Ending the Epidemic of Prescription Drug Abuse

Moving from Awareness to Action National Prescription Drug Abuse Summit

Atlanta, GA

April 23, 2014

Thomas R. Frieden, MD, MPH Director

Centers for Disease Control and Prevention

Dr. Frieden has disclosed no relevant, real or apparent personal or professional

financial relationships.

125,000

Overdose deaths are the tip of the iceberg

SAMHSA NSDUH, DAWN, TEDS data sets. Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007.

emergency  department  visits  

For  every  1  prescrip3on  opioid  overdose  death  in  2010  there  were…  

>$500 billion

U.S. opioid prescribing in 2012

288 million prescriptions

18 billion opioid pills

Enough pills to give every American 18 years or older

75 opioid pills in 2012 IMS Health, National Prescription Audit, 2012

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

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Rat

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Opioid Sales KG/10,000

Opioid Deaths/100,000

Opioid Treatment Admissions/10,000

Opioid Sales Kg/10,000

National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS

Heroin abuse and dependence is also increasing

SAMHSA NSDUH 2012.

214K 467K

>2 million

Heroin

Opioids

3 out of 4 people reporting Rx opioid and heroin use in past year took

Rx opioids first

Jones, C.M., Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002–2004 and 2008–2010. Drug Alcohol Depend. (2013).

Public health, law enforcement & communities working together cut crash deaths in half We can do the same for overdoses

NCHS Data Brief, December, 2011, updated with 2009 and 2010 mortality data.

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Motor Vehicle Traffic Drug Poisoning (Overdose)

We are making some progress, but much

more is needed

To reverse the epidemic

1.  Track trends, early warnings 2.  Improve clinical practice with data,

tools, guidance, and follow-up 3.  Partnerships, esp. patients/families 4.  Support states

•  Optimize PDMPs

•  Medicaid, other insurer and pharmacy benefit manager strategies

•  Policies and surveillance to improve clinical practice

5.  Innovate

PDMPs currently in use in 48 states

Source: PDMP Training and Technical Assistance Center. http://www.pdmpassist.org/pdf/pmpprogramstatus2013_a.pdf

But… no PDMP is yet: •  Universal, •  Real-time, and •  Actively managed

Universal PDMP works

Source: Brandeis University, PDMP Center of Excellence. COE Briefing: Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States. Feb. 2014.

After NYS mandated PDMP use…

Multiple providers decreased 75%

Number of opioid Rxs decreased 10%

Number of buprenorphine Rxs increased 15%

Source: Brandeis University, PDMP Center of Excellence. COE Briefing: Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States. Feb. 2014.

Buprenorphine works Opioid overdose deaths declined 75% after

buprenorphine introduced in France

Ling et al. J Subst Abuse Treat 2002;23:87-92. Auriacombe et al. JAMA 2001;285:45.

Real-time PDMP is possible and effective

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50,000

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350,000 3Q

2010

4Q20

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Prescriber Dispenser LE/Regulatory

Information provided by Don Vogt, OK PDMP, 2013.

24 hour reporting

5 minute reporting

Real-time PDMP decreased doctor shopping

564

417

306

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2010 2011 2012

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Information provided by Don Vogt, OK PDMP, 2013.

Electronic health record / PDMP integration works

•  Indiana: 58% of PDMP queries resulted in reduction in prescriptions written or pills dispensed

•  Ohio: prescribers reported PDMP data helpful about half the time; several times a day on average, prescribers learned something they did not know that was helpful to decision-making

•  Washington: 2/3 of prescribers said that PDMP embedded in EHR systems made it easier to access data and positively impacted treatment

Challenge Up to $6 million to states over the next 3 years to: •  Optimize PDMPs •  Enhance insurance

mechanisms to prevent abuse/overdose

•  Evaluate prevention policies to identify what works

Drug

August 2011 through

July 2012

August 2012 through

July 2013 % Change Hydrocodone 239,037,354 214,349,392 –10%

Oxycodone 87,090,503 77,022,586 –11%

Oxymorphone 1,753,231 1,138,817 –35%

Alprazolam 71,669,411 62,088,568 –13%

Methylphenidate 10,659,840 11,454,025 + 8%

Amphetamine 13,795,147 15,065,833 + 9% All Controlled Substances 739,263,679 676,303,581 – 9%

Opioid doses dispensed decreased in KY after comprehensive law passed (HB1)

Buprenorphine prescriptions increased nearly 90% in the 2nd quarter of 2013 compared to the 3rd quarter of 2011 Source: Kentucky Office of Drug Control Policy

Components of a robust public health response

Real-time data •  Improve surveillance and clinical practice •  Build evidence base of what works for prevention

Prevention •  Identify and scale up effective strategies •  Advance state-level and community interventions

Clinical care •  Uniform clinical strategy for pain management •  Improve prescribing practices and quality of care,

including treatment of addiction

Success is possible – key now is to scale up

Prevention, treatment, advocacy, laws/regulations, and changes to our culture are interrelated and

can be synergistic

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: cdcinfo@cdc.gov Web: www.cdc.gov