Rx Epidemic- Who is misusing, who is supplying, the economic & social costs....

1. 1

2. An epidemic is the occurrence of
more cases of disease than would
normally be expected in a specific
place or group of people over a
given period of time.
http://www.cdc.gov/excite/classroom/intro_epi.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6004a5.htm?s_cid=su6004a5_w 2

3. 3

4. Rx Drug Abuse includes:
Taking someone else’s
prescription for
self-medication
OR Taking a Rx medication in
a way other than intended
OR Taking medication to get high
http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications 4

5. 5

6. 100 people die from drug
overdoses every day in the
United States.
CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008.
MMWR 2011; 60: 1-6
http://www.cdc.gov/HomeandRecreationalSafety/rxbrief/states.html 6

7. Enough prescription
painkillers were
prescribed in 2010 to
medicate every American
adult around-the-clock for
one month.
http://www.cdc.gov/HomeandRecreationalSafety/rxbrief/states.html 7

8. History of Drug Overdoses
10
Eight-Fold Deaths from Rx Medication
9
Drug Overdoses
8 1970-2007
Death rate per 100,000
7
6
5
4
3 Cocaine
2
Heroin
1
0
'70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06
http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdF 8
National Vital Statistics System, http://wonder.cdc.gov

9. Drug Overdose Death Rates by State, 2007
http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-
brief.pdf 9

10. Poisoning is now the leading cause of death
from injuries in the U.S. and nearly 9 out of
10 poisoning deaths are caused by drugs.
• During the past three decades, the number of drug poisoning deaths increased
sixfold from about 6,100 in 1980 to 36,450 in 2008
• In 2008, poisoning became the leading cause of injury death in the United States
and nearly 9 out of 10 poisoning deaths are caused by drugs.
http://www.cdc.gov/nchs/data/databriefs/db81.htm 10

11. Emergency Department Visits Involving Illicit
Drugs or Non-Medical Use of Pharmaceuticals,
2004-2009
http://www.oas.samhsa.gov/2k10/DAWN034/EDHighlights.h 11
tm

12. 2008 Statistics: Opioid Pain Relievers deaths
and Related Consequences of Misuse
Deaths (14,800 people)
Treatment Admission (148,000 people)
Emergency Room (473,600 people)
Abuse/Misuse (1,924,000 people)
Non-medical use (12,210,000 people)
2008, Total number of Drug Overdoses was 36,450 of this
number 20,444 were due to Rx abuse and 73% of Rx Deaths
or 14,800 were due to opioid pain relievers (OPR).
http://www.cdc.gov/injury/about/focus-rx.html
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm#tab1 12
http://www.cdc.gov/nchs/data/databriefs/db81.htm

13. Deaths from Opioid Pain Relievers
http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications 13

14. Opioid refers to Narcotic drugs or pain pills
which are DEA controlled substances.
14

15. Top 10 Prescribing Specialties
immediate-release opioids, 2009
Unspec. 4.5%
Orthopedist 7.4%
Anesthesiologists 3.2%
Physical Med & Rehab 2.7%
Other 20.2%
Emergency Medicine 4.7%
Physicians Assistants 4.0%
Nurse Practitioners 3.5%
Dentists 7.7%
Internal Medicine 15.4%
General Practitioners/Family Medicine 26.7%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%
SDI, Vector One: National, 2009. Extracted June 2010. 15
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvisoryCommittee/UCM217510.pdf

16. Source of Rx Narcotics
Among Those Who Used in the
Past-Year, 12th Grade
Given by friend/relative 59.10%
Bought from friend/relative 37.80%
Presription 32.50%
Brough from dealer/stranger 19.50%
Took from friend/relative 18.80%
Other 11.00%
Internet 1.10% Categories are not mutually exclusive
http://www.drugabuse.gov/sites/default/files/rrprescription.pdf 16

17. Total Number of Opioid Rx Dispensed by U.S.
Retail Pharmacies, 1991-2010
17
http://www.drugabuse.gov/sites/default/files/rrprescription.pdf

18. 18

19. New Users in the Past Year of Specific Illicit
Drugs among Persons Aged 12 or Older, 2010
Note: The specific drug refers to the drug
that was used for the first time in the past
year, regardless of whether it was the first
drug ever used or not.
*Includes pain relievers, tranquilizers, stimulants, and sedatives
http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm 19

20. Past Month Nonmedical Use of Types of Psychotherapeutic Drugs
Past Month Nonmedical Use of Types of
among Persons Aged 12 or Older: 2002-2010
Psychotherapeutic Drugs among
Persons Aged 12 or Older, 2002- 2010
+ Difference between this estimate and the 2010 estimate is statistically significant at the .05 level.
http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16 20

