Prescription Painkiller Overdoses: A growing epidemic, especially among women
Source: Centers for Disease Control and Prevention
Nearly 48,000 women died of prescription painkiller* overdoses between 1999 and 2010.
Deaths from prescription painkiller overdoses among women have increased more than 400% since 1999, compared to 265% among men.
For every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse.
About 18 women die every day of a prescription painkiller overdose in the US, more than 6,600 deaths in 2010. Prescription painkiller overdoses are an under-recognized and growing problem for women.
Although men are still more likely to die of prescription painkiller overdoses (more than 10,000 deaths in 2010), the gap between men and women is closing. Deaths from prescription painkiller overdose among women have risen more sharply than among men; since 1999 the percentage increase in deaths was more than 400% among women compared to 265% in men. This rise relates closely to increased prescribing of these drugs during the past decade. Health care providers can help improve the way painkillers are prescribed while making sure women have access to safe, effective pain treatment.
Spotlight On… Drug Diversion
Source: U.S. Department of Health and Human Services, Office of Inspector General
It is becoming so pervasive that the Centers for Disease Control and Prevention has formally labeled it an “epidemic.” It is one of our nation’s fastest growing public health problems, and it takes a hefty toll on individuals, families, taxpayers, and society. What is the crisis? Prescription drug abuse.
According to the Congressional Budget Office, the Federal Government spent $62 billion on prescription drugs in 2010. Drug diversion, or the redirection of prescription drugs for illegitimate purposes, takes a portion of Medicare and Medicaid funds away from legitimate care. Furthermore, Federal health programs bear the added costs of additional health care as a result of patients misusing prescription drugs.
Office of Inspector General (OIG) investigations of drug diversion are on the rise. A contributing factor may be that this type of fraud can be very lucrative. In Northern California, for example, OIG agents report that a bottle of 30mg Oxycodone tablets are trafficked at a price of $1100 – 2400 a bottle! This is up to 12 times the normal price of a legally filled script. Furthermore, drug diverters may be drawn to prescription drugs because they are more “reliable” than street drugs like heroin or cocaine. Drug users know what they’re getting. Meanwhile, the risk for dealers is lower because trafficking in pharmaceutical drugs is generally less dangerous than with traditional street drugs.
2013 World Drug Report notes stability in use of traditional drugs and points to alarming rise in new psychoactive substances
At a special high-level event of the Commission on Narcotic Drugs (CND), the United Nations Office on Drugs and Crime (UNODC) today launched in Vienna the 2013 World Drug Report. The special high-level event marks the first step on the road to the 2014 high-level review by the Commission on Narcotic Drugs of the Political Declaration and Plan of Action which will be followed, in 2016, by the UN General Assembly Special Session on the issue.
While drug challenges are emerging from new psychoactive substances (NPS), the 2013 World Drug Report (WDR) is pointing to stability in the use of traditional drugs. The WDR will be a key measuring stick in the lead up to the 2016 Review.
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
Under the Medicare Part D program, CMS contracts with private insurance companies, known as sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll. In recent years, prescription drug abuse has emerged as a serious and growing problem. The Centers for Disease Control and Prevention has characterized prescription drug abuse as an epidemic. With the rise in prescription drug abuse, concerns about Medicare fraud, particularly prescriber fraud, have increased.
HOW WE DID THIS STUDY
We based this study on an analysis of Prescription Drug Event records. Sponsors submit these records to CMS for each drug dispensed to beneficiaries enrolled in their plans. Each record contains information about the pharmacy, prescriber, beneficiary, and drug. We analyzed all of the records for drugs billed in 2009. We developed five measures to describe Part D prescribing patterns and to identify general-care physicians with questionable patterns.
WHAT WE FOUND
Over 1 million individual prescribers ordered drugs paid by Part D in 2009. Prescribing patterns varied widely by specialty. Over 700 general-care physicians had questionable prescribing patterns. Each of these physicians prescribed extremely high amounts for at least one of the five measures we developed. For example, many of these physicians prescribed extremely high numbers of prescriptions per beneficiary, which may indicate that these prescriptions are medically unnecessary. Moreover, more than half of the 736 general-care physicians with questionable prescribing patterns ordered extremely high percentages of Schedule II or III drugs, which have potential for addiction and abuse. Although some of this prescribing may be appropriate, such questionable patterns warrant further scrutiny.
