Transcript Office of National Drug Control Policy (ONDCP)

Pharmaceutical Misuse & Abuse:
from National to Local
What the Data Say and Mean for
Montgomery County Public Schools
Presenter:
Kenneth Hoffman, MD, MPH
June 20, 2005
Objectives
 Define
the problem
 Review the National Data
 Licit
and illicit drug use
 Review
the Maryland State Department of
Education Maryland Adolescent Survey
 Licit
and illicit drug use
 Discuss
next steps
Desired: Appropriate Drug Use
 Over
the Counter (OTC)
 High
margin of safety (but surprises happen)
 Through
 For
Indicated Use
Listed
 For
 By
prescription by licensed provider
on the FDA regulated package insert
“Off-Label” Use
regulated prescription (with DEA number)
 for
known drugs of potential abuse
Desired: Monitor Use of
Potentially Abused Drugs
 Licensed
Provider Application Process for
Drug Enforcement Agency (DEA) Number
 Drugs of potential abuse placed into a
DEA/FDA controlled substance schedule:
I:
never medically indicated
II: medical indications, high abuse, non-refillable
III-IV: medical indications, high abuse, refillable
V: medical indications, some abuse concern
 Prescription
Drug Monitoring Act (proposed)
Desired: Shared Decision Making
 Provider-patient
 Provider
shared decision for drug use
believes drug useful for treatment
Explains
rationale to patient
Benefits outweigh the risks
 Patient
agrees that drug will be useful
Understands
rationale
Accepts the risks for the desired benefit
 Patient
takes the drug as directed
 Provider gets patient feedback
Problem: Drug misuse
 Drugs
not taken as intended
 Provider
prescribes for “wrong reason”
 Patient does not take drug as directed
Unintentional:
forgetfulness, too many drugs, mindaltering drug interactions
Intentional: patient doesn’t feel need or believes drug
not working and doesn’t discuss with the provider
 Drugs
diverted to another person
 Potential
problem & illegal (with prescribed drugs)
Problem: Drug Abuse
 Interactions
 Individual
affecting decision-making
- a voluntary decision to use
Psychologically
pleasurable
Physically enhancing for specific outcomes
 Environmental
– friends & groups affect decision
Drug
is available at a “reasonable” price
Drug enhances group bonding
Drug connected to desired group activities
 Drug
abuse more common than dependence
Problem: Drug Dependence
 Physical
dependence: tolerance or withdrawal
 Addiction: “Involuntary” once use begins
 Out
of control, obsessive-compulsive use
 Predisposing factor: Genetics
Psychological
“hedonistic” pleasure
Metabolism of specific drugs
 Precipitating
Drug
factor: Environment
available
Initial use encouraged, by social group or prescription
Prescription Drug Abuse in the
United States
March 2004
Nonmedical use of prescription drugs, reported by
6.2 million persons in 2002, is second only to
marijuana use.
Past Month Users, Ages 12 and Older (in Millions)
14.6
Marijuana
6.2
Prescription Drugs
2.0
Cocaine
(incl. crack)
Crack
0.6
Ecstasy
0.7
Meth
0.6
Inhalants
0.6
Heroin
0.2
LSD
0.1
0
5
10
Source: SAMHSA, 2002 National Survey on Drug Use and Health.
2/2004
15
Pain relievers account for the largest portion of
nonmedical use of prescription drugs.
Past Month Users, Ages 12 and Older (Thousands)
6,210
Prescription Drugs
4,377
Pain Relievers
1,804
Tranquilizers
1,218
Stimulants
436
Sedatives
0
1,000
2,000
3,000
4,000
Source: SAMHSA, 2002 National Survey on Drug Use and Health.
2/2004
5,000
6,000
7,000
Nonmedical use of prescription drugs is most prevalent
among young adults and youth.
Users (Percentage)
30.0
27.7
12-17
18-25
26 and older
19.3
20.0
14.2
13.7
9.2
10.0
4.5
5.4
4.0
2.0
0.0
Lifetime
2/2004
Past Year
Source: SAMHSA, 2002 National Survey on Drug Use and Health.
Past Month
Over 2 million are estimated to be dependent on or
abusing prescription drugs in the past year.
Past Year Dependent/Abusers, Ages 12 or Older (in Thousands)
4,294
Marijuana
2,018
Prescription Drugs
1,488
Cocaine
426
Hallucinogens
Heroin
214
Inhalants
180
0
1,000
2,000
3,000
Source: SAMHSA, 2002 National Survey on Drug Use and Health.
