ER Wright Presentation on Epidemiology of Nonmedical Prescription Drug Abuse in Indiana 12-10-2010

7/29/2019 ER Wright Presentation on Epidemiology of Nonmedical Prescription Drug Abuse in Indiana 12-10-2010

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Eric R. Wright, PhD

Director, Center for Health Policy

An Epidemiological Overview

of Nonmedical PrescriptionDrug (Rx) Use in Indiana


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SPF SIG

Funding was provided by the U.S. Department ofHealth and Human Services Center for SubstanceAbuse Prevention, as part of the Strategic PreventionFramework State Incentive Grant (SPF SIG) Program,

and by the Indiana Family and Social ServicesAdministration/Division of Mental Health and Addictionthrough the SAMHSA Substance Abuse Prevention andTreatment (SAPT) Block Grant CFDA 93.959. The SPF

SIG program sponsors initiatives to encourage states toengage in data-based decision-making for substanceabuse prevention planning and grant making.


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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 andAddiction (DMHA), formed a formal partnership to provide

support in executing the SPF SIG, for the period 2006-2010.

The Center for Health Policys 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 toassess the impact of new prevention programs funded aspart of Indiana's SPF SIG program.


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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 documentsDrug Fact Sheets

English

Spanish

Chart Pack (CD)
http://www.healthpolicy.iupui.edu/http://www.healthpolicy.iupui.edu/


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Recent ATOD Issue Briefs

Whats 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 Indianas College

Campuses? (2009)

Prescription Drug Abuse Is a Growing Problem in Indiana(2008)

Fatal Drug Overdoses: A Growing Concern in Indiana (2008)


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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) andbenzodiazepines (e.g., Valium, Xanax)

Stimulants (used to treat attention deficit disorders,narcolepsy, and weight loss)

Dextroamphetamine (e.g., Dexedrine, Adderall) andmethylphenidate (e.g., Ritalin, Concerta) 1


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The INSPECT Program

INSPECT: Indiana Scheduled PrescriptionElectronic Collection & Tracking Program

Indianas Rx drug monitoring program

Collects information on all controlled substances(schedules II-V) dispensed in Indiana

Maintained by the Indiana Professional LicensingAgency/Board of Pharmacy
http://www.in.gov/pla/inspect.htm


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Rx Drugs Dispensed in Indiana

(INSPECT, 2008)

In 2008, almost 11.5 million controlledsubstances were dispensed to Indiana

residents53.2% pain relievers

30.9% CNS depressants

9.9% stimulants

6.2% others

Source: Indiana State Board of Pharmacy, 20102


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Rx Drugs Dispensed, by Gender

Note: results were significant, P< .001.Source: Indiana State Board of Pharmacy, 20102

Opioids CNSDepressants StimulantsMale 54.6% 25.7% 13.7%Female 52.3% 34.3% 7.4%


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Rx Drugs Dispensed, by Age Group

AgeGroup Opioids CNSDepressants Stimulants0-17 23.3% 5.7% 68.6%18-25 61.6% 17.6% 17.3%26-35 61.2% 27.1% 7.4%36-45 56.0% 32.1% 6.1%46-55 54.3% 34.6% 4.3%56-65 53.4% 35.9% 2.9%65+ 52.4% 39.3% 1.1%Note: results were significant, P< .001.Source: Indiana State Board of Pharmacy, 20102


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The Growing Problem of Prescription

Rx Abuse

Abuse of Rx drugs is a serious and growingpublic health problem in Indiana and the U.S.

Almost 52 million Americans (20.8%) ages 12+

have used Rx drugs nonmedically at least oncein 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 leastonce in their life (2002-2004)3


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Lifetime, Past Year, and Current Nonmedical Rx

Drug Use, Indiana and U.S. (National Survey on

Drug Use and Health)

Lifetime Use Past Year

Use

Past Month

Use

Indiana U.S. Indiana U.S. Indiana U.S.

