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Office for State, Tribal, Local and Territorial Supportpresents . . .

CDC Vital SignsPrescription Painkiller Overdoses Among Women

July 9, 20132:00–3:00 pm (EDT)

Welcome

Centers for Disease Control and PreventionOffice for State, Tribal, Local and Territorial Support

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Agenda2:00 pm Welcome & Introductions Richard Schieber, MD

Coordinator, CDC Vital Signs Program, CDC

2:04 pm Presentations Karin Mack, PhDSenior Behavioral Scientist, Prescription Drug Overdose Team, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC

Anne Rogers, MEdData and Research Manager, Maine Office of Substance Abuse, Maine Department of Health and Human Services

Hal Johnson, MPHBehavioral Health Epidemiologist, Florida Department of Children and Families, Substance Abuse Program Office

2:30 pm Q&A and Discussion Richard Schieber, MD

2:55 pm Wrap-up

3:00 pm End of Call

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Vital Signs Teleconference

to support STLT efforts and build momentum around the monthly

release of CDC Vital Signs

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Prescription Painkiller Overdoses Among Women

Karin A. Mack, PhDDivision of Unintentional Injury Prevention

CDC Vital Signs Town HallJuly 9, 2013

National Center for Injury Prevention and ControlDivision of Unintentional Injury Prevention

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Key Findings• In 2010, drug overdoses in the United States caused 15,323

deaths among women • Opioid pain relievers (prescription painkillers) were involved in 6,631

deaths

• Deaths from prescription painkiller overdoses among women have increased more than 400% since 1999, compared to 265% among men

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Women and Selected Drugs 2004–2010

National Vital Statistics System; DAWN Public Use File; Crude rates per 100,000 population

Drug overdose deaths Emergency department visits for misuse or abuse

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Prescription Painkiller Overdoses Are a Serious Problem Among Women

• In 2010 approximately 18 women died every day of a prescription painkiller overdose

• Women ages 45 to 54 are at the highest risk of dying of a prescription painkiller overdose

• Non-Hispanic white and American Indian or Alaska Native women have the highest risk of prescription painkiller overdose death

• For every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse

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3.9-6.9 7.0-10.9 11.0-14.9Age-adjusted rate per 100,000 population

6.7

7.8

5.3

6.5

8.3

6.4

3.9

6.5

6.3

11.312.9

9.4

8.9

11.4

9.9

12.6

18.0

11.0

9.1

9.416.7

8.7

6.212.115.7

5.4

13.0

15.7

12.2

10.3

10.6

12.7

10.5

16.2

11.7

13.8

8.8

12.0

11.6

18.5

13.2

NH 8.7VT 6.0MA 7.2RI 10.3CT 6.8NJ 4.3DE 13.0MD 7.4DC 5.3

11.0

15.0-18.5

Female Death Rates of Drug Overdose by State, 2009–2010

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To Reverse this Epidemic, States Can…

• Take steps to improve prescription drug monitoring programs (PDMPs)

• Use PDMP, Medicaid, and workers’ compensation data to identify improper prescribing of painkillers

• Consider setting up programs for Medicaid, workers’ compensation programs, and state-run health plans that identify and address improper patient use of painkillers

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To Reverse this Epidemic, States Can…

• Consider pill mill, doctor shopping, and other laws that can reduce prescription painkiller abuse

• Increase access to substance abuse treatment, including immediate access to treatment for pregnant women

• Consider steps to reduce barriers to substance abuse treatment for women

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State Resources• Policy Impact: Prescription

Painkiller Overdoses• A short issue brief on promising state

policies that CDC recommends forprevention of prescription painkilleroverdoses

www.cdc.gov/HomeandRecreationalSafety/rxbrief

• State legislative strategies governing prescription drug abuse and diversion• CDC selected seven types of laws addressing this issue and surveyed

the laws of all 50 states and the District of Columbia to see if they had enacted them as of August 31, 2010

www.cdc.gov/homeandrecreationalsafety/Poisoning/laws

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For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov/injury

National Center for Injury Prevention and ControlDivision of Unintentional Injury Prevention

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Use and Abuse of Prescription Drugs by

Women in Maine

Anne Rogers, MEd, ABD, CHES

Data and Research Manager

14www.maine.gov/dhhs/samhs

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Prescriptions Filled per 1,000 Maine Residents by Drug by Gender by Year, 2010-2012

Source: Maine Prescription Monitoring Program, Office of Substance Abuse and Mental Health Services. Data ran by Brandeis Center of Excellence, June 2013.

male female male female male femaleOpioids Stimulants Benzodiazepines

0

200

400

600

800

1000

1200

891

1079

290

236

366

687

840

998

292

250 35

8

665

828

982

306

272 35

6

665

2010

2011

2012

16

<18 18-24 25-34 35-44 45-54 55-64 65 and older

733

420356

239140

9137

337398

534

382

242145

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2012 Male

2012 Female

Stimulant Prescriptions FilledMaine Residents, by gender, by age group, per 1,000

Source: Maine Prescription Monitoring Program, Office of Substance Abuse and Mental Health Services. Data ran by Brandeis Center of Excellence, June 2013.

<18 18-24 25-34 35-44 45-54 55-64 65 and older

716

432

301

193124 85

29

311381

439

307

204124

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2010 Male

2010 Female

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2008 2009 2010 2011 2012Opioids

534,396 563,857 573,117 540,781 534,488

678,093 708,553 721,884

667,663 659,559

Males

Females

Number of Opioid Prescriptions DispensedMaine residents 20 and older, by gender, by year

Source: Maine Prescription Monitoring Program, Office of Substance Abuse and Mental Health Services. June 2013.

