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Date: April 29, 2024 Mon
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Results for prescription drug abuse
39 results foundAuthor: O'Reilly, Bridie Title: Benzodiazepine and Pharmaceutical Opioid Misuse and Their Relationship to Crime: An Examination of Illicit Prescription Drug Markets in Melbourne, Hobart and Darwin. Northern Territory Report Summary: The National Drug Law Enforcement Research Fund commissioned research to enhance law enforcement understanding of the impact of benzodiazepine and pharmaceutical opiate use on crime in three select Australian jurisdictions where there was evidence of emergent or consolidated illicit markets: Victoria, Tasmania and the Northern Territory. The aims were to gain understanding of illicit benzodiazepine and pharmaceutical opiate market characteristics, investigate the hypothesized relationship between benzodiazepine and pharmaceutical opiate use and crime, explore the implications for emergency services staff and consider appropriate interventions to address the impact on law enforcement and health. The current research replicated core methods in the three target jurisdictions in four stages over a 14-month period commencing April 2003: interviews with law enforcement personnel, two surveys of benzodiazepine and pharmaceutical opiate users, analysis of secondary indicator data and in-depth interviews with key informants. This report focuses only on the Northern Territory findings. Details: Hobart, Tasmania: National Drug Law Enforcement Research Fund, 2007. 241p. Source: Internet Resource: Accessed August 28, 2010 at: http://www.ndlerf.gov.au/pub/Monograph_24.pdf Year: 2007 Country: Australia URL: http://www.ndlerf.gov.au/pub/Monograph_24.pdf Shelf Number: 119696 Keywords: Drugs Abuse and CrimeIllicit DrugsOpiatesPrescription Drug Abuse |
Author: Bruno, Raimondo Title: Benzodiazepine and Pharmaceutical Opioid Misuse and Their Relationship to Crime Summary: The purpose of the current study was to contribute to the understanding of the law enforcement sector in regard to the impact of benzodiazepine and pharmaceutical opiate misuse on crime. In particular, the study aimed: to examine the nature of the illicit market in benzodiazepines and pharmaceutical opiates; to investigate any links between misuse of such drugs and criminal activity; to examine the implications of use for health and law enforcement staff; and to consider opportunities, and the potential impacts of, interventions into this issue. The study was conducted in three Australian jurisdictions where there was evidence of existing or emerging patterns of use of diverted pharmaceutical products amongst individuals who inject illicit drugs. This report details only the Tasmanian-specific primary data collected as part of this larger study. Details: Hobart, Tasmania: National Drug Law Enforcement Research Fund, 2007. 186p. Source: Internet Resource: Monograph Series No. 22: Accessed August 28, 2010 at: http://www.ndlerf.gov.au/pub/Monograph_22.pdf Year: 2007 Country: Australia URL: http://www.ndlerf.gov.au/pub/Monograph_22.pdf Shelf Number: 119697 Keywords: Drug Abuse and CrimeIllicit DrugsOpiatesPrescription Drug Abuse |
Author: Fry, Craig Title: Benzodiazepine and Pharmaceutical Opioid Misuse and their Relationship to Crime: An Examination of Illicit Prescription Drug Markets in Melbourne, Hobart and Darwin. National Overview Report Summary: This National Overview Report presents a review of the literature, an overview of study methodology, key findings and jurisdiction-specific discussion points. It should be read in conjunction with each of the companion Jurisdiction Reports for Melbourne (Smith et al. 2004), Hobart (Bruno, 2004) and Darwin (O’Reilly et al. 2004), which contain detailed data content, and discussion of the findings and issues of local relevance to those study sites. This report avoids duplication of the data content of each Jurisdiction Report, in preference for summary and discussion of the main important findings and themes that have emerged from this comprehensive study. Specifically, the report focuses upon: • Salient issues that have emerged from the review of relevant national and international literature (current knowledge and gaps in the literature); • Comparison of key findings across study sites (descriptive and explanatory/statistical comparisons concerning market characteristics, diversion and links to crime); and • Discussion of the implications of these findings for law enforcement and health services (including implications for front line workers, options for intervention within the market, and future directions). Details: Hobart, Tasmania: National Drug Law Enforcement Research Fund, 2007. 214p. Source: Internet Resource: Monograph Series No. 21: Accessed October 6, 2010 at: http://www.ndlerf.gov.au/pub/Monograph_21.pdf Year: 2007 Country: Australia URL: http://www.ndlerf.gov.au/pub/Monograph_21.pdf Shelf Number: 119864 Keywords: Drug Abuse and CrimeDrug MarketsIllicit DrugsOpiatesPrescription Drug Abuse |
Author: University of Kentucky Special Commission on the Study of Methamphetamine and Other Drug Use in Kentucky Title: Report on Methamphetamine and Other Drug Use in Kentucky Summary: The Commission on Methamphetamine and Other Drug Use in Kentucky spent two years listening to various experts and research about the scope of methamphetamine use and use of prescription drugs in Kentucky. While these two classes or types of drug use are not the only ones that pose a problem for the state, they are, nonetheless, ones that have been widely portrayed in the media and have received public notice. We recognize that there are other types of substance abuse that have very great impact on Kentucky. These pilot studies conducted in Kentucky and our exploration of national data applied to Kentucky populations, yield several preliminary findings that deserve attention. Overall for Kentucky National estimates of the prevalence of drug and alcohol problems by industry type suggest that Kentucky has an estimated 54,000 workers with drug abuse and 170,000 with alcohol-related problems. Methamphetamine use and prescription drug use Methamphetamine, while used by a relatively small percent of the population, is associated with serious health and legal problems. Sixty percent of the primary care physicians in eastern Kentucky report that prescription opiates are among the most serious drug problems in the state. Primary care physicians in the western part of Kentucky have more concern about the use of methamphetamine on health. Dental health Dentists estimate that restoring dental health to individuals with “meth mouth” would cost over $5,000 per person and payer sources for their care is very uncertain. Drug exposed children Children in homes where neglect or abuse have been investigated are more likely to have been exposed to trauma in families where methamphetamine has been used. The cost of Out-of-Home placements of children in methamphetamine exposed homes is greater than for other Out-of-Home care for children in other neglect or abuse cases. Law enforcement and corrections The correctional system in Kentucky has a large percentage of inmates who report having used methamphetamine before entering prison and the system is burdened by high health care costs of inmates with drug abuse histories and methamphetamine may add to those costs. Arrest data for methamphetamine charges suggest a west-to-east trend, suggesting regional differences in the availability of methamphetamine or in local law enforcement focus. Details: Lexington, KY: University of Kentucky, 2008. 73p. Source: Internet Resource: Accessed July 19, 2011 at: http://cdar.uky.edu/Downloads/Methamphetamine%20Report%203-20-2008.pdf Year: 2008 Country: United States URL: http://cdar.uky.edu/Downloads/Methamphetamine%20Report%203-20-2008.pdf Shelf Number: 122107 Keywords: Drug Abuse and AddictionDrug OffendersMethamphetamine (Kentucky)Prescription Drug Abuse |
Author: McGregor, Catherine Title: Prescription Drug Use Among Detainees: Prevalence, Sources and Links to Crime Summary: This report is the first of its kind in Australia to examine the self-reported use of illicit pharmaceuticals among a sample of police detainees surveyed as part of the Australian Institute of Criminology’s Drug Use Monitoring in Australia (DUMA) program. In all, 986 detainees were interviewed, of which 19 percent reported having recently used pharmaceutical drugs for non-medical purposes in the past 12 months — nearly five times as high as reported by the general Australian population. Non-medical prescription drug use was found to be substantially higher in the detainee population by comparison with the general community. Among the detainees surveyed, more prescription drug users were unemployed, derived their income from welfare or benefits, considered themselves drug dependent, were currently on a drug-related charge and had been arrested or imprisoned in the previous 12 months by comparison with non-users. Most pharmaceuticals were sourced from family and friends or from the person’s usual doctor and pharmacy. There was little support for the view that pharmaceuticals are commonly obtained through script forgery or over the internet. Benzodiazepines, followed by opioids, were the most commonly used pharmaceuticals for non-medical purposes in this sample of police detainees. This paper provides policymakers with valuable information about the reasons for use and the methods by which pharmaceuticals are typically accessed for non-medical purposes. Further research to investigate the methods of obtaining illicit pharmaceuticals from within the general community is needed. Details: Canberra: Australian Institute of Criminology, 2011. 6p. Source: Internet Resource: Trends & Issues in Crime and Criminal Justice, No. 423: Accessed August 11, 2011 at: http://www.aic.gov.au/publications/current%20series/tandi.aspx Year: 2011 Country: Australia URL: http://www.aic.gov.au/publications/current%20series/tandi.aspx Shelf Number: 122361 Keywords: Drug Abuse and CrimeDrug OffendersPrescription Drug AbusePrescription Fraud |
Author: Maryland. Office of the Attorney General Title: Prescription for Disaster: The Growing Problem of Prescription Drug Abuse in Maryland Summary: Maryland Attorney General J. Joseph Curran Jr. released a report which warns of a burgeoning crisis of prescription drug abuse and diversion in Maryland and nationwide which will only get worse unless federal and state officials step up efforts to address the problem. Entitled "Prescription for Disaster:The Growing Problem of Prescription Drug Abuse in Maryland," the report makes several recommendations, including the creation of an electronic prescription monitoring program, increased penalties for illegal distribution of pharmaceuticals, and a public outreach campaign to heighten awareness about the dangers of prescription drug abuse, with particular focus on the virtually unfettered youth access to controlled dangerous substances via the Internet. The report cites federal data showing that prescription drug abuse is rising faster and more consistently than abuse of illicit drugs, particularly among young people. An alarming one in five teens report having used a prescription pain reliever, like Vicodin® or OxyContin®, to get high, and they are more likely to have done so than to have experimented with most illicit drugs like Ecstasy, cocaine, crack and LSD. Maryland is no exception to national trends, with prescription drug abuse rising almost five times faster than abuse of illicit drugs. The State ranked 6th in the nation in its recent rates of admission for prescription drug abuse treatment, and law enforcement officials cite concerns that the Baltimore region is becoming a "source area" for diverted OxyContin®. Adults and teens obtain prescription drugs through prescription fraud, doctor-shopping, theft and the Internet, which is fast becoming a frightening pipeline for prescription drug diversion. While Curran said it must fall to the federal government to impose much-needed regulation on the pharmaceutical Internet trade, which he urged Congress to do, he emphasized steps the State can and should take immediately to address the problem. First, he called for illegal distribution of prescription drugs to be made a felony instead of a misdemeanor. In addition, Curran promised he would work to see that Maryland join 21 other states in establishing an electronic prescription monitoring program, in which a central database of all prescriptions written and dispensed in the State would be kept to help detect abuse and diversion. Most states surrounding Maryland, like Pennsylvania, West Virginia and Virginia, either have or will soon have such programs up and running. Curran cautioned that a prescription monitoring program must be designed carefully, drawing upon the input and expertise of pain management specialists, pharmacists, law enforcement, patient advocates and others. He has already begun discussions with medical and pharmaceutical experts, and he emphasized the importance of making sure the program would protect patient privacy and would not interfere with the legitimate use of pain relievers and other drugs. Recognizing that people already often have trouble getting prescription pain relievers and other drugs which would be of tremendous help to them, he said, "the last thing we want to do is make that problem worse. We want to keep prescription drugs out of the wrong hands, but we must make sure that doctors can provide the best care possible to their patients, and patients get the medicines they need." Finally, Curran urged an educational effort to make parents and others more aware of prescription drug abuse, its growing prevalence and warning signs, and the increasing availability of a wide range of powerful prescription drugs on the Internet. Details: Maryland: State of Maryland Office of the Attorney General, 2009. 35p. Source: Internet Resource: Accessed February 29, 2012 at http://www.oag.state.md.us/Reports/PrescriptionDrugAbuse.pdf Year: 2009 Country: United States URL: http://www.oag.state.md.us/Reports/PrescriptionDrugAbuse.pdf Shelf Number: 124325 Keywords: Abuse and AddictionDrug Abuse (Maryland)Drug ControlOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: Butler, Steve Title: Scheduled Prescription Drug Distribution in Wyoming: Analysis of the Wyoming Prescription Drug Monitoring Program 2004-2009 Summary: The Wyoming Survey & Analysis Center (WYSAC) at the University of Wyoming proposed this research project as part of the 2010 State Justice Statistics Program for Statistical Analysis Centers. Accepted projects were funded by the Bureau of Justice Statistics. The study examines statewide prescribing patterns of Schedule II and above drugs as recorded through the Wyoming Prescription Drug Monitoring Program (PDMP). PDMPs are databases that contain prescribing information of drugs that have high potential for abuse, such as opioids, benzodiazepines, stimulants, and barbiturates, among others (Schedule II and above). In Wyoming and other states, PDMPs have primarily been used to assist doctors and pharmacists in identifying patients who might be attaining illicit access to drugs through doctor-shopping and fraudulent prescription scams. Also helping states to understand legitimate scheduled drug prescribing, PDMPs analysis reveals the scale and scope of scheduled drug distribution, both geographically and over time. Testament of the usefulness of PDMPs is demonstrated through their proliferation throughout the U.S.: In 2002 only nineteen states had PDMPs and as of 10/2008 forty-seven states had such systems. In the 2002 United States General Accounting Office report, Prescription Drugs: State Monitoring Programs Provide Useful Tools to Reduce Diversion, the GAO asserted that PDMPs in some states were used to evaluate prescribing patterns in order to identify medical practitioners who are overprescribing. After identifying possible cases, PDMP officials inform doctors that their patterns are unrepresentative of the greater medical community, and thereby attempt to influence prescribing by educating practitioners. PDMPs also identify patients who are abusing or diverting prescription drugs for sale on the black-market and provide this information to doctors and pharmacists. Programs that educate physicians, pharmacies, and the public about the existence of diversion scams, along with the tactics employed, are constructive outcomes of the public dissemination of PDMP analyses. Once educated about diversion tactics, key stakeholders can become a substantial force in the prevention of abuse and diversion. For example, based on PDMP analysis in Nevada and Utah, physicians were sent drug utilization letters containing information that signaled potential diversion activity, including the number and types of drugs prescribed. Here in Wyoming, a RX Abuse Stakeholders was created in 2008 and is chaired by the U.S. Attorney’s Office. Representatives from health care, government, law enforcement and community members serve on the taskforce. The mission is to prevent the increasing abuse of prescription medications while ensuring that they remain available for patients in need. Methods of advancement include educating healthcare professionals, law enforcement and the general public about use and abuse of scheduled drugs, and strengthening the regulatory framework. The Wyoming State Board of Pharmacy manages the PDMP and according to Wyoming statute, legitimate uses of the system include: “release of information to practitioners and pharmacists when the release of the information may be of assistance in preventing or avoiding inappropriate use of controlled substances; The board shall report any information that it reasonably suspects may relate to fraudulent or illegal activity to the appropriate law enforcement agency and the relevant occupational licensing board and the board may release data for educational, research or public information purposes” (W.S 35-7-1060). Data for this study consists of all Wyoming PDMP records from 2004 through 2009. Prior to this project, no comprehensive study has been conducted on the distribution of prescribed Schedule II, III, and IV drugs as recorded in the Wyoming PDMP. Details: Laramie, WY: Wyoming Survey & Analysis Center, University of Wyoming, 2011. 307p. Source: Internet Resource: WYSAC Technical Report No. CJR-1007: Accessed May 4, 2012 at: https://wysac.uwyo.edu/ReportView.aspx?DocId=479&A=1 Year: 2011 Country: United States URL: https://wysac.uwyo.edu/ReportView.aspx?DocId=479&A=1 Shelf Number: 125158 Keywords: Prescription Drug AbusePrescription Drugs (Wyoming)Prescription Fraud |