21. Sales
Rates of opioid pain
reliever (OPR)
overdose death, OPR Deaths
treatment
admissions, and
kilograms of OPR
sold --- United
States, 1999--2010 Treatment
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm 21

22. Drug overdose death rate in 2008 and rate of
kilograms (kg) of opioid pain relievers (OPR) sold
in 2010 — United States
Opioid Sales
Death Rate
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm 22

23. Nonmedical use of Rx Drugs are Destroying
Families in the United States
From the innocent unborn & infants to the
vulnerable elderly our nation has succumb to
the marketing ploy of drug companies
encouraging the public to utilize Rx drugs for
every minor pain and/or slight feeling of
anxiety.
Sadly, this ploy is working all too well….
23

24. Weighted National Estimates of the
Rates of NAS per 1000 Hospital Births
per Year
Patrick, S. W. et al. JAMA NAS indicates neonatal abstinence syndrome.
doi:10.1001/jama.2012.3951 24

25. Number of painkiller-addicted
newborns
Triples in 10 years
The Journal of American Medical
Association published about 3.4
of every 1,000 infants born in a
hospital in 2009 suffered from a
type of drug withdrawal
commonly seen in the babies of
pregnant women who abuse
narcotic pain medications.
Stephen Patrick of the University of Michigan, neonatal-
perinatal medicine stated, “That’s about 13,539 infants
a year or one drug-addicted baby born every hour.”
http://usatoday30.usatoday.com/news/h
ealth/story/2012-04-29/durg-addicted- 25
painkller-babies/54646654/1

26. Newborns in Florida
Number of Newborns Treated for
Withdrawal Symptom
for the State of Florida
1600
1374
1400
1200
1000
968
800
659
600
481
400
354
200
0
2006 2007 2008 2009 2010
Opiate Use During Pregnancy: The Short and Long-Term Effects on Women, Babies, and
Children
http://www.usatoday.com/news/health/wellness/babies/story/2011-11-13/Doctors-
see-surge-in-newborns-hooked-on-mothers-pain-pills/51186076/1
http://databases.sun- 26
sentinel.com/Orlando/health/orlandoBabies/ftlaudDrugBabies_list.php

27. Current Substance Use Among Pregnant Women
Aged 15-44, by Age, 2008-2009 Combined
http://oas.samhsa.gov/2k9/135/PregWoSubUse.cfm 27
http://oas.samhsa.gov/2k9/135/PregWoSubUse.htm

28. First time Users
In 2010, 2 million people
reported using prescription
painkillers nonmedically for
the first time within the last
year—nearly 5,500 a day.
http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16 28

29. Adolescent
http://www.drugabuse.gov/publications/drugfacts/prescription-
over-counter-medications 29

30. College Campus
College
students are
TWICE as likely
to abuse
Adderall® than
non-college
students
http://www.oas.samhsa.gov/2k9/adderall/adderall.htm 30

31. College Campus
Full-time college students
who used Adderall® non-
medically in the past year
were and almost FIVE
times more likely to use
OxyContin® non-medically
(44.9 vs. 8.6 %).
http://www.oas.samhsa.gov/2k9/adderall/adderall.htm 31

32. Baby Boomers
National Institutes of
Health surveys show that
in 2010, the most current
year available, 2.4
million people ages 50-
59 said they had abused
prescription or illegal
drugs within the past
month — almost three
times as many people as
reported that behavior in
2002.
http://www.drugabuse.gov/news-events/nida-notes/2010/12/drug-abuse-highest-level- 32
in-nearly-decade

33. Older Adults
At least one in four older adults use
psychoactive medications with abuse
potential (Simoni-Wastila, Yang, 2006)
http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Prescription- 33
Medication-Misuse-and-Abuse-Webinar-12-12-11.ppt

34. Older Adult admissions for substance abuse
treatment nearly tripled
Older Adult admissions for
substance abuse treatment nearly
triples, increasing from 13.7% in
1992 to 39.7% in 2008. CDC.
What happened after ED visit?
52.3% were treated and released
37.5% were admitted to the hospital
http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Prescription- 34
Medication-Misuse-and-Abuse-Webinar-12-12-11.ppt

