Presentation on theme: "P RESCRIPTION D RUG A BUSE : P ROBLEMS IN I DAHO AND I MPACT ON W OMEN AND B ABIES R EX W. F ORCE, BS(P HARM ), P HARM D A SSOCIATE D EAN FOR C LINICAL."— Presentation transcript:
P RESCRIPTION D RUG A BUSE : P ROBLEMS IN I DAHO AND I MPACT ON W OMEN AND B ABIES R EX W. F ORCE, BS(P HARM ), P HARM D A SSOCIATE D EAN FOR C LINICAL R ESEARCH D IVISION OF H EALTH S CIENCES I DAHO S TATE U NIVERSITY Email: Force@fmed.isu.edu
In 2010, 16,651 died in the US due to prescription drug overdoses – Since 9/11/2001, 2,215 Americans have died in Afghanistan One death every 19 minutes due to Rx drug abuse 1,244 people died from drug-induced causes in Idaho from 2000-09 – Deaths each year increased from 69 in 2000 to 184 in 2009 H OW M ANY O THERS ?
Discuss the scope of the problem of prescription drug abuse…with a focus on opioids Evaluate different approaches to preventing the problem of prescription drug abuse on the “supply side” – Prescription monitoring programs – Prescribing guidelines – Legal interventions – Patient-based interventions (contracts, etc.) Examine the epidemic of prescription drug abuse and its effect on women and babies T ODAY ’ S G OALS
The US accounts for 5% of world’s population and 80% of prescription opioid use; 99% of world’s hydrocodone use Hydrocodone (Vicodin, Lortab) has been #1 drug dispensed in the US since 2002 Idaho is routinely in the US top 5 of per capita hydrocodone use 80% of new heroin users used prescription opioids in the month prior T HE P ROBLEM
I DAHO S TATESMAN – N OV. 7, 2012 …a sign with instructions on how to mix prescription medi- cation with alcohol and a sign advertising drinks like lattes mixed with Xanax (an anti- anxiety medication that is also used as a drug of abuse) and vodka…
Cost of prescription drug abuse (including opioids like OxyContin, Vicodin, Norco, and Lortab): $53 billion – Opioid abusers cost $16,000/year – Legit users of opioids: $1,800/year Additional societal costs: – Children at risk – Lost worker productivity – Increases in health care and Medicaid costs – Escalation of crime to support the habit – Destruction of families – Decreased life expectancy
H OW DID WE GET HERE ? Many years of inadequate treatment of pain – continues today Little evidence for optimal use of pain medicines Reduced patient satisfaction – pain as 5th vital sign Perceived as ‘safe’ Focus on pain rather than function (Illegal) promotional efforts to assess and use opioids – Oxycontin introduced in 1996 – 2007 Purdue Pharma fined $634,000,000 for misleading claims about risk of dependence and addiction 70% of abused opioids were prescribed (to someone) A call for judicious use – see Juurlink et al. JAMA March 6, 2013 and Zgierska et al. JAMA April 4, 2012.
Nevada pioneered proactive reporting in 1997 By June 2012, 41 states had operating PDMPs, 49 have legislative mandates Majority have secure on-line portal for prescribers and pharmacists to look up patient histories Allows for identification of doctor/pharmacy shopping, excessive prescribing, etc. In Idaho ½ of providers are signed up and only ½ of those access it with any regularity. P RESCRIPTION D RUG M ONITORING P ROGRAMS Clark et al. PDMP COE White Paper. September 2012
P RESCRIBING AND DISPENSING GUIDELINES State mandated – Idaho BoM has adopted guidelines for management of pain – Evaluation – Treatment plan – Informed consent and agreement for treatment – Periodic review – Consultation, if necessary – Accurate medical records – Compliance with controlled substance laws/regulations http://bom.idaho.gov/BOMPortal/BOM/FAQ/Controlled%20Substances%20&%20 Treatment%20of%20Pain%20Policy.pdf
Personal or family hx of substance abuse Aberrant behavior – Warning signs of manipulation, dishonesty, threats Doctor shoppers Deception about pain severity Forging or altering Rx’s Criminal behavior Patterns of use Use screening tools, document, be cautious I DENTIFYING T HOSE P ATIENTS A T R ISK
4D’ S OF P RESCRIBER I NVOLVEMENT Deficient – outdated and under-educated Duped – co-dependent, assumes the best about their patients Deliberate (dealing) – pill factory Drug dependent – addicted themselves
M EDICATION A GREEMENTS Use one practice and one pharmacy No other substance abuse Adhere to visit schedule Prohibit sharing or selling medication No premature renewals or for ‘lost’ meds Med renewals only during business hours Urine tox screens
Law enforcement Behavioral Health/Substance Abuse Professionals Public Health Prescribers Pharmacists Patients Societal W HOSE P ROBLEM IS T HIS ?
T HE L INK B ETWEEN R X D RUG A BUSE AND M ATERNAL AND C HILD H EALTH
In 2012, analysis of impact of race and educational attainment on life expectancy in the US Life expectancy has fallen by 5 years for white women with less than high school education - since 1990 Unprecedented in modern times: rivals only 7-year drop in men observed with collapse of Soviet Union No better life expectancy than those seen in the 1950s Prescription drug abuse, smoking, obesity, access to health care are proposed causes L IFE E XPECTANCY Health Affairs 2012;31(8): 1803-1813 NY Times 9/20/12
W OMEN AND O VERDOSE D EATHS Centers for Disease Control surveillance study In 2010, 943,365 visits by women to ED for drug misuse or abuse Men more likely to die from Rx drug overdose, but death rate in women increased by 415% from 1999-2010. One or more Rx drugs was involved in 85% of cases and 71% were from opioids in women MMWR 2013:62(26);537-542
W OMEN AND O VERDOSE D EATHS 2009-10 MMWR 2013:62(26);537-542 National Ave: 9.8 (range 3.9-18.5)
W OMEN AND O VERDOSE D EATHS 2004-10 MMWR 2013:62(26);537-542
National Birth Defects Prevention Study (1997- 2005) – case-control design Prescription opioid exposure evaluated from 1 month prior to pregnancy to end of 1 st trimester Approximately 2-fold greater risk for ASD, VSD, hypoplastic left heart, gastroschisis, and also hydrocephaly, spina bifida, and glaucoma Similar rates of neural tube defects observed in other studies (Obstet Gynecol 2013;122(4):838- 44) and animal models B IRTH D EFECTS Am J Obstet Gynecol 2011;204:314.e1-11
N EONATAL A BSTINENCE S YNDROME JAMA 2012;307(18):1934-1940 Large cross-sectional study of newborns with NAS Between 2000-2009: – NAS increased from 1.20 to 3.39/1,000 births – Antepartum opioid use increased 1.19 to 5.63/1,000 births Babies with NAS had more respiratory complications (30.9% v. 8.9%) and low birth wt – 1500-2400 gm (19.1% v. 7.0%), and longer length of stay (16.4 v. 3.3 d). Normalized hospital charges increased from $39,400 to $53,400 between 2000 and 2009. All other births averaged $9,500.
Prescription opioid use is truly at epidemic levels Women and their babies are harmed by this problem Resultant health and societal costs are high Coordinated, interdisciplinary approaches are necessary C ONCLUSIONS