CPS 2014 Annual Meeting 8/8/2014 Conflict of Interest Disclosure Legislative Solutions to the Opioid Crisis: • For this talk, I have no conflicts of interest to disclose. New Developments in the U.S. and Colorado • I have (in the past, on other topics) received federal, state, Robert Valuck, PhD, RPh, FNAP municipal, foundation, and industry funding (research grants, speaker honoraria for single talks, advisory boards). Departments of Clinical Pharmacy, Epidemiology, and Family Medicine Director, Colorado Consortium for Prescription Drug Abuse Prevention Colorado Pharmacists Society Annual Meeting June 22, 2018 Office of the Office of the Governor Governor Objectives • Summarize the scope and impact of the opioid crisis in the United States and Colorado. What are the current data? • Describe recent federal and state legislative solutions that have been passed to address the crisis. • Discuss opportunities for pharmacists to get involved in the legislative process and implementing solutions. Office of the Office of the Governor Governor Drug Overdose Mortality Drug Overdose Mortality • In 2016, over 63,000 people died from drug overdoses • In 2016, over 63,000 people died from drug overdoses in in the United States the United States – One every 10 minutes (6 more during this session) – One every 10 minutes (6 more during this session) – Nearly 2/3 of those deaths involved prescription drugs – Nearly 2/3 of those deaths involved prescription drugs – Opioids (Rx or illicit) were involved in 75% of those deaths – Opioids (Rx or illicit) were involved in 75% of those deaths • In Colorado, there were 912 drug overdose deaths in 2016 • In Colorado, there were 912 drug overdose deaths in 2016 • Of these 912, 504 were opioid involved (Rx or illicit, combined) • Of these 912, 504 were opioid involved (Rx or illicit, combined) – Good news: Rx opioid deaths down slightly (329 in 2015, 300 in 2016) – 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 – Bad news: Heroin deaths (160 in 2015, 228 in 2016), Fentanyl deaths all up sharply [Net Gain for all Opioids: 472 in 2015, 504 in 2016] (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) • 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. CDC/MMWR Jan 13, 2012; 61(01):10-13. Office of the Office of the Colorado Rx Abuse Task Force data Colorado Rx Abuse Task Force data SAMSHA/NSDUH 2009 survey Governor SAMSHA/NSDUH 2009 survey Governor . . 1
CPS 2014 Annual Meeting 8/8/2014 Drug Overdose Mortality Drug Overdose Mortality • In 2016, over 63,000 people died from drug overdoses in • In 2017 (provisional), 558 were opioid involved (11% increase) the United States – Rx Opioid deaths rising again (329 in 2015, 300 in 2016, 372 in 2017) – One every 10 minutes (6 more during this session) – Heroin deaths (160 in 2015, 228 in 2016, 223 in 2017) – Nearly 2/3 of those deaths involved prescription drugs – Fentanyl deaths (41 in 2015, 49 in 2016, 81 in 2017) – Opioids (Rx or illicit) were involved in 75% of those deaths • In Colorado, there were 912 drug overdose deaths in 2016 – Methadone deaths (34 in 2015, 56 in 2016, 58 in 2017) • Of these 912, 504 were opioid involved (Rx or illicit, combined) • The problem knows no regional, gender, age, income, or other – Good news: Rx opioid deaths down slightly (329 in 2015, 300 in 2016) bounds: it is truly an epidemic (CDC: top four) – 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. CDC/MMWR Jan 13, 2012; 61(01):10-13. Office of the Office of the Colorado Rx Abuse Task Force data Colorado Rx Abuse Task Force data SAMSHA/NSDUH 2009 survey Governor SAMSHA/NSDUH 2009 survey Governor . . Drug Overdose Mortality in Colorado Drug Overdose Mortality in Colorado CDC/NCHS National Vital Statistics System, CDC/NCHS National Vital Statistics System, Office of the Office of the CDC Wonder. Updated 2010.. CDC Wonder. Updated 2010.. Governor Governor Drug Overdose Mortality in Colorado Drug Overdose Death Rates in the US CDC/NCHS National Vital Statistics System, Office of the CDC WONDER data file, Nov 21, Office of the CDC Wonder. Updated 2010.. Governor 2014; 63(46);1095. Governor 2