All Psycho-

therapeutics 20.7% 20.8% 7.6% 6.1% 2.7% 2.5%

Pain Relievers 15.0% 14.0% 6.1% 4.8% 2.0% 1.9%

OxyContin 2.5% 1.9% 0.8% 0.6% 0.3% 0.2%

Tranquilizers 9.1% 8.6% 2.8% 2.0% 0.8% 0.7%

Sedatives 3.9% 3.6% 0.4% 0.2% 0.1% 0.1%Stimulants 8.3% 8.5% 1.7% 1.1% 0.8% 0.4%

Note: Indiana data based on NSDUH averages from 2002-2004 (most recent estimates); U.S. databased on 2008 results.Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies,n.d.3


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Nonmedical Pain Reliever Use in the Past Year,Indiana and U.S., by Age Group (NSDUH, 2008)

Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, n.d.3

12 -17 18-25 26 and older

Indiana 7.7% 14.2% 4.4%

U.S. 6.6% 12.1% 3.4%

0%

5%

10%

15%

20%


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Youth Consumption Patterns

Most 12th

grade students received narcotics from a friendor relativegiven for free, purchased, or stolen

Teenagers of middle- and upper-class socioeconomicstatus are most likely to abuse these substances by

crushing and snorting the tablets

1

Pain relievers such as OxyContin and Vicodin are themost commonly abused prescription drugs by teens

Image Source: http://www.visionsteen.com/blog/labels/East-Seattle.html
http://www.visionsteen.com/blog/labels/East-Seattle.htmlhttp://www.visionsteen.com/blog/labels/East-Seattle.htmlhttp://www.visionsteen.com/blog/labels/East-Seattle.htmlhttp://www.visionsteen.com/blog/labels/East-Seattle.html


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Special Focus: Oxycodone

Oxycodone (and its forms) is one of the mostwidely abused prescription pain relievers inIndiana

Image Source: http://www.justice.gov/dea/photos/oxy/e710_pile.jpg
http://www.justice.gov/dea/photos/oxy/e710_pile.jpghttp://www.justice.gov/dea/photos/oxy/e710_pile.jpg


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Oxycodone Distribution

Oxycodone (e.g., OxyContin) distribution toretail registrants in Indiana (pharmacies,hospitals, and practitioners) nearly doubledfrom about 29 million dosage units in 2002 to a

projected 54 million in 20074


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Schedule II Narcotics

Oxycodone (and its forms) is listed as a Schedule IINarcotic 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 UnitedStates or a currently accepted medical use withsevere restrictions

(C) Abuse of the drug or other substances may lead tosevere psychological or physical dependence 5


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Oxycodone Distribution to Indiana Retail

Registrants, January 1, 2007, through June 30, 2008

Source: U.S. Drug Enforcement Administration, 20084


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Rx Use Reported at Admission (TEDS, 2009)

FREQUENCY

Indiana Family and Social Services Administration, Revenue Enhancement and Data, 20106


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PERCENTAGE


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RATE


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Percentage of Indiana and U.S. Treatment Episodes

with Nonmedical Rx Drug Use (TEDS, 2008)

Source: Substance Abuse and Mental Health Data Archive, n.d.7

ALL RX USE

All Prescription Drugs Pain Relievers Sedatives & Tranquilizers Stimulants

Indiana 18.9% 13.7% 7.3% 1.0%

U.S. 14.0% 10.2% 4.1% 1.2%

0%

5%

10%

15%

20%


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Source: Substance Abuse and Mental Health Data Archive, n.d.7

Percentage of Indiana and U.S. Treatment Episodes

with Nonmedical Rx Drug Dependence (TEDS, 2008)

ALL RX DEPENDENCE

All Prescription Drugs Pain Relievers Sedatives & Tranquilizers Stimulants

Indiana 9.6% 7.8% 1.6% 0.3%

U.S. 7.1% 5.9% 0.8% 0.4%

0%

2%

4%

6%

8%

10%


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Number of Arrests for Possession and Sale/

Manufacture of Other Drugs (Barbiturates and

Benzedrine) in Indiana (Uniform Crime ReportingProgram, 19992007)

1999 2000 2001 2002 2003 2004 2005 2006 2007

Possession 1,617 1,255 1,493 1,621 1,688 2,191 2,620 2,643 2,720

Sale 316 528 537 476 556 659 746 767 690

0

500

1,000

1,500

2,000

2,500

3,000

Source: National Archive of Criminal Justice Data, Inter-university Consortium for Political and SocialResearch, University of Michigan, n.d.8

1999 2000 2001 2002 2003 2004 2005 2006 2007

Possession 1,617 1,255 1,493 1,621 1,688 2,191 2,620 2,643 2,720

Sale 316 528 537 476 556 659 746 767 690

0

500

1,000

1,500

2,000

2,500

3,000


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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, 19992007)

