Opioids: Colorado’s Response Robert Valuck, PhD, RPh, FNAP Departments of Clinical Pharmacy, Epidemiology, and Family Medicine Director, Colorado Consortium for Prescription Drug Abuse Prevention May 18, 2018 Office of the Governor
Objectives • Describe the efforts of the Colorado Consortium for Prescription Drug Abuse Prevention to reduce misuse/abuse • Understand the many strategies being implemented across Colorado to reduce prescription drug abuse • Identify strategies that can be implemented in medical practices to reduce prescription drug abuse Office of the Governor
What are the current data? Office of the Governor
Drug Overdose Mortality • In 2016, over 63,000 people died from drug overdoses in the United States – One every 10 minutes (6 more during this session) – Nearly 2/3 of those deaths involved prescription drugs – Opioids (Rx or illicit) were involved in 75% of those deaths • In Colorado, there were 912 drug overdose deaths in 2016 • Of these 912, 504 were opioid involved (Rx or illicit, combined) – Good news: Rx opioid deaths down slightly (329 in 2015, 300 in 2016) – Bad news: Heroin deaths (160 in 2015, 228 in 2016), Fentanyl deaths (41 in 2015, 49 in 2016) and Methadone deaths (34 in 2015, 56 in 2016) are all up sharply [Net Gain for all Opioids: 472 in 2015, 504 in 2016] • The problem knows no regional, gender, age, income, or other bounds: it is truly an epidemic (CDC: top four) CDC/MMWR Jan 13, 2012; 61(01):10-13. Office of the Colorado Rx Abuse Task Force data SAMSHA/NSDUH 2009 survey Governor .
Drug Overdose Mortality • In 2016, over 63,000 people died from drug overdoses in the United States – One every 10 minutes (6 more during this session) – Nearly 2/3 of those deaths involved prescription drugs – Opioids (Rx or illicit) were involved in 75% of those deaths • In Colorado, there were 912 drug overdose deaths in 2016 • Of these 912, 504 were opioid involved (Rx or illicit, combined) – Good news: Rx opioid deaths down slightly (329 in 2015, 300 in 2016) – Bad news: Heroin deaths (160 in 2015, 228 in 2016), Fentanyl deaths (41 in 2015, 49 in 2016) and Methadone deaths (34 in 2015, 56 in 2016) are all up sharply [Net Gain for all Opioids: 472 in 2015, 504 in 2016] • The problem knows no regional, gender, age, income, or other bounds: it is truly an epidemic (CDC: top four) CDC/MMWR Jan 13, 2012; 61(01):10-13. Office of the Colorado Rx Abuse Task Force data SAMSHA/NSDUH 2009 survey Governor .
Drug Overdose Mortality • In 2016, over 63,000 people died from drug overdoses in the United States – One every 10 minutes (6 more during this session) – Nearly 2/3 of those deaths involved prescription drugs – Opioids (Rx or illicit) were involved in 75% of those deaths • In Colorado, there were 912 drug overdose deaths in 2016 • Of these 912, 504 were opioid involved (Rx or illicit, combined) – Good news: Rx opioid deaths down slightly (329 in 2015, 300 in 2016) – Bad news: Heroin deaths (160 in 2015, 228 in 2016), Fentanyl deaths (41 in 2015, 49 in 2016) and Methadone deaths (34 in 2015, 56 in 2016) are all up sharply [Net Gain for all Opioids: 472 in 2015, 504 in 2016] • The problem knows no regional, gender, age, income, or other bounds: it is truly an epidemic (CDC: top four) CDC/MMWR Jan 13, 2012; 61(01):10-13. Office of the Colorado Rx Abuse Task Force data SAMSHA/NSDUH 2009 survey Governor .
Drug Overdose Mortality • In 2016, over 63,000 people died from drug overdoses in the United States – One every 10 minutes (6 more during this session) – Nearly 2/3 of those deaths involved prescription drugs – Opioids (Rx or illicit) were involved in 75% of those deaths • In Colorado, there were 912 drug overdose deaths in 2016 • Of these 912, 504 were opioid involved (Rx or illicit, combined) • In 2017 (provisional), 536 were opioid involved (5% increase) – Rx opioid deaths rising again (329 in 2015, 300 in 2016, 357 in 2017) – Heroin deaths (160 in 2015, 228 in 2016, 213 in 2017) – Fentanyl deaths (41 in 2015, 49 in 2016, 74 in 2017) – Methadone deaths (34 in 2015, 56 in 2016, 58 in 2017) • The problem knows no regional, gender, age, income, or other bounds: it is truly an epidemic (CDC: top four) CDC/MMWR Jan 13, 2012; 61(01):10-13. Office of the Colorado Rx Abuse Task Force data SAMSHA/NSDUH 2009 survey Governor .
