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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
Dr. Frieden has disclosed no relevant, real or apparent personal or professional
financial relationships.
125,000
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…
>$500 billion
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
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
Rat
e
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
Heroin abuse and dependence is also increasing
SAMHSA NSDUH 2012.
214K 467K
>2 million
Heroin
Opioids
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).
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
Dea
ths
per 1
00,0
00 p
opul
atio
n
Motor Vehicle Traffic Drug Poisoning (Overdose)
We are making some progress, but much
more is needed
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
PDMPs currently in use in 48 states
Source: PDMP Training and Technical Assistance Center. http://www.pdmpassist.org/pdf/pmpprogramstatus2013_a.pdf
But… no PDMP is yet: • Universal, • Real-time, and • Actively managed
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.
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.
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.
Real-time PDMP is possible and effective
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000 3Q
2010
4Q20
10
1Q20
11
2Q20
11
3Q20
11
4Q20
11
1Q20
12
2Q20
12
3Q20
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4Q20
12
Num
ber o
f PD
MP
repo
rts
requ
este
d
Prescriber Dispenser LE/Regulatory
Information provided by Don Vogt, OK PDMP, 2013.
24 hour reporting
5 minute reporting
Real-time PDMP decreased doctor shopping
564
417
306
0
100
200
300
400
500
600
2010 2011 2012
Num
ber o
f doc
tor s
hopp
ers
iden
tifie
d
Information provided by Don Vogt, OK PDMP, 2013.
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
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
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
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
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
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: [email protected] Web: www.cdc.gov