Category Archives: Prescription drugs
Inappropriate and dangerous prescription practices for painkillers are driving high addiction and overdose rates—46 people die of a prescription painkiller overdose every day—according to a new Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC).
The CDC has also found wide variation in prescription practices across the country:
- Southern states had the most prescriptions per person for painkillers, especially Alabama and Tennessee.
- The Northeast, especially Maine and New Hampshire, had the most prescriptions per person for long-acting and high-dose painkillers.
- Nearly 22 times as many prescriptions were written for oxymorphone (a specific type of painkiller) in Tennessee than were written in Minnesota.
In total, doctors wrote 259 million prescriptions for painkillers in 2012—or enough for a bottle of prescription pain pills for every American adult in the country.
“Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem,” said CDC Director Tom Frieden, MD, MPH. “Overdose rates are higher where these drugs are prescribed more frequently. States and [medical] practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs.”
According to the CDC, deaths from drug overdoses have been rising steadily over the past two decades and have become the leading cause of injury death in the United States—linked strongly to the overuse of prescription painkillers. In 2011, of the 41,340 drug overdose deaths in the United States, 55 percent were related to pharmaceuticals, and almost three quarters of those were from prescription painkillers.
Study: Today’s Drugged Drivers More Likely to Mix Alcohol and Drugs, Have Taken Multiple Prescription Medicines
The profile of a drugged driver has changed substantially since 1993, according to a new study released today in the journal Public Health Reports, which shows that more drivers are now testing positive for prescription drugs, marijuana and multiple drugs.
“While we’ve seen a decrease over the years in motor vehicle fatalities involving people under the influence, the nature of those crashes is changing,” said study author Fernando Wilson, PhD, an associate professor at the University of Nebraska Medical Center.
The study examines trends in the characteristics of U.S. drivers who were involved in fatal crashes between 1993 and 2010 and tested positive for drugs. The study, funded by the Public Health Law Research program of the Robert Wood Johnson Foundation, was set up to investigate the relationship between state laws and the consumption of alcohol and other drugs in fatal car crashes. It found that the percentage of drugged drivers with three or more drugs in their system nearly doubled from 1993 to 2010, increasing from 11.5 percent to 21.5 percent.
“In 1993, about one in eight drivers were using multiple drugs concurrently. By 2010, it was closer to one in five. That’s a large increase in drug use,” Wilson said. “Beyond that, we’re also seeing more and more people using drugs and alcohol together. About 70 percent of drivers who tested positive for cocaine had also been consuming alcohol, and almost 55 percent of drivers who tested positive for cannabis also had alcohol in their systems.”
- Almost 60 percent of cannabis-only users were younger than 30 years.
- Thirty-nine percent of prescription drug users were 50 years old or older, which seems to be in line with an overall increase in the use of prescription drugs by Americans, and the older population in general.
“These trends are likely to continue into the future given the aging U.S. population, an increasing reliance on prescription medications by medical providers and increasing initiatives to legalize marijuana,” said Wilson. “However, it is unclear whether current state policies are completely up to the challenge of addressing the growing issue of drugged driving.”
NewPublicHealth recently spoke with Wilson about the study. He said he embarked on the research because of the tens of thousands of motor vehicle crashes each year and the need to figure out the most effective policies to curb distracted driving. According to Wilson, eighteen states have zero-tolerance laws for drugged drivers, but recent studies suggest that these laws may not be effective enough in decreasing traffic deaths.
A new database on pain research established by the National Institutes of Health (NIH) and several other federal agencies might help practitioners choose more effective and safer options for their patients dealing with pain. It could also potentially reduce reliance on opioid drugs, which often turns patients into addicts and creates an easy source of the drugs for potential abusers.
The database, launched last week, is called the Interagency Pain Research Portfolio (IPRP) and offers information on federal pain research projects. According to the NIH, pain is a symptom of many disorders and can be a disease itself; the economic cost of pain is estimated to be hundreds of billions of dollars annually in lost wages and productivity.
“This database [allows] the public and the research community...to learn more about the breadth and details of pain research supported across the federal government. They can search for individual research projects or sets of projects grouped by themes uniquely relevant to pain,” said Linda Porter, PhD, Policy Advisor for Pain at the National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH.
Both in public speeches and private briefings with reporters, U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, has called on physicians to find alternatives to narcotics for pain patients when medically advisable, such as guided imagery and other forms of relaxation. He’s also called for starting with less potent medications than narcotics, in order to reduce the chance of addiction and to introduce far fewer amounts of prescription drugs into the community where they are often taken from medicine cabinets by people—especially young adults—for whom they’re not prescribed. According to the Substance Abuse and Mental Health Administration, approximately 22 million people nationwide have taken narcotic pain relievers for non-medical reasons.
