Prescription Drug Abuse

1. Prescription Drug Abuse Dave Morgan, RPh Weymouth Youth Coalition Substance Abuse Prevention Team Co-Chair

2. 1 equals 16 OxyContin Problem and Solutions

3. 100 equals 1600 Percocets $8000 OxyContin Problem and Solutions

4. Mass OxyContin and Heroin Commission November 4, 2009 • Opioid overdose has become the leading cause of injury death in Massachusetts • “The Commonwealth is in the midst of a serious and dangerous epidemic.” • “Addiction is a medical disorder and we have a public health epidemic on our hands that is larger than the flu pandemic.”

5. 2009 Mass OxyContin and Heroin Commission Recommendations include: Update the Massachusetts Prescription Drug Monitoring Program to: • Deter “Doctor Shopping” • Detect Doctors who are overprescribing

6. “Doctor Shopping” and Overprescribing

7. Example of "Doctor Shopping” Oxycodone was prescribed by 10 Different Doctors in 2011

8. Prescription Monitoring Program Instructions for Enrollment

9. How to Access the PMP Enrollment Packet http://www.mass.gov/dph/dcp/onlinepmp Scroll down and click on to: MA Online PMP Enrollment Packet

10. PMP Enrollment Form • Complete the one page form • Have the form notarized • Mail the form to the address listed on the enrollment form

11. PMP Notification Once the state Department of Public Health receives your enrollment form, you will receive two (2) emails which will include: Log In Information • Username • Temporary Password

12. Using the Prescription Monitoring Program

13. Virtual Gateway Home Page

14. Login

15. Welcome Page

16. Entering Online PMP

17. Record Search

18. Clearing Pop Up Message

19. Search Event

20. Case Information Window

21. Record Overview

22. System Shut Down

23. Logout

24. Next steps

25. Help Desk Support Questions about your username and password: • http://www.mass.gov/loginassistance • 800-421-0938. For all other questions: • dcp.dph@state.ma.us • 617-983-6700

26. Senate Bill 2125 • Signed by Governor August 2012 • Effective January 2013 • All prescribers will be automatically enrolled • Regulations on usage to be developed by DPH • CII’s only from contiguous states and Maine

27. Senate Bill 2125 • Pamphlets to be developed for CII’s and CIII’s • Lock boxes must be available • Establishes working group to look at problem

28. Numbers • 35 million people took opioids non-medically in 2010 • 7,000,000 Pharmers who take prescription drugs non-medically regularly • 700,000 real farmers in the US • 340,000 ER visits for opioids in 2009 • $75 billion spent on non-medical use of opioids

29. Numbers • 2008 – 39,000 motor vehicle death • 2008- 36,000 overdose deaths • 20,000 prescription drugs • 16,000 illicit drugs , mainly heroin and cocaine • Most heroin abusers start with prescription drugs

30. Numbers • 2010 prescription sales data • Lipitor 37million Rx’s • Number one $ volume drug that year • Hydrocodone 122 million Rx’s • Oxycodone 29 million Rx’s • OxyContin 7 million RX’s • TOTAL 158 million Rx’s or 4.75 Billion tablets • 158 tablets for every person in the U.S.

31. Source of opioids for non-medical use • 55% free from friends or relatives • 17% MD prescription • 11% bought from friend or relatives • 5% stole from friend or relative • 4% drug dealer or stranger • <1% internet • 70% from friends or relatives

32. Numbers • U.S. has 310 million people or about 4.6% of world population • U.S. consumes 99% of world supply of hydrocodone • U.S. consumes 83% of world supply of oxycodone

33. ER visits for non medical use of opiods • 2004 145,000 • 2010 425,000 • Increase of 145% • Cost ???????

34. Chronic Opioid Therapy- COT • Patient selection tools • Patient /prescriber agreements • Pill counts • Urine drug screens – UDS • May 2012 FDA stated no clear evidence that COT improves functional status

35. Decrease demand • Education of patients and prescribers • Education of youth • Patient selection

36. Decrease supply • Weymouth has 4 take back days per year • DA Morrissey installed kiosks in most police stations in Norfolk County • Lock boxes • Appropriate prescribing • Education

37. NAS- neonatal abstinence syndrome • 2000 – 1.2 per 1000 births • 2009- 3.4 per 1000 births • Avg LOS in NICU for NAS is 16 days • Cost ????? • Some Florida hospitals have over 50% of babies in NICU’s with NAS

38. Miscellaneous • Nasal naloxone • Joint Commission • BOP BOM • BCBS • 80% of all crime is substance abuse related • State of Washington • TV ads for drugs

39. Miscellaneous • NEJM article • Patient satisfaction surveys • No one complains about getting RX but will complain if they don’t get one

40. Questions Dave Morgan, RPh DMorganRph@aol.com