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2011 20120

200

400

600

800

1000

1200

571

928

797

1109

Maine EMS Drug/Medication Overdose Response

Male

Female

Source: Maine Department of Public Safety, Bureau of Emergency Medical Services

Medication Overdoses by sex, by year, Maine EMS 2011-2012

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Hospital Visits for Opioid Analgesic Poisoning by sex, drug type, and year 2007-

2010

Source: Maine Center for Disease Control, Maine Health Data Organization. Combined in-patients and out-patients by discharge diagnosis. ICD-9 96502 and 96509. Calendar Year

2007 2008 2009 2010 2007 2008 2009 2010Poisoning Methadone Poisoning Opioids

0

50

100

150

200

250

75 76 7869

115

156170 174

49 46 4556

156 159 165

224

M

F

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2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

2

4

6

8

10

12

14

16

18

9.3

12.5 1314

15.216.2 16.2

14.915.5

12.3

4.1

9

7.5 7.4

9.6

8 8

9.610.6

8.1

Male

Female

Drug-related Overdose Deaths by gender, by year, per 100,000, 2001-2010

Source: Suggested Citation: Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2010 on CDC WONDER Online Database, released January 2013. Data are compiled from Compressed Mortality File 1999-2010 Series 20 No. 2P, 2013. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Jun 25, 2013 11:37:19 AM

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2007 2008 2009 2010 2011-IP0

200

400

600

800

1000

1200

1400

257305

411489

321

536

964

1220

1370

399

newborn drug withdrawal Drug Dependence of Mother

Number of Hospital/ED Discharges for Newborn Withdrawal Syndrome and Maternal Drug Dependence, Maine, 2007–10

Source: Maine Center for Disease Control, Maine Health Data Organization. Combined in and outpatient by discharge diagnosis. CY2007-2010. CY2011 in-patient (IP) only ICD-9 :7795; 64830-4.

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2009 2010 2011 20120

20

40

60

80

100

120

140

Stimulant Addiction TxBy SFY, Gender

Female Male

Substance Abuse Treatment

Source: Maine Substance abuse and Mental Health Services, Treatment data System. 12 months of data per SFY 2009-2012.

2009 2010 2011 20120

50

100

150

200

250

300

350

400

Benzodiazepine Addiction TxBy SFY, Gender

Female Male

23www.maine.gov/dhhs/samhs

Working to increase use of Prescription Monitoring Program (PMP)

Identifying problem areas Contract for women’s residential

treatment services Fetal alcohol spectrum disorders and

drug addicted babies

Prescription Drug Abuse:Maine’s Efforts

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2007 2008 2009 20100

20

40

60

80

100

120

140

160

180

43

71

110

175

Narcotics affect fetus or newborn via placenta

Number of Fetal/Newborns Affected by Narcotics through the Placenta, Maine, 2007–2010

Source: Maine Center for Disease Control, Maine Health Data Organization. Combined IP/OP by discharge diagnosis. CY2007-2010 only. ICD-9:76072.

25www.maine.gov/dhhs/samhs

http://www.maine.gov/pmp

Anne RogersData and Research Manager

Anne.Rogers@maine.gov207-287-4706

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Gender Differences in Prescription Drug

Epidemiology in Florida

Hal Johnson, MPHFlorida Department of Children and Families, Substance Abuse and

Mental Health Program

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Prescription Drug Monitoring Program Data

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Prescription Drug Monitoring Program Data

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Prescription Drug Monitoring Program Data

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Prescription Drug Monitoring Program Data

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Medical Examiner Death Data

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Medical Examiner Death Data

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Medical Examiner Death Data

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Hospitalizations and ED Visits for Unintentional Drug

Poisoning

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Hospitalizations and ED Visits for Unintentional Drug

Poisoning

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Hospitalizations and ED Visits for Unintentional Drug

Poisoning

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Hospitalizations Related to Fetal Substance Exposure per

1,000 Live Births

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Florida Legislative Action2011• Banned dispensing of Schedule II & III of the Controlled

Substance Act by physicians• Created standard of care for chronic pain management• Electronic prescribing or counterfeit-proof pads• Wholesale distributors report on distribution• Pharmacies distributing Schedule II & III re-permitted• Created and funded 7 regional drug strike forces• Added new criminal penalties2012• Statewide task force on Rx abuse and newborns

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Results• 60% reduction in pain clinics since

2010• $9,000,000 in general revenue for

substance abuse services to pregnant women

• From March 2011–December 2012• 3,742 arrests (including 67 doctors)• Seizure of 848,037 pharmaceutical pills• Seizure of over $10,000,000

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A Sign of Progress?

-6%

-4.3%

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Hal Johnson, MPHhal_johnson@dcf.state.fl.us

Thanks to the following for providing the Prescription Behavior Surveillance System data:

Rebecca Poston, BPharm, Program Manager, E-FORCSE Florida’s PDMP

Gail Strickler, PhD, PBSS Project Manager, Schneider Institutes for Health Policy, Brandeis University

Peter Kreiner, Phd, PBSS Principal Investigator, Brandeis University

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Public Health Practice Stories from the Field Stories about the

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www.cdc.gov/stltpublichealth/phpracticestories

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For more information, please contact Centers for Disease Control and Prevention.

1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348Email: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Please mark your calendars for the next Vital Signs Town Hall Teleconference

August 13, 20132:00–3:00 pm (EDT)

Centers for Disease Control and PreventionOffice for State, Tribal, Local and Territorial Support

Provide feedback on this teleconference: OSTLTSFeedback@cdc.gov