WHAT WE RECOMMEND
These findings show the need for increased oversight of Part D. We recommend that CMS (1) instruct the Medicare Drug Integrity Contractor to expand its analysis of prescribers, (2) provide sponsors with additional guidance on monitoring prescribing patterns, (3) provide education and training for prescribers, and (4) follow up on prescribers with questionable prescribing patterns. CMS concurred with all four recommendations.
The Report on the Drug Problem in the Americas was delivered, by the OAS Secretary General, José Miguel Insulza, to the President of Colombia, Juan Manuel Santos on Friday, May 17, 2013. The document is composed of two parts: the Analytical Report, which explains the reasons that lead society to worry about drug consumption and to try to control its effects on human health and the Scenarios Report, an examination of the paths that the phenomenon could take in the coming years in the region.
For his part, the CICAD Chair and Minister of Public Security of Costa Rica, Mario Zamora Cordero, closed the session by stating that “more judges, more prosecutors and more police will mean more people arrested but not fewer crimes committed. In this Report we have the key to how to address the issue of violence associated with drug use.”
Source: White House
The Obama Administration’s inaugural National Drug Control Strategy, published in 2010, charted a new course in our efforts to reduce illicit drug use and its consequences in the United States—an approach that rejects the false choice between an enforcement-centric “war on drugs” and drug legalization. Science has shown that drug addiction is not a moral failing but rather a disease of the brain that can be prevented and treated. Informed by this basic understanding, the 2010, 2011 and 2012 Strategies established and promoted a balance of evidence-based public health and safety initiatives focusing on key areas such as substance abuse prevention, treatment, and recovery.
The 2013 National Drug Control Strategy, released on April 24, builds on the foundation laid down by the Administration’s previous three Strategies and serves as the Nation’s blueprint for reducing drug use and its consequences. Continuing our collaborative, balanced, and science-based approach, the new Strategy provides a review of the progress we have made over the past four years. It also looks ahead to our continuing efforts to reform, rebalance, and renew our national drug control policy to address the public health and safety challenges of the 21st century.
Nonmedical Use of Prescription-Type Drugs, by County Type
Source: Substance Abuse and Mental Health Services Administration
- About 15.7 million persons aged 12 or older used prescription-type drugs nonmedically in the past year, and 6.7 million did so in the past month.
- Past year nonmedical use of prescription-type drugs was lower among persons living in rural counties than among those in metropolitan and urbanized non-metropolitan counties (5.4 vs. 6.4 and 6.6 percent); past month use was similar among all three types of counties.
- The rate of past year nonmedical use of pain relievers was lower in rural counties than in metropolitan and urbanized non-metropolitan counties (4.2 vs. 4.9 and 5.1 percent), as was the rate of nonmedical use of tranquilizers (1.8 vs. 2.1 and 2.3 percent); the rate of nonmedical use of stimulants and sedatives did not vary by type of county.
Source: Canadian Centre on Substance Abuse
Certain prescription drugs, like opioids, sedative – hypnotics and stimulants, are associated with serious harms like addiction, overdose and death. These drugs can have a devastating impact on individuals and their families, as well as place a significant burden on our health, social services and public safety syst ems. In countries like Canada, where these prescription drugs are readily available, the associated harms have become a leading public health and safety concern. Canada is the world’s second largest per capita consumer of one type of these drugs, opioids ( International Narcotics Control Board, 2013). Some First Nations in Canada have declared a community crisis owing to the prevalence of the harms associated with prescription drugs (Dell et al., 2012). While Canadian cost data is lacking, recent research from the United States estimates the annual cost of the non – medical use of prescription opioids to be more than $50 billion, with lost productivity and crime accounting for 94% of this amount (Hansen, Oster, Edelsberg, Woody, & Sullivan, 201 1).
