A Brief Overview and Forecast
of the Prescription Drug Abuse
Problem in Indiana*
Eric R. Wright, PhD
Director, Center for Health Policy
Professor and Chair, Department of Health Policy and Management
IU Richard M. Fairbanks School of Public Health at IUPUI
Email: [email protected]
* Panel Presentation for “Indiana’s Prescription Drug Abuse Epidemic” with the Honorable Greg Zoeller,
Indiana Attorney General and Members of the State’s Prescription Drug Abuse Task Force Panel; Annual
Meeting of the Indiana Rural Health Association Conference, August 8, 2013.
A BRIEF OVERVIEW
OF THE PROBLEM
Past-Year Nonmedical Prescription Pain
Reliever Use, Ages 12+, Indiana and U.S.,
2004-2011, NSDUH
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Indiana
U.S.
2004
5.4%
4.8%
2005
5.4%
4.8%
2006
5.9%
5.0%
2007
6.2%
5.1%
2008
6.0%
4.9%
2009
5.7%
4.8%
Source: Substance Abuse and Mental Health Services Administration, 2013
2010
5.7%
