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General Session: State Policy Changes and CDC Impacting the Rx Drug Abuse Epidemic - Dr. Tom Frieden

General Session: State Policy Changes and CDC Impacting the Rx Drug Abuse Epidemic - Dr. Tom Frieden

Published in: Health & Medicine
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  • 1. 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
  • 2. Dr. Frieden has disclosed no relevant, real or apparent personal or professional financial relationships.
  • 3. 125,000
  • 4. 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…  
  • 5. >$500 billion
  • 6. 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
  • 7. 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 Rate 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
  • 8. Heroin abuse and dependence is also increasing SAMHSA NSDUH 2012. 214K 467K >2 million Heroin Opioids
  • 9. 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).
  • 10. 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. 0 5 10 15 20 25 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Deathsper100,000population Motor Vehicle Traffic Drug Poisoning (Overdose)
  • 11. We are making some progress, but much more is needed
  • 12. 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
  • 13. PDMPs currently in use in 48 states Source: PDMP Training and Technical Assistance Center. http://www.pdmpassist.org/pdf/ pmpprogramstatus2013_a.pdf
  • 14. But… no PDMP is yet: •  Universal, •  Real-time, and •  Actively managed
  • 15. 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.
  • 16. 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.
  • 17. 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.
  • 18. Real-time PDMP is possible and effective 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 3Q2010 4Q2010 1Q2011 2Q2011 3Q2011 4Q2011 1Q2012 2Q2012 3Q2012 4Q2012 NumberofPDMPreportsrequested Prescriber Dispenser LE/Regulatory Information provided by Don Vogt, OK PDMP, 2013. 24 hour reporting 5 minute reporting
  • 19. Real-time PDMP decreased doctor shopping 564 417 306 0 100 200 300 400 500 600 2010 2011 2012 Numberofdoctorshoppersidentified Information provided by Don Vogt, OK PDMP, 2013.
  • 20. 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
  • 21. 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
  • 22. 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
  • 23. 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
  • 24. 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
  • 25. 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

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