Examining What's Happening Across America National Rx Drug Abuse Summit 4-11-12

1. Examining What’s
Happening Across America
April 10-12, 2012
Walt Disney World Swan Resort

2. Accepted
Learning
Objec1ves:
1. Analyze
the
characteris1cs
of
effec1ve
programs
designed
to
reduce
the
growth
of
prescrip1on
drug
abuse
and
provide
evidence-­‐based
programs
that
can
be
replicated
in
rural
and
urban
communi1es.
2. Iden1fy
common-­‐interest
issues
related
to
grassroots
preven1on
and
treatment
programs.
3. Describe
resources
to
advocate
for
change,
with
specific
focus
on
model
state
drug
laws.

3. Disclosure
Statement
All
presenters
for
this
session,
Sherry
Green,
Robert
I.L.
Morrison,
and
Steve
Pasierb,
have
disclosed
no
relevant,
real
or
apparent
personal
or
professional
financial
rela1onships.

4. State
Substance
Abuse
Agencies
and
Prescrip2on
Drug
Abuse
Ini1al
Results
from
a
NASADAD
Membership
Inquiry
Robert
Morrison,
Execu1ve
Director
Cliff
Bersamira,
Research
Analyst
Na1onal
Associa1on
of
State
Alcohol
and
Drug
Abuse
Directors,
Inc.
(NASADAD)
April
2012

5. Na1onal
Associa1on
of
State
Alcohol
and
Drug
Abuse
Directors,
Inc.
• State
Substance
Abuse
Agency
Directors
(SSAs)
manage
the
publicly-­‐funded
State
substance
abuse
preven1on,
treatment,
and
recovery
systems.
• NASADAD
established
in
1971
in
Washington,
DC.
• Component
Groups:
Na1onal
Preven1on
Network
(NPN)
and
Na1onal
Treatment
Network
(NTN).

6. Poisoning
is
the
Leading
Cause
of
Death
from
Injury
in
30
States
(CDC,
2011)
Warner
M,
Chen
LH,
Makuc
DM,
Anderson
RN,
Miniño
AM.
Drug
poisoning
deaths
in
the
United
States,
1980–2008.
NCHS
data
brief,
no
81.
Hya`sville,
MD:
Na1onal
Center
for
Health
Sta1s1cs.
2011.

7. Opioid
Analgesics
Involved
in
More
Than
40%
of
Drug
Poisoning
Deaths
in
2008
(CDC,
2011)
Number
of
drug
poisoning
deaths
involving
opioid
analgesics
and
other
drugs:
United
States,
1999–2008
Warner
M,
Chen
LH,
Makuc
DM,
Anderson
RN,
Miniño
AM.
Drug
poisoning
deaths
in
the
United
States,
1980–2008.
NCHS
data
brief,
no
81.
Hya`sville,
MD:
Na1onal
Center
for
Health
Sta1s1cs.
2011.

8. NASADAD
Membership
Inquiry:
Primary
Objec1ves
• Understand
how
States
Substance
Abuse
Agencies
are
addressing
prescrip1on
drug
abuse.
• Iden1fy
effec1ve
prac1ces
and
challenges/barriers.
• Iden1fy
training,
technical
assistance,
and
resource
needs.

9. Membership
Inquiry:
Overview
• Web
survey
conducted
in
March
2012.
• Invited
State
Directors
(SSAs),
Treatment
Leads
(NTNs),
and
Preven1on
Leads
(NPNs)
to
par1cipate.
• 46
States,
2
Territories,
and
the
District
of
Columbia
responded.
• Analysis
includes
46
States
and
the
District
of
Columbia
(N
=
47
States).