Author: Nicholas, Roger Title: Pharmaceutical Drug Misuse Problems in Australia: Complex Issues, Balanced Responses Summary: This review was prepared by NCETA as part of the process of developing Australia’s National Pharmaceutical Drug Misuse Strategy (NPDMS). The Strategy was developed during 2011 at the request of the Ministerial Council on Drug Strategy (MCDS) and the Intergovernmental Committee on Drugs and was funded through the MCDS Cost Shared Funding Model. The work was undertaken by a consortium led by the National Centre for Education and Training on Addiction (NCETA) at Flinders University and overseen by the Victorian Department of Health. The review examines the extent and nature of the evidence base concerning this issue and primarily focuses on: • prescription opioids • benzodiazepines • codeine-containing analgesics. The review and broader strategy development process identified the need to implement approaches that enhance the quality use of these medicines. Accordingly, it is important to ensure their continued availability for therapeutic purposes and to maximise their appropriate use, while minimising opportunities for misuse. As these medicines are highly beneficial to many individuals, it is important to ensure that their clinically appropriate supply is maintained and their use is in no way stigmatised. A central goal in the development of the NPDMS was to ensure a balance among diverse perspectives and interests. There was also a need to have measures in place to minimise harm from any unsanctioned use of these medications. This includes use by persons other than those for whom the drugs are prescribed, or at doses, or via routes of administration, that were unintended by the prescriber. The review is structured into three parts, as follows. PART A Part A examines the extent and nature of pharmaceutical drug misuse problems in Australia and internationally, including issues surrounding the quality use of opioids and benzodiazepines. This part describes the spectrum of individuals who are misusing pharmaceutical drugs. This ranges from those who intentionally misuse these medicines to experience their non-therapeutic benefits or to on-sell them for profit, through to those who unintentionally misuse them in response to inappropriate prescribing. Pharmaceutical drug misuse problems are increasing in Australia. Evidence emanating from general population surveys, surveys of illicit drug users, drug treatment data and data concerning offenders points to this increase. Part A also describes the rapid increase in the utilisation of certain prescribed opioids, in particular morphine and oxycodone, as well as changes in the patterns of benzodiazepine prescription, particularly the increase in alprazolam prescribing. The increase in opioid prescribing and changes in benzodiazepine prescribing are not necessarily problematic. But unfortunately they have been associated with an increase in harms, such as poisonings, injection-related problems, the illicit sale of pharmaceuticals and related demand for treatment. The misuse of over the counter codeine-containing medicines is also leading to harms such as codeine dependence and illnesses associated with exposure to high levels of ibuprofen and paracetamol found in these medicines. A range of systemic factors impacting on patterns of pharmaceutical misuse are described in Part A. These include: • the availability of multiple formulations of opioids • current hospital discharge planning arrangements leading to patients continuing to use medications beyond the period of time for which they are clinically indicated • difficulties in accessing pain management and drug treatment programs • recent national registration arrangements for health practitioners whereby prescriptions written in one jurisdiction can be filled in another • lack of availability of certain non-opioid pain treatment medicines on the PBS which increases the likelihood of opioid prescribing • intimidation of prescribers by patients leading to inappropriate prescribing. Important demographic changes such as the ageing of the population are likely to increase demand for opioids and benzodiazepines. Clients receiving opioid substitution therapy (OST) are also ageing and will therefore have particular needs in the future as a result of their longer-term exposure to opioids. Australia is not alone in experiencing an increase in the prescribing of, and the harms associated with, opioids. The United States and Canada in particular are also experiencing a range of similar problems, albeit of greater severity. Australia is well placed to intervene at this relatively early stage of the trajectory of problems before they reach the level being experienced in these countries. There appears to be a significant evidence-practice gap in the prescribing of opioids and benzodiazepines in Australia. The role of prescription opioids in OST, the treatment of serious acute pain and malignant pain is relatively uncontroversial. It appears, however, that opioids are increasingly prescribed for less serious acute pain and for chronic non-malignant pain, for which the evidence of efficacy has not been established. Similarly, benzodiazepines should not be a front-line treatment for the treatment of anxiety or insomnia and nor is their use indicated for the longer-term treatment of these conditions. Benzodiazepines are, at times, prescribed in a manner inconsistent with quality use. This can result in inadvertent misuse. The extent of medication shopping in Australia is unclear. Evidence is not readily available on this issue from Medicare Australia and even if it were it would only include data on PBS-subsidised medicines. Available evidence suggests that this is a significant issue. Part B Part B outlines key stakeholders, paradigms, strategies and activities of relevance to pharmaceutical drug misuse problems and responses in Australia. It highlights the importance of adopting a systems approach and of utilising principles associated with effective prevention programs in responding to pharmaceutical drug misuse challenges. The social determinants which impact on a range of aspects of the health of Australians also affect levels of pharmaceutical drug-related harm. There is, for example, evidence that pharmaceutical overdose deaths are more common among socially disadvantaged groups in the community and those living in rural areas. The injection of pharmaceutical drugs is also more common in rural, compared with urban, areas. This requires targeted approaches to address this inequity. Part B also contains an outline of other national strategies and the ways in which they interact with Part C Part C discusses potential responses to pharmaceutical misuse problems. The first of these are infrastructure, research, monitoring and systems issues. Foremost in this regard is the need for a Coordinated Medication Management System in Australia which provides on-line, real time information for prescribers, pharmacists and regulators concerning the medication prescription and dispensing histories of patients. This is important to minimise misuse and to ensure that, as a result of increasing levels of pharmaceutical misuse, prescribers do not lose confidence in prescribing these medicines to patients for whom they would be of therapeutic benefit. There is a range of gaps in our understanding of the extent and nature of pharmaceutical drug misuse in Australia. Consequently, there is a need to enhance data collection and research processes. The second area of response concerns changes to clinical practices. The potential roles of general practitioners and other prescribers, pharmacists, the alcohol and other drug sector are described. Also discussed is the important role that psychological therapies can play in responding to conditions such as chronic pain, anxiety and insomnia. In many cases, these therapies are more effective and have more sustained benefits than pharmacological approaches. Next a range of potential workforce development strategies are described to enhance prescribing practices. Evidence suggests that only modest returns are available from practices such as audit and feedback, educational outreach visits, educational meetings and educational materials such as guidelines. Nonetheless, these tools may have some clinically beneficial effect on improving the quality of prescribing, especially if tailored to practitioners identified as over-prescribing and address individual barriers to change. Harm reduction responses are also needed. Measures are required to reduce the harm to those who use these medicines in unintended ways or dosages. This could include disseminating information to problematic misusers and providing access to injecting equipment such as filters to reduce harms associated with the injection of medications that are not intended to be injected. Consumer-oriented responses are also required. Strategies are required that address unrealistic expectations that consumers may have about the efficacy of medicines and therefore enhance levels of health literacy1 among the population. The standardisation of medication labelling is also important as are awareness raising programs among the general public about the risks of exceeding therapeutic doses of over the counter (OTC) medications. Enhances in technology can also assist with reducing pharmaceutical drug-related harm. Potential approaches include the introduction of tamper-resistant technologies for medicines, methods of tracking medicines from production to patient and measures to reduce tampering with, or forgeries of, prescriptions. Finally, Part C contains an examination of issues surrounding the marketing of medicines in Australia. The marketing of pharmaceuticals is an important way in which companies stimulate demand and generate turnover. Prescribers are the key targets of pharmaceutical marketing in Australia because direct-to-consumer advertising is prohibited and because doctors have the power to prescribe medicines. This marketing and promotion occurs under a self regulatory code of conduct administered by Medicines Australia, the peak body for the pharmaceutical industry. There are concerns that the self-regulatory approach may be insufficient and that current advertising and promotion practices may be unduly affecting prescribing practices. Details: Adelaide: National Centre for Education and Training on Addiction (NCETA), Flinders University, 2011. 136p. Source: Internet Resource: Accessed May 9, 2012 at: http://enews.vaada.org.au/news/2012/02/29/pharmaceutical-drug-misuse-problems-australia-complex-issues-balanced-responses Year: 2011 Country: Australia URL: http://enews.vaada.org.au/news/2012/02/29/pharmaceutical-drug-misuse-problems-australia-complex-issues-balanced-responses Shelf Number: 125227 Keywords: Drug Abuse and Addiction (Australia)Prescription Drug Abuse |
Author: California State Task Force on Prescription Drug Misuse Title: Prescription Drugs: Misuse, Abuse and Dependency Summary: The nonmedical use of prescription drugs has emerged as a growing and serious problem in California. In response, the California Department of Alcohol and Drug Programs (ADP), under the leadership of Director Renée Zito, convened the Prescription Drug Misuse (PDM) Task Force. The Task Force was charged with studying the problem and developing recommendations to increase awareness, limit access, and reduce misuse rates. For the past year, this group has convened by teleconference. The Task Force developed information and discussed issues concerning use patterns, availability, awareness levels and problems associated with the nonmedical use of prescription drugs by diverse population sub‐groups. This report is a culmination of their efforts. Details: Sacramento: California Department of Alcohol and Drug Programs, 2009. 37p. Source: Internet Resource: Accessed July 3, 2012 at: http://www.adp.ca.gov/director/pdf/Prescription_Drug_Task_Force.pdf Year: 2009 Country: United States URL: http://www.adp.ca.gov/director/pdf/Prescription_Drug_Task_Force.pdf Shelf Number: 125462 Keywords: Drug Abuse and AddictionDrug ControlPrescription Drug AbusePrescription Drugs |
Author: Clark, Thomas Title: Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices Summary: The role of state prescription drug monitoring programs (PDMPs) in facilitating appropriate prescribing of controlled prescription drugs and helping to address the prescription drug abuse epidemic has been highlighted in recent studies and in the 2011 White House Office of National Drug Control Policy’s Prescription Drug Abuse Prevention Plan (GAO, 2002; Pradel et al., 2009; Baehren et al., 2010; Katz et al., 2010; Johnson et al., 2011; Office of National Drug Control Policy, 2011). A special concern for PDMPs is the diversion of opioid pain relievers into nonmedical use and abuse. A PDMP is a statewide electronic database that gathers information from pharmacies on dispensed prescriptions for controlled substances (most states that permit practitioners to dispense also require them to submit prescription information to the PDMP). Many PDMPs now provide secure online access to this information for authorized recipients. Prescription data (usually for the past year, and including information on date dispensed, patient, prescriber, pharmacy, medicine, and dose) are made available on request from end users, typically prescribers and pharmacists, and sometimes distributed via unsolicited reports. Recipients of PDMP data may also include practitioner licensure boards, law enforcement and drug control agencies, medical examiners, drug courts and criminal diversion programs, addiction treatment programs, public and private third-party payers, and other public health and safety agencies. States vary widely in which categories of users are permitted to request and receive prescription history reports and under what conditions. PDMPs represent a substantially underutilized resource in efforts to improve public health outcomes and address prescription drug abuse (Katz et al., 2010). Key reasons for this underutilization include differences in the data PDMPs collect, whether and how they ensure data quality, the kinds of data analyses and reports they produce, to which users and under what conditions they make data available, and differences in an array of other procedures and practices. With respect to many of these practices, there is not widespread understanding of which constitute “best practices”; that is, which practices are associated with maximizing PDMP effectiveness. The purpose of this white paper is to describe what is known about PDMP best practices, describe and assess the evidence supporting their identification as best practices, and document the extent to which PDMPs have implemented these practices. The paper is structured as follows: • Section II provides background on the history of PDMPs and a conceptual framework for assessing their effectiveness. The contexts in which PDMPs developed have been an important influence on the range of PDMP practices and the extent of their current adoption. Practices can be organized in terms of PDMP workflow and functions (e.g., data collection, analysis, and reporting). Their effectiveness can be assessed by observing their differential impact in achieving intermediate objectives, such as increasing the utilization of PDMPs by all appropriate end users, and ultimate goals, such as improving patient health and reducing the diversion of prescription drugs into illegal use (drug diversion) and overdose. • Section III provides an overview of the paper’s methods and discusses types of evidence for effectiveness, the relative strength of the methods and evidence, and how the current evidence base for potential PDMP best practices was assessed. • Section IV describes candidate PDMP best practices, the extent to which they are implemented by PDMPs, and the evidence base for each practice, and identifies barriers to their adoption. • Section V discusses conclusions and recommendations regarding PDMP best practices. It includes a table summarizing the types of evidence that currently exist for each practice and the strength and consistency of evidence within those types. This section also outlines a research agenda, suggesting the kinds of studies needed to produce a stronger evidence base for practices we believe have the greatest potential to improve PDMP effectiveness. • Section VI provides the references we have examined in developing this white paper. These references are summarized in two tables in an appendix: one providing an overview of the peer-reviewed, published literature on PDMP practices and effectiveness, and a second providing an overview of other literature of evaluation studies and reports, case studies, anecdotal information, and expert opinion. Details: Washington, DC: Pew Charitable Trusts, 2012. 100p. Source: Internet Resource: Accessed September 25, 2012 at: http://www.pewhealth.org/uploadedFiles/PHG/Content_Level_Pages/Reports/PDMP_Full%20and%20Final.pdf Year: 2012 Country: United States URL: http://www.pewhealth.org/uploadedFiles/PHG/Content_Level_Pages/Reports/PDMP_Full%20and%20Final.pdf Shelf Number: 126443 Keywords: Drug Abuse and AddictionDrug Abuse PreventionPrescription Drug AbusePrescription Drug Monitoring |
