Join the Fight Against Prescription Drug Abuse - NCAPDA.org

Join the Fight Against Prescription Drug Abuse - NCAPDA.org

Proposed Prescription Drug Legislation

Proposed Prescription Drug Legislation

Proposed Prescription Drug Legislation

Proposed Prescription Drug Legislation

One doctors rant!

I recently had an opportunity to ask a doctor his opinion about our legislation proposal.  

"A research-based questionnaire screening (DAST-20) for substance use and addictive disorders and a urine test (LC/MS/MS) for alcohol and other drugs shall be administered to all patients prior to prescribing any scheduled drug." 

After hearing what this proposal said he flew into a 60 minute rant that at times was hysterical, irrational, inconsistent, uninformed, and confused.  He seemed to  be so threatened by even hearing of such a proposal his ability to reason and converse rationally was non-existent.  


At one point he indicated that there is nothing that can be done to lower the deaths, addiction and overdoses, so why even try.  He said that do getters come along and try to legislate medicine and they and their legislation are the problem, not the deaths, addiction and overdoses due to scheduled prescription drugs.


He indicated that the people who are addicts are the cause of the problem, not the doctors prescribing the drugs.  The "few"addicts ruin scheduled prescription drugs for those who need it, the addicts are the problem.  


To summarize he believes there is not a solution, so no point trying.  Really!  Because the addicts are always going to get their drugs so there is no point in trying to stop them.

Proposed Prescription Drug Legislation

Proposed Prescription Drug Legislation

States counting the victims

Utah had 310 deaths from prescription drugs in 2009, up by 400% since 2000.
Washington treatment for prescription drugs increased over the last decade 325 to 3,276.
King county Washington in 2008 had 153 prescription drug deaths.
Tennessee over three years 2006-2007 had 1,600 deaths from prescription drugs.
Florida in 2007 had 2,320 deaths from prescription drugs.
Kentucky in 2008 had 485 deaths from prescription drugs.
Massachusetts between 2002-2007 had 3,265 deaths from prescription drugs.
North Carolina in 2000 had 389 deaths from prescription drugs, in 2009 they had 1,103 deaths from prescription drugs.
West Virgina has had a five fold increase in deaths from prescription drugs since 1999, highest death rate in the nation.

ksl.com - Prescription overdose: top cause of injury death in Utah

ksl.com - Prescription overdose: top cause of injury death in Utah

Teenage Drug Overdose - Brain Damage

Prescription drug overdose

Attorney General's eager for effective ntational legislation

Yesterday I contacted several state attorney general's officies by phone then email providing information supporting our legislation proposal regarding scheduled prescription drug abuse.  Voices on the other end of the phone sounded with great relief that a national legislation was even being considered that would stop pill mill, doctor shopping, illegal internet sales, over prescribing doctors, and unethical doctors.  This bill will imediately reduce deaths, overdoses, addiction, overcrowding of er rooms, police intervention, undue costs to tax payers and hospitals. 
The other most incredable part about this legislation is that it will cost the government not one single penny!
While all this may sound wonderful we anticipate an extremely stiff oposition by the drug lobby because of their fear of a drop in sales of misued scheduled drugs from the effect of this legislation.  This being said it will take a strong support base of everyone who has been negatively impacted , to overcome the drug lobbies influrence of power, even with the to long ignored deady/addictive misuse of their scheduled drugs addicting millions and killing thousands!

Legislation evaluation period, expectations good

After meeting with two legislative offices on Tuesday expectations are good regarding a serious evaluation concerning the validity of the prescription drug abuse legislation.  With overwhelming evidence of the magnitude of the prescription drug problem being presented in 1/2" packet documented with information from NIDA, CDC, AAP, Dawn, US Senate and more aides recognize something has to be done.  It is going to take three weeks or longer before we hear back one way or another, after researching this deadly problem for over two years three weeks seems like a small window. 

Scheduled prescription drug legislation moving foward

Meeting with Congressman Wally Herger's aid Ralph Keeley tomorrow morning to discuss the legislation proposal. Great news, have two national health organizations looking at the legislation for sponsoring, great news.  In the afternoon tomorrow I have a phone meeting with Senator Feinstein's health aid Nora Connors to discuss the legislation as well.

"A research-based questionnaire screening (DAST-20) for substance use and addictive disorders and a urine test (LC/MS/MS) for alcohol and other drugs shall be administered to all patients prior to prescribing any scheduled drug."

This legislation will immediately stop pill mills and doctor shopping while reducing deaths, overdoses and addiction caused by scheduled prescription drugs.  This legislation will also reduce medical liabilities and lower the over crowding and negative fiscal impact on hospital emergency rooms.

Jim Bettencourt
www.drugpreventioned.com

Prescription drug legislation

www.end2meth.org

"A research-based questionnaire screening (DAST-20) for substance use and addictive disorders and a urine test (LC/MS/MS) for alcohol and other drugs shall be administered to all patients prior to prescribing any scheduled drug."

The above legislation proposal is a standard practice of pain management specialist when prescribing scheduled drugs to their patients.  We believe all doctors need to follow the same screening practices utilized by pain management specialists when prescribing scheduled drugs;

This legislation will stop pill mills and doctor shopping while reducing deaths, overdoses and addiction caused by scheduled prescription drugs.  This legislation would also reduce doctor liabilities and lower the over crowding and negative fiscal impact on hospital emergency rooms.

