioid abusers (one published; three summarized in the package
insert), Embeda had significantly lower "drug liking" and "drug high" scores than morphine without naltrexone.4
Hysingla ER is an ER hydrocodone tablet formulation; when dissolved it forms a viscous gel that is difficult to inject
through a hypodermic needle. In oral and intranasal administration trials in nondependent opioid abusers (summarized in the
package insert), Hysingla ER had significantly lower scores for "drug liking" and desire to "take drug again" than immediaterelease hydrocodone.5
Zohydro ER (Zogenix), an ER hydrocodone capsule formulation, was originally approved without abuse-deterrent
properties,6 but now incorporates excipients that form a viscous gel when the capsules are crushed and dissolved. The
manufacturer is expected to submit clinical data supporting claims of abuse deterrence in the labeling later this year.7
Targiniq ER (Purdue), an opioid agonist/antagonist combination containing ER oxycodone and naloxone, has been approved
by the FDA with claims of abuse deterrence in the labeling, but is not yet commercially available. If the formulation is
crushed and administered intravenously or intranasally, high naloxone concentrations block opiate-induced euphoria and can
induce withdrawal symptoms.
Naloxone (Narcan)
Naltrexone (Vivitrol)
Efficacy of oral dose
Does not work if taken by mouth. Comes in IV, IM, Subq,
intranasal, and inhalation.
Naltrexone when taken orally has low bioavailability (540%) and is broken in the liver.
Cost (AWP)
Narcan nasal: $75.00
Evzio auto-injection: 0.4 mg/0.4 mL (0.4 mL): $2250.00
Naloxone HCl solution injection:
0.4 mg/mL (1 mL): $18.71
1 mg/mL (2 mL): $39.60
Vivitrol (IM): $1200.00 to 1570.80/ month
Naltrexone HCl 50 mg (30 tabs): $75.60 - $137.20
depending on manufacture . Average price $128.25
Use in acute drug overdose
Evzio is most commonly used when EMTs find patients
Does not help in acute drug overdose. The time it takes
unresponsive and opioid overdose is suspected. It works
for the IM or oral route to work is over 60 minutes and
immediately to help with respiratory depression and will not hurt oral would be broken down to the point of little efficacy.
someone who has not been on opioids. Onset of action is roughly
2 minutes.
Duration of activity
About 30 minutes to 2 hours depending on which dosage form is Oral: 50 mg 24 hours
used.
100 mg: 48 hours
150 mg: 72 hours
IM: 4 weeks
Effectiveness as a deterrent
Does not work as a deterrent due to its short duration of action.
Simply works for those that have over-dosed on opioid.
The IM dose is most effective because it is not broken
down in the liver as much as the oral dose. The IM
injection releases slowly into the body so that if an
opioid is used it does not cause the euphoria or “high” by
blocking the receptors in the brain.
1) Data from the Massachusetts correctional facilities.
While 77 percent of released offenders find themselves back behind bars within five years, the
recidivism rate among loyal Vivitrol users is only 9 percent.
•One way to combat opioid addiction is through partnering with the Vivitrol manufacturer, Alkermes, to
provide affordable treatment for addiction
For example: The use of vivitrol in Massachusetts correctional facilities began about 4 years ago
when Sherriffs jesse Cummings & Peter Koutijian started investigating the use of Vivitrol in their jails.
The jails partnered with Alkermes, the manufacturer that produces Vivitrol, to begin the program.
Alkermes provides the first injection to the facilities free of charge. They also have a value program
that pays up to $500 per month toward the cost of the co-pay or deductible for patients 18 and older
who are not covered by federal or state health insurance.
Newly released inmates are eligible for coverage through Medicaid or MassHealth, both of which
cover the cost of Vivitrol.
•Inmates likely to be eligible are identified within the facility, then screened for mental and physical
health, educated about the drug, and given oral Vivitrol to test for allergic reactions.
•Provided no red flags are raised along the way, inmates are given an injection between two and
seven days before their release, and sent into the community with a comprehensive recovery plan
using local rehabilitation centers.
Detox
Outpatient detox ranges from $1,000 to $1,500 in total. Most inpatient rehabs include detox in
the cost of program. The exact cost of detox depends on whether it’s part of an inpatient
program and the type of drug addiction being treated. Substances with dangerous detox side
effects require more careful monitoring, making the price higher.
Inpatient Rehab
Some inpatient rehabs may cost around $6,000 for a 30-day program. Well-known centers often cost up to
$20,000 for a 30-day program. For those requiring 60- or 90-day programs, the total average cost of rehab
could range anywhere from $12,000 to $60,000.
Outpatient Rehab
Outpatient programs for mild to moderate addictions are cheaper than inpatient rehab. Many cost $5,000
for a three month program. Some outpatient programs, such as the program at Hazelden Betty Ford, cost
$10,000. The price tag depends on how often the individual visits the treatment center each week and for
how long.
