Issue Category: Substance Misuse and Mental Health

Prescription Drug Abuse: Strategies to Stop the Epidemic

«state» has the «rank_2010» Drug Overdose Mortality Rate in the United States

«state» Scored «total_score» out of 10 on New Policy Report Card of Promising Strategies to Help Curb Prescription Drug Abuse

Washington, D.C. October 7, 2013 – «state» has the «lrank_2010» drug overdose mortality rate in the United States, with «rate_2010» per 100,000 people suffering drug overdose fatalities, according to a new report, Prescription Drug Abuse: Strategies to Stop the Epidemic.

The number of drug overdose deaths – a majority of which are from prescription drugs – «od_death_change_desc» have doubled in 29 states since 1999, quadrupled in four of these states and tripled in 10 more.

The report also finds that «state» received «l_total_score» out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Nationally, 28 states and Washington, D.C. scored six or less, with New Mexico and Vermont scoring the highest, with a 10, and South Dakota scoring the lowest with two out of 10.

According to the report by the Trust for America’s Health (TFAH), prescription drug abuse has quickly become a top public health concern, as prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states«do_gt_mv_2010» and Washington, D.C. Misuse and abuse of prescription painkillers alone costs the country an estimated $53.4 billion a year in lost productivity, medical costs and criminal justice costs. The report also notes that, currently, only one in 10 Americans with a substance abuse disorder receives treatment.

“Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response – starting with prevention and education all the way through to expanding and modernizing treatment,” said Jeffrey Levi, PhD, executive director of TFAH. “There are many promising signs that we can turn this around – but it requires urgent action.”

In the Prescription Drug Abuse report, TFAH – in consultation with a number of public health, clinical, injury prevention, law enforcement and community organization experts – reviewed a range of national recommendations and examined a set of 10 indicators of strategies being used in states to help curb the epidemic. There are indications that some of these efforts and strategies may be having a positive impact – the number of Americans abusing prescription drugs decreased from 7 million in 2010 to 6.1 in 2011, according to the National Survey on Drug Use and Health.

Some key «state» findings from the report include:

No. Indicator Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Existence of Prescription Drug Monitoring Program (PDMP): Has an active program

«key_1»

49
2 PDMP: Requires mandatory utilization by prescribers

«key_2»

16
3 Doctor Shopping Laws: Has a law specifying that patients are prohibited from withholding information about prior prescriptions from their healthcare provider

«key_3»

50 and Washington, D.C.
4 Support for Substance Abuse Treatment Services: Participating in Medicaid Expansion, which helps expand coverage of substance abuse services and treatment

«key_4»

24 and Washington, D.C.
5 Prescriber Education Required or Recommended

«key_5»

22
6 Good Samaritan Laws: Has a law to provide a degree of immunity or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose

«key_6»

17 and Washington, D.C.
7 Rescue Drug Laws: Has a law to expand access to, and use of naloxone, a prescription drug that can help counteract an overdose, by laypeople

«key_7»

17 and Washington, D.C.
8 Physical Exam Requirement: Has a law requiring healthcare providers to physically examine patients or have a bona fide patient-physician relationship before prescribing a controlled substance

«key_8»

44 and Washington, D.C.
9 ID Requirement: Has a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance

«key_9»

32
10 Lock-In Programs: Has a pharmacy lock-in program under the state’s Medicaid plan where individuals suspected of misusing controlled substances must use a single prescriber and pharmacy

«key_10»

46 and Washington, D.C.
Total «total_score»

“Fifty Americans die a day from prescription drug overdoses, and more than 6 million suffer from prescription drug abuse disorders. This is a very real epidemic – and warrants a strong public health response,” said Andrea Gielen, ScD, Director of the Johns Hopkins Center for Injury Research and Policy. “We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis.”