• According to the American Academy of Pediatrics between 1994 and 2007 controlled medications prescribed to adolescents and young adults ages 15 to 29 increased by 14.2 million, an increase of 58%.
• According to the American Academy of Pediatrics between 1997 and 2006, the sale of oxycodone increased by 732%, hydrocodone by 244%, and methadone by 1177%.
• According to the American Academy of Pediatrics the non-medical use of prescription medications to adolescents and young adults ages 15 to 29 has increased by 162% in the past decade and has surpassed all illicit drugs except marijuana in the United States.
• In Shasta County from December 2005 through December of 2008 a total of 141 Drug—Induced deaths were identified.

·        The five most common drugs found by Shasta County Public Health in the 141 deaths were Methadone, Hydrocodone, Acetaminophen, Methamphetamine and Morphine.

• In Shasta County between 1992 & 2003 there has been a 140.5% increase in self reported opioid abuse.
• In Butte County between 2007 & 2009 four Chico State students died from poly-drug overdoses with multiple scheduled drugs in their system.
• According to the Butte County Public health one in every three deaths in Butte County are from prescription drugs.
• According to Butte County Public Health you are more apt to be killed from a prescription drugs than an automobile accident, diabetes, or many forms of cancer
• According to the Center for Diesease Control in 2008 told the Senate sub-committee on crime & drugs that prescriptions drug abuse is an epidemic, with over 13,000 deaths a year caused by prescription drugs alone. 

James C. Bettencourt

Chairperson: Not In Our Town Glenn County

327 N. Culver Ave.

Willows, Ca. 95988

530-330-3139

jim-bettencourt@sbcglobal.net

Drug Lobby

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Special Report

Drug Lobby Second to None

How the pharmaceutical industry gets its way in Washington

By M. Asif Ismail

WASHINGTON, July 7, 2005 — The pharmaceutical and health products industry has spent more than $800 million in federal lobbying and campaign donations at the federal and state levels in the past seven years, a Center for Public Integrity investigation has found. Its lobbying operation, on which it reports spending more than $675 million, is the biggest in the nation. No other industry has spent more money to sway public policy in that period. Its combined political outlays on lobbying and campaign contributions is topped only by the insurance industry.
The drug industry's huge investments in Washington—though meager compared to the profits they make—have paid off handsomely, resulting in a series of favorable laws on Capitol Hill and tens of billions of dollars in additional profits. [See What the Industry Got.] They have also fended off measures aimed at containing prices, like allowing importation of medicines from countries that cap prescription drug prices, which would have dented their profit margins. Pfizer, the world's largest drug company, made a profit of $11.3 billion last year, out of sales of $51 billion.
The industry's multi-faceted influence campaign has also led to a more industry-friendly regulatory policy at the Food and Drug Administration, the agency that approves its products for sale and most directly oversees drug makers. [See FDA: A Shell of its Former Self]
Most of the industry's political spending paid for federal lobbying. Medicine makers hired about 3,000 lobbyists, more than a third of them former federal officials, to advance their interests before the House, the Senate, the FDA, the Department of Health and Human Services, and other executive branch offices.
In 2003 alone, the industry spent nearly $116 million lobbying the government. That was the year that Congress passed, and President George W. Bush signed, the Medicare Modernization Act of 2003, which created a taxpayer-funded prescription drug benefit for senior citizens.
That figure was not anomalous. In 2004, drug makers upped their reported expenditures on lobbyists to $123 million, a record amount for the industry. Of the 1,291 lobbyists who were listed that year as prepresenting pharmaceutical corporations and their trade groups, some 52 percent were former federal officials.
By adding the benefit to Medicare, the government program that provides health insurance to some 41 million people, the industry found a reliable purchaser for its products. Thanks to a provision in the law for which the industry lobbied, government programs like Medicare are barred from negotiating with companies for lower prices.
Critics charge that the prescription drug benefit will transfer wealth from taxpayers, who provide the funding for Medicare, to pharmaceutical firms. According to a study done in October 2003 by Boston University professors Alan Sager and Deborah Socolar, 61 percent of Medicare money spent on prescription drugs will become profit for drug companies. Drug-makers will receive $139 billion in increased profits over eight years, the study predicts. The Medicare prescription drug benefit starts in 2006.

America the lucrative

The U.S. government contributes more money to the development of new drugs—in the form of tax breaks and subsidies—than any other government. Of the 20 largest pharmaceutical corporations, nine are based in the United States. Yet drugs are more expensive in the United States than in any other part of the world, and global drug companies make the bulk of their profits in the United States.

