Prescription Drug Abuse: Strategies to Stop the Epidemic

Prescription Drug Abuse: Strategies to Stop the Epidemic finds that 28 states and Washington, D.C. scored six or less out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Two states, New Mexico and Vermont, got the highest score, receiving all 10 possible indicators, while South Dakota scored the lowest with two out of 10.

According to the report, prescription drug abuse has quickly become a top public health concern, as the number of drug overdose deaths – a majority of which are from prescription drugs – doubled in 29 states since 1999. The rates quadrupled in four of these states and tripled in 10 more of these states.

Prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C. Misuse and abuse of prescription drugs costs the country an estimated $53.4 billion a year in lost productivity, medical costs and criminal justice costs, and currently only one in 10 Americans with a substance abuse disorder receives treatment.

In the Prescription Drug Abuse report, TFAH – in consultation with a number of public health, clinical, 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 findings from the report include:

• Appalachia and Southwest Have the Highest Overdose Death Rates: West Virginia had the highest number of drug overdose deaths, at 28.9 per every 100,000 people – a 605 percent increase from 1999, when the rate was only 4.1 per every 100,000. North Dakota had the lowest rate at 3.4 per every 100,000 people. Rates are lowest in the Midwestern states.
• Rescue Drug Laws: Just over one-third of states (17 and Washington, D.C.) have a law in place to expand access to, and use of naloxone – a prescription drug that can be effective in counteracting an overdose – by lay administrators.
• Good Samaritan Laws: Just over one-third of states (17 and Washington, D.C.) have laws in place to provide a degree of immunity from criminal charges or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose.
• Medical Provider Education Laws: Fewer than half of states (22) have laws that require or recommend education for doctor and other healthcare providers who prescribe prescription pain medication.
• Support for Substance Abuse Treatment: Nearly half of states (24 and Washington, D.C.) are participating in Medicaid Expansion – which helps expand coverage of substance abuse services and treatment.
• ID Requirement: 32 states have a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance.
• Prescription Drug Monitoring Programs: While nearly every state (49) has a Prescription Drug Monitoring Program (PDMP) to help identify “doctor shoppers,” problem prescribers and individuals in need of treatment, these programs vary dramatically in funding, use and capabilities. For instance, only 16 states require medical providers to use PMDPs.

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

Score Summary: 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, 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