june 20, 2005 pharmaceutical misuse & abuse: from national to local what the data say and mean...

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June 20, 2005

Pharmaceutical Misuse & Abuse: from National to

Local

What the Data Say and Mean for

Montgomery County Public Schools

Presenter:

Kenneth Hoffman, MD, MPH

Objectives

Define the problem Review the National Data

Licit and illicit drug use Review the Maryland State Department

of Education Maryland Adolescent Survey Licit and illicit drug use

Discuss next steps

Desired: Appropriate Drug Use

Over the Counter (OTC) High margin of safety (but surprises happen)

Through prescription by licensed provider For Indicated Use

Listed on the FDA regulated package insert For “Off-Label” Use

By regulated prescription (with DEA number) for known drugs of potential abuse

Desired: Monitor Use of Potentially Abused Drugs

Licensed Provider Application Process for Drug Enforcement Agency (DEA) Number

Drugs of potential abuse placed into a DEA/FDA controlled substance schedule:

I: never medically indicated II: medical indications, high abuse, non-refillable III-IV: medical indications, high abuse, refillable V: medical indications, some abuse concern

Prescription Drug Monitoring Act (proposed)

Desired: Shared Decision Making

Provider-patient shared decision for drug use Provider believes drug useful for treatment

Explains rationale to patient Benefits outweigh the risks

Patient agrees that drug will be useful Understands rationale Accepts the risks for the desired benefit

Patient takes the drug as directed Provider gets patient feedback

Problem: Drug misuse

Drugs not taken as intended Provider prescribes for “wrong reason” Patient does not take drug as directed

Unintentional: forgetfulness, too many drugs, mind-altering drug interactions

Intentional: patient doesn’t feel need or believes drug not working and doesn’t discuss with the provider

Drugs diverted to another person Potential problem & illegal (with prescribed

drugs)

Problem: Drug Abuse

Interactions affecting decision-making Individual - a voluntary decision to use

Psychologically pleasurable Physically enhancing for specific outcomes

Environmental – friends & groups affect decision Drug is available at a “reasonable” price Drug enhances group bonding Drug connected to desired group activities

Drug abuse more common than dependence

Problem: Drug Dependence

Physical dependence: tolerance or withdrawal

Addiction: “Involuntary” once use begins Out of control, obsessive-compulsive use Predisposing factor: Genetics

Psychological “hedonistic” pleasure Metabolism of specific drugs

Precipitating factor: Environment Drug available Initial use encouraged, by social group or

prescription

March 2004

Prescription Drug Abuse in the United States

Nonmedical use of prescription drugs, reported by 6.2 million persons in 2002, is second only to marijuana use.

0.1

0.2

0.6

0.6

0.7

0.6

2.0

6.2

14.6

0 5 10 15

LSD

Heroin

Inhalants

Meth

Ecstasy

Crack

Cocaine

Prescription Drugs

Marijuana

(incl. crack)

Past Month Users, Ages 12 and Older (in Millions)

Source: SAMHSA, 2002 National Survey on Drug Use and Health.

2/2004

Pain relievers account for the largest portion of nonmedical use of prescription drugs.

436

1,218

1,804

4,377

6,210

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000

Sedatives

Stimulants

Tranquilizers

Pain Relievers

Prescription Drugs

Past Month Users, Ages 12 and Older (Thousands)

Source: SAMHSA, 2002 National Survey on Drug Use and Health.

2/2004

Nonmedical use of prescription drugs is most prevalent among young adults and youth.

13.7

9.2

4.0

14.2

5.44.5

2.0

27.7

19.3

0.0

10.0

20.0

30.0

Lifetime Past Year Past Month

12-17

18-25

26 and older

Users (Percentage)

Source: SAMHSA, 2002 National Survey on Drug Use and Health.2/2004

Over 2 million are estimated to be dependent on or abusing prescription drugs in the past year.

180

214

426

1,488

2,018

4,294

0 1,000 2,000 3,000 4,000 5,000

Inhalants

Heroin

Hallucinogens

Cocaine

Prescription Drugs

Marijuana

Past Year Dependent/Abusers, Ages 12 or Older (in Thousands)

Source: SAMHSA, 2002 National Survey on Drug Use and Health.

1/2004

4.5

4.5

4.8

5.9

6.0

6.7

9.9

10.5

34.9

0 10 20 30 40

Ecstasy

OxyContin®

Cocaine

Hallucinogens

Sedatives

Tranquilizers

Amphetamine

Vicodin®

Marijuana

Past Year Users (Percent)

Source: University of Michigan, 2003 Monitoring the Future study.

2/2004

The rate of Vicodin® use in the past year ranks second to marijuana use among 12th graders in 2003.

Number of mentions

0

25,000

50,000

75,000

100,000

125,000

1995 1996 1997 1998 1999 2000 2001 2002

Benzodiazepines Narcotic analgesics

Emergency department mentions of narcotic analgesics (pain relievers) rose steadily and have overtaken benzodiazepines

(sedatives) in 2002.

Source: SAMHSA, Drug Abuse Warning Network.2/2004

DAWN ED Mention of Narcotics

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

1994 1995 1996 1997 1998 1999 2000 2001 2002

Narcotic Analgesics Heroin

Mentions

Source: Drug Abuse Warning Network

Number of mentions

0

10,000

20,000

30,000

1995 1996 1997 1998 1999 2000 2001 2002

Hydrocodone Oxycodone

Oxycodone and hydrocodone both registered substantial increases in emergency department mentions in the last 5

years.

Source: SAMHSA, Drug Abuse Warning Network.2/2004

1994-2002

Drug Abuse in the Montgomery County Public

Schools (MCPS)

Source: Maryland Department of Education

Maryland Adolescent Survey

Data specific to Montgomery County

MCPS Beer, Wine, Coolers Use

0

10

20

30

40

50

60

70

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS “Hard” Liquor Use

0

10

20

30

40

50

60

70

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS 5+ Drinks/Same Occasion

0

10

20

30

40

50

60

70

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Cigarette Use

05

101520253035404550

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Smokeless Tobacco Use

0123456789

10

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Steroids for Body Building

0

0.5

1

1.5

2

2.5

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Marijuana or Hashish Use

05

101520253035404550

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS LSD Use

02468

101214161820

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Mescaline, ‘shroom Use

02468

101214161820

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS PCP Use

0123456789

10

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Amphetamine Use

0123456789

10

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Methamphetamine Use

0123456789

10

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Cocaine (not crack) Use

0123456789

10

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS MDMA, Ecstasy Use

0123456789

10

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Narcotic (not Heroin) Use

0123456789

10

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

MCPS Barbit. or Tranquilizer Use

0123456789

10

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

19941996199820012002

Source: 1994, 1996, 1998, 2001, 2002 Maryland Adolescent Survey

Discussion

Montgomery County has a drug use problem Misuse, abuse, and dependence

Who chooses to become an addict? (rhetorical question)

What can we do? (prevention strategies) Primary – healthy community, social norms Secondary – identify high risk, early intervention,

prescription drug monitoring Tertiary – effective treatment easily accessed

Next steps?

Contact Information

Kenneth Hoffman, MD, MPH

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

Division of Pharmacologic Therapies

1 Choke Cherry Road, Rockville, MD 20857

Telephone: (240) 276-2701

Email: kenneth.hoffman@samhsa.hhs.gov

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