prescription drug abuse in indiana joan duwve, m.d., m.p.h. indiana rural health association june...

Prescription Drug Abuse in Indiana

Joan Duwve, M.D., M.P.H.Indiana Rural Health Association

June 10, 2014

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Drug Overdose Death Rates Versus Motor Vehicle Accidents

NCHS Data Brief, December, 2011, updated with 2009 and 2010 mortality data

Years 1980-2010

CDC. Death rates for drug poisoning, by state of residence, United States, 2010. Available at http://www.cdc.gov/nchs/pressroom/states/drug_deaths_2010.pdf

Opioid sales, opioid-related deaths and opioid treatment admissions, U.S.

Source: Warner et al. 2011

Percent Change in Ten Leading Causes of Injury Death* Indiana, 2000–2010

*Age-adjusted rates Source: WISQARS

Source: Indiana State Department of Health, Epidemiology Resource Center, Data Analysis Team

Unintentional Poisoning Death Rates, Age-Specific, Indiana, 2005 – 2010

Source: Centers for Disease Control and Prevention, WISQARS Database

* Rates based on 20 or fewer deaths may be unstable. Use with caution.

Geographic Variation in Opioid Prescribing in the U.S.

Journal of Pain, Volume 13, Issue 10, October 2012, Pages 988–996

Source: U.S. Drug Enforcement Administration, 2008

Oxycodone Distribution to Indiana Retail Registrants, January 2007 through June 2008

Number of Prescription Drug Overdose Deaths in Indiana, 2002-2011

Average Annual Accidental Poisoning by and Exposure to Drugs,Medicaments, and Biological Substances by Indiana County (2009

and 2010) – Rates per 100,000ICD 10 Codes X40 – X44‐

Indiana State Department of Health Mortality Data;

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Other Adverse Outcomes

http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

Date of download: 1/6/2013Copyright © 2012 American Medical

Association. All rights reserved.

Neonatal Abstinence Syndrome and Associated Health Care Expenditures:  United

States, 2000-2009

JAMA. 2012;307(18):1934-1940. doi:10.1001/jama.2012.3951

NAS indicates neonatal abstinence syndrome. Error bars indicate 95% CI. P for trend < .001 over the study period. The unweighted sample sizes for rates of NAS and for all other US hospital births are 2920 and 784 191 in 2000; 3761 and 890 582 in 2003; 5200 and 1 000 203 in 2006; and 9674 and 1 113 123 in 2009; respectively.

Figure Legend:

2009 NAS vs. OtherLOS 16.4 d vs. 3.3dCosts $53,400 vs. $9,500

Percentage of College Students Reporting Rx Misuse in the Past Six

Months in Indiana, 2013Rx Drug Prevalence

Adderall 10.1%Vicodin 3.6%Xanax 3.5%Codeine 2.7%Ritalin 1.7%Lortab 1.5%Percocet 0.9%Oxycontin 1.3%Morphine 0.4%Methadone 0.2%Steroids 0.1%

Key:OpioidStimulantCNS DepressantOther

Source: Indiana College Substance Use Survey, 2013. Indiana Prevention Resource Center.

Youth and Controlled Substances

National Survey on Drug Use and Health 2011.

Narcotic Sources

Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past

Year Users Aged 12 or Older: 2010-2011

Source: SAMHSA, National Survey of Drug Use and Health, 2011

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ONDCP's Prescription Drug Abuse Prevention Plan

• Education– Parents, youth, patients– Prescribers

• Monitoring (INSPECT)– Discourage “Doctor Shopping” and Diversion– Interstate monitoring

• Proper Medication Disposal– Take back programs

• Enforcement– Identify and eliminate “Pill Mills” and unethical

prescribing practices

Indiana’s Prescription Drug Abuse Prevention Plan

• Education– Parents, youth, patients– Prescribers– Neonatal Abstinence Syndrome

• Monitoring (INSPECT)– Discourage “Doctor Shopping” and Diversion– Interstate monitoring

• Proper Medication Disposal– Take back programs

• Enforcement– Identify and eliminate “Pill Mills” and unethical prescribing

practices• Treatment and Recovery

– Addiction treatment services– Naloxone Rescue

The Indiana Prescription Drug Abuse Prevention Task Force

Chair: Greg Zoeller, Indiana Attorney GeneralCo-chair: Joan Duwve, Indiana State Department of

HealthCommitteesEducation: Dr. Deb McMahan, LHO, Allen CountyINSPECT: Greg Pachmayr, Director, Pharmacy BoardTake-Back: Representative Steve Davisson, PharmacistEnforcement: Tim McClure, OAGTreatment and Recovery: Steve McCaffrey, MHA

Awareness

Accomplishments to DateEducation Committee• Provider Education

– Provider Toolkit for management of chronic, non-terminal pain

– Emergency rules for opioid prescribing for chronic non-terminal pain

– Annual symposium– Public speaking

• Public Education– Bitterpill.in.gov– Pills of Peril PBS documentary – Adult and adolescent education

http://www.in.gov/bitterpill/voices.html - meghan

“First Do No Harm”Indiana’s Safe Prescribing

Recommendations

Accomplishments to Date

• NAS Committee formed to better support families during pregnancy and after delivery– Formalized as IPN committee by legislature– make recommendations for screening pregnant

women for substance use – identify and report infants with NAS to

understand incidence and improve newborn care

Accomplishments to Date• INSPECT

– Legislature authorized 100% of CSR fees to be used to maintain and operate INSPECT

– Working with Health Information Exchange and Indiana Network for Patient Care to integrate into EHR systems

– Decreased reporting interval to INSPECT phased in beginning July 2015

Accomplishments to Date

• Take-Back– State-wide take-back

days– Indiana law permits

pharmacy-based take-back (waiting for federal DEA rule revision to be published)

– Working with large pharmacy in central Indiana to develop a pilot take-back program

Accomplishments to Date

• Enforcement– Indiana Code now

requires owners of clinics dispensing controlled substances to have a Controlled Substance Registration with Indiana Professional Licensing Agency

Accomplishments to Date• Treatment and Recovery

– Loan repayment programs for addiction treatment training

– Naloxone rescue liability protection for first responders and expansion of life-line law

– Working with Indiana Medicaid to ensure appropriate formulary coverage for addiction treatment medications

Joan Duwve, M.D., M.P.H.

Associate Dean for Public Health PracticeIU Richard M. Fairbanks School of Public Health

Chief Medical ConsultantIndiana State Department of Health

jduwve@iu.edu317-278-0754