Key recommendations from the report include:

  • Educate the public to understand the risks of prescription drug use to avoid misuse in the first place;
  • Ensure responsible prescribing practices, including increasing education of healthcare providers and prescribers to better understand how medications can be misused and to identify patients in need of treatment;
  • Increase understanding about safe storage of medication and proper disposal of unused medications, such as through “take back” programs;
  • Make sure patients do receive the pain and other medications they need, and that patients have access to safe and effective drugs;
  • Improve, modernize and fully-fund Prescription Drug Monitoring Programs, so they are real-time, interstate and incorporated into Electronic Health Records, to quickly identify patients in need of treatment and connect them with appropriate care and identify doctor shoppers and problem prescribers;
  • Make rescue medications more widely available by increasing access for at-risk individuals to naloxone and provide immunity for individuals and others seeking help; and
  • Expand access to and availability of effective treatment options as a key component of any strategy to combat prescription drug abuse.

According to the Centers for Disease Control and Prevention (CDC), nationally, sales of prescription painkillers per capita have quadrupled since 1999 – and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month.

“The release of the prescription drug abuse report by the Trust for America’s Health represents a significant step forward in elevating public awareness of the state of prescription drug abuse in the US”, according to Ginny Ehrlich, CEO of Clinton Health Matters Initiative (CHMI). “We are proud that the Trust has completed this important research as part of its CHMI Commitment to Action and congratulate the Trust on continuing to advocate for innovation and action towards addressing this public epidemic.”

The report was supported by a grant from the Robert Wood Johnson Foundation.

Score Summary: A full list of all of the indicators and scores, listed below, is available along with the full report on TFAH’s web site at www.healthyamericans.org and RWJF’s web site at www.rwjf.org/RxReport. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. Data for the indicators were drawn from a number of sources, including the National Alliance for Model State Drug Laws, NCIPC, Centers for Disease Control and Prevention, the Alliance of States with Prescription Drug Monitoring Programs, the National Conference of State Legislators, the Network for Public Health Law, the Kaiser Family Foundation and a review of current state legislation and regulations by TFAH. In August 2013, state health departments were provided with opportunity to review and revise their information.

10 out of 10: New Mexico and Vermont

9 out of 10: Kentucky, Massachusetts, New York and Washington

8 out of 10: California, Colorado, Connecticut, Delaware, Illinois, Minnesota, North Carolina, Oklahoma, Oregon, Rhode Island and West Virginia

7 out of 10: Florida, Nevada, New Jersey, Tennessee and Virginia

6 out of 10: Arkansas, District of Columbia, Georgia, Hawaii, Iowa, Louisiana, Maryland, Michigan, North Dakota, Ohio, Texas and Utah

5 out of 10: Alaska, Idaho, Indiana, Maine, Mississippi, Montana, New Hampshire and South Carolina

4 out of 10: Alabama, Arizona, Kansas, Pennsylvania, Wisconsin and Wyoming

3 out of 10: Missouri and Nebraska

2 out of 10: South Dakota

STATE-BY-STATE DRUG OVERDOSE MORTALITY RANKINGS

Note: Rates include total drug overdose mortality rates, the majority of which are from prescription drugs. 1 = Highest rate of drug overdose fatalities,51 = lowest rate of drug overdose fatalities. Rankings are based on data from CDC’s National Center for Health Statistics, WONDER Online Database, 2010.The numbers are based on the number of people per 100,000.

1. West Virginia**** (28.9); 2. New Mexico (23.8); 3. Kentucky**** (23.6); 4. Nevada (20.7); 5. Oklahoma*** (19.4); 6. Arizona (17.5); 7. Missouri*** (17); 8. (tie) Tennessee** and Utah (16.9); 10. Delaware** (16.6); 11. Florida** (16.4); 12. Ohio*** (16.1); 13. Rhode Island** (15.5); 14. Pennsylvania (15.3); 15. Wyoming*** (15); 16. South Carolina*** (14.6); 17. Indiana**** (14.4); 18. Michigan*** (13.9); 19. Louisiana*** (13.2); 20. Washington (13.1); 21. (tie) District of Columbia and Montana** and Oregon** (12.9); 24. Colorado (12.7); 25. Arkansas** (12.5); 26. (tie) Alabama*** and Idaho** and New Hampshire** (11.8); 29. Alaska (11.6); 30. (tie) Mississippi***and North Carolina** (11.4); 32. (tie) Maryland and Massachusetts (11); 34. (tie) Hawaii and Wisconsin** (10.9); 36. Georgia*** (10.7); 37. California (10.6); 38. Maine (10.4); 39. Connecticut (10.1); 40. Illinois (10); 41. New Jersey (9.8); 42. Vermont** (9.7); 43. (tie) Kansas** and Texas (9.6); 45. Iowa**** (8.6); 46. New York (7.8); 47. Minnesota** (7.3); 48. Virginia (6.8); 49. Nebraska** (6.7); 50. South Dakota (6.3); 51. North Dakota (3.4).