1/2004
4,000
5,000
The rate of Vicodin® use in the past year ranks
second to marijuana use among 12th graders in 2003.
Past Year Users (Percent)
34.9
Marijuana
10.5
Vicodin®
9.9
Amphetamine
6.7
Tranquilizers
Sedatives
6.0
Hallucinogens
5.9
Cocaine
4.8
OxyContin®
4.5
Ecstasy
4.5
0
10
20
Source: University of Michigan, 2003 Monitoring the Future study.
2/2004
30
40
Emergency department mentions of narcotic analgesics
(pain relievers) rose steadily and have overtaken
benzodiazepines (sedatives) in 2002.
Number of mentions
125,000
100,000
75,000
50,000
25,000
Benzodiazepines
Narcotic analgesics
0
1995
2/2004
1996
1997
1998
Source: SAMHSA, Drug Abuse Warning Network.
1999
2000
2001
2002
DAWN ED Mention of Narcotics
Mentions
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
1994
1995
1996
1997
1998
Narcotic Analgesics
Source: Drug Abuse Warning Network
1999
2000
Heroin
2001
2002
Oxycodone and hydrocodone both registered
substantial increases in emergency department
mentions in the last 5 years.
Number of mentions
30,000
Hydrocodone
Oxycodone
20,000
10,000
0
1995
2/2004
1996
1997
1998
Source: SAMHSA, Drug Abuse Warning Network.
1999
2000
2001
2002
Drug Abuse in the Montgomery
County Public Schools (MCPS)
Source: Maryland Department of Education
Maryland Adolescent Survey
Data specific to Montgomery County
1994-2002
MCPS Beer, Wine, Coolers Use
% Use in Prior 12 mos
70
60
50
1994
1996
1998
2001
2002
40
30
20
10
0
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS “Hard” Liquor Use
% Use in Prior 12 mos
70
60
50
1994
1996
1998
2001
2002
40
30
20
10
0
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS 5+ Drinks/Same Occasion
% Use in Prior 12 mos
70
60
50
1994
1996
1998
2001
2002
40
30
20
10
0
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Cigarette Use
% Use in Prior 12 mos
50
45
40
35
30
25
20
15
10
5
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Smokeless Tobacco Use
% Use in Prior 12 mos
10
9
8
7
6
5
4
3
2
1
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Steroids for Body Building
% Use in Prior 12 mos
2.5
2
1994
1996
1998
2001
2002
1.5
1
0.5
0
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Marijuana or Hashish Use
% Use in Prior 12 mos
50
45
40
35
30
25
20
15
10
5
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS LSD Use
% Use in Prior 12 mos
20
18
16
14
12
10
8
6
4
2
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Mescaline, ‘shroom Use
% Use in Prior 12 mos
20
18
16
14
12
10
8
6
4
2
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS PCP Use
% Use in Prior 12 mos
10
9
8
7
6
5
4
3
2
1
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Amphetamine Use
% Use in Prior 12 mos
10
9
8
7
6
5
4
3
2
1
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Methamphetamine Use
% Use in Prior 12 mos
10
9
8
7
6
5
4
3
2
1
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Cocaine (not crack) Use
% Use in Prior 12 mos
10
9
8
7
6
5
4
3
2
1
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS MDMA, Ecstasy Use
% Use in Prior 12 mos
10
9
8
7
6
5
4
3
2
1
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Narcotic (not Heroin) Use
% Use in Prior 12 mos
10
9
8
7
6
5
4
3
2
1
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
MCPS Barbit. or Tranquilizer Use
% Use in Prior 12 mos
10
9
8
7
6
5
4
3
2
1
0
1994
1996
1998
2001
2002
6th grade
8th grade
10th grade
12th grade
Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey
Discussion
 Montgomery
 Misuse,
County has a drug use problem
abuse, and dependence
 Who
chooses to become an addict? (rhetorical
question)
 What can we do? (prevention strategies)
 Primary
– healthy community, social norms
 Secondary – identify high risk, early intervention,
prescription drug monitoring
 Tertiary – effective treatment easily accessed
 Next
steps?
Contact Information
Kenneth Hoffman, MD, MPH
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Division of Pharmacologic Therapies
1 Choke Cherry Road, Rockville, MD 20857
Telephone: (240) 276-2701
Email: [email protected]