prescription drug abuse, daniel blaney-koen - slc 2015

The nation’s opioid epidemic:Are we asking the right questions?

© 2015 American Medical Association. All rights reserved.

A. Are the number of unintentional overdoses and deaths due to opioids going up or down?

B. Are the number of prescriptions for opioids going up or down?

C. Do mandates for prescribers to check prescription drug monitoring programs lower prescribing rates or mortality rates?

D. Do mandates for prescribers to take “pain” or “prescribing” education lower prescribing rates or mortality rates?

E. Why don’t more physicians provide medication assisted treatment?

F. Do you know a physician who has co-prescribed naloxone?

2


Drug Poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 1999–2013

% CHANGE2006-2013

+ 17%

+ 184%

Sources: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

2006-2013 mortality data

http://www.cdc.gov/

http://www.cdc.gov/

http://www.cdc.gov/injury




4

Drug overdose rates by state


5


6

© 2015 American Medical Association. All rights reserved. 7

517,000


National prescribing trends

• Overall utilization of opioids– 2013: 251,814,805– 2014: 244,457,347

• Growth, opioid utilization– 2014: 2.9% decrease

• Growth, hydrocodone utilization– 2014: 10% decrease

•


State Growth in opioid utilization (2013-2014) PDMP mandate?

AR 1.3 NoNV 1.3 YesNM 1.0 YesVT -0.6 YesDE -1.1 No – based on judgmentWV -1.3 YesSC -1.4 NoFL -1.6 NoOR -1.9 NoKY -1.9 YesCA -2.3 (ranked 26th) NoUT -2.4 NoTX -3.3 NoMA -3.3 YesTN -3.4 YesOH -4.1 Yes


State Age-adjusted drug poisoning death rate (CDC/NCHS, NVSS)

Growth in opioid utilization 2013-2014 (%) (IMS Health)

CA Rate significantly lower than overall US rate -2.3 (ranked 26th)TX Rate significantly lower than overall US rate -3.3MA Rate not significantly different from overall US rate -3.3OR Rate not significantly different from overall US rate -1.9AR Rate not significantly different from overall US rate 1.3FL Rate not significantly different from overall US rate -1.6DE Rate not significantly different from overall US rate -1.1SC Rate not significantly different from overall US rate -1.4VT Rate not significantly different from overall US rate -0.6NM Rate significantly higher than overall US rate 1.0OH Rate significantly higher than overall US rate -4.1KY Rate significantly higher than overall US rate -1.9TN Rate significantly higher than overall US rate -3.4NV Rate significantly higher than overall US rate 1.3UT Rate significantly higher than overall US rate -2.4WV Rate significantly higher than overall US rate -1.3


So why are mandates still so attractive?

• 244,000,000+• 16,000+


• AMA Task Force to Reduce Opioid Abuse– Increase registration and use of PDMPs– Ensure safe, evidence-based prescribing– Support comprehensive pain care; reduce the stigma of pain– Reduce the stigma of substance use disorder; increase access to treatment – Increase access to naloxone, Good Samaritan protections

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March 2015: U.S. Dept. of Health and Human Services

• Opioid prescribing practices to reduce opioid use disorders and overdose

• The expanded use of naloxone, used to treat opioid overdoses• Expanded use of Medication-assisted Treatment (MAT) to reduce

opioid use disorders and overdose

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October 2015: Charleston, West Virginia

“We can’t fight this epidemic without removing stigma.”President Obama, 10/21/2015


Is this how to reduce the stigma?

• Two-year limit on treatment?• Formularies that restrict types of treatment?• Drug courts that believe in abstinence?• Fail first therapies for MAT?• Threat of involuntary commitment?


States with naloxone access laws, September 2015: Network for Public Health Law


States with overdose Good Samaritan laws, September 2015: Network for Public Health Law


A. Are the number of unintentional overdoses and deaths due to opioids going up or down?

B. Are the number of prescriptions for opioids going up or down?

C. Do mandates for prescribers to check prescription drug monitoring programs lower prescribing rates or mortality rates?

D. Do mandates for prescribers to take “pain” or “prescribing” education lower prescribing rates or mortality rates?

E. Why don’t more physicians provide medication assisted treatment?

F. Do you know a physician who has co-prescribed naloxone?

21


For more information:Daniel Blaney-Koen, JD

Senior Legislative AttorneyAdvocacy Resource Center

(312) [email protected]

mailto:[email protected]

prescription drug abuse, daniel blaney-koen - slc 2015

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