Marketing Maladies More than a third of pharmaceutical companies' resources go into promotion and marketing.
Company	Marketing costs	Research and Development
Pfizer	$16.90 billion	$7.68 billion
GlaxoSmithKline	$12.93 billion	$5.20 billion
Sanofi-Aventis	$5.59 billion	$9.26 billion
Johnson & Johnson	$15.86 billion	$5.20 billion
Merck	$7.35 billion	$4.01 billion
Novartis	$8.87 billion	$4.21 billion
AstraZeneca	$7.84 billion	$3.80 billion
Hoffman La Roche	$7.24 billion	$4.01 billion
Bristol-Myers Squibb	$6.43 billion	$2.50 billion
Wyeth	$5.80 billion	$2.46 billion
Abbott Labs	$4.92 billion	$1.70 billion
Annually, the industry spends nearly twice as much on marketing as it spends on research and development, although drug companies report neither total precisely. Various news reports estimate that the industry spent anywhere between $30 billion to $60 billion on marketing in 2004. The trade group PhRMA estimates its members spent $39 billion on R&D that year. As this table shows, the same year, 11 major companies reported spending close to $100 billion on marketing, along with administrative expenses not categorized separately. Those companies reported spending $50 billion on R&D. In 2004, Pfizer spent almost $120 million for media ads for Lipitor, the world's number-one selling prescription drug, while companies promoting erectile dysfunction treatments Viagra, Levitra and Cialis spent $425 million. Direct to consumer advertisement has also grown significantly: from $791 million in 1996 to $3.8 billion in 2004.

Many blame the industry's clout in Congress and with the executive branch for the high price of drugs. While many governments worldwide have regulated drug prices, the industry has been able to block a host of measures aimed at controlling prices in the United States. In the past few years, the industry has mounted an effective, organized campaign against legalizing importation of drugs from Canada.
As the Center reported in January, the industry trade group, Pharmaceutical Research and Manufacturers of America, hired a former U.S. ambassador to Canada, Gordon Giffin, and his top aide to lobby the Canadian government on the issue. The industry's pressure may be paying off. Last week, Canadian Health Minister Ujjal Dosanjh announced that his government would ban the bulk export of prescription drugs and crack down on Internet pharmacies that sell drugs to Americans.
A spokesman for PhRMA, Jeff Trewitt, told the Center in January that price controls thwart innovation and importation of drugs pose serious health risks.
The top 20 drug corporations and the industry's two trade groups, PhRMA and the Biotechnology Industry Organization, which represents biomedicine companies, disclosed lobbying on more than 1,600 bills between 1998 and 2004. They may have lobbied on far more bills; the Center could only count bills specifically mentioned by the companies and trade groups in their filings. In many cases, lobbyists list issues, like "animal health issues," rather than specific bills. In counting the number of bills, the Center excluded those lobbied on by BIO that relate solely to biotechnology issues, such as genetically engineered foods.
Apart from Congress, the industry lobbied an array of agencies including the Department of Health and Human Services, the Food and Drug Administration and the State Department on dozens of issues. For instance, PhRMA lobbied 33 federal agencies on 39 issues separately identified under the Lobbying Disclosure Act of 1995.
As the Center reported last week, the agencies include the Office of the U.S. Trade Representative, which shapes the country's trade agreements with other nations. Since 1998, it has filed 59 lobbying reports concerning the USTR, more than any other lobby or interest.
In recent years, the industry has shown significant power in influencing U.S. trade policy. For example, current drafts of the Dominican Republic-Central American Free Trade Agreement reflect PhRMA's desire to remove price controls on drugs and provide intellectual property protection in proposed member countries. Recently, the USTR, at the behest of the pharmaceutical industry, pressured Guatemala into repealing a recently passed law permitting wider marketing of generic drugs.

Lobbying numbers since 1998
Amount spent on lobbying	$675 million
Lobbyists	3,009
Former officials who registered to lobby	1,014
Former members of Congress who lobbied	75
Bills lobbied	More than 1,600

The top 20 corporations and the trade groups reported spending nearly $478 million on lobbying, or nearly 70 percent of all the money the industry reported. These corporations had roughly 64 percent of the global market share, according to IMS Health, a private consulting company that studies the industry.
Congress is most frequently listed as a target of the industry's lobbying attentions; contacts with the House or Senate are listed on about 5,500 lobby disclosure reports. The Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Food and Drug Administration and the Executive Office of the President are other agencies heavily lobbied by the industry.
Like other well connected interests in Washington, pharmaceutical firms look to former insiders to carry their message to Congress and executive branch officials. In May 2003, as the battle over the Medicare legislation was climaxing, the Pharmaceutical Research and Manufactures of America, the industry trade group, hired the newly formed lobby shop of Larson Dodd, LLC to join its already formidable army of representatives swarming the hallways of Congress. The hiring of Dave Larson and Quin Dodd by PhRMA—and later by Wyeth and other drug manufactures—was in keeping with the industry's standard operating procedure: employing former officials to lobby on bills sponsored by their ex-bosses.
Larson was a health policy advisor to Senate Majority Leader Bill Frist, the chief sponsor of a Medicare bill that, six months later, would become law, with potentially tens of billions of dollars of windfall for the drug companies. Dodd is a former legislative director to Sen. Kay Bailey Hutchison, the fourth ranking Republican in the upper chamber.
A third of all lobbyists employed by the industry are former federal government employees, including more than 15 former Senators and more than 60 former members of the U.S. House of Representatives. The two trade groups, PhRMA and BIO, are headed by two influential former members of Congress. PhRMA chief Billy Tauzin and BIO president Jim Greenwood were on committees that regulated drug companies and they each sponsored several bills related to the industry.
The Center reviewed the 1,600 plus bills the top 20 drug corporations and PhRMA and BIO lobbied. Sponsors of more than 50 percent of those bills had one or more former staff members representing the industry. A few of the sponsors have gone on to become lobbyists themselves.