1999 2000 2001 2002 2003 2004 2005 2006 2007

Indiana Possession 0.27 0.21 0.24 0.26 0.27 0.35 0.42 0.42 0.43

U.S. Possession 0.52 0.56 0.59 0.65 0.76 0.86 0.95 0.92 0.86

Indiana Sale 0.05 0.09 0.09 0.08 0.09 0.11 0.12 0.12 0.11

U.S. Sale 0.13 0.18 0.17 0.15 0.17 0.17 0.22 0.17 0.15

0.00

0.20

0.40

0.60

0.80

1.00

1.20

Per1,0

00

Population

Source: National Archive of Criminal Justice Data, Inter-university Consortium for Political and SocialResearch, University of Michigan, n.d.8


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How Do People Illegally Obtain Rx

Drugs?

Receiving/purchasing/stealing medication fromfamily or friends

Receiving extra amounts of a medication when

physicians overprescribe (either intentionally ornegligently)

Doctor Shopping

Illegal online pharmacies

Theft and burglaries (from residences andpharmacies)9


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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


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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 AverageAdjusted 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

TOTAL $1,145.46 $1,688.46Note: 4-state average is based on 2005 data for Illinois, Michigan, Ohio, and Kentucky, as reported by CASA (2009).10 Wethen applied the CPI to adjust for inflation and improve comparability to Indiana.


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Conclusions and Some

Final Thoughts

Abuse of Rx drugs is a serious and growing public health problem inIndiana and the U.S.

Opioid-based pain medications (e.g., oxycodone) are the mostfrequently 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 theconsequences of the negative consequences of alcohol, tobacco, and

other drug use than on prevention. Studies suggest that if effective prevention policies and programswere implemented nationwide, substance abuse initiation woulddecline for 1.5 million youth and be delayed for 2 years on average.11


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References1. 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, INSPECTPrescription 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 andHealth. Retrieved September 15, 2009, from https://nsduhweb.rti.org/

4. U.S. Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting andAnalysis Unit. (2007). State of Indiana oxycodone purchases 2002-2007. Received September 14, 2007 from Dennis Wichern, inpersonal 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 andEnforcement Part B - Authority to Control; Standards and Schedules. Retrieved March 26, 2010, from

http://www.justice.gov/dea/pubs/csa/812.htm6. 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. RetrievedSeptember 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, fromhttp://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 Abuseon Federal, State, and Local Budgets. Retrieved September 24, 2009, fromhttp://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
http://www.nida.nih.gov/ResearchReports/Prescription/Prescription.htmlhttps://nsduhweb.rti.org/http://www.justice.gov/dea/pubs/csa/812.htmhttp://webapp.icpsr.umich.edu/cocoon/SAMHDA/STUDY/24280.xmlhttp://www.icpsr.umich.edu/NACJD/http://www.whitehousedrugpolicy.gov/drugfact/prescrptndrgs/index.htmlhttp://www.casacolumbia.org/absolutenm/articlefiles/380ShovelingUpII.pdfhttp://www.casacolumbia.org/absolutenm/articlefiles/380ShovelingUpII.pdfhttp://www.whitehousedrugpolicy.gov/drugfact/prescrptndrgs/index.htmlhttp://www.icpsr.umich.edu/NACJD/http://webapp.icpsr.umich.edu/cocoon/SAMHDA/STUDY/24280.xmlhttp://www.justice.gov/dea/pubs/csa/812.htmhttps://nsduhweb.rti.org/http://www.nida.nih.gov/ResearchReports/Prescription/Prescription.html


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Center for Health Policy

The Center for Health Policy collaborates with state and local government, aswell as public and private healthcare organizations in health policy andprogram development to conduct high quality program evaluation and appliedresearch on critical health policy-related issues.

Eric R. Wright, PhD

Director, Center for Health PolicyProfessor 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 46202317-274-3161

[email protected]

www.healthpolicy.iupui.edu
mailto:[email protected]://www.healthpolicy.iupui.edu/http://www.healthpolicy.iupui.edu/mailto:[email protected]

ER Wright Presentation on Epidemiology of Nonmedical Prescription Drug Abuse in Indiana 12-10-2010

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