General Session: State Policy Changes and CDC Impacting the Rx Drug Abuse Epidemic - Dr. Tom Frieden

1. Ending the Epidemic of
Prescription Drug Abuse
Moving from Awareness to Action
National Prescription Drug Abuse Summit
Atlanta, GA
April 23, 2014
Thomas R. Frieden, MD, MPH
Director
Centers for Disease Control and Prevention

2. Dr. Frieden has disclosed no relevant,
real or apparent personal or professional
financial relationships.

3. 125,000

4. Overdose deaths are the tip
of the iceberg
SAMHSA NSDUH, DAWN, TEDS data sets.
Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/
drugDiversion.pdf 2007.
emergency
department
visits
For
every
1
prescrip3on
opioid
overdose
death
in
2010
there
were…

5. >$500 billion

6. U.S. opioid prescribing in 2012
288 million
prescriptions
18 billion
opioid pills
Enough pills to give every
American 18 years or older
75 opioid pills in 2012
IMS Health, National Prescription Audit, 2012

7. Opioid overdose deaths, sales, and
treatment admissions rise in parallel
US, 1999-2010
National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS
0
1
2
3
4
5
6
7
8
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Rate
Opioid Sales KG/10,000
Opioid Deaths/100,000
Opioid Treatment Admissions/10,000
Opioid Sales Kg/10,000
National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System,
SAMHSA’s TEDS

8. Heroin abuse and dependence
is also increasing
SAMHSA NSDUH 2012.
214K
467K
>2 million
Heroin
Opioids

9. 3 out of 4 people reporting Rx opioid
and heroin use in past year took
Rx opioids first
Jones, C.M., Heroin use and heroin use risk behaviors among nonmedical users of prescription
opioid pain relievers – United States, 2002–2004 and 2008–2010. Drug Alcohol Depend. (2013).

10. Public health, law enforcement & communities
working together cut crash deaths in half
We can do the same for overdoses
NCHS Data Brief, December, 2011, updated with 2009 and 2010 mortality data.
0
5
10
15
20
25
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
Deathsper100,000population
Motor Vehicle Traffic Drug Poisoning (Overdose)

11. We are making some
progress, but much
more is needed

12. To reverse the epidemic
1. Track trends, early warnings
2. Improve clinical practice with data,
tools, guidance, and follow-up
3. Partnerships, esp. patients/families
4. Support states
• Optimize PDMPs
• Medicaid, other insurer and pharmacy
benefit manager strategies
• Policies and surveillance to improve
clinical practice
5. Innovate

13. PDMPs currently in use in 48 states
Source: PDMP Training and Technical Assistance Center. http://www.pdmpassist.org/pdf/
pmpprogramstatus2013_a.pdf

14. But… no PDMP is yet:
• Universal,
• Real-time, and
• Actively managed

15. Universal PDMP works
Source: Brandeis University, PDMP Center of Excellence. COE Briefing: Mandating PDMP
Participation by Medical Providers: Current Status and Experience in Selected States. Feb. 2014.

16. After NYS mandated PDMP use…
Multiple providers decreased 75%
Number of opioid Rxs decreased 10%
Number of buprenorphine Rxs increased 15%
Source: Brandeis University, PDMP Center of Excellence. COE Briefing: Mandating PDMP
Participation by Medical Providers: Current Status and Experience in Selected States. Feb. 2014.

17. Buprenorphine works
Opioid overdose deaths declined 75% after
buprenorphine introduced in France
Ling et al. J Subst Abuse Treat 2002;23:87-92.
Auriacombe et al. JAMA 2001;285:45.

18. Real-time PDMP is possible
and effective
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
3Q2010
4Q2010
1Q2011
2Q2011
3Q2011
4Q2011
1Q2012
2Q2012
3Q2012
4Q2012
NumberofPDMPreportsrequested
Prescriber Dispenser LE/Regulatory
Information provided by Don Vogt, OK PDMP, 2013.
24 hour
reporting
5 minute
reporting

19. Real-time PDMP decreased
doctor shopping
564
417
306
0
100
200
300
400
500
600
2010 2011 2012
Numberofdoctorshoppersidentified
Information provided by Don Vogt, OK PDMP, 2013.

20. Electronic health record / PDMP
integration works
• Indiana: 58% of PDMP queries
resulted in reduction in prescriptions
written or pills dispensed
• Ohio: prescribers reported PDMP data
helpful about half the time; several
times a day on average, prescribers
learned something they did not know
that was helpful to decision-making
• Washington: 2/3 of prescribers said
that PDMP embedded in EHR systems
made it easier to access data and
positively impacted treatment

21. Challenge
Up to $6 million to states
over the next 3 years to:
• Optimize PDMPs
• Enhance insurance
mechanisms to prevent
abuse/overdose
• Evaluate prevention policies
to identify what works

22. Drug
August 2011
through
July 2012
August 2012
through
July 2013 % Change
Hydrocodone 239,037,354 214,349,392 –10%
Oxycodone 87,090,503 77,022,586 –11%
Oxymorphone 1,753,231 1,138,817 –35%
Alprazolam 71,669,411 62,088,568 –13%
Methylphenidate 10,659,840 11,454,025 + 8%
Amphetamine 13,795,147 15,065,833 + 9%
All Controlled
Substances 739,263,679 676,303,581 – 9%
Opioid doses dispensed decreased in KY
after comprehensive law passed (HB1)
Buprenorphine prescriptions increased nearly 90% in the 2nd
quarter of 2013 compared to the 3rd quarter of 2011
Source: Kentucky Office of Drug Control Policy

23. Components of a robust
public health response
Real-time data
• Improve surveillance and clinical practice
• Build evidence base of what works for prevention
Prevention
• Identify and scale up effective strategies
• Advance state-level and community interventions
Clinical care
• Uniform clinical strategy for pain management
• Improve prescribing practices and quality of care,
including treatment of addiction

24. Success is possible –
key now is to scale up
Prevention, treatment, advocacy,
laws/regulations, and changes to
our culture are interrelated and
can be synergistic

25. Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Phone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov