Prescription Opioid Dependence

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Prescription Opioid Dependence

• Presented at the
• American Association for the Treatment of Opiate
  Dependence Conference
• October 16, 2004
• Orlando, Florida
• By
• Robert L. Walsh
• Chief, Regulatory Affairs Branch
• DPMCDA, NIDA

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Prescription drug abuse is the intentional misuse
of a medication outside of the normally accepted
standards of its use
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(No Transcript)
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Current Use

• 8.8 million current users of illicit drugs other
  than marijuana
• 6.3 million currently use psychotherapeutic drugs
  nonmedically
• This represents about 2.7 of the population aged
  12 years or older

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Current Nonmedical Users of Psychotherapeutic
Drugs
Number In millions
2003 National Survey on Drug Use and Health,
SAMHSA
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Lifetime Non-Medical Use of Pain Relievers Among
Persons Aged 12 and older
Number In millions
2003 National Survey on Drug Use and Health,
SAMHSA
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Annual Numbers of New Nonmedical Users of Pain
Relievers 1965-2002
2003 National Survey on Drug Use and Health
(NSDUH)
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Narcotic analgesics that changed in frequency
from 1995 to 2002
NOS not otherwise specified
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Rates of Narcotic Analgesics / Combinations ED
Mentions Per100,000 Population 2002
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Narcotic Analgesics

• In 2002, narcotic analgesics were involved in
  108,320 (16) of total drug-abuse related ED
  visits
• Increase of 20 over 2001
• Increase of 153 from 1995
• From 1995 to 2002, the number of ED visits
  increased for all age groups except 12-17 year
  olds
• 45-54 age group experienced the largest increase
  (298)
• Dependence was the most frequently mentioned
  motive for drug-abuse related ED visits

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Drug abuse-related ED visits involving narcotic
analgesics 1995-2002
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Trends in rates of narcotic analgesic-involved
ED visits, by age 1995-2002
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Dependence or Abuse of Specific Illicit Drugs
among Persons Aged 12 or Older 2003
Numbers (in Thousands) of Users with Dependence
or Abuse
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Abuse Rates by Gender
Source The DAWN Report September 2004
Narcotic Analgesics, 2002 Update
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Factors increasing the odds of problem use of
narcotic analgesics

• Female
• Unmarried
• Age 35 years or older

Simoni-Wastila, et.al., Am J Pub Health, February
2004, Vol 94, No. 2, pp266-268
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Narcotic Analgesics Identified by NFLIS
Laboratories 2003
Total of 28,176 identified in 2003 Nearly 3 of
all items analyzed NFLIS 41 State Lab Systems
82 Local / Municipal Lab Systems 232 Individual
Labs Analyze nearly 70 of all state and local
drug cases annually
Source National Forensic Laboratory Information
System Year 2003 Annual Report, DEA
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MOST FREQUENTLY IDENTIFIED NARCOTIC ANALGESICS IN
STRIDE (8 DEA Laboratories) 20012003
Source National Forensic Laboratory Information
System Year 2003 Annual Report, DEA
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Oxycodone / Hydrocodone

• Oxycodone mentions in emergency department visits
  in SAMHSA's DAWN increased from 4,000 in 1994 to
  22,000 mentions in 2002, an increase of 450.
• About 29 of the oxycodone-related visits
  involved only oxycodone, 26 involved another
  drug, 24 involved two other drugs, and 22
  involved three or more other drugs.
• While DAWN emergency department mentions of
  hydrocodone were more than twice as frequent as
  oxycodone in 1994, the gap has narrowed with
  hydrocodone mentions increasing 170 from 9,300
  to over 25,000 in 2002.
• The most frequent substances found in combination
  with oxycodone and hydrocodone in drug abuse
  related emergency department visits were alcohol,
  benzodiazepines, other opioid pain relievers, and
  cocaine.

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Trends in drug abuse-related ED visits involving
hydrocodone and oxycodone, coterminous U.S.,
1994-2002
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Narcotic Painkillers

• In SAMHSA's Treatment Episode Data Set (TEDS),
  the substance abuse treatment admission rates for
  narcotic painkillers increased 155 between 1992
  and 2002. The increase was smallest in large
  central metropolitan areas (58) and greatest in
  the most rural areas ,i.e., non-metropolitan
  areas without a city (269).
• Injecting narcotic painkillers among the
  treatment admissions for narcotic painkillers
  decreased from 25 in 1992 to 11 in 2002 this
  decrease occurred in all rural/urban groups.
• Taking narcotic painkillers orally increased from
  66 to 77 only the non-metropolitan areas
  without a city showed a decrease (from 76 to
  69).
• Inhaling narcotic painkillers increased from 3
  to 8 this increased in all rural/urban groups,
  especially in the non-metropolitan areas without
  a city (from 2 to 12).

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Conclusions

• The abuse of prescription opioids continues to
  increase
• The problem is a national concern not just a
  local phenomenon
• It appears to affect both genders equally

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THANK YOU!