Dr. Ileana Arias, Principal Deputy Director Center for Disease Control

and Prevention (CDC) and Agency for Toxic Substances and Disease Registry

(ATSDR)

Prescription Drug Overdoses: The Public Health Perspective

April 10-12, 2012 Walt Disney World Swan Resort

Ileana Arias, PhD Principal Deputy Director

Centers for Disease Control and Prevention

•  Describe current prescription drug overdose trends

•  Identify populations at greatest risk for overdose

•  Understand CDC’s public health approach to preventing prescription drug overdose

•  Describe CDC’s policy recommendations on prescription drug overdose

Learning Objectives

CDC Saving lives. Protecting people. Saving money.

•  CDC works 24/7 to save lives, protect people and communities from health threats, and save money

•  CDC puts science and prevention into action to make the healthy choice the easy choice

•  CDC helps people live longer, healthier, more productive lives with lower health care costs

CDC Goal

  Reduce abuse and overdose of opioids and other controlled prescription drugs while ensuring patients with pain are safely and effectively treated..

The Public Health Approach to Prevention

Ensure Widespread

Adoption Develop and Test

Prevention Strategies

Identify Risk and Protective

Factors

Define the Problem

Ensure Widespread

Adoption Develop and Test

Prevention Strategies

Identify Risk and Protective

Factors

Define the Problem

The Public Health Approach to Prevention

Motor Vehicle Traffic, Poisoning, and Drug Overdose Death Rates: United States, 1980-2009

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tion

Year

Number of Drug Overdose Deaths Involving Opioid Pain Relievers and other Drugs:

United States, 1999-2009

Any opioid pain reliever

Specified drug(s) other than opioid analgesic

Only non-specified drug(s)

Year

0

1

2

3

4

5

6

7

8

9

10

'70 '71 '72 '73 '74 '75 '76 '77 '78 '79 '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 07 08 09

28,578 unintentional overdose deaths in 2009

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er 1

00,0

00 P

op

ula

tion

Unintentional Drug Overdose Deaths

United States, 1970-2009

Drug Overdose Deaths per 100,000 People, United States, 2004-2008

Public Health Impact of Opioid Pain Reliever Use

For every 1 overdose death there are

30

118

795

9

Economic Costs

•  $72.5 Billion in healthcare costs

•  Opioid abusers generate, on average, annual direct health care costs 8.7 times higher than nonabusers

Ensure Widespread

Adoption Develop and Test

Prevention Strategies

Identify Risk and Protective

Factors

Define the Problem

The Public Health Approach to Prevention

Ra

te

Rates of Opioid Overdose Deaths and Sales, 1999-2010

Year

0

1

2

3

4

5

6

7

8

99 00 01 02 03 04 05 06 07 08 09 10

Opioid Overdose Deaths/100,000

Opioid Sales KG/10,000

Drug overdose death rate 2008 and opioid pain reliever sales rate 2010

Kg of opioid pain relievers used per 10,000

Age-adjusted rate per 100,000

Populations at High Risk for Overdose

•  “Doctor Shoppers” •  People on high daily dosages of opioid pain

relievers and poly-drug abusers •  Low-income people and those living in rural areas •  Medicaid populations

•  People with mental illness or history of substance abuse

Ensure Widespread

Adoption Develop and Test

Prevention Strategies

Identify Risk and Protective

Factors

Define the Problem

The Public Health Approach to Prevention

Administration’s Rx Abuse Plan Where Does CDC Fit In?

•  Blueprint for Federal government

•  4 Focus Areas •  Education •  Monitoring •  Disposal •  Enforcement

•  CDC is focusing on areas that fit within our mission and complement other Federal agencies

CDC Strategic Focus Areas

  Enhance Prescription Drug Abuse Surveillance   Improve Clinical Practice   Inform Policy

CDC Policy Recommendations

•  Maximize Prescription Drug Monitoring Programs (PDMPs)

•  Evaluate and Implement Patient Review and Restriction programs

•  Improve Clinical Practice Through Health Care Provider Accountability

CDC Policy Recommendations

•  Enforce policies aimed at reducing drug diversion, abuse and overdose

•  Leverage Insurer & Pharmacy Benefit Manager (PBM) mechanisms

•  Increase Access to Substance Abuse Treatment

•  Overdose deaths have reached epidemic levels in the United States

•  A concerted public health and public safety approach is required

•  CDC is applying the public health model to this issue

•  Success will come through collaboration with all stakeholders

Conclusions

Thank You

www.cdc.gov/HomeandRecreationalSafety/Poisoning

References Slide 7: NCHS Data Brief, December, 2011, updated with 2009 mortality data Slide 8: CDC/NCHS, National Vital Statistics System; and Warner M, Chen LH, Makuc DM,

Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980–2008. NCHS data brief, no 81. Hyattsville, MD: National Center for Health Statistics. 2011. http://www.cdc.gov/nchs/data/databriefs/db81.htm

Slides 9 & 10: National Vital Statistics System Slide 11: SAMHSA National Survey on Drug Use and Health, SAMHSA Treatment Episode Data

Set, SAMHSA Drug Abuse Warning Network Slide 12: 1. Coalition Against Insurance Fraud. Prescription for peril: how insurance fraud

finances theft and abuse of addictive prescription drugs. Washington, DC: Coalition Against Insurance Fraud; 2007.

2. White AG, Birnbaum, HG, Mareva MN, et al. Direct Costs of Opioid Abuse in an Insured Population in the United States. J Manag Care Pharm. 11(6):469-479. 2005

 

References Slides 14 & 15: National Vital Statistics System, DEA Automation of Reports and Consolidated Orders

System (ARCOS) Slide 16: 1. White AG,; Birnbaum HG, Schiller M, Tang J, Katz NP. Analytic models to identify

patients at risk for prescription opioid abuse. Am J of Managed Care 2009;15(12):897-906.

2. Green TC, Graub LE, Carver HW, Kinzly M, Heimer R. Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997–2007. Drug and Alcohol Dependence 2011;115:221-8.

3. Paulozzi et al. A history of being prescribed controlled substances and risk of drug overdose death. Pain Medicine. 2012; 13(1):87-95

4. Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300(22):2613–20.

5. CDC. Overdose deaths involving prescription opioids among Medicaid enrollees-Washington, 2004-2007.MMWR. 2010;59;705-9.

6. Bohnert ASB, Valenstein M, Bair MJ, Ganoczy D, McCarthy JF, Ilgen MA, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305(13):1315–21.