1

In 2011, the Center for Disease

ControlDeclared

Prescription Drug Abuse

A National Epidemic

2

An epidemic is the occurrence of more cases of disease than would normally be expected in a specific place or group of people over a given period of time.

http://www.cdc.gov/excite/classroom/intro_epi.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/su6004a5.htm?s_cid=su6004a5_w

3

The Facts About Rx Abuse & Misuse in the

United States

4

Rx Drug Abuse includes:

OR

OR

Taking someone else’s prescription for self-medication

Taking a Rx medication in a way other than intended

Taking medication to get high

http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications

5

Why is Rx abuse aNational Epidemic?

6

100 people die from drug overdoses every day in the United States. CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. MMWR 2011; 60: 1-6

http://www.cdc.gov/HomeandRecreationalSafety/rxbrief/states.html

7http://www.cdc.gov/HomeandRecreationalSafety/rxbrief/states.html

Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for one month.

8

0

1

2

3

4

5

6

7

8

9

10

'70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06

De

ath

rate

pe

r 1

00

,00

0

Heroin

Cocaine

Rx Medication

History of Drug Overdoses

http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdF National Vital Statistics System, http://wonder.cdc.gov

Eight-Fold Deaths from Drug Overdoses

1970-2007

9

Drug Overdose Death Rates by State, 2007

http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdf

10http://www.cdc.gov/nchs/data/databriefs/db81.htm

• During the past three decades, the number of drug poisoning deaths increased sixfold from about 6,100 in 1980 to 36,450 in 2008

• In 2008, poisoning became the leading cause of injury death in the United States and nearly 9 out of 10 poisoning deaths are caused by drugs.

Poisoning is now the leading cause of death from injuries in the U.S. and nearly 9 out of 10 poisoning deaths are caused

by drugs.

11

Emergency Department Visits Involving Illicit Drugs or Non-Medical Use of

Pharmaceuticals, 2004-2009

http://www.oas.samhsa.gov/2k10/DAWN034/EDHighlights.htm

12

Deaths

Treatment Admission

Emergency Room

Abuse/Misuse

Non-medical use

2008 Statistics: Opioid Pain Relievers deaths and Related Consequences of

Misuse

(14,800 people)

(148,000 people)

(473,600 people)

(1,924,000 people)

(12,210,000 people)

2008, Total number of Drug Overdoses was 36,450 of this number 20,444 were due to Rx abuse and 73% of Rx Deaths or 14,800 were due to opioid pain relievers (OPR).

http://www.cdc.gov/injury/about/focus-rx.htmlhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm#tab1 http://www.cdc.gov/nchs/data/databriefs/db81.htm

13http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications

Deaths from Opioid Pain Relievers

14

Suppliers of Opioid Rx Drugs

Opioid refers to Narcotic drugs or pain pills which are DEA controlled substances.

15

General Practitioners/Family Medicine

Internal Medicine

Dentists

Nurse Practitioners

Physicians Assistants

Emergency Medicine

Other

Physical Med & Rehab

Anesthesiologists

Orthopedist

Unspec.

26.7%

15.4%

7.7%

3.5%

4.0%

4.7%

20.2%

2.7%

3.2%

7.4%

4.5%

SDI, Vector One: National, 2009. Extracted June 2010. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvisoryCommittee/UCM217510.pdf

Top 10 Prescribing Specialties immediate-release opioids, 2009

16http://www.drugabuse.gov/sites/default/files/rrprescription.pdf

Source of Rx NarcoticsAmong Those Who Used in the

Past-Year, 12th Grade

Internet

Other

Took from friend/relative

Brough from dealer/stranger

Presription

Bought from friend/relative

Given by friend/relative

1.10%

11.00%

18.80%

19.50%

32.50%

37.80%

59.10%

Categories are not mutually exclusive

17http://www.drugabuse.gov/sites/default/files/rrprescription.pdf

Total Number of Opioid Rx Dispensed by U.S. Retail Pharmacies, 1991-2010

18

What Drugs are Being Abused/Misused?

19

*Includes pain relievers, tranquilizers, stimulants, and sedatives

Note: The specific drug refers to the drug that was used for the first time in the past year, regardless of whether it was the first drug ever used or not.

New Users in the Past Year of Specific Illicit Drugs among Persons Aged 12 or

Older, 2010

http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm

20

+ Difference between this estimate and the 2010 estimate is statistically significant at the .05 level.

Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2010

http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16

Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among

Persons Aged 12 or Older, 2002- 2010

21

Sales

Deaths

Treatment

What is the Correlation between Sales, Prescriptions and Deaths?

Rates of opioid pain reliever (OPR) overdose death, OPR treatment admissions, and kilograms of OPR sold --- United States, 1999--2010

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm

22

Death Rate Opioid Sales

Drug overdose death rate in 2008 and rate of kilograms (kg) of opioid pain

relievers (OPR) sold in 2010 — United States

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm

23

From the innocent unborn & infants to the vulnerable elderly our nation has succumb to the marketing ploy of drug companies encouraging the public to utilize Rx drugs for every minor pain and/or slight feeling of anxiety.

Sadly, this ploy is working all too well….

Nonmedical use of Rx Drugs are Destroying Families in the United States

24Patrick, S. W. et al. JAMA doi:10.1001/jama.2012.3951

Weighted National Estimates of the Rates of NAS per 1000 Hospital

Births per Year

NAS indicates neonatal abstinence syndrome.

25

http://usatoday30.usatoday.com/news/health/story/2012-04-29/durg-addicted-painkller-babies/54646654/1

Number of painkiller-addicted newborns

Triples in 10 yearsThe Journal of American Medical Association published about 3.4 of every 1,000 infants born in a hospital in 2009 suffered from a type of drug withdrawal commonly seen in the babies of pregnant women who abuse narcotic pain medications.

Stephen Patrick of the University of Michigan, neonatal-perinatal medicine stated, “That’s about 13,539 infants a year or one drug-addicted baby born every hour.”

26

http://www.usatoday.com/news/health/wellness/babies/story/2011-11-13/Doctors-see-surge-in-newborns-hooked-on-mothers-pain-pills/51186076/1

Newborns in Florida

2006 2007 2008 2009 20100

200

400

600

800

1000

1200

1400

1600

354

481

659

968

1374

Number of Newborns Treated for Withdrawal Symptom for the State of Florida

http://databases.sun-sentinel.com/Orlando/health/orlandoBabies/ftlaudDrugBabies_list.php

Opiate Use During Pregnancy: The Short and Long-Term Effects on Women, Babies, and Children

27

Current Substance Use Among Pregnant Women Aged 15-44, by Age, 2008-2009

Combined

http://oas.samhsa.gov/2k9/135/PregWoSubUse.cfmhttp://oas.samhsa.gov/2k9/135/PregWoSubUse.htm

28

In 2010, 2 million people reported using prescription painkillers nonmedically for the first time within the last year—nearly 5,500 a day.

First time Users

http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16

29http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications

Adolescent

30

College Campus

College students are TWICE as likely to abuse Adderall® than non-college students

http://www.oas.samhsa.gov/2k9/adderall/adderall.htm

31

Full-time college students who used Adderall® non-medically in the past year were and almost FIVE times more likely to use OxyContin® non-medically (44.9 vs. 8.6 %).

http://www.oas.samhsa.gov/2k9/adderall/adderall.htm

College Campus

32

National Institutes of Health surveys show that in 2010, the most current year available, 2.4 million people ages 50-59 said they had abused prescription or illegal drugs within the past month — almost three times as many people as reported that behavior in 2002.

Baby Boomers

http://www.drugabuse.gov/news-events/nida-notes/2010/12/drug-abuse-highest-level-in-nearly-decade

33

At least one in four older adults use psychoactive medications with abuse potential (Simoni-Wastila, Yang, 2006) 

Older Adults

http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Prescription-Medication-Misuse-and-Abuse-Webinar-12-12-11.ppt

34

Older Adult admissions for substance abuse treatment nearly triples, increasing from 13.7% in 1992 to 39.7% in 2008. CDC.

Older Adult admissions for substance abuse treatment nearly tripled

What happened after ED visit?52.3% were treated and released37.5% were admitted to the hospital

http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Prescription-Medication-Misuse-and-Abuse-Webinar-12-12-11.ppt

35

Drug-Related Emergency Department (ED) Visits Resulting in Hospitalization among

Adults Aged 50 or Older, by Type of Visit and Age Group: 2009

http://www.samhsa.gov/data/spotlight/Spot066DrugReaxOlderAdults2012.pdf http://www.cdc.gov/MedicationSafety/Adult_AdverseDrugEvents.html

Older adults are at particular risk for experiencing adverse reactions to medications. Compared with younger adults, they are more sensitive to medications and more likely to take multiple medications because they have more health problems that require treatment.

