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11
“Tre
atm
ent S
trat
egie
s to
Add
ress
“T
reat
men
t Str
ateg
ies
to A
ddre
ss
Pre
scrip
tion
Dru
g M
isus
e an
d P
resc
riptio
n D
rug
Mis
use
and
Abu
se”
Abu
se”
Todd
W. M
ande
ll, M
.D.
Med
ical
Dire
ctor
Ver
mon
t Age
ncy
of H
uman
Ser
vice
s
Div
isio
n of
Alc
ohol
and
Dru
g A
buse
P
rogr
ams
22
SA
MH
SA
’s R
ole
in F
ight
ing
Pre
scrip
tion
Dru
g M
isus
e an
d A
buse
SA
MH
SA
’s R
ole
in F
ight
ing
Pre
scrip
tion
Dru
g M
isus
e an
d A
buse
•A
t a p
olic
y le
vel,
the
Sub
stan
ce A
buse
and
M
enta
l Hea
lth S
ervi
ces
Adm
inis
trat
ion
(SA
MH
SA
) w
orks
to e
nsur
e th
at s
cien
ce, r
athe
r th
an id
eolo
gy
form
s th
e fo
unda
tion
for
the
Nat
ion'
s ad
dict
ion
trea
tmen
t sys
tem
.
•S
AM
HS
A a
nd it
s co
mpo
nent
Cen
ters
ser
ve
heal
th p
rofe
ssio
nals
and
the
publ
ic b
y di
ssem
inat
ing
scie
ntifi
cally
sou
nd, c
linic
ally
re
leva
nt in
form
atio
n on
bes
t pra
ctic
es in
the
trea
tmen
t of a
ddic
tive
diso
rder
s, a
nd w
orki
ng to
en
hanc
e pu
blic
acc
epta
nce
of th
at tr
eatm
ent.
33
Pas
t Mon
th N
onm
edic
al U
se o
f P
resc
riptio
n D
rugs
Am
ong
Per
sons
12
+:20
02-2
008
Pas
t Mon
th N
onm
edic
al U
se o
f P
resc
riptio
n D
rugs
Am
ong
Per
sons
12
+:20
02-2
008
Per
cent
Usi
ng in
Pas
t Mon
th
Sou
rce:
NS
DU
H 2
008
1.9%
0.8%
0.6%
1.9%
0.7%
0.5%
2.1%
0.7%
0.4%
1.9%
0.2%
0.1%
0.6%
0.8%
2%
0.1%
0.5%
0.7%
1.8%
0.1%
0.2%
2.1%
0.6%
0.7%
0.1%
0.1%
0.4%
0.7%
0%1%1%2%2%3%
Pai
n R
elie
vers
Tra
nqui
lizer
sS
timul
ants
Sed
ativ
es
2002
2003
2004
2005
2006
2007
2008
44
Nonm
edic
al U
se o
f Sele
cted P
ain
Relievers in
Nonm
edic
al U
se o
f Sele
cted P
ain
Relievers in
Lifetim
e b
y Age G
roup, N
um
bers
in T
housands,
Lifetim
e b
y Age G
roup, N
um
bers
in T
housands,
2008
2008
Sou
rce:
NS
DU
H 2
008
4,06
96,32
3
601
7452
21,
012
1,17
3
15,8
8615
,219
1,29
5
9,59
7
3,56
1
0
2,00
0
4,00
0
6,00
0
8,00
0
10,0
00
12,0
00
14,0
00
16,0
00
Age
d 12
-17
Age
d 18
-25
Age
d 26
and
old
er
Numbers in Thousands
Pro
poxy
phen
e or
Cod
eine
Pro
duct
sH
ydro
codo
ne P
rodu
cts
Oxy
codo
ne P
rodu
cts
Tra
mad
ol P
rodu
cts
55
Pas
t Yea
r In
itiat
es fo
r S
peci
fic Il
licit
Dru
gs a
mon
g P
erso
nsA
ged
12 o
r ol
der:
200
8
Pas
t Yea
r In
itiat
es fo
r S
peci
fic Il
licit
Dru
gs a
mon
g P
erso
nsA
ged
12 o
r ol
der:
200
8
53
11418
1
394
599
722
894
1,12
7
2,17
6
2,20
8
729
050
01,
000
1,50
02,
000
PC
P
He
roin
Se
dativ
es
LSD
Stim
ulan
ts
Coc
aine
Inha
lant
s
Ecs
tasy
Tra
nqui
lize
rs
Pai
n R
elie
vers
Mar
ijuan
a
Num
bers
in T
hous
ands
Sour
ce: N
SDU
H 2
008
Num
ber o
f Ind
ivid
uals
repo
rtin
g fir
st u
se o
f sub
sta
nce
in p
ast y
ear
66N
ote:
Tot
als
may
not
sum
to 1
00%
bec
ause
of r
ound
ing
or b
ecau
se s
uppr
esse
d es
timat
es a
re n
ot s
how
n.S
ourc
e: N
SD
UH
200
8
Sou
rce
Whe
re P
ain
Rel
ieve
rs W
ere
Obt
aine
d S
ourc
e W
here
Pai
n R
elie
vers
Wer
e O
btai
ned
for
Mos
t Rec
ent N
onm
edic
al U
se a
mon
g P
ast
for
Mos
t Rec
ent N
onm
edic
al U
se a
mon
g P
ast
Yea
r U
sers
Age
d 12
or
Old
er: 2
008
Yea
r U
sers
Age
d 12
or
Old
er: 2
008
0.4%
55.9
%
4.3%
18.0
%
5.4% 8.