Author: MITRE Corporation Title: Enhancing Access to Prescription Drug Monitoring Programs Using Health Information Technology: Work Group Recommendations Summary: Prescription drug misuse and overdose is one of the fastest growing health epidemics in the United States. In 2010, U.S. pharmacies dispensed enough opioid pain relievers to medicate every adult in America with a 5 mg hydrocodone every 4 hours for an entire month. As of 2010, nearly 5% of people 12 years or older in the United States stated that they used opioids nonmedically. The amount of controlled substances dispensed and used nonmedically is alarming considering that the Centers for Disease Control and Prevention (CDC) reported that in 2009, opioid drugs, including oxycodone and hydrocodone, caused more than 15,500 overdose deaths - a number that is increasing. The overdose death rates for all drugs including opioids increased in Louisiana, Mississippi, Kentucky and West Virginia from the years 1999 to 2008. In 2008, New Mexico and West Virginia reported the highest drug overdose death rates at 27 and 25.8 deaths per 100,000 population respectively. To address the prescription drug abuse problem, many states have established Prescription Drug Monitoring Programs (PDMPs). These programs collect prescription data on medications that the federal government classifies as controlled substances and other non-controlled substance drugs. Their purpose is to reduce prescription drug abuse and diversion. PDMPs are not federally operated; they are statewide electronic databases that collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing physicians. PDMP information can be useful to improve decision-making when prescribing and dispensing scheduled prescription drugs, but not all states benefit equally from these programs. Although this data is made available to authorized healthcare professionals in the majority of states, access is generally optional. Details: McLean, VA: MITRE Corporation, 2012. 191p. Source: Internet Resource: Accessed December 7, 2012 at: http://www.ihealthtran.com/Enhancing-Access-to-prescription-drug-monitoring-programs-using-health-information-technology-report.pdf Year: 2012 Country: United States URL: http://www.ihealthtran.com/Enhancing-Access-to-prescription-drug-monitoring-programs-using-health-information-technology-report.pdf Shelf Number: 127134 Keywords: Drug Abuse and AddictionDrug Abuse PreventionPrescription Drug Abuse |
Author: Bagalman, Erin Title: Prescription Drug Abuse Summary: An estimated 6.8 million individuals currently abuse prescription drugs in the United States. Unlike policy on street drugs, federal policy on prescription drug abuse is complicated by the need to maintain access to prescription controlled substances (PCS) for legitimate medical use. The federal government has several roles in reducing prescription drug abuse. Coordination. The Office of National Drug Control Policy (ONDCP) coordinates and tracks prescription drug abuse reduction efforts and funding of multiple federal agencies. Regulation. The primary federal statutes governing prescription drug regulation are the Federal Food, Drug, and Cosmetic Act (FFDCA) and the Comprehensive Drug Abuse Prevention and Control Act of 1970, commonly called the Controlled Substances Act (CSA). Law Enforcement. Federal law enforcement, primarily the Drug Enforcement Administration (DEA), aims to prevent, detect, and investigate the diversion of prescription drugs while regulating the supply for legitimate medical, commercial, and scientific purposes. Health. Federal agencies and programs involved in health may address prescription drug abuse through service delivery (e.g., the Veterans Health Administration), financing (e.g., Medicare), and research (e.g., the National Institute on Drug Abuse). The federal government, state and local governments, and various private entities (e.g., pharmacies) are currently undertaking a range of approaches to reducing prescription drug abuse. Scheduling of PCS. The scheduling status of a PCS (1) affects patient access to PCS (e.g., by limiting refills); (2) affects the degree of regulatory requirements (e.g., supply chain recordkeeping); and (3) determines the degree of criminal punishment for illegal traffickers. Safe Storage and Disposal. DEA regulates storage of PCS by registered entities (e.g., pharmacies); provides registered entities with options for proper disposal of PCS; and sponsors National Prescription Drug Take-Back Days to assist citizens in safe disposal of PCS. Enhancing Law Enforcement. Federal law enforcement efforts may focus on geographic areas with higher rates of prescription drug abuse or on High Intensity Drug Trafficking Areas (HIDTA) that experience a higher volume of illicit trafficking of PCS. Using Data to Identify Risk. Most states operate prescription drug monitoring programs - databases of prescriptions filled for PCS. Other public and private entities also have data that may be analyzed to identify high-risk behavior among prescribers, dispensers, or patients. Awareness and Education. Efforts to increase awareness and education about prescription drug abuse may focus on health care providers, patients, or the general public. Treatment. Some prescription drug abuse may be avoided in treating underlying conditions (e.g., pain) or may be treated with pharmacologic or non-pharmacologic interventions. New products may improve treatment for both underlying conditions and prescription drug abuse. Details: Washington, DC: Congressional Research Service, 2014. 23p. Source: Internet Resource: R43559: Accessed June 17, 2014 at: http://www.nacds.org/ceo/2014/0529/CRS_Drug_Abuse_Report.pdf Year: 2014 Country: United States URL: http://www.nacds.org/ceo/2014/0529/CRS_Drug_Abuse_Report.pdf Shelf Number: 132480 Keywords: Drug Abuse and AddictionDrug Abuse PolicyDrug Abuse PreventionDrug EnforcementDrug RegulationPrescription Drug Abuse |
Author: Wedd, Alan Title: Ohio Multijurisdictional Task Force Trend Analysis: 2010-2013 Summary: This report presents data from Ohio multijurisdictional task forces funded by the Office of Criminal Justice Services (OCJS) through the JAG/Byrne grant program. As a requirement of the JAG grants, task forces submitted two semi-annual performance reports to OCJS highlighting their activities and accomplishments for calendar years 2010 V 2013. The data from these performance reports was analyzed in this multi-year report. To provide a clear account of the data while accounting for the different number of task forces funded each year, data are typically presented as both averages and totals. Summary - The total number of task forces funded by the JAG/Byrne grant program increased from 32 in 2010 to 38 in 2013. - Task forces increased their average number of felony indictments while decreasing the average number of new cases worked. This indicates that task forces became more efficient from 2010 to 2013. - Task forces obtained more indictments for street drugs between 2010 and 2013, primarily due to large increases in indictments for heroin trafficking and possession. They also recorded more seizures for nearly every type of street drug collected in this study during the same time period. - Indictments for pharmaceutical drugs increased during the reporting period. Oxycodone, hydrocodone, and alprazolam were the most frequently seized/diverted drugs by the task forces. Details: Columbus, OH: Ohio Office of Criminal Justice Services, 2014. 17p. Source: Internet Resource: Accessed October 1, 2014 at: http://publicsafety.ohio.gov/links/2010-2013_DTF_Report.pdf Year: 2014 Country: United States URL: http://publicsafety.ohio.gov/links/2010-2013_DTF_Report.pdf Shelf Number: 133526 Keywords: Drug Abuse and Addition (Ohio)Drug EnforcementDrug OffendersOpioidsPrescription Drug Abuse |
Author: Clark, Marilyn Title: The Gender Dimension of Non-Medical Use of Prescription Drugs (NMUPD) in Europe and the Mediterranean Region Summary: Understanding gender as it relates to drug use and drug use disorders is a critical requirement to developing effective policy and practice responses. This study aims to explore the gender dimension of non-medical use of prescription drugs (NMUPD) in Europe and the Mediterranean region and continues to build on the corpus of knowledge on the subject and also help identify gaps. Working Definitions The definition of NMUPD developed by the Lithuanian Presidency of the Council of the EU in 2013 was adopted: 'use of a prescription drug, whether obtained by prescription or otherwise, other than in the manner or for the time period prescribed, or by a person for whom the drug was not prescribed (2013:14). The term "nonmedical use," does not correspond to the definition of substance related disorders in DSM-V. For the purpose of the survey tool the 'use of prescription drugs' was defined as 'consumption with doctor's prescription and/or consumption as prescribed by a medical practitioner'. Project Purpose and Design The main aims of this study are: - To explore gender differences in NMUPD in Europe and the Mediterranean region through a documentation of secondary sources with the aim of constructing a snapshot of the current scenario with regards to gender and use and misuse of prescription drugs. - To identify gaps in the data available in the various regions in Europe and the Mediterranean. - To make recommendations for further research. - To make recommendations for policy development and practice A survey questionnaire targeted towards experts nominated by the Permanent Correspondents of the Pompidou Group Member States and former Member States and for the Mediterranean countries, experts nominated through the MedNET correspondents, constitutes the research tool. Details: Strasbourg: Council of Europe, Pompidou Group expert Working Group on the Gender Dimension of NMUPD, 2015. 152p. Source: Internet Resource: Accessed May 9, 2015 at: http://www.coe.int/t/dghl/standardsetting/equality/03themes/gender-mainstreaming/PompidouGenderDimension-V5.pdf Year: 2015 Country: Europe URL: http://www.coe.int/t/dghl/standardsetting/equality/03themes/gender-mainstreaming/PompidouGenderDimension-V5.pdf Shelf Number: 135541 Keywords: Drug Abuse and AddictionGenderPrescription Drug Abuse |
Author: Indiana State Epidemiology and Outcomes Workgroup Title: The Consumption and Consequences of Alcohol, Tobacco, and Drugs in Indiana: A State Epidemiological Profile 2015 Summary: This report represents the tenth official State Epidemiological Profile completed by the SEOW. As in past years, we have updated the core set of analyses to reflect the most recent data available. In order to make the report most useful for state and local policymakers and service providers, we present detailed information and descriptive analyses regarding the patterns and consequences of substance use both for the state and, whenever possible, each of Indiana's 92 counties. Prescription drug abuse remains a significant problem in Indiana, and we continue to work closely with the State Board of Pharmacy, reviewing data on dispensation of controlled substances to identify geographic patterns. Details: Indianapolis: Center for Health Policy at Indiana University-Purdue University Indianapolis (IUPUI): 2016. 228p. Source: Internet Resource: Accessed August 25, 2016 at: http://www.healthpolicy.iupui.edu/PubsPDFs/2015%20State%20Epidemiological%20Profile.pdf Year: 2016 Country: United States URL: http://www.healthpolicy.iupui.edu/PubsPDFs/2015%20State%20Epidemiological%20Profile.pdf Shelf Number: 140033 Keywords: Drug Abuse and AddictionPrescription Drug AbuseSubstance Abuse |
Author: U.S. National Heroin Task Force Title: National Heroin Task Force Final Report and Recommendations Summary: "The United States is in the grip of a national crisis - an unprecedented surge in the illicit use of prescription opioid medications and heroin. In 2014, 1.9 million people had a prescription opioid use disorder and nearly 600,000 had a heroin use disorder. The national data on overdose deaths are startling: in 2014, there were more than 27,000 overdose deaths involving prescription opioid medications and /or heroin. That is equivalent to an average of one death every 20 minutes. The opioid epidemic affects a broad cross-section of the United States population without regard to age, gender, race, ethnicity, or economic status. Living in a rural, suburban, or urban jurisdiction does not insulate an individual from the ravages of the opioid epidemic. Traditional law enforcement methods are a critical component of any counter-illicit drug strategy, but they will not resolve this crisis alone. The opioid crisis is also fundamentally a public health problem. The recommendations contained in this report are premised up on three principles: 1) public safety and public health authorities must integrate and harmonize their response to the misuse of prescription opioid medications and use of heroin; 2) policies regarding heroin use and misuse of prescription opioid medications must be grounded in a scientific understanding that substance use disorder is a chronic brain disease that can be prevented and treated; and 3) treatment and recovery services and support must be accessible and affordable. Details: Washington, DC: U.S. Department of Justice: U.S. Office of National Drug Control Policy, 2015. 35p. Source: Internet Resource: Accessed September 17, 2016 at: https://www.justice.gov/file/822231/download Year: 2015 Country: United States URL: https://www.justice.gov/file/822231/download Shelf Number: 140330 Keywords: Drug Abuse and AddictionDrug EnforcementDrug PolicyHeroinPrescription drug Abuse |
