1 / 37

Prescription Drug Abuse: Problems in Idaho and Impact on Women and Babies

Prescription Drug Abuse: Problems in Idaho and Impact on Women and Babies. Rex W. Force, BS(Pharm), PharmD Associate Dean for Clinical Research Division of Health Sciences Idaho State University. Email: Force@fmed.isu.edu. How Many Others?.

callia
Download Presentation

Prescription Drug Abuse: Problems in Idaho and Impact on Women and Babies

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Prescription Drug Abuse:Problems in Idaho and Impact on Women and Babies Rex W. Force, BS(Pharm), PharmD Associate Dean for Clinical Research Division of Health Sciences Idaho State University Email: Force@fmed.isu.edu

  2. How Many Others? • In 2010, 16,651 died in the US due to prescription drug overdoses • Since 9/11/2001, 2,215 Americans have died in Afghanistan • One death every 19 minutes due to Rx drug abuse • 1,244 people died from drug-induced causes in Idaho from 2000-09 • Deaths each year increased from 69 in 2000 to 184 in 2009

  3. Today’s Goals • Discuss the scope of the problem of prescription drug abuse…with a focus on opioids • Evaluate different approaches to preventing the problem of prescription drug abuse on the “supply side” • Prescription monitoring programs • Prescribing guidelines • Legal interventions • Patient-based interventions (contracts, etc.) • Examine the epidemic of prescription drug abuse and its effect on women and babies

  4. Not in my town….? Uh, we’re #4

  5. The Problem • The US accounts for 5% of world’s population and 80% of prescription opioid use; 99% of world’s hydrocodone use • Hydrocodone (Vicodin, Lortab) has been #1 drug dispensed in the US since 2002 • Idaho is routinely in the US top 5 of per capita hydrocodone use • 80% of new heroin users used prescription opioids in the month prior

  6. Scope of Problem

  7. Scope of Problem

  8. Opioid Sales, Treatment Admission, & Deaths by Year

  9. Scope of Problem

  10. Idaho Statesman – Nov. 7, 2012 …a sign with instructions on how to mix prescription medi-cation with alcohol and a sign advertising drinks like lattes mixed with Xanax (an anti- anxiety medication that is also used as a drug of abuse) and vodka…

  11. Just Last Week… http://journalnet. com

  12. Just This Week… http://journalnet. com

  13. Scope of Problem

  14. Scope of Problem • Cost of prescription drug abuse (including opioids like OxyContin, Vicodin, Norco, and Lortab): $53 billion • Opioid abusers cost $16,000/year • Legit users of opioids: $1,800/year • Additional societal costs: • Children at risk • Lost worker productivity • Increases in health care and Medicaid costs • Escalation of crime to support the habit • Destruction of families • Decreased life expectancy

  15. How did we get here? • Many years of inadequate treatment of pain – continues today • Little evidence for optimal use of pain medicines • Reduced patient satisfaction – pain as 5th vital sign • Perceived as ‘safe’ • Focus on pain rather than function • (Illegal) promotional efforts to assess and use opioids • Oxycontin introduced in 1996 • 2007 Purdue Pharma fined $634,000,000 for misleading claims about risk of dependence and addiction • 70% of abused opioids were prescribed (to someone) • A call for judicious use – see Juurlink et al. JAMA March 6, 2013 and Zgierska et al. JAMA April 4, 2012.

  16. Prescription Drug Monitoring Programs • Nevada pioneered proactive reporting in 1997 • By June 2012, 41 states had operating PDMPs, 49 have legislative mandates • Majority have secure on-line portal for prescribers and pharmacists to look up patient histories • Allows for identification of doctor/pharmacy shopping, excessive prescribing, etc. • In Idaho ½ of providers are signed up and only ½ of those access it with any regularity. Clark et al. PDMP COE White Paper. September 2012

  17. Prescribing and dispensing guidelines • State mandated – Idaho BoM has adopted guidelines for management of pain • Evaluation • Treatment plan • Informed consent and agreement for treatment • Periodic review • Consultation, if necessary • Accurate medical records • Compliance with controlled substance laws/regulations http://bom.idaho.gov/BOMPortal/BOM/FAQ/Controlled%20Substances%20&%20 Treatment%20of%20Pain%20Policy.pdf

  18. Identifying Those Patients At Risk • Personal or family hx of substance abuse • Aberrant behavior • Warning signs of manipulation, dishonesty, threats • Doctor shoppers • Deception about pain severity • Forging or altering Rx’s • Criminal behavior • Patterns of use • Use screening tools, document, be cautious

  19. 4D’s of Prescriber Involvement • Deficient – outdated and under-educated • Duped – co-dependent, assumes the best about their patients • Deliberate (dealing) – pill factory • Drug dependent – addicted themselves

  20. Medication Agreements • Use one practice and one pharmacy • No other substance abuse • Adhere to visit schedule • Prohibit sharing or selling medication • No premature renewals or for ‘lost’ meds • Med renewals only during business hours • Urine tox screens

  21. Whose Problem is This? • Law enforcement • Behavioral Health/Substance Abuse Professionals • Public Health • Prescribers • Pharmacists • Patients • Societal

  22. The Link Between Rx Drug Abuse and Maternal and Child Health

  23. Life Expectancy • In 2012, analysis of impact of race and educational attainment on life expectancy in the US • Life expectancy has fallen by 5 years for white women with less than high school education - since 1990 • Unprecedented in modern times: rivals only 7-year drop in men observed with collapse of Soviet Union • No better life expectancy than those seen in the 1950s • Prescription drug abuse, smoking, obesity, access to health care are proposed causes Health Affairs 2012;31(8): 1803-1813 NY Times 9/20/12

  24. Life Expectancy

  25. Life Expectancy

  26. Women and Overdose Deaths • Centers for Disease Control surveillance study • In 2010, 943,365 visits by women to ED for drug misuse or abuse • Men more likely to die from Rx drug overdose, but death rate in women increased by 415% from 1999-2010. • One or more Rx drugs was involved in 85% of cases and 71% were from opioids in women MMWR 2013:62(26);537-542

  27. Women and Overdose Deaths 2009-10 National Ave: 9.8 (range 3.9-18.5) MMWR 2013:62(26);537-542

  28. Women and Overdose Deaths 2004-10 MMWR 2013:62(26);537-542

  29. Birth Defects • National Birth Defects Prevention Study (1997-2005) – case-control design • Prescription opioid exposure evaluated from 1 month prior to pregnancy to end of 1st trimester • Approximately 2-fold greater risk for ASD, VSD, hypoplastic left heart, gastroschisis, and also hydrocephaly, spina bifida, and glaucoma • Similar rates of neural tube defects observed in other studies (Obstet Gynecol 2013;122(4):838-44) and animal models Am J Obstet Gynecol 2011;204:314.e1-11

  30. Neonatal Abstinence Syndrome • Large cross-sectional study of newborns with NAS • Between 2000-2009: • NAS increased from 1.20 to 3.39/1,000 births • Antepartum opioid use increased 1.19 to 5.63/1,000 births • Babies with NAS had more respiratory complications (30.9% v. 8.9%) and low birth wt – 1500-2400 gm (19.1% v. 7.0%), and longer length of stay (16.4 v. 3.3 d). • Normalized hospital charges increased from $39,400 to $53,400 between 2000 and 2009. All other births averaged $9,500. JAMA 2012;307(18):1934-1940

  31. Conclusions • Prescription opioid use is truly at epidemic levels • Women and their babies are harmed by this problem • Resultant health and societal costs are high • Coordinated, interdisciplinary approaches are necessary

More Related