1. Prescription Drug Abuse in Indiana
Deaths from Prescription painkillers have reached epidemic proportions. In 2009, over 6,000 persons per day abused prescription pain relievers for the first time.
And 2,500 of those were teens. Between , Quest diagnostics reported a 40% increase in employees testing positive for prescription narcotics. A 2010 report found 8% full time and 11.5% part time employees were current drug abusers.
Joan Duwve, M.D., M.P.H.
Indiana Rural Health Association
June 10, 2014

2. In 2007, 27,658 unintentional drug overdose deaths occurred in the United States. = 1 death every 19 minutes.
That number increased to 36,500 in Rates have increased roughly five-fold since 1990.

3. Drug Overdose Death Rates Versus Motor Vehicle Accidents
Now have more deaths from drug overdose than mva
Years
NCHS Data Brief, December, 2011, updated with 2009 and 2010 mortality data

4. CDC. Death rates for drug poisoning, by state of residence, United States, 2010.
Available at

5. Opioid sales, opioid-related deaths and opioid treatment admissions, U
Opioid sales, opioid-related deaths and opioid treatment admissions, U.S.
Source: Warner et al. 2011

6. Percent Change in Ten Leading Causes of Injury Death
Percent Change in Ten Leading Causes of Injury Death* Indiana, 2000–2010
In Indiana, there was a >350% increase in unintentional poisoning injury deaths from
It is important to note these are the ten leading causes of injury deaths from , not just randomly selected causes of injury deaths.
Source: WISQARS
*Age-adjusted rates 6

7. Source: Indiana State Department of Health, Epidemiology Resource Center, Data Analysis Team

8. Unintentional Poisoning Death Rates, Age-Specific, Indiana, 2005 – 2010
* Rates based on 20 or fewer deaths may be unstable. Use with caution.
* Rates based on 20 or fewer deaths may be unstable. Use with caution.
Source: Centers for Disease Control and Prevention, WISQARS Database 8

9. Geographic Variation in Opioid Prescribing in the U.S.
Journal of Pain, Volume 13, Issue 10, October 2012, Pages 988–996

10. Number of Prescription Drug Overdose Deaths in Indiana, 2002-2011
Oxycodone Distribution to Indiana Retail Registrants,
January 2007 through June 2008
Indiana Center for Health Policy
If the unintentional poisoning death rate stays the same as it was in 2007, about as many Americans will die from unintentional drug poisoning deaths over the next decade as live in cities the size of Newark, New Jersey; Anchorage, Alaska; or St. Paul, Minnesota.”
Dr. Len Paulozzi, National Center for Injury Prevention and Control,
Centers for Disease Control and Prevention
280,000 people, roughly
Source: U.S. Drug Enforcement Administration, 2008

11. Indiana State Department of Health Mortality Data;
Average Annual Accidental Poisoning by and Exposure to Drugs, Medicaments, and Biological Substances by Indiana County (2009 and 2010) – Rates per 100,000 ICD‐10 Codes X40 – X44
Indiana State Department of Health Mortality Data;

12. Other Adverse Outcomes
Other important adverse outcomes

14. Copyright © 2012 American Medical Association. All rights reserved.
Neonatal Abstinence Syndrome and Associated Health Care Expenditures:  United States,
2009
NAS vs. Other
LOS d vs d
Costs $53,400 vs. $9,500
Marked increase in neonatal abstinence syndrome
Figure Legend:
NAS indicates neonatal abstinence syndrome. Error bars indicate 95% CI. P for trend < .001 over the study period. The unweighted sample sizes for rates of NAS and for all other US hospital births are 2920 and 784 191 in 2000; 3761 and 890 582 in 2003; 5200 and 1 000 203 in 2006; and 9674 and 1 113 123 in 2009; respectively.
JAMA. 2012;307(18): doi: /jama
Date of download: 1/6/2013
Copyright © 2012 American Medical Association. All rights reserved.

15. Percentage of College Students Reporting Rx Misuse in the Past Six Months in Indiana, 2013
Rx Drug
Prevalence
Adderall
10.1%
Vicodin
3.6%
Xanax
3.5%
Codeine
2.7%
Ritalin
1.7%
Lortab
1.5%
Percocet
0.9%
Oxycontin
1.3%
Morphine
0.4%
Methadone
0.2%
Steroids
0.1%
Key:
Opioid
Stimulant
CNS Depressant
Other
* Indiana College Substance Use Survey, 2011
* Most widely misused Rx is Adderall, a stimulant (used/abused by one in ten college students)
Source: Indiana College Substance Use Survey, Indiana Prevention
Resource Center.