9%
Frie
nd/R
elat
ive
for
Fre
eB
ough
t fro
mF
riend
/Rel
ativ
eT
ook
from
Frie
nd/R
elat
ive
Pre
scrip
tion
from
One
Doc
tor
Fro
m D
rug
Dea
ler
or S
tran
ger
Fro
m In
tern
et
81.7
%of
pai
n re
lieve
rs
obta
ined
from
fr
iend
/rel
ativ
e fo
r fr
ee w
ere
obta
ined
from
on
e do
ctor
.1.
6%w
ere
obta
ined
from
a
drug
dea
ler.
70%
of P
resc
riptio
n P
ain
Rel
ieve
rs U
sed
Non
-Med
ical
ly
Com
e fr
om F
riend
s or
Rel
ativ
es
77
The
“O
ne D
octo
r” S
ourc
e fo
r P
resc
riptio
n D
rugs
The
“O
ne D
octo
r” S
ourc
e fo
r P
resc
riptio
n D
rugs
•A
ccor
ding
to N
SD
UH
200
8 da
ta, o
nly
1 in
20
nonm
edic
al u
sers
(4.
3%)
of p
resc
riptio
n pa
in
relie
vers
got
them
from
a d
rug
deal
er.
•In
mos
t cas
es, p
resc
riptio
n dr
ugs
obta
ined
for
nonm
edic
al p
urpo
ses
orig
inat
ed fr
om a
sin
gle
doct
or–
rath
er th
an fr
om m
ultip
le s
ourc
es.
88
Incr
ease
d Is
suan
ce o
f Stim
ulan
t P
resc
riptio
nsIn
crea
sed
Issu
ance
of S
timul
ant
Pre
scrip
tions
•A
n F
DA
stu
dy r
epor
ted
a fo
ur-f
old
incr
ease
in
stim
ulan
t pre
scrip
tions
bet
wee
n 20
00 a
nd 2
004,
•F
rom
200
2 to
200
5 th
e st
udy
foun
d a
90%
in
crea
se in
adu
lt us
e of
stim
ulan
t pre
scrip
tions
.
•T
he s
tudy
con
clud
ed th
at b
oth
of th
ese
tren
ds
are
likel
y to
con
tinue
in th
e ye
ars
to c
ome.
Stim
ulan
t Use
on
Col
lege
Cam
puse
sS
timul
ant U
se o
n C
olle
ge C
ampu
ses
•F
ull-t
ime
colle
ge s
tude
nts
aged
18
to 2
2 w
ere
twic
e as
like
ly a
s th
eir
coun
terp
arts
who
wer
e no
t ful
l-tim
e co
llege
stu
dent
s to
hav
e us
ed
Add
eral
l® n
onm
edic
ally
in th
e pa
st y
ear
(6.4
vs.
3.
0pe
rcen
t)
Non
med
ical
Use
of A
dder
all®
amon
g F
ull-T
ime
Col
lege
Stu
dent
s,”T
he
NS
DU
H R
epor
t, A
pril
7, 2
009
Stim
ulan
t Use
on
Col
lege
Cam
puse
sS
timul
ant U
se o
n C
olle
ge C
ampu
ses
•F
ull-t
ime
colle
ge s
tude
nts
who
wer
e no
nmed
ical
use
rs o
f A
dder
all®
wer
e al
mos
t 3 ti
mes
as
likel
y as
thos
e w
ho h
ad
not u
sed
Add
eral
l® n
onm
edic
ally
to h
ave
used
mar
ijuan
a in
the
past
yea
r (7
9.9
vs. 2
7.2
perc
ent)
,•
8 tim
es m
ore
likel
y to
hav
e us
ed c
ocai
ne in
that
per
iod
(28.