Source: National Institute on Drug Abuse
Illicit drug use in America has been increasing. In 2011, an estimated 22.5 million Americans aged 12 or older—or 8.7 percent of the population—had used an illicit drug or abused a psychotherapeutic medication (such as a pain reliever, stimulant, or tranquilizer) in the past month. This is up from 8.3 percent in 2002. The increase mostly reflects a recent rise in the use of marijuana, the most commonly used illicit drug.
Acute Kidney Injury Associated with Synthetic Cannabinoid Use — Multiple States, 2012
Source: Morbidity and Mortality Weekly Report (CDC)
In March 2012, the Wyoming Department of Health was notified by Natrona County public health officials regarding three patients hospitalized for unexplained acute kidney injury (AKI), all of whom reported recent use of synthetic cannabinoids (SCs), sometimes referred to as “synthetic marijuana.” SCs are designer drugs of abuse typically dissolved in a solvent, applied to dried plant material, and smoked as an alternative to marijuana. AKI has not been reported previously in users of SCs and might be associated with 1) a previously unrecognized toxicity, 2) a contaminant or a known nephrotoxin present in a single batch of drug, or 3) a new SC compound entering the market. After the Wyoming Department of Health launched an investigation and issued an alert, a total of 16 cases of AKI after SC use were reported in six states. Review of medical records, follow-up interviews with several patients, and laboratory analysis of product samples and clinical specimens were performed. The results of the investigation determined that no single SC brand or compound explained all 16 cases. Toxicologic analysis of product samples and clinical specimens (available from seven cases) identified a fluorinated SC previously unreported in synthetic marijuana products: (1-(5-fluoropentyl)-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl) methanone, also known as XLR-11, in four of five product samples and four of six patients’ clinical specimens. Public health practitioners, poison center staff members, and clinicians should be aware of the potential for renal or other unusual toxicities in users of SC products and should ask about SC use in cases of unexplained AKI.
Amphetamine-induced psychosis – a separate diagnostic entity or primary psychosis triggered in the vulnerable?
Source: BMC Psychiatry
Use of amphetamine and methamphetamine is widespread in the general population and common among patients with psychiatric disorders. Amphetamines may induce symptoms of psychosis very similar to those of acute schizophrenia spectrum psychosis. This has been an argument for using amphetamine-induced psychosis as a model for primary psychotic disorders. To distinguish the two types of psychosis on the basis of acute symptoms is difficult. However, acute psychosis induced by amphetamines seems to have a faster recovery and appears to resolve more completely compared to schizophrenic psychosis. The increased vulnerability for acute amphetamine induced psychosis seen among those with schizophrenia, schizotypal personality and, to a certain degree other psychiatric disorders, is also shared by non-psychiatric individuals who previously have experienced amphetamine-induced psychosis. Schizophrenia spectrum disorder and amphetamine-induced psychosis are further linked together by the finding of several susceptibility genes common to both conditions. These genes probably lower the threshold for becoming psychotic and increase the risk for a poorer clinical course of the disease.The complex relationship between amphetamine use and psychosis has received much attention but is still not adequately explored. Our paper reviews the literature in this field and proposes a stress-vulnerability model for understanding the relationship between amphetamine use and psychosis.
Parental Drug Use as Child Abuse
Source: Child Welfare Information Gateway
This factsheet discusses laws that address the issue of substance abuse by parents. Two areas of concern are the harm caused by prenatal drug exposure to the health and development of affected infants and the harm caused to children of any age by exposure to illegal drug activity in their homes or environment. Summaries of laws for all States and U.S. territories are included.
Source: Substance Abuse and Mental Health Services Administration
The number of people aged 18 to 25 who used prescription drugs for non-medical purposes in the past month declined 14 percent — from 2.0 million in 2010 to 1.7 million in 2011 — the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) announced today, during the 23rd annual national observance of National Recovery Month. Non-medical use of prescription drugs among children aged 12 to 17 and adults aged 26 or older remained unchanged.