Political giving

In addition to hiring former members and their staffs, the industry has also helped keep lawmakers in office by making political contributions. Since the 1998 election cycle, employees of the pharmaceutical and health product industry, their family members and industry political action committees have given $133 million in campaign contributions to candidates running for federal and state offices, according to the Center for Responsive Politics. Since 2000, the top drug corporations and their employees and PhRMA gave more than $10 million to 527 organizations, tax-exempt political committees which operate in the grey area between federal and state campaign finance laws.
Nearly $87 million of the contributions went to federal politicians in campaign donations, with almost 69 percent going to Republican candidates. Top recipients of the industry's campaign money include President George W. Bush (upwards of $1.5 million) and members who sit on committees that have jurisdiction over pharmaceutical issues.
In the states, the industry gave more than $46 million to candidates since '98, according to the Institute on Money in State Politics, which tracks campaign finance at the state level.
The Center could not determine the amount drug interests spent on lobbying in states because of the lack of comparable state disclosure requirements for expenditures. But their lobbying, campaign donations and grassroots efforts have taken on an added dimension because many states are threatening the industry's high profit margins in a way the federal government and Congress have been unwilling to do.
With states running into fiscal crises, several governors and legislatures have been exploring ways to contain drug prices. Among the several options that have been considered around the country include allowing seniors and others to legally buy drugs from Canada and other countries.
Though some states have been less amenable to drug industry pressure, the drug industry hasn't given up the fight. For Washington's biggest spending lobby, it's a small investment to make for its continuing prosperity.
Victoria Kreha, Alexander Cohen, Kevin Boettcher and Emily McNeill contributed to this report.

Nonmedical Use of Selected Prescription Drugs --- United States

http://www.cdc.gov/

Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs --- United States, 2004--2008

Weekly

June 18, 2010 / 59(23);705-709

Rates of overdose deaths involving prescription drugs increased rapidly in the United States during 1999--2006 (1). However, such mortality data do not portray the morbidity associated with prescription drug overdoses. Data from emergency department (ED) visits can represent this morbidity and can be accessed more quickly than mortality data. To better understand recent national trends in drug-related morbidity, CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) reviewed the most recent 5 years of available data (2004--2008) on ED visits involving the nonmedical use of prescription drugs from SAMHSA's Drug Abuse Warning Network (DAWN). This report describes the results of that review, which showed that the estimated number of ED visits for nonmedical use of opioid analgesics increased 111% during 2004--2008 (from 144,600 to 305,900 visits) and increased 29% during 2007--2008. The highest numbers of ED visits were recorded for oxycodone, hydrocodone, and methadone, all of which showed statistically significant increases during the 5-year period. The estimated number of ED visits involving nonmedical use of benzodiazepines increased 89% during 2004--2008 (from 143,500 to 271,700 visits) and 24% during 2007--2008. These findings indicate substantial, increasing morbidity associated with the nonmedical use of prescription drugs in the United States during 2004--2008, despite recent efforts to control the problem. Stronger measures to reduce the diversion of prescription drugs to nonmedical purposes are warranted.
DAWN is a public health information system that tracks the impact of drug use, misuse, and abuse in the United States by monitoring drug-related hospital ED visits. In a manner similar to the National Electronic Injury Surveillance System,* DAWN uses a sample of EDs to estimate national ED visit rates (2). DAWN collects data from a stratified, simple random sample of approximately 220 nonfederal, short-stay, general hospitals that operate 24-hour EDs in the United States. DAWN's sampling frame is based on the American Hospital Association annual survey database and is updated annually to reflect new, closed, merged, and demerged hospitals, and to give new hospitals an opportunity to be selected into the sample.
The DAWN sample is designed to produce estimates and trends for individual metropolitan areas (12 in 2008) and the United States overall (2). To achieve this, the selected metropolitan areas are oversampled. The oversampled hospitals and a supplementary sample of hospitals outside those areas together capture ED visits in all 50 states and the District of Columbia. Trained DAWN reporters review the medical charts of all patients treated in the participating hospital EDs to identify visits for conditions induced by or related to drug use. DAWN reporters record de-identified information from the ED medical records using standard abstraction forms. DAWN does not conduct interviews or follow-up with clinicians, patients, or family members. Rates presented in this report are based on the numbers of ED visits weighted so that they are representative of the U.S. population. Denominators for this report were based on U.S. Census postcensal estimates. Differences between counts and between rates were tested using two-sided t tests.†
DAWN defines nonmedical use of a prescription or over-the-counter drug as taking a higher-than-recommended dose, taking a drug prescribed for another person, drug-facilitated assault, or documented misuse or abuse, all of which must be documented in the medical record. DAWN classifies suicide attempts, patients seeking detoxification, and unintentional ingestions in other categories.
For 2008, a total of 231 hospitals submitted data that were used for estimation. The overall weighted hospital response rate was 32.9% (response rates have been stable from year to year). In 2008, DAWN recorded 351,697 drug-related ED visits. On average, a DAWN member hospital submitted 1,522 DAWN cases.
DAWN estimated 1.6 million ED visits for the misuse and abuse of all drugs in 2004 and 2.0 million in 2008. Among these, illicit drugs such as cocaine and heroin were involved in 1.0 million visits in both 2004 and 2008, whereas prescription or over-the-counter drugs used nonmedically were involved in 0.5 million visits in 2004 and 1.0 million visits in 2008. The estimated number of ED visits involving nonmedical use of opioid analgesics§ increased from 144,600 in 2004 to 305,900 in 2008 (111%, p<0.001), whereas rates increased from 49.4 per 100,000 to 100.6 per 100,000, an increase of 104% (p<0.05).
ED visit rates for opioid analgesics were highest for oxycodone, hydrocodone, and methadone during the entire study period (Figure 1). Estimated ED visits involving oxycodone increased from 41,700 to 105,200 (p<0.001), and rates increased from 14.2 per 100,000 to 34.6 per 100,000, an increase of 144% (p<0.05). The estimated number of ED visits involving nonmedical use of benzodiazepines increased from 143,500 in 2004 to 271,700 in 2008 (89%, p=0.01), and rates increased from 49.0 to 89.4 per 100,000, an increase of 82% (p<0.05). The increases in numbers of ED visits during 2004--2008 for individual benzodiazepines were significant: alprazolam (125%, p=0.01), clonazepam (72%, p<0.001), diazepam (70%, p=0.02), and lorazepam (107%, p=0.006), as was the increase for the sleep aid zolpidem (121%, p=0.002). Carisoprodol-related visits also increased significantly (132%, p=0.04). The estimated number of visits for alprazolam in 2008 (104,800) was more than twice the number for the next most common benzodiazepine, clonazepam (48,400).
Although women had more benzodiazepine-related visits than men (Table), this difference was not statistically significant. Among opioid analgesic--related visits, 38% did not involve any other drug (including alcohol); the corresponding figure was 21% for benzodiazepine-related visits. Benzodiazepines were involved in 26% of opioid analgesic--related visits. Alcohol was involved in 15% and 25% of visits for opioids and benzodiazepines, respectively. Approximately one in four patients was admitted. For the year 2008, rates for both types of drugs increased sharply after age 17 years, peaked in the 21--24 years age group, and declined after age 54 years (Figure 2). The largest increases during 2004--2008 occurred among persons aged 21--29 years.

