Dayton - opiate prescription abuse in utah

Opiate Prescription Abuse in UtahSeptember, 17, 2014

John Dayton, MD, FACEP, FAAEMEmergency PhysicianAssistant ProfessorDivision of Emergency MedicineUniversity of Utah

Division of Emergency Medicine

The Problem

Recent Headlines:


The Problem

113 people die every day in the United States as a result of drug overdose.

Drug overdose was the leading cause of injury-related death in 2010.

More than 38,000 drug overdose deaths occurred in the United States in 2010.

Drug overdose death rates in the United States have tripled since 1990.

Drug overdose deaths exceeded the number of deaths from motor vehicle accidents in 2011.

The CDC characterized opioid overdose as an epidemic in 2012, with most deaths deemed preventable.

Centers for Disease Control and Prevention. Prescription Drug Overdose in the United States: Fact Sheet, July 3, 2014;http://1.usa.gov/1jQziHt.


http://1.usa.gov/1jQziHt

The Problem

Abuse of prescription pain medications costs the US $53 billion a year in lost productivity, medical costs and criminal justice costs

http://oas.samhsa.gov/2k8state/Cover.pdfhttp://healthyamericans.org/reports/drugabuse2013/release.php?stateid=UThttp://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf


http://oas.samhsa.gov/2k8state/Cover.pdf


http://healthyamericans.org/reports/drugabuse2013/release.php?stateid=UT

http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf

The Problem

Since 1999, the number of narcotic pain medications, per capita, has quadrupled.

Associated with this increase in medication availability, deaths due to prescription drugs doubled in 29 states and quadrupled in 10.

On the positive side, 6.24% of Utahans reported using illegal drugs – lower than the national average of 8%

http://oas.samhsa.gov/2k8state/Cover.pdfhttp://healthyamericans.org/reports/drugabuse2013/release.php?stateid=UThttp://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf






The Problem

However, Utah has the 8th highest drug overdose mortality rate in the US

The rate of drug-induced deaths in Utah is almost double the national average (20.6 vs 12.7 per 100,000)

From 2000 – 2010, there were more deaths for prescription overdose than were due from MVCs and firearm deaths.

http://oas.samhsa.gov/2k8state/Cover.pdfhttp://healthyamericans.org/reports/drugabuse2013/release.php?stateid=UThttp://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdfhttp://useonlyasdirected.org/docs/upd.pdf






http://useonlyasdirected.org/docs/upd.pdf

http://useonlyasdirected.org/docs/upd.pdf

The Problem


http://healthyamericans.org/reports/drugabuse2013/

http://www.useonlyasdirected.org/the-problem

The Solution

The Prescription Drug Abuse report, created by Trust for America’s Health, recommends 10 strategies to curb prescription abuse



http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/09/interactive--prescription-drug-abuse.html




Prescription Drug Monitoring Program

Utah’s Controlled Substance Database Program Began in 1996 after state law authorized

creation in 199549 states have this – Missouri is the only on

that doesn’tRoom for improvement: doesn’t include VA

and not linked to other states PDMPsUse is not mandated

http://pmpalliance.org/content/utah-state-profile


http://pmpalliance.org/content/utah-state-profile

Prescription Drug Monitoring Program

Utah’s Controlled Substance Database Program


Doctor Shopping Law

Doctor shopping is the practice of obtaining multiple controlled substances from multiple providers without the prescribers’ knowledge of the other prescriptions

The Utah passed House Bill 28 in 2010 to introduce penalties for doctor shoppint and to increase use of the Controlled Substance Database by physicians

Doctor shopping is illegal in all 50 states and DC.

http://le.utah.gov/~2010/bills/static/HB0028.html


Prescriber Education Required or Recommended

In 2013, the Utah State House passed Senate Bill 214 and joined 21 other states in requiring or recommending Continuing Medication Education (CME) related to controlled substance abuse22 States require this.Every year, to maintain licensing and hospital credentialing, physicians are required to complete CMESenate Bill 214 mandated the Utah Physicians obtain CME about controlled substance abuse in Utah as a requirement to renew their license.

http://le.utah.gov/~2013/bills/static/SB0214.htmlhttps://utahmed.inreachce.com/Details?resultsPage=1&sortBy=&&groupId=9b09fe03-a287-4c02-b05c-e92edb8cb628


http://le.utah.gov/~2013/bills/static/SB0214.html

http://le.utah.gov/~2013/bills/static/SB0214.html

https://utahmed.inreachce.com/Details?resultsPage=1&sortBy=&&groupId=9b09fe03-a287-4c02-b05c-e92edb8cb628

Prescriber Education Required or Recommended


https://www.utahmed.org/WCM/Physician_Support/Controlled_Substances_Course/wcm/_PhysicianSupport/Controlled_Substances_Course.aspx?hkey=0314aae7-1c25-4711-8128-2ab9a23ea320

Physical Exam Requirement

Utah requires that a physician perform a physical exam and have a bona fide patient-physician relationship before a controlled substance can be prescribed.

