Opening Keynote National Rx Drug Abuse Summit 4-10-12

2. Preven&ng
Prescrip&on
Drug
Abuse
April
10-­‐12,
2012
Walt
Disney
World
Swan
Resort
R.
Gil
Kerlikowske,
Director
White
House
Office
of
Na;onal
Drug
Control
Policy

3. Na;onal
Drug
Control
Strategy
• Science-­‐based,
public
health
approach
to
drug
policy
• Coordinated
federal
effort
on
115
ac&on
items
– Special
emphasis
on
ac&ve
duty,
veterans,
and
military
families;
women
and
girls;
individuals
in
the
criminal
jus&ce
system;
and
college
students
• Signature
ini&a&ves
– Prescrip&on
Drug
Abuse
– Preven&on
– Drugged
Driving

4. Pain
Reliever
Prescrip;ons:
2000-­‐2009
ER
–
Extended
Release,
LA
–
Long-­‐Ac&ng,
IR
–
Immediate
Release
Source:
SDI,
Vector
One:
Na;onal.
Extracted
June
2010.

5. 2011 Monitoring the Future Study
Prevalence of Past Year Drug Use Among 12th graders
Drug Prev. Drug Prev.
Alcohol 63.5 OxyContin* 4.9
Marijuana/Hashish 36.4 Sedatives* 4.3
Synthetic Marijuana 11.4 Hall other than LSD 4.3
Amphetamines* 8.2 Inhalants 3.2
Vicodin* 8.1 Cocaine (any form) 2.9
Adderall* 6.5 LSD 2.7
Salvia 5.9 Ritalin* 2.6
Tranquilizers* 5.6 Ketamine 1.7
Cough Medicine* 5.3 Provigil 1.5
MDMA (Ecstasy) 5.3 GHB 1.4
Hallucinogens 5.2 Methamphetamine 1.4
* Nonmedical use Categories not mutually exclusive

6. Prescrip;ons
Dispensed
for
select
opioids
in
U.S.
Outpa;ent
Retail
Pharmacies,
2000-­‐2009
140,000,000
120,000,000
100,000,000
Number
of
Prescrip;ons
80,000,000
60,000,000
40,000,000
20,000,000
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Hydrocodone
Oxyocodne
methadone
buprenorphine
tramadol
Source:
SDI,
Vector
One:
Na;onal.
Extracted
June
2010.

7. Uninten&onal
Drug
Overdose
Deaths
United
States,
1970–2007
27,658
uninten&onal
drug
overdose
deaths
Cocaine
Heroin
Year
Na;onal
Vital
Sta;s;cs
System,
hZp://wonder.cdc.gov

8. Emergency
Department
Visits

9. Persons
Classified
with
Substance
Abuse/
Dependence
on
Psychotherapeu;cs
2,500
2,000
1,500
1,000
500
0
2002
2003
2004
2005
2006
2007
2008
2009
2010*
Results
from
the
2010
Na2onal
Survey
on
Drug
Use
and
Health
(NSDUH):
Na2onal
Findings,
SAMHSA
(2011).
hXp://www.oas.samhsa.gov/nsduhLatest.htm.
*Number
in
2010
is
sta;s;cally
significantly
higher
than
in
2005.

10. Drug-­‐Induced
Deaths
vs.
Other
Injury
Deaths,
1999–
2009
50,000
45,000
NUMBER OF DEATHS
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0 1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Injury
by
firearms
28,874
28,663
29,573
30,242
30,136
29,569
30,694
30,896
31,224
31,593
31,347
Drug-­‐induced
19,128
19,720
21,705
26,040
28,723
30,711
33,541
38,396
38,371
38,649
39,147
Homicide
16,889
16,765
20,308
17,638
17,732
17,357
18,124
18,573
18,361
17,826
16,799
Suicide
29,199
29,350
30,622
31,655
31,484
32,439
32,637
33,300
34,598
36,035
36,909
Motor
vehicle
accidents
42,401
43,356
43,788
45,380
44,757
44,933
45,343
45,316
43,495
39,790
36,216
Causes
of
death
aZributable
to
drugs
include
accidental
or
inten;onal
poisonings
by
drugs
and
deaths
from
medical
condi;ons
resul;ng
from
chronic
drug
use.
Drug-­‐induced
causes
exclude
accidents,
homicides,
and
other
causes
indirectly
related
to
drug
use.
Not
all
injury
cause
categories
are
mutually
exclusive.
Source:
Na;onal
Center
for
Health
Sta;s;cs,
Centers
for
Disease
Control
and
Preven;on.
Na;onal
Vital
Sta;s;cs
Reports
Deaths:
Final
Data
for
the
years
1999
to
2009
(January
2012).

