National Institute on Drug Abuse

1. Prescription Drug Abuse: An Escalating Public Health Threat National Institute on Drug Abuse

2. Millions of Americans Abuse Prescription Drugs Current (Past Month) Use of Prescription Drugs for Non-Medical Purposes 2007 National Survey on Drug Use and Health Source: SAMHSA, NSDUH 2007

3. Annual Numbers of New Nonmedical Usersof Pain Relievers: 1965-2002 Thousands of New Users 3,000 All Ages 2,500 2,000 Aged 18 or Older 1,500 Aged Under 18 1,000 500 0 1965 1970 1975 1980 1985 1990 1995 2000 Source: SAMHSA, NSDUH 2007

4. Drug Abuse Related ED Visits:Involving Narcotic Analgesics:1995 - 2002 Source: SAMHSA, The Dawn Report: Narcotic Analgesics, 2002 Update, September 2004

5. As Prescriptions Increase Emergency Room Visits for Non-Medical Use Also Increase DAWN Update Source: SDI Health, VONA and SAMHSA, DAWN 2002, 2008

6. Number of Past Year Initiates of Substance Use Among Persons Aged 12 or Older Source: SAMHSA, NSDUH 2007

7. Percentage of U.S. 12th Grade Students Reporting Past Month Use of Cigarettes and Marijuana, 1975 to 2008 40% 30% 20% 10% Cigarettes Marijuana 1978 1982 1986 1990 1994 1998 2002 2006 1976 1980 1984 1988 1992 1996 2000 2004 2008 CESAR FAX January 19, 2009, Vol. 18, Issue 2. Adapted by CESAR from University of Michigan, “Trends in 30-Day Prevalence of Use of Various Drugs in Grades 8, 10, and 12,”Monitoring the Future study, 2008.

8. Issues of Concern Percent of 12th Graders Reporting Nonmedical Use of OxyContin and Vicodin in the Past Year Remained High *No year-to-year differences are statistically significant. Source: University of Michigan, 2008 Monitoring the Future Study

9. Prescription/Over-the-Counter Drugs Account for 7 out of 11 of the Most Frequently Abused Drugs Prevalence of Past Year Drug Use Among 12th Graders Percent of 12th Graders In 2008, 15.4% of 12th graders reported abusing prescription drugs within the past year. Source: University of Michigan, 2008 Monitoring the Future Study

10. Mean Age at First Use Among Past Year Initiates of Substance Use Aged 12 to 49 Age in Years Source: SAMHSA, NSDUH 2007

11. Sources of Prescription Drugs among Nonmedical Users Source: SAMHSA, NSDUH 2007

12. Between 1999 and 2005 there was a near doubling of unintentional poisoning deaths mainly from opioid analgesic abuse Between 1994 and 2004 there was a 300% increase in treatment admissions for opioids other than heroin (as primary abused drug) Why Has the Abuse of Prescription Drugs Been Increasing?

13. Reasons Youth Give For Abusing • Prescription Medications: • Safer than illicit drugs • Inexpensive, easy to get • Not illegal • Less social stigma than illicit drugs • Parents soft attitudes about their use • Performance enhancement (stimulants)

14. Increased Media Attention

15. What Do We Do? Find the Balance: • Reduce suffering for patients with pain • Increase awareness of the abuse potential of opioid medications NIDA is working to engage primary care physicians and dentists as our partners in recognizing, preventing & treating drug abuse

16. SDI Health: Vector One® National and Total Patient Tracker • SDI Health, LLC • Collects data from a representative sample of pharmacies, payers, and other third party data providers (over 99% of pharmacies captured) • As of 2006 over 56,100 pharmacies nationwide • VONA: Vector One National • Each month, nearly 50% of the retail prescriptions dispensed are collected and projected through methods that stratify by geography, pay type and class of trade • Trend data available for prescription counts from 1991 • TPT: Total Patient Tracker • Projects the unique number of patients taking a therapy or multiple therapies over time • Patient based data available as of 2002

17. National Estimated Prevalence (Rate per 1,000 Population, aged 0 to 85+) Of Persons with a Dispensed Opioid Prescription, by Specialty, 2007 Opioids Include Codeine & Comb NON-INJ (USC 02232), Morphine & Opium NON-INJ (USC 0222), Morphine & Opium INJ (USC 0221), Codeine & Comb INJ (USC 02231). Source: SDI Health, TPT 2008 09-29-08 Opiates and US Census

18. National Estimated Prevalence (Rate per 1,000 Population, aged 0 to 85+) Of Persons with a Dispensed Opioid Prescription, by a Dentist, by Year Opioids Include Codeine & Comb NON-INJ (USC 02232), Morphine & Opium NON-INJ (USC 0222), Morphine & Opium INJ (USC 0221), Codeine & Comb INJ (USC 02231). Source: SDI Health, TPT 2008 09-29-08 Opiates and US Census

19. National Estimated Prevalence (Rate per 1,000 Population, aged 0 to 85+) Of Persons with a Dispensed Opioid Prescription, by a GP/FP/DO, by Year Opioids Include Codeine & Comb NON-INJ (USC 02232), Morphine & Opium NON-INJ (USC 0222), Morphine & Opium INJ (USC 0221), Codeine & Comb INJ (USC 02231). Source: SDI Health, TPT 2008 09-29-08 Opiates and US Census

20. Prescriptions Dispensed by US Retail Pharmacies by Type of Prescription, 2002 - 2007 Opioids Include Codeine & Comb NON-INJ (USC 02232), Morphine & Opium NON-INJ (USC 0222), Morphine & Opium INJ (USC 0221), Codeine & Comb INJ (USC 02231). Source: SDI Health, VONA 2008 11-12-08 Opiates

22. Monitoring the Future • Annual school survey by the University of Michigan funded by NIDA • 12th graders since 1975 • 8th and 10th graders since 1991 • 2008 Sample: • 386 public and private schools • 46,348 students • Questionnaires are administered to students in their classrooms

23. NSDUH National Survey on Drug Use & Health • Annual nationwide survey funded by SAMHSA • Includes civilian, noninstitutionalized population aged 12 years old or older residing within the United States • 2007 survey • Respondent sample of 67,870 persons representative of the U.S. general population aged 12 or older (since 1991, the civilian, noninstitutionalized population) • Data collection • In-person computer assisted interviews with sample persons, incorporating procedures that would be likely to increase respondents' cooperation and willingness to report honestly about their illicit drug use behavior