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