Who is behind the drug abuse crisis?

1. JUDGE DAVID T. MATIA
CUYAHOGA COURT OF COMMON PLEAS

4. Not necessarily these guys

7. 7

10. Even the Amish Ache!

13. 13

18. Enough prescription pain
medication was prescribed to
medicate every adult American
around the clock for 1 month!

20. Prior to 2011 Boscarino study rates of addicition assiciated with prescription opiod therapy were
believed to be 2-18%.
July 2011 study assessed rates of opioid abuse/dependence using both DSM-IV and proposed DSM-
V criteria in CNCP:
35%!!!!!
Credits to Dr. Binit Shah at UHHS.
Boscarino JA, Rukstalis MR, Hoffman SN. Prevalence of prescription opioid-use disorder among chronic pain patients:
comparison of the DSM-5 vs. DSM-4 diagnostic criteria. Jour of Add Dis 2011;30:185-94.

21. 34% of the patients treating with opioids used illegal drugs in
addition to those prescribed.1
Only 15% of the chronic pain patients who were not treated with
opioids used illegal drugs.
1. Christo PJ, Manchikanti L, Ruan X, et al. Urine drug testing in chronic pain. Pain Phys 2011;14:123-43
2 Wong WS, Chen PP, Yap J, et al. Chronic pain and psychiatric morbidity: a comparison between patients
attending specialist orthopedics clinic and multidisciplinary pain clinic. Pain Med 2011;12:426-59.

22. In a large epidemiologic study in Denmark, chronic pain patients using opioids had worse
pain, higher health care utilization and lower activity levels than matched chronic pain
patients not using opioids.1
Opioid use may go against important principles of chronic pain management including
increased self-efficacy, reduced reliance on the health care system, reinforcement of pain
behavior, and passivity and loss of autonomy by externalization of the locus of control.2
Credits to Dr. Binit Shah at UHHS.
1. Eriksen J, Sjogren P, Bruera E, et al. Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain
2006;125:172-9. 2. Large RG, Schug Sa. Opioids for chronic pain of non-malignant origin- caring or crippling? Health Care Anal
1995;3:5-11.

23. A systematic review of randomized trials for multiple opioids utilized for
managing various chronic pain conditions, showed fair evidence for
tramadol in managing osteoarthritis. For all other conditions and all other
drugs excluding tramadol, the evidence was poor based on either weak
positive evidence or indeterminate or negative evidence.
Credits to Dr. Binit Shah at UHHS.
Manchikanti L, Ailinani H, Koyyalagunta D, et al. A systematic review of randomized trials of long-term opioid
management for chronic non-cancer pain. Pain Phys 2011;14:91-121.

24. Pill Mills are on the decline.
2007 10 pill mills in Scioto County alone
2011 1 pill mill (Thank you House Bill 93).

26. Chronic Intractable Pain is a challenging problem faced by the practicing
physician. It is a common presenting complaint in the outpatient setting. The
treatment of this condition is complex and nuanced, but for some patients, after a
thorough evaluation has been completed and after numerous alternate treatments
have been considered or attempted, opioid therapy may be a consideration.
It is well known that there are substantial risks associated with the
treatment of chronic pain with opioids, including but not limited to, tolerance,
physical dependence, psychological dependence, addiction, opioid-induced
hyperalgesia and death. There is also a risk of diversion that may complicate this
form of treatment. University Hospitals (“UH”) wishes to mitigate the treatment
risks and professional risks of its physicians associated with the prescribing of
opiods for the treatment of chronic non-cancer pain. After extensive review and
discussion, UH is recommending the following set of guidelines for its physicians
to follow when the treatment of chronic intractable non-cancer pain with opioids
is undertaken.
1. Prior to considering any prescription of opioids for a chronic non-cancer
pain condition, such as low back pain, a referral to a pain medicine specialist
should be sought to evaluate for other treatment options besides opioids. Chronic
opioid therapy should be considered only after exhausting other non-opioid
options.

28. What is a “specialized” docket?

29. Extra resources to handle a common
reoccurring issue.

30. •JUDICIAL ATTENTION
•SUPERVISION
•TREATMENT OF SUFFICIENT
DURATION

31. •1996 Common Pleas Judges reject drug court funds.
•Cleveland Municipal Court (Judge Larry Jones) starts county’s
first drug court.
•2008 Judge Jones leaves for Court of Appeals.
•2008 Common Pleas Judges vote to take over Drug Court
•May 2009 Common Pleas admits first defendant to Drug Court.

32. 254 Admitted
100 Graduates
47 Terminations
5 Deaths

33. No future cases.
G.E.D.
Get jobs, pay taxes. Less gov’t aid to dependants.
Raise their children.

34. •Prefer 2nd time offenders.
•No violent or sex offenders.
•Dependants, not abusers.
•Those likely to be back without intervention.

35. •60% Opiate dependant
•Over half of those opiate dependant started by treating a
medical condition.
•Treating a public health issue under a criminal justice
umbrella!

36. ONE OF THE MOST EXPENSIVE

37. $ Spent to treat the disease.

39. 1. Dependency is a disease.
2. It’s really, really expensive.
3. It’s a big believer in diversity.
4. Too much spent treating symptoms and too little spent
treating the disease.
5. Medical profession is an unwitting partner.