BUT…..I GOT A SCRIPT FOR IT!

“But I Got A Script For It”

Presented by: Vanessa Price

October 18, 2011

© Vanessa Price, October 18, 2011The following presentation may not be copied in whole or in part without the written permission of the author or the National Drug Court Institute. Written permission will generally be given without cost, upon request.

BUT…..I GOT

A SCRIPT FOR IT!

HOW PRESCRIPTION DRUG ABUSE

AND ADDICTION

CAN IMPACT THE DRUG

COURT SETTING

OBJECTIVES • Identify trends in prescription medication use, abuse, and dependence

• Discuss how the trends may impact your specialty court

• Utilize information discussed to improve service delivery

Legitimate Usage• Acute medical paint

treatment and humane hospice care for cancer patients (opioids)

• Serious anxiety disorders (benzodiazepines)

• Stimulants have a range of valuable uses in the medical field

Challenges• Development of

national policy that balances efforts:– to minimize abuse of

prescription drugs– need to ensure access for

their legitimate useDevelopment

of Specialty Court

Responses

• Prescription drug abuse and addiction has traditionally been overlooked when considering its impact on criminal justice

• National studies and published reports indicated that the abuse of prescription and over-the-counter (OTC) drugs is a growing concern

• The impact of prescription drug abuse and addiction on the criminal justice system must be considered in the design of, target population, and service delivery in specialty courts

National PerspectivesLocal Impact

• Yahoo – 9,360,000• Lost talents

– Freddie Prinze @ 22– Howard Hughes @ 70– Elvis Presley @ 42– Russell T. Jones @ 35– Dinah Washington @ 29– Chris Benoit @ 40– Anna Nicole Smith @ 39– Keith Moon @ 32– Dana Plato @ 34– Judy Garland @ 47– Jimi Hendrix @ 27

January 2007January 2007

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Rogue Internet Pharmacy Avg*U.S. Pharmacy Avg Excluding (34) Rogue Internet Pharmacies

DO

SA

GE

UN

ITS

Comparison of CY2006 Purchases of Comparison of CY2006 Purchases of Hydrocodone by PharmaciesHydrocodone by Pharmacies

*Based on 34 Suspected Rogue Pharmacies (Operating via the Internet)(as of 3/7/2007) Date Prepared: 03/07/2007

Source: ARCOS

2.9 million 88,000

January 2007January 2007

Cyber vs. Brick & Mortar SalesCyber vs. Brick & Mortar Sales

*SOURCE: 2003 NCPA-Pfizer Digest New York, New York - June 26, 2003

Average Independent ‘Brick & Mortar’

Pharmacy*

‘Cyber’ Pharmacy

Pre

scri

ptio

ns

Fill

ed P

er

Da

y

Noncontrolled RXs(89%)

Noncontrolled RXs (5%)

Controlled Substance RXs

(95%)

Controlled Substance RXs (11%)

Sources of Pain Relievers/Nonmedical Use

• 56% free from friend or relative

• 19% from one doctor• 7% other source• 4% bought from

drug dealer• 5% took from friend

or relative without asking

• 9%Bought from friend or relative

Drug Involved Impact

• More than 50% of violent crimes

• 60-80% of child abuse and neglect cases

• 50-70% of theft and property crimes

• 75% of drug dealing• 1.5 million prison-bound

arrestees at risk for drug abuse or dependenceBelenko and Pough, 1998; National Institute of Justice 1999Urban Institute Report, April 2008

National Picture 11 million people pass through American jails each year

• 46% were on probation/parole at the time of arrest

• 41% had current or prior violent offenses

• 46% were nonviolent repeat offenders

• 13% had a current or prior drug offense only

77% of convicted jail inmates were alcohol or drug-involved at the time of their current offense

www.ojp.usdoj.gov

DEA 2010 Data • Narcotic analgesics were the third most frequently prescribed class of drugs– 244 million prescriptions

• 12 or OLDER, the proportion that reported pain reliever abuse increased more than fourfold between 1998 and 2008– From 2.2% to 9.8%

Prescription Percentages

Analgesics Reports137,670

• Oxycodone 41.36%• Hydrocodone 31.95%• Buprenorphine 7.10%• Methadone 6.03%• Morphine 5.05%• Codeine 2.50%• Hydromorphone 1.79%• Propoxyphene 1.50%• Tramadol (uncontrolled)

1.01%• Oxymorphone 0.50%• Opium 0.42%• Fentanyl 0.42%• Meperidine 0.16%• Other narcotics 0.11%

Regional Reporting Trends

• Northeast– 54% Oxycodone– 17% Buprenorphine

• West– 38% Hydrocodone

For practioners living in these regions…how can these trends impactTreatmentSupervision Drug Testing

Clandestine Responses

• PsudeoephedrineRegulations

KansasMissouriMississippiOregonCalifornia

Tranquilizers and Depressants

• 4% of all drug reports in 2010– Alprazolam accounted for

52%• 59% in South• 50% Midwest

– Clonazepam accounted for 18% in Northeast

– Diazepam accounted for 13% in the West

For practioners living in these regions…how can these trends impactTreatmentSupervision Drug Testing