Author: New York State. Heroin and Opioid Task Force Title: Combatting the Heroin and Opioid Crisis Summary: Across the state the Task Force has heard from families who have loved ones addicted to heroin or other opioids, who have overdosed or have had serious health problems as a result of their addiction. Heroin overdose is now the leading cause of accidental death in the state. Between 2005 and 2014, upstate New York has seen an astonishing 222 percent increase in admissions to OASAS certified treatment programs among those 18 to 24 years of age for heroin and other opioids; Long Island has seen a 242 percent increase among the same age group for heroin and other opioids. In all, approximately 1.4 million New Yorkers suffer from a substance use disorder. Heroin and opioid addiction is now a major public health crisis in New York State. Further work must continue to fully realize the Governor's vision for a more responsive, accessible, and compassionate health care system for patients, as well as stronger education, prevention, and enforcement measures. The Task Force recommends that study and work on these issues continue as a high priority, so that New York can remain in the forefront when it comes to helping patients and their families. New York has taken important steps to address the urgent needs of those in critical condition and to prevent future generations from suffering from the disease of addiction. For the 2016 fiscal year, New York State allocated over $1.4 billion to the Office of Alcoholism and Substance Abuse Services (OASAS) to fight this battle including funding for 1,455 beds for patients in crisis; 2,221 beds for inpatient rehabilitation programs; 5,247 beds for intensive residential programs; 2,142 beds for community residential programs; 1,842 beds in supportive living programs; and 265 beds in residential rehabilitation programs for youth. Additionally, OASAS provides more than $74 million to fund prevention services through 165 providers serving communities in every county, including 1,400 schools across the state. The State has also enacted legislation to address this growing epidemic. In 2012 the State enacted the Prescription Drug Reform Act, overhauling the way prescription drugs are dispensed and tracked in New York to improve safeguards for drugs that are prone to abuse. The Act updated the Prescription Monitoring Program (PMP) Registry (also known as I-STOP) to require pharmacies to report information about dispensed controlled substances on a "real time" basis, as well as require health care practitioners to consult the PMP Registry before prescribing or dispensing certain controlled substances most prone to abuse and diversion. The Act also mandated electronic prescription of controlled substances, updated the Controlled Substances Schedules, improved education and awareness efforts for prescribers, and established a safe disposal program for prescription drugs. By the end of 2015, I-STOP had led to a 90 percent decrease in "doctor shopping" - when patients visit multiple prescribers and pharmacies to obtain prescriptions for controlled substances within a three-month time period. Earlier this year, New York State entered into an agreement with New Jersey to share PMP data both ways and prevent "doctor shopping" across state borders. In 2014, the State enacted legislation that granted Good Samaritan protections to individuals who administer an opioid antagonist like naloxone, expanded access to naloxone by allowing nonpatient-specific prescriptions, enacted insurance reforms to improve treatment options for individuals suffering from addiction, directed OASAS to create a wraparound services demonstration program to provide services to adolescents and adults for up to nine months after successful completion of a treatment program, and enhanced penalties to crack down on illegal drug distribution. Despite being on the forefront of nationally-recognized best practices, the epidemic continues to grow in New York. In response, Governor Andrew M. Cuomo convened a team of experienced healthcare providers, policy advocates, educators, parents, and New Yorkers in recovery to serve on a Heroin and Opioid Task Force and develop a comprehensive plan to bring the crisis under control. The Task Force's work was informed by two executive meetings, eight listening sessions across the state, and the 246 comments submitted through www.ny.gov/herointaskforce. This public process resulted in the following recommendations - broken into four areas: prevention, treatment, recovery, and enforcement - to continue to address the crisis. Details: Albany, NY: The Task Force, 2016. 34p. Source: Internet Resource: Accessed September 19, 2016 at; https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/HeroinTaskForceReport_3.pdf Year: 2016 Country: United States URL: https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/HeroinTaskForceReport_3.pdf Shelf Number: 140350 Keywords: Drug Abuse and AddictionDrug EnforcementDrug TreatmentHeroinIllegal DrugsOpioidsPrescription Drug Abuse |
Author: LeCroy & Milligan Associates, Inc. Title: Marijuana and Prescription Drug Misuse and Abuse in Arizona Summary: Recent national attention focusing on the heroin epidemic, reported increases in marijuana and prescription drug misuse and abuse among youth and recent policy shifts in our state1 have raised concerns among some policymakers and the public about the extent of the problem in Arizona and the implications for our communities. For example, data relating to Arizona high school students indicate steady increases in the percentage of 12th grade students reporting marijuana use in the past 30 days. In 2014, this percentage reached a five-year high of 23% among Arizona 12th graders, up from 18% in 2010. Nearly half (45%) of Arizona 12th grade students also reported using marijuana at least once in their lifetime, with little change occurring over the past five years. Similar trends can be seen among Arizona undergraduate students (ages 18-25), with annual increases reported in marijuana use in the past 30 days (increased from 15% in 2010 to 19% in 2014). Furthermore, Arizona has experienced steady increases in the rates of marijuana and opioid related emergency department and hospital visits. In response to these trends, the Governor's Office of Youth, Faith and Family (GOYFF) requested data from the Arizona Substance Abuse Epidemiology Work Group regarding marijuana and prescription drug misuse and abuse. The Substance Abuse Epidemiology Work Group is a formal work group of the Arizona Substance Abuse Partnership (ASAP). The purpose of the report is to provide data on the current state of marijuana and prescription drug misuse and abuse in Arizona and, where data exists, show how Arizona compares to trends at the national and regional levels. This represents a first of its kind report for Arizona. The executive summary highlights key findings from descriptive data gathered across seven areas of interest for the Epidemiology Work Group. Details: Tucson, AZ: LeCroy & Milligan Associates, 2016. 63p. Source: Internet Resource: Accessed October 14, 2016 at: http://www.lecroymilligan.com/data/resources/finalgoyff20160603-1.pdf Year: 2016 Country: United States URL: http://www.lecroymilligan.com/data/resources/finalgoyff20160603-1.pdf Shelf Number: 144805 Keywords: Drug Abuse and AddictionMarijuanaPrescription Drug Abuse |
Author: Gau, Jacinta M. Title: Non-Medical Use of Prescription Drugs: Policy Change, Law Enforcement Activity, and Diversion Tactics Summary: The crisis in prescription-opioid addiction began long before it was finally brought out into the open (Inciardi et al., 2009). Southern states experienced the most notable rates of addiction and overdose. This finding was attributed to this group’s high level of involvement in manuallabor occupations and tendency to be uninsured and live in areas with few or no medical resources (Young, Havens, & Leukefeld, 2012). Many people's opioid addiction begins when they are prescribed these pills for legitimate pain. The State of Florida emerged as the epicenter of the national opioid epidemic. In 2010, the Florida Medical Examiners Commission's (FMEC) annual report revealed startling rates of deaths due to or related to oxycodone, hydrocodone, and other prescription opioids; in fact, more people died from opioids than from cocaine. The report found that, excluding alcohol, prescription drugs were 81% of all drug-related or drug-caused deaths (FMEC, 2011). In 2011, this rose to 83% (FMEC, 2012). The Florida legislature’s first contribution to the fight against prescription pill abuse was the authorization of the creation of a prescription drug monitoring program (PDMP) in 2009 (also known as E-FORSE; FS 893.055). The PDMP became operational in 2011. Law enforcement officers may become certified to access the PDMP directly; those who are not certified can gain access only via a certified officer or the Florida Department of Health (FDOH). The second major step occurred in 2010 with the official creation of the term "pain management clinic" (PMC) and requirement that certain medical establishments register with the FDOH as pain clinics under the law (FS 458.3265 (applicable to medical practices) and FS 459.0137 (applicable to osteopathic practice). There are two triggers which would require a medical office to register as a pain clinic: (a) if the clinic advertises in any medium that it offers pain management services; or (b) if in any month a majority of the clinic's patients are prescribed opioids, benzodiazepines, barbiturates, or carisoprodol for the treatment of chronic, nonmalignant pain. The third meaningful piece of legislation was House Bill (HB) 7095. Dubbed the "pill mill law," HB 7095 was signed into law on June 3, 2011 (and went into effect on July 1, 2011) and established several new regulations pertaining to the physical facilities of pain clinics and the acceptable minimum extent of medical examinations and follow-ups physicians must perform on patients before and after prescribing them opioids for the treatment of chronic, nonmalignant pain. HB 7095 was intended to compel physicians and clinics currently operating in a subpar manner to either improve or go out of business, while at the same time adding no burden to physicians already delivering high-quality, ethical care. This law also contained a dispensing ban, which prohibits PMCs from operating on-site pharmacies. Now, patients receiving prescriptions from PMCs must fill those prescriptions at independently operated community pharmacies (CPs). The present project is an overview of trends in PMCs occurring in the three years following the important changes to Florida law and policy that occurred primarily in 2011 (though changes began in 2009). Quantitative and qualitative data were collected. The first source of quantitative data is the FDOH, which is charged with receiving and approving applications, inspecting facilities, handling disciplinary allegations and hearings, and forcibly closing clinics found to be in persistent violation of regulatory standards. Second are three police departments serving large cities across the state, from which geocoded crime-incident data were obtained. Finally, qualitative data from in-depth interviews with law-enforcement officers around the state allow for a detailed look into the challenges law enforcement face in attempting to hold pain-management clinic physicians criminally liable. Details: Orlando, FL: Department of Criminal Justice University of Central Florida, 2017. 22p. Source: Internet Resource: Accessed March 21, 2017 at: https://www.ncjrs.gov/pdffiles1/nij/grants/250603.pdf Year: 2017 Country: United States URL: https://www.ncjrs.gov/pdffiles1/nij/grants/250603.pdf Shelf Number: 144536 Keywords: Drug Abuse and AddictionDrug Abuse and CrimeDrug AddictionDrug Control PolicyPrescription Drug AbusePrescription Drugs |
Author: Dave, Dhaval M. Title: Mandatory Accessed Prescription Drug Monitoring Programs and Prescription Drug Abuse Summary: Despite the significant cost of prescription (Rx) drug abuse and calls from policy makers for effective interventions, there is limited research on the effects of policies intended to limit such abuse. This study estimates the effects of prescription drug monitoring (PDMP) programs which is a key policy targeting the non-medical use of Rx drugs. Based on objective indicators of abuse as measured by substance abuse treatment admissions related to Rx drugs, estimates do not suggest any substantial effects of instituting an operational PDMP. We find, however, that mandatory-access provisions, which raised PDMP utilization rates by actually requiring providers to query the PDMP prior to prescribing a controlled drug, are significantly associated with a reduction in Rx drug abuse. The effects are driven primarily by a reduction in opioid abuse, generally strongest among young adults (ages 18-24), and underscore important dynamics in the policy response. Robustness checks are consistent with a causal interpretation of these effects. We also assess potential spillovers of mandatory PDMPs on the use of other illicit drugs, and find a complementary reduction in admissions related to cocaine and marijuana abuse. Details: Cambridge, MA: National Bureau of Economic Research, 2017. 37p. Source: Internet Resource: NBER Working Paper No. 23537: Accessed June 26, 2017 at: http://www.nber.org/papers/w23537 Year: 2017 Country: United States URL: http://www.nber.org/papers/w23537 Shelf Number: 146380 Keywords: Drug Abuse and Addiction Drug Abuse Policy Drug Abuse Prevention Drug Abuse Treatment Drug Enforcement Drug Regulation Prescription Drug Abuse |
Author: Global Commission on Drug Policy Title: The Opioid Crisis in North America Summary: North America is facing an epidemic of opioid addiction and opioid overdose with an unprecedented level of mortality. The crisis was spurred by a broad expansion of medical use of opioids, which began in the 1990s as a legitimate response to the under-treatment of pain, but which was soon exploited by the unethical behavior of pharmaceutical companies eager to increase their revenue. The rise in supply fed high levels of diversion among an economically stressed and vulnerable population. The present wave of opioid dependence differs from the heroin crises of the 1980s and 1990s, both in the sheer extent and in the social backgrounds of a large part of the affected populations. In Canada, which is second only in per capita opioid consumption to the United States, the rise in fatal overdoses is more linked to higher potency or ad-mixing of other drugs in areas where there was already a relatively high incidence of heroin use. Initial reactions were to limit prescriptions and to introduce pills that were harder to manipulate. The reduced supply of prescription opioids, however, drove an important minority of people with addiction to less expensive and more accessible street heroin. Under what has become known as the "iron law of prohibition", cheaper and more potent opioids - including fentanyl and its derivatives - increasingly appeared on the market. This has even further accelerated the rate of fatal overdoses. Media and government attention has primarily focused on the supply through doctors. The fact that most addictions start with diverted supplies rather than among pain patients has been largely ignored. Policymakers have also failed to address the role of economic upheaval, unemployment, inequality, and other systemic sources of despair in increasing the risk for addiction and decreasing the odds of recovery. Health systems were completely unprepared and treatment is still dominated by abstinence-focused programs, where no regulatory standards have to be met. Furthermore, among other factors, prejudice against the most effective treatments for opioid addiction - opioid substitution therapy (OST) - has translated into lack of treatment for those in need. Opioid substitution therapy has proven effective in treating addictions to heroin and should be offered to those dependent on or addicted to prescription opioids. While in recent years media and politicians have been more open to viewing addiction as a public health problem, leadership is needed to turn this into an urgent and commensurate response to the crisis. To mitigate the current crisis, the Global Commission on Drug Policy recommends: - Do not cut the supply of prescription opioids without first putting supporting measures in place. This includes sufficient treatment options for people with addiction and viable alternatives for pain patients. - Make proven harm reduction measures and treatment widely available, especially naloxone distribution and training, low-threshold opioid substitution therapy, heroin-assisted treatment, needle and syringe programs, supervised injection facilities, and drug checking. In states that have not yet done so, legally regulate the medical use of marijuana. - This crisis shows the need for well-designed regulation with proper implementation, including guidelines and training on prescription, and regular monitoring. The aim is to achieve the right balance in regulation to provide effective and adequate pain care, while minimizing opportunities for misuse of these medications. This includes improving the regulation of relationships between the pharmaceutical industries on the one hand and doctors and lawmakers on the other, prescription guidelines that ensure adequate relief for pain patients, and training for physicians on evidence-based opioid prescribing, which is funded by neutral bodies. n Decide to de facto decriminalize drug use and possession for personal use at municipal, city or State/Province levels. Do not pursue such offenses so that people in need of health and social services can access them freely, easily, and without fear of legal coercion. - More research is needed in critical areas: -- The most effective treatments for addiction to prescription opioids -- The link between economic, physical and psychological problems and the opioid crisis ("crisis of despair"). -- The exact role of fentanyl and its derivatives in overdoses, especially how and when fentanyl is added and whether the distribution of test kits could play a positive role. While these recommendations, if followed, would help curb opioid-related mortality in the United States and Canada, underlying problems remain. The Global Commission on Drug Policy has consistently called for the decriminalization of personal use and possession, and for alternatives to punishment for non-violent, low-level actors in illicit drug markets. The criminalization of drug use and possession has little to no impact on the levels of drug use but instead encourages high-risk behaviors, such as unsafe injecting, and deters people in need of drug treatment from seeking it and from using other health services and harm reduction programs that would help them. The health, economic and social benefits of decriminalization have been shown in countries that took this step decades ago. Details: Geneva, SWIT: The Commission, 2017. 20p. Source: Internet Resource: Position Paper: Accessed October 10, 2017 at: http://www.globalcommissionondrugs.org/wp-content/uploads/2017/09/2017-GCDP-Position-Paper-Opioid-Crisis-ENG.pdf Year: 2017 Country: United States URL: http://www.globalcommissionondrugs.org/wp-content/uploads/2017/09/2017-GCDP-Position-Paper-Opioid-Crisis-ENG.pdf Shelf Number: 147644 Keywords: Drug Abuse and Addiction Drug Policy Drug Reform Opioids Prescription Drug Abuse |
