![Page 1: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/1.jpg)
Prescription Drug Abuse in Indiana
Joan Duwve, M.D., M.P.H.Indiana Rural Health Association
June 10, 2014
![Page 2: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/2.jpg)
![Page 3: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/3.jpg)
3
Drug Overdose Death Rates Versus Motor Vehicle Accidents
NCHS Data Brief, December, 2011, updated with 2009 and 2010 mortality data
Years 1980-2010
![Page 4: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/4.jpg)
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
![Page 5: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/5.jpg)
Opioid sales, opioid-related deaths and opioid treatment admissions, U.S.
Source: Warner et al. 2011
![Page 6: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/6.jpg)
Percent Change in Ten Leading Causes of Injury Death* Indiana, 2000–2010
*Age-adjusted rates Source: WISQARS
![Page 7: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/7.jpg)
Source: Indiana State Department of Health, Epidemiology Resource Center, Data Analysis Team
![Page 8: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/8.jpg)
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.
![Page 9: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/9.jpg)
Geographic Variation in Opioid Prescribing in the U.S.
Journal of Pain, Volume 13, Issue 10, October 2012, Pages 988–996
![Page 10: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/10.jpg)
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
![Page 11: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/11.jpg)
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;
![Page 12: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/12.jpg)
12
Other Adverse Outcomes
http://www.cdc.gov/homeandrecreationalsafety/rxbrief/
![Page 14: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/14.jpg)
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
![Page 15: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/15.jpg)
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.
![Page 16: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/16.jpg)
Youth and Controlled Substances
![Page 17: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/17.jpg)
National Survey on Drug Use and Health 2011.
Narcotic Sources
![Page 18: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/18.jpg)
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
![Page 19: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/19.jpg)
![Page 20: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/20.jpg)
![Page 21: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/21.jpg)
![Page 22: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/22.jpg)
![Page 23: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/23.jpg)
23
![Page 24: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/24.jpg)
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
![Page 25: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/25.jpg)
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
![Page 26: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/26.jpg)
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
![Page 27: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/27.jpg)
Awareness
![Page 28: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/28.jpg)
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
![Page 29: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/29.jpg)
“First Do No Harm”Indiana’s Safe Prescribing
Recommendations
![Page 30: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/30.jpg)
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
![Page 31: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/31.jpg)
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
![Page 32: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/32.jpg)
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
![Page 33: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/33.jpg)
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
![Page 34: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/34.jpg)
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
![Page 35: Prescription Drug Abuse in Indiana Joan Duwve, M.D., M.P.H. Indiana Rural Health Association June 10, 2014](https://reader036.vdocument.in/reader036/viewer/2022062519/5697c0291a28abf838cd7599/html5/thumbnails/35.jpg)
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