Reported by

R Cai, MS, E Crane, PhD, K Poneleit, MPH, Office of Applied Studies, Substance Abuse and Mental Health Services Admin. L Paulozzi, MD, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

The number of ED visits involving nonmedical use of prescription or over-the-counter drugs increased rapidly during 2004--2008, and by 2008 matched the number of ED visits involving illicit drugs. ED visits involving such pharmaceuticals accounted for all of the growth in overall drug misuse/abuse rates during 2004--2008. ED visits involving opioids or benzodiazepines were the largest contributors to the increase in ED visits involving the nonmedical use of prescription or over-the-counter drugs.
Notably, results from 2008 indicate that in addition to the large increase in visits compared with 2004, peak visit rates for both opioids and benzodiazepines appear to have shifted into the 21--24 and 25--29 years age groups and away from the 30--34 and 35--44 years age groups. As late as 2006, the peak mortality rate for fatal drug overdoses involving opioid analgesics had been in the 35--54 years age group (1).
The 5-year increase in ED visit rates reflects, in part, substantial increases in the prescribing of these classes of drugs (3). The increase also might reflect an increase in the rate of nonmedical use of prescription drugs per 1,000 prescriptions, as has been observed for selected opioids (4). In the 2008 National Survey of Drug Use and Health (NSDUH), 4.6% of persons aged ≥18 years reported past-year nonmedical use of prescription pain relievers, and 2.1% reported nonmedical use of tranquilizers, a category that includes benzodiazepines (5).
In contrast to the results of this study, NSDUH results have shown no increase in self-reported rates of nonmedical use of selected pharmaceuticals since 2004 (5). Increasing ED visit rates in the context of stable self-reported nonmedical use rates might indicate that persons seen in EDs are different from typical respondents to NSDUH; a shift toward riskier types of pain relievers and benzodiazepines, riskier modes of use, more frequent or heavier use; and/or an increased tendency to seek emergency care because of greater awareness of the serious consequences of nonmedical use of such drugs. However, changes in health-seeking behavior would not affect changes in drug-related deaths, and DAWN ED visit trends are consistent with medical examiner data from six states also tracked by DAWN (Maine, Maryland, New Hampshire, New Mexico, Utah, and Vermont). In these states, the number of nonsuicidal deaths related to benzodiazepines increased 64.2%, and the number related to opioid analgesics other than methadone increased 47.4% during 2004--2007 (6).
The relative magnitudes of the rates shown generally reflect prescription volumes. For example, the benzodiazepine with the highest number of ED visits, alprazolam, was the most prescribed benzodiazepine in the United States in 2008, with an estimated 44 million prescriptions (7). However, some exceptions exist: hydrocodone was prescribed nearly 124 million times and oxycodone nearly 45 million times in 2008, but hydrocodone ED rates were not higher than oxycodone ED rates. The high frequency of multidrug involvement is a reflection of the tendency of persons who abuse drugs to combine them to moderate or enhance their effects. The lower proportion of single-drug ED visits among benzodiazepine ED visits compared with opioid analgesic visits is consistent with the relative rarity of a benzodiazepine being the sole drug involved in a fatal overdose (6,8).
The findings in this report are subject to at least four limitations. First, the drugs involved in ED visits might not all be identified and documented. The extent to which ED staff members document drug involvement might have increased over time. Second, information on the motivation for use might be incomplete; some of the ED visits might have represented suicide attempts. Third, rates based on population cannot be used to determine risk per patient or per prescription. Finally, distinguishing drugs taken for nonmedical and medical reasons is not always possible, especially when multiple drugs are involved.
These increases in nonmedical use of pharmaceuticals suggest that previous prevention measures, such as provider and patient education and restrictions on use of specific formulations, have not been adequate. Given the societal burden of the problem, additional interventions are urgently needed, such as more systematic provider education, universal use of state prescription drug monitoring programs by providers, the routine monitoring of insurance claims information for signs of inappropriate use, and efforts by providers and insurers to intervene when patients use drugs inappropriately (9,10). This report also reinforces the value of timely, population-based national surveillance for nonmedical use of drugs, which can be used to assess the effect of such interventions.

