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Prescription Drug Use in Michigan

Prescription Drug Use in Michigan. Elizabeth Agius, Wayne State University Su Min Oh, Office of Recovery Oriented Systems of Care Theresa Webster, Southeast Michigan Community Alliance (SEMCA ) Presentation to the SUD Conference Traverse City, MI September 16, 2013. Introduction.

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Prescription Drug Use in Michigan

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  1. Prescription Drug Use in Michigan Elizabeth Agius, Wayne State University Su Min Oh, Office of Recovery Oriented Systems of Care Theresa Webster, Southeast Michigan Community Alliance (SEMCA) Presentation to the SUD Conference Traverse City, MI September 16, 2013

  2. Introduction • Purpose: To explore three facets of prescription drug use with data and information • National and state data - Su Min Oh • Survey Data - Elizabeth Agius • Local Perspectives – Theresa Webster • Key Theme: Prescription drug misuse and abuse is a rapidly growing and complex problem

  3. The Basics • Prescription drug misuse can be defined as the use of prescription medications in a manner not prescribed and/or by someone for whom the medication was not prescribed (MDCH, 2010). • NIDA most commonly misused/abused prescription medications are opioids – pain medications; depressants/sedatives – for anxiety and sleep; and stimulants – for ADHD, obesity and narcolepsy. • SAMHSA estimates that 16.42 million adults (>18 y/o) in the United States abused prescription drugs in 2010, representing greater prevalence than heroin, methamphetamines, cocaine, and other illicit drugs.

  4. Number of Unintentional Drug Poisoning Deaths, Michigan, 1999-2010 Number of deaths Year

  5. Age-Adjusted Unintentional Drug Poisoning Death Rates by Gender, Michigan,1999–2010 Male Total Rate per 100,000 population Female Year

  6. Unintentional Drug Poisoning Death Rates by Age Groups, Michigan, 1999–2010 45 – 54 years 35– 44 years 25– 34 years Rate per 100,000 population 55-64 years 15-24 years 65+ years Year

  7. Unintentional Drug Poisoning Deaths by Major Drug Type, Michigan, 1999–2010 Unspecified Other specified Opioid analgesic involvement Crude Rate per 100,000 population Heroin only Cocaine only Cocaine and heroin Year

  8. Unintentional Drug Poisoning Deaths involving Opioid Analgesics, Michigan, 1999–2010 Total Only opioid analgesic Crude rate per 100,000 population With cocaine With heroin Heroin & cocaine Year

  9. Unintentional Drug Poisoning Death Rates by Region, Michigan, 1999 Detroit

  10. Unintentional Drug Poisoning Death Rates by Region, Michigan, 2004

  11. Unintentional Drug Poisoning Death Rates by Region, Michigan, 2004

  12. How did we get here? • Prior to 2000, physicians were under prescribing for chronic pain • Positive benefits of treating chronic pain with high dose levels of pain medication discovered • Physicians became more liberal in prescribing patterns • Pharmaceutical industry pushed pain medications as the preferred method of treating chronic pain

  13. The number of opioid analgesic prescriptions filled at pharmacies increased from 175 million in 2000 to 254 million in 2009. Executive Office of the President of the United States. Epidemic Responding to America’s Prescription Drug Abuse Crises, 2011 How did we get here?

  14. Why Focus on Pharmacists? • Pharmacist have a professional responsibility to prevent the abuse and diversion of prescription drugs • Pharmacist are trained to recognize common patient behaviors and characteristics • Pharmacists are in a position to observe patterns of prescribing

  15. Perceptions of Pharmacists • Two surveys of pharmacists • SEMCA Pharmacist survey • As part of 2010-2011 Needs Assessment • Michigan Pharmacist Association professional org members living or working in Southeast Michigan; 372 responses • BSAAS Pharmacist survey • December 2012 – February 2013 • Sample – CAs & Michigan Primary Care emails, then SEMCA list; only 72 responses

  16. SEMCA Pharmacist Survey • Respondents saw High Potential for abuse for Opiods (95%), Amphet-amines(91%), Cocaine and Heroin (90%).. • Compared to 72% for Alcohol & 69% for Marijuana

  17. Observations of Behaviors

  18. In their words.. Pharmacist Open-ended Question Comments (Total N=71) • Doctors contributing to problem/need to be held accountable (over-prescribing, RX mills, not saying “no” to patients) (n=31) • Need stricter laws for prescribing and reporting abuse (triplicate blanks, greater regulations/penalties, patients identify doctors abusing, checklist to prescribers, doctors using MAPs) (n=13) • Identifying prevalent or increased opioid and sedative use and abuse- (docs prescribing and patients asking for oxycontin, opana, hydrocodone, soma) (n=12) • No steps pharmacists can take to combat the abuse problem (hold doctors accountable, law enforcement not helpful) (n=11)

  19. Community Perspectives • Community Survey asked 563 adults in out-Wayne County how easy it would be to get rx drugs.. 61% say “easy”.. Most (44%) would get it from Medical Professional, 21% from friends, 12% from family • 13.3% of the sample reports some lifetime use of non-medical rx drug use • Perceived risk of harm from non-medical use of rx drugs • Occasional use – 80% High risk, Regular use 96% HR

  20. Youth Use • Monitoring the Future 2010 • Ritalin past year 2.7% for 10th & 12th graders • Other rx drugs - est of 15% for past 30 days • MiPhy 2010 (non generalizable sample) • 7% Out-Wayne County used rx drugs (Ritalin, Adderall, Xanax); 16% had used painkillers without Dr. script

  21. BSAAS Pharmacist Survey • Smaller survey, but similar results • 75% SA: prescription drug abuse is a serious problem (100% with agree added) • 76% SA: Prescribers have major responsibility in helping to prevent prescription drug abuse • Prescription drugs, Heroin, Cocaine most serious – in this order

  22. Use of MAPS • 42% felt MAPS was veryuseful, 43% felt it was somewhat useful, 12% felt it was a little useful and 3% felt MAPS was not useful at all. • Estimate % of customers served where you also reviewed their controlled substance prescription records using MAPS (N=68) • 1-9% of customers 56% • 10-19% of customers 31% • 20% or more 13%

  23. Perceived Responsibilities

  24. Training Needs

  25. How did we respond? • Safe Medication Disposal Campaign • Resources for your community • Permanent Medication Disposal Drop Box • How to get one in your area

  26. How did we respond? • Responsible Opiate Prescribing for Physicians • Medication Use Safety Training • Resources • Pharmacists Tool Kit • Medication Monitoring Inventory • Prescription Bag Tags

  27. Wrap up • Questions about materials presented • Information to share about your community

  28. Contact Information • Elizabeth Agius • Wayne State University School of Social Work; 313-577-5251, eagius@wayne.edu • Su Min Oh • MDCH Office of Recovery Oriented Systems of Care; 517-241-2957, ohs@michigan.gov • Theresa Webster • SEMCA Prevention Coordinator; 734-229-3500, theresa.webster@semca.org

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