36

Unintentional Drug Overdose Deaths

by age group and sex, 2007

http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdf

37

Asians

Native

Haw

aiians

Amer

ican

Indian

s or A

lask

a Nat

ive

Two

or M

ore

Races

Hispan

ics

White

s

Black

s0%

2%

4%

6%

8%

10%

12%

14%

16%

4% 6%

16%

10% 10% 9% 8%

Rates of Substance Abuse or Dependence by Race/Ethnicity,

2010

http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm

38

Past Month Illicit Drugs among Persons Aged 12 or Older, by County Type: 2010

http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm

39http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/pdfs/FF_report_2008.pdf

Adults 18-64 years old accounted for a disproportionate share of all MHSA hospitalizations (83 %) relative to their share of the total population (63 %) and all hospitalizations (49 %).

(83 %)

Mental Health Substance Abuse Discharges by Age

(63 %)

40

What is the Cost to our Society?

http://www.justice.gov/ndic/pubs44/44731/44731p.pdf

41

Direct and indirect costs attributable to illicit drug use are estimated in three principal areas:

http://www.justice.gov/ndic/pubs44/44731/44731p.pdf

32%

6%62%

Crime

Health

Productivity

$61,376,694

$11,416,232

$120,303,004

$193 Billion

42

• Labor participation costs • Specialty treatment costs for services

provided at the state level and the federal level hospitalization costs

• Incarceration costs • Premature mortality costs (nonhomicide &

homicide)

These subtotal $120,304,004.

Productivity Costs

Dollars in Thousands

43

Loss of productivity: Early Mortality

Lost productivity due to premature mortality remains a principal component of all costs that drug use imposes on American society.

Age at Death for Males- Drug Related- 40-45 yrs

Age at Death for ALL Males 75-80 yrs

44

Crime cost includes three components: $56,373,254 criminal justice system $1,455,555 crime victim $3,547,885 other crime

These subtotal $61,376,694

Cost of Crime

Dollars in Thousands

45

Health includes five components:

1. Specialty treatment costs ($3,723,338), 2. Hospital & emergency department costs for nonhomicide

cases ($5,684,248) 3. Hospital & emergency department costs for homicide cases

($12,938) 4. Insurance administration costs ($544) 5. Other health costs ($1,995,164).

These subtotal $11,416,232.

Health Care Costs

Dollars in Thousands

46

Drug courts can save states as much $12,000 per client compared to othercriminal justice strategies, according to the organization. CDC Accidental Overdoses

Drug Court

www.cdc.gov/HomeandRecreationalSafety/pubs/RXReport_web-a.pdf

47

Additional Important Elements of Rx Abuse

Saving Lives through Education & Prevention

Legal Consequences: 2010 Legal Consequences of Prescription Drug Misuse

Rx Drug Facts & Health Consequences of Misuse: 2010 Facts and Consequences of Nonmedical Use of Prescription Drugs

48

Important Facts

• The US is the only developed country in the world that does not control RX drug prices.

• The US and New Zealand are the only countries that allow drug makers to advertise to consumers.

• In medical schools the median # of hours for pain education in the United States is 7 at VETINARIAN schools the median required hours is 75.

• The pharmaceutical companies spent more on lobbying between 1998 and 2004 than any other industry... employing a legion of lobbyists.. more than two for each member of Congress.

49

Website Sourceshttp://www.cdc.gov/excite/classroom/intro_epi.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/su6004a5.htm?s_cid=su6004a5_w

http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications

http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Prescription-Medication-Misuse-and-Abuse-Webinar-12-12-11.ppt

http://www.drugabuse.gov/sites/default/files/rrprescription.pdf

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvisoryCommittee/UCM217510.pdf

http://www.justice.gov/ndic/pubs44/44731/44731p.pdf

http://www.isp.idaho.gov/pgr/Research/documents/drugsandcrime.pdf

National Vital Statistics System, http://wonder.cdc.gov

http://www.ahrq.gov/news/press/pr2010/hospmedpr.htm

Healthcare Cost and Utilization Project (HCUP) http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/TOC_2008.jsp

http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/pdfs/FF_report_2008.pdf

http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm

http://www.drugabuse.gov/news-events/nida-notes/2010/12/drug-abuse-highest-level-in-nearly-decadehttp://oas.samhsa.gov/2k9/135/PregWoSubUse.htmhttp://oas.samhsa.gov/2k9/135/PregWoSubUse.cfm