Education Track, National Rx Drug Abuse Summit, April 2-4, 2013. Overview of Federal Policies presentation by Dianne Luensmann and Megan O'Donnell.

1. Overview of Federal Policies
RADM Dr. Peter Delaney, PhD, LCSW-C
Director, Center for Behavioral Health Statistics
and Quality
Diane Luensmann
Director of Communications, The Office of
Congressman Nick J. Rahall II
Megan O’Donnell
Legislative Director, The Office of Congressman
Harold “Hal” Rogers

2. Learning Objectives
1. Identify warning signs of misuse and abuse and
how claim managers can take action.
2. Describe the treatment experience.
3. Outline how to employ a 12-step, abstinence-
based treatment program.

3. Disclosure Statement
• Peter Delaney has no financial relationships with
proprietary entities that produce health care
goods and services.

4. Understanding the Non-Medical Use of
Prescription Pain Relievers
Peter J. Delany, PhD, LCSW-C, Director
Center for Behavioral Health Statistics and Quality
National Rx Drug Abuse Summit,
April 3, 2013

5. Past Month Use of Selected Illicit Drugs among Persons
Aged 12 or Older: 2002-2011
Percent Using in Past Month
8.7 8.9 8.7
9
8.3 8.2+ 8.1+ 8.3 8.1+ Illicit Drugs
7.9+ 8.0+
8
6.9 7.0
7 6.7 Marijuana
6.2+ 6.2+ 6.1+ 6.0+ 6.0+ 6.1+
5.8+
6
5
4
2.7+ 2.7+ 2.7+ 2.9+ 2.8+ 2.8+ 2.7+
3 2.5 2.5 2.4 Psycho-
therapeutics
2
0.9+ 1.0+ 0.8+ 1.0+ 1.0+ 0.8+
1 0.7+ 0.7 0.6 0.5
Cocaine
0.5+ 0.4 0.4 0.4 0.4 0.4 0.4 0.5+ 0.5+ 0.4 Hallucinogens
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 5

6. Past Month Nonmedical Use of Types of Psychotherapeutic
Drugs among Persons Aged 12 or Older: 2002-2011
Percent Using in Past Month
2.5
2.1+ 2.1+ 2.1+
2.0+ 2.0+
2.0 1.9 1.9 1.9
1.8
1.7 Pain
Relievers
1.5
1.0 0.9
0.8 0.8 0.8
0.7 0.7 0.7 0.7 0.7 0.7
Tranquilizers
0.5 0.6+ 0.6+ 0.6+
0.5+ 0.5+ 0.5+ Stimulants
0.2+ 0.2+ 0.4 0.4 0.4 0.4
0.1 0.1 0.1 0.1 0.1 0.1+ 0.1 0.1
Sedatives
0.0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 6

7. Nonmedical Pain Reliever Use in the Past Month,
by Age Group: 2002-2011
Percent Using in Past Month
6
5.0+
5 4.7+ 4.7+ 4.7+ 4.8+
4.6+ 4.5+ 4.4+
4.1+
4 3.6
3.2+ 3.2+ 18 to 25
3.0+
3 2.7+ 2.7+ 2.7+ 2.7+
2.5
2.3 2.3
12 to 17
2 1.6 1.6
1.5 1.4 1.5 1.4
1.3 1.3 1.2 1.3
26 or Older
1
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 7

8. Nonmedical Pain Reliever Use in the Past Year,
by Age Group: 2002-2011
Percent Using in Past Year
14
12.4+ 12.5+ 12.2+
12.0+ 11.9+ 12.0+ 12.0+
12 11.4+ 11.1+
9.8
10 18 to 25
7.6+ 7.7+ 7.4+
8 6.9+ 7.2+
6.7+ 6.5 6.6+ 6.3
5.9
6 4.9+ 4.9+ 5.1+ 5.1+ 4.9+ 12 to 17
4.7+ 4.7+ 4.8+ 4.8+
4.3
4 3.3 3.3 3.6+ 3.6+ 3.3 3.5 3.6 12 or Older
3.1 3.0 3.2
26 or Older
2
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 8

9. Nonmedical Pain Reliever Use on 52 or More Days in the
Past Year, by Age Group: 2002-2011
Percent Using on 52 or More Days in Past Year
4
3.0 3.1 3.0
3 2.7 2.7 2.8 2.8 2.7
2.6
18 to 25
2.3
2 1.7+
1.5+ 1.5 1.5 1.5 1.6+
1.3 1.4 1.3 1.2
12 to 17
1 26 or Older
1.0 1.0 1.0 1.1 1.1
0.8 0.8 0.8 0.9
0.7
0
2002 2003 2004 2005 2006 2007 2008
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
2009 2010 2011
NOTE: Persons initiating use in the past year are not included in percentages using on 52 or more days in the past year.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 9

10. Source Where Pain Relievers Were Obtained for
Most Recent Nonmedical Use among Past Year Users
Aged 12 or Older: 2010-2011
Bought from Friend Took from Friend or Relative
or Relative (12.2%) without Asking (4.4%)
Bought from Drug Dealer
or Other Stranger (3.9%)
Bought on the Internet (0.3%)
Some Other Way (4.3%)
From Friend From Single
or Relative for Doctor (18.1%)
Free (54.2%)
From Multiple Doctors (1.9%)
Wrote Fake Prescription (0.2%)
Stole from Doctor's Office, Clinic,
Source: SAMHSA National Survey on Drug Use and Health (NSDUH),
2010-2011.
Hospital, or Pharmacy (0.5%) 10

