WilsonM.Compton,M.D.,M.P.E. M. Compton, M.D., M.P.E ... · 1 Wilson M. Compton, M.D., M.P.E....
Transcript of WilsonM.Compton,M.D.,M.P.E. M. Compton, M.D., M.P.E ... · 1 Wilson M. Compton, M.D., M.P.E....
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Wilson M. Compton, M.D., M.P.E.Director, Division of Epidemiology, Services and Prevention Research
National Institute on Drug Abuse
22 June 2010
Wilson M. Compton, M.D., M.P.E.Wilson M. Compton, M.D., M.P.E.Director, Division of Epidemiology, Services and Prevention ReseDirector, Division of Epidemiology, Services and Prevention Researcharch
National Institute on Drug AbuseNational Institute on Drug Abuse
22 June 201022 June 2010
RatesRates
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Pharmaceutical Drug Abuse is a Particular Problem in USA
Pharmaceutical Drug Abuse is a Particular Problem in USA
Past Month Use of Illicit Drugs among Persons Aged 12+ in 2007
Numbers in Millions
Psychotherapeutics
Inhalants
Heroin
Hallucinogens
Cocaine
Marijuana
0.2
0.6
1.0
2.1
6.9
14.4
19.9
0 5 10 15 20 25
Illicit Drugs
Source: SAMHSA, 2007 National Survey on Drug Use and Health
8.0%
5.8%
2.8%
0.8%0.4%0.3%
0.1%
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Past Year Initiates for Specific Illicit Drugs, Ages 12+, 2007
Numbers in Thousands
Source: SAMHSA, 2007 National Survey on Drug Use and Health
2,147 2,090
1,232
906781 775
642
270 198 106 580
500
1,000
1,500
2,000
2,500
Marijuana Heroin
Pain Relievers
Cocaine
SedativesTranquilizers PCPStimulantsEcstasy
Inhalants LSD
2009 Monitoring the Future Study of USA Secondary Students, 12th Grade (~Age 17‐18): Past Year Drug Use
2009 Monitoring the Future Study of USA Secondary Students, 12th Grade (~Age 17‐18): Past Year Drug Use
* Nonmedical use
Drug Prev. Drug Prev.Alcohol 66.2 MDMA (Ecstasy) 4.3Marijuana/Hashish 32.8 Cocaine (any form) 3.4Vicodin* 9.7 Inhalants 3.4Amphetamines* 6.6 Cocaine Powder 3.0Tranquilizers* 6.3 Ritalin* 2.1Cough Medicine* 5.9 LSD 1.9Salvia 5.7 Provigil* 1.8Adderall* 5.4 Ketamine 1.7Sedatives* 5.2 Steroids 1.5OxyContin* 4.9 Crack 1.3Hallucinogens 4.7 Methamphetamine 1.2
Cigarettes: Lifetime 43.6%, Past Month 20.1%
Past Month Nonmedical Use of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002‐2008
1.9
0.7
0.4
0.1
2.12.1
1.91.8
2.01.9
0.70.8 0.8
0.7 0.7 0.7
0.6+ 0.6+
0.5+ 0.5+ 0.6+
0.40.1
0.2+
0.10.10.10.2+
0.0
0.5
1.0
1.5
2.0
2.5
2002 2003 2004 2005 2006 2007 2008
Pain Relievers
Tranquilizers
Sedatives
Stimulants
6
Percent Using in Past Month
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level. Source: SAMHSA, 2008 National Survey on Drug Use and Health
ConsequencesConsequences
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Source: Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2010
Opioid Analgesics increased from 144,600 to 305,900 (111%), 2004 to 2008
Benzodiazepines increased from 143,500 to 271,700 (89%), 2004 to 2008
No change in illicit drug reports (1.9 million to 1.9 million overall, non‐alcohol illicit 1.0 million to 1.0 million, cocaine 475,425 to 482,188, ).
Emergency Department Mentions Increasing for Pharmaceuticals, Not for Illicit Drugs in the USA
Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2008
Numbers in Thousands
126
175
282
351
358
451
1,716
4,199
1,411
0 1,000 2,000 3,000 4,000 5,000
Sedatives
Inhalants
Heroin
Stimulants
Hallucinogens
Tranquilizers
Cocaine
Pain Relievers
Marijuana
9Source: SAMHSA, 2008 National Survey on Drug Use and Health
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Increasing Treatment for Pharmaceutical Opioids
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Numbers in Thousands
415 424466
547 558601
360+
0
100
200
300
400
500
600
700
2002 2003 2004 2005 2006 2007 2008+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
SAMHSA: 2008 National Survey on Drug Use and Health
Treatment Admissions Increasing for Pharmaceutical Opioids in General Population in USA:
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Source: CDC, Unintentional Drug Poisoning in the United States,, National Vital Statistics System, 2010
Increasing Mortality from Unintentional Drug Overdose
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Source: CDC, Unintentional Drug Poisoning in the United States,, National Vital Statistics System, 2010
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Source: CDC, Unintentional Drug Poisoning in the United States,, National Vital Statistics System, 2010
CausesCauses
Increased Media Attention?Increased Media Attention?