CPS 2014 Annual Meeting 8/8/2014 Prescription Drugs: primary driver of Deaths are the Tip of the Iceberg Overdose Deaths in United States For every opioid overdose death in 2014 there were… 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 SAMHSA NSDUH, DAWN, TEDS data sets Jones et al. JAMA 2013; and CDC/NCHS 2010. Office of the Office of the Coalition Against Insurance Fraud. Prescription for Peril. Governor http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor 13 14 Deaths are the Tip of the Iceberg Deaths are the Tip of the Iceberg For every opioid overdose death in 2014 there were… For every opioid overdose death in 2014 there were… SAMHSA NSDUH, DAWN, TEDS data sets SAMHSA NSDUH, DAWN, TEDS data sets Office of the Office of the Coalition Against Insurance Fraud. Prescription for Peril. Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor 15 16 Deaths are the Tip of the Iceberg Deaths are the Tip of the Iceberg For every opioid overdose death in 2014 there were… For every opioid overdose death in 2014 there were… SAMHSA NSDUH, DAWN, TEDS data sets SAMHSA NSDUH, DAWN, TEDS data sets Office of the Office of the Coalition Against Insurance Fraud. Prescription for Peril. Coalition Against Insurance Fraud. Prescription for Peril. http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor http://www.insurancefraud.org/downloads/drugDiversion.pdf 2007 . Governor 17 18 3
CPS 2014 Annual Meeting 8/8/2014 Costs of the Epidemic: Past and Projected Substance Abuse Treatment Gap: 90% SAMHSA/NSDUH 2011 survey Altarum Research Institute. Economic Toll of Opioid Crisis in U.S. Office of the Office of the Exceeded $1 Trillion Since 2001. Feb 13, 2018. Viewed at: Governor Governor www.altarum.org/about/news-and-events/ Access to Medication Assisted Treatment (MAT) in Colorado: April 2017 How does this problem start? Colorado Health Institute. Miles Away from Help: The Opioid Office of the Office of the Epidemic and Medication-Assisted Treatment in Colorado. Governor Governor May 2017. Accessed at: www.coloradohealthinstitute.org Sales of Opioid Pain Relievers and Sales of Opioid Pain Relievers and Nonmedical Opioid Use (2010-11) Nonmedical Opioid Use (2010-11) #2 in U.S. #37 in U.S. (Oregon = 6.4) Office of the Office of the SAMHSA/NSDUH 2011 survey SAMHSA/NSDUH 2011 survey Governor Governor 4
CPS 2014 Annual Meeting 8/8/2014 Sources of Opioids among Nonmedical Users Sources of Opioids among Nonmedical Users Over 70% obtain opioids from friends or relatives…the “Medicine Cabinet” problem (most common starting point to Nonmedical use and Addiction) CDC/MMWR Jan 13, 2012; 61(01):10-13. CDC/MMWR Jan 13, 2012; 61(01):10-13. Office of the Office of the SAMHSA/NSDUH 2009 survey SAMHSA/NSDUH 2009 survey . Governor . Governor New Persistent Opioid Users after Surgery Sources of Opioids among Nonmedical Users After surgery, major or minor, Also significant: 17% 6% of people of patients who are started on opioids started on opioids for post surgical legitimately, but begin pain are new, nonmedical use with persistent users the “leftovers” 1 year later (after their acute pain has subsided) Brummett et al, JAMA Surg. 2017: 152(6) CDC/MMWR Jan 13, 2012; 61(01):10-13. Office of the Office of the SAMHSA/NSDUH 2009 survey . Governor Governor Majority of Heroin users in past year reported Nonmedical use of Opioids before heroin initiation (US, 2002-2004 and 2008-2010) Age first use OPR same as heroin Age first use heroin before OPR Age first use OPR before heroin 100 90 80 What is being done? 70 65.1 64.1 66.8 69.1 74.7 76.4 77.4 60 82.6 Percent 50 40 2.1 30 16.4 25.4 18.4 20 6.7 15.2 9.7 32.8 6.2 10 16.9 16.8 12.4 12.9 10.1 10.5 11.2 0 2002-2004 2008-2010 2002-2004 2008-2010 2002-2004 2008-2010 2002-2004 2008-2010 1-29 Days PYNMU 30-99 Days PYNMU 100-365 Days PYNMU Any PYNMU Frequency of Past Year Nonmedical Use Office of the Office of the Jones, C.M. Drug Alcohol Depend., 2013. Governor Governor 29 5
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