References

1. Warner M, Chen LJ, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999--2006. NCHS data brief, no 22. Hyattsville, MD: National Center for Health Statistics; 2009.
2. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2007: national estimates of drug-related emergency department visits. Available at http://dawninfo.samhsa.gov/files/ed2007/dawn2k7ed.pdf . Accessed June 10, 2010.
3. Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Safety 2006;15:618--27.
4. Dormitzer C. Summary of drug abuse "rates" in the United States. Available at http://www.fda.gov/ohrms/dockets/ac/08/slides/2008-4356s1-04-fda-corepresentations.ppt . Accessed June 10, 2010.
5. Substance Abuse and Mental Health Services Administration. Results from the 2008 National Survey on Drug Use and Health: national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2009. HHS publication no. SMA 09-4434. Available at http://www.oas.samhsa.gov/nsduh/2k8nsduh/2k8results.cfm. Accessed June 10, 2010.
6. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2007: area profiles of drug-related mortality. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2009. HHS publication no. SMA 09-4407. Available at http://dawninfo.samhsa.gov/pubs/mepubs. Accessed June 10, 2010.
7. SDI/Verispan. 2008 top 200 generic drugs by total prescriptions. Available at http://drugtopics.modernmedicine.com/top200gen. Accessed June 10, 2010.
8. Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 2008;300:2613--20.
9. Kraman P. Drug abuse in America---prescription drug diversion. Lexington, KY: Council of State Governments; 2004. Available at http://www.csg.org/knowledgecenter/docs/ta0404drugdiversion.pdf . Accessed June 10, 2010.
10. CDC. CDC's issue brief: unintentional drug poisoning in the United States. Available at: http://www.cdc.gov/homeandrecreationalsafety/poisoning/brief.htm. Accessed June 10, 2010.

* U.S. Consumer Product Safety Commission. NEISS All Injury Program: sample design and implementation. Washington, DC: U.S. Consumer Product Safety Commission; 2001.

† To minimize the effect of nonresponse, the DAWN weighting plan includes nonresponse adjustment factors for within-hospital nonresponse and hospital nonresponse; the weighting plan also includes a poststratification adjustment factor that reconciles the weighted number of total visits for responding hospitals with the number of total visits from the most recent American Hospital Association Annual Survey Database. Estimates for all DAWN-eligible hospitals in the United States are produced by applying poststratified weights to the data received from the sampled hospitals. Estimates (and their associated rates and confidence intervals) are suppressed if based on an unweighted count of fewer than 30 cases, if the estimate is less than 30, or if the relative standard error is greater than 50%. The DAWN data collection protocol aims for 100% chart review but accepts any percentage above 90% as complete. In EDs where chart subsampling has been implemented, reporters review 100% of the charts for sampled days. Chart subsampling is employed at large facilities with more than 3,500 visits per month. In these facilities, charts are typically reviewed every other day. Additional information about DAWN is available in appendix C at http://dawninfo.samhsa.gov/files/ed2007/dawn2k7ed.pdf .

§ An additional 60,900 visits involving "opiates/opioids unspecified" were not included because some might have involved heroin.

What is already known on this topic?

Deaths involving the nonmedical use of prescription drugs increased in the United States through 2006.

What is added by this report?

Emergency department visits involving nonmedical use of two types of prescription drugs, opioid analgesics and benzodiazepines, more than doubled during 2004--2008 in the United States; visits for misused prescription and over-the-counter drugs are now as common as emergency department visits for use of illicit drugs.

What are the implications for public health practice?

Recent public health and law enforcement measures intended to prevent nonmedical use of such drugs have not prevented rate increases, and additional measures are needed urgently.

