5/16/18 Managing the Effect cts of Op Opio ioid ids s on Your Pool Battling the Opioid Crisis: It Takes All of Us Working Together Government Communities Health Care and Support Providers Systems Medical Insurance Associations Providers and Boards FDA and Pharma 1
5/16/18 What are Opioids? Opioid ioids = = op opia iates = = narcot otics ics Common Immediate Release: Common Long-Acting: • Vicodin (hydrocodone) • Opana ER (oxymorphone ER) • Percocet, OxyIR (oxycodone) • MS Contin (morphine ER) • Dilaudid (hydromorphone) • Methadone • Opana (oxymorphone) • OxyContin (oxycodone ER) • Nucynta (tapentadol) • Butrans (buprenorphine patch) • Ultram (tramadol) • Duragesic patches (fentanyl) Credit: MedCost Someone in the United States dies approximately every 12 minutes due to an opioid-related drug overdose CDC: Centers for Disease Control and Prevention; www.cdc.gov 2
5/16/18 Addiction Benzodiazepines – Xanax, Valium, Klonopin Physical Muscle Relaxers Tolerance Alcohol Dependence Antidepressants – Prozac, Lexapro, Zoloft Opioid Mixed Agonist/Antagonist and Risks Partial Agonist Opioid Analgesics – Butrans, buprenorphine Drug NOT A COMPREHENSIVE LIST! Abuse Interactions Many interactions can lead to hypotension, profound sedation, Overdose respiratory depression, coma and even death Credit: MedCost Understanding the Opioid Epidemic 1999 - 2016 630,000 Deaths from Drug Overdose 2016 Overdose Deaths 66% Involved an Opioid Opioid Overdose Deaths 5 Times Higher in 2016 than in 1999 Credit: MedCost Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention https://www.cdc.gov/drugoverdose/epidemic/index.html 3
5/16/18 The Opioid Epidemic – Closer Than You Think Sources of Prescription Opioids Among 60% Past-Year Non-Medical Users 2,3 60 Given by friend or of US citizens relative for free 50 have left over Prescribed by > 1 prescription 40 physicians narcotics Percent of Users Stolen from friend or in their home 1 30 relative Bought from friend or 70% 20 relative Bought from drug dealer 10 or other stranger of abused Other prescription 0 opioids come Past-Year Non-Medical Users from a friend or relative 2 1 JAMA Intern Med. 2016;176(7):1027-1029) 2 Jones, C, Paulozzi, Mack K. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use. United States, 2008-2011. JAMA Int Med 2014; 174(5):802-803. 3 Obtained from US National Survey on Drug use and Health, 2008-2011. 4
5/16/18 A Problem Unique to the U.S. 80% CDC – US State Prescribing Rates 2016 of all prescription opioids are written and consumed in the United States 1 2013 250,000,000 Prescriptions for Opioids This is enough for every Source: U.S. Centers for Disease Control American adult to have their own bottle of pills 2 1 National Institute on Drug Abuse 2 IMS Health, National Prescription Audit (NPATM). Cited in internal document: Preliminary Update on Opioid Pain Reliever (OPR) Prescription Rates Nationally and by State: 2010-2013. 5
5/16/18 The Arkansas Story • Population < 3 Million People • Drug companies sold 235,934,613 opioid pills in 2016. • Opioids are the top-selling class of prescription drug in Arkansas (more than twice as prevalent as the next). • Manufacturers and distributors supplied nearly 2B mg of opioids to Arkansas pharmacies in 2015. • There are more opioid prescriptions in Arkansas than people • Drug companies sell enough opioids in Arkansas for every man, woman, and child to each take 80 pills per year. • Overdose deaths in Arkansas have ballooned 262% from 5.1 per 100,000 citizens in the year 2000 to 13.4 per 100,000 in 2016. • Number of drug overdose deaths rose to 401 —at least 335 of which are opioid-related (2016 – Arkansas) • Arkansas’s near-tripling in overdose deaths between 2000 and 2015 coincides with a span in which opioid sales have quadrupled . Source: Arkansas Municipal League 6
5/16/18 Vermont 7
5/16/18 CIS Oregon Work Comp Program: Highest Rx Total Usage All Time 171K Sum of RxPrice + POWERED BY DOMO | exported 23 Apr 2018 8
5/16/18 CIS Oregon Work Comp Program: Highest Rx per tablet All Time 171K Sum of RxPrice + POWERED BY DOMO | exported 23 Apr 2018 Prescription for Battling the Opioid Crisis 9
5/16/18 Re Resources Federal government: Centers for Disease Control and Prevention • The “Map:” https://www.cdc.gov/drugoverdose/maps/rxcounty2016.html • “Overdose:” https://www.cdc.gov/drugoverdose/index.html “Understanding the Epidemic” https://www.cdc.gov/drugoverdose/epidemic/index.html • National League of Cities • A Prescription for Action (2016 Report conducted jointly with NACo) • https://www.nlc.org/article/a-prescription-for-action-ending-the-opioid-crisis • Opioid Use Disorder: City Actions and Opportunities to Address the Epidemic https://www.nlc.org/resource/opioid-use-disorder-city-actions-and-opportunities-to-address-the-epidemic • • Prescription Drug Discount Program through CVS Caremark • U.S. Communities Program – Discount for Narcan • How Cities Can Fight the Opioid Epidemic With Life-Saving Medications (CitiesSpeak Blog): https://bit.ly/2KsRlSq National Safety Council Prescription Nation 2018: Facing America’s Opioid Epidemic • • http://safety.nsc.org/prescription-nation-facing-americas-opioid-epidemic Arkansas Municipal League & Association of Arkansas Counties • Lawsuit against opioid manufacturers and distributers https://www.arcounties.org/site/assets/files/3397/2018-04-02secondamendedcomplaint.pdf • 10
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