Narcotic Abuse & Drug Disposal National Survey on Drug Use and - - PDF document

ITAC 12/13/2016 Karl D. Fiebelkorn, MBA, RPh 1

Narcotic Abuse & Drug Disposal

Karl Fiebelkorn, MBA, RPh

Senior Associate Dean Clinical Associate Professor of Pharmacy Practice & Administration University at Buffalo School of Pharmacy & Pharmaceutical Sciences

Narcotic Abuse Drug Disposal

IT TAKES

A

COMMUNITY

Drug and Alcohol PREVENTION

COALITION

ITAC

› Survey published by SAMSA on the use of illegal drugs, alcohol and tobacco by the civilian, noninstitutionalized population of the US aged 12 and over.

› 27 million people aged 12 and older used an illicit drug in the past 30 days (10.2%)

– Aged 12 to 17 2.3 million (9.4%) – Aged 18 to 25 7.7 million (22.0%) – Aged ≥ 26 17 million (8.3%)

National Survey on Drug Use and Health (NSDUH) 2014

Substance Abuse and Mental Health Services Administration (SAMSA)

National Survey on Drug Use and Health (NSDUH) 2014

Substance Abuse and Mental Health Services Administration (SAMSA)

› 27 million people aged 12 and older used an illicit drug in the past 30 days.

– 4.3 million Americans reported current non‐medical use of prescription pain relievers – Approximately 1.9 million Americans met criteria for prescription pain reliever use disorder based on their use of prescription pain relievers in the past year.

› 1.4 million people used prescription painkillers non‐medically for the first time in the past year.

– The average age for prescription painkiller first‐time use was 21.2 in the past year.

Deaths from Prescription Opioids CDC Statistics

› 1999 ‐ 2014

– 165,000 deaths – Aged 25‐54 most common – Overdose rates highest

› Non‐Hispanic whites › Deaths Men > women

› 2014

– 14,000 deaths

› Most common drugs in prescription overdose

– Methadone – Oxycodone – Hydrocodone

http://www.cdc.gov/drugoverdose/data/overdose.html Accessed October 27, 2016

NYS Drug Overdoses

› 1.4 million New Yorkers suffer from a substance abuse disorder › Upstate NY had a 222% increase in admissions to OASAS certified treatment programs among 18‐24 year old for heroin and other opioids › 2014

– 2,028 New Yorkers died of a drug overdose

› 30% in New York City

NYS Heroin and Opioid Task Fore Report June 9, 2016

NYS Opioid Crisis: Statistics

› Nearly 80% of recent heroin uses started with opioid analgesics

Jones, CM (2013). Heroin Use and Heroin Use Risk Behaviors among Nonmedical Users of Prescription Opioid Pain Relievers: United States, 2002

• 2004 and 2008- 2010. Retrieved September 27, 2016, from

http://www.ncbi.nlm.nih.gov/pubmed/23410617

ITAC 12/13/2016 Karl D. Fiebelkorn, MBA, RPh 2

Narcotic Abuse & Drug Disposal

Narcotic Abuse

› NYS Combatting the Heroin and Opioid Crisis

– Heroin and Opioid Task Force Report

› June 9, 2016 › 31 page report by governor’s task force › https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/HeroinTas kForceReport_3.pdf

› Heroin overdose is now the leading cause of accidental death in NYS

New York State Office of Alcoholism and Substance Abuse Services (2016)

Deaths in Erie County Due to Overdose of Opioids

› 2014 127 › 2015 256 › 2016 320‐350*

– *estimate by Erie County Department of Health

› Typical overdose victim

– 38 y.o. white male

› Fentanyl is behind sharp rise in overdose deaths

http://www.wgrz.com/news/projected‐opiate‐overdose‐deaths‐down/362428788 http://buffalonews.com/2016/09/01/fentanyl‐behind‐sharp‐rise‐overdose‐deaths/

http://www.cdc.gov/vitalsigns/heroin/index.html, accessed 10/30/2016

Fentanyl et al (CHINA WHITE)