TABLE. Estimated number and rate of emergency department visits for nonmedical use of opioid analgesics and benzodiazepines, by selected characteristics --- United States, 2008
Characteristic	Opioid analgesics			Benzodiazepines
	No.	Rate*	95% CI†	No.	Rate	95% CI
Total	305,900	100.6	(75.6--125.6)	271,700	89.4	(61.6--117.1)
Sex
Male	150,800	100.6	(74.9--126.3)	119,600	79.7	(57.1--102.4)
Female	155,000	100.6	(75.1--126.1)	152,100	98.7	(64.8--132.5)
No. of drugs (including alcohol)
One drug	116,800	38.4	(31.4--45.4)	56,900	18.7	(15.1--22.3)
Multidrug	189,000	62.2	(42.8--81.6)	214,800	70.6	(45.9--95.4)
Alcohol involvement	46,200	15.2	(10.9--19.5)	68,600	22.6	(14.6--30.6)
Admitted to hospital	72,700	23.9	(15.7--32.1)	81,300	26.8	(14.5--39.0)
Source: Substance Abuse and Mental Health Services Administration (SAMHSA)'s Drug Abuse Warning Network (DAWN), 2004--2008. Additional information available in appendix C at http://dawninfo.samhsa.gov/files/ed2007/dawn2k7ed.pdf . * Per 100,000 population † Confidence interval.

FIGURE 1. Rates of emergency department (ED) visits* for nonmedical use of selected opioid analgesics, by type --- United States, 2004--2008

Source: Substance Abuse and Mental Health Services Administration (SAMHSA)'s Drug Abuse Warning Network (DAWN), 2004--2008. Additional information available in appendix C at http://dawninfo.samhsa.gov/files/ed2007/dawn2k7ed.pdf .

* Per 100,000 population.

† 95% confidence interval.

§ Rate significantly less than the rate in 2008, by two-sided t test (p<0.05).

¶ Drug types include combination products (e.g., combinations of oxycodone and aspirin).

Alternate Text: The figure above shows rates of emergency department (ED) visits for nonmedical use of selected opioid analgesics, by type, in the United States during 2004-2008. ED visit rates for opioid analgesics were highest for oxycodone, hydrocodone, and methadone during the entire study period.

FIGURE 2. Age-specific rates of emergency department visits* for nonmedical use of opioid analgesics (OAs) and benzodiazepines (BZDs) --- United States, 2004 and 2008

Source: Substance Abuse and Mental Health Services Administration (SAMHSA)'s Drug Abuse Warning Network (DAWN), 2004--2008. Additional information available in appendix C at http://dawninfo.samhsa.gov/files/ed2007/dawn2k7ed.pdf .

* Per 100,000 population.

Alternate Text: The figure above shows age-specific rates of emergency department visits for nonmedical use of opioid analgesics and benzodiazepines in the United States for 2004 and 2008. In 2008, ED visit rates for both types of drugs increased sharply among persons aged >18 years, peaked in the 21-24 years age group, and declined after age 54 years.

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All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

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Prescription-drug overdoses killed nearly 1,270 Floridian

Rx for Danger

s in first half of 2010

Legal medications found more than illegal drugs in victims of drug death, FDLE report says

By Amy L. Edwards Orlando Sentinel
8:17 PM EST, December 2, 2010

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Prescription-drug overdoses killed nearly 1,270 people in Florida during the first half of this year, according to a statewide report released Thursday.

State medical examiners continue to find prescription drugs more often in the bodies of the dead than illicit drugs, documenting the fatal consequences of the nation's prescription-drug epidemic.

One painkiller, oxycodone, was blamed for more deaths than alcohol, cocaine and heroin combined.

"It is no longer just illegal narcotics like cocaine and heroin being bought and sold on our streets. Drug dealers have made legal narcotics a top-shelf product," said Commissioner Gerald Bailey of the Florida Department of Law Enforcement, which issued the report.

By comparison, 1,157 people died from prescription-drug overdoses during the first half of 2009, according to the Florida Medical Examiners Commission.

"Even when used correctly by a prescribing physician, these are potent drugs. When abused, overused and mixed, they can become deadly," Bailey said.

From January to June, about 89,800 people died in Florida. About 4,150 people died with one or more drugs that could be detected in their bodies.

Of those, about 2,580 people died with one or more prescription medications in their systems — drugs at lethal and nonlethal levels. The prescription drugs in these cases also may have been mixed with alcohol and illicit drugs.

Occurrences of the painkillers oxycodone and hydrocodone in the bodies of the dead increased about 11 percent and about 4 percent, respectively, when compared with the last six months of 2009.

Deaths caused solely by oxycodone and hydrocodone also increased when compared with the last half of 2009. Statistics showed there were 63 more oxycodone deaths and 10 more hydrocodone deaths during the first half of the 2010 than during the previous six-month period.

"This new drug crisis rivals the crack-cocaine epidemic of the 1980s," said Bruce Grant, director of the Office of Drug Control. "We must get agencies at all levels of government along with our communities and our medical professionals to step up and take action."

Throughout Florida, law-enforcement agencies and local governments are doing what they can to combat the state's prescription-drug epidemic and death toll.

Cities and counties are taking measures to regulate pain-management clinics, which are often fronts for so-called "pill mills," where doctors dole out powerful prescription drugs for cash.

Orange County leaders are drafting an ordinance that could limit the number of pain-management clinics and their hours of operation. Commissioners are slated to discuss and vote on the ordinance at a public hearing Tuesday.