Author: Pharmacists Mutual Insurance Company Title: 5 year analysis of Pharmacy Burglary and Robbery Experience Summary: Burglaries and robberies represent a significant expense to pharmacies in the United States. Beyond direct insurance costs, which are driven by loss experience, pharmacists experience financial, business interruption and psychological costs. Pharmacists are concerned about armed robberies, and even finding that a store has been burglarized overnight can be upsetting and cause the expenditure of thousands of dollars in an effort to prevent reoccurrence. Beyond what is covered by insurance, customers pay deductibles that can easily be exceeded as a result of criminal efforts to gain entrance. Pharmacists that are victimized face hours of dealing with police, the DEA, board of pharmacy, contractors and their insurance company. As state and national efforts increase to address the underlying problem of prescription drug diversion, pharmacists face increasing administrative and regulatory compliance costs. When we seek methods to effectively combat the problem, it is important to understand the larger problem of prescription drug diversion and how it fuels pharmacy burglaries and robberies. Described by the Centers for Disease Control as having reached epidemic proportions in the United States, demand for prescription narcotics, coupled with a widely available supply, create an environment that is ripe for criminal activity. While the U.S. represents only 4.6% of the world's population, we consume 80% of the global opioid supply Five million Americans use opioid painkillers for non-medical use We experience almost 17,000 deaths from prescription narcotic overdoses annually. In a 4 year period, more deaths than we experienced in the Vietnam War. Morphine production was at 96 milligrams per person in 1997. By 2009, that number increased by 8 fold. The origins of the problem are complex, but are based on a cycle of over-prescribing that has occurred over the past two decades. While well intentioned, liberal prescribing coupled with aggressive marketing, incentives and even encouragement to physicians to relieve pain at all costs sparked the fire. Unchecked by adequate physician education on drug diversion and dependency, and a lack of appropriate chronic pain management protocols, demand and dependency increased. As demand increased, so did production levels, opportunities for profit and creative methods of diversion. Pharmacy crime involves every part of the distribution chain from manufacture through wholesale, retail, and ultimately to the end user. Pharmacists have been victims of deceptive practices, prescription fraud, employee diversion, burglaries and robberies. According to the Centers for Disease Control, prescription drug diversion, measured by drug overdose deaths and pharmacy crime, are at epidemic proportions. Details: Algona, IA: Pharmacists Mutual Insurance Company, 2013. 13p. Source: Internet Resource: Accessed October 18, 2017 at: https://www.videofied.com/_asset/tqrmk5/Pharmacy-5yr-Crime-Analysis.pdf Year: 2013 Country: United States URL: https://www.videofied.com/_asset/tqrmk5/Pharmacy-5yr-Crime-Analysis.pdf Shelf Number: 147723 Keywords: BurglaryPharmacy CrimePrescription Drug AbuseRetail CrimeRobberies |
Author: Independent Broad-based Anti-corruption Commission Title: Operation Tone: Special report concerning drug use and associated corrupt conduct involving Ambulance Victoria paramedics Summary: The Victorian community places great trust in paramedics. Paramedics are often among the first to arrive at the scene of an emergency and are responsible for treating and stabilising patients. They have access to an array of powerful, prescription medications that they can administer (in accordance with clinical guidelines) depending on a patient's needs and circumstances. Victorians rightfully expect that paramedics will demonstrate professionalism and expertise in carrying out their duty of care to patients. This report concerns an investigation by the Independent Broad-based Anti-corruption Commission (IBAC) into allegations that Ambulance Victoria (AV) paramedics engaged in serious corrupt conduct, namely the theft, trafficking and use of drugs of dependence, and misappropriation of AV equipment. Many paramedics are exemplars of their profession. However, Operation Tone has identified a culture of illicit drug use and misappropriation of AV equipment by individuals and among certain groups, particularly in the Barwon South West region. Based on evidence obtained during the investigation, IBAC believes it is probable that this conduct occurs beyond that identified in this investigation. Illicit drug use by paramedics is concerning on several fronts: - Illicit drug use, possession and trafficking are criminal offences and contravene the Code of Conduct for Victorian Public Sector Employees and the AV Workplace Conduct Policy. A paramedic who procures and uses illicit drugs is, by definition, engaging in criminal conduct. - The use of drugs of dependence undermines the safety of the Victorian community. It is imperative that a paramedic's judgement and performance not be impaired by illicit drugs, particularly when they are dealing with patients. The use of drugs of dependence also poses a safety risk for individual users and their AV colleagues. Since 2012, fentanyl or morphine have been involved in three paramedic deaths in Victoria. - The use of drugs of dependence erodes public confidence in AV. AV has proactively responded to the vulnerabilities identified in Operation Tone. When IBAC commenced its investigation in November 2015, AV's capacity to identify and expose at-risk paramedics was initially limited. During IBAC's investigation, AV introduced new policies and practices to minimise opportunities for the possession, use and misappropriation of drugs of dependence. New AV policies and practices also limit the opportunity for misappropriation of AV equipment. AV has advised it accepts the content of this report and the recommendations made. AV also advised it has continued to implement initiatives to address illicit drug use and misuse of drugs of dependence since the completion of IBAC's investigation. During Operation Tone, one paramedic was terminated and eight paramedics resigned while under investigation. Six paramedics retained their employment with a formal warning; of these, five were relocated to different regions for varying periods, were enrolled in an ethics counselling course, and precluded from development opportunities for 12 months. Following the IBAC investigation, one witness pleaded guilty in the Geelong Magistrates. Court to breaching a confidentiality nottice and misleading IBAC, and was fined $5000. Details: Melbourne: The Commission, 2017. 38p. Source: Internet Resource: Accessed November 13, 2017 at: http://www.ibac.vic.gov.au/docs/default-source/special-reports/operation-tone-special-report-september-2017.pdf?sfvrsn=2 Year: 2017 Country: Australia URL: http://www.ibac.vic.gov.au/docs/default-source/special-reports/operation-tone-special-report-september-2017.pdf?sfvrsn=2 Shelf Number: 148138 Keywords: CorruptionDrug AbuseDrug TraffickingEmployee MisconductIllicit Drug UsePrescription Drug Abuse |
Author: Police Executive Research Forum Title: The Unprecedented Opioid Epidemic: As Overdoses Become a Leading Cause of Death, Police, Sheriffs, and Health Agencies Must Step Up Their Response Summary: Consider the following pieces of information: - In Philadelphia, 35 people died of heroin overdoses in less than a week last December. - In New York City, fatal drug overdoses, which numbered 1,374 in 2016, are four times more common than homicides. The police are moving mountains to analyze overdose cases quickly, in order to stop the fatalities when an extremely powerful batch of heroin or fentanyl hits the streets. - In Louisville, Kentucky, police had 52 overdose calls over a 32-hour period last February. On average, police save someone's live with naloxone about twice a day, and one person dies from an overdose every day. - In Cabell County, West Virginia, officials reported 26 drug overdoses in a five-hour period, due to a batch of heroin containing fentanyl. The county reported the highest overdose death rate in the state, with 132 deaths among a population of less than 100,000. - In Ohio, the state with the most overdose deaths, an average of 11 people died every 24 hours in 2016, and coroners report that the numbers for 2017 are even higher. In Akron, 16 drug dealers have been sentenced to long prison terms because their product was linked to fatal overdoses, but the police chief doesn't think those prosecutions have "sent a message" to other dealers or slowed down the heroin trafficking. - In Cook County, Illinois, where Chicago and some of its suburbs are located, fentanyl took hold with a vengeance in 2016, causing more than 560 fatal overdoses. When Chicago's opioid overdoses are laid out on a map of the city, it correlates closely with the locations of shootings, prompting one police official to note that "our violent crime problem is our drug problem." - In New Jersey, crime labs have backlogs, but they find a way to turn heroin analyses around in a matter of hours if fatalities are involved. - In Baltimore, where 694 people suffered fatal overdoses in 2016, the Health Department is very concerned about the high likelihood that prescription opioid pills will lead to more cases of heroin addiction. So it is taking action. The Health Department is asking doctors to provide a prescription for naloxone along with every prescription they write for opioid pain pills. The idea is that doctors will think twice about prescribing oxycodone if they have to tell their patients, "Here's a prescription for your shoulder pain. And this other prescription is in case you end up having a heroin overdose." These are a few of the stories that you will find in the report you are holding. This is PERF's third major report about the epidemic of overdoses by persons addicted to opioid drugs. In 2014 and again in 2016, we held national conferences and released reports about the crisis, focusing on what local police and other agencies were doing to reduce the carnage. This new report summarizes what we learned at a third national PERF conference, held at the New York City Police Department's headquarters in April 2017. The reason PERF continues to focus on the opioids crisis is that despite the groundbreaking work that police and other agencies are doing, the epidemic is continuing to worsen. The latest numbers, released by the Centers for Disease Control and Prevention (CDC) in August 2017, are horrible. Drug overdose deaths in 2016 totaled 64,070, a 21-percent increase over the year before. And approximately three-fourths of all drug overdose deaths are caused by opioid drugs. Let's put those numbers in context: - The 64,070 drug fatalities in 2016 outnumber the 35,092 motor vehicle fatalities in 2015. - Drug fatalities in 2016 outnumber American fatalities in the entire course of the Vietnam War, which totaled 58,200. - Drug fatalities in 2016 outnumber AIDS-related deaths in the worst year of the HIV epidemic, when 50,628 people died in 1995. - Drug fatalities in 2016 outnumber the peak year of homicides in the United States, when 24,703 people were murdered in 1991. - Drug fatalities in 2016 outnumber suicides, which have been increasing for nearly 30 years and which totaled 44,193 in 2015. Furthermore, the new CDC statistics confirm what police chiefs have been telling us-Fentanyl is driving the sharp increases in opioid-related fatalities. CDC identified 15,466 fatalities in 2016 resulting from heroin overdoses, but 20,145 fatalities caused by fentanyl or other synthetic opioids. So it is clear that police and other criminal justice agencies, along with public health departments, drug treatment and social service providers, elected officials, and others, must step up their efforts to prevent new cases of opioid addiction, while helping addicted persons through the long and difficult process of getting free of opioid drugs. Details: Washington, DC: PERF, 2017. 92p. Source: Internet Resource: Accessed April 12, 2018 at: http://www.policeforum.org/assets/opioids2017.pdf Year: 2017 Country: United States URL: http://www.policeforum.org/assets/opioids2017.pdf Shelf Number: 149796 Keywords: Drug Abuse and AddictionDrug-Related DeathsOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: King County Heroin and Prescription Opiate Addiction Task Force Final Report and Recommendations Title: Heroin and Prescription Opiate Addiction Task Force: Final Report and Recommendations Summary: Heroin and opioid use are at crisis levels in King County. In 2015, 229 individuals died from heroin and prescription opioid overdose in King County alone. To confront this crisis, in March 2016, King County Executive Dow Constantine, Seattle Mayor Ed Murray, Renton Mayor Denis Law and Auburn Mayor Nancy Backus convened the Heroin and Prescription Opiate Addiction Task Force. The Task Force, co-chaired by the King County Department of Community and Human Services and Public Health - Seattle & King County, was charged with developing both short and long-term strategies to prevent opioid use disorder, prevent overdose, and improve access to treatment and other supportive services for individuals experiencing opioid use disorder. The Heroin and Prescription Opiate Addiction Task Force met over a six month period from March to September 2016 to review 1) current local, state and federal initiatives and activities related to prevention, treatment and health services for individuals experiencing opioid use disorder; 2) promising strategies being developed and implemented in other communities; and 3) evidence-based practice in the areas of prevention, treatment and health services. The Task Force strived to avoid redundancy with other related activities and to leverage existing partnerships and activities where appropriate. Additionally, the Task Force applied an equity and social justice lens to the work to ensure that recommendations do not exacerbate, but rather lessen, inequities experienced by communities of color as a direct result of the "War on Drugs." This report provides a summary of the group's recommendations to both prevent opioid addiction and improve opioid use disorder outcomes in King County. Details: Seattle: The Task Force, 2016. 101p. Source: Internet Resource: Accessed May 4, 2018 at: https://www.kingcounty.gov/~/media/depts/community-human-services/behavioral-health/documents/herointf/Final-Heroin-Opiate-Addiction-Task-_Force-Report.ashx Year: 2016 Country: United States URL: https://www.kingcounty.gov/~/media/depts/community-human-services/behavioral-health/documents/herointf/Final-Heroin-Opiate-Addiction-Task-_Force-Report.ashx Shelf Number: 150055 Keywords: Drug Abuse and AddictionDrug TreatmentOpiatesPrescription Drug AbuseSubstance Abuse Treatment |