10. Importance
of
Prescrip1on
Drug
Abuse
to
State
Substance
Abuse
Agencies
4%
Most
Important
(11)
15%
23%
Very
Important
(27)
Important
(7)
Moderately
Important
(2)
Of
Li`le
Importance
(0)
58%
Unimportant
(0)

11. State
Task
Force
Addressing
Prescrip1on
Drug
Abuse
4%
Yes,
currently
exists
(29)
19%
Yes,
once
existed
but
no
longer
ac1ve
(7)
No
(9)
15%
62%
Unsure
(2)

12. State
Task
Force
:
California
• State
Agency
Task
Force
established
in
2008.
• Task
Force
included:
Department
of
Jus1ce;
Department
of
Public
Health;
California
Universi1es;
Partnership
for
a
Drug-­‐Free
America;
AOD
workforce
professionals;
State
Substance
Abuse
Agency
• Summary
Report
and
Recommenda1ons
on
Prescrip1on
Drugs:
Misuse,
Abuse
and
Dependency
(2009)
h`p://www.adp.cahwnet.gov/Director/pdf/Prescrip1on_Drug_Task_Force.pdf

13. State
Task
Force:
Iowa
• 370%
increase
(1999-­‐2009)
in
those
seeking
treatment
for
prescrip1on
drug
abuse
• 187
in
1999
to
878
in
2009
• Iowa
Prescrip1on
Drug
Abuse
Reduc1on
Task
Force
(PAR)
• Iowa
Plan
for
Reducing
Prescrip1on
Drug
Abuse
(2011)
h`p://nursing.iowa.gov/images/pdf/BM%20A`achments/ReducPresDrgAbuse.pdf
• Educa1on/Interven1on;
Safe
Disposal;
Monitoring;
Enforcement

14. State
Legisla1on
Addressing
Prescrip1on
Drug
Abuse
Any
Legisla2on
(N
=
47)
Breakdown
by
Legisla2on
Focus
(N
=
47)
Yes
(37)
No
(9)
Focus
on
Demand
62%
30%
6%
No
Response
(1)
2%
19%
Focus
on
Supply
45%
36%
17%
Focus
on
Legal
51%
30%
17%
Dispenser/Pharmacy
Focus
on
Prescriber
40%
43%
15%
Percent
of
States
79%
Yes
No
Unsure
No
Response

15. Educa1ng
the
General
Public
on
Prescrip1on
Drug
Abuse
Any
Educa2on
(N
=
47)
By
Educa2on
Type
(N
=
47)
Yes
(39)
No
(8)
Yes,
Printed
materials
64%
17%
Yes,
Internet
campaign
26%
Yes,
Mul1media
(radio
or
television)
40%
Yes,
Other
32%
No
17%
83%
0%
20%
40%
60%
80%
Percent
of
States

16. Programs
or
Ini1a1ves
for
Target
Popula1ons
Yes
No
Unsure
No
Response
• Other
Popula1ons
Cited:
• Na1ve
Americans
and
Adolescent/
6%
Young
Adults
53%
34%
6%
Tribes
(2)
• Pregnant
Women
(2)
• Those
with
Chronic
Older
Adults
23%
47%
13%
17%
Health
Condi1ons
(1)
• Post-­‐Natural
Disaster
Communi1es
(1)
Women
19%
55%
13%
13%
Percent
of
States

17. Addressing
Target
Popula1ons:
Mississippi
• Development
of
print
materials
targeted
towards
adolescents.
• Trainings
for
care
givers
of
older
adults.

18. Educa1onal
Ac1vi1es
for
Physicians,
Pharmacists,
and
Pa1ents
Yes
No
Unsure
No
Response
Physicians/Other
Prescribers?
51%
28%
15%
6%
Target
Group
Pharmacists?
38%
32%
17%
13%
Pa1ents/Families?
53%
34%
11%
Percent
of
States

19. State
Substance
Abuse
Agency
Involvement
with
the
Prescrip1on
Drug
Monitoring
Program
(PDMP)
(N
=
28)
3%
11%
Directly
oversees
PDMP
(3)
11%
Part
of
commi`ee
that
oversees
PDMP
(3)
43%
Serves
in
an
advisory
capacity
(9)
No
involvement
(12)
32%
Unsure
(1)

20. Usefulness
of
PDMP
Data
to
State
Substance
Abuse
Agencies
6%
Very
Useful
(17)
11%
Useful
(13)
4%
36%
Somewhat
Useful
(6)
2%
Not
Par1cularly
Useful
(1)
Not
Useful
(2)
13%
Not
Applicable
(5)
Unsure
(3)
28%

