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5/16/18
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Managing the Effects of Opioids on Your Pool
Battling the Opioid Crisis: It Takes All of Us Working Together
Government
Communities and Support
Systems
Insurance Providers
FDA and Pharma
Medical Associations and Boards
Health Care Providers
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What are Opioids?Opioids = opiates = narcotics
Common Immediate Release:• Vicodin (hydrocodone)• Percocet, OxyIR (oxycodone)• Dilaudid (hydromorphone)• Opana (oxymorphone)• Nucynta (tapentadol)• Ultram (tramadol)
Common Long-Acting:• Opana ER (oxymorphone ER)• MS Contin (morphine ER)• Methadone• OxyContin (oxycodone ER)• Butrans (buprenorphine patch)• Duragesic patches (fentanyl)
Credit: MedCost
CDC: Centers for Disease Control and Prevention; www.cdc.gov
Someone in the United States dies
approximately every 12 minutes due to an opioid-related
drug overdose
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Opioid Risks
Addiction
Physical Dependence
Drug Interactions
Overdose
Abuse
Tolerance
Benzodiazepines –Xanax, Valium, KlonopinMuscle Relaxers Alcohol Antidepressants –Prozac, Lexapro, Zoloft Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics –Butrans, buprenorphine
NOT A COMPREHENSIVE LIST!
Many interactions can lead to hypotension, profound sedation, respiratory depression, coma and even death
Credit: MedCost
Understanding the Opioid Epidemic
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention https://www.cdc.gov/drugoverdose/epidemic/index.html
1999 - 2016
630,000 Deaths from Drug Overdose
Overdose Deaths Involved an Opioid
2016
66%
Opioid Overdose Deaths 5 Times Higher in
2016 than in 1999Credit: MedCost
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The Opioid Epidemic – Closer Than You Think
70%of abused prescription opioids come from a friendor relative2 1JAMA Intern Med. 2016;176(7):1027-1029)
2 Jones, C, Paulozzi, Mack K. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use. United States, 2008-2011. JAMA Int Med 2014; 174(5):802-803. 3
Obtained from US National Survey on Drug use and Health, 2008-2011.
0
10
20
30
40
50
60
Past-Year Non-Medical Users
Pe
rce
nt
of
Use
rs
Sources of Prescription Opioids AmongPast-Year Non-Medical Users2,3
Given by friend or
relative for free
Prescribed by > 1
physicians
Stolen from friend or
relative
Bought from friend or
relative
Bought from drug dealer
or other stranger
Other
60%of US citizens have left over prescription narcoticsin their home1
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A Problem Unique to the U.S.
80%of all prescription
opioids are written and consumed in the
United States1
CDC – US State Prescribing Rates 2016
1 National Institute on Drug Abuse2 IMS Health, National Prescription Audit (NPATM). Cited in internal document: Preliminary Update on Opioid Pain Reliever (OPR) Prescription Rates Nationally and by State: 2010-2013.
2013250,000,000
Prescriptions for OpioidsThis is enough for everyAmerican adult to have their own bottle of pills2
Source: U.S. Centers for Disease Control
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The Arkansas Story• Population < 3 Million People
• Drug companies sold 235,934,613 opioid pills in 2016.
• Opioids are the top-selling class of prescription drug in Arkansas (more than twice as prevalent as the next).
• Manufacturers and distributors supplied nearly 2B mg of opioids to Arkansas pharmacies in 2015.
• There are more opioid prescriptions in Arkansas than people • Drug companies sell enough opioids in Arkansas for every man, woman, and child to
each take 80 pills per year.
• Overdose deaths in Arkansas have ballooned 262% from 5.1 per 100,000 citizens in the year 2000 to 13.4 per 100,000 in 2016.
• Number of drug overdose deaths rose to 401—at least 335 of which are opioid-related (2016 – Arkansas)
• Arkansas’s near-tripling in overdose deaths between 2000 and 2015 coincides with a span in which opioid sales have quadrupled.
Source: Arkansas Municipal League
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Vermont
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+ POWERED BY DOMO | exported 23 Apr 2018
CIS Oregon Work Comp Program: Highest Rx Total UsageAll Time 171K Sum of RxPrice
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+ POWERED BY DOMO | exported 23 Apr 2018
CIS Oregon Work Comp Program: Highest Rx per tabletAll Time 171K Sum of RxPrice
Prescription for Battling the Opioid Crisis
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ResourcesFederal government: Centers for Disease Control and Prevention• The “Map:” https://www.cdc.gov/drugoverdose/maps/rxcounty2016.html• “Overdose:” https://www.cdc.gov/drugoverdose/index.html• “Understanding the Epidemic” https://www.cdc.gov/drugoverdose/epidemic/index.html
National League of Cities • A Prescription for Action (2016 Report conducted jointly with NACo)
• https://www.nlc.org/article/a-prescription-for-action-ending-the-opioid-crisis
• Opioid Use Disorder: City Actions and Opportunities to Address the Epidemic• https://www.nlc.org/resource/opioid-use-disorder-city-actions-and-opportunities-to-address-the-epidemic
• Prescription Drug Discount Program through CVS Caremark• U.S. Communities Program – Discount for Narcan
• How Cities Can Fight the Opioid Epidemic With Life-Saving Medications (CitiesSpeak Blog): https://bit.ly/2KsRlSq
National Safety Council• Prescription Nation 2018: Facing America’s Opioid Epidemic
• http://safety.nsc.org/prescription-nation-facing-americas-opioid-epidemic
Arkansas Municipal League & Association of Arkansas Counties• Lawsuit against opioid manufacturers and distributers
• https://www.arcounties.org/site/assets/files/3397/2018-04-02secondamendedcomplaint.pdf