Analogs include: Acetylalphamethyl‐fentanyl Acetyl fentanyl Alfentanil Alphamethylfentanyl Alphamethylthiofentanyl Betahydroxy‐fentanyl Beta‐hydroxy‐3methylfentanyl Fentanyl 3‐methylfentanyl 3‐methylthio‐fentanyl Parafluoro‐fentanyl Remifentanil Sufentanil Thiofentanyl Carfentanil

http://www.wsj.com/articles/this‐is‐u‐47700‐once‐a‐lab‐experiment‐now‐a‐killer‐opioid‐ 1478269461: accessed 11/4/2016 http://www.emcdda.europa.eu/publications/drug‐profiles/fentanyl: accessed 11/10/2016

This is U‐47700, Once a Lab Experiment (1973 Upjohn) , Now a Killer Opioid

http://www.wsj.com/articles/this‐is‐u‐47700‐once‐a‐lab‐experiment‐now‐a‐killer‐opioid‐ 1478269461: accessed 11/4/2016 “It’s hard to keep track

• f what’s killing

people,” says Karl Williams, chief medical examiner in Allegheny County, which includes Pittsburgh.

OPIOID OVERDOSE PREVENTION TRAINING

ERIE ERIE COUNT UNTY DE DEPARTMEN MENT OF OF HE HEAL AL TH TH

ITAC 12/13/2016 Karl D. Fiebelkorn, MBA, RPh 3

Narcotic Abuse & Drug Disposal

Recalled: Mucosal Atomization Device (MAD)

› The affected MAD300 lot numbers are: 160108, 160117, 160126, 160145, 160146, 160200, 160219, 160225, 160231, 160300, 160313, 160327, 160400, 160409, 160422, 160432, 160440, 160500, 160518, 160602, 160611, 160621, 160631, 160701, 160708, 160718, 160728, 160800, 160804, 160814, 160816, 160823.

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Availability of Naloxone in NYS

› Listing of pharmacies by county who are listed on the NYS Naloxone Standing Order

› http://www.health.ny.gov/diseases/aids/general/opioid_over dose_prevention/docs/pharmacy_directory.pdf

DEA Drug Take Back Programs Twice a Year / 35 sites in WNY

› April 30, 2016 › 32 sites › 13,348 pounds › 4,666 car › 55 degrees/mild/sun › October 22, 2016 › 35 sites › 4,842 pounds › 1,537 cars › 37 degrees/windy/rain Prescription Drop Boxes /Locations

https://www.health.ny.gov/professionals/narcotic/medication_drop_boxes/

List of Drop Boxes in Erie County

https://www.health.ny.gov/professionals/narcotic/medication_drop_boxes/erie.htm

› Kenmore Police Department 2395 Elmwood Avenue Kenmore, NY 14217 › New York State University Police Bissell Hall Buffalo, NY 14260 › Erie County Sheriff's Substation Clarence 6185 Goodrich Road Clarence, NY 14031 › Erie County Substation Colden 8812 State Road Colden, NY 14033 › Erie Community College South Public Safety 4041 Southwestern Blvd Bldg # 5 Orchard Park, NY 14127 › Medialle College Public Safety Office 2 Agassiz Circle Buffalo, NY 14214 › Depew Police Department 85 Manitou Street Depew, NY 14043 › Erie County Sheriff Substation Grand Island 1856 Whitehaven Road Grand Island, NY 14072

List of Drop Boxes in Erie County

https://www.health.ny.gov/professionals/narcotic/medication_drop_boxes/erie.htm

› Erie County Sheriff Substation Springville 65 Franklin Street Springville, NY 14141 › Erie County Community College North Public Safey 6205 Main Street Williamsville, NY 14221 › Erie Community Public Safety 121 Ellicot Street Buffalo, NY 14260 › Town of Hamburg Police S6100 South Park Avenue Hamburg, NY 14075 › Erie County Sheriff's Substation Elma 1600 Bowman Road Elma, NY 14059 › Erie County Sheriffs Office 10 Delaware Avenue Lobby Buffalo, NY 14202 › Canisius College 2001 Main Street Bosch Building Public Security Buffalo, NY 14208 › Lancaster Police Department Criminal Justice Bldg. Lancaster Town

