Elizabeth Agius, Wayne State UniversitySu Min Oh, Office of Recovery Oriented Systems

of CareTheresa Webster, Southeast Michigan

Community Alliance (SEMCA)

Presentation to the SUD Conference Traverse City, MI

September 16, 2013

IntroductionPurpose: To explore three facets of

prescription drug use with data and informationNational and state data - Su Min OhSurvey Data - Elizabeth AgiusLocal Perspectives – Theresa Webster

Key Theme: Prescription drug misuse and abuse is a rapidly growing and complex problem

The BasicsPrescription drug misuse can be defined as the use

of prescription medications in a manner not prescribed and/or by someone for whom the medication was not prescribed (MDCH, 2010).

NIDA most commonly misused/abused prescription medications are opioids – pain medications; depressants/sedatives – for anxiety and sleep; and stimulants – for ADHD, obesity and narcolepsy.

SAMHSA estimates that 16.42 million adults (>18 y/o) in the United States abused prescription drugs in 2010, representing greater prevalence than heroin, methamphetamines, cocaine, and other illicit drugs.

Number of Unintentional Drug Poisoning Deaths, Michigan, 1999-

2010

Nu

mb

er

of

death

s

Year

Age-Adjusted Unintentional Drug Poisoning Death Rates by Gender,

Michigan,1999–2010

Rate

per

100

,000

pop

ulati

on

Year

Male

Female

Total

Unintentional Drug Poisoning Death Rates by

Age Groups, Michigan, 1999–2010

Rate

per

100

,000

pop

ulati

on

Year

15-24 years

65+ years

55-64 years

45 – 54 years

35– 44 years

25– 34 years

Unintentional Drug Poisoning Deaths by Major Drug Type, Michigan, 1999–2010

Unspecified

Opioid analgesic involvement

Other specified

Heroin only

Cocaine and heroin

Cocaine only

Crud

e Ra

te p

er 1

00,0

00 p

opul

ation

Year

Unintentional Drug Poisoning Deaths involving Opioid Analgesics, Michigan, 1999–

2010

Crud

e ra

te p

er 1

00,0

00 p

opul

ation

Year

Only opioid analgesic

With cocaineWith heroin

Heroin & cocaine

Total

Detroit

Unintentional Drug Poisoning Death Rates by Region, Michigan, 1999

Unintentional Drug Poisoning Death Rates by Region, Michigan, 2004

Unintentional Drug Poisoning Death Rates by Region, Michigan, 2004

How did we get here?Prior to 2000, physicians were

under prescribing for chronic painPositive benefits of treating

chronic pain with high dose levels of pain medication discovered

Physicians became more liberal in prescribing patterns

Pharmaceutical industry pushed pain medications as the preferred method of treating chronic pain

How did we get here?The number of opioid

analgesic prescriptions filled at pharmacies increased from 175 million in 2000 to 254 million in 2009.

Executive Office of the President of the United States. Epidemic Responding to America’s Prescription Drug Abuse Crises, 2011

Why Focus on Pharmacists?Pharmacist have a

professional responsibility to prevent the abuse and diversion of prescription drugs

Pharmacist are trained to recognize common patient behaviors and characteristics

Pharmacists are in a position to observe patterns of prescribing

Perceptions of PharmacistsTwo surveys of pharmacists

SEMCA Pharmacist survey As part of 2010-2011 Needs Assessment Michigan Pharmacist Association professional org

members living or working in Southeast Michigan; 372 responses

BSAAS Pharmacist survey December 2012 – February 2013 Sample – CAs & Michigan Primary Care emails,

then SEMCA list; only 72 responses

SEMCA Pharmacist SurveySeverity and Seriousness of Substance Abuse (N=372)

Drug Not at all/Not too serious

Somewhat

serious

Very ser

IousAlcohol Abuse (N=327)

4% 27.5% 68.5%

Illicit drugs (N=327)

3.7% 14.1% 68.5%

Prescriptions drugs (N=372)

.6% 13% 86.2%

OTC drugs (N=324)

15.4% 50.6% 34%

Opioid drugs (N=326)

1.5% 13.5% 85%

Respondents saw High Potential for abuse for Opiods (95%), Amphet-amines(91%), Cocaine and Heroin (90%)..

