Transcript A Prescription for Success: Addressing the Rx Drug Abuse

Addressing the Substance
Abuse Epidemic in Tennessee
John J. Dreyzehner
Commissioner
A Rising Tide
Near Tripling in Opioid-related Deaths (in parallel
with opioid sales and Rx opioid treatment admits)
8
7
Opioid Sales (Kg/10,000)
Opioid-Related Deaths/100,000
Opioid Treatment Admissions /10,000
6
Rate
5
4
3
2
1
0
Year
Sources: National Vital Statistics System, DEA Automation of Reports and
Consolidated Orders System, SAMHSA TEDS
2011 OD Deaths
(U.S.):
• 41,340 Any Drug
• 22,810 Rx drug
• 16,917 Rx
opioid
• 4,397 Heroin
The Numbers in Tennessee
Deaths Due to Drug Overdose by Intent
Tennessee, 1999-2011
1000
900
Number of Deaths
800
Accidental
Intentional
Undetermined
700
600
500
400
300
200
100
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Data source: Tennessee Department of Health, Office of Health Statistics, Death Statistical System. Overdose deaths were
defined as having underlying cause of death ICD-10 codes X40-X44 (accidental), X60-X64 (intentional suicide), X85
(intentional homicide), and Y10-Y14 (undetermined).
The Numbers in Tennessee
Deaths Due to Drug Overdose
Tennessee, 1999-2012
1,200
1,059 1,062
963
1,000
972
924
1,094
929
Number of Deaths
868
800
753
660
600
484
400
342
391
422
200
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Data source: Tennessee Department of Health, Office of Health Statistics, Death Statistical System.
Overdose deaths were defined as having underlying cause of death ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14.
Deaths by Age Group, TN
Opioid Prescription Rates by County
TN, 2007-2011
2007
2008
2009
2010
2011
Data source: Tennessee Department of Health; Controlled Substance Monitoring Database.
Dopamine
Neurotransmission
1100
1000
900
800
700
600
500
400
300
200
100
0
% of Basal Release
These prescription drugs,
like other drugs of abuse
(cocaine, heroin, marijuana)
raise brain dopamine levels
% of Basal Release
Why Do People Abuse Prescription Drugs?
AMPHETAMINE
0
1
2
3
4
5 hr
Time After Amphetamine
FOOD
200
150
100
50 Empty Feeding
Box
0 0
60
120
Time (min)
180
Di Chiara et al.
“Ask your doctor if taking a pill to solve all your
problems is right for you.”
How We got Here
“Dr. Portenoy and other pain doctors who promoted the drugs say they
erred by overstating the drugs’ benefits and glossing over risks.”
“…urged tackling what they called an epidemic of untreated
pain…[and]…campaigned to make pain…’the fifth vital sign’ that doctors
should monitor, alongside blood pressure, temperature, heartbeat and
breathing.”
A PAIN-DRUG CHAMPION
HAS SECOND THOUGHTS
“In 1998, the Federation of State Medical Boards released a
recommendation policy reassuring doctors they wouldn’t face regulatory
action for prescribing even large amounts of narcotics…In 2004, the group
called on state medical boards to make undertreatment of pain
punishable for the first time…That policy was drawn up with the help of
several people with links to opioid makers…the federation said it received
nearly $2 million from opioid makers since 1997.”
“In 2001, the Joint Commission, which accredits U.S. hospitals, issued new
standards telling hospitals to regularly ask patients about pain and to make
treating it a priority…The Joint Commission published a guide sponsored by
Purdue Pharma. ‘Some clinicians have inaccurate and exaggerated
concerns’ about addiction, tolerance and risk of death, the guide said. ‘This
attitude prevails despite the fact there is no evidence that addiction is a
significant issue when persons are given opioids for pain control.’”
TN’s Prescription Drug Problem
Prescription Painkillers Sold By State, 2012
Data source: CDC, Vital Signs: Opioid Painkiller Prescribing. July 2014. Available at:
http://www.cdc.gov/vitalsigns/opioid-prescribing/
TN: Tied for 1st
in country for
kilograms of
prescription
painkillers sold
per 100 people
Source of Opiates for Non-Medical Use
Other
5%
Internet
0%
Dealer
4%
One
Doctor
18%
More than
One
Doctor
2%
Friend or
Relative
71%
Results from the 2011 National Survey on Drug Use and Health: Summary of National
Findings. SAMHSA
Transmission in the substance abuse epidemicHow did we get here?
Abuse
Misuse
Misuse
Abuse
Misuse
Abuse
Abuse
Misuse
Misuse
Overdose
Resistant
(Religious)
Resistant
(Recovery)
Misuse
AbusePregnancy
Abuse
NAS
Resistant (Bad
Relationship)
Supply and Demand: The Substance
Abuse/Misuse Market
Substance Abuse/Misuse: Constraining the
Market
PDMP
Addresses
All Three
Prescription Safety & Population Protection
Steady reduction in the number of high-use patients since third quarter of 2012.
Survey of 800 CSMD users found:
• 71 percent had changed a treatment plan after viewing the patient’s information on
the CSMD
• 73 percent said they are now more likely to discuss substance abuse issues with a
patient
• 57 percent said they are now more likely to
Fig 1. Number of High Utilization Patients* in CSMD 20122014
refer a patient for substance abuse treatment
2500
Cumulative milligram morphine equivalent
dispensed shows decline in year-to-year
comparison since CSMD became
mandatory:
• 0.7 percent in 2013
• 6.7 percent thus far in 2014
2000
2012
1500
2013
2014
1000
500
0
1st quarter
2nd quarter
3rd quarter
4th quarter
*Individual who obtained controlled substance prescriptions from five or more
prescribers and utilized five or more pharmacies within the quarter
A New Tool To Combat Overdose Deaths:
Naloxone
Effective July 1, 2014
Licensed practitioner in Tennessee can prescribe
The Prescription for Success Plan
Plan for the Future:
1. Decrease the number of
Tennesseans that abuse controlled
substances.
2. Decrease the number of
Tennesseans who overdose on
controlled substances.
3. Decrease the amount of controlled
substances dispensed in
Tennessee.
4. Increase access to drug disposal
outlets.
5. Increase access and quality of
early inter vention, treatment and
recover y ser vices.
6. Expand collaborations among state
agencies.
7. Expand collaboration with other
states.
REMEMBER
Doctor shopping is associated
with a 5-fold higher risk of
death.
An MME of 100 or more is
associated with an 11-fold
higher risk of death.
Source: “High-Risk Use by Patients Prescribed Opioids for
Pain and Its Role in Overdose Deaths” by Baumbatt, et al,
JAMA Internal Medicine, May 2014
Image credit: Naypong, FreeDigitalPhotos.net
Thank you for your
partnership.
There’s a lot more for us
to do together.