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National Rx Drug Abuse Summit, April 2-4, 2013, keynote presentation, "Stopping the Epidemic of Prescription Opioid Abuse" by Dr. Thomas Frieden.
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Stopping the Epidemic of Prescription Opioid Abuse
National Prescription Drug Abuse Summit Orlando, FL
April 2, 2013
Thomas R. Frieden, MD, MPH Director
Centers for Disease Control and Prevention
Prescription drug abuse is a public health epidemic
Every year more than 16,500 people in the US
die from prescription opioid-related drug
overdose, more than from heroin and cocaine
combined
Drug overdose deaths involving opioids are rising rapidly
US, 1999-2010
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Num
ber o
f Dea
ths
Opioids Heroin Cocaine Benzodiazepines
CDC/NCHS National Vital Statistics System, CDC Wonder. Updated with 2010 mortality.
Drug overdose now kills more people than motor vehicle crashes
US, 1980-2010
NCHS Data Brief, December, 2011, updated with 2009 and 2010 mortality data.
0
5
10
15
20
25
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
Dea
ths
per 1
00,0
00 p
opul
atio
n
Motor Vehicle Traffic Drug Poisoning (Overdose)
Opioid overdose deaths, sales, and treatment admissions rise in parallel
US, 1999-2010
National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS
0
1
2
3
4
5
6
7
8
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Rat
e
Opioid Sales KG/10,000
Opioid Deaths/100,000
Opioid Treatment Admissions/10,000
Opioid Sales Kg/10,000
Large burden of overdose deaths
CDC strategic focus areas
• Better monitoring to better understand epidemic and what works to stop it
• Support States • Improve clinical practice
Public health approach
• Prescription Drug Monitoring Programs (PDMPs)
• Patient review & restriction Programs
• Laws/regulations/strategies
• Insurers & Pharmacy Benefit Managers (PBM) mechanisms
• Clinical guidelines
• Substance abuse treatment
Real-time Prescription Drug Monitoring Program reporting, Oklahoma
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
3Q20
10
4Q20
10
1Q20
11
2Q20
11
3Q20
11
4Q20
11
1Q20
12
2Q20
12
3Q20
12
4Q20
12
Num
ber o
f PD
MP
repo
rts
requ
este
d
Prescriber Dispenser LE/Regulatory
Information provided by Don Vogt, OK PDMP, 2013.
24 hour reporting
5 minute reporting
As PDMP use increased in Oklahoma, doctor shopping decreased
564
417
306
0
100
200
300
400
500
600
2010 2011 2012
Num
ber o
f doc
tor s
hopp
ers
iden
tifie
d
Information provided by Don Vogt, OK PDMP, 2013.
After sharp increases, oxycodone-related deaths decreased in Florida
0
200
400
600
800
1000
1200
1400
1600
2007 2008 2009 2010 2011
Num
ber o
f dea
ths
Oxycodone
Alprazolam
Methadone
Hydrocodone
Fentanyl
Source: Florida Medical Examiners Commission Annual Reports.
Washington State is reversing the epidemic of Rx opioid overdose
0 2000 4000 6000 8000 10000 12000 14000 16000 18000
0
100
200
300
400
500
600
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Num
ber o
f Dea
ths
Num
ber o
f Dea
ths
WA State US
Source: CDC/NCHS and Washington State Department of Health, Death Certificates. Note for WA State: * Tramadol only deaths included in 2009, but not in prior years.
300 or more deaths
prevented
Deaths from all opioid types are declining
Washington State, 1995-2011
0
50
100
150
200
250
300
350
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Num
ber o
f Dea
ths
Fentanyl Hydrocodone Methadone Oxycodone
Source: Washington State Department of Health, Death Certificates
Both health and law enforcement are essential to reverse the epidemic of opiate abuse
Four components of the opioid overdose problem – each needs specific approach
Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333
Phone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: [email protected] Web: www.cdc.gov
