a brief introduction to the opioid epidemic · 2018. 8. 8. · source: cdc/nchs, national vital...
TRANSCRIPT
A Brief Introduction to the Opioid Epidemic
Christopher M. Jones, PharmD, MPHCDR, US Public Health Service
Director, Division of Science Policy
Office of the Assistant Secretary for Planning and Evaluation
Overview
• Epidemiology crash course
• Policy and information sharing
Source: CDC/NCHS, National Vital Statistics System, Mortality File.
0
5
10
15
20
25
1980 1985 1990 1995 2000 2005 2010 2014
Dea
ths
pe
r 1
00
,00
0 p
op
ula
tio
n
MV Traffic Drug Poisoning
Age-adjusted death rates for Motor Vehicle Traffic and Drug Poisoning,
United States,1980-2014
2002
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2003
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2004
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2005
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2006
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2007
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2008
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2009
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2010
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2011
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2012
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2013
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2002
2013
Source: CDC, NVSS, Slide courtesy of M. Warner, CDC/NCHS
2013
2002
Rx opioids mostly commonly abused prescription drug, US, 2014
Source: SAMHSA National Survey on Drug Use and Health, 2014
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
Rx Opioids Tranquilizers Stimulants Sedatives
Nu
mb
er
of
pe
op
le r
ep
ort
ing
be
hav
ior
(in
th
ou
san
ds)
Initiation Dependence or Abuse Past Month Nonmedical Use
Past year opioid use disorders, US, 2003-2014
18
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er
of
Ind
ivid
ual
s
Any Opioid Use Disorder Prescription Opioid Use Disorder Heroin Use Disorder
Source: SAMHSA, NSDUH 2003-2014 PUF
Opioid-related overdose deaths, US, 1999-2014
0
1
2
3
4
5
6
7
8
9
10
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Age
Ad
just
ed
-Rat
e p
er
10
0,0
00
po
pu
lati
on
All Opioids Heroin Natural/Semi-Sythetic Opioids Methadone Synthetic Opioids
Increases in Rx opioid prescribing coincide with increases in Rx opioid overdose deaths
0
1
2
3
4
5
6
7
8
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Rat
e
Source: CDC/NVSS and DEA ARCOS.
KG of morphine milligram equivalent per 10,000 population
Opioid overdose deaths per 100,000 population
Primary care physician’s views on Rx opioids
0
10
20
30
40
50
60
No problem atall
Small problem Moderateproblem
Big problem
Pe
rce
nt
Magnitude of Rx abuse in community
0
10
20
30
40
50
60
Stronglydisagree
Somewhatdisagree
Somewhatagree
Strongly agree
Pe
rce
nt
Opioids overused for pain
0
10
20
30
40
50
60
Not at all Slightly Moderately Very
Pe
rce
nt
Confidence in clinical skills related to opioid prescribing
0
10
20
30
40
50
60
Not at all Slightly Moderately Very
Pe
rce
nt
Comfort in prescribing opioids for chronic noncancer pain
Source: Hwang et al. Prescription drug abuse: a national survey of primary care physicians. JAMA 2015
Increase in opioid prescribing dose for same conditions over time
Source: Wunsch et al. JAMA 2016
Changing demographics of heroin use
Source: Jones CM et al. MMWR 2016; Cicero et al JAMA Psychiatry 2014.
Multiple facets of the opioid epidemic
Demographics▪ Men
▪ 35-54 year olds (deaths)
▪ 18-35 (abuse)
▪ Whites
▪ American Indians/Alaska Natives
Socioeconomics and Geography▪ Medicaid, uninsured
▪ Rural
Clinical Characteristics▪ Chronic pain
▪ Substance abuse
▪ Mental health
▪ Nonmedical use
▪ Multiple prescriptions
▪ Multiple prescribers
▪ High daily dosage
▪ Combination of opioids and benzodiazepines
Risk factors for Rx opioid abuse and overdose
Use data to identify patients in need of treatment and improve continuity of information across information systems
• PDMPs
– Key piece of information in the clinical work flow
– Starting point for a conversation with patients
• EHRs
– Like PDMPs, could provide full visibility on prior drug and treatment exposure, clinical conditions, risk factors
– Clinical decision support can facilitate screening, assessment, intervention, and monitoring
– Incorporate guidelines on appropriate prescribing for both acute and chronic pain conditions
• Insurer/PBM data/Claims data
– Examine utilization patterns to identify patients at risk or abusing substances
– Academic detailing, alerts to providers, alters to patients, connection with employee assistance programs, etc.
• Connection with other information systems such as human and social services, inpatient systems, etc., is needed
HHS Opioid Initiative
• Launched by Secretary Burwell in March 2015
• Three focus areas
– Improve opioid prescribing
– Increase use of naloxone to reverse opioid overdose
– Expand use of Medication-Assisted Treatment (MAT) for opioid use disorders