U.S. Food and Drug Administration head Margaret Hamburg, MD, also spoke on the subject during a town hall meeting last week on prescription drug abuse, hosted by the Johns Hopkins School of Public Health and the Clinton Foundation. Hamburg said that “we need to recognize that opiates are... probably most often not the treatment strategy of first choice...but it may be the option a provider knows best. We need to actively engage with the scientific research community and industry to try to develop new non-opiate, non-addictive pain strategies...”
This Saturday, April 26, is The National Prescription Drug Take-Back Day, an effort led by the U.S. Drug Enforcement Administration (DEA) for the eighth time in three years to safely dispose of potentially dangerous expired, unused and unwanted prescription drugs.
Last October, Americans turned in more than 647,000 pounds of prescription drugs at more than 4,100 sites operated by the DEA in partnership with state and local law enforcement offices. More than 3.4 million pounds of pills have been collected since the initiative began. The goal is to help reduce the huge cache of prescription pills that pose a risk of poisoning and death for young children, as well as the potential for abuse, overdose and death by the millions of people who take prescription drugs not prescribed for them in an effort to get high.
Every state has put resources into reducing prescription drug abuse in the last few years and recent surveys indicate abuse rates are dropping—though the problem is still significant. The 2013 National Survey on Drug Use and Health produced by the Substance Abuse and Mental Health Services Administration found that that 5.3 percent of young adults used prescription drugs for nonmedical purposes in the past month, similar to rates in several previous years, but lower than 2009, when 6.4 percent of young adults used prescription drugs for nonmedical purposes.
DEA studies show that a majority of abused prescription drugs are obtained from family and friends, often from home medicine cabinets. Contributing to the pileup is the fact that people are advised not to put many drugs in the trash or down the toilet so as to avoid contaminating water supplies and harming animals.
New laws are being proposed in many states to help families and facilities more easily get rid of unused drugs. Health departments in many communities, including the State of Colorado, can refer people to sites that will accept some unused prescription pills—though often not narcotics—at various times of the year for disposal.
In an effort to combat the growing epidemic of prescription drug abuse and overdose, the U.S. Food and Drug Administration (FDA) has approved a small, easy-to-use injector—similar to an EpiPen—that can be used to revive people who have stopped breathing or lost consciousness from an opioid drug overdose. The device, called Evzio, provides a single dose of naloxone, which is the standard treatment for opioid overdoses but up until now was mostly only available in hospitals and other medical settings.
The device, expected to be available starting this summer, will enable early intervention that increases the chances of survival. According to the National Center for Injury Prevention and Control , nationally, sales of prescription painkillers per capita have quadrupled since 1999—and the number of fatal poisonings due to prescription painkillers has also quadrupled.
The FDA’s approval comes at a critical time. In October of last year, Trust for America’s Health released a report that found that a very small number of states are implementing more than just a few promising strategies that have been identified to help combat the widespread drug abuse that continues to increase across the United States. The report, Prescription Drug Abuse: Strategies to Stop the Epidemic, which was funded by a grant from the Robert Wood Johnson Foundation, showed that only two states—New Mexico and Vermont—have implemented all ten strategies. TFAH also released an interactive tool with state-by-state prescription drug overdose death rates and state scores on the 10 key steps to curb abuse.
Carl R. Sullivan III, MD, director of the addictions program at West Virginia University, said the FDA’s approval of Evzio “is a big deal, and I hope [it] gets wide attention,” according to The New York Times. “It’s pretty simple: Having these things in the hands of people around drug addicts just makes sense because you’re going to prevent unnecessary mortality.”
Read the full story from The New York Times.
HHS Will Allow Some to Skip Insurance for 2014 without Penalty
The U.S Department of Health and Human Services (HHS) made some key rule changes to the Affordable Care Act (ACA) late last week. People whose insurance plans were cancelled for 2014 because the plans did not meet the requirements for plans under the ACA — such as covering essential benefits including some preventive care with no copays — will be permitted to buy a “catastrophic” plan which has only minimal coverage or opt for no insurance for the coming year, but pay no penalty. HHS has set up a hotline, 1-866-837-0677, for people whose policies were canceled so they can get advice on coverage for 2014. Read more on the Affordable Care Act.
NIH Study: Drop in Prescription Drug Abuse, Rise in Marijuana Use Among High School Seniors
The percentage of high-schoolers who think using marijuana regularly poses a major risk to health has fallen dramatically in the past 10 years, according to this year’s Monitoring the Future survey, which measures drug use and attitudes among the nation’s eighth-, 10th-, and 12th-graders. Actual rates of marijuana use have also increased among high school seniors, with 6.5 saying they smoke marijuana daily, up from 6 percent in 2003 and 2.4 percent in 1993.
