Stopping the Epidemic ofPrescription Opioid AbuseNational Prescription Drug Abuse SummitOrlando, FLApril 2, 2013Thomas R. Frieden, MD, MPHDirectorCenters for Disease Control and Prevention
Prescription drug abuseis a public health epidemicEvery year more than16,500 people in the USdie from prescriptionopioid-related drugoverdose, more thanfrom heroin and cocainecombined
Drug overdose deaths involvingopioids are rising rapidlyUS, 1999-201002,0004,0006,0008,00010,00012,00014,00016,00018,0001999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010NumberofDeathsOpioids Heroin Cocaine BenzodiazepinesCDC/NCHS National Vital Statistics System, CDC Wonder. Updated with 2010 mortality.
Drug overdose now kills more peoplethan motor vehicle crashesUS, 1980-2010NCHS Data Brief, December, 2011, updated with 2009 and 2010 mortality data.05101520251980198219841986198819901992199419961998200020022004200620082010Deathsper100,000populationMotor Vehicle Traffic Drug Poisoning (Overdose)
CDC strategic focus areas• Better monitoring to better understandepidemic and what works to stop it• Support States• Improve clinical practice
Public health approach• Prescription Drug MonitoringPrograms (PDMPs)• Patient review & restrictionPrograms• Laws/regulations/strategies• Insurers & Pharmacy BenefitManagers (PBM) mechanisms• Clinical guidelines• Substance abuse treatment
Real-time Prescription Drug MonitoringProgram reporting, Oklahoma050,000100,000150,000200,000250,000300,000350,0003Q20104Q20101Q20112Q20113Q20114Q20111Q20122Q20123Q20124Q2012NumberofPDMPreportsrequestedPrescriber Dispenser LE/RegulatoryInformation provided by Don Vogt, OK PDMP, 2013.24 hourreporting5 minutereporting
As PDMP use increased in Oklahoma,doctor shopping decreased56441730601002003004005006002010 2011 2012NumberofdoctorshoppersidentifiedInformation provided by Don Vogt, OK PDMP, 2013.
After sharp increases, oxycodone-related deaths decreased in Florida020040060080010001200140016002007 2008 2009 2010 2011NumberofdeathsOxycodone Alprazolam Methadone Hydrocodone Fentanyl Source: Florida Medical Examiners Commission Annual Reports.
Washington State is reversing theepidemic of Rx opioid overdose02000400060008000100001200014000160001800001002003004005006001995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011NumberofDeathsNumberofDeathsWA State USSource: CDC/NCHS and Washington State Department of Health, Death Certificates. Note for WAState: * Tramadol only deaths included in 2009, but not in prior years.300 or moredeathsprevented
Deaths from all opioidtypes are decliningWashington State, 1995-20110501001502002503003501995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011NumberofDeathsFentanylHydrocodoneMethadoneOxycodoneSource: Washington State Department of Health, Death Certificates
Both health and law enforcementare essential to reverse theepidemic of opiate abuse
Four components of the opioid overdoseproblem – each needs specific approach
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