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
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