“This is not just an issue of increased daily use,” said NIDA Director Nora D. Volkow, MD. “It is important to remember that over the past two decades, levels of THC — the main psychoactive ingredient in marijuana — have gone up a great deal, from 3.75 percent in 1995 to an average of 15 percent in today’s marijuana cigarettes. Daily use today can have stronger effects on a developing teen brain than it did 10 or 20 years ago.”
Other findings of the survey include:
- For the first time, the percentage of students in all three grades combined who say they smoked cigarettes in the past month is below 10 percent (9.6 percent) compared to 16.7 percent 10 years ago and 24.7 percent in 1993.
- Continued abuse of Adderall, commonly used to treat attention deficit hyperactivity disorder, with 7.4 percent of seniors reporting taking it for non-medical reasons in the past year.
- Five percent of seniors report abuse of cough products containing dextromethorphan, down from 6.9 percent in 2006, the first year it was measured by the survey.
- For cocaine and heroin, while there was no significant change from the 2012 rates, there continues to be a gradual decline in use, with both drugs at historic lows in all three grades.
- Use of alcohol by teens continues a steady decline. For 12th-graders, alcohol use peaked in 1997, with more than half (52.7 percent) reporting drinking alcohol in the past month. Only 39.2 percent of seniors reported past month use this year.
Read more on Substance Abuse.
Earlier Cataract Surgery for Seniors Could Reduce Car Accidents
Researchers at the University of Alabama at Birmingham have found that earlier surgery cataract surgery may reduce car accidents among older drivers by about 16 percent.
Currently, most U.S. insurers cover the surgery based on both findings of an eye exam and vision complaints by patients. However, the researchers say that cognitive deficits, age, insurance coverage, income, or simple procrastination, may keep older people from telling their doctor about their vision problems.
The researchers developed a model to simulate a common vehicle collision for people 60 to 89 and implemented control conditions of earlier and later cataract surgery and found that the change to earlier surgeries would increase cataract surgery expenditure for people ages 65 and older by eight percent and for people ages 60-64 by about 47 percent. However, those expenses would be offset by reductions in medical and emergency services costs following car accidents. The study was published in Accident Analysis and Prevention. Read more on aging.
In 2008, the U.S. Department of Veterans Affairs (VA) sent Army paratrooper Jeffrey Waggoner to an Oregon hospital to recover from an addiction to painkillers. However, once there they instead gave him a steady stream of medications, eventually releasing him for a weekend with 19 prescription drugs in hand. He was found dead of an overdose three hours later.
“As a parent, you’d want to know how this happened to your child,” said his father, Greg Waggoner, according to a new report from The Center for Investigative Reporting (CIR). “You send your child to a hospital to get well, not to die.”
In its investigation, CIR found that, post 9/11, the VA has increasingly been treating addictions with a variety of drugs, “feeding addictions and contributing to a fatal overdose rate among VA patients that is nearly double the national average.” Over the past dozen years, prescriptions for the four opiates hydrocodone, oxycodone, methadone and morphine have increased by 270 percent.
Waggoner’s weekend leave medications included 12 oxycodone pills.
As part of its investigation, CIR has created a comprehensive interactive tool that shows the VA systems with the highest prescription rates and allows users to search for information by region and system. The data is culled from CIR’s own research, as well as information from the VA and the U.S. Census Bureau.
Trust for America’s Health also recently released an interactive tool on the growing public health issue of prescription drug abuse—about 6.1 million Americans use or abuse prescription drugs. The tool allows users to search state-by-state prescription drug overdose death rates and find out how each scores on 10 key steps to curb abuse.
>>Read The Center for Investigative Reporting’s “VA’s opiate overload feeds veterans’ addictions, overdose deaths”
>>Read NewPublicHealth’s story, “New Report: Most States Not Implementing Enough Proven Strategies to Prevent Prescription Drug Abuse”
New Report: Most States Not Implementing Enough Proven Strategies to Prevent Prescription Drug Abuse
Prescription drug-related deaths now outnumber deaths from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C.
A new report about prescription drug abuse released today by Trust for America’s Health (TFAH), finds that few states are implementing more than just a few promising strategies that have been identified to help combat the widespread drug abuse that continues to increase across the U.S. The report, Prescription Drug Abuse: Strategies to Stop the Epidemic, which was funded by a grant from the Robert Wood Johnson Foundation, shows that only two states – New Mexico and Vermont – have implemented all ten strategies.
According to the National Center for Injury Prevention and Control (NCIPC), nationally, sales of prescription painkillers per capita have quadrupled since 1999 – and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month.
