Prescription Drug Overdose Prevention at CDC

Prescription Drug Overdose Prevention at CDC Karin A. Mack, PhD Associate Director for Science

Harold Rogers Prescription Drug Monitoring Program September 2014

National Center for Injury Prevention and Control Division of Analysis, Research, and Practice Integration

Three Pillars of CDC’s PDO Prevention Work 

Improve data quality and track trends



Strengthen state efforts by scaling up effective public health interventions



Supply healthcare providers with resources to improve patient safety

Prescription drug overdoses have

tripled since 1999

& this increase is driven by

opioid painkillers

Opioid pain reliever-related overdose deaths increasing at a faster rate than deaths from any major cause % change in number of deaths, United States, 2000-2010 Rx opioid overdose Alzheimer's Hypertension Parkinson's Disease Nephritis Suicide Liver Disease Chronic Lower Respiratory disease Septicemia HIV Malignant Neoplasms Pneumonitis Diabetes Mellitus 0% Homicide -3% Perinatal Period -14% Heart disease -16% Motor vehicle traffic -22% Cerebro-vascular -23% Influenza & Pneumonia -23% Aortic Aneurysm -34% -50%

0%

276%

68% 47% 40%

36% 31% 20% 13% 11% 7% 4% 2%

50%

100%

WISQARS, 2000 and 2010; CDC/NCHS, National Vital Statistics System

150%

200%

250%

300%

2010 Overdose Deaths

Sizes are approximate; not to scale Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013 Feb 20;309(7):657-9. doi: 10.1001/jama.2013.272.

Middle-aged adults are at greatest risk for opioid pain reliever overdose 12

45-54 Death rates by age group

Deaths per 100,000 population

10

35-44

8

25-34

6

55-64

4

15-24

2

65 +

0 1999

2000

2001

2002

2003

2004

2005 Year

2006

2007

2008

2009

2010

2011

Chen LH, Hedegaard H, Warner M. Drug-poisoning deaths involving opioid analgesics: United States, 1999–2011. NCHS data brief, no 166. Hyattsville, MD: National Center for Health Statistics. 2014.

the sharp increase in opioid

a sharp increase in opioid

prescribing

deaths

Opioid deaths, sales, and treatment admissions have increased in lock step 8

Sales (kg per 10k)

7 6

Deaths (per 100k) 5 4 3

Treatment Admissions (per 10k)

2 1 0 1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Leonard Paulozzi, Christopher Jones, Karin A. Mack, Rose Rudd. 2011. “Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008”, MMWR, 60 (November 1):1-6.

drug diversion pharmacy shopping a small number of patients multiple prescribers mental health disorders high dosages

highest risk of overdose

Certain patients account for disproportionate share of overdoses 100% 90% 80% 70% 60% Non user Other user Daily user

50% 40% 30% 20% 10% 0% Patients

Drug abuse diagnosis

Drug overdose

Opioid overdose

Leonard Paulozzi, Kun Zhang, Christopher Jones, Karin A. Mack. 2014. “Risk of adverse health outcomes with increasing duration and regularity of opioid therapy”, Journal of the American Board of Family Medicine. May-June; 27(3):329-338.









CDC’s Pillars in Action A total of 16 Core VIPP funded states chose one or more PDO prevention-related focus areas including:  10 states (AZ, CO, HI, KY, NC, NE, OR, PA, RI, WA) are working to improve physician/pharmacist participation in or implementation of a prescription drug monitoring program.  8 states (AZ, CO, KY, OH, OK, PA, UT, WA) are working to improve clinical prescribing guidelines and educating prescribers on safe prescribing practices.  8 states (AZ, CO, MD, NE, OK, TN, UT, WA) are working to increase public awareness and education about the risks of prescription drug misuse.  5 states (CO, KY, NE, OH, TN) are working on the proper disposal of prescription drugs.  4 states (MA, KY, OH, RI) are implementing naloxone distribution programs.  OH is implementing Screening, Brief Intervention and Referral to Treatment programs in healthcare settings.  MD is analyzing data to compare trends in PDO hospital admissions/discharge data and poison control center calls.  KY is working to decrease the number of pain management clinics owned by non health care providers.

CDC’s Pillars in Action Prescription Drug Overdose: Prevention Boost  West Virginia, Kentucky, Tennessee, Utah, Oklahoma President’s Budget Initiative  $15.6 million to scale up state-level prevention Advancing research on the epidemic  Evaluating what works to save lives  Building new tools for monitoring the epidemic

Example Program: Boost for State Prevention Advance and evaluate comprehensive state-level interventions for preventing prescription drug overdose in 3 areas: • Enhancing and maximizing PDMPs

• Improving and evaluating public insurer mechanisms • Evaluating state-level laws, policies, and regulations

“It is one of the happy incidents of the federal system that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.” –Justice Louis Brandeis









Supply healthcare providers with resources to improve patient safety 

Developing and promoting clinical guidelines that improve prescribing of these drugs for all patients.



Identifying effective insurance strategies such as patient review and restriction programs and claims review programs.



Enhancing electronic health record systems to improve clinical decision support facilitate use of best practices.

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: [email protected] Web: www.cdc.gov/injury

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.