Overdoses involving prescription painkillers—a class of drugs that includes hydrocodone, methadone, oxycodone, and oxymorphone—are a public health epidemic. These drugs are widely misused and abused. One in 20 people in the United States, ages 12 and older, used prescription painkillers nonmedically (without a prescription or just for the "high" they cause) in 2010.
The highest drug overdose death rate was found in West Virginia, which was nearly 7 times that of the state with the lowest drug overdose death rate, South Dakota.
Of the 36,500 drug poisoning deaths in 2008, more than 40% (14,800) involved opioid analgesics
An 'immediate release' liquid or tablet that you take every 2 to 4 hours
* Age-adjusted rates per 100,000 population for OPR deaths, crude rates per 10,000 population for OPR abuse treatment admissions, and crude rates per 10,000 population for kilograms of OPR sold.Alternate Text: The figure above shows rates of opioid pain reliever (OPR) overdose death, OPR treatment admissions, and kilograms of OPR sold in the United States during 1999-2010. During 1999-2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR all increased substantially.
The lag in death rate to opioid sales/state may be due to death rate #’s are 2008 and sales are 2010. TM.
more than twice as likely to use Marijuana (79.9 vs. 27.2%)
Older adults are at particular risk for experiencing adverse reactions to medications. Compared with younger adults, they are more sensitive to medications and more likely to take multiple medications because they have more health problems that require treatment.(*2) Older adults may also experience cognitive issues or memory problems that affect their ability to understand and follow medication instructions.(*3) To learn more about how to prevent adverse reactions to medications, older adults and their families can visit http://www.cdc.gov/MedicationSafety/Adult_AdverseDrugEvents.html.
By age, the distribution of MHSA hospitalizations differed substantially from the distribution of hospitalizations for all reasons and from the distribution of the U.S. population in 2008. Adults 18-64 years old accounted for a disproportionate share of all MHSA hospitalizations (83 percent) relative to their share of the total population (63 percent) and all hospitalizations (49 percent). While those 65 years and older were responsible for 35 percent of all stays and 13 percent of the U.S. population, they accounted for only 9 percent of MHSA stays. Children 1-17 years old accounted for 4 percent of all hospital stays and 7 percent of MHSA stays, compared to their population share of 23 percent. Children under 1 year accounted for 1 percent of the overall population, 12 percent of all hospital stays (mostly as newborns), and less than 0.1 percent of MHSA discharges (mostly for drug-related disorders).
2012 Why is Rx abuse and epidemic?
An epidemic is the occurrence ofmore cases of disease than wouldnormally be expected in a specificplace or group of people over agiven period of time. http://www.cdc.gov/excite/classroom/intro_epi.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/su6004a5.htm?s_cid=su6004a5_w 2
Rx Drug Abuse includes:Taking someone else’s prescription for self-medication OR Taking a Rx medication in a way other than intended OR Taking medication to get high http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications 4
100 people die from drugoverdoses every day in theUnited States.CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008.MMWR 2011; 60: 1-6 http://www.cdc.gov/HomeandRecreationalSafety/rxbrief/states.html 6
Enough prescriptionpainkillers wereprescribed in 2010 tomedicate every Americanadult around-the-clock forone month. http://www.cdc.gov/HomeandRecreationalSafety/rxbrief/states.html 7
History of Drug Overdoses 10 Eight-Fold Deaths from Rx Medication 9 Drug Overdoses 8 1970-2007Death rate per 100,000 7 6 5 4 3 Cocaine 2 Heroin 1 0 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06 http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdF 8 National Vital Statistics System, http://wonder.cdc.gov
Drug Overdose Death Rates by State, 2007http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdf 9
Poisoning is now the leading cause of deathfrom injuries in the U.S. and nearly 9 out of 10 poisoning deaths are caused by drugs.• During the past three decades, the number of drug poisoning deaths increased sixfold from about 6,100 in 1980 to 36,450 in 2008• In 2008, poisoning became the leading cause of injury death in the United States and nearly 9 out of 10 poisoning deaths are caused by drugs. http://www.cdc.gov/nchs/data/databriefs/db81.htm 10
Emergency Department Visits Involving IllicitDrugs or Non-Medical Use of Pharmaceuticals, 2004-2009 http://www.oas.samhsa.gov/2k10/DAWN034/EDHighlights.h 11 tm