Author: Sacco, Lisa N. Title: Prescription Drug Monitoring Programs Summary: In the midst of national concern over the opioid epidemic, federal and state officials are paying greater attention to the manner in which opioids are prescribed. Nearly all prescription drugs involved in overdoses are originally prescribed by a physician (rather than, for example, being stolen from pharmacies). Thus, attention has been directed toward better understanding how opioids are being prescribed and preventing the diversion of prescription drugs after the prescriptions are dispensed. Prescription drug monitoring programs (PDMPs) maintain statewide electronic databases of prescriptions dispensed for controlled substances (i.e., prescription drugs with a potential for abuse that are subject to stricter government regulation). Information collected by PDMPs may be used to educate and inform prescribers, pharmacists, and the public; identify or prevent drug abuse and diversion; facilitate the identification of prescription drug-addicted individuals and enable intervention and treatment; outline drug use and abuse trends to inform public health initiatives; or educate individuals about prescription drug use, abuse, diversion, and PDMPs themselves. As of February 2018, 50 states, the District of Columbia, and two territories (Guam and Puerto Rico) had operational PDMPs within their borders. How PDMPs are organized and operated varies among states. Each state determines which agency houses the PDMP; which controlled substances must be reported; which types of dispensers (e.g., pharmacies) are required to submit data; how often data are collected; who may access information in the PDMP database (e.g., prescribers, dispensers, or law enforcement); the circumstances under which the information may (or must) be accessed; and what enforcement mechanisms are in place for noncompliance. PDMP costs may vary widely, with startup costs that can range as high as $450,000 to over $1.5 million and annual operating costs ranging from $125,000 to nearly $1.0 million. States finance PDMPs using monies from a variety of sources including the state general fund, prescriber and pharmacy licensing fees, state controlled substance registration fees, health insurers' fees, directsupport organizations, state grants, and/or federal grants. The federal government supports state PDMPs through programs at the Departments of Justice (DOJ) and Health and Human Services (HHS). Since FY2002, DOJ has administered the Harold Rogers Prescription Drug Monitoring Program, and in FY2017, DOJ incorporated this grant program into the new Comprehensive Opioid Abuse Program. HHS programs include National All Schedules Prescription Electronic Reporting (NASPER), State Demonstration Grants for Comprehensive Opioid Abuse Response, Opioid Prevention in States grants, State Targeted Response to the Opioid Crisis Grants, and various pilots and initiatives under the Office of the National Coordinator for Health Information Technology (ONC). Of note, NASPER last received appropriations (of $2.0 million) in FY2010. State PDMPs vary with respect to whether or how information contained in the database is shared with other states. Federal policymakers have repeatedly emphasized the importance of enhancing interstate information sharing and the interoperability of state PDMPs. In 2011, the Obama Administration included efforts to increase interstate data sharing in its action plan to counter prescription drug abuse. In 2017, a presidential commission recommended, among other things, that the Trump Administration support legislation to require DOJ to fund a "data-sharing hub" and require states receiving federal grant funds to share PDMP data. Details: Washington, DC: Congressional Research Service, 2018. 34p. Source: Internet Resource: R42593: Accessed May 25, 2018 at: https://fas.org/sgp/crs/misc/R42593.pdf Year: 2018 Country: United States URL: https://fas.org/sgp/crs/misc/R42593.pdf Shelf Number: 150372 Keywords: Drug Abuse and AddictionDrug Abuse PolicyDrug Abuse PreventionDrug RegulationOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: Minnesota Department of Health Title: Patterns of Opioid Prescribing in Minnesota: 2012 and 2015 Summary: Opioids are a class of drugs that include prescription opioid medications for pain relief - such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and fentanyl- as well as illicitly produced drugs like heroin and fentanyl-related substances (also called fentanyl analogs). While prescription opioids play a role in the management of some types of severe acute, cancer-related and end-of-life pain, increased opioid use since 1990, including for chronic pain unrelated to cancer, has resulted in sharply rising opioid addiction and overdoses, as well as increased healthcare utilization and costs. Recent Centers for Disease Control and Prevention (CDC) guidelines point out the limitations of the evidence base in support of opioid therapy for pain, recommend non-opioid therapy for chronic pain, and emphasize the risks associated with opioid therapy. In Minnesota, opioids-both prescription and illicit-were responsible for 336 overdose deaths in 2015, more than a six-fold increase since 2000. In 2016, opioid use accounted for 395 overdose deaths in Minnesota-a one-year increase of nearly 18 percent. Forty-nine percent of the opioid overdose deaths in Minnesota in 2016 were from prescription opioids. In addition to overdose deaths, opioids play a causal role in other deaths, including automobile accidents. As Minnesota, like other states, struggles with the economic, community and individual impacts of the opioid epidemic, this issue brief looks to bring new empirical evidence specific to Minnesota to discussions about the shape of the problem, contributing factors, and options for addressing them. This issue brief focuses on opioid prescription patterns among Minnesotans with private or public insurance coverage in 2012 and 2015. We explore opioid prescription trends by payer, patients' diagnoses preceding a prescription opioid fill, number of prescribers, and patients' geographic location. The results may offer insights to policy makers and payers about opportunities Key Findings: - Overall rates of opioid prescribing declined in Minnesota from 2012 to 2015, but the morphine milligram equivalents (MME) per prescription increased. - Medicare and Medicaid, where eligibility is determined by age, disability status, and/or income, covered approximately one-third of Minnesotans with general health coverage and accounted for two-thirds of opioid prescriptions filled in 2015. - Nearly one in three Minnesotans with an opioid prescription in 2015 had multiple prescribers. - In both 2012 and 2015, 6 in 10 opioid prescriptions were filled within 15 days of the patient's last medical visit; however, 1 in 10 opioid prescriptions were filled without a medical visit in the past 90 days, suggesting closer patient-prescriber communication or opioid oversight may be needed in some cases. - Prescription opioid use varied across counties. In some counties, prescription opioid use in 2015 was over times the statewide average of 523 MME per resident. to reduce unnecessary use and overuse of prescription opioids. They may also help identify additional analytic questions and contribute to assessments of the impact of policy changes currently debated by the Minnesota Legislature. Details: St. Paul, MN: The Department, 2018. 15p., app. Source: Internet Resource: Accessed May 30, 2018 at: http://www.health.state.mn.us/divs/hpsc/hep/publications/opioidbrief20185.pdf Year: 2018 Country: United States URL: http://www.health.state.mn.us/divs/hpsc/hep/publications/opioidbrief20185.pdf Shelf Number: 150407 Keywords: Drug Abuse and AdditionOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: U.S. Department of Health and Human Services. Office on Women's Health Title: Final Report: Opioid Use, Misuse, and Overdose in Women Summary: This report was developed as part of an initiative of the U.S. Department of Health and Human Services (HHS) Office on Women's Health (OWH) to examine prevention, treatment, and recovery issues for women who misuse opioids, have opioid use disorders (OUDs), and/or overdose on opioids. Since this work began in March 2015, OWH developed a White Paper: Opioid Use, Misuse, and Overdose in Women (https://www.womenshealth.gov/files/documents/white-paper-opioid-508.pdf) and convened a national meeting in September 2016 and a Region I (New England) meeting in October 2016 to discuss these critical issues. Opioids, both illegal (e.g., heroin, illicitly manufactured synthetic opioids) and legal (e.g., oxycodone, hydrocodone) are drugs that reduce the body's perception of pain. The Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5) defines opioid use disorder as a problematic pattern of opioid use leading to significant impairment or distress. Opioid use disorder is increasing at alarming rates for both men and women in the United States. While the epidemic is being addressed at many different levels, much still needs to be done. The prevalence of prescription opioid and heroin use among women is substantial. Between 1999 and 2015, the rate of deaths from prescription opioid overdoses increased 471 percent among women, compared to an increase of 218 percent among men, and heroin deaths among women increased at more than twice the rate than among men. Most alarmingly, there has been a startling increase in the rates of synthetic opioid-related deaths; these deaths increased 850 percent in women between 1999 and 2015. At the same time, the differences between how opioid misuse and use disorder impact women and men are often not well understood. Even in areas where differences between the sexes are apparent, such as women appearing to progress more quickly to addiction than men, very little is understood about why those differences occur. This Report highlights the key background and findings from the white paper, provides a summary of the September 2016 national meeting, and concludes with a section focused on findings and takeaways from both the national and regional meetings. Details: Washington, DC: The Office of Women's Health, 2017. 87p. Source: Internet Resource: Accessed June 8, 2018 at: https://www.womenshealth.gov/files/documents/final-report-opioid-508.pdf Year: 2017 Country: United States URL: https://www.womenshealth.gov/files/documents/final-report-opioid-508.pdf Shelf Number: 150515 Keywords: Drug Abuse and Addiction Drug Policy Drug Treatment Opioid Epidemic Opioids Prescription Drug AbusePublic Health |
Author: Reichert, Jessica Title: Opioid Prescribing in Illinois: Examining Prescription Drug Monitoring Program Data Summary: Almost three times as many opioids are prescribed in the United States today as compared to 1999. Health care practitioners wrote 259 million prescriptions for opioid pain medication in 2012, which is enough to provide a full bottle of pills for almost every adult in the country. An estimated one in five patients with pain symptoms who go to their doctor's office receive an opioid prescription. In a 2015 national survey, 13 percent of adults who report taking prescription opioids also reported misuse (defined as non-medical use). Of those, 41 percent obtained opioids for free from friends or relatives. Illinois opioid prescribing is relatively low compared to other states. According to the Centers for Disease Control and Prevention, Illinois ranked 41st out of 50 states and District of Columbia on opioid prescription totals. However, prescription rates vary greatly by county, city, and medical practitioner. This article describes Illinois opioid prescription practices using Illinois Prescription Monitoring Program (ILPMP) data, focusing on trends and prescribing variations by county. A review of available research on the association between opioid prescribing, opioid misuse, and opioid use disorders also is summarized. Policy and practice implications also are included. Details: Chicago: Illinois Criminal Justice Information Authority, 2018. 21p. Source: Internet Resource: Accessed July 2, 2018 at: http://www.icjia.state.il.us/assets/articles/PMP_Article_050918.pdf Year: 2018 Country: United States URL: http://www.icjia.state.il.us/assets/articles/PMP_Article_050918.pdf Shelf Number: 150756 Keywords: Drug Abuse and AddictionOpioid EpidemicOpioidsPrescription Drug AbusePrescription Drug Monitoring |
Author: Sullivan, Riley Title: The Fiscal Impact of the Opioid Epidemic in the New England States Summary: The rise in the abuse of-and addiction to-opioids and the rapid increase in the number of fatal overdoses in recent years have made the opioid epidemic a priority for local, state, and federal policymakers. Understanding the epidemic's direct fiscal impact is key to acknowledging its scope and magnitude. While opioid abuse has many direct and indirect fiscal costs, few studies quantify them. This report assembles available data on the impact of opioid epidemic on criminal justice, treatment, and related health expenditures in the New England states. The research finds that state governments in the region spend a higher percentage on total opioid-related costs and more per capita than the national averages. Across the region, treating opioid-use disorder-on both an emergency and a long-term basis-accounts for the majority of the costs. Estimates for medical treatment expenditures associated with opioid abuse reach as high as $340 million annually in Massachusetts alone. While providing new insight the author acknowledges that the costs considered in this policy report are incomplete. It's plausible that the opioid epidemic's impact on state revenues is also significant and could affect regional fiscal health. For example, individuals incarcerated for drug crimes or in residential treatment programs are not earning wages. Evidence also suggests that non-institutionalized individuals abusing opioids are more likely out of work than employed, likewise resulting in lost revenue (Krueger 2017). The author plans to conduct further research on opioid abuse's impact on employment and labor force participation, which should contribute to a fuller understanding of the epidemic's fiscal cost to the region. However, beyond the fiscal cost is the toll opioid abuse has taken on individuals, families, and communities. The costs analyzed in this report are just a small part of the greater damage inflicted across the region and the country. Details: Boston: New England Public Policy Center; Federal Reserve Bank of Boston: 2018. 28p. Source: Internet Resource: Policy Report 18-1: Accessed July 9, 2018 at: https://www.bostonfed.org/publications/new-england-public-policy-center-policy-report/2018/the-fiscal-impact-of-the-opioid-epidemic-in-the-new-england-states.aspx#collapse2 Year: 2018 Country: United States URL: https://www.bostonfed.org/publications/new-england-public-policy-center-policy-report/2018/the-fiscal-impact-of-the-opioid-epidemic-in-the-new-england-states.aspx#collapse2 Shelf Number: 150778 Keywords: Cost AnalysisCosts of Criminal JusticeDrug Abuse and AddictionDrug Abuse TreatmentOpioid CrisisOpioid EpidemicOpioidsPrescription Drug Abuse |
Author: Ghertner, Robin Title: The Opioid Crisis and Economic Opportunity: Geographic and Economic Trends Summary: This study examines relationships between indicators of economic opportunity and the prevalence of prescription opioids and substance use in the United States. Overall, areas with lower economic opportunity are disproportionately affected by the opioid crisis. However, the extent of that relationship varies regionally. (1) The prevalence of drug overdose deaths and opioid prescriptions has risen unevenly across the county, with rural areas more heavily affected. Specific geographic areas, such as Appalachia, parts of the West and the Midwest, and New England, have seen higher prevalence than other areas. (2) Poverty, unemployment rates, and the employment-to-population ratio are highly correlated with the prevalence of prescription opioids and with substance use measures. On average, counties with worse economic prospects are more likely to have higher rates of opioid prescriptions, opioid-related hospitalizations, and drug overdose deaths. (3) Some high-poverty regions of the country were relatively isolated from the opioid epidemic, as shown by our substance use measures, as of 2016 Details: Washington, DC: U.S. Department of Health and Human Services, 2018. 21p. Source: Internet Research: ASPE Research Brief: Accessed July 10, 2018 at: https://aspe.hhs.gov/system/files/pdf/259261/ASPEEconomicOpportunityOpioidCrisis.pdf Year: 2018 Country: United States URL: https://aspe.hhs.gov/system/files/pdf/259261/ASPEEconomicOpportunityOpioidCrisis.pdf Shelf Number: 150798 Keywords: Drug Abuse and Addiction Economic Analysis Opioid Epidemic Opioids Prescription Drug Abuse |