9 vs
. 3.6
perc
ent)
, •
8 tim
es m
ore
likel
y to
hav
e be
en n
onm
edic
al u
sers
of
pres
crip
tion
tran
quili
zers
(24
.5 v
s. 3
.0pe
rcen
t), a
nd
•5
times
mor
e lik
ely
to h
ave
been
non
med
ical
use
rs o
f pr
escr
iptio
n pa
in r
elie
vers
(44
.9 v
s. 8
.7pe
rcen
t)
Non
med
ical
Use
of A
dder
all®
amon
g F
ull-T
ime
Col
lege
Stu
dent
s,”T
he N
SD
UH
Rep
ort,
Apr
il 7,
200
9
1111
20.8
Mill
ion
Nee
ding
But
Not
Rec
eivi
ng
20.8
Mill
ion
Nee
ding
But
Not
Rec
eivi
ng
Trea
tmen
t for
Illic
it D
rug
or A
lcoh
ol U
seTr
eatm
ent f
or Il
licit
Dru
g or
Alc
ohol
Use
3.7%
Fel
t The
y N
eede
d Tr
eatm
ent a
nd D
id
Mak
e an
Effo
rt
Did
Not
Fee
l T
hey
Nee
ded
Trea
tmen
t
Fel
t The
y N
eede
d Tr
eatm
ent a
nd D
id
Not
Mak
e an
Effo
rt
1.1%
95.2
%
Pas
t Yea
r P
erce
ived
Nee
d fo
r an
d E
ffort
Mad
e to
Rec
eive
S
peci
alty
Tre
atm
ent a
mon
g P
erso
ns A
ged
12 o
r O
lder
N
eedi
ng B
ut N
ot R
ecei
ving
Tre
atm
ent f
or Il
licit
Dru
g or
A
lcoh
ol U
se: 2
008
Pas
t Yea
r P
erce
ived
Nee
d fo
r an
d E
ffort
Mad
e to
Rec
eive
S
peci
alty
Tre
atm
ent a
mon
g P
erso
ns A
ged
12 o
r O
lder
N
eedi
ng B
ut N
ot R
ecei
ving
Tre
atm
ent f
or Il
licit
Dru
g or
A
lcoh
ol U
se: 2
008
(766
,000
)
(233
,000
)
(19.
8 M
illio
n)
Sou
rce:
NS
DU
H 2
008
1212
Rea
sons
for
Not
Rec
eivi
ng S
ubst
ance
Use
T
reat
men
t: P
erso
ns A
ged
12+
Rea
sons
for
Not
Rec
eivi
ng S
ubst
ance
Use
T
reat
men
t: P
erso
ns A
ged
12+
Per
cent
Rep
ortin
g R
easo
n
Not
Rea
dy to
Sto
p U
sing
No
Pro
gram
Hav
ing
Type
of T
reat
men
t
No
Hea
lth C
over
age
and
Cou
ld N
ot
Affo
rd C
ost
No
Tran
spor
tatio
n/In
conv
enie
nt
Mig
ht C
ause
Nei
ghbo
rs/C
omm
unity
to
Hav
e N
egat
ive
Opi
nion
Abl
e to
Han
dle
Pro
blem
with
out
Trea
tmen
t
8.1%
7.7%
7.4%
37.4%
29.3
%
13.0
%
10.6
%
8.3%
8.2%
0%10
%20
%30
%40
%
Tho
se w
ho N
eede
d &
Mad
e th
e E
ffort
to G
et T
reat
men
t
Tho
se w
ho N
eede
d &
Mad
e th
e E
ffort
to G
et T
reat
men
t
But
Did
B
ut D
id N
otNot
Rec
eive
Spe
cial
ty T
reat
men
tR
ecei
ve S
peci
alty
Tre
atm
ent
Sou
rce:
NS
DU
H, 2
005-
2008
com
bine
d
Mig
ht H
ave
Neg
ativ
e E
ffect
on
Job
Did
Not
Kno
w W
here
to G
o fo
r Tr
eatm
ent
Did
n’t F
eel N
eed
for
Trea
tmen
t at t
he
Tim
e
1313
Med
icat
ion
Med
icat
ion--
Ass
iste
d O
pioi
d T
hera
pyA
ssis
ted
Opi
oid
The
rapy
Med
icat
ion
Med
icat
ion--
Ass
iste
d O
pioi
d T
hera
pyA
ssis
ted
Opi
oid
The
rapy
Source: SAM
HSA, TEDS 2
007
29.1
%
20.0
%
0.3%1.
4%2.0%
2.2%3.
2%
0%5%
10%
15%
20%
25%
30%
35%
Her
oin
Oth
er O
piat
es
Met
ham
phet
amin
e/am
phet
amin
e
Oth
er s
timul
ants
Tra
nqui
lizer
s
Sed
ativ
es
Hal
luci
noge
ns
Primary Substance of Abuse
% A
dmis
ions
for W
hom
Med
icat
ion-
assi
sted
Opi
od T
her
apy
Pla
nned
Per
cent
of T
reat
men
t Adm
issi
ons
for
who
m M
AT
was
pla
nned
:
1414
INT
ER
ME
DIA
RY
DE
TE
RM
INA
NT
S
OF
HE
ALT
H
SO
CIO
EC
ON
OM
ICP
OLI
TIC
AL
CO
NT
EX
T
Gov
erna
nce
Mac
roec
onom
ic
Pol
icie
s
Soci
al P
olic
ies
Lab
or M
arke
t,H
ousi
ng, L
and.