16. Youth and Controlled Substances
50% of teens believe that prescription drugs are much safer than illegal street drugs.
60-70% say that home medicine cabinets are their source of drugs.

17. Narcotic Sources National Survey on Drug Use and Health 2011.
More than half of nonmedical users get their prescription drugs from family or friends free
National Survey on Drug Use and Health 2011.

18. Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older:
Source: SAMHSA, National Survey of Drug Use and Health, 2011

24. ONDCP's Prescription Drug Abuse Prevention Plan
Education
Parents, youth, patients
Prescribers
Monitoring (INSPECT)
Discourage “Doctor Shopping” and Diversion
Interstate monitoring
Proper Medication Disposal
Take back programs
Enforcement
Identify and eliminate “Pill Mills” and unethical prescribing practices
1. Educate parent, youth and patients about dangers of abusing prescription drugs, and prescribers on appropriate and safe us, proper storage and disposal.
2. Implement monitoring programs in every state, capable of sharing data with other states. For use by healthcare providers and law enforcement. Reduce doctor shopping and diversion.
3. Develop convenient and environmentally responsible prescription drug disposal programs to decrease supply of unused meds in home.
4. Provide law enforcement with necessary tools to eliminate improper prescribing practices and stop pill mills.

25. Indiana’s Prescription Drug Abuse Prevention Plan
Education
Parents, youth, patients
Prescribers
Neonatal Abstinence Syndrome
Monitoring (INSPECT)
Discourage “Doctor Shopping” and Diversion
Interstate monitoring
Proper Medication Disposal
Take back programs
Enforcement
Identify and eliminate “Pill Mills” and unethical prescribing practices
Treatment and Recovery
Addiction treatment services
Naloxone Rescue
1. Educate parent, youth and patients about dangers of abusing prescription drugs, and prescribers on appropriate and safe us, proper storage and disposal.
2. Implement monitoring programs in every state, capable of sharing data with other states. For use by healthcare providers and law enforcement. Reduce doctor shopping and diversion.
3. Develop convenient and environmentally responsible prescription drug disposal programs to decrease supply of unused meds in home.
4. Provide law enforcement with necessary tools to eliminate improper prescribing practices and stop pill mills.

26. The Indiana Prescription Drug Abuse Prevention Task Force
Chair: Greg Zoeller, Indiana Attorney General
Co-chair: Joan Duwve, Indiana State Department of Health
Committees
Education: Dr. Deb McMahan, LHO, Allen County
INSPECT: Greg Pachmayr, Director, Pharmacy Board
Take-Back: Representative Steve Davisson, Pharmacist
Enforcement: Tim McClure, OAG
Treatment and Recovery: Steve McCaffrey, MHA
Committees modeled after ONDCP
Natalie Robinson, Michelle Sybesma, Kristen Kelley, many more

27. Awareness

28. Accomplishments to Date
Education Committee
Provider Education
Provider Toolkit for management of chronic, non-terminal pain
Emergency rules for opioid prescribing for chronic non-terminal pain
Annual symposium
Public speaking
Public Education
Bitterpill.in.gov
Pills of Peril PBS documentary
Adult and adolescent education
- meghan

29. “First Do No Harm” Indiana’s Safe Prescribing Recommendations

30. Accomplishments to Date
NAS Committee formed to better support families during pregnancy and after delivery
Formalized as IPN committee by legislature
make recommendations for screening pregnant women for substance use
identify and report infants with NAS to understand incidence and improve newborn care

31. Accomplishments to Date
INSPECT
Legislature authorized 100% of CSR fees to be used to maintain and operate INSPECT
Working with Health Information Exchange and Indiana Network for Patient Care to integrate into EHR systems
Decreased reporting interval to INSPECT phased in beginning July 2015

32. Accomplishments to Date
Take-Back
State-wide take-back days
Indiana law permits pharmacy-based take-back (waiting for federal DEA rule revision to be published)
Working with large pharmacy in central Indiana to develop a pilot take-back program

33. Accomplishments to Date
Enforcement
Indiana Code now requires owners of clinics dispensing controlled substances to have a Controlled Substance Registration with Indiana Professional Licensing Agency

34. Accomplishments to Date
Treatment and Recovery
Loan repayment programs for addiction treatment training
Naloxone rescue liability protection for first responders and expansion of life-line law
Working with Indiana Medicaid to ensure appropriate formulary coverage for addiction treatment medications

35. Joan Duwve, M.D., M.P.H. Associate Dean for Public Health Practice IU Richard M. Fairbanks School of Public Health Chief Medical Consultant Indiana State Department of Health