Opioid Abuse Epidemic

8/10/2019 Opioid Abuse Epidemic

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Opioid Abuse Epidemic in the USJasmine Shah

UIC P4 Pharmacy StudentDrug Information Center


2/18

Prompted by a question to the DI center regarding investigating

the Final Rule released by the DEA which has just taken effect

on October 9th

The Final Rule: created in an effort to decrease pharmaceutical

controlled substances in the home, thereby reducing the risk of

diversion or harm in light of the opioid overdose epidemic

1) Regulate and make stricter the ways in which controlled

substances can be disposed of

Must be non-retrievable

2) Allow for an expansion of take-back methods and centers


3/18

Prompted by a question to the DI center regarding investigating

the Final Rule released by the DEA which has just taken effect

on October 9th

The Final Rule: created in an effort to decrease pharmaceutical

controlled substances in the home, thereby reducing the risk of

diversion or harm in light of the opioid overdose epidemic

1) Regulate and make stricter the ways in which controlled

substances can be disposed of

Must be non-retrievable

2) Allow for an expansion of take-back methods and centers


4/18

DEA Final Rule

allowing law enforcement to voluntarily continue to

conduct take-back events, administer mail-back programs,

and maintain collection receptacles

will allow authorized manufacturers, distributors, reverse

distributors, narcotic treatment programs (NTPs),

hospitals/clinics with an on-site pharmacy, and retail

pharmacies to voluntarily administer mail-back programsand maintain collection receptacles


5/18

What is the opioid overuse epidemic?

Over the past two decades, an opioid epidemic with adverse

consequences has escalated

Can be contributed to a variety of factors including increased

prevalence of chronic pain, misguided notions, and new algorithms to

treating pain


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data from the CDCs Policy Impact: Prescription Painkiller Overdoses


7/18

Factors contributing to the epidemic

the introduction of the concept of pain as a fifth vital sign

new pain management standards by the Joint Commission

on the Accreditation of Healthcare Organizations (JCAHO) in

2000, putting pressure on hospitals and physicians to

overprescribe

misconceptions of pain treatment by patients, leading to afalse belief that all pain can and should be completely

relieved by medications


8/18

"This is an out of control epidemic, not caused

by a virus or a bacteria.

This epidemic has been caused by a brilliant

marketing campaign that dramatically

changed the way physicians treat pain.

-Andrew Kolodny, chairman of psychiatry at

Maimonides Medical Center in New York


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The potential dark side of the opioid epidemic


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When evidence-based medicine isnt

practiced Misconceptions that began to arise gradually:

The risk of addiction is low in patients who obtain their narcotic

painkillers legitimately

There is no maximum dose of the drugs that can't be safely

prescribed nor a maximum length of time

People who seek more frequent prescriptions or higher doses of

the drugs aren't addicts, they are "pseudoaddicts" who just need

more pain relief and more opioids

End result: It was touted that opioid medications were effective

for many types of non-cancer pain, and could be used for long

periods of time at high doses safelyand withlow addiction

potential


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But the truth was

There was no rigorous data or studies showing that opioidswere safe and non-addicting in the long-term or at high doses

An April 2011 paper in theArchives of Internal Medicine foundthat as dose escalated the risk of opioid-related deathincreased. For high-dose patients the risk of death was threetimes greater than in lower-dose patients.

The National Institute on Drug Abuse says addiction ratesamong chronic pain patients have ranged from 3% to 40%, butthese may be even higher in certain subpopulations

Tolerance to opioids develops rapidly, requiring escalation ofdoses to achieve the same level of pain relief


12/18Medication-Assisted Therapies Tackling the Opioid-Overdose Epidemic. n engl j med 370;22


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The DEAs Final Rule

Rationale

A study investigated 250 pts who were prescribed opioids forsurgery. A sample size was interviewed, and the study foundthat an average of 19 tablets per pt remained unused, leaving

4,639 pills left over. Take-back receptacles will hopefully reduce the number of

opiates in the wild (leftover drugs)

Obstacles

Will require additional costs to be taken upon those centers and

pharmacies which choose to be authorized collectors Requires pro-activity on the part of the patient to dispose of

their leftover controlled substances

Only targeting the population of those who are not intending tomisuse/sell


14/18data from the CDCs Policy Impact: Prescription Painkiller Overdoses

The Final Rule will ideally impact


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Other potential solutions

for a multi-faceted problem Physician education and better screening for high risk patients

Prescription Drug Monitoring Programs

Currently only 36 states

Federal and State Laws

Reversal agents

Substance Abuse Programs

Public Education

Such as in the case of antibiotic overuse


16/18

Opioid Overdose Reversal Kit

Rationale

Opioid overdose-related deathscan be prevented when naloxone isadministered in a timely manner

Naloxone injection has beenapproved by FDA and used formore than 40 years by emergencymedical services (EMS) personnelto reverse opioid overdose and

resuscitate persons who otherwisemight have died in the absence oftreatment

Controversy

Who should have access?


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Movie Rec

-Documentary focusing on the opioid

and heroin problems faced in the

teen subpopulation of Orange County


18/18

Questions?

Please contact me if you would like references to any of the

graphs/data!

Opioid Abuse Epidemic

Documents

Transcript of Opioid Abuse Epidemic