Transcript ED Mentions and Prescriptions of Fentanyl

Prescription Drug Abuse:
An Escalating Public Health Threat
National Institute on Drug Abuse
Current (Past Month) Use of Prescription Drugs
for Non-Medical Purposes
2007 National Survey on Drug Use and Health
Millions of Americans
6
5.2 million
5
4
3
2.1 million
2
1.1 million
1
0
Stimulants
Source: SAMHSA, NSDUH 2007
Sedatives & Tranquilizers
Pain Relievers
Thousands of New Users
3,000
2,500
All Ages
2,000
Aged 18
or Older
Aged
Under 18
1,500
1,000
500
0
1965
1970
Source: SAMHSA, NSDUH 2007
1975
1980
1985
1990
1995
2000
120000
108,320
Emergency Dept. Visits
100000
90,232
75,837
80000
64,534
60000
42,857 44,028
50,584 54,516
40000
20000
0
1995
1996
1997
1998
1999
2000
Source: SAMHSA, The Dawn Report: Narcotic Analgesics, 2002 Update, September 2004
2001
2002
DAWN Update
120
70
Hydrocodone Prescriptions
Oxycodone Prescriptions
Emergency Visits
Emergency Visits
60
100
50
80
40
60
30
40
20
20
10
0
0
1994
1995
1996
1997
1998
1999
Source: SDI Health, VONA and SAMHSA, DAWN 2002, 2008
2000
2001
2002
2003
2004
2005
2006
ED Mentions (thousands)
Number of Prescriptions (millions)
140
Number of Past Year Initiates
(thousands)
2500
2147 2090
2000
1500
1000
500
0
Source: SAMHSA, NSDUH 2007
1232
906
781 775
642
270 198
106
58
40%
Cigarettes
30%
Marijuana
20%
10%
1978 1982 1986 1990 1994 1998 2002 2006
1976 1980 1984 1988 1992 1996 2000 2004 2008
CESAR FAX January 19, 2009, Vol. 18, Issue 2.
Adapted by CESAR from University of Michigan, “Trends in 30-Day Prevalence of Use of
Various Drugs in Grades 8, 10, and 12,”Monitoring the Future study, 2008.
Percent of 12th Graders Reporting Nonmedical Use
of OxyContin and Vicodin in the Past Year Remained High
*No year-to-year differences are statistically significant.
Percent of 12th Graders
12
9.6
10
10.5
9.3 9.5 9.7 9.6 9.7
8
6
4
4
4.5
5
5.5
5.2
4.3
4.7
2
0
Oxycontin
2002
2003
Vicodin
2004
Source: University of Michigan, 2008 Monitoring the Future Study
2005
2006
2007
2008
Percent of 12th Graders
Prevalence of Past Year Drug Use Among 12th Graders
35
30
25
20
15
10
5
0
32.4
9.7
6.8
5.8
6.2
Source: University of Michigan, 2008 Monitoring the Future Study
5.5
5.9
4.4
4.7
4.3
3.4
Age in Years
Source: SAMHSA, NSDUH 2007
Source: SAMHSA, NSDUH 2007
Between 1999 and 2005
there was a near doubling
of unintentional poisoning
deaths mainly from
opioid analgesic abuse
Between 1994 and 2004 there
was a 300% increase in
treatment admissions for
opioids other than heroin (as
primary abused drug)
•Safer than illicit drugs
•Inexpensive, easy to get
•Not illegal
•Less social stigma than illicit drugs
•Parents soft attitudes about their use
•Performance enhancement (stimulants)
Find the Balance:
• Reduce suffering for patients
with pain
• Increase awareness of the
abuse potential of opioid
medications
NIDA is working to engage
primary care physicians and
dentists as our partners in
recognizing, preventing &
treating drug abuse
• SDI Health, LLC
– Collects data from a representative sample of pharmacies, payers, and other third
party data providers (over 99% of pharmacies captured)
– As of 2006 over 56,100 pharmacies nationwide
• VONA: Vector One National
– Each month, nearly 50% of the retail prescriptions dispensed are collected and
projected through methods that stratify by geography, pay type and class of trade
– Trend data available for prescription counts from 1991
• TPT: Total Patient Tracker
– Projects the unique number of patients taking a therapy or multiple therapies over
time
– Patient based data available as of 2002
Prevalence Rate/1,000 Pop.
70
60
53
54
15-19
20-24
58
49
50
40
30
20
10
12
2
6
0
0-4
5-9
10-14
25-29
Age Group
GP/FM/DO
Dentists
IM
EM
Ortho Surg
Opioids Include Codeine & Comb NON-INJ (USC 02232), Morphine & Opium NON-INJ (USC 0222),
Morphine & Opium INJ (USC 0221), Codeine & Comb INJ (USC 02231).
Source: SDI Health, TPT 2008 09-29-08 Opiates and US Census
Uspec
30+
Prevalence Rate/1,000 Pop.
70
60
50
40
30
20
10
0
0-4
5-9
10-14
15-19
20-24
25-29
Age Group
2002
2003
2004
2005
2006
Opioids Include Codeine & Comb NON-INJ (USC 02232), Morphine & Opium NON-INJ (USC 0222),
Morphine & Opium INJ (USC 0221), Codeine & Comb INJ (USC 02231).
Source: SDI Health, TPT 2008 09-29-08 Opiates and US Census
2007
30+
Prevalence Rate/1,000 Pop.
70
60
50
40
30
20
10
0
0-4
5-9
10-14
15-19
20-24
25-29
Age Group
2002
2003
2004
2005
2006
Opioids Include Codeine & Comb NON-INJ (USC 02232), Morphine & Opium NON-INJ (USC 0222),
Morphine & Opium INJ (USC 0221), Codeine & Comb INJ (USC 02231).
Source: SDI Health, TPT 2008 09-29-08 Opiates and US Census
2007
30+
Percent Prescriptions
100%
New Trxs
Refill Txs
85% 86%
81% 83% 83% 84%
75%
50%
60% 62% 62% 62% 63% 63%
25%
40% 38% 38% 38% 37% 37%
19% 17% 17% 16%
15% 14%
0%
2002 2003 2004 2005 2006 2007
Dentists
2002 2003 2004 2005 2006 2007
All Others
Opioids Include Codeine & Comb NON-INJ (USC 02232), Morphine & Opium NON-INJ (USC 0222),
Morphine & Opium INJ (USC 0221), Codeine & Comb INJ (USC 02231).
Source: SDI Health, VONA 2008 11-12-08 Opiates
• Annual school survey by the University of Michigan
funded by NIDA
– 12th graders since 1975
– 8th and 10th graders since 1991
• 2008 Sample:
– 386 public and private schools
– 46,348 students
• Questionnaires are administered to students in their
classrooms
• Annual nationwide survey funded by SAMHSA
– Includes civilian, noninstitutionalized population aged 12 years old or older
residing within the United States
• 2007 survey
– Respondent sample of 67,870 persons representative of the U.S. general
population aged 12 or older (since 1991, the civilian, noninstitutionalized
population)
• Data collection
– In-person computer assisted interviews with sample persons, incorporating
procedures that would be likely to increase respondents' cooperation and
willingness to report honestly about their illicit drug use behavior