Drug Overdose Mortality in Colorado CDC/NCHS National Vital Statistics System, Office of the CDC Wonder. Updated 2010.. Governor
Drug Overdose Mortality in Colorado CDC/NCHS National Vital Statistics System, Office of the CDC Wonder. Updated 2010.. Governor
Drug Overdose Mortality in Colorado CDC/NCHS National Vital Statistics System, Office of the CDC Wonder. Updated 2010.. Governor
Drug Overdose Death Rates in the US CDC WONDER data file, Nov 21, Office of the 2014; 63(46);1095. Governor
Prescription Drugs: primary driver of Overdose Deaths in United States 18,000 16,000 14,000 12,000 Number of Deaths 10,000 8,000 6,000 4,000 2,000 0 Drug or Drug Class Jones et al. JAMA 2013; and CDC/NCHS 2010. Office of the Governor 12
Deaths are the Tip of the Iceberg For every opioid overdose death in 2014 there were… SAMHSA NSDUH, DAWN, TEDS data sets Office of the Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor 13
Deaths are the Tip of the Iceberg For every opioid overdose death in 2014 there were… SAMHSA NSDUH, DAWN, TEDS data sets Office of the Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor 14
Deaths are the Tip of the Iceberg For every opioid overdose death in 2014 there were… SAMHSA NSDUH, DAWN, TEDS data sets Office of the Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor 15
Deaths are the Tip of the Iceberg For every opioid overdose death in 2014 there were… SAMHSA NSDUH, DAWN, TEDS data sets Office of the Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor 16
Deaths are the Tip of the Iceberg For every opioid overdose death in 2014 there were… SAMHSA NSDUH, DAWN, TEDS data sets Office of the Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor 17
Costs of the Epidemic: Past and Projected Altarum Research Institute. Economic Toll of Opioid Crisis in U.S. Office of the Exceeded $1 Trillion Since 2001. Feb 13, 2018. Viewed at: Governor www.altarum.org/about/news-and-events/
Substance Abuse Treatment Gap: 90% SAMHSA/NSDUH 2011 survey Office of the Governor
Access to Medication Assisted Treatment (MAT) in Colorado: April 2017 Colorado Health Institute. Miles Away from Help: The Opioid Office of the Epidemic and Medication-Assisted Treatment in Colorado. Governor May 2017. Accessed at: www.coloradohealthinstitute.org
How did we get here? Office of the Governor
The Ubiquity and Impact of Opioid Prescription Drugs on the US Population 8 No. per US Population 6 Kg of Opioids Sold (per 10,000) 4 2 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year 1. Volkow ND et al. N Engl J Med . 2014;370:2063-2066. Office of the 2. CDC Vital Signs. http://www.cdc.gov. Governor
The Ubiquity and Impact of Opioid Prescription Drugs on the US Population sold 3.9-fold increase in quantity of opioids sold 1 8 No. per US Population Kg of Opioids Sold (per 10,000) 6 4 2 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year 1. Volkow ND et al. N Engl J Med . 2014;370:2063-2066. Office of the 2. CDC Vital Signs. http://www.cdc.gov. Governor
The Ubiquity and Impact of Opioid Prescription Drugs on the US Population sold 3.9-fold increase in quantity of opioids sold 1 8 No. per US Population Kg of Opioids Sold (per 10,000) 6 4 2 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year 259 million opioid prescriptions were dispensed at retail in 2013 2 …enough for every American adult to have a bottle of pills…every year! 1. Volkow ND et al. N Engl J Med . 2014;370:2063-2066. Office of the 2. CDC Vital Signs. http://www.cdc.gov. Governor
The Ubiquity and Impact of Opioid Prescription Drugs on the US Population 8 3.9-fold increase in No. per US Population quantity of opioids sold 1 6 Kg of Opioids Sold (per 10,000) Overdose Deaths (per 10,000) 4 Treatment Admission (per 100,000) 2 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year 259 million opioid prescriptions were dispensed at retail in 2013 2 …enough for every American adult to have a bottle of pills…every year 1. Volkow ND et al. N Engl J Med . 2014;370:2063-2066. Office of the 2. CDC Vital Signs. http://www.cdc.gov. Governor
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