Pub
lic P
olic
ies,
Edu
cati
on, H
ealt
h,So
cial
pro
tect
ion,
D
rug
Law
s*,
Imm
igra
tion
law
s*
Cul
ture
and
So
ciet
al V
alue
Soci
oeco
nom
ic
Pos
itio
n
Soc
ial C
lass
Gen
der
Eth
nici
ty (
raci
sm)
Sex
ual O
rien
tatio
n*A
ge*
Leg
al S
tatu
s*
Edu
catio
n
Occ
upat
ion
Inco
me
Hea
lth S
yste
m
IMPA
CT
ON
E
QU
ITY
IN
H
EA
LTH
A
ND
W
EL
L-B
EIN
G
Mat
eria
l Cir
cum
stan
ces
(Liv
ing
and
Wor
king
C
ondi
tion
s, F
ood
& W
ater
Ava
ilabi
lity,
etc
)
Beh
avio
rs a
nd
Bio
logi
cal F
acto
rs(i
nclu
ding
alc
ohol
an
d dr
ug u
se)*
Psy
chol
ogic
al F
acto
rs
ST
RU
CT
UR
AL D
ET
ER
MIN
AN
TS
OF
HE
ALT
H IN
EQ
UIT
IES
Soci
al c
ohes
ion
& S
ocia
l Cap
ital
The
Soc
ial D
eter
min
ants
of H
ealth
*T
he S
ocia
l Det
erm
inan
ts o
f Hea
lth*
* A
dapt
ed fr
om th
e W
orld
Hea
lth O
rgan
izat
ion
15
Rec
over
y is
a “
Hol
istic
” P
roce
ssR
ecov
ery
is a
“H
olis
tic”
Pro
cess
Rec
over
y is
a “
Hol
istic
” P
roce
ssR
ecov
ery
is a
“H
olis
tic”
Pro
cess
•R
ecov
ery
is a
“ho
listic
” pr
oces
s th
at b
enef
its
from
the
part
icip
atio
n of
a d
iver
se g
roup
of
priv
ate
and
publ
ic r
esou
rces
.
•E
very
res
ourc
e, s
yste
m, s
ervi
ce, e
tc.,
that
co
ntrib
utes
to th
e re
cove
ry o
f an
indi
vidu
al
“ow
ns”
a pi
ece
of th
e re
cove
ry p
roce
ss.
•T
he F
eder
al g
over
nmen
t has
a r
ole,
but
the
appr
oach
is m
uch
larg
er –
enco
mpa
ssin
g a
wid
e sp
ectr
um o
f Sta
te, l
ocal
, Trib
al, c
omm
unity
-ba
sed,
faith
-bas
ed, a
nd p
eer-
to-p
eer
supp
orts
, se
rvic
es, a
nd s
yste
ms.
16
Pre
scrip
tion
Dru
g A
buse
Pre
scrip
tion
Dru
g A
buse
Rol
e of
Fed
eral
Gov
ernm
ent
•F
eder
al A
genc
ies
–F
ood
and
Dru
g A
dmin
istr
atio
n (F
DA
)
–D
rug
Enf
orce
men
t Adm
inis
trat
ion
(DE
A)
–F
eder
al C
ontr
olle
d S
ubst
ance
s A
ct
•R
estr
ictio
ns o
n P
ract
ition
ers
–F
eder
al L
aws
and
regu
latio
ns
Rol
e of
Sta
te G
over
nmen
ts•
Reg
ulat
ion
of p
rofe
ssio
nal p
ract
ice
occu
rs a
t the
Sta
te le
vel
•N
umer
ous
Sta
te la
ws,
reg
ulat
ions
, and
pol
icie
s go
vern
the
use
of c
ontr
olle
d dr
ugs
by p
hysi
cian
s, n
urse
s, d
entis
ts,
vete
rinar
ians
, and
oth
er h
ealth
pro
fess
iona
ls
Reg
ulat
ing
Pre
scrip
tion
Med
icat
ion
Reg
ulat
ing
Pre
scrip
tion
Med
icat
ion
Man
ufac
ture
r
Pha
rmac
ist
Phy
sici
an
Pat
ient
FD
AD
EA
Sta
tes
DE
AS
tate
sD
EA
Sta
tes
DE
AS
tate
s
RE
MS
RE
MS
RE
MS
•F
DA
doe
s no
t dire
ctly
reg
ulat
e
phar
mac
ists
and
phy
sici
ans.