43 other states and DC also have the same requirements


http://immigrantvisa.wordpress.com/

ID Requirement

Utah, and 31 other states, requires that patients provide identification prior to filling a controlled substance.

This helps the pharmacists to prevent fraud.

Many local hospitals have a policy to not prescribe a controlled substance unless the patient has their ID.


https://www.tumblr.com/search/fake%20ID

Lock-In Program

This is a Medicaid program that requires patients suspected of misusing controlled substances to use only one prescriber and one pharmacy.

46 States and DC have this law

A Washington study found that when 20 specific Medicaid patients were enrolled in a “lock-in” program, the state saved $6,000 per patient.

Best S. PMP Use by Medicaid. Washing State Health Care Authority. http://www.pdmpexcellence.org/sites/all/pdfs/Best/pdf


http://oxywatchdog.com/2011/05/ohio-bill-proposes-medicadi-program-to-limit-doctor-shopping/

Good Samaritan Law

In 2014, Utah passed House Bill 11

This law provides a degree of immunity from criminal charges or mitigated sentencing to individuals who seek help for themselves or others during an overdose.

DC and 17 states have similar laws in place


Rescue Drug Law

In 2014, Utah passed House Bill 119, the Emergency Administration of Opiate Antagonist Act

This law allows the dispensing of an opiate antagonist (naloxone) by non-health care workers to people who have overdosed on narcotics.

DC and 17 states have similar laws in place.


http://www.mother-of-a-junkie.org/empowerment/naloxone/

The Two Recommendations Utah Doesn’t Have (yet) Prescription Drug Monitoring

Program is not mandated

Support for Substance Abuse Treatment Services have not been increased

• Medicaid Expansion will expand coverage of substance abuse services and treatment

• Medicaid Expansion may be in the works


http://www.deseretnews.com/article/865610609/Herbert-reaches-understanding-conceptually-on-Medicaid-expansion.html

Use Only As Directed

In 2007, the Utah Department of Health appointed an advisory committee to make recommendations on how the state could reduce prescription drug abuse.

An education plan was created.

After the plan was put in place, an study showed that the campaign raised awareness of the dangers of misusing prescription drugs.

Additionally, the death rate from opioids was reduced by 14% over the next year. http://statepolicyoptions.nga.org/casestudy/utah-use-only-directed-prescription-drug-public-awareness-campaign


http://useonlyasdirected.org/



Safe Use: Never take prescription pain medication that

is not prescribed to you. Never take your prescription pain medications

more often or in higher doses than prescribed.Never drink alcoholic beverages while taking

prescription pain medications.Driving under the influence of alcohol and/or

drugs – to include legally prescribed or over the counter medications – is not only dangerous, it is illegal.

http://www.useonlyasdirected.org/safe-use

http://narcotic.net/percocet/alcohol-and-percocet



Safe Use: Driving under the influence of alcohol and/or drugs – to

include legally prescribed or over the counter medications – is not only dangerous, it is illegal.

Never share your prescription pain medications with anyone.Taking prescription pain medications with other depressants

such as sleep aids, anti-anxiety medications, or cold medicine can be dangerous.

Properly dispose of all unused and expired prescription pain medications.

Tell your healthcare provider about ALL medicines and supplements you take.

http://www.useonlyasdirected.org/safe-use

Use Only As DirectedSafe StorageStore prescription pain medications out of

reach of kids, family and guests.Know where your prescription pain

medications are at all times.Keep prescription pain pills in the original

bottle with the label attached, and with the child-resistant cap secured.

Keep track of how many prescription pain pills are in your bottle so you are immediately aware if any are missing.

Dispose of all unused and expired prescription pain medications properly.

http://www.useonlyasdirected.org/safe-storage


http://www.rxshelving.com/catx/catxdisplay_part.cgi?partkey=128


Safe Disposal

Do not throw medications away or flush them down the toilet

Use one of the 58 disposal bins located in 15 counties

There are disposal sites at the Police Departments in Herriman, Riverton, Sandy and Taylorsville

http://www.useonlyasdirected.org/safe-disposal


http://useonlyasdirected.org/safe-disposal

So Does All of This Help?


http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/09/interactive--prescription-drug-abuse.html

Health & Medicine

Dayton - opiate prescription abuse in utah