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8/4/2019 The Epidemic of Prescription Drug Abuse in New York State
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The Epidemic of Prescription Drug Abuse inNew York State
Andrew J. Kolodny, M.D.Chairman, Department of Psychiatry
Maimonides Medical Center
Senate Round Table Discussion
August 31, 2011
New York, NY
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2
0
1
2
3
4
5
6
7
8
9
10
'70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06
Deathrate
per1
00,0
00
Heroin
Cocaine
27,658 unintentional drug overdose deaths
Unintentional Drug Overdose DeathsUnited States, 19702007
National Vital Statistics System, http://wonder.cdc.gov
Year
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0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
'99 '00 '01 '02 '03 '04 '05 '06 '07
Deaths
3
Unintentional Overdose Deaths InvolvingOpioid Analgesics, Cocaine and Heroin
United States, 19992007
Opioid analgesic
Cocaine
Heroin
National Vital Statistics System, http://wonder.cdc.gov, multiple cause dataset
Year
8/4/2019 The Epidemic of Prescription Drug Abuse in New York State
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0
10000
20000
30000
40000
50000
60000
70000
80000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Opioid Analgesic Treatment Admissions: U.S.
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. TreatmentEpisode Data Set (TEDS) Highlights - - 2007 National Admissions to Substance Abuse Treatment
Services. OAS Series #S-45, HHS Publication No. (SMA) 09-4360, Rockville, MD, 2009.
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0
1000
2000
3000
4000
5000
6000
7000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Opioid Analgesic Treatment Admissions: NYS
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment EpisodeData Set (TEDS) Highlights - - 2007 National Admissions to Substance Abuse Treatment Services. OASSeries #S-45, HHS Publication No. (SMA) 09-4360, Rockville, MD, 2009.
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Unintentional overdose deaths involving opioidanalgesics parallel per capita sales of opioidanalgesics in morphine equivalents by year,
U.S., 1997-2007
0
100
200
300
400
500
600
700
800
0
2000
4000
6000
8000
10000
12000
14000
'97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07
Source: National Vital Statistics System, multiple cause of death dataset, and DEA ARCOS
* 2007 opioid sales figure is preliminary.
Number of
DeathsOpioid sales(mg/person)
*
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Source: United States General Accounting Office: Dec. 2003, OxyContin Abuse and Diversion and
Efforts to Address the Problem.
Dollars Spent Marketing OxyContin (1996-2001)
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Physician Education Regarding Opioids forChronic Non-Cancer Pain Emphasizes:
Opioid addiction is rare in pain patients.
Physicians are needlessly allowing patients to
suffer because of opiophobia.
Opioids are safe and effective for chronic pain
Patients who appear to be drug seeking mayhave pseudo-addiction.
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Controlling the epidemic:A Three-pronged Approach
Primary Prevention- prevent new cases ofopioid addiction
Secondary Prevention- provide people whoare addicted with effective treatment
Supply control- collaborate with lawenforcement, DEA and OPMC to limit black-market availability
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Data from Prescription Drug MonitoringProgram Can Be Used to:
Flag high volume prescribers.
Allow (or require) providers to utilize data.
Provide prescribers with their own prescriptionhistory.
Identify patients in need of addiction treatment.
S f il d ib l t th t
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9/1/2011
Some family docs prescribe a lot, others notso much
0
10
20
30
40
50
60
70
Lowest Middle Highest
Physician prescribing frequency
Numberoffinalopioidp
rescriptionsbeforedeath
issuedbyphysiciansineachquintile
0
100
200
300
400
500
600
700
800
900
1000
Numberofopioidprescriptionsp
er1000eligiblepatientsissuedby
physiciansineachquintile
Dhalla I et al Canadian Family Physician in press
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Regulatory & Policy Interventions
Utilize PDMP data
Up-schedule hydrocodone (Vicodin & Norco)products
Establish standards of care for prescribing ofcontrolled substances urine tox
dosing limits
use of PDMP data
Prescriber/pharmacy requirements to viewpatient photo IDs
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Summary
New York State is in the midst of a severeprescription epidemic
Prescribers and the public need to be better informed
about risks of opioid use/misuse
The effective interventions to control this epidemicare within our grasp.
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To write prescriptions is
easy, but to come to anunderstanding with peopleis hard.
Franz Kafka, A Country Doctor
17