•
The
y ar
e ab
le to
indi
rect
ly a
ffect
them
thro
ugh
a
Ris
k E
valu
atio
n an
d M
itiga
tion
Str
ateg
y (R
EM
S).
•R
EM
S is
a s
trat
egy
to m
anag
e a
know
n or
pot
entia
l ser
ious
ris
k
asso
ciat
ed w
ith a
dru
g or
bio
logi
cal p
rodu
ct.
•A
RE
MS
can
incl
ude
a M
edic
atio
n G
uide
, Pat
ient
Pac
kage
Inse
rt, a
co
mm
unic
atio
n pl
an, e
lem
ents
to a
ssur
e sa
fe u
se, a
nd a
n im
plem
enta
tion
syst
em, a
nd m
ust i
nclu
de a
tim
etab
le fo
r as
sess
men
t of t
he R
EM
S.
RE
MS
for
Opi
oids
RE
MS
for
Opi
oids
•In
res
pons
e to
Con
gres
sion
al m
anda
te, F
DA
has
be
gun
deve
lopm
ent o
f RE
MS
for
Opi
oids
.•
Alth
ough
RE
MS
are
dire
cted
at m
anuf
actu
rers
, co
ncer
ns h
ave
been
rai
sed
abou
t pos
sibl
e im
pact
on
phar
mac
ists
, phy
sici
ans,
clin
icia
ns,
and
patie
nts,
incl
udin
g:–
Cha
nges
in r
egul
atio
ns fo
r pr
escr
ibin
g–
Req
uire
d pr
ovid
er a
nd p
ublic
edu
catio
n–
Incr
ease
d m
onito
ring
–R
estr
icte
d ac
cess
to e
ffect
ive
pain
m
edic
atio
ns fo
r ca
ncer
pat
ient
s or
pat
ient
s w
ith c
hron
ic p
ain.
1919
SA
MH
SA
/CS
AT
’s P
resc
riptio
n D
rug
SA
MH
SA
/CS
AT
’s P
resc
riptio
n D
rug
Abu
se In
itiat
ive
Abu
se In
itiat
ive
SA
MH
SA
/CS
AT
’s P
resc
riptio
n D
rug
SA
MH
SA
/CS
AT
’s P
resc
riptio
n D
rug
Abu
se In
itiat
ive
Abu
se In
itiat
ive
•S
AM
HS
A in
itiat
ive:
Dis
posi
ng &
saf
egua
rdin
g of
pr
escr
iptio
n m
edic
atio
n to
red
uce
pote
ntia
l m
isus
e.•
Fen
tany
l-rel
ated
Ove
rdos
es a
nd D
eath
Mee
ting
(200
7)•
CS
AT
Tre
atm
ent S
trat
egie
s fo
r P
resc
riptio
n D
rug
Mis
use
and
Abu
se in
itiat
ive.
•
Ope
n D
ialo
gue
mee
tings
with
pha
rmac
eutic
al
indu
stry
.
2020
SA
MH
SA
/CS
AT
’s P
resc
riptio
n D
rug
SA
MH
SA
/CS
AT
’s P
resc
riptio
n D
rug
Abu
se In
itiat
ive
Abu
se In
itiat
ive
SA
MH
SA
/CS
AT
’s P
resc
riptio
n D
rug
SA
MH
SA
/CS
AT
’s P
resc
riptio
n D
rug
Abu
se In
itiat
ive
Abu
se In
itiat
ive
•R
x A
ctio
n A
llian
ce (
cons
ortiu
m o
f add
ictio
n ex
pert
s, m
edic
al s
ocie
ties,
pat
ient
adv
ocac
y gr
oups
, reg
ulat
ory
and
law
enf
orce
men
t or
gani
zatio
ns, a
nd p
harm
aceu
tical
m
anuf
actu
rers
)
•A
dvis
ory
Com
mitt
ee o
n N
on-M
edic
al U
se o
f S
timul
ant D
rugs
(pr
escr
iptio
n st
imul
ant a
buse
by
high
sch
ool a
nd c
olle
ge y
outh
)
•N
atio
nal A
ssoc
iatio
n of
Dru
g D
iver
sion
In
vest
igat
ors
(NA
DD
I)
21
CS
AT
’s P
resc
riptio
n D
rug
Abu
se In
itiat
ive:
C
SA
T’s
Pre
scrip
tion
Dru
g A
buse
Initi
ativ
e:
Sta
keho
lder
Out
reac
hS
take
hold
er O
utre
ach
CS
AT
’s P
resc
riptio
n D
rug
Abu
se In
itiat
ive:
C
SA
T’s
Pre
scrip
tion
Dru
g A
buse
Initi
ativ
e:
Sta
keho
lder
Out
reac
hS
take
hold
er O
utre
ach
•O
pen
Dia
logu
e m
eetin
gs w
ith p
harm
aceu
tical
indu
stry
.
