Eric R. Wright, PhD

Director, Center for Health Policy

An Epidemiological Overview of Nonmedical Prescription

Drug (Rx) Use in Indiana

SPF SIGFunding was provided by the U.S. Department of Health and Human Services’ Center for Substance Abuse Prevention, as part of the Strategic Prevention Framework State Incentive Grant (SPF SIG) Program, and by the Indiana Family and Social Services Administration/Division of Mental Health and Addiction through the SAMHSA Substance Abuse Prevention and Treatment (SAPT) Block Grant CFDA 93.959. The SPF SIG program sponsors initiatives to encourage states to engage in data-based decision-making for substance abuse prevention planning and grant making.

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 and Addiction (DMHA), formed a formal partnership to provide support in executing the SPF SIG, for the period 2006-2010.

The Center for Health Policy’s 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 to assess the impact of new prevention programs funded as part of Indiana's SPF SIG program.

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 documents

Drug Fact Sheets English Spanish

Chart Pack (CD)

Recent ATOD Issue Briefs What’s 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 Indiana’s College Campuses? (2009)

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

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

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) and

benzodiazepines (e.g., Valium, Xanax)• Stimulants (used to treat attention deficit disorders,

narcolepsy, and weight loss)Dextroamphetamine (e.g., Dexedrine, Adderall) and

methylphenidate (e.g., Ritalin, Concerta) 1

The INSPECT Program

• INSPECT: Indiana Scheduled Prescription Electronic Collection & Tracking Program

• Indiana’s Rx drug monitoring program• Collects information on all controlled substances

(schedules II-V) dispensed in Indiana• Maintained by the Indiana Professional Licensing

Agency/Board of Pharmacy

Rx Drugs Dispensed in Indiana (INSPECT, 2008)

In 2008, almost 11.5 million controlled substances were dispensed to Indiana residents

53.2% pain relievers30.9% CNS depressants 9.9% stimulants6.2% others

Source: Indiana State Board of Pharmacy, 20102

Rx Drugs Dispensed, by Gender

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

OpioidsCNS

Depressants StimulantsMale 54.6% 25.7% 13.7%Female 52.3% 34.3% 7.4%

Rx Drugs Dispensed, by Age Group

Age Group Opioids

CNS Depressants Stimulants

0-17 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

The Growing Problem of Prescription Rx Abuse• Abuse of Rx drugs is a serious and growing

public health problem in Indiana and the U.S.• Almost 52 million Americans (20.8%) ages 12+

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

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. data based on 2008 results.Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, n.d.3

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 0.0766 0.1416 0.0444

U.S. 0.0656 0.1205 0.0344

3%

8%

13%

18%

Youth Consumption Patterns• Most 12th grade students received narcotics from a friend

or relative—given for free, purchased, or stolen• Teenagers of middle- and upper-class socioeconomic

status are most likely to abuse these substances by crushing and snorting the tablets1

• Pain relievers such as OxyContin and Vicodin are the most commonly abused prescription drugs by teens

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

Special Focus: Oxycodone

• Oxycodone (and its forms) is one of the most widely abused prescription pain relievers in Indiana

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

Oxycodone Distribution

• Oxycodone (e.g., OxyContin) distribution to retail registrants in Indiana (pharmacies, hospitals, and practitioners) nearly doubled from about 29 million dosage units in 2002 to a projected 54 million in 20074

Schedule II Narcotics

Oxycodone (and its forms) is listed as a Schedule II Narcotic 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 United States or a currently accepted medical use with severe restrictions

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

Oxycodone Distribution to Indiana Retail Registrants, January 1, 2007, through June 30, 2008

Source: U.S. Drug Enforcement Administration, 20084

Rx Use Reported at Admission (TEDS, 2009)FREQUENCY

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

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

Rx Use Reported at Admission (TEDS, 2009)PERCENTAGE

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

Rx Use Reported at Admission (TEDS, 2009)RATE

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 StimulantsIndiana 0.189 0.137 0.073 0.01U.S. 0.14 0.102 0.041 0.012

3%

8%

13%

18%

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 StimulantsIndiana 0.096 0.078 0.016 0.003U.S. 0.071 0.059 0.008 0.004

1%

3%

5%

7%

9%

Number of Arrests for Possession and Sale/ Manufacture of “Other Drugs” (Barbiturates and Benzedrine) in Indiana (Uniform Crime Reporting Program, 1999–2007)

1999 2000 2001 2002 2003 2004 2005 2006 2007Possession 1617 1255 1493 1621 1688 2191 2620 2643 2720Sale 316 528 537 476 556 659 746 767 690

250

750

1,250

1,750

2,250

2,750

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

1999 2000 2001 2002 2003 2004 2005 2006 2007Possession 1617 1255 1493 1621 1688 2191 2620 2643 2720Sale 316 528 537 476 556 659 746 767 690

250

750

1,250

1,750

2,250

2,750

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, 1999–2007)

1999 2000 2001 2002 2003 2004 2005 2006 2007Indiana Possession

0.272084805653712

0.206398009369318

0.244163902174171

0.263189170829093

0.272449526223509

0.351258639383388

0.41773139010643

0.418625426069768

0.43

U.S. Possession

0.522617174750906

0.555146911815813

0.587248442921008

0.648572476644375

0.757488285005328

0.86098132389521

0.948937676290203

0.921374067741191

0.860000000000001

Indiana Sale

0.0531717987548376

0.0868351784438248

0.087820506006383

0.0772844203051501

0.0897404837560848

0.105650133890302

0.118941838557022

0.121485320391794

0.11

U.S. Sale

0.132061564188037

0.175835076164741

0.172090581212229

0.148705460912077

0.171397262990242

0.174597223438392

0.219678523834811

0.173634813148771

0.15

0.10

0.30

0.50

0.70

0.90

1.10

Per 1

,000 P

opula

tion

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

How Do People Illegally Obtain Rx Drugs?

• Receiving/purchasing/stealing medication from family or friends

• Receiving extra amounts of a medication when physicians overprescribe (either intentionally or negligently)

• “Doctor Shopping”• Illegal online pharmacies• Theft and burglaries (from residences and

pharmacies)9

Estimated Costs/Allocations Attributableto 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

TOTAL IMPACT:$7.3 BILLION

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

Conclusions and Some Final Thoughts• Abuse of Rx drugs is a serious and growing public health problem in

Indiana and the U.S.• Opioid-based pain medications (e.g., oxycodone) are the most

frequently 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 the

consequences of the negative consequences of alcohol, tobacco, and other drug use than on prevention.

• Studies suggest that if effective prevention policies and programs were implemented nationwide, substance abuse initiation would decline for 1.5 million youth and be delayed for 2 years on average.11

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, INSPECT Prescription 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 and Health. Retrieved September 15, 2009, from https://nsduhweb.rti.org/

4. U.S. Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit. (2007). State of Indiana oxycodone purchases 2002-2007. Received September 14, 2007 from Dennis Wichern, in personal 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 and Enforcement Part B - Authority to Control; Standards and Schedules. Retrieved March 26, 2010, from http://www.justice.gov/dea/pubs/csa/812.htm 

6. 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. Retrieved September 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, from http://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 Abuse on Federal, State, and Local Budgets. Retrieved September 24, 2009, from http://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

Center for Health Policy

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

Eric R. Wright, PhD

Director, Center for Health Policy

Professor 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 46202

317-274-3161

ewright@iupui.edu

www.healthpolicy.iupui.edu