35. Drug-Related Emergency Department (ED) Visits
Resulting in Hospitalization among Adults Aged 50
or Older, by Type of Visit and Age Group: 2009
Older adults are at particular risk for experiencing adverse reactions to
medications. Compared with younger adults, they are more sensitive to
medications and more likely to take multiple medications because they
have more health problems that require treatment.
http://www.samhsa.gov/data/spotlight/Spot066DrugReaxOlderAdults2012.pdf
http://www.cdc.gov/MedicationSafety/Adult_AdverseDrugEvents.html 35

36. Unintentional Drug Overdose Deaths
by age group and sex, 2007
http://www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdf 36

37. 16%
14%
12%
10%
8% 16%
6%
10% 10% 9%
4% 8%
6%
2% 4%
0%
Asians Native American Two or Hispanics Whites Blacks
Hawaiians Indians or More
Alaska Races
Native
http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm 37

38. Past Month Illicit Drugs among Persons Aged
12 or Older, by County Type: 2010
http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm 38

39. Adults 18-64 years
old accounted for a
disproportionate
share of all MHSA
hospitalizations (83 (63 %) (83 %)
%) relative to their
share of the total
population (63 %) and
all hospitalizations
(49 %).
http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/pdfs/FF_report_2008.pdf 39

40. 40
http://www.justice.gov/ndic/pubs44/44731/44731p.pdf

41. Direct and indirect costs attributable to
illicit drug use are estimated in three
principal areas:
32% Crime $61,376,694
Health $11,416,232
Productivity $120,303,004
62% 6%
$193 Billion
41
http://www.justice.gov/ndic/pubs44/44731/44731p.pdf

42. • Labor participation costs
• Specialty treatment costs for services
provided at the state level and the federal
level hospitalization costs
• Incarceration costs
• Premature mortality costs (nonhomicide &
homicide)
These subtotal $120,304,004.
Dollars in Thousands
42

43. Age at Death for Males- Drug Related- 40-45 yrs
Age at Death for ALL Males 75-80 yrs
Lost productivity due to premature mortality
remains a principal component of all costs that
drug use imposes on American society.
43

44. Crime cost includes three
components:
$56,373,254 criminal justice
system
$1,455,555 crime victim
$3,547,885 other crime
These subtotal $61,376,694
Dollars in Thousands
44

45. Health includes five components:
1. Specialty treatment costs ($3,723,338),
2. Hospital & emergency department costs for nonhomicide
cases ($5,684,248)
3. Hospital & emergency department costs for homicide cases
($12,938)
4. Insurance administration costs ($544)
5. Other health costs ($1,995,164).
These subtotal $11,416,232.
Dollars in Thousands
45

46. Drug courts can save states as much
$12,000 per client compared to other
criminal justice strategies, according to
the organization. CDC Accidental Overdoses
www.cdc.gov/HomeandRecreationalSafety/pubs/RXReport_web-a.pdf 46

47. Legal Consequences:
2010 Legal Consequences of Prescription Drug
Misuse
Rx Drug Facts & Health Consequences of Misuse:
2010 Facts and Consequences of Nonmedical Use
of Prescription Drugs
Saving Lives through Education &
Prevention
47

48. • The US is the only developed country in the world that
does not control RX drug prices.
• The US and New Zealand are the only countries that allow
drug makers to advertise to consumers.
• In medical schools the median # of hours for pain
education in the United States is 7 at VETINARIAN schools
the median required hours is 75.
• The pharmaceutical companies spent more on lobbying
between 1998 and 2004 than any other industry...
employing a legion of lobbyists.. more than two for each
member of Congress.
48

49. Website Sources
http://www.cdc.gov/excite/classroom/intro_epi.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6004a5.htm?s_cid=su6004a5_w
http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications
http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Prescription-Medication-Misuse-and-
Abuse-Webinar-12-12-11.ppt
http://www.drugabuse.gov/sites/default/files/rrprescription.pdf
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndLifeSupportDrugsAdvis
oryCommittee/UCM217510.pdf
http://www.justice.gov/ndic/pubs44/44731/44731p.pdf
http://www.isp.idaho.gov/pgr/Research/documents/drugsandcrime.pdf
National Vital Statistics System, http://wonder.cdc.gov
http://www.ahrq.gov/news/press/pr2010/hospmedpr.htm
Healthcare Cost and Utilization Project (HCUP) http://www.hcup-
us.ahrq.gov/reports/factsandfigures/2008/TOC_2008.jsp
http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/pdfs/FF_report_2008.pdf
http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm
http://www.drugabuse.gov/news-events/nida-notes/2010/12/drug-abuse-highest-level-in-nearly-decade
http://oas.samhsa.gov/2k9/135/PregWoSubUse.htm
http://oas.samhsa.gov/2k9/135/PregWoSubUse.cfm
49