2008 Statistics: Opioid Pain Relievers deaths and Related Consequences of Misuse Deaths (14,800 people) Treatment Admission (148,000 people) Emergency Room (473,600 people) Abuse/Misuse (1,924,000 people) Non-medical use (12,210,000 people) 2008, Total number of Drug Overdoses was 36,450 of this number 20,444 were due to Rx abuse and 73% of Rx Deaths or 14,800 were due to opioid pain relievers (OPR). http://www.cdc.gov/injury/about/focus-rx.html http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm#tab1 12 http://www.cdc.gov/nchs/data/databriefs/db81.htm
Deaths from Opioid Pain Relievers http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications 13
Opioid refers to Narcotic drugs or pain pillswhich are DEA controlled substances. 14
Top 10 Prescribing Specialties immediate-release opioids, 2009 Unspec. 4.5% Orthopedist 7.4% Anesthesiologists 3.2% Physical Med & Rehab 2.7% Other 20.2% Emergency Medicine 4.7% Physicians Assistants 4.0% Nurse Practitioners 3.5% Dentists 7.7% Internal Medicine 15.4%General Practitioners/Family Medicine 26.7% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% SDI, Vector One: National, 2009. Extracted June 2010. 15 http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvisoryCommittee/UCM217510.pdf
Source of Rx Narcotics Among Those Who Used in the Past-Year, 12th Grade Given by friend/relative 59.10% Bought from friend/relative 37.80% Presription 32.50%Brough from dealer/stranger 19.50% Took from friend/relative 18.80% Other 11.00% Internet 1.10% Categories are not mutually exclusive http://www.drugabuse.gov/sites/default/files/rrprescription.pdf 16
Total Number of Opioid Rx Dispensed by U.S. Retail Pharmacies, 1991-2010 17 http://www.drugabuse.gov/sites/default/files/rrprescription.pdf
New Users in the Past Year of Specific IllicitDrugs among Persons Aged 12 or Older, 2010 Note: The specific drug refers to the drug that was used for the first time in the past year, regardless of whether it was the first drug ever used or not. *Includes pain relievers, tranquilizers, stimulants, and sedatives http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm 19
Past Month Nonmedical Use of Types of Psychotherapeutic Drugs Past Month Nonmedical Use of Types of among Persons Aged 12 or Older: 2002-2010 Psychotherapeutic Drugs among Persons Aged 12 or Older, 2002- 2010+ Difference between this estimate and the 2010 estimate is statistically significant at the .05 level. http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16 20
Sales Rates of opioid painreliever (OPR)overdose death, OPR Deathstreatmentadmissions, andkilograms of OPRsold --- UnitedStates, 1999--2010 Treatment http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm 21
Drug overdose death rate in 2008 and rate ofkilograms (kg) of opioid pain relievers (OPR) sold in 2010 — United States Opioid Sales Death Rate http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm 22
Nonmedical use of Rx Drugs are Destroying Families in the United StatesFrom the innocent unborn & infants to thevulnerable elderly our nation has succumb tothe marketing ploy of drug companiesencouraging the public to utilize Rx drugs forevery minor pain and/or slight feeling ofanxiety.Sadly, this ploy is working all too well…. 23
Weighted National Estimates of the Rates of NAS per 1000 Hospital Births per YearPatrick, S. W. et al. JAMA NAS indicates neonatal abstinence syndrome.doi:10.1001/jama.2012.3951 24
Number of painkiller-addicted newborns Triples in 10 years The Journal of American Medical Association published about 3.4 of every 1,000 infants born in a hospital in 2009 suffered from a type of drug withdrawal commonly seen in the babies of pregnant women who abuse narcotic pain medications. Stephen Patrick of the University of Michigan, neonatal- perinatal medicine stated, “That’s about 13,539 infants a year or one drug-addicted baby born every hour.”http://usatoday30.usatoday.com/news/health/story/2012-04-29/durg-addicted- 25painkller-babies/54646654/1
Newborns in Florida Number of Newborns Treated for Withdrawal Symptom for the State of Florida1600 1374140012001000 968 800 659 600 481 400 354 200 0 2006 2007 2008 2009 2010 Opiate Use During Pregnancy: The Short and Long-Term Effects on Women, Babies, and Children http://www.usatoday.com/news/health/wellness/babies/story/2011-11-13/Doctors- see-surge-in-newborns-hooked-on-mothers-pain-pills/51186076/1 http://databases.sun- 26 sentinel.com/Orlando/health/orlandoBabies/ftlaudDrugBabies_list.php
Current Substance Use Among Pregnant Women Aged 15-44, by Age, 2008-2009 Combined http://oas.samhsa.gov/2k9/135/PregWoSubUse.cfm 27 http://oas.samhsa.gov/2k9/135/PregWoSubUse.htm
First time Users In 2010, 2 million people reported using prescription painkillers nonmedically for the first time within the last year—nearly 5,500 a day. http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16 28
College CampusCollegestudents areTWICE as likelyto abuseAdderall® thannon-collegestudents http://www.oas.samhsa.gov/2k9/adderall/adderall.htm 30
College CampusFull-time college studentswho used Adderall® non-medically in the past yearwere and almost FIVEtimes more likely to useOxyContin® non-medically(44.9 vs. 8.6 %). http://www.oas.samhsa.gov/2k9/adderall/adderall.htm 31
Baby BoomersNational Institutes ofHealth surveys show thatin 2010, the most currentyear available, 2.4million people ages 50-59 said they had abusedprescription or illegaldrugs within the pastmonth — almost threetimes as many people asreported that behavior in2002. http://www.drugabuse.gov/news-events/nida-notes/2010/12/drug-abuse-highest-level- 32 in-nearly-decade
Older AdultsAt least one in four older adults usepsychoactive medications with abusepotential (Simoni-Wastila, Yang, 2006) http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Prescription- 33 Medication-Misuse-and-Abuse-Webinar-12-12-11.ppt
Older Adult admissions for substance abuse treatment nearly tripledOlder Adult admissions forsubstance abuse treatment nearlytriples, increasing from 13.7% in1992 to 39.7% in 2008. CDC.What happened after ED visit? 52.3% were treated and released 37.5% were admitted to the hospital http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Prescription- 34 Medication-Misuse-and-Abuse-Webinar-12-12-11.ppt
Drug-Related Emergency Department (ED) VisitsResulting in Hospitalization among Adults Aged 50 or Older, by Type of Visit and Age Group: 2009 Older adults are at particular risk for experiencing adverse reactions to medications. Compared with younger adults, they are more sensitive to medications and more likely to take multiple medications because they have more health problems that require treatment. http://www.samhsa.gov/data/spotlight/Spot066DrugReaxOlderAdults2012.pdf http://www.cdc.gov/MedicationSafety/Adult_AdverseDrugEvents.html 35
Unintentional Drug Overdose Deaths by age group and sex, 2007 http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdf 36
16%14%12%10%8% 16%6% 10% 10% 9%4% 8% 6%2% 4%0% Asians Native American Two or Hispanics Whites Blacks Hawaiians Indians or More Alaska Races Native http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm 37
Past Month Illicit Drugs among Persons Aged 12 or Older, by County Type: 2010 http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm 38
Adults 18-64 yearsold accounted for adisproportionateshare of all MHSAhospitalizations (83 (63 %) (83 %)%) relative to theirshare of the totalpopulation (63 %) andall hospitalizations(49 %). http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/pdfs/FF_report_2008.pdf 39
Direct and indirect costs attributable toillicit drug use are estimated in threeprincipal areas: 32% Crime $61,376,694 Health $11,416,232 Productivity $120,303,004 62% 6% $193 Billion 41 http://www.justice.gov/ndic/pubs44/44731/44731p.pdf
• Labor participation costs• Specialty treatment costs for services provided at the state level and the federal level hospitalization costs• Incarceration costs• Premature mortality costs (nonhomicide & homicide)These subtotal $120,304,004. Dollars in Thousands 42
Age at Death for Males- Drug Related- 40-45 yrs Age at Death for ALL Males 75-80 yrs Lost productivity due to premature mortality remains a principal component of all costs that drug use imposes on American society. 43
Crime cost includes threecomponents:$56,373,254 criminal justicesystem $1,455,555 crime victim $3,547,885 other crimeThese subtotal $61,376,694 Dollars in Thousands 44
Health includes five components:1. Specialty treatment costs ($3,723,338),2. Hospital & emergency department costs for nonhomicide cases ($5,684,248)3. Hospital & emergency department costs for homicide cases ($12,938)4. Insurance administration costs ($544)5. Other health costs ($1,995,164).These subtotal $11,416,232. Dollars in Thousands 45
Drug courts can save states as much$12,000 per client compared to othercriminal justice strategies, according tothe organization. CDC Accidental Overdoses www.cdc.gov/HomeandRecreationalSafety/pubs/RXReport_web-a.pdf 46
Legal Consequences:2010 Legal Consequences of Prescription DrugMisuseRx Drug Facts & Health Consequences of Misuse:2010 Facts and Consequences of Nonmedical Useof Prescription Drugs Saving Lives through Education & Prevention 47
• The US is the only developed country in the world that does not control RX drug prices.• The US and New Zealand are the only countries that allow drug makers to advertise to consumers.• In medical schools the median # of hours for pain education in the United States is 7 at VETINARIAN schools the median required hours is 75.• The pharmaceutical companies spent more on lobbying between 1998 and 2004 than any other industry... employing a legion of lobbyists.. more than two for each member of Congress. 48