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WilsonM.Compton,M.D.,M.P.E. M. Compton, M.D., M.P.E ... · Wilson M. Compton, M.D., M.P.E. Director, Division of Epidemiology, Services and Prevention Research National Institute

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    Wilson M. Compton, M.D., M.P.E.Director, Division of Epidemiology, Services and Prevention Research

    National Institute on Drug Abuse

    22 June 2010

    Wilson M. Compton, M.D., M.P.E.Wilson M. Compton, M.D., M.P.E.Director, Division of Epidemiology, Services and Prevention ReseDirector, Division of Epidemiology, Services and Prevention Researcharch

    National Institute on Drug AbuseNational Institute on Drug Abuse

    22 June 201022 June 2010

  • RatesRates

  • 3

    Pharmaceutical Drug Abuse is a Particular Problem in USA

    Pharmaceutical Drug Abuse is a Particular Problem in USA

    Past Month Use of Illicit Drugs among Persons Aged 12+ in 2007

    Numbers in Millions

    Psychotherapeutics

    Inhalants

    Heroin

    Hallucinogens

    Cocaine

    Marijuana

    0.2

    0.6

    1.0

    2.1

    6.9

    14.4

    19.9

    0 5 10 15 20 25

    Illicit Drugs

    Source:  SAMHSA, 2007 National Survey on Drug Use and Health

    8.0%

    5.8%

    2.8%

    0.8%0.4%0.3%

    0.1%

  • 4

    Past Year Initiates for Specific Illicit Drugs, Ages 12+, 2007

    Numbers in Thousands

    Source:  SAMHSA, 2007 National Survey on Drug Use and Health

    2,147 2,090

    1,232

    906781 775

    642

    270 198 106 580

    500

    1,000

    1,500

    2,000

    2,500

    Marijuana Heroin

    Pain Relievers

    Cocaine

    SedativesTranquilizers PCPStimulantsEcstasy

    Inhalants LSD

  • 2009 Monitoring the Future Study of USA Secondary Students, 12th Grade (~Age 17‐18):  Past Year Drug Use

    2009 Monitoring the Future Study of USA Secondary Students, 12th Grade (~Age 17‐18):  Past Year Drug Use

    * Nonmedical use

    Drug Prev. Drug Prev.Alcohol 66.2 MDMA (Ecstasy) 4.3Marijuana/Hashish 32.8 Cocaine (any form) 3.4Vicodin* 9.7 Inhalants 3.4Amphetamines* 6.6 Cocaine Powder 3.0Tranquilizers* 6.3 Ritalin* 2.1Cough Medicine* 5.9 LSD 1.9Salvia 5.7 Provigil* 1.8Adderall* 5.4 Ketamine 1.7Sedatives* 5.2 Steroids 1.5OxyContin* 4.9 Crack 1.3Hallucinogens 4.7 Methamphetamine 1.2

    Cigarettes:  Lifetime  43.6%, Past Month 20.1%

  • Past Month Nonmedical Use of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002‐2008

    1.9

    0.7

    0.4

    0.1

    2.12.1

    1.91.8

    2.01.9

    0.70.8 0.8

    0.7 0.7 0.7

    0.6+ 0.6+0.5+ 0.5+

    0.6+

    0.40.1

    0.2+0.10.10.1

    0.2+

    0.0

    0.5

    1.0

    1.5

    2.0

    2.5

    2002 2003 2004 2005 2006 2007 2008

    Pain Relievers

    Tranquilizers

    Sedatives

    Stimulants

    6

    Percent Using in Past Month

    + Difference between this estimate and the 2008 estimate is statistically significant at the .05 level. Source:  SAMHSA, 2008 National Survey on Drug Use and Health

  • ConsequencesConsequences

  • 8

    Source: Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2010

    Opioid Analgesics increased from 144,600 to 305,900 (111%), 2004 to 2008

    Benzodiazepines increased from 143,500 to 271,700 (89%), 2004 to 2008 

    No change in illicit drug reports (1.9 million to 1.9 million overall, non‐alcohol illicit 1.0 million to 1.0 million, cocaine 475,425 to 482,188, ). 

    Emergency Department Mentions  Increasing for Pharmaceuticals, Not for Illicit Drugs in the USA

  • Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2008

    Numbers in Thousands

    126

    175

    282

    351

    358

    451

    1,716

    4,199

    1,411

    0 1,000 2,000 3,000 4,000 5,000

    Sedatives

    Inhalants

    Heroin

    Stimulants

    Hallucinogens

    Tranquilizers

    Cocaine

    Pain Relievers

    Marijuana

    9Source:  SAMHSA, 2008 National Survey on Drug Use and Health

  • 10

    Increasing Treatment for Pharmaceutical Opioids

  • 11

    Numbers in Thousands

    415 424466

    547 558601

    360+

    0

    100

    200

    300

    400

    500

    600

    700

    2002 2003 2004 2005 2006 2007 2008+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.