>>Watch a one-minute video on the scope of the prescription drug abuse epidemic in the United States.
The report also found that the number of drug overdose deaths – a majority of which are from prescription drugs – has doubled in 29 states, tripled in ten states and quadrupled in four states since 1999.
“The rapid rise of abuse requires nothing short of a full-scale response – starting with prevention and education all the way through to expanding and modernizing treatment,” said Jeffrey Levi, PhD, executive director of TFAH. “There are many promising signs that we can turn this around – but it requires urgent action,” says Levi.
In the new report, TFAH, based on consultations with experts in public and clinical health, injury prevention, law enforcement and community organization, reviewed national recommendations and examined strategies currently in use to help curb the epidemic. Recommendations include expanding access to treatment options; ensuring responsible prescribing practices; and improving Prescription Drug Monitoring Programs.
>> Learn how your state scores on the 10 key steps to curb prescription drug abuse, with a new app from the Robert Wood Johnson Foundation.
Ohio is one of several states that have implemented six of the proven strategies recommended in the report and today, in fact, will introduce new prescriber guidelines.
NewPublicHealth spoke with Ted Wymyslo, MD, director of the Ohio Department of Health about that state’s review of drug abuse and recent efforts to reduce the epidemic through a variety of means, including public and provider education.
For the last several years, each incoming president of the Association of State and Territorial Health Officials (ASTHO) has introduced a President’s Challenge for the year of their presidency to focus attention on a critical national health issue. Previous challenges have included injury prevention, health equity and reducing the number of preterm births. This year, incoming ASTHO president Terry Cline, PhD, will focus his President’s Challenge on prescription drug abuse, a national public health crisis that results in tens of thousands of deaths each year.
>>Follow our ASTHO Annual Meeting coverage throughout the week.
Just before the ASTHO annual meeting began, NewPublicHealth spoke with Cline about the scope of the issue and steps Cline will introduce to help health officers collectively focus their attention on reducing this public health crisis.
NPH: Why have you chosen prescription drug abuse as your President’s Challenge?
Terry Cline: If you look at the trend lines in the United States, we’ve seen a very rapid increase in the number of deaths from the misuse of prescription drugs. We’ve also seen a huge increase in the number of children born with neonatal abstinence syndrome, which has actually tripled in the last decade. Prescription drug abuse has created an incredible burden on the health of people in the United States. Deaths are just one indicator; others include lost productivity, absenteeism and health care costs. Just using neonatal abstinence syndrome as an example, in 2000 the total hospital charges were about $190 million and in 2009, which is the last year we have that data, it was $720 million. Because in many states Medicaid pays for a large percentage of the births, in 2000 that amount was about $130 million out of the $190 million, and in 2009 it was $560 million of the $720 million. So that is becoming a larger and larger financial burden on states as well, and that does not include the long-term effects on babies.
The President’s Challenge will be looking at the absolute number—bringing down the number of deaths, which stand at more than 16,000 deaths per year. We’ve seen opioid deaths increase and continue every year over the last decade. And in most states now, the number of deaths from prescription drugs is actually greater than the number of deaths from automobile accidents, which has steadily gone down over the last decade. So, one is an example of a public health success; the decrease in motor vehicle deaths stems from a comprehensive approach and work with multiple sectors to bring that death rate down. The other, prescription drug deaths, is an alarming increase. My hope is that with the President’s Challenge, we can really increase awareness and leverage public health agencies across the country to mobilize around this issue.
While men are more likely to die of a prescription painkiller overdose, since 1999 the percentage increase in deaths has been greater among women than among men, according to the Vital Signs monthly health indicator report released today by the Centers for Disease Control and Prevention (CDC). The increase in deaths between 1999 and 2010 has been 400 percent in women compared to 265 percent in men, according to the new report. The overdoses killed nearly 48,000 women during that time period.
“Prescription painkiller deaths have skyrocketed in women…” says CDC Director Tom Frieden, MD, MPH. “Stopping this epidemic in women – and men – is everyone’s business. Doctors need to be cautious about prescribing and patients about using these drugs.”
Key findings include:
- About 42 women die every day from a drug overdose.
- Since 2007, more women have died from drug overdoses than from motor vehicle crashes.
- Drug overdose suicide deaths accounted for 34 percent of all suicides among women compared with 8 percent among men in 2010.
- More than 940,000 women were seen in emergency departments for drug misuse or abuse in 2010.
For the Vital Signs report, CDC analyzed data from the National Vital Statistics System (1999-2010) and the Drug Abuse Warning Network public use file (2004-2010).
According to the CDC, studies have shown that women may become dependent on prescription painkillers more quickly than men and may be more likely than men to engage in “doctor shopping” (obtaining prescriptions from multiple prescribers).