Author: Wambeam, Rodney Title: Telling the Story of Opioid Use in Wyoming Summary: The State Epidemiological and Outcomes Workgroup (SEOW) strives to provide public health stakeholders with data to inform decisions and policies. It is imperative to investigate the unique version of the opioid crisis that is happening in the state of Wyoming and respond with data-driven decisions, as well as targeted strategies and solutions for prevention and treatment. Historically opioids have been used as painkillers, but they also have great potential for misuse. Opioids are a class of drugs that include the illegal drug heroin, and legally available pain relievers by prescription such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and many others. Not all of the data presented in this report is specifically for prescription opioids. Some of the data, such as the hospital data, includes all opioids, both prescription and illicit. Some of the data represents Schedule II drugs, which the Drug Enforcement Administration (DEA) classifies as drugs that have an accepted medical use, but also have an elevated potential for abuse and addiction (e.g., oxycodone, diazepam). Data from the Wyoming surveys ask about "prescription drugs" more generally, which would include other prescriptions such as depressants (Valium, Xanax, etc.) and stimulants (Adderall and Ritalin, etc.). Several opioid data sources, currently available in Wyoming, can assist with tracking opioid misuse and abuse across the state. Evaluators at the Wyoming Survey & Analysis Center (WYSAC) have presented the results of the data inventory throughout this report organized by opioid-related indicators, with key findings and general notes about the data source listed. Additionally, descriptive information about and external links to each data source are catalogued in the appendix. National data are presented here, as well as state and some local level data. When possible, the state data are compared to the national data. The multiple indicators throughout this report address both consumption rates and related consequences of opioid use and abuse. Self-reported nonmedical use of prescription drugs stems from both national and state surveys administered to adults and youth. In addition, poisoning deaths and opioid drug-related poisonings provide further insight into the consequences that may result from opioid use and abuse. Finally, we also examine the amount of opioids dispensed/prescribed in the state through the Automation of Reports and Consolidated Orders System (ARCOS) data, the Wyoming Prescription Drug Monitoring Program (PDMP) data, and recently released opioid prescribing data. However, it should be noted that these measures are not a direct correlate of opioid use or abuse, as there are legitimate medical uses for opioids. According to data from the National Survey of Drug Use and Health (NSDUH), Wyoming is generally below the national average in prescription drug misuse among individuals ages 12 and up. In Wyoming, prescription drug misuse is most common among young adults ages 18- 25, though rates are decreasing both among this age group and school-age students. Of young adults that report misusing prescription opioids, most deny use in the previous month. Among school-age children, some counties exceed the state average for prescription drug misuse among students in middle school (i.e., Campbell, Fremont, Natrona, Platte, and Washakie) and high school (i.e., Campbell, Carbon, Fremont, Goshen, Hot Springs, Park, Teton, Uinta, and Weston). Wyoming has a stabilizing rate of poisonings deaths due to opioids while the nation continues to increase. Carbon County reports the highest rate of opioid-related inpatient discharges. Though Wyoming is below the national average for prescription drug misuse, Wyoming generally exceeds the national average in opioid prescribing rates. Alternatively, Wyoming is below the national average in morphine milligram equivalent doses distributed per capita, though this gap is closing. Finally, two counties in Wyoming fill more prescriptions than people residing in that county (Uinta and Hot Springs), and one county prescribes more opioids than people in that county (Uinta). However, the Wyoming State Hospital, which provides quality active treatment for a variety of mental disorders, is located in Uinta County, which could explain the higher number of prescriptions fills. Schedule II prescription drug fills slightly decreased from 2014 to 2015. Details: Laramie, WY: Wyoming Survey and Analysis Center, 2019. 28p. Source: Internet Resource: Accessed September 6, 2018 at: https://wysac.uwyo.edu/wysac/reports/View/6665 Year: 2018 Country: United States URL: https://wysac.uwyo.edu/wysac/reports/View/6665 Shelf Number: 151403 Keywords: Drug Abuse and Addiction Opioid Epidemic Opioids Prescription Drug Abuse |
Author: Australian Institute of Health and Welfare Title: Opioid harm in Australia: and comparisons between Australia and Canada Summary: Locally and internationally, the rising use of opioids is a cause of concern. All opioids-including codeine-can be addictive and their use can result in dependence, accidental overdose, hospitalisation or death. This report brings together information from a range of data sources to tell the national story of opioid use and its harmful effects. It is the first time that the AIHW has produced such a comprehensive report that presents current national data and trends on opioid use and harms in Australia. The report also presents findings from a collaboration between the AIHW and the Canadian Institute for Health Information (CIHI). This includes comparisons between ED presentations and hospitalisations in Australia and Canada, where possible, and discussion of the benefits and challenges of international collaboration. In Australia in 2016-17, 3.1 million people had 1 or more prescriptions dispensed for opioids (most commonly for oxycodone); about 40,000 people used Heroin; and about 715,000 people used Pain-killers/analgesics and pharmaceutical opioids for illicit or non-medical purposes. Opioid deaths and poisoning hospitalisations have increased in the last 10 years Legal or pharmaceutical opioids (including codeine and oxycodone) are responsible for far more deaths and poisoning hospitalisations than illegal opioids (such as heroin). Every day in Australia, nearly 150 hospitalisations and 14 emergency department (ED) presentations involve opioid harm, and 3 people die from drug-induced deaths involving opioid use. In 2016, the number of opioid deaths (1,119) was the highest number since the peak in 1999 (1,245 deaths). After 1999, the number of deaths fell to a low of 439 in 2006, then began to climb again. In 2016, opioid deaths accounted for 62% of all drug-induced deaths. From 2007 to 2016, after adjusting for differences in the age structure of the population, the rate of opioid deaths increased by 62%, from 2.9 to 4.7 deaths per 100,000 population. The increase was driven by an increase in accidental opioid deaths and in pharmaceutical opioid deaths. Similarly, from 2007-08 to 2016-17, after adjusting for age, the rate of hospitalisations per 100,000 population with a principal diagnosis (main reason for hospitalisation) of opioid poisoning increased by 25%, while the rate of hospitalisations with any diagnosis (all reasons for hospitalisation) of opioid poisoning increased by 38%. Pharmaceutical opioids are responsible for more opioid deaths and poisoning hospitalisations than heroin In 2016, the most commonly mentioned opioid in opioid deaths was Naturally derived opioids (for example, oxycodone, codeine and morphine), which was mentioned in 49% of opioid deaths. Similarly, in 2016-17, hospitalisations with a principal diagnosis of opioid poisoning were more likely to involve pharmaceutical opioids than heroin or opium. The rate per 100,000 for those by Naturally derived opioids was more than twice as high as for those by Heroin. More opioid prescriptions were dispensed but on average prescriptions were for lower doses and/or quantities In 2016-17, 15.4 million opioid prescriptions were dispensed under the Pharmaceutical Benefits Scheme (PBS) to 3.1 million people. The oral morphine equivalent (OME) is a measure of opioid use that adjusts for the difference in potency between different opioids. It converts the amount of each opioid dispensed to the amount of oral morphine that would be required to produce the same pain-relieving effect. After adjusting for differences in the age structure of the population, from 2012-13 to 2016-17, although there was a rise in the rate of prescriptions dispensed per 100,000 population and the number of people per 100,000 population receiving them (9% and 4% respectively), the OME stayed the same over the same period (989 to 987 OME mg per 1,000 population per day)-on average, the prescriptions dispensed were for lower doses and/or quantities. Oxycodone and codeine most commonly dispensed opioids -- Oxycodone was the most commonly dispensed prescription opioid in 2016-17, with 5.7 million prescriptions dispensed to 1.3 million people, followed by codeine (3.7 million prescriptions to 1.7 million people) and tramadol (2.7 million prescriptions to 600,000 people). Similar to the results for all opioid prescriptions dispensed, on average prescriptions dispensed for oxycodone were for lower doses and/or quantities. After adjusting for differences in the age structure of the population over time, from 2012-13 to 2016-17 there was approximately a 30% rise in both the number of oxycodone prescriptions dispensed per 100,000 population and the number of people receiving them per 100,000 population, but the OME over the same period remained the same (338 to 340 OME mg for oxycodone per 1,000 population per day). Higher rates of OME for opioids dispensed in Inner regional and Outer regional areas -- After adjusting for differences in the age structure of the population, the total number of prescriptions dispensed per 100,000 population was highest for Inner regional areas (74,000 per 100,000 population) and lowest for Very remote areas (38,000 per 100,000 population). The rate of OME was also highest for Inner regional areas (1,374 OME mg per 1,000 population per day), followed closely by Outer regional areas (1,362 OME mg per 1,000 population per day). These rates of OMEs are 2 times higher than in Very remote areas, which at 645 OME mg per 1,000 population per day was the lowest of all areas. 1 in 10 Australians have ever used any type of opioid for illicit or non-medical purposes In 2016, around 1 in 10 (11%) of Australians aged 14 and over had ever used at least 1 type of opioid for illicit or non-medical purposes; recent use (that is, use in the last 12 months) was much lower, at 3.7%. Most had used pharmaceutical opioids rather than illegal opioids, with 9.7% having ever used Pain-killers/analgesics and pharmaceutical opioids, compared with 1.3% who had ever used Heroin. Of people who reported non-medical use of Pain-killers/analgesics and pharmaceutical opioids, 75% had used Over-the-counter codeine products, 40% had used Prescription codeine products and 17% had used Oxycodone. Opioid use varies between Australia and Canada -- Both Australia and Canada have government-funded pharmaceuticals. Overall, there was a downward trend in both countries in the total average opioid dosage (the defined daily dose or DDD) per 1,000 people, per day prescribed in the 5 years to 2016-17. However there were slight differences in the types of opioids prescribed, with the DDD rate for hydromorphone substantially higher in Canada, and the DDD rate for tramadol and buprenorphine higher in Australia. Both countries had a similar DDD rate for fentanyl. Illicit use of fentanyl is more common in Canada than it is in Australia, while heroin use is comparatively higher in Australia than in Canada. The impact of this difference is that people using these different drugs-while they are all opioids-have different trajectories and contact with the acute care system. Fentanyl is more potent than heroin and has a greater potential to be lethal, meaning many users die before they can receive acute care. Side effects from opioid use are responsible for the greatest number of hospitalisations in both Canada and Australia Despite differences in the rates of hospital care in Australia and Canada for opioid harms-due in part to differences in systems and infrastructure for health services-there are similarities in the profiles of people most likely to receive hospital care for opioid harm. In both Australia and Canada, the greatest volume of harm treated in hospitals came from side effects from opioid use. The age distribution for people hospitalised for this reason was similar in Australia and Canada, with rates of hospitalisation increasing with increasing age, reflecting the rates of prescription opioids in both countries. Details: Canberra: AIHW, 2018. 130p. Source: Internet Resource: Accessed November 14, 2018 at: https://www.aihw.gov.au/getmedia/605a6cf8-6e53-488e-ac6e-925e9086df33/aihw-hse-210.pdf.aspx?inline=true Year: 2018 Country: Australia URL: https://www.aihw.gov.au/getmedia/605a6cf8-6e53-488e-ac6e-925e9086df33/aihw-hse-210.pdf.aspx?inline=true Shelf Number: 153417 Keywords: Drug Abuse and AddictionIllicit DrugsOpioid CrisisOpioid DeathsOpioids Prescription Drug Abuse Prescription Drugs |
Author: Kilmer, Beau Title: Considering Heroin-Assisted Treatment and Supervised Drug Consumption Sites in the United States Summary: Current levels of opioid-related morbidity and mortality in the United States are staggering. Data for 2017 indicate that there were more than 47,000 opioid-involved overdose deaths, and one in eight adults now reports having had a family member or close friend die from opioids. Increasing the availability and reducing the costs of approved medications for those with an opioid use disorder (OUD) is imperative; however, jurisdictions addressing OUDs and overdose may wish to consider additional interventions. Two interventions that are implemented in some other countries but not in the United States are heroin-assisted treatment (HAT; sometimes referred to as supervised injectable heroin treatment) and supervised consumption sites (SCSs; sometimes referred to as overdose prevention sites). Given the severity of the opioid crisis, there is urgency to evaluate tools that might reduce its impact and save lives. In this mixed-methods report, the authors assess evidence on and arguments made about HAT and SCSs and examine some of the issues associated with implementing them in the United States. Key Findings -- Evidence from randomized controlled trials of HAT in Canada and Europe indicates that supervised injectable HAT - with optional oral methadone - can offer benefits over oral methadone alone for treating OUD among individuals who have tried traditional treatment modalities, including methadone, multiple times but are still injecting heroin. Although heroin cannot be prescribed in the United States because it is a Schedule I drug, it would be legal to conduct a human research trial on HAT. The literature on treating OUD with hydromorphone (e.g., Dilaudid) is less extensive than the literature on HAT; however, the existing results are encouraging. Hydromorphone trials in the United States would face fewer barriers than HAT trials. The scientific evidence about the effectiveness of SCSs is limited in quality and the number of locations evaluated. Many SCSs have been around for 15 to 30 years. Persistence does not imply effectiveness, but it seems unlikely that these SCSs - which were initially controversial in many places - would have such longevity if they had serious adverse consequences for their clients or communities. For drug consumption that is supervised, SCSs reduce the risk of a fatal overdose, disease transmission, and harms associated with unhygienic drug use practices; however, there is uncertainty about the size of the population-level effects of SCSs. There are significant legal issues surrounding the implementation of SCSs in the United States.. Both HAT and SCSs, as currently implemented, serve only a small share of people who use heroin. It is important to have a sense of potential scale limitations and costs when discussing HAT and SCSs. It might be constructive to view HAT and SCSs as exemplars of broader strategies, not as the only option within their class. Recommendations -- Given (1) the increased mortality associated with fentanyl, (2) the fact that some people who use heroin may not respond well to existing medications for OUD, (3) HAT's successful implementation abroad, and (4) questions concerning whether the success would carry over to the United States, HAT trials should be conducted in some of the U.S. jurisdictions that already provide a spectrum of social services and good accessibility to medication treatments for OUD. Conducting trials with HAT and hydromorphone are not mutually exclusive, and it may make sense to include both in the same study, as was done in Canada. Assessing the impact of injectable hydromorphone via clinical trials (with or without a HAT arm) would inform future regulatory decisions about using it as a medication treatment for OUD. Some researchers and advocates believe that, during an emergency like the present opioid crisis, the absence of a large downside risk for an intervention that has strong face validity (e.g., SCSs) may be sufficient for some decisionmakers to proceed, rather than waiting for further evidence. Nevertheless, if attempts to implement SCSs in the United States are successful, a strong research component should be incorporated into these efforts. Details: Santa Monica, CA: RAND, 2018. 93p. Source: Internet Resource: Accessed Dec. 6, 2018 at: https://www.rand.org/pubs/research_reports/RR2693.html?utm_source=WhatCountsEmail&utm_medium=Drug%20Policy%20Research%20Center%20(DPRC)+AEM:%20%20Email%20Address%20NOT%20LIKE%20DOTMIL&utm_campaign=AEM:363632650 Year: 2018 Country: United States URL: https://www.rand.org/pubs/research_reports/RR2693.html?utm_source=WhatCountsEmail&utm_medium=Drug%20Policy%20Research%20Center%20(DPRC)+AEM:%20%20Email%20Address%20NOT%20LIKE%20DOTMIL&utm_campaign=AEM:363632650 Shelf Number: 153920 Keywords: Drug Abuse and AddictionDrug Consumption FacilitiesDrug-Related DeathsFentanylOpioid EpidemicOpioidsPrescription Drug AbuseSubstance Abuse Treatment |
