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Wed frieden web-version_rx_od (unite) - apr 8 -video_external
The director of the CDC discussed the prescription drug and opioid overdose epidemic in the United States. He noted that over 145,000 lives have been lost to prescription opioid overdoses in the past decade as opioid prescribing has increased 4-fold since 1999. The CDC is working with multiple states experiencing outbreaks of HIV linked to injection drug use. The director outlined a potential "technical package" of interventions including improving prescribing practices, increasing access to treatment, reducing drug availability, and public awareness campaigns. Progress requires a comprehensive, evidence-based public health approach with law enforcement and community involvement.
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Wed frieden web-version_rx_od (unite) - apr 8 -video_external
- 1. Preventing Prescription DrugOverdose: New Challenges, New Opportunities National Rx Drug Abuse Summit Operation UNITE Atlanta, GA April 8, 2015 Thomas R. Frieden, MD, MPH Director Centers for Disease Control and Prevention
- 2. Indiana HIV outbreak– sentinel impact of prescription opioid epidemic • ISHD reports 89 cases of HIV (as of April 7) • >90% identified report injecting Opana • All geographically linked to Scott County (Pop: 24,000, Austin: 4,300 people) • Cases in at least 7 other counties • Immediate response: case detection, linkage to HIV and drug treatment, safe injection • Medium/long term: prescription practices, drug treatment, injection safety, HIV/HCV care & funding • CDC has more than 10 experts currently in the field • Working w/ state & county governments, SAMHSA, HRSA
- 3. Prescription drug abuseis a public health epidemic 4X The more than 4-fold increase in opioid overdose deaths parallels the 4-fold increase in sales since 1999 Prescription opioids are potentially dangerous drugs – overdoses have claimed more than 145,000 lives over the past decade
- 4. Prescription opioids: dangerous drugs Highlyaddictive • Just a few doses may lead to a lifelong struggle with addiction Potentially lethal • Just a few too many pills may suppress breathing and lead to death • Increases risk of injection drug use including heroin
- 5. US opioid prescribingin 2012 IMS Health, National Prescription Audit, 2012. 259M 259M
- 7. Death rates fromheroin overdose are increasing rapidly as death rates from prescription opioids are leveling off 0 1 2 3 4 5 6 7 8 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Deathrate (per100,000,ageadjusted) Heroin Rx Opioids All opioids (Heroin and Rx) CDC Vital Statistics
- 8. While recent trendsin opioid overdose vary by state, heroin overdose is increasing everywhere • Increases in heroin OD death rates were significantly associated with increases in Rx opioid death rates • Heroin OD death rates increased in all subgroups – suggesting there is something besides replacement occurring MMWR, Oct 3, 2014.
- 9. 3 out of4 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. Two groups ofpeople, two different sets of needs Addicted/Dependent Need access to services At risk for addiction/dependence Protect from dangerous drugs
- 11. Progress is possible: Lessonsfrom public health successes Motor vehicle crashes • Legal, law enforcement, public health & communities working together Tuberculosis control • Accountability for every single person started on treatment Tobacco control • Comprehensive approaches to make the product less appealing and accessible, highlight impact on others, offer treatment
- 12. Public health, lawenforcement & communities working together cut crash deaths more than half… We can do the same for overdoses 0 5 10 15 20 25 Deathsper100,000population Motor Vehicle Traffic Drug Poisoning (Overdose) Source: NCHS.
- 13. Technical package • Selectedgroup of related interventions that, together, will achieve and sustain substantial improvements in specific risk factor or disease outcomes • Ensures focus on specific interventions known to be most effective, feasible, sustainable, and scalable • Avoids using large number of interventions, many of which may have only a small impact • Can sometimes achieve synergy among intervention elements • Simplicity is key to success
- 14. Possible technical packageelements for Rx opioid misuse/abuse and OD prevention • Improve prescribing • PDMPs, pain clinic laws, prescribing defaults in EHR software, prior authorization for risky prescriptions, and more • Involve payors including Medicaid/Medicare, health systems, PBMs; clinicians; patients • Treatment of opiate addiction and overdose: Increase access, quality, and accountability • Reduce availability of illicit drugs • Promote social awareness and economic development to reduce initiation and continuation of drug use • Rigorous, real-time monitoring and appropriate action
- 15. Opioid prescribing ratesare 3x higher in some states than others MMWR Vital Signs, July 2014. Source: IMS, National Prescription Audit (NPATM), 2012.
