Current Trends Keynote National Rx Drug Abuse Summit 4-11-12

1. Dr. Ileana Arias, Principal Deputy
Director Center for Disease Control
and Prevention (CDC) and Agency for
Toxic Substances and Disease Registry
(ATSDR)

2. Prescription Drug Overdoses:
The Public Health Perspective
Ileana Arias, PhD
Principal Deputy Director
Centers for Disease Control and Prevention
April 10-12, 2012
Walt Disney World Swan Resort

3. Learning Objectives
• Describe current prescription drug overdose trends
• Identify populations at greatest risk for overdose
• Understand CDC’s public health approach to
preventing prescription drug overdose
• Describe CDC’s policy recommendations on
prescription drug overdose

4. CDC
Saving lives. Protecting people. Saving money.
• CDC works 24/7 to save lives, protect people and
communities from health threats, and save money
• CDC puts science and prevention into action to
make the healthy choice the easy choice
• CDC helps people live longer, healthier, more
productive lives with lower health care costs

5. CDC Goal
 Reduceabuse and overdose of opioids
and other controlled prescription drugs
while ensuring patients with pain are
safely and effectively treated..

6. The Public Health Approach
to Prevention
Ensure
Widespread
Adoption
Develop
and Test
Prevention
Strategies
Identify Risk
and Protective
Factors
Define the
Problem

7. The Public Health Approach
to Prevention
Ensure
Widespread
Adoption
Develop
and Test
Prevention
Strategies
Identify Risk
and Protective
Factors
Define the
Problem

8. Motor Vehicle Traffic, Poisoning, and Drug
Overdose Death Rates: United States, 1980-2009
Deaths per 100,000 population
Year

9. Number of Drug Overdose Deaths Involving
Opioid Pain Relievers and other Drugs:
United States, 1999-2009
Any opioid pain
reliever
Specified drug(s) other
than opioid analgesic
Only non-specified
drug(s)
Year

10. Unintentional Drug Overdose Deaths
United States, 1970-2009
28,578 unintentional overdose deaths in 2009
10
Death Rate per 100,000 Population
9
8
7
6
5
4
3
2
1
0
'70 '71 '72 '73 '74 '75 '76 '77 '78 '79 '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 07 08 09

11. Drug Overdose Deaths per 100,000 People,
United States, 2004-2008

12. Public Health Impact of Opioid Pain Reliever Use
For every 1 overdose death there are
9
30
118
795

13. Economic Costs
• $72.5 Billion in healthcare costs
• Opioid abusers generate, on
average, annual direct health
care costs 8.7 times higher than
nonabusers

14. The Public Health Approach
to Prevention
Ensure
Widespread
Adoption
Develop
and Test
Prevention
Strategies
Identify Risk
and Protective
Factors
Define the
Problem

15. Rates of Opioid Overdose Deaths and Sales,
1999-2010
8
7
6
5
Opioid Overdose Deaths/
Rate
4 100,000
Opioid Sales KG/10,000
3
2
1
0
99 00 01 02 03 04 05 06 07 08 09 10
Year

16. Drug overdose death rate 2008 and
opioid pain reliever sales rate 2010
Kg of opioid pain
relievers used per
10,000
Age-adjusted rate
per 100,000

17. Populations at High Risk for Overdose
• “Doctor Shoppers”
• People on high daily dosages of opioid pain
relievers and poly-drug abusers
• Low-income people and those living in rural areas
• Medicaid populations
• People with mental illness or history of substance
abuse

18. The Public Health Approach
to Prevention
Ensure
Widespread
Adoption
Develop
and Test
Prevention
Strategies
Identify Risk
and Protective
Factors
Define the
Problem

19. Administration’s Rx Abuse Plan
Where Does CDC Fit In?
• Blueprint for Federal
government
• 4 Focus Areas
• Education
• Monitoring
• Disposal
• Enforcement
• CDC is focusing on areas that
fit within our mission and
complement other Federal
agencies

20. CDC Strategic Focus Areas
 Enhance Prescription Drug Abuse Surveillance
 Improve Clinical Practice
 Inform Policy

21. CDC Policy Recommendations
• Maximize Prescription Drug
Monitoring Programs (PDMPs)
• Evaluate and Implement
Patient Review and Restriction
programs
• Improve Clinical Practice
Through Health Care Provider
Accountability

22. CDC Policy Recommendations
• Enforce policies aimed at reducing drug diversion,
abuse and overdose
• Leverage Insurer & Pharmacy Benefit Manager
(PBM) mechanisms
• Increase Access to Substance Abuse Treatment

23. Conclusions
• Overdose deaths have reached
epidemic levels in the United States
• A concerted public health and
public safety approach is required
• CDC is applying the public health
model to this issue
• Success will come through
collaboration with all stakeholders

24. Thank You
www.cdc.gov/HomeandRecreationalSafety/Poisoning

25. References
Slide 7:
NCHS Data Brief, December, 2011, updated with 2009 mortality data
Slide 8:
CDC/NCHS, National Vital Statistics System; and Warner M, Chen LH, Makuc DM,
Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980–2008.
NCHS data brief, no 81. Hyattsville, MD: National Center for Health Statistics. 2011.
http://www.cdc.gov/nchs/data/databriefs/db81.htm
Slides 9 & 10:
National Vital Statistics System
Slide 11:
SAMHSA National Survey on Drug Use and Health, SAMHSA Treatment Episode Data
Set, SAMHSA Drug Abuse Warning Network
Slide 12:
1. Coalition Against Insurance Fraud. Prescription for peril: how insurance fraud
finances theft and abuse of addictive prescription drugs. Washington, DC: Coalition
Against Insurance Fraud; 2007.
2. White AG, Birnbaum, HG, Mareva MN, et al. Direct Costs of Opioid Abuse in an
Insured Population in the United States. J Manag Care Pharm. 11(6):469-479. 2005

26. References
Slides 14 & 15:
National Vital Statistics System, DEA Automation of Reports and Consolidated Orders
System (ARCOS)
Slide 16:
1. White AG,; Birnbaum HG, Schiller M, Tang J, Katz NP. Analytic models to identify
patients at risk for prescription opioid abuse. Am J of Managed Care 2009;15(12):
897-906.
2. Green TC, Graub LE, Carver HW, Kinzly M, Heimer R. Epidemiologic trends and
geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997–2007.
Drug and Alcohol Dependence 2011;115:221-8.
3. Paulozzi et al. A history of being prescribed controlled substances and risk of drug
overdose death. Pain Medicine. 2012; 13(1):87-95
4. Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, et al. Patterns of abuse
among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300(22):2613–
20.
5. CDC. Overdose deaths involving prescription opioids among Medicaid enrollees-
Washington, 2004-2007.MMWR. 2010;59;705-9.
6. Bohnert ASB, Valenstein M, Bair MJ, Ganoczy D, McCarthy JF, Ilgen MA, et al.
Association between opioid prescribing patterns and opioid overdose-related
deaths. JAMA. 2011;305(13):1315–21.