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Dayton - opiate prescription abuse in utah

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This lecture discusses health policy related to curbing abuse of controlled substances - like narcotics. This article discusses several steps Utah has made to decrease the number of opiate-related deaths.

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Dayton - opiate prescription abuse in utah

  1. 1. Opiate Prescription Abuse in Utah September, 17, 2014 John Dayton, MD, FACEP, FAAEM Emergency Physician Assistant Professor Division of Emergency Medicine University of Utah Division of Emergency Medicine
  2. 2. The Problem Recent Headlines: Division of Emergency Medicine
  3. 3. 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. Division of Emergency Medicine
  4. 4. 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.pdf  http://healthyamericans.org/reports/drugabuse2013/release.php?stateid=UT  http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf Division of Emergency Medicine
  5. 5. 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.pdf  http://healthyamericans.org/reports/drugabuse2013/release.php?stateid=UT  http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf Division of Emergency Medicine
  6. 6. 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.pdf  http://healthyamericans.org/reports/drugabuse2013/release.php?stateid=UT  http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf  http://useonlyasdirected.org/docs/upd.pdf Division of Emergency Medicine
  7. 7. The Problem Division of Emergency Medicine http://healthyamericans.org/reports/drugabuse2013/
  8. 8. http://www.useonlyasdirected.org/the-problem
  9. 9. The Solution The Prescription Drug Abuse report, created by Trust for America’s Health, recommends 10 strategies to curb prescription abuse http://healthyamericans.org/reports/drugabuse2013/ Division of Emergency Medicine http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/09/interactive--prescription-drug-abuse.html
  10. 10. Prescription Drug Monitoring Program Utah’s Controlled Substance Database Program Began in 1996 after state law authorized creation in 1995 49 states have this – Missouri is the only on that doesn’t Room for improvement: doesn’t include VA and not linked to other states PDMPs Use is not mandated http://pmpalliance.org/content/utah-state-profile Division of Emergency Medicine
  11. 11. Prescription Drug Monitoring Program Utah’s Controlled Substance Database Program Division of Emergency Medicine
  12. 12. 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 Division of Emergency Medicine
  13. 13. 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 abuse  22 States require this.  Every year, to maintain licensing and hospital credentialing, physicians are required to complete CME  Senate 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.html https://utahmed.inreachce.com/Details?resultsPage=1&sortBy=&&groupId=9b09fe03-a287-4c02-b05c-e92edb8cb628 Division of Emergency Medicine
  14. 14. Prescriber Education Required or Recommended Division of Emergency Medicine https://www.utahmed.org/WCM/Physician_Support/Controlled_Substances_Course/wcm/_PhysicianSupport/Controlled_Substances_Course.aspx?hk ey=0314aae7-1c25-4711-8128-2ab9a23ea320
  15. 15. 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 Division of Emergency Medicine http://immigrantvisa.wordpress.com/
  16. 16. 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. Division of Emergency Medicine https://www.tumblr.com/search/fake%20ID
  17. 17. 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 Division of Emergency Medicine http://oxywatchdog.com/2011/05/ohio-bill-proposes-medicadi-program-to-limit-doctor-shopping/
  18. 18. 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 Division of Emergency Medicine
  19. 19. 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. Division of Emergency Medicine http://www.mother-of-a-junkie.org/empowerment/naloxone/
  20. 20. 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 Division of Emergency Medicine http://www.deseretnews.com/article/865610609/Herbert-reaches-understanding-conceptually-on-Medicaid-expansion.html
  21. 21. 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 Division of Emergency Medicine http://useonlyasdirected.org/
  22. 22. Use Only As Directed Division of Emergency Medicine 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
  23. 23. Use Only As Directed Division of Emergency Medicine 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
  24. 24. Use Only As Directed Safe Storage Store 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 Division of Emergency Medicine http://www.rxshelving.com/catx/catxdisplay_part.cgi?partkey=128
  25. 25. Use Only As Directed 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 Division of Emergency Medicine http://useonlyasdirected.org/safe-disposal
  26. 26. So Does All of This Help? Division of Emergency Medicine http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/09/interactive--prescription-drug-abuse.html

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