My First Time • 2010 SAMHSA Survey– 12-49 years of age

• 21.0 years for pain relievers• 21.2 years for cocaine and

stimulants• 24.6 years for tranquilizers• 22.8 years for OxyContin

Juvenile Specialty CourtsFamily Specialty CourtsAdult Specialty CourtsDWI Specialty CourtsVeterans Specialty Courts

At Risk Populations

• Adolescents• College Students• Elderly• Chronic Pain Sufferers• Physical Laborers• VeteransTarget Population?Monitoring Resources?Service Delivery?Eligibility

Requirements

Speaking of EducationAdderalland the

College Student

– Full time student 18-22 were twice as likely to use adderall

– 3 times more likely to use THC

– 8 times more likely to use cocaine

– 8 times more likely to use tranquilizers

– 5 times more likely to use prescription pain relievers

POLY-DRUG USE ISSUES

Older Adults • Nonmedical use of prescription type drugs was as common as use of marijuana among adults aged 60 or older

• Among adults aged 50 or older who used illicit drugs in the past year 31.5% used only prescription type drugs non-medically

Veterans• Illicit drug use

increased from 5% to 12%– Activity duty service

members– 3 year period (2005-2008)– Primarily attributed to

prescription drug abuse

Recovery Field Response

• Only 12.5 percentof those with a prescription drug use disorder in the past year received specialty treatment for drug problems in that period

• You don’t know what you don’t know

The ExcusesWhere did that new

bottle of pills come from?

Those are not mine?My car was broken into?

Those are for my dog?I got a prescription

though!My doctor knows about

this….Really.

Signs of addiction and abuse

• Doctor Shopping• Rapid Increase in the

amount of medicine needed

• Frequent, unscheduled refill request

• Continually losing prescriptions

• Taking higher doses despite warnings

• Stealing, forging or selling prescriptions

• Excessive mood swings

PHYSICIANS • Research shows that by discussing problems, physicians can have a powerful effect on a patient’s willingness to address addiction

• Educating community physicians about drug court and its purpose to gain support

Physicians • Help to identifying prescription drug abuse when it exists

• Helping the patients recognize abuse problems

• Supporting the patients in seeking appropriate treatment

• Patient Accountability

Collaborations• Screening about AOD

Abuse, current prescriptions and OTC use and reasons

• Prescribing Physicians Forms

• Non-Narcotic Options, when appropriate

• Utilizing Resources –PDMP website (doctor shopping)

PMDP • Prescription Drug Monitoring Programs

• DEA• Electronic database • Collects electronic data

on substances dispensed in a state

• 37 states operational• 8 states have enacted

legislation but not yet operational

• 5 states have legislation pending

Key Community Stakeholders

• PDMP (Prescription Drug Monitoring Program)– assist law

enforcement in the collection and analysis of data related to controlled substances

– centralized database administered by an authorized state agency.

– activities related to the illegal prescribing, dispensing and procuring of controlled substances

COLLABORATE • Judicial Intervention• Specialized Treatment

Plans• Supervision• Physician Support• Participant Involvement

Positive OutcomesPain Management

ContractsYou are FIRED!

TEAM APPROACH • Look at program policy regarding prescription drugs

• How is team monitoring and sharing information

• What type of boundaries exist to maintain accountability and protect privacy of participant

• ALWAYS ALWAYSALWAYS FACTOR IN HIPPA RESTRICTIONS

Recovery Based Care

• Recovery-based care refers to a philosophy of how systems should operate to provide support to individuals with substance use problems and disorders

• Recovery-oriented systems are a holistic, public health approach, focusing on the physical, mental, spiritual and social wellness of the individual

• SAMHSA Standards

Goals and Outcomes of

working together• To intervene earlier• To respond

appropriately• To improve treatment

outcomes• To support long-term

recoveryIf I were suffering from

heart disease would you just address that issue for 28 days, 6 months, a year?

National Support • White House Position Paper– Epidemic: Responding

to America’s Prescription Drug Abuse Crisis

– Critical role of• Parents• Patients• Healthcare Providers• Manufacturers

Prescription Drug Abuse Prevention

Plan

• Education• Monitoring• Proper Disposal• Enforcement

Suggested Reading and

Resources

• Harrison narcotics Act 1914• Federal Pure Food Drug Act of 1906• Comprehensive Drug Abuse Prevention

and Control Act of 1970• Drug Court 10 Key Components• DEA State Prescription Drug Monitoring

Programs Q&A• Epidemic: Responding to America’s

Prescription Drug Abuse Crisis• Prescription for Disaster: How teens abuse

medicine• NSDUH Report (Sept 2011 & April 2009)• SAMHSA – Results from the 2010 National

Survey on Drug Use and Health: Summary and national findings

• NFLIS 2010 Annual Report• SAMHSA KAP Series TIP 13, 28, 30, 33, 40,

43, 42, 43, 44, 45, 49• www.dea.gov• www.allrise.org• www.samhsa.gov• www.nida.nih.gov• www.nlm.nih.gov

Questions?

Thank YouInspector Vanessa Price

Law Enforcement Consultantcoreinc05@cox.net