1

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+

0.10.10.10.2+

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!

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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 1

1.6%

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

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