•B
upre
norp
hine
Sum
mits
(20
04, 2
005,
200
7,20
10)
•R
x A
ctio
n A
llian
ce (
cons
ortiu
m o
f add
ictio
n ex
pert
s,
med
ical
soc
ietie
s, p
atie
nt a
dvoc
acy
grou
ps, r
egul
ator
y an
d la
w e
nfor
cem
ent o
rgan
izat
ions
, and
pha
rmac
eutic
al
man
ufac
ture
rs)
•A
dvis
ory
Com
mitt
ee o
n N
on-M
edic
al U
se o
f Stim
ulan
t D
rugs
(pr
escr
iptio
n st
imul
ant a
buse
by
high
sch
ool a
nd
colle
ge y
outh
)
•N
atio
nal A
ssoc
iatio
n of
Dru
g D
iver
sion
Inve
stig
ator
s (N
AD
DI)
Wha
t is
NA
SP
ER
?W
hat i
s N
AS
PE
R?
•N
atio
nal A
ll S
ched
ules
Pre
scrip
tion
Ele
ctro
nic
Rep
ortin
g A
ct (
NA
SP
ER
) •
Fed
eral
Pre
scrip
tion
Dru
g M
onito
ring
Dat
abas
e •
A b
ill p
ropo
sed
by th
e A
mer
ican
Soc
iety
of
Inte
rven
tiona
l Pai
n P
hysi
cian
s to
pro
vide
and
im
prov
e pa
tient
acc
ess
with
qua
lity
care
.•
Pro
tect
s pa
tient
s an
d ph
ysic
ians
from
de
lete
rious
effe
cts
of c
ontr
olle
d su
bsta
nces
m
isus
e, a
buse
and
mon
itorin
g.
2323
Nat
iona
l All
Sch
edul
es P
resc
riptio
n N
atio
nal A
ll S
ched
ules
Pre
scrip
tion
Ele
ctro
nic
Rep
ortin
g (N
AS
PE
R)
Ele
ctro
nic
Rep
ortin
g (N
AS
PE
R)
•32
sta
tes
curr
ently
hav
e op
erat
iona
l pre
scrip
tion
mon
itorin
g pr
ogra
ms
(PM
Ps)
in p
lace
.•
Just
ice
prog
ram
fund
s ab
out $
7 m
illio
n fo
r 18
co
mpe
titiv
e P
MP
gra
nts.
•
$2.0
mill
ion
SA
MH
SA
sta
te fo
rmul
a gr
ant b
egan
w
ith F
Y 2
009
appr
opria
tion
•A
war
d re
quire
men
ts in
clud
e st
ate
law
au
thor
izin
g P
MP
pro
gram
with
app
ropr
iate
pe
nalti
es fo
r un
auth
oriz
ed u
se o
r di
sclo
sure
of
info
rmat
ion
•ht
tp://
ww
w.n
aspe
r.or
g/da
taba
se.h
tm
24
SA
MH
SA
200
9 P
MP
Aw
ards
SA
MH
SA
200
9 P
MP
Aw
ards
Sta
te
Allo
tmen
t
Mai
ne
$4
0,51
4
Mic
higa
n
$19
3,36
2
Mis
siss
ippi
$
79,2
46
Nev
ada
$5
2,92
2
New
Yor
k
$34
2,26
4
Ohi
o*
$1
90,9
95
Sta
te
Allo
tmen
tA
laba
ma
$115
,396
Cal
iforn
ia
$454
,587
Con
nect
icut
*
$
65,9
76
Illin
ois
$188
,843
Indi
ana
*
$1
08,0
79
Kan
sas
*
$
66,4
07
Ken
tuck
y *
$1
01,4
09
* S
tate
s th
at r
ecei
ved
both
NA
SP
ER
and
Har
old
Rog
ers
gran
ts in
FY
200
9.
25
Scr
eeni
ng, B
rief I
nter
vent
ion
& R
efer
ral
Scr
eeni
ng, B
rief I
nter
vent
ion
& R
efer
ral
to T
reat
men
t (S
BIR
T)
to T
reat
men
t (S
BIR
T)
Scr
eeni
ng, B
rief I
nter
vent
ion
& R
efer
ral
Scr
eeni
ng, B
rief I
nter
vent
ion
& R
efer
ral
to T
reat
men
t (S
BIR
T)
to T
reat
men
t (S
BIR
T)
•S
BIR
T h
as g
reat
futu
re p
oten
tial f
or p
rom
otin
g ch
ange
s to
the
entir
e pr
imar
y ca
re m
edic
al
serv
ice
deliv
ery
syst
em.