In addition, the 2011 National Survey on Drug Use and Health (NSDUH), a survey conducted annually by SAMHSA, showed that the rates of past month drinking, binge drinking and heavy drinking among underage people continued a decline from 2002. Past month alcohol use among 12 to 20 year olds declined from 28.8 percent in 2002 to 25.1 percent in 2011, while binge drinking (consuming 5 or more drinks on a single occasion on at least 1 day in the past 30 days) declined from 19.3 percent in 2002 to 15.8 percent in 2011, and heavy drinking declined from 6.2 percent in 2002 to 4.4 percent in 2011.
Overall, the use of illicit drugs among Americans aged 12 and older remained stable since the last survey in 2010. The NSDUH shows that 22.5 million Americans aged 12 or older were current (past month) illicit drug users — (8.7 percent of the population 12 and older in 2011 versus 8.9 percent in 2010).
Marijuana continues to be the most commonly used illicit drug. In 2011, 7.0 percent of Americans were current users of marijuana — up from 5.8 percent in 2007. Among youths aged 12 to 17, the rate of current marijuana use remained about the same from 2009 (7.4 percent) to 2011 (7.9 percent). Increases in the rate of current marijuana use occurred from 2007 to 2011 among adolescents (ages 12-17), young adults (ages 18 to 25), and adults (ages 26 or older). Additionally, the number of people aged 12 and older who used heroin in the past year rose from 373,000 in 2007 to 621,000 in 2010 and 620,000 in 2011.
People often arrive in substance abuse treatment programs with multiple problems—including dependency on or addiction to both alcohol and drugs. National data from the Treatment Episode Data Set (TEDS) for 2009 show that 730,228 substance abuse treatment admissions (37.2 percent) reported abuse of alcohol and at least one other drug; 23.1 percent of all admissions reported the abuse of alcohol and one other drug, and 14.1 percent reported the abuse of alcohol and two other drugs.When alcohol is used with other drugs, it tends to be ingested in greater quantities than when used in their absence.2 Combining alcohol with other drugs is dangerous. For example, taking benzodiazepines concomitantly with alcohol increases the chances of benzodiazepine-involved death. It is important for treatment providers to identify patients who use alcohol with other drugs since that is an especially dangerous usage pattern.
Source: RAND Corporation
Discussions about reducing the harms associated with drug use and antidrug policies are often politicized, infused with questionable data, and unproductive. This paper provides a nonpartisan primer that should be of interest to those who are new to the field of drug policy, as well as those who have been working in the trenches. It begins with an overview of problems and policies related to illegal drugs in the United States, including the nonmedical use of prescription drugs. It then discusses the efficacy of U.S. drug policies and programs, including long-standing issues that deserve additional attention. Next, the paper lists the major funders of research and analysis in the area and describes their priorities. By highlighting the issues that receive most of the funding, this discussion identifies where gaps remain. Comparing these needs, old and new, to the current funding patterns suggests eight opportunities to improve understanding of drug problems and drug policies in the United States: (1) sponsor young scholars and strengthen the infrastructure of the field, (2) accelerate the diffusion of good ideas and reliable information to decisionmakers, (3) replicate and evaluate cutting-edge programs in an expedited fashion, (4) support nonpartisan research on marijuana policy, (5) investigate ways to reduce drug-related violence in Mexico and Central America, (6) improve understanding of the markets for diverted pharmaceuticals, (7) help build and sustain comprehensive community prevention efforts, and (8) develop more sensible sentencing policies that reduce the excessive levels of incarceration for drug offenses and address the extreme racial disparities. The document offers some specific suggestions for researchers and potential research funders in each of the eight areas.
New GAO Report and Testimony
Source: Government Accountability Office
1. Drug Control: Initial Review of the National Strategy and Drug Abuse Prevention and Treatment Programs. GAO-12-744R, July 6.
1. Federal Real Property: Improved Data and a National Strategy Needed to Better Manage Excess and Underutilized Property, by David Wise, director, physical infrastructure, before the Subcommittee on Economic Development, Public Buildings and Emergency Management, House Committee on Transportation and Infrastructure. GAO-12-958T, August 6.
Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Vital statistics data suggest that the opioid pain reliever (OPR) methadone is involved in one third of OPR-related overdose deaths, but it accounts for only a few percent of OPR prescriptions.