Medications
The type of treatment and medications needed affects the price tag on rehab. Some people don’t need
medication for their addiction. Medications most often treat alcohol and opiate addiction. It can cost several
thousand dollars a year. Year-long methadone treatment for heroin users costs around $4,700.
Vivitrol has its downsides. In rare cases, it can cause liver failure
or hepatitis. Unlike methadone and Suboxone, Vivitrol is only
offered after the addict completes withdrawal; a shot of Vivitrol
before withdrawal can force the body into agonizing days of
detoxification. Also, a person who is injured while on Vivitrol will
not respond to opioid pain medications. (Addicts on Vivitrol
wear tags to inform emergency medical personnel.)
Judge Robert Peeler (from Warren County Ohio) had another idea. He
already had three defendants die of heroin overdoses after he released
them from jail early.
"They died because I released them. It's impossible to keep them all in
jail," he said.
So, in a first for local criminal justice systems and a move that's being
studied at several prisons and jails across the country, Peeler ordered
the defendant to undergo a series of nine to 12 injections of Vivitrol,
the non-narcotic drug naltrexone that blocks the brain's ability to get
high on opiates, including heroin, or drunk on alcohol. He ordered the
teen to receive the first shot while in jail.
Experts say it's best to give the first injection in jail. That buys the
inmate a month to get Medicaid benefits to pay for the next shots
and to set up drug counseling on the outside. Receiving the
injections with counseling makes the treatment more successful,
experts say.
Medicaid won't pay for the first shot because inmates lose those
benefits while they are incarcerated. A county is responsible for the
cost of inmates' health care while they are in jail. It's an extremely
expensive drug, and jails certainly don't budget for that drug.
Is drug addiction treatment worth its cost?
Substance abuse costs our Nation over $600 billion annually and treatment can help
reduce these costs. Drug addiction treatment has been shown to reduce
associated health and social costs by far more than the cost of the treatment itself.
Treatment is also much less expensive than its alternatives, such as incarcerating
addicted persons. For example, the average cost for 1 full year of methadone
maintenance treatment is approximately $4,700 per patient, whereas 1 full year of
imprisonment costs approximately $24,000 per person.
Drug addiction treatment reduces drug use and its associated health and social costs.
According to several conservative estimates, every dollar invested in addiction
treatment programs yields a return of between $4 and $7 in reduced drug-related
crime, criminal justice costs, and theft. When savings related to healthcare are included,
total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and to
society also stem from fewer interpersonal conflicts; greater workplace productivity;
and fewer drug-related accidents, including overdoses and deaths.
What product would the government allow on the market that we know that it will have adverse effects to over
50% of the people who take it and kill over 20,000 people a year?
Why do we not require all patients to have a referral from their general practitioner to go to a pain clinic?
The states and federal government sued the tobacco industry to help cover the healthcare cost that smoking
causes.
Why do we not do the same to the manufacturers of hydrocodone and oxycodone?
There are over 1400 Lobbyists for the drug industry in Washington.
There is 535 members of Congress.
The drug industry spent $422,000 per congressman on average.
This is why it would be very hard to get any thing done that would negatively effect the drug companies in
Washington.
We will have to start at the local and state level.
Unintended consequences of the decrease in hydocodone use.
1. With hydrocodone going to a schedule II classification its use decreased, but
oxycodone use increased.
2. The price of oxycodone is one of the major reasons for the increase use in Heroin.
Possible unintended consequences of the success of treating with Vivitrol and putting
Naloxone or Naltrexone in oxycodone products?
1. Increase use of cocaine or benzodiazepines?
2. Increase use of other non opiate drugs?
3. Decrease staffing needed for jails?
Naloxone. Lexi-Drugs. Lexicomp Online [database online]. Hudson, OH: Lexicomp, Inc.
http://online.lexi.com. Updated August 28, 2016. Accessed September 7,2016.
Naltrexone. Lexi-Drugs. Lexicomp Online [database online]. Hudson, OH: Lexicomp, Inc.
http://online.lexi.com. Updated August 1,2016.. Accessed September 7,2016.
Red Book Online [database online]. Greenwood Village, CO: Truven Health Analytics.
http://www.micromedexsolutions.com/. Updated July 19, 2016. Accessed September 7, 2016.
NH prison system to start using Vivitrol. CorrectionsOne. Blessing, B. K.
http://www.correctionsone.com/contraband/articles/179698187-NH-prison-system-to-start-using-Vivitrol. Accessed
September 07, 2016,
Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute of Drug
Abuse. NIH. https://www.drugabuse.gov. Updated December, 2012. Accessed September 7,2016.
Chasing the Dragon ---- https://www.fbi.gov/.../raising-awareness-of-opioid-ad
Prescription thugs ---
www.prescriptionthugs.com/