11. Source
of
Prescrip;on
Pain
Relievers
Source:
SAMHSA,
Center
for
Behavioral
Health
Sta&s&cs
and
Quality,
Na&onal
Survey
on
Drug
Use
and
Health,
2008-­‐2009

12. Prescrip;on
Drug
Abuse
Preven;on
Plan
• Coordinated
effort
across
the
Federal
government
• 4
focus
areas
– Educa;on
– Prescrip;on
Drug
Monitoring
Programs
– Proper
Medica;on
Disposal
– Enforcement

13. Educa;on
• Educa;on
Goals
for
healthcare
providers
– Knowledge
on
appropriate
prescribing
– Effec;vely
iden;fying
those
at
risk
for
abuse
– PDMP
use
in
everyday
clinical
prac;ce
– Screening,
interven;on,
and
referral
for
those
misusing
or
abusing
prescrip;on
drugs
• Main
Ac;ons
– Legisla;on
requiring
mandatory
educa;on
for
all
clinicians
who
prescribe
controlled
substances
– Increase
substance
abuse
educa;on
in
health
profession
schools,
residency
programs,
and
con;nuing
educa;on
– Work
with
the
American
College
of
Emergency
Physicians
to
develop
evidence-­‐based
clinical
guidelines
that
establish
best
prac;ces
for
opioid
prescribing
in
the
Emergency
Department
– Expedi;ng
research
on
the
development
of
abuse
deterrent
formula;ons

14. Top
10
prescribing
special&es
immediate-­‐release
opioids,
2009
Orthopedist;
7.4%
Unspec.;
4.5%
Anesthesiologists;
3.2%
Physical
Med
&
General
Rehab;
2.7%
Prac&&oners/Family
Medicine;
26.7%
Other;
20.2%
Internal
Medicine;
15.4%
Den&sts;
7.7%
Emergency
Medicine;
4.7%
Physicians
Nurse
Prac&&oners;
Assistants;
4.0%
3.5%
SDI, Vector One: National, 2009. Extracted June 2010.
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvisoryCommittee/UCM217510.pdf

15. Top
10
prescribing
special&es
extended-­‐release/long
ac&ng
opioids,
2009
Other;
11.8%
General
Prac&&oners/
Family
Medicine;
Anesthesiologists;
27.0%
13.8%
Physical
Med
&
Rehab;
9.3%
Internal
Medicine;
16.8%
Unspec.;
4.9%
Neurologist;
2.8%
Orthopedist;
1.9%
Physicians
Assistants;
4.3%
Nurse
Prac&&oners;
Hematology;
1.7%
5.7%
SDI, Vector One: National. Years 2009. Extracted June 2010.
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvisoryCommittee/UCM217510.pdf

16. Educa;on
Gaps
• Physicians
– 2000
survey:
56
%
of
residency
programs
required
substance
use
disorder
training,
median
number
of
curricular
hours
ranged
from
3
to
12
hours1
– 2008
follow-­‐up:
“Although
the
educa;on
of
physicians
on
substance
use
disorders
has
gained
increased
aZen;on,
and
progress
has
been
made
to
improve
medical
school,
residency,
and
postresidency
substance
abuse
educa;on
since
2000,
these
efforts
have
not
been
uniformly
applied.”2
• Pharmacists3
– 67.5%
report
receiving
two
hours
or
less
of
addic;on
or
substance
abuse
educa;on
in
pharmacy
school
– 29.2%
reported
receiving
no
addic;on
educa;on
– Pharmacists
with
greater
amounts
of
addic;on-­‐specific
educa;on:
• Higher
likelihood
of
correctly
answering
ques;ons
rela;ng
to
the
science
of
addic;on
and
substance
abuse
counseling
• Counseled
pa;ents
more
frequently
and
felt
more
confident
about
counseling
1.
Isaacson
JH,
Fleming
M,
Kraus
M,
Kahn
R,
Mundt
M.
A
Na;onal
Survey
of
Training
in
Substance
Use
Disorders
in
Residency
Programs.
J
Stud
Alcohol.
61(6):912-­‐915.
2000.
2.
Polydorou
S,
Gunderson
EW,
Levin
FR.
Training
Physicians
to
Treat
Substance
Use
Disorders.
Curr
Psychiatry
Rep.
10(5):399-­‐404.
2008.
3.
Lafferty
L.
Hunter
TS,
Marsh
WA.
Knowledge,
aktudes
and
prac;ces
of
pharmacists
concerning
prescrip;on
drug
abuse.
J
Psychoac:ve
Drugs.
2006
Sep:38(3):229-­‐232.

18. Proper
Medica;on
Disposal
• Goals:
– Easily
accessible,
environmentally
friendly
method
of
drug
disposal
that
reduces
the
amount
of
prescrip;on
drugs
available
for
diversion
and
abuse
• Main
Ac;ons
– Publish
and
implement
regula;ons
allowing
pa;ents
and
caregivers
to
easily
dispose
of
controlled
substance
medica;ons
– Next
DEA
Take
Back
Day
April
28
– Once
regula;ons
are
in
place,
partner
with
stakeholders
to
promote
proper
medica;on
disposal
programs

19. Enforcement
• Goals:
– Assist
states
in
addressing
“pill
mills”
and
doctor
shopping
• Main
Ac;ons
– Provide
technical
assistance
to
states
on
model
regula;ons/laws
for
pain
clinics
– Encourage
High-­‐Intensity
Drug
Trafficking
Areas
(HIDTAs)
to
work
on
prescrip;on
drug
abuse
issues
– Support
prescrip;on
drug
abuse-­‐related
training
programs
for
law
enforcement

20. hZp://www.whitehouse.gov/ondcp