- 16. We are makingsome progress, but much more is needed
- 17.
- 18. 49 states havean operating PDMP – but only Oklahoma’s is updated in real time NAMDSL. Annual Review of Prescription Monitoring Programs, 2015. Data through Dec. 2014. Missouri has PDMP legislation pending, DC has enacted legislation but PDMP is not yet operational.
- 19. But… no PDMPis yet: • Universal, • Real-time, and • Actively managed
- 20. “The death rateis a fact. Everything else is an inference.” William Farr
- 21. Oregon 0 2 4 6 8 10 12 14 2006 2007 20082009 2010 2011 2012 2013 heroin overdose death rate (per 100,000) Rx opioid overdose death rate (per 100,000) Rx opioid prescribing rate (hundreds of MME/person) 2009: Research shows methadone associated with ~1/3 of opioid OD deaths in state; Prior authorization required by Medicaid for non- preferred long-acting opioids 2014: Methadone removed from Medicaid program formulary2010: Drug utilization letters sent to Medicaid prescribers of methadone at doses more than 40 mg/day; Prior authorization required by Medicaid for Methadone doses >100mg/day 2012: Prior authorization required by Medicaid for all high-dose opioid prescriptions (>120 mg in morphine equivalents (MME) per day)
- 22. Florida 0 2 4 6 8 10 12 14 16 2006 2007 20082009 2010 2011 2012 2013 heroin overdose death rate (per 100,000) Rx opioid overdose death rate (per 100,000) Rx opioid prescribing rate (hundreds of MME/person) 2010: Pain clinic registration; state/federal investigation of pain clinics 2011: Joint law enforcement raids; physician dispending prohibited; mandatory PDMP reporting 2012: Wholesale distributor regulations expanded
- 23. Florida: state actioncan make a difference MMWR, July 4, 2014.
- 24. Buprenorphine works Opioid overdosedeaths declined 75% after buprenorphine introduced in France 565 143 2900 25000 49000 55000 60000 0 10000 20000 30000 40000 50000 60000 70000 0 100 200 300 400 500 600 1995 1996 1997 1998 1999 #onBuprenorphineTreatment #ofOpioidODDeaths # of Opioid Deaths # on Bup Treatment Ling et al. J Subst Abuse Treat 2002;23:87-92. Auriacombe et al. JAMA 2001;285:45.
- 25. States receiving pilotprevention funding 2010-2013 2010 OPR Prescriptions per 100 people State Rank: 2010 OPR prescription rate 2013 Projected OPR prescriptions per 100 people State Rank: 2013 OPR Prescription Rate % Change 2010 to 2103 Kentucky 138 3 112 8 –19 West Virginia 145 1 130 2 –10 Tennessee 141 2 128 3 –10 Utah 87 24 82 23 –6 IMS Health. National Prescription Audit, 2014
- 26. Prescription Drug OverdoseInitiative Applications close May 8 • Funding will support up to 17 states to expand PDO prevention programs with community involvement • States receiving funding must address prescribing and advance innovative prevention efforts on multiple fronts • Expand and enhance their state PDMP • Implement community and health insurer or health system interventions • May also choose to also conduct policy evaluations or implement other prescribing innovations • HHS proposes major expansion of program in 2016 to expand to all 50 states & DC
- 27. New HHS initiative(3/26/15) Targeted initiative aimed at reducing prescription opioid and heroin related overdose, death, and dependence ($133M in new funding proposed) • Training and educational resources, including updated guidelines and PDMP/HIT support, to improve opioid prescribing decisions • Increasing use of naloxone and continuing support for development/distribution • Expanding use of medication-assisted treatment (MAT) to provide a comprehensive treatment approach
- 28.
- 29. Public Education • CDCeducation campaign will build on social media stories and momentum • Educate about opioid risks • Promote safe/effective pain management with health care providers • Target people at increased risk of Rx opioid overdose death • Work in conjunction with other evidence-based practices • Campaign being developed to be piloted in select states • Personal stories
- 30. 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
- 31. Centers for DiseaseControl 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