** Drug Overdose Mortality Rates doubled from 1999 to 2010

*** Drug Overdose Mortality Rates tripled from 1999 to 2010

**** Drug Overdose Mortality Rates quadrupled from 1999 to 2010

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. For more information, visit www.healthyamericans.org.

New Report Provides High-Impact Recommendations to Improve Prevention Policies in America

January 29, 2013

Washington, D.C., January 29, 2013 – Today, Trust for America’s Health (TFAH) released A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years – which provides high-impact recommendations to prioritize prevention and improve the health of Americans.

The Healthier America report outlines top policy approaches to respond to studies that show 1) more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented, and 2) that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.

“America’s health faces two possible futures,” said Gail Christopher, DN, President of the Board of TFAH and Vice President – Program Strategy of the W.K. Kellogg Foundation.  “We can continue on the current path, resigning millions of Americans to health problems that could have been avoided or we invest in giving all Americans the opportunity to be healthier while saving billions in health care costs.  We owe it to our children to take the smarter way.”

The Healthier America report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective.  Some recommendations include:

  • Advance the nation’s public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities;
  • Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
  • Integrate community-based strategies into new health care models, such as by expanding Accountable Care Organizations into Accountable Care Communities;
  • Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs;
  • Maintain the Prevention and Public Health Fund and expand the Community Transformation Grant program so all Americans can benefit;
  • Implement all of the recommendations for each of the 17 federal agency partners in the National Prevention Strategy; and
  • Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs.

“Prevention delivers real value as a cost-effective way to keep Americans healthy and improve their quality of life,” said Jeffrey Levi, PhD, executive director of TFAH.  “Everyone wins when we prevent disease rather than treating people after they get sick.  Health care costs go down, our local neighborhoods are healthier and provide more economic opportunity, and people live longer, healthier, happier lives.”

A Healthier America also features more than 15 case studies from across the country that show the report’s recommendations in action, such as:

  • The first-of-its-kind Accountable Care Community (ACC) launched by the Austen BioInnovation Institute in Akron, Ohio, which brings together more than 70 partners to coordinate health care inside and outside the doctor’s office for patients with type 2 diabetes.  By improving care and making healthier choices easier in people’s daily lives, the ACC reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month within 18 months of starting the program – an estimated savings of $3,185 per person per year;
  • The Community Asthma Initiative (CAI), implemented by Boston Children’s Hospital, has provided support to improve the health of children with moderate to severe asthma in at-risk Boston neighborhoods.  The CAI has led to a return of $1.46 to insurers/society for every $1 invested; an 80 percent reduction in percentage of patients with one or more asthma-related hospital admission; and a 60 percent reduction in the percentage of patients with asthma-related emergency department visits; and
  • The Healthy Environments Collaborate (HEC) in North Carolina is an innovative partnership across four state agencies – Health and Human Services, Transportation, Environment and Natural Resources and Commerce. The partnership focuses on creating win-win policies and programs that improve health while also meeting other priority goals, such as improved transportation, increased commerce and stable housing programs.

In addition, the report includes recommendations for a series of 10 key public health issues: reversing the obesity epidemic; preventing tobacco use and exposure; encouraging healthy aging; improving the health of low-income and minority communities; strengthening healthy women, healthy babies; reducing environmental health threats; enhancing injury prevention; preventing and controlling infectious diseases; prioritizing health emergencies and bioterrorism preparedness; and fixing food safety.

The report was supported by grants from the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation and The Kresge Foundation and is available on TFAH’s website at www.healthyamericans.org.

 Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

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