11. Nonmedical Prescription Drug Use in the Past Month, by Age
Group: 2002-2011
Percent Using in Past Month
7 6.5+
6.3+ 6.4+
6.1+ 6.1+
5.9+ 5.9+ 5.9+
6 5.5
5.0
5 18 to 25
4.0+ 4.0+
4 3.6+
3.3+ 3.3+ 3.3+
3.1 3.0
2.9 2.8
3 12 to 17
2.2+ 2.2 2.1 2.2
2.0 2.0 1.9 1.9 1.9
1.8
2 26 or Older
1
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 11

12. Past Month Use of Any Illicit Drug, Marijuana, and
Nonmedical Prescription Drugs among Persons
Aged 50 to 59: 2002-2011
Percent Using in Past Month
7
6.3 6.3
Illicit Drugs
6 5.7
5.0
5 4.6+ 4.7
4.4+ 4.4+ 4.5 Marijuana
4.0
3.8+
4
3.4
3.1+ 3.1+ 3.0+
2.7+ 2.8+ 2.8+
3
2.1+ 2.0 2.0
1.9 1.8 Nonmedical
2 1.7+
1.5 1.4 Prescription
1.1 1.0+ 1.1 Drugs
0.9+
1
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 12

13. Past Year Dependence or Abuse for Any Illicit Drug,
Nonmedical Prescription Drugs, and Pain Relievers among
Persons Aged 12 or Older: 2002-2011
Percent Dependent or Abusing in Past Year
4
3.0+ 3.0+
2.9+ 2.9+
3 2.8+ 2.8 2.8+ 2.8+ 2.8+
2.5
Illicit Drugs
2
Nonmedical
0.9 0.9 0.9 0.9 0.9 0.9 Prescription
1 0.8 0.8 0.8 0.8
Drugs
0.7 0.7 0.8 0.7 Pain
0.7 0.7
0.6 0.6 0.6 0.6 Relievers
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 13

14. Past Year Dependence or Abuse for Any Illicit Drug,
Nonmedical Prescription Drugs, and Pain Relievers among
Persons Aged 12 or Older: 2002-2011
Number (in Millions) Dependent or Abusing in Past Year
8
7.3+
7.1 7.0 7.0 7.1+ 7.1
6.8 6.8 6.9
7 6.5
Illicit Drugs
6
5
4
3 2.4 Nonmedical
2.2 2.2 2.3 Prescription
2.0 2.0 2.0 2.0 2.1
1.9 Drugs
2
1.9 1.9
Pain
1.7 1.7 1.8 Relievers
1.5 1.5 1.6
1 1.4+ 1.4+
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Source: SAMHSA National Survey on Drug Use and Health (NSDUH), 2002-2011. 14

15. Emergency Department Visits Involving Nonmedical Use of
Prescription Pharmaceuticals: 2004-2011
Number of Emergency Department Visits
1,400,000
1,244,872
1,172,403
1,200,000
1,078,714+
970,657+
1,000,000
855,334+
740,457+
800,000
668,211+
535,447+
600,000
400,000
200,000
0
2004 2005 2006 2007 2008 2009 2010 2011
+ Difference between this number of visits and the number of visits in 2011 is statistically significant at the .05 level.
Source: SAMHSA Drug Abuse Warning Network (DAWN), 2004-2011. 15

16. Emergency Department Visits Involving Nonmedical Use of
Specific Prescription Pharmaceuticals: 2004-2011
Number of Emergency Department Visits Narcotic Pain
400,000 Relievers
359,921 366,181 (PR)
342,983
350,000 Benzo-
357,836 diazepines (B)
305,892 345,691
300,000 312,931
250,000 237,239+ 271,692+
201,280+
189,704+
200,000 218,640
143,549+ 195,625+
150,000 168,379+
144,655+
100,000
54,151 50,878 53,708 Muscle
38,918 40,769 46,269 Relaxants
50,000 25,934+ 33,695
+
+ 18,794+ 18,879 Central
9,979+ 11,519+ 14,276 40,648
21,997+ 28,491+ Nervous
0 System
2004 2005 2006 2007 2008 2009 2010 2011 Stimulants
+ Difference between this number of visits and the number of visits in 2011 is statistically significant at the .05 level.
Source: SAMHSA Drug Abuse Warning Network (DAWN), 2004-2011.

17. Number of Substance Abuse Treatment Admissions Aged 12 or
Older Reporting Primary Abuse of Prescription Pain
Number of Admissions
Relievers: 1999-2010
160,000 8.3% of admissions 151,225
136,086
140,000
115,990
120,000
100,000 92,887
77,603
80,000
66,927
57,673
60,000 49,949
43,342
35,615
40,000
26,466
20,916
20,000
0 1.2% of admissions
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Source: SAMHSA Treatment Episode Data Set (TEDS), 2010. 17

18. Questions