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Prescription Drug Abuse: Problems in Idaho and Impact on Women and Babies. Rex W. Force, BS(Pharm), PharmD Associate Dean for Clinical Research Division of Health Sciences Idaho State University. Email: How Many Others?.

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prescription drug abuse problems in idaho and impact on women and babies

Prescription Drug Abuse:Problems in Idaho and Impact on Women and Babies

Rex W. Force, BS(Pharm), PharmD

Associate Dean for Clinical Research

Division of Health Sciences

Idaho State University



How Many Others?

  • In 2010, 16,651 died in the US due to prescription drug overdoses
    • Since 9/11/2001, 2,215 Americans have died in Afghanistan
  • One death every 19 minutes due to Rx drug abuse
  • 1,244 people died from drug-induced causes in Idaho from 2000-09
    • Deaths each year increased from 69 in 2000 to 184 in 2009

Today’s Goals

  • Discuss the scope of the problem of prescription drug abuse…with a focus on opioids
  • Evaluate different approaches to preventing the problem of prescription drug abuse on the “supply side”
    • Prescription monitoring programs
    • Prescribing guidelines
    • Legal interventions
    • Patient-based interventions (contracts, etc.)
  • Examine the epidemic of prescription drug abuse and its effect on women and babies
the problem
The Problem
  • The US accounts for 5% of world’s population and 80% of prescription opioid use; 99% of world’s hydrocodone use
  • Hydrocodone (Vicodin, Lortab) has been #1 drug dispensed in the US since 2002
  • Idaho is routinely in the US top 5 of per capita hydrocodone use
  • 80% of new heroin users used prescription opioids in the month prior
idaho statesman nov 7 2012
Idaho Statesman – Nov. 7, 2012

…a sign with instructions on how to mix prescription medi-cation with alcohol and a sign

advertising drinks like lattes

mixed with Xanax (an anti-

anxiety medication that is also

used as a drug of abuse) and vodka…


Just Last Week…

http://journalnet. com


Just This Week…

http://journalnet. com

scope of problem3
Scope of Problem
  • Cost of prescription drug abuse (including opioids like OxyContin, Vicodin, Norco, and Lortab): $53 billion
    • Opioid abusers cost $16,000/year
    • Legit users of opioids: $1,800/year
  • Additional societal costs:
    • Children at risk
    • Lost worker productivity
    • Increases in health care and Medicaid costs
    • Escalation of crime to support the habit
    • Destruction of families
    • Decreased life expectancy
how did we get here
How did we get here?
  • Many years of inadequate treatment of pain – continues today
  • Little evidence for optimal use of pain medicines
  • Reduced patient satisfaction – pain as 5th vital sign
  • Perceived as ‘safe’
  • Focus on pain rather than function
  • (Illegal) promotional efforts to assess and use opioids
    • Oxycontin introduced in 1996
    • 2007 Purdue Pharma fined $634,000,000 for misleading claims about risk of dependence and addiction
  • 70% of abused opioids were prescribed (to someone)
  • A call for judicious use – see Juurlink et al. JAMA March 6, 2013 and Zgierska et al. JAMA April 4, 2012.
prescription drug monitoring programs
Prescription Drug Monitoring Programs
  • Nevada pioneered proactive reporting in 1997
  • By June 2012, 41 states had operating PDMPs, 49 have legislative mandates
  • Majority have secure on-line portal for prescribers and pharmacists to look up patient histories
  • Allows for identification of doctor/pharmacy shopping, excessive prescribing, etc.
  • In Idaho ½ of providers are signed up and only ½ of those access it with any regularity.

Clark et al. PDMP COE White Paper. September 2012

prescribing and dispensing guidelines
Prescribing and dispensing guidelines
  • State mandated – Idaho BoM has adopted guidelines for management of pain
    • Evaluation
    • Treatment plan
    • Informed consent and agreement for treatment
    • Periodic review
    • Consultation, if necessary
    • Accurate medical records
    • Compliance with controlled substance laws/regulations


identifying those patients at risk
Identifying Those Patients At Risk
  • Personal or family hx of substance abuse
  • Aberrant behavior
    • Warning signs of manipulation, dishonesty, threats
  • Doctor shoppers
  • Deception about pain severity
  • Forging or altering Rx’s
  • Criminal behavior
  • Patterns of use
  • Use screening tools, document, be cautious
4d s of prescriber involvement
4D’s of Prescriber Involvement
  • Deficient – outdated and under-educated
  • Duped – co-dependent, assumes the best about their patients
  • Deliberate (dealing) – pill factory
  • Drug dependent – addicted themselves
medication agreements
Medication Agreements
  • Use one practice and one pharmacy
  • No other substance abuse
  • Adhere to visit schedule
  • Prohibit sharing or selling medication
  • No premature renewals or for ‘lost’ meds
  • Med renewals only during business hours
  • Urine tox screens
whose problem is this
Whose Problem is This?
  • Law enforcement
  • Behavioral Health/Substance Abuse Professionals
  • Public Health
  • Prescribers
  • Pharmacists
  • Patients
  • Societal

Life Expectancy

  • In 2012, analysis of impact of race and educational attainment on life expectancy in the US
  • Life expectancy has fallen by 5 years for white women with less than high school education - since 1990
  • Unprecedented in modern times: rivals only 7-year drop in men observed with collapse of Soviet Union
  • No better life expectancy than those seen in the 1950s
  • Prescription drug abuse, smoking, obesity, access to health care are proposed causes

Health Affairs 2012;31(8): 1803-1813

NY Times 9/20/12


Women and Overdose Deaths

  • Centers for Disease Control surveillance study
  • In 2010, 943,365 visits by women to ED for drug misuse or abuse
  • Men more likely to die from Rx drug overdose, but death rate in women increased by 415% from 1999-2010.
  • One or more Rx drugs was involved in 85% of cases and 71% were from opioids in women

MMWR 2013:62(26);537-542


Women and Overdose Deaths


National Ave: 9.8

(range 3.9-18.5)

MMWR 2013:62(26);537-542


Women and Overdose Deaths


MMWR 2013:62(26);537-542


Birth Defects

  • National Birth Defects Prevention Study (1997-2005) – case-control design
  • Prescription opioid exposure evaluated from 1 month prior to pregnancy to end of 1st trimester
  • Approximately 2-fold greater risk for ASD, VSD, hypoplastic left heart, gastroschisis, and also hydrocephaly, spina bifida, and glaucoma
  • Similar rates of neural tube defects observed in other studies (Obstet Gynecol 2013;122(4):838-44) and animal models

Am J Obstet Gynecol 2011;204:314.e1-11


Neonatal Abstinence Syndrome

  • Large cross-sectional study of newborns with NAS
  • Between 2000-2009:
    • NAS increased from 1.20 to 3.39/1,000 births
    • Antepartum opioid use increased 1.19 to 5.63/1,000 births
  • Babies with NAS had more respiratory complications (30.9% v. 8.9%) and low birth wt – 1500-2400 gm (19.1% v. 7.0%), and longer length of stay (16.4 v. 3.3 d).
  • Normalized hospital charges increased from $39,400 to $53,400 between 2000 and 2009. All other births averaged $9,500.

JAMA 2012;307(18):1934-1940



  • Prescription opioid use is truly at epidemic levels
  • Women and their babies are harmed by this problem
  • Resultant health and societal costs are high
  • Coordinated, interdisciplinary approaches are necessary