21. Highlights
of
State
Programs
and
Ini1a1ves:
Themes
across
States
• Collabora'on
• e.g.
across
State
agencies;
with
law
enforcement;
with
primary
care
providers;
across
States
• Educa'on
and
Preven'on
• e.g.
provide
community
educa1on;
mobilize
preven1on
coali1ons;
educate
prescribers
and
pharmacists
• Early
Iden'fica'on
and
Referral
to
Treatment
• e.g.
SBIRT
training
for
physicians
• Supply
Reduc'on
• e.g.
take
back
ini'a'ves

22. Highlights:
Ohio
• In
2009,
opiates
were
primary
drug
of
choice
for
18%
of
all
clients
(up
from
7%
in
2001).
• Top
priority
of
Governor
Kasich
–
includes
a
Task
Force
led
by
SSA.
• State
conference
in
2011.
• “Recovery
2
Work”
Ini1a1ve
–
Led
by
SSA,
Rehabilita1on
Services,
and
County
Authori1es.
• Integrates
addic1on
treatment
with
voca1onal
rehab
services
–
focus
on
jobs.
h`p://recovery2work.org

23. Highlights:
Oregon
• In
2010,
the
State
Agency
developed
the
Prescrip1on
Opioid
Poisoning
Preven1on
(POP)
Ac1on
Plan
to
reduce
analgesic
overdose
deaths
in
the
State.
• This
plan
took
a
mul1-­‐agency,
public-­‐private
collabora1on
approach
to
addressing
four
areas:
1)
communica1on;
2)
educa1on;
3)
clinical
prac1ce
and
policy;
4)
system
coordina1on
clinical
prac1ce
issues.

24. Highlights:
Utah
• Legisla1on
requires
prescribers
to
a`end
four
hours
of
substance
abuse
classes.
• April
is
designated
as
“Clean
Out
your
Medicine
Cabinet”
Month.
h`p://www.medica1ondisposal.utah.gov/cleanoutcabinet.htm
• Through
local
preven1on
coali1ons,
successful
take
back
events
have
collected
6,550
pounds
of
prescrip1on
drugs.

25. Highlights:
Vermont
• 2nd
highest
State
per
capita
for
admissions
to
prescrip1on
opiates
treatment
in
2008.
• Prescrip1on
Drug
Abuse
Work
Group.
• State
Agency
sponsored
hospital
grand
rounds
–
call
a`en1on
to
awareness.
• Conference
in
2009
on
Pain
Management.
• Hub
and
Spoke:
5
loca1ons
with
specialty
treatment
/assessment/counseling
(hub)
monitoring/support/physician
prac1ces
(spoke).

26. Highlights:
Arizona
• State
Agency
collaborated
with
Poison
Control
Centers
to
iden1fy
repeat
poisonings
and
make
referrals
to
SUD
treatment
services.
• Online
trainings
were
developed
for
Emergency
Department
doctors
to
increase
the
understanding
of
screening
and
referral
process.

27. Highlights:
Connec1cut
• Community
preven1on
coali1ons
are
priori1zing
prescrip1on
drug
abuse
and
misuse.
• Drop
Boxes
are
installed
in
mul1ple
police
sta1ons
across
the
State.

28. Remaining
Challenges:
Themes
across
States
• Easy
access
(high
supply)
of
prescrip1on
drugs.
• Lack
of
funding.
• Need
for
workforce
development
(lack
of
capacity
to
address
this
issue).
• Challenges
with
data
(lack
of
data;
data
that
doesn’t
capture
the
en1re
story).
• Need
to
priori1ze
the
issue.
• Challenges
with
collabora1on.
• Need
for
PDMP
improvement
(need
for
improved
collabora1on
with
PDMP
host
agency;
lack
of
funding
for
PDMP).

29. Conclusion
• This
is
a
complex
problem.
• Collaborate
with
your
State
Substance
Abuse
Agency.
Contact
Informa2on:
Email:
rmorrison@nasadad.org
Website:
www.nasadad.org