Author: Harris, Katharine Neill Title: The Drug Overdose Epidemic: Not Just about Opioids Summary: The rise in opioid-related overdose deaths in the last two decades is widely regarded as an epidemic that originated with the overprescribing of prescription pain relievers in the late 1990s. But a research study published in the September issue of Science suggests that the opioid overdose crisis is actually part of a larger trend that started 40 years ago. In the study, researchers mapped drug overdose deaths in the U.S. from 1979 through 2016. The authors analyzed data from the National Vital Statistics System on 599,255 deaths in which the main cause of death was listed as accidental drug poisoning. The authors found that drug overdose fatalities have been increasing dramatically since 1979, stating that "this exponentially increasing mortality rate has tracked along a remarkably smooth trajectory for at least 38 years," suggesting that "the current wave of opioid overdose deaths may just be the latest manifestation of a more fundamental longer term process." Within this broad trend of steady growth, there is significant variation in terms of the specific drugs involved and the populations most affected by drug overdose deaths. Currently, the population most at risk for cocaine overdose is aging black males living in urban counties, while methamphetamine-related deaths skew toward white and rural male populations. For opioid-related deaths, age is a defining feature of variation in risk patterns. Deaths involving heroin and synthetic opioids are higher for people between the ages of 20 and 40, especially white males living in urban counties. In contrast, prescription opioid deaths are higher among those 40 to 60 years old, especially white females living in rural counties. Nearly every region of the country, except for the northern Midwest, has been a "hot spot" for drug overdose deaths in the last few years. Despite some limitations, this analysis provides strong evidence for the existence of a protracted drug epidemic that requires both immediate and long-term interventions. The finding that the relatively recent increase in opioid-specific overdoses may be a particularly intense manifestation of a more persistent problem implies that a major feature of the government response to opioid-involved overdoses - restricting the supply of prescription painkillers - does little to stem the overall uptick in drug-related fatalities. The fact that the increase in overdose deaths has remained constant despite varying trends for specific drugs also suggests that factors often thought to drive the overdose epidemic, such as a rise in drug use or an overabundant drug supply, are not sufficient explanations. Details: Houston, TX: Rice University's Baker Institute for Public Policy, 2018. 5p. Source: Internet Resource: Accessed December 17, 2018 at: https://www.bakerinstitute.org/media/files/files/dc464f15/bi-brief-110118-drug-overdoseepidemic.pdf Year: 2018 Country: United States URL: https://www.bakerinstitute.org/media/files/files/dc464f15/bi-brief-110118-drug-overdoseepidemic.pdf Shelf Number: 153877 Keywords: Cocaine Drug OverdoseDrug UseMethamphetamineOpioid EpidemicOpioidsPrescription Drug AbuseRural CrimeSubstance Abuse |
Author: Larson, Sharon Title: Supervised Consumption Facilities -- Review of the Evidence Summary: The intent of this document is to: - Describe literature related to supervised consumption facilities as harm-reduction strategies in addressing overdose deaths, infections and community harms from heroin and other opioid use. - Apply estimates of outcomes from other communities to the City of Philadelphia's data, where data are available, to approximate the possible impact of a supervised consumption facility located where deaths from overdose have been most likely to occur. Background on the current crisis in opioid use and overdose deaths is reviewed in order to establish a context, at the national and local level, followed by a review of studies on the impacts on harm reduction from safe use consumption settings. The report then replicates models used to estimate the potential financial and health impacts of a supervised consumption facility in Philadelphia, in comparison to Baltimore and San Francisco, two cities whose officials are currently considering the implementation of a supervised consumption facility or facilities. The limitations on interpretation from these modeling approaches are discussed, and recommendations for metrics to be used in evaluation if the City determines to implement a supervised consumption facility are presented. Supervised consumption facilities (SCFs) around the world have reduced overdose deaths within their service areas[2]. These facilities generally are staffed with health professionals available to educate and respond to overdoses promptly. Moreover, a safe and clean facility that makes sterile injection equipment readily available leads to less transmission of blood-borne infections and fewer soft tissue injuries. Perhaps most importantly, these facilities can make other types of health care available and serve as a conduit for substance abuse treatment services. The impact from the opioid crisis has had a profound effect on communities, neighborhoods and families. To date, no evidence has been found that SCFs increase (or decrease) crime, but there is evidence of a reduction in overdose deaths, injections done in public, blood-borne disease infections, discarded injection equipment, and perceived neighborhood disorder, as well as potential cost savings in health services. In the models, we find the infection-related impact associated with a hypothetical SCF in Philadelphia would be: - between 1 and 18 averted cases of HIV infections annually; and - between 15 and 213 averted cases of hepatitis C infections annually. Given the complexity of estimating the potential impact on deaths from drug overdose, we apply two different models from the literature. In the first one, using data from the Philadelphia Department of Public Health, we estimate that overdose deaths could be reduced by a range between 27 and 48 each year. In the second model, we estimate the potential of averted deaths from drug overdose to be between 24 and 76 annually. We also replicate the models used to estimate the financial impact of a hypothetical SCF in Philadelphia and find the following: - Reduced costs related to hospitalization for skin and soft tissue infections (SSTI) are estimated to be between $1,512,356 and $1,868,205 per year. - We estimate the total value of overdose deaths averted is between $12,462,213 and $74,773,276 annually. - Our estimates for the impact on health care costs annually are: o a reduction of $123,776 from ambulance costs, o $280,683 savings from a reduction in hospital emergency department utilization, and o $247,971 savings from reduced hospitalizations. Evidence suggests that SCFs reach and are accepted by their target populations (e.g., marginalized street users, those at high risk of infectious disease or overdose). We conclude in this report that SCFs may be a viable strategy to reduce the harms of opioids on hard-to-reach populations and the communities in which they live. Details: Wynnewood, PA: Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research, 2017. 46p. Source: Internet Resource: Accessed March 12, 2019 at: https://dbhids.org/wp-content/uploads/2018/01/OTF_LarsonS_PHLReportOnSCF_Dec2017.pdf Year: 2017 Country: United States URL: https://dbhids.org/wp-content/uploads/2018/01/OTF_LarsonS_PHLReportOnSCF_Dec2017.pdf Shelf Number: 154896 Keywords: Drug Abuse and Addiction Drug Addicts Drug Consumption Facilities Drug Overdose Fatalities Drug Policy Fentanyl Illegal Drugs Opioid Epidemic Prescription Drug Abuse |
Author: Maksabedian Hernandez, Ervant J. Title: Increasing Access to Medication-Assisted Treatment for Opioid Use Disorders: Estimating Costs, Supply, and the Effects of Insurance Expansions Summary: Drug overdose deaths in America exceeded 50,000 in 2015, claiming more lives annually than gun violence and motor vehicle accidents. Of these, more than 63% of overdose deaths were due to opioids. Medication-assisted treatment is regarded as the most effective form of treatment for those struggling with an opioid use disorder. However, medication costs and insurance coverage remain identified barriers to treatment. My dissertation measures access to buprenorphine, the fastest growing form of medication-assisted treatment, and the effects of demand side interventions aiming to tackle the opioid problem in America. While some supply side interventions have mixed effectiveness or unintended consequences potentially exacerbating the problem, demand side interventions may be more effective in reducing overall demand for opioids and opioid-related deaths. Insurance expansions, such as the federal insurance parity law of 2008 or the 2014 Medicaid expansions associated with the Affordable Care Act, could have increased access to treatment. The three main insights from this dissertation are: 1) who pays for the medication matters when considering the average cost of buprenorphine maintenance treatment. Patients with public insurance have lower buprenorphine costs compared to those paying with cash-only or with commercial insurance. 2) The federal parity law for substance use disorders (MHPAEA) did not increase access to medication-assisted treatment for opioid use disorders. 3) Out-of-pocket costs for prescription opioids have decreased dramatically while costs for buprenorphine have not declined at similar pace, thus complicating access for those with an opioid use disorder. Efforts by Congress to push commercial insurers to expand coverage for addiction services have not led to lower costs for opioid treatment, unlike the experience among those with public insurance. Policymakers need to look for other ways to get commercial insurers to lower costs, particularly if further health care reform leads to a reduction in Medicaid funding and enrollment. Details: Santa Monica, CA: RAND, 2017. 125p. Source: Internet Resource: Dissertation: Accessed March 12, 2019: https://www.rand.org/pubs/rgs_dissertations/RGSD404.html Year: 2017 Country: United States URL: https://www.rand.org/pubs/rgs_dissertations/RGSD404.html Shelf Number: 154927 Keywords: Cost of InsuranceDrug Overdose DeathsMedical InsuranceOpioid EpidemicOpioidsPrescription Drug AbuseSubstance Abuse Treatment |
Author: Pardo, Bryce Title: Assessing the Evidence on Supervised Drug Consumption Sites Summary: Current levels of opioid-related morbidity and mortality in the United States are staggering. Data for 2017 indicate that there were more than 47,000 opioid-involved overdose deaths (roughly similar to deaths from AIDS at its peak in 1995), and 1 in 8 adults now report having had a family member or close friend die from opioids. There has been a near universal call from blue-ribbon commissions and expert panels for increasing access to Food and Drug Administration-approved medications for those with an opioid use disorder; however, jurisdictions addressing opioid use disorder and overdose may wish to consider additional interventions beyond increasing access to these medications. Two interventions that are implemented in some other countries but not in the United States are heroin-assisted treatment (HAT) and supervised consumption sites (SCSs). Given the severity of the opioid crisis, there is urgency to evaluate tools that might reduce its impact and save lives. This working paper is part of a series of reports assessing the evidence on and arguments made about HAT and SCSs and examining some of the issues associated with implementing them in the United States. The target audiences include decision makers in rural and urban areas grappling with opioids as well as researchers and journalists. This working paper assesses evidence on and arguments made about SCSs. It also offers a descriptive assessment of SCSs and the logic model behind their implementation. The other parts of this series of reports include: (1) a summary report of all the components of the research study; (2) a review of the HAT literature; (3) a report on key informant views on the acceptability and feasibility of implementing HAT and SCSs in selected U.S. jurisdictions heavily affected by the opioid crisis and (4) a report on international experience with the implementation of HAT and SCSs. Details: Santa Monica, CA: RAND, 2018. 91p. Source: Internet Resource: Working Paper: WR-1261-RC: Accessed April 11, 2019 at: https://www.rand.org/content/dam/rand/pubs/working_papers/WR1200/WR1261/RAND_WR1261.pdf Year: 2018 Country: International URL: https://www.rand.org/content/dam/rand/pubs/working_papers/WR1200/WR1261/RAND_WR1261.pdf Shelf Number: 155363 Keywords: Drug Abuse and Addiction Drug Addicts Drug Consumption Facilities Drug Overdose Fatalities Drug Policy Fentanyl Illegal Drugs Opioid Epidemic Prescription Drug Abuse |
Author: Sherman, Susan Title: FORECAST Study Summary Report: Fentanyl Overdose Reduction Checking Analysis Study Summary: Life expectancy in the United States has declined for two years in a row, largely driven by the opioid epidemic. Overdoses claimed more than 64,000 lives in 2016 and all indications are that the impact of the crisis in 2017 will be even greater. Fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine, is the primary cause of the rapid increase in overdose deaths. Fentanyl and its associated analogues (including carfentanyl, furanyl fentanyl, and acetyl fentanyl) have been found mixed with heroin, cocaine and pressed into counterfeit prescription drugs. In 2015, the Drug Enforcement Agency issued a nationwide alert calling fentanyl a "threat to health and public safety." Recently, the Centers for Disease Control and Prevention reported that fentanyl and associated analogues were associated with over half of the opioid overdoses in ten states during the second half of 2016. The potential of death from even small amounts of fentanyl has changed the landscape of opioid use in the United States. Evidence to date suggests that people who use drugs often do not know whether fentanyl is present in what they are about to consume. A recent study among 242 heroin users across 17 sites in British Columbia, Canada, found that 29% tested positive for fentanyl, 73% of whom did not report knowingly using fentanyl. To explore the viability of a public health response to the fentanyl crisis, the Bloomberg American Health Initiative awarded funding to support the Fentanyl Overdose Reduction Checking Analysis Study (FORECAST). This study aimed to examine the accuracy of three technologies in identifying the presence of fentanyl in samples of illicit drugs. It also aimed to gauge whether people who use drugs and other stakeholders would be interested in using such technology as part of harm reduction programs. Details: Baltimore, Maryland: Johns Hopkins Bloomberg School of Public Health, 2018. 14p. Source: Internet Resource: Accessed June 17, 2019 at: https://americanhealth.jhu.edu/sites/default/files/inline-files/Fentanyl_Executive_Summary_032018.pdf Year: 2018 Country: United States URL: https://americanhealth.jhu.edu/sites/default/files/inline-files/Fentanyl_Executive_Summary_032018.pdf Shelf Number: 156368 Keywords: Drug Abuse Fentanyl Harm Reduction Illicit Drugs Opioid Crisis Opioid Epidemic Prescription Drug Abuse |