1. H.R. 1925 Prescription drug abuse prevention and treatment Act of 2011

2. Prescription drug abuse prevention and treatment Act. H.R. 1925 Title: Prescription Drug Abuse Prevention and Treatment Act of 2011. Introduced in May 13, 2011in 112 th Congress (2011-2012) in House of Representatives. Sponsor: Rep. Rahall, Nick J.(D- WV-3) Co- sponsors: Rep. Keating, William (D-MA-10) Rep. McGovern, James P (D-MA-3) Rep. Michaud, Michael M (D-ME-2) Rep. Tonko, Paul (D- NY-21)

3. H.R.1925 To provide for federal oversight of prescription opioid treatment and assistance to states in reducing opioid abuse, diversion and, deaths.

4. Prescription Drug Abuse Prevention Prescription drugs abuse is the nation’s fastest growing problem and the CDC has classified prescription drugs abuse as an epidemic, “We are in the midst of an epidemic,” said CDC director Thomas Friedan, M.D., M.P.HCDC director Thomas Friedan, M.D., M.P.

5. Drugs / medication Abuse Marijuana Prescription drugs Cocaine Heroin Methamphetamine Others

6. Prescription Drug Abuse  Types of Drugs  Opioid Analgesics (Methadone, OxyContin, Vicodin)  Tranquilizer  Stimulants  Sedatives  Reason for use  Chronic pain or cancers  ADHD  Anxiety  Escalated use for “high”

7. Trend in Prescription Drug Abuse In 2009, approximately 7.0 million people were current nonmedical users of prescription drugs (2.8 percent of US population). Nonmedical use of prescription drugs is the second most commonly abused drug after marijuana and ahead of cocaine. 25% of emergency department visits are associated with non-medical use of prescription drugs abuse and overdose. Source : National Institute of drug abuse info-facts 2008: High school and youth trend.

8. High-risk group for Prescription drug Abuse Young adults age 15 to 25 65 and older Men Non-Hispanic white Medicaid populations Rural population Mentally ill, especially people with depression SOURCE: CDC/NCHS, National Health and Nutrition examination survey SOURCE; National vital statistics system, Drug Abuse Warning Network. Hall AJ, et al. JAMA 2008

9. Prescription Drug Overdose and Deaths Prescription drugs overdose deaths have tripled in US since 1990. Overdose kills 15000 people each year ( 40 people per day) Methadone related deaths increased 11 folds in younger people ( age 15 to 24) Highest drug overdose death rates in 2008 were found in New Mexico and West Virginia Lowest drug overdose death rates in 2008 was found in Nebraska. SOURCE : CDC. Press release November 1, 2011 prescription overdose at epidemic level.

10. Methods of Diversion Inappropriate prescribing Illegal sales Employee theft Prescription rings Doctor shopping Fraudulent prescriptions Pharmacy theft Foreign diversion and smuggling into U.S.

11. Federal and State effort Office of National Drug Control Policy (ONDCP), FDA, and DEA official release a federal action plan to address prescription drug abuse ( April 19, 2011) White House Director of National Drug Control Policy, Gil Kerlikowske, released the Administration’s 2011 National Drug Control Strategy (July 14, 2011) H.R.1925 is the House companion measure to the Senate bill S. 507, authored by Rockefeller (D- WV)who is the Chairman of the Senate Finance Subcommittee on Health Care

12. Strategies to Control Prescription Drug Abuse H.R.1925 Prescription Drug Abuse Prevention and Treatment Act addressed the following strategies: Education Prescription drug monitoring program Clinical standards for controlled substances Comprehensive reporting of opioid-related deaths

13. 1- EDUCATION  Education for parents and patients Increase awareness Safe medication use, storage, and disposal  Education for health care providers Appropriate prescribing Adverse events and drug interactions Identify those at risk for abuse Counseling on proper storage and disposal Prescribers must comply 16 hours training requirement every 3 year to get DEA registration

14. 2- Prescription Drug Monitoring Programs (PDMPs) Support access to legitimate medical use of controlled substances Identify and prevent drug abuse and diversion Drug interactions and therapeutic duplication H.R. 1925 would provide $25 million a year to establish PDMPs within each state.

15. 3- Controlled Substance Clinical Standards Commission H.R.1925 proposed to established Controlled Substance Clinical Standard Commission. This Commission composed of representatives from Government, CDC, FDA, DEA, NIDA. Goals:  Safe dosing guidelines for methadone  Guidelines for reduction of methadone abuse  Guidelines for initial pain management with methadone  Guidelines for methadone maintenance therapy

16. Model Opioid Treatment Program Mortality Report H.R.1925 proposed to develop a Model Opioid Treatment Program Mortality Report for each individual who dies while receiving treatment in the opioid treatment program.

17. 4- National Opioid Death Registry H.R.1925 also proposed to establish National Opioid Death Registry to track opioid related deaths. Goal is to create a uniform reporting system that contain the following information:  Dosage level  Drug formulation  Age and sex of the individual  Disclosure of whether the individual was in an opioid treatment program  Disclosure of whether the medication involved can be traced back to a physician’s prescription.

18. FEDERAL PARTNERSHIPS ONDCP ( Office of National Drug Control Policy) FDA ( Food and Drug Administration) DEA ( Drug Enforcement administration) SAMHSA ( CDC ( Centers for Disease Control) NIDA ( National Institute of Drug Abuse)

19. Barriers to Implementation Inattentive behavior Medical confidentiality and patient privacy, Insufficient database for tracking the dosages and disposal of narcotics analgesics Lack of methadone and other opioid overdose death monitoring system

20. Status of H.R.1925 H.R.1925 which is referred to the Committee on Energy and Commerce, and Committee of Judiciary, is in the first step of legislation process. This bill is in line with the strategies outlined by the White House Office of National Drug ControlPolicy

21. CONCLUSION Prescription drug abuse is the fastest growing problem in U.S. Comprehensive approach for education, prevention and enforcement to reverse this epidemic. Success can be achieved with the coordination and collaboration of federal, state, and local organisations.