    SAMHSA:  2008 National Survey on Drug Use and Health

    Treatment Admissions Increasing for  Pharmaceutical Opioids in General Population in USA:  

  • 12

    Source: CDC, Unintentional Drug Poisoning in the United States,, National Vital Statistics System, 2010

    Increasing Mortality from Unintentional Drug Overdose

  • 13

    Source: CDC, Unintentional Drug Poisoning in the United States,, National Vital Statistics System, 2010

  • 14

    Source: CDC, Unintentional Drug Poisoning in the United States,, National Vital Statistics System, 2010

  • CausesCauses

  • Increased Media Attention?Increased Media Attention?

  • Easy Access? Possible Role of the Internet“Delivered in the Privacy of your Home”

    Easy Access? Possible Role of the Internet“Delivered in the Privacy of your Home”

    “Some reasons why you should consider using this pharmacy”

    No prescription required!

    “Some reasons why you should consider using this pharmacy”

    No prescription required!

  • 18

    In 2007‐2008 Where Pain Relievers Were Obtained for Most Recent Nonmedical Use: Ages 12+

    Note: Totals may not sum to 100% because of rounding or because suppressed estimates.1 The Other category includes the sources:  “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”

    Bought/Took  from Friend/Relative

    14.3%

    Drug Dealer/Stranger4.3%

    Bought on Internet0.4% Other 1

    4.8%

    Source Where Respondent Obtained

    One Doctor18.0%

    More than One Doctor2.4%

    Free from Friend/Relative

    55.9%

    Free from Friend/Relative

    6.2%

    Bought/Took fromFriend/Relative

    5.4%

    OneDoctor81.7%

    Drug Dealer/Stranger1.6%Bought on

    Internet0.1%

    Source Where Friend/Relative Obtained

    More than One Doctor3.4%

    Source:  SAMHSA, 2008 National Survey on Drug Use and Health

    Other 11.6%

  • Dunn K M et al. Ann Intern Med 2010;152:85-92

    ©2010 by American College of Physicians

    Increasing Non‐Fatal Overdose Associated with Higher Opioid Dosages

  • Total Deaths Classified: 295  

    95%

    78%

    63%

    22%

    21%

    17%

    16%

    4%

    17%

    0% 20% 40% 60% 80% 100%

    ANY INDICATOR

    History of substance abuse

    Any diverted pharmaceuticals

    Nonmedical route of administration

    >4 Clinicians prescribed controlledsubstances

    Contributory alcohol

    Previous overdose

    Contributory illicit drug

    Current opiate treatment

    20Hall, A. J. et al. JAMA 2008;300:2613-2620.

    Substance Abuse Indicators Among Unintentional Pharmaceutical Overdose Deaths, West Virginia, 2006

  • Total Number of Prescriptions for Hydrocodone and Oxycodone Products Dispensed by US Retail Pharmacies, Years 1991−2009

    Source: SDI’s Vector One® National,  VONA 03‐16‐10 Hydrocodone & Oxycodone 1991‐2009

    Source: SDI’s Vector One®: National, VONA 03‐16‐10 Stimulants  1991‐2009

    Projected Number of Prescriptions for Stimulants*  Dispensed by US Retail Pharmacies, Years 1991‐2009  *excludes modafinil and atomoxetine products

  • •How many adults and adolescents misuse/abuse pharmaceuticals?

    MANY

    • Is misuse/abuse of pharmaceuticals changing?STABLE AT HIGH RATE AFTER INCREASING IN 1990s CONSEQUENCES  (MORBIDITY, MORTALITY, TREATMENT SEEKING) MAY BE INCREASING

    •How many adults and adolescents misuse/abuse pharmaceuticals?

    MANY

    • Is misuse/abuse of pharmaceuticals changing?STABLE AT HIGH RATE AFTER INCREASING IN 1990s CONSEQUENCES  (MORBIDITY, MORTALITY, TREATMENT SEEKING) MAY BE INCREASING

    Epidemiology Epidemiology 

  • What Explains the Increase in Pharmaceutical Abuse?

    What Explains the Increase in Pharmaceutical Abuse?

    1) Increasing numbers of prescriptions (greater availability)

    2) Attention by the media and advertising (television and newspaper)

    3) Easy access through family and friends

    4) Improper knowledge and monitoring (addiction may go unrecognized)

    1) Increasing numbers of prescriptions (greater availability)

    2) Attention by the media and advertising (television and newspaper)

    3) Easy access through family and friends

    4) Improper knowledge and monitoring (addiction may go unrecognized)

  • SummarySummary

    When used properly, opioid, sedative and stimulant pharmaceutical agents have many 

    benefits; however, risks of abuse and addiction are significant and NIDA seeks to draw research attention to these vital issues

    When used properly, opioid, sedative and stimulant pharmaceutical agents have many 

    benefits; however, risks of abuse and addiction are significant and NIDA seeks to draw research attention to these vital issues

  • Visit Our Website @Visit Our Website @

    www.drugabuse.govwww.drugabuse.gov

    http://www.nida.nih.gov/nidamed/