CDC analyzed rates of fatal methadone overdoses and sales nationally during 1999–2010 and rates of overdose death for methadone compared with rates for other major opioids in 13 states for 2009.
Methadone overdose deaths and sales rates in the United States peaked in 2007. In 2010, methadone accounted for between 4.5% and 18.5% of the opioids distributed by state. Methadone was involved in 31.4% of OPR deaths in the 13 states. It accounted for 39.8% of single-drug OPR deaths. The overdose death rate for methadone was significantly greater than that for other OPR for multidrug and single-drug deaths.
Methadone remains a drug that contributes disproportionately to the excessive number of opioid pain reliever overdoses and associated medical and societal costs.
Implications for Public Health Practice:
Health-care providers who choose to prescribe methadone should have substantial experience with its use and follow consensus guidelines for appropriate opioid prescribing. Providers should use methadone as an analgesic only for conditions where benefit outweighs risk to patients and society. Methadone and other extended-release opioids should not be used for mild pain, acute pain, “breakthrough” pain, or on an as-needed basis. For chronic noncancer pain, methadone should not be considered a drug of first choice by prescribers or insurers.
Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.
Reporting Period Covered: September 2010–December 2011.
Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.
Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.
Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.
Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.
Neonatal Abstinence Syndrome and Associated Health Care Expenditures
Source: Journal of the American Medical Association
Context: Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome primarily caused by maternal opiate use. No national estimates are available for the incidence of maternal opiate use at the time of delivery or NAS.
Objectives: To determine the national incidence of NAS and antepartum maternal opiate use and to characterize trends in national health care expenditures associated with NAS between 2000 and 2009.
Design, Setting, and Patients: A retrospective, serial, cross-sectional analysis of a nationally representative sample of newborns with NAS. The Kids’ Inpatient Database (KID) was used to identify newborns with NAS by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. The Nationwide Inpatient Sample (NIS) was used to identify mothers using diagnosis related groups for vaginal and cesarean deliveries. Clinical conditions were identified using ICD-9-CM diagnosis codes. NAS and maternal opiate use were described as an annual frequency per 1000 hospital births. Missing hospital charges (<5% of cases) were estimated using multiple imputation. Trends in health care utilization outcomes over time were evaluated using variance-weighted regression. All hospital charges were adjusted for inflation to 2009 US dollars.
Main Outcome Measures: Incidence of NAS and maternal opiate use, and related hospital charges.
Results: The separate years (2000, 2003, 2006, and 2009) of national discharge data included 2920 to 9674 unweighted discharges with NAS and 987 to 4563 unweighted discharges for mothers diagnosed with antepartum opiate use, within data sets including 784 191 to 1.1 million discharges for children (KID) and 816 554 to 879 910 discharges for all ages of delivering mothers (NIS). Between 2000 and 2009, the incidence of NAS among newborns increased from 1.20 (95% CI, 1.04-1.37) to 3.39 (95% CI, 3.12-3.67) per 1000 hospital births per year (P for trend < .001). Antepartum maternal opiate use also increased from 1.19 (95% CI, 1.01-1.35) to 5.63 (95% CI, 4.40-6.71) per 1000 hospital births per year (P for trend < .001). In 2009, newborns with NAS were more likely than all other hospital births to have low birthweight (19.1%; SE, 0.5%; vs 7.0%; SE, 0.2%), have respiratory complications (30.9%; SE, 0.7%; vs 8.9%; SE, 0.1%), and be covered by Medicaid (78.1%; SE, 0.8%; vs 45.5%; SE, 0.7%; all P < .001). Mean hospital charges for discharges with NAS increased from $39 400 (95% CI, $33 400-$45 400) in 2000 to $53 400 (95% CI, $49 000-$57 700) in 2009 (P for trend < .001). By 2009, 77.6% of charges for NAS were attributed to state Medicaid programs.
Conclusion: Between 2000 and 2009, a substantial increase in the incidence of NAS and maternal opiate use in the United States was observed, as well as hospital charges related to NAS.
See: About One Baby Born Each Hour Addicted to Opiate Drugs in U.S. (Science Daily)