About 100 deaths in Orange County last year involved misuse of prescription drugs, the Medical Examiner's Office has reported. This year's local death toll is on track to match or surpass that of 2009.

Amy L. Edwards can be reached at aledwards@orlandosentinel.com or 407-420-5735.

Copyright © 2010, Orlando Sentinel

The New York Times

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January 5, 2011

Prescription Drug Abuse Sends More People to the Hospital

By ABBY GOODNOUGH

The number of emergency room visits resulting from misuse or abuse of prescription drugs has nearly doubled over the last five years, according to new federal data, even as the number of visits because of illicit drugs like cocaine and heroin has barely changed.

The Substance Abuse and Mental Health Services Administration found there were about 1.2 million visits to emergency rooms involvingpharmaceutical drugs in 2009, compared with 627,000 in 2004. The agency did not include visits due to adverse reactions to drugs taken as prescribed.

Emergency room visits resulting from prescription drugs have exceeded those related to illicit drugs for three consecutive years, said R. Gil Kerlikowske, President Obama’s top drug policy adviser.

“I would say that when you see a 98 percent increase,” Mr. Kerlikowske said, “and you think about the cost involved in lives and families, not to mention dollars, it’s pretty startling.”

In 2010, the Substance Abuse and Mental Health Services Administration reported that the number of people seeking treatment for addiction to painkillers jumped 400 percent from 1998 to 2008. And in a growing number of states, deaths from prescription drugs now exceed those from motor vehicle accidents, with opiate painkillers like Vicodin, Percocet and OxyContin playing a leading role.

In September, the Drug Enforcement Administration organized the first national prescription drug take-back program, and thousands of people dropped off old or unused drugs at designated locations around the country. While the effort captured but a tiny fraction of the addictive drugs in the nation’s medicine cabinets, law enforcement officials said it helped people understand how deadly such drugs can be. Another collection day is being planned for April, Mr. Kerlikowske said.

“The most important thing that actually seems to be gaining a lot of traction,” he said, “is the recognition that the prescription drugs sitting in your medicine cabinet can be dangerous. That’s huge.”

Published on Sunshine State News (http://www.sunshinestatenews.com)

---

Bondi, Aronberg Aim to Shut Down 'Pill Mills'

Republican AG appoints Democrat to lead fight against prescription drug abuse

Kenric Ward

Posted: January 6, 2011 3:55 AM

Calling Florida "the drug supplier for the rest of the country," former state Sen. Dave Aronberg is leading Attorney General Pam Bondi's fight against "pill mills."

Aronberg, a Greenacres Democrat, was selected by Bondi, a Republican, based on his long-running battle against the abuse of prescription drugs.

"Attorney General Bondi and I both believe that public safety isn't a partisan issue. Florida has become the drug supplier for the rest of the country, and with seven Floridians a day dying from prescription drug abuse, urgent action is needed," Aronberg told Sunshine State News.

Aronberg, who ran unsuccessfully for attorney general in the Democratic primary, worked on the prescription drug abuse issue for a decade, since he was an assistant attorney general under Bob Butterworth investigating the makers of Oxycontin.

"I am excited about returning to my old office to help save lives, and I credit Pam Bondi for making this crisis a top priority of her administration," Aronberg said.

Former Lt. Gov. Jeff Kottkamp, one of Bondi's opponents in the GOP primary, also listed pill mills as his No. 1 concern.

Pill mills have attracted increased attention amid a rising death toll. A 2010 report by the state Office of Drug Control called abuse of prescription drugs "the major public health and safety problem facing Florida.

"The number of deaths caused by at least one prescription drug increased from 1,234 in 2003 to 2,488 in 2009 (a 102 percent increase)," the report stated.  "This translates to seven Floridians dying per day."

Data from the 2009 National Prescription Drug Threat Assessment confirm that misuse of prescription drugs is the fastest growing trend in drug abuse.  

"Florida has become the epicenter for the availability of illegally diverted prescription drugs," according to the state report. "Pill mills have sprung up throughout the state, with a heavy concentration located in South Florida."

Pill mills are described in the report as doctor's offices or health-care facilities that "routinely collude in the prescribing and dispensing of controlled substances outside the scope of the prevailing standards of medical practices."

The 2010 report concluded that the state's prescription drug system is "broken." Bondi agrees.

“It is unacceptable that Florida has become the nation’s pill mill capital and that multiple Floridians are dying every day from illegal prescription drug abuse. In cooperation with federal, state and local law enforcement, we will use all the powers and resources of the Attorney General’s Office in a comprehensive effort to eradicate pill mills from our state,” Bondi said.

“After getting to know Dave last year, I quickly learned that we share a strong commitment to shutting down pill mills. I have complete trust in Dave's ability to take on this very important fight with me,” Bondi said.

Aronberg served from 2002 to 2010 in the Florida Senate, where he advocated for legislation to establish a prescription drug database and for stricter regulation of ownership and operation of pain clinics.

The 39-year-old Aronberg is a graduate of Harvard College and Harvard Law School.

--

Reach Kenric Ward at kward@sunshinestatenews.com or at (772) 801-5341.

Pills: 200,000 deaths - Opinion - The Charleston Gazette - West Virginia News and Sports -

Pills: 200,000 deaths - Opinion - The Charleston Gazette - West Virginia News and Sports -