Upload
maximillian-brown
View
220
Download
0
Tags:
Embed Size (px)
Citation preview
Addressing the Substance Abuse Epidemic in Tennessee
John J. Dreyzehner Commissioner
A Rising Tide
2011 OD Deaths (U.S.): • 41,340 Any
Drug• 22,810 Rx
drug• 16,917 Rx
opioid• 4,397
HeroinSources: National Vital Statistics System, DEA Automation of Reports and Consolidated Orders System, SAMHSA TEDS
0
1
2
3
4
5
6
7
8 Opioid Sales (Kg/10,000) Opioid-Related Deaths/100,000 Opioid Treatment Admissions /10,000
Year
Rate
Near Tripling in Opioid-related Deaths (in parallel with opioid sales and Rx opioid
treatment admits)
The Numbers in Tennessee
Data source: Tennessee Department of Health, Office of Health Statistics, Death Statistical System. Overdose deaths were defined as having underlying cause of death ICD-10 codes X40-X44 (accidental), X60-X64 (intentional suicide), X85 (intentional homicide), and Y10-Y14 (undetermined).
0
100
200
300
400
500
600
700
800
900
1000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Num
ber o
f Dea
ths
Year
Deaths Due to Drug Overdose by IntentTennessee, 1999-2011
Accidental
Intentional
Undetermined
Data source: Tennessee Department of Health, Office of Health Statistics, Death Statistical System. Overdose deaths were defined as having underlying cause of death ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14.
342391 422
484
660
753
868
963 972924 929
1,059 1,062 1,094
0
200
400
600
800
1,000
1,200
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Num
ber o
f Dea
ths
Year
Deaths Due to Drug OverdoseTennessee, 1999-2012
The Numbers in Tennessee
Deaths by Age Group, TN
Data source: Tennessee Department of Health; Controlled Substance Monitoring Database.
2007
2008
2009
2010
2011
Opioid Prescription Rates by CountyTN, 2007-2011
0
50
100
150
200
0 60 120 180Time (min)
% o
f Bas
al R
elea
se
EmptyBox Feeding
Di Chiara et al.
FOOD
These prescription drugs, like other drugs of abuse (cocaine, heroin, marijuana) raise brain dopamine levels Dopamine
Neurotransmission
Why Do People Abuse Prescription Drugs?
0100200300400500600700800900
10001100
0 1 2 3 4 5 hrTime After Amphetamine
% o
f Bas
al R
elea
se
AMPHETAMINE
“Ask your doctor if taking a pill to solve all your problems is right for you.”
How We got Here
A PAIN-DRUG CHAMPION HAS SECOND THOUGHTS
“Dr. Portenoy and other pain doctors who promoted the drugs say they erred by overstating the drugs’ benefits and glossing over risks.”
“…urged tackling what they called an epidemic of untreated pain…[and]…campaigned to make pain…’the fifth vital sign’ that doctors should
monitor, alongside blood pressure, temperature, heartbeat and breathing.”
“In 1998, the Federation of State Medical Boards released a recommendation policy reassuring doctors they wouldn’t face regulatory action for prescribing even large amounts of narcotics…In 2004, the group called on state medical boards to make undertreatment of pain punishable
for the first time…That policy was drawn up with the help of several people with links to opioid makers…the federation said it received nearly
$2 million from opioid makers since 1997.”
“In 2001, the Joint Commission, which accredits U.S. hospitals, issued new standards telling hospitals to regularly ask patients about pain and to make treating it a priority…The Joint Commission published a guide sponsored by
Purdue Pharma. ‘Some clinicians have inaccurate and exaggerated concerns’ about addiction, tolerance and risk of death, the guide said. ‘This
attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.’”
TN’s Prescription Drug Problem
Data source: CDC, Vital Signs: Opioid Painkiller Prescribing. July 2014. Available at: http://www.cdc.gov/vitalsigns/opioid-prescribing/
Prescription Painkillers Sold By State, 2012TN: Tied for 1st in country for kilograms of prescription painkillers sold per 100 people
Source of Opiates for Non-Medical Use
Friend or Relative
71%
Dealer4%
Internet0%
Other5%
One Doctor18%
More than One Doctor
2%
Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. SAMHSA
Transmission in the substance abuse epidemic- How did we get here?
Abuse
Misuse
Misuse Abuse
Misuse
Abuse
Abuse
Abuse
Misuse Misuse
Misuse Abuse-Pregnancy
NAS
Overdose
Resistant (Religious)
Resistant (Recovery)
Resistant (Bad
Relationship)
Supply and Demand: The Substance Abuse/Misuse Market
PDMP Addresse
s All Three
Substance Abuse/Misuse: Constraining the Market
Steady reduction in the number of high-use patients since third quarter of 2012.
Survey of 800 CSMD users found:
• 71 percent had changed a treatment plan after viewing the patient’s information on the CSMD
• 73 percent said they are now more likely to discuss substance abuse issues with a patient
• 57 percent said they are now more likely to refer a patient for substance abuse treatment
1st quarter 2nd quarter 3rd quarter 4th quarter0
500
1000
1500
2000
2500
Fig 1. Number of High Utilization Patients* in CSMD 2012-2014
2012
2013
2014
*Individual who obtained controlled substance prescriptions from five or more prescribers and utilized five or more pharmacies within the quarter
Prescription Safety & Population Protection
Cumulative milligram morphine equivalent dispensed shows decline in year-to-year comparison since CSMD became mandatory:
• 0.7 percent in 2013
• 6.7 percent thus far in 2014
Effective July 1, 2014 Licensed practitioner in Tennessee can
prescribe
A New Tool To Combat Overdose Deaths: Naloxone
The Prescription for Success Plan
Plan for the Future:
1. Decrease the number of Tennesseans that abuse controlled substances.
2. Decrease the number of Tennesseans who overdose on controlled substances.
3. Decrease the amount of controlled substances dispensed in Tennessee.
4. Increase access to drug disposal outlets.
5. Increase access and quality of early intervention, treatment and recovery services .
6. Expand collaborations among state agencies.
7. Expand collaboration with other states.
REMEMBER
Doctor shopping is associated with a 5-fold higher risk of death.An MME of 100 or more is associated with an 11-fold higher risk of death.
Image credit: Naypong, FreeDigitalPhotos.net
Source: “High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths” by Baumbatt, et al, JAMA Internal Medicine, May 2014
Thank you for your partnership.
There’s a lot more for us to do together.