Easy Access? Possible Role of the Internet“Delivered in the Privacy of your Home”
Easy Access? Possible Role of the Internet“Delivered in the Privacy of your Home”
“Some reasons why you should consider using this pharmacy”
No prescription required!
“Some reasons why you should consider using this pharmacy”
No prescription required!
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In 2007‐2008 Where Pain Relievers Were Obtained for Most Recent Nonmedical Use: Ages 12+
Note: Totals may not sum to 100% because of rounding or because suppressed estimates.1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”
Bought/Took from Friend/Relative
14.3%
Drug Dealer/Stranger4.3%
Bought on Internet0.4% Other 1
4.8%
Source Where Respondent Obtained
One Doctor18.0%
More than One Doctor2.4%
Free from Friend/Relative
55.9%
Free from Friend/Relative
6.2%
Bought/Took fromFriend/Relative
5.4%
OneDoctor81.7%
Drug Dealer/Stranger1.6%Bought on
Internet0.1%
Source Where Friend/Relative Obtained
More than One Doctor3.4%
Source: SAMHSA, 2008 National Survey on Drug Use and Health
Other 1
1.6%
Dunn K M et al. Ann Intern Med 2010;152:85-92
©2010 by American College of Physicians
Increasing Non‐Fatal Overdose Associated with Higher Opioid Dosages
Total Deaths Classified: 295
95%
78%
63%
22%
21%
17%
16%
4%
17%
0% 20% 40% 60% 80% 100%
ANY INDICATOR
History of substance abuse
Any diverted pharmaceuticals
Nonmedical route of administration
>4 Clinicians prescribed controlledsubstances
Contributory alcohol
Previous overdose
Contributory illicit drug
Current opiate treatment
20Hall, A. J. et al. JAMA 2008;300:2613-2620.
Substance Abuse Indicators Among Unintentional Pharmaceutical Overdose Deaths, West Virginia, 2006
Total Number of Prescriptions for Hydrocodone and Oxycodone Products Dispensed by US Retail Pharmacies, Years 1991−2009
Source: SDI’s Vector One® National, VONA 03‐16‐10 Hydrocodone & Oxycodone 1991‐2009
Source: SDI’s Vector One®: National, VONA 03‐16‐10 Stimulants 1991‐2009
Projected Number of Prescriptions for Stimulants* Dispensed by US Retail Pharmacies, Years 1991‐2009 *excludes modafinil and atomoxetine products
•How many adults and adolescents misuse/abuse pharmaceuticals?
MANY
• Is misuse/abuse of pharmaceuticals changing?STABLE AT HIGH RATE AFTER INCREASING IN 1990s CONSEQUENCES (MORBIDITY, MORTALITY, TREATMENT SEEKING) MAY BE INCREASING
•How many adults and adolescents misuse/abuse pharmaceuticals?
MANY
• Is misuse/abuse of pharmaceuticals changing?STABLE AT HIGH RATE AFTER INCREASING IN 1990s CONSEQUENCES (MORBIDITY, MORTALITY, TREATMENT SEEKING) MAY BE INCREASING
Epidemiology Epidemiology
What Explains the Increase in Pharmaceutical Abuse?
What Explains the Increase in Pharmaceutical Abuse?
1) Increasing numbers of prescriptions (greater availability)
2) Attention by the media and advertising (television and newspaper)
3) Easy access through family and friends
4) Improper knowledge and monitoring (addiction may go unrecognized)
1) Increasing numbers of prescriptions (greater availability)
2) Attention by the media and advertising (television and newspaper)
3) Easy access through family and friends
4) Improper knowledge and monitoring (addiction may go unrecognized)
SummarySummary
When used properly, opioid, sedative and stimulant pharmaceutical agents have many
benefits; however, risks of abuse and addiction are significant and NIDA seeks to draw research attention to these vital issues
When used properly, opioid, sedative and stimulant pharmaceutical agents have many
benefits; however, risks of abuse and addiction are significant and NIDA seeks to draw research attention to these vital issues
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