•E
mbe
ddin
g sc
reen
ing,
brie
f int
erve
ntio
n, r
efer
ral
& tr
eatm
ent o
f sub
stan
ce a
buse
pro
blem
s w
ithin
pr
imar
y ca
re s
ettin
gs s
uch
as e
mer
genc
y ce
nter
s, c
omm
unity
hea
lth c
are
clin
ics,
and
tr
aum
a ce
nter
s he
lps
to:
–Id
entif
y pa
tient
s w
ho d
on’t
perc
eive
a n
eed
for
trea
tmen
t,–
Pro
vide
them
with
a s
olid
str
ateg
y to
red
uce
or
elim
inat
e su
bsta
nce
abus
e, a
nd
–M
ove
them
into
app
ropr
iate
ser
vice
s.
26
FY
200
8 S
BIR
T M
edic
al R
esid
ency
F
Y 2
008
SB
IRT
Med
ical
Res
iden
cy
Pro
gram
Pro
gram
FY
200
8 S
BIR
T M
edic
al R
esid
ency
F
Y 2
008
SB
IRT
Med
ical
Res
iden
cy
Pro
gram
Pro
gram
•S
AM
HS
A h
as a
war
ded
11 S
BIR
T M
edic
al R
esid
ency
gr
ants
•T
he S
BIR
T M
edic
al R
esid
ency
Pro
gram
will
tra
in m
edic
al
phys
icia
ns to
pro
vide
SB
IRT
ser
vice
s.
•T
he g
oal i
s to
est
ablis
h S
BIR
T tr
aini
ng a
s a
com
pone
nt o
f re
side
ncy
prog
ram
s in
a v
arie
ty o
f dis
cipl
ines
, inc
ludi
ng
emer
genc
y m
edic
ine,
trau
ma,
and
oth
ers.
•A
noth
er p
urpo
se is
to p
rom
ote
adop
tion
of S
BIR
T
thro
ugh
deliv
ery
of tr
aini
ng to
loca
l and
Sta
tew
ide
med
ical
com
mun
ities
for
wid
er d
isse
min
atio
n of
SB
IRT
pr
actic
es.
27
Uni
vers
al P
reca
utio
ns a
nd
Res
pons
ible
Pre
scrib
ing
Pre
scrip
tion
drug
abu
se
Pre
scrip
tion
drug
abu
se
•V
aryi
ng r
epor
ts a
s to
the
mag
nitu
de a
nd th
e se
ctor
s of
the
popu
latio
n in
volv
ed
Approaches
Approaches
•U
nive
rsal
Pre
caut
ions
•R
espo
nsib
le P
resc
ribin
g of
con
trol
led
subs
tanc
es
•U
nuse
d dr
ug d
ispo
sal:
Pro
tect
ing
the
envi
ronm
ent a
nd th
e pu
blic
Universal Precautions*
Universal Precautions*
His
tory
of t
he te
rmH
IV/A
IDS
: -
Avo
idan
ce o
f dis
crim
inat
ion
-A
nyon
e m
ay b
e at
ris
k
Cur
rent
app
licat
ion
for
addi
ctio
nsA
ddic
tions
:-
Noo
ne is
imm
une
to th
e po
ssib
ility
of d
evel
opin
g an
ad
dict
ion
-Id
entif
icat
ion
of a
ddic
tions
sug
gest
s th
e ne
ed
for
trea
tmen
t, no
t dis
mis
sal f
rom
you
r pr
actic
e
*Gou
rlay,
D.,
and
H.H
eit.
Uni
vers
al p
reca
utio
ns: a
mat
ter o
f mut
ual t
rust
and
resp
onsi
bilit
y. P
ain
Med
icin
e, M
ar.-
Apr
. 200
6,
7(2)
:210
-211
, aut
hor r
eply
212
.
