1. Summary of Drug Abuse “Rates” in the United States: Focus on Morphine Catherine Dormitzer, PhD, MPH Division of Epidemiology Office of Surveillance and Epidemiology Catherine Dormitzer, PhD, MPH Division of Epidemiology Office of Surveillance and Epidemiology Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008

2. 2 OverviewOverview Background Methods Summary of calculations Conclusions Background Methods Summary of calculations Conclusions Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008

3. 3 Background/MethodsBackground/Methods Numerator data –Non-medical Use ED Visits (DAWN) Denominator data –Retail prescriptions (SDI) used as proxy for drug availability Calculated estimates per 10,000 retail prescriptions Numerator data –Non-medical Use ED Visits (DAWN) Denominator data –Retail prescriptions (SDI) used as proxy for drug availability Calculated estimates per 10,000 retail prescriptions Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008

4. 4 LimitationsLimitations Calculating estimates using data from different sources –Sampling methodologies –No confidence intervals –Populations –Data are not linked Calculating estimates using data from different sources –Sampling methodologies –No confidence intervals –Populations –Data are not linked Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008

5. SAMHSA/OAS Morphine, CR vs. IR – Nonmedical Use Source: DAWN estimates for the U.S., 2004-2007 *Significant change, 2004 vs. 2007 2005 vs. 2007 No significant change 2006 vs. 2007

6. 6 Projected Retail Prescriptions Dispensed for Morphine by Release Type, 2004-2007 SDI Vector One™: National (VONA)., Extracted 10-08 Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008

7. 7 Sources: National estimates from DAWN, 2004-2007; SDI VONA Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008 Ratios: Non-Medical Use ED Visits per 10,000 Retail Prescriptions, Morphine by Release Type, 2004 - 2007 ED Visits per 10,000 prescriptions

8. 8 SummarySummary These data are intended to be descriptive and qualitative. Statistical attributes such as confidence intervals would be required to form more definitive conclusions. Ratios of non-medical use of morphine appear to be considerably higher for immediate release products versus extended release products. These data are intended to be descriptive and qualitative. Statistical attributes such as confidence intervals would be required to form more definitive conclusions. Ratios of non-medical use of morphine appear to be considerably higher for immediate release products versus extended release products. Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008

9. Questions?Questions?

10. Back-Up Slides Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008

11. SAMHSA/OAS Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2007 Source: National estimates from DAWN, 2007 * Single- & multi-ingredient formulations CI lower bound Estimate CI upper bound

12. 12 Projected Retail Prescriptions Dispensed for Selected Opioids, 2007 SDI Vector One™: National (VONA). Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008

13. 13 DAWN: Non-Medical Use ED Visits per 10,000 Retail Prescriptions: 2007 * Includes all formulations Source: National estimates from DAWN, 2007; SDI VONA Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 14, 2008