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8/4/2013 Easy ways to save patients lives: How to prevent, recognize and deter prescription drug abuse. Chris Stock, PharmD, BCPP Professor (Adjunct), U of U Clinical Pharmacy Specialist, VAMC 1 8/4/2013 Attending the presentation will


  1. 8/4/2013 Easy ways to save patients’ lives: How to prevent, recognize and deter prescription drug abuse. Chris Stock, PharmD, BCPP Professor (Adjunct), U of U Clinical Pharmacy Specialist, VAMC 1

  2. 8/4/2013 Attending the presentation will enhance pharmacists' knowledge of available information regarding pain medication abuse and possible opportunities for intervention and patient and prescriber education. • Attendees will be able to: 1) State the statistics of pain medication abuse occurring in the United States, among various demographic groups. 2) Specify the impact of the under treatment of pain and inadequate pain relief. 3) Identify a number of ways to deter pain medication abuse in the homes of families in the United States. 4) Identify the dangers associated with non medical use of prescription pain medications. 5) Identify means to reduce the risk of prescription opioid abuse At the end of the presentation you will be able to correctly answer these questions: 1) According to Utah regulations, pharmacists can authorize a pharmacy technician to access the Utah Controlled Substance Database. True or False 2) According to Utah regulations, prescribers can authorize a non9medical clinic employee to access the Utah Controlled Substance Database. True or False 3) According to the National Survey on Drug Use and Health 2011 results, which group is most likely to engage in the non9medical use of opioid prescription medications? • 1. 12915 years old • 2. 18925 years old • 3. 26945 years old • 4. Over 65 years old 4) The National Associations of Boards of Pharmacy has promoted which of the following methods to deter inappropriate prescribing as well as abuse of controlled substances. • 1. National database of “doctor shoppers” • 2. National database of “pill mill” doctors • 3. Searchable national database of controlled substance prescriptions • 4. National hot line for reporting pharmacy robberies 2

  3. 8/4/2013 INCB* 2012 Annual Report North America IS: • THE BIGGEST illicit drug market in the world. • HIGHEST drug9related mortality rate. – 1 in every 20 deaths in North America (159 64age) • Overdose deaths • HIV/AIDS • Trauma9related deaths including MVAs International Narcotics Control Board of UN Economic Costs of Drug Abuse Department of Justice 2011 $193 Billions $11,416,232 Crime Productivity Health $68,403,082 $113,277,616 3

  4. 8/4/2013 ��������������������������������������������������������������� Marijuana 29,739,000 Rx drugs 14,657,000 Opioids 11,143,000 Hallucinogens 4,069,000 Cocaine 3,857,000 Inhalants 1,861,000 Heroin 620,000 - 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 30,000,000 35,000,000 Substance Abuse and Mental Health Services Administration, ������������������������������������������������������ ������������������������������������ , NSDUH Series H944, HHS Publication No. (SMA) 1294713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. Costs of Abuse of Prescription Drugs 2006 $53 Billions $0.94 $2.20 $8.20 Productivity Criminal Justice Treatment Medical $42.00 Hansen, et al. Economic Costs� Clin J Pain 2011;27:194–202 4

  5. 8/4/2013 Drug's Costs $53 Billions Hydromorph Fentanyl 2% 0% Meperidine Other 4% 4% OxyContin 14% Morphine 5% Codeine Oxycod 8% 11% Methadone 12% Hydrocod 24% Darvon 16% Hansen, et al. Economic Costs� Clin J Pain 2011;27:194–202 Who is abusing, misusing, dying? 5

  6. 8/4/2013 ���������������������������������� ������������ 1,500,000 12 to 17 18 to 25 3,600,000 26+ 6,600,000 Substance Abuse and Mental Health Services Administration, ������������������������������������������������������ ������������������������������������ , NSDUH Series H944, HHS Publication No. (SMA) 1294713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. Nonmedical Use of Pain Relievers 2010$11 among Persons Aged 12 or Older SAMHSA 2012 NSDUH Survey Report 6

  7. 8/4/2013 • What are the consequences? Addiction Bridging (may be related to addiction or unmanaged pain) Overdose Addiction • Chronic disease of the portions of the brain that control – Reward – Motivation – Memory • Root causes can be traced back to – Genetics – Environment – Resiliency – Culture ASAM: ��!���������"�#������������$���������$�����������%&����'������(����� 7

  8. 8/4/2013 Spectrum of use: Age 12 and over �!����)������ 2,000,000 Users 11,000,000 Abstainers 241,000,000 Substance Abuse and Mental Health Services Administration, ������������������������������������������������������ ������������������������������������ , NSDUH Series H944, HHS Publication No. (SMA) 1294713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. ���������������������*�������������������������������������� 1 2 3 4 5 Millions Substance Abuse and Mental Health Services Administration, ������������������������������������������������������ ������������������������������������ , NSDUH Series H944, HHS Publication No. (SMA) 1294713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. 8

  9. 8/4/2013 ���������������� ���+���������$������������������������������������� 5,000,000 4,500,000 Have Abuse 4,000,000 Dependence 3,500,000 Treatment gap 3,000,000 2,500,000 2,000,000 Received Treatment 1,500,000 1,000,000 500,000 - Substance Abuse and Mental Health Services Administration, ������������������������������������������������������ Total Dependent Total Treated ������������������������������������ , NSDUH Series H944, HHS Publication No. (SMA) 1294713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. “BRIDGING” • Using what ever is available on the street to temporarily substitute for or replace the drugs you have become addicted to. – Oxycodone – Hydrocodone – Suboxone – Methadone – Tramadol – Above plus Seroquel, gabapentin, benzodiazepine, etc. 9

  10. 8/4/2013 Why do we care #�����������������'�����#����������#"����,�-�������"�����,�� ����!������.����))///,���,�� )��.�)����.�,.��, 10

  11. 8/4/2013 ����)���?�������������$��������������������� �����������.���0;�=���;,� �001 ���� �6"*����� +<*�= ������6 ���������� ���> �031 4#-5�-��������������6 8�9� ���������� �001 �����#����2 �. '�����#��� ���:���!��� ���; �003 ������������"����� 4#-5�&�������������� �6"�$���� �67��� One death every 19 minutes. Increase has been driven by increased use of opioid analgesics. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm Jones, Mack, Paulozzi (CDC). JAMA, February 20, 2013 11

  12. 8/4/2013 Gender: 38, 329 Overdose Deaths 2010 15,323 Male Female 23,006 Mack, Jones, Paulozzi (CDC). MMWR, July 2, 2013 Compton, Volkow, Throckmorton (NIDA/FDA) Ann Intern Med. 2013;158:65-66 Jones, Mack, Paulozzi (CDC). JAMA, February 20, 2013 12

  13. 8/4/2013 Jones, Mack, Paulozzi (CDC). JAMA, February 20, 2013 @A�B Jones, Mack, Paulozzi (CDC). JAMA, February 20, 2013 13

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