Prescription Drug Abuse
Prescription Drug Abuse
Wis
e or
res
pons
ible
pre
scrib
ing
such
that
the
amou
nts
of
cont
rolle
d su
bsta
nces
are
kee
p to
a m
inim
um1
Sm
alle
r pr
escr
iptio
ns e
spec
ially
on
initi
atio
nF
unct
ioni
ng le
vel t
rum
ps r
epor
ts o
f pai
nU
se o
f the
pre
scrip
tion
mon
itorin
g pr
ogra
ms2
Impa
irmen
t ass
essm
ent
Pat
ient
trea
tmen
t agr
eem
ents
Urin
e D
rug
Scr
eens
Tre
atm
ent P
rovi
der
Com
mun
icat
ions
1 Pal
liativ
e ca
re e
xcep
ted
2 Pra
ctic
e lia
bilit
y
Pain Management and Addictions
Pain Management and Addictions
One
of t
he m
ost c
halle
ngin
g cl
inic
al c
ombi
natio
ns
espe
cial
ly in
the
prim
ary
care
set
ting
Man
agin
g ch
roni
c pa
in w
hile
kee
ping
in c
ontr
ol o
f pr
escr
ibin
g an
d em
otio
ns
Ver
mon
t pre
scrib
er q
uery
res
ults
Fut
ure
plan
s: L
ocal
and
Nat
iona
l
Med
icat
ion
Dis
posa
lM
edic
atio
n D
ispo
sal
“Kitt
y Li
tter”
Tak
e B
ack
Pro
gram
sS
ingl
e E
vent
sP
olic
e S
tatio
n D
rop
Offs
Tak
e B
ack
Pro
gram
Mod
el*
Tak
e B
ack
Pro
gram
Mod
el*
Pro
gram
Par
ticip
ants Sec
ure
deliv
ery
to M
aine
Dru
g E
nfor
cem
ent A
genc
y
Env
elop
es re
ceiv
ed, l
ogge
d,
cata
logu
ed a
nd d
estr
oyed
un
der
MD
EA
cus
tody
*Uni
vers
ity o
f M
aine
, Cen
ter
on A
ging
Dru
g R
etur
ns D
ata
Dru
g R
etur
ns D
ata
Mai
ne
Saf
e M
edic
ine
Dis
posa
l for
ME
: Fin
ding
s an
d R
ecom
me
ndat
ions
fr
om P
hase
s I &
II
Fac
ilita
tor:
Kat
hy S
ykes
, Sen
ior A
dvis
or, U
.S.E
.P.A
. Agi
ng In
itiat
ive,
Was
hing
ton,
DC
3,8
50 e
nvel
opes
retu
rned
43%
ret
urn
rate
1,
800
lbs
colle
cted
24
0,00
0 pi
lls c
olle
cted
85
% o
f ret
urns
are
pre
scrip
tion
drug
s, 1
2% o
ver
the
coun
ter
31%
of r
etur
ns in
clud
ed m
ail o
rder
dru
gs
Tot
al E
stim
ated
Cos
t of U
EM
s: $
208,
024.
85
ww
w.m
aine
benz
o.or
g/20
09co
nfer
ence
.htm
Dru
g R
etur
ns D
ata
Dru
g R
etur
ns D
ata
Ver
mon
tT
hree
up
and
runn
ing
24-h
our
drop
off
site
s:
>15
0,00
0 pi
lls
Med
ical
Stu
dent
-Dep
artm
ent o
f Hea
lth S
umm
er
Initi
ativ
e
Res
ourc
es:
Res
ourc
es:
ww
w.c
omm
unity
ofco
mpe
tenc
e.co
m
http
://w
ww
.mai
nebe
nzo.
org/
2009
conf
eren
ce.h
tm
Ver
mon
t Med
ical
Soc
iety
http
://w
ww
.vtm
d.or
gF
rom
the
hom
e pa
ge, c
lick
on E
duca
tion,
then
on
Opi
oid
Dep
ende
nce,
Info
rmat
ion
and
Link
s. T
hat w
ill b
ring
you
to O
pioi
d T
hera
pies
for
Pat
ient
s w
ith C
hron
ic P
ain
(200
8)
Man
agin
g C
hron
ic P
ain
Whi
le K
eepi
ng C
ontr
ol P
art 1
http
s://w
ebde
mo.
ganc
onfe
renc
e.co
m/?
mee
ting=
7951
532
Man
agin
g C
hron
ic P
ain
Whi
le K
eepi
ng C
ontr
ol P
art 2
http
s://w
ebde
mo.
ganc
onfe
renc
e.co
m/?
mee
ting=
2840
263
Man
agin
g C
hron
ic P
ain
Whi
le K
eepi
ng C
ontr
ol P
art 2
http
s://w
ebde
mo.
ganc
onfe
renc
e.co
m/?
mee
ting=
9039
293
Prescribing Opioids for Chronic
Pain
Prescribing Opioids for Chronic
Pain
40
SA
MH
SA
/CS
AT
Info
rmat
ion
SA
MH
SA
/CS
AT
Info
rmat
ion
•S
AM
HS
A w
ebsi
te: w
ww
.sam
hsa.
gov
•In
form
atio
n w
eb s
ite:
ww
w.b
upre
norp
hine
.sam
hsa.
gov
•M
edic
atio
n-A
ssis
ted
Tre
atm
ent i
nfor
mat
ion:
http
://w
ww
.dpt
.sam
hsa.
gov/
patie
nts/
mat
.asp
x
•S
HIN
1-8
00-7
29-6
686
for
publ
icat
ion
orde
ring
or
info
rmat
ion
on fu
ndin
g op
port
uniti
es
–1-
800-
487-
4889
–T
DD
line
•1-
800-
662-
HE
LP –
SA
MH
SA
’s N
atio
nal H
elpl
ine
(ave
rage
# o
f tx
calls
per
mo.
-24
,000
)
Recommended