Transcript Prescription Drug Abuse - RWJF Health Policy Fellows

Prescription Drug Abuse
How Changes in Education Policy
Can Help Address the Crisis
A. Carole Pratt, DDS
Robert Wood Johnson Foundation Health Policy Fellow
2011-2012
From an Addict
• “At first, habit only binds us with silken threads, but alas! these
threads finally change to links of strongest steel.”
• A turn-of-the-century morphine addict
Prescription drug abuse is “one of the biggest
drug threats we have ever faced.”
Michele Leonhart, Administrator, DEA
• In 2008 poisoning, largely from drug overdose, became
the leading cause of death in the US.
• 75% of these deaths are related to prescription drugs,
nearly 4 times as many as in 2009.
• Drug overdose deaths exceeded deaths by car crash in
2009.
CDC calls the prescription painkiller overdose a
“public health epidemic.”
Prescription drug abuse costs insurers an
estimated $72.5 B annually.
More than 100 people die each day from
prescription overdose.
“We now understand the depth of the problem, what a heavy toll
the abuse and misuse of these drugs cause. Public education is
key; professional education is fundamental as well to treat patients
appropriately.”
Dr. Margaret Hamburg, Commissioner, FDA
“You have a lot of physicians trying to do the right
thing without the proper training.”
Dr. Nora Volkow, Director of the National Institute of Drug Abuse
7 - The average number of hours of
medical school training in pain
management
75 - The average number of hours of
veterinary school training in pain
management
Prescriber Satisfaction
with Education
• In one study, 81.5% of attending physicians
rated their medical school education in chronic
pain treatment as insufficient.
• The same study said 54.7% of residents rated
their training as inadequate.
J Gen Intern Med. 2006 June; 21(6): 652–655.
Primary Care Provider Concerns about Management of Chronic
Pain in Community Clinic Populations
Government Actions
• 1906 - Pure Food and Drug Act
• 1914 - Harrison Narcotics Act
• 1973 - Creation of Drug Enforcement
Administration
• 1986 and 1988 - Anti-Drug Abuse Acts
• 1988 - Formation of Office of National Drug
Control Policy, “drug czar”
• 1992 - SAMHSA
National Prescription Drug
Take-Back Day
April, 2012
552,161 pounds
October, 2011
377,086 pounds
April, 2011
376,593 pounds
September, 2010
242,000 pounds
Next prescription drug take-back day
September 29, 2012
Government Actions
• Prescription Drug Monitoring Programs
• State actions such as in New York and Florida
• Congressional Caucus on Prescription Drug
Abuse
• Hydrocodone Rescheduling Amendment
• Other provisions in the Food and Drug
Administration Safety and Innovation Act, S.
3187
Government Actions
Prescription Drug Abuse Prevention and Treatment Act of 2011, (S. 507)
Helps fill the knowledge gap about safe pain management by requiring
specialized training on pain management in order to be licensed to prescribe
these powerful drugs
Would provide competitive grants to states and community organizations
to educate consumers and communities about safe and appropriate use of
prescription pain medications
Would create the Controlled Substances Clinical Standards Commission,
appropriate $25 million a year for NASPER, and create a National Opioid
Death Registry, among other provisions
Costs of Drug Abuse and
Addiction
• The United
States uses
99% of the
world’s
supply of
hydrocodone.
Florida "Pill Mill”
Crackdown
Legislative reforms
have led to a 97%
decrease in the
number of Oxycodone
pills prescribed by
doctors in the state.
• PDMP
• Pharmacy Cap
• Stringent Laws
Pharmacy Robberies ‘An
Epidemic’
• Pharmacy robberies
have increased 82% from
2006-2011
• 3,535 pharmacies
robbed
• Bottle of Oxycontin
worth up to $5,000
Source: CNN
Public-Private Partnerships
• More than 13,000 US infants were
afflicted with opiate drug withdrawal
syndrome in 2009.
• Mean hospital charges for diagnosed
newborns were $53,000.
• Mothers using or dependent on opiates
per 1000 hospital births increased from
1.19 in 2000 to 5.63 in 2009.
• text4baby sends appropriate free texts
• Florida AG action
Source: JAMA
Other State Actions
WASHINGTON
• Project ECHO, (Extension for Community
Health Outcomes) twice a week 90-minute
TelePain provider-to-provider consultation
• LOES, Look Over the Expert Shoulder,
postgraduate educational program for
advanced training and certification
Project Lazarus Model
North Carolina and Other States
• Coalition formation
• Community awareness
• Diversion control
• Pain patient support
• Provider education
• Hospital policy change
• Expanded access to
treatment
Source: drugfree.org
• Harm reduction and
naloxone
Naloxone- Intranasal OD Antidote
State Initiatives:
North Carolina Project Lazarus
“Prescribing a pill is far and away
the quickest way to bring closure
to a patient encounter.”
--Mark Vonnegut, MD
With Appreciation
Robert Wood Johnson Foundation
Dr. Marie Michnich
Jovett Solomon
Yumi Watanuki
Dr. Harvey Fineberg and the Institute of Medicine
Senator John D. Rockefeller, IV
Jocelyn Moore
Sarah Dash