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Managing the Effects of Opioids on Your Pool

Battling the Opioid Crisis: It Takes All of Us Working Together

Government

Communities and Support

Systems

Insurance Providers

FDA and Pharma

Medical Associations and Boards

Health Care Providers

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What are Opioids?Opioids = opiates = narcotics

Common Immediate Release:• Vicodin (hydrocodone)• Percocet, OxyIR (oxycodone)• Dilaudid (hydromorphone)• Opana (oxymorphone)• Nucynta (tapentadol)• Ultram (tramadol)

Common Long-Acting:• Opana ER (oxymorphone ER)• MS Contin (morphine ER)• Methadone• OxyContin (oxycodone ER)• Butrans (buprenorphine patch)• Duragesic patches (fentanyl)

Credit: MedCost

CDC: Centers for Disease Control and Prevention; www.cdc.gov

Someone in the United States dies

approximately every 12 minutes due to an opioid-related

drug overdose

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Opioid Risks

Addiction

Physical Dependence

Drug Interactions

Overdose

Abuse

Tolerance

Benzodiazepines –Xanax, Valium, KlonopinMuscle Relaxers Alcohol Antidepressants –Prozac, Lexapro, Zoloft Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics –Butrans, buprenorphine

NOT A COMPREHENSIVE LIST!

Many interactions can lead to hypotension, profound sedation, respiratory depression, coma and even death

Credit: MedCost

Understanding the Opioid Epidemic

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention https://www.cdc.gov/drugoverdose/epidemic/index.html

1999 - 2016

630,000 Deaths from Drug Overdose

Overdose Deaths Involved an Opioid

2016

66%

Opioid Overdose Deaths 5 Times Higher in

2016 than in 1999Credit: MedCost

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The Opioid Epidemic – Closer Than You Think

70%of abused prescription opioids come from a friendor relative2 1JAMA Intern Med. 2016;176(7):1027-1029)

2 Jones, C, Paulozzi, Mack K. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use. United States, 2008-2011. JAMA Int Med 2014; 174(5):802-803. 3

Obtained from US National Survey on Drug use and Health, 2008-2011.

0

10

20

30

40

50

60

Past-Year Non-Medical Users

Pe

rce

nt

of

Use

rs

Sources of Prescription Opioids AmongPast-Year Non-Medical Users2,3

Given by friend or

relative for free

Prescribed by > 1

physicians

Stolen from friend or

relative

Bought from friend or

relative

Bought from drug dealer

or other stranger

Other

60%of US citizens have left over prescription narcoticsin their home1

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A Problem Unique to the U.S.

80%of all prescription

opioids are written and consumed in the

United States1

CDC – US State Prescribing Rates 2016

1 National Institute on Drug Abuse2 IMS Health, National Prescription Audit (NPATM). Cited in internal document: Preliminary Update on Opioid Pain Reliever (OPR) Prescription Rates Nationally and by State: 2010-2013.

2013250,000,000

Prescriptions for OpioidsThis is enough for everyAmerican adult to have their own bottle of pills2

Source: U.S. Centers for Disease Control

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The Arkansas Story• Population < 3 Million People

• Drug companies sold 235,934,613 opioid pills in 2016.

• Opioids are the top-selling class of prescription drug in Arkansas (more than twice as prevalent as the next).

• Manufacturers and distributors supplied nearly 2B mg of opioids to Arkansas pharmacies in 2015.

• There are more opioid prescriptions in Arkansas than people • Drug companies sell enough opioids in Arkansas for every man, woman, and child to

each take 80 pills per year.

• Overdose deaths in Arkansas have ballooned 262% from 5.1 per 100,000 citizens in the year 2000 to 13.4 per 100,000 in 2016.

• Number of drug overdose deaths rose to 401—at least 335 of which are opioid-related (2016 – Arkansas)

• Arkansas’s near-tripling in overdose deaths between 2000 and 2015 coincides with a span in which opioid sales have quadrupled.

Source: Arkansas Municipal League

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Vermont

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+ POWERED BY DOMO | exported 23 Apr 2018

CIS Oregon Work Comp Program: Highest Rx Total UsageAll Time 171K Sum of RxPrice

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+ POWERED BY DOMO | exported 23 Apr 2018

CIS Oregon Work Comp Program: Highest Rx per tabletAll Time 171K Sum of RxPrice

Prescription for Battling the Opioid Crisis

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ResourcesFederal government: Centers for Disease Control and Prevention• The “Map:” https://www.cdc.gov/drugoverdose/maps/rxcounty2016.html• “Overdose:” https://www.cdc.gov/drugoverdose/index.html• “Understanding the Epidemic” https://www.cdc.gov/drugoverdose/epidemic/index.html

National League of Cities • A Prescription for Action (2016 Report conducted jointly with NACo)

• https://www.nlc.org/article/a-prescription-for-action-ending-the-opioid-crisis

• Opioid Use Disorder: City Actions and Opportunities to Address the Epidemic• https://www.nlc.org/resource/opioid-use-disorder-city-actions-and-opportunities-to-address-the-epidemic

• Prescription Drug Discount Program through CVS Caremark• U.S. Communities Program – Discount for Narcan

• How Cities Can Fight the Opioid Epidemic With Life-Saving Medications (CitiesSpeak Blog): https://bit.ly/2KsRlSq

National Safety Council• Prescription Nation 2018: Facing America’s Opioid Epidemic

• http://safety.nsc.org/prescription-nation-facing-americas-opioid-epidemic

Arkansas Municipal League & Association of Arkansas Counties• Lawsuit against opioid manufacturers and distributers

• https://www.arcounties.org/site/assets/files/3397/2018-04-02secondamendedcomplaint.pdf