Compared to 72% for Alcohol & 69% for Marijuana

Observations of BehaviorsOPIODS Monthl

yWeekly

1 –2x wk

Daily

Falsified Rx 64 19 10 7

Rx from multiple sources

44 23 17 17

Excessive # Rx from one doc

47 17 17 17

Excessive Rx at short interval

41 34 14 24

Rx non local source 42 21 15 22

Family members scam Rx

53 26 11 11

Inappropriate combo of drugs

25 29 15 19

After hours purchase 36 20 15 30

In their words..Pharmacist Open-ended Question Comments (Total N=71)Doctors contributing to problem/need to be held

accountable (over-prescribing, RX mills, not saying “no” to patients) (n=31)

Need stricter laws for prescribing and reporting abuse (triplicate blanks, greater regulations/penalties, patients identify doctors abusing, checklist to prescribers, doctors using MAPs) (n=13)

Identifying prevalent or increased opioid and sedative use and abuse- (docs prescribing and patients asking for oxycontin, opana, hydrocodone, soma) (n=12)

No steps pharmacists can take to combat the abuse problem (hold doctors accountable, law enforcement not helpful) (n=11)

Community PerspectivesCommunity Survey asked 563 adults in out-

Wayne County how easy it would be to get rx drugs.. 61% say “easy”.. Most (44%) would get it from Medical Professional, 21% from friends, 12% from family

13.3% of the sample reports some lifetime use of non-medical rx drug use

Perceived risk of harm from non-medical use of rx drugs Occasional use – 80% High risk, Regular use

96% HR

Youth UseMonitoring the Future 2010

Ritalin past year 2.7% for 10th & 12th gradersOther rx drugs - est of 15% for past 30 days

MiPhy 2010 (non generalizable sample) 7% Out-Wayne County used rx drugs (Ritalin,

Adderall, Xanax); 16% had used painkillers without Dr. script

BSAAS Pharmacist SurveySmaller survey, but similar results 75% SA: prescription drug abuse is a serious

problem (100% with agree added) 76% SA: Prescribers have major

responsibility in helping to prevent prescription drug abuse

Prescription drugs, Heroin, Cocaine most serious – in this order

Use of MAPS42% felt MAPS was very useful, 43% felt it

was somewhat useful, 12% felt it was a little useful and 3% felt MAPS was not useful at all.

Estimate % of customers served where you also reviewed their controlled substance prescription records using MAPS (N=68)

1-9% of customers 56%10-19% of customers 31%20% or more 13%

Perceived Responsibilities I believe the responsibilities of a community pharmacist with regard to prescription drug abuse are: (N=281) Multiple responses per individual

Educate the consumer about the potential for addiction and harm of mood and mind altering substances

84%

Counseling the consumer about the potential for addiction and harm of mood and mind altering substances

83%

Discuss alternative medications and/or measures 64%

Refusing to fill prescription when I suspect an illegal prescription or inappropriate use

91%

Refusing to fill prescriptions for medications with abuse potential if I suspect the medication will be used inappropriately

62%

Notifying law enforcement when I suspect the potential for illegal use of prescription drugs

64%

Training NeedsStrongly

AgreeAgree

Neither Agree nor Disagree

DisagreeStrongly Disagree

I feel the need for additional training in substance abuse. (N=69)

16% 45% 22% 17% 0%

I feel the need for additional training in mental health. (N=69)

23% 53% 12% 12% 0%

I am willing to participate in training from the local substance abuse/mental health in SBIRT. (N=68)

21% 48% 23% 6% 2%

I am interested in receiving additional training in pain management. (N=68)

23% 54% 15% 6% 2%

I am interested in receiving training in identifying prescription drug abuse/ addiction (N=68)

27% 57% 10% 2% 4%

How did we respond?Safe Medication Disposal Campaign

Resources for your communityPermanent Medication Disposal Drop Box

How to get one in your area

How did we respond?Responsible Opiate

Prescribing for Physicians

Medication Use Safety Training

ResourcesPharmacists Tool KitMedication

Monitoring InventoryPrescription Bag

Tags

Wrap upQuestions about materials presented

Information to share about your community

Contact Information• Elizabeth Agius

Wayne State University School of Social Work; 313-577-5251, eagius@wayne.edu

• Su Min Oh• MDCH Office of Recovery Oriented Systems

of Care; 517-241-2957, ohs@michigan.gov

• Theresa Webster• SEMCA Prevention Coordinator; 734-229-3500,

theresa.webster@semca.org