• Bldg. 529 Pavement Road

Lancaster, NY 14086

ITAC 12/13/2016 Karl D. Fiebelkorn, MBA, RPh 4

Narcotic Abuse & Drug Disposal

Drug Disposal DEA Rule Federal Register September 9, 2014

›Pharmacies are now allowed to take back prescription medications

–Community, & Hospitals for households –Nursing homes for nursing home residents only

–Must be registered –Disposal regulations

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› Must be in area where employee can be vigilant

– Community

› when pharmacy is open

– Hospital

› not in emergency department

– Nursing home

› For resident’s medications only › Must get approval from resident

› No questions asked › May not look at what is being destroyed.

Receptacle

ITAC 12/13/2016 Karl D. Fiebelkorn, MBA, RPh 5

Narcotic Abuse & Drug Disposal

Drug Disposal Systems: UBSPPS $50,000 In‐kind Grant Narcotic Dispensing Regulations

› Prescriber 7 day’s supply for acute, non‐chronic, non cancer pain

› SECTION 3331, 5. (b), (c). A practitioner may not initially prescribe

more than a 7‐day supply of an opioid medication for acute pain. Acute pain is defined as pain, whether resulting from disease, accidental or intentional trauma, or other cause, that the practitioner reasonably expects to last only a short period of time. › This rule SHALL NOT include prescribing for chronic pain, pain being treated as a part of cancer care, hospice or other end‐of‐life care,

• r pain being treated as part of palliative care practices.

› Upon any subsequent consultations for the same pain, the practitioner may issue, in accordance with existing rules and regulations, any appropriate renewal, refill, or new prescription for an opioid.

› http://www.combatheroin.ny.gov/ › Governor’s Task Force › Kitchen Table Toolkit › Recognizing warning signs and symptoms › Availability of treatment › Paying for treatment › Key steps to prevention

NYS Combat Heroin and Prescription Drug Abuse

›1‐877‐8‐HOPENY

–(1‐877 846‐7369)

› Offering help and hope 24 hours a day, 365 days a year for alcoholism, drug abuse and problem gambling.

Office of Alcoholism and Substance Abuse Services (OASAS) Erie County Crisis Services

“Buck slip”

› Every patient dispensing on or after October 22, 2016 the pharmacists must provide the patient with information about the › 1. Dangers of misuse and potential risk for addiction to prescription controlled substances › 2. The physical and behavior warning signs of addiction › 3. Available alcohol and drug addiction treatment resources › 4. Proper disposal guidelines for unused prescription controlled substances

› Information must be provided in languages other than English as deemed appropriate

by the NYS Commissioner of Health (up to the 10 most common languages in NYS). › May be provided to the patient electronically if requested by the patient. › Appendix

Pharmacy Required Information Sheet Controlled Substances October 22, 2016

ITAC 12/13/2016 Karl D. Fiebelkorn, MBA, RPh 6

Narcotic Abuse & Drug Disposal

Physician & Buprenorphine Patient Expansion

› Licensed physicians who have had a waiver to treat 100 patients for at least 1 year can become eligible for the patient limit of 275

– New waiver – Effective August 8, 2016

› https://www.samhsa.gov/medication‐assisted‐ treatment/physician‐program‐data/treatment‐ physician‐locator

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Federal Register July 8, 2016

Contact Information

Karl D. Fiebelkorn Senior Associate Dean UB School of Pharmacy & Pharmaceutical Sciences 282 Kapoor Hall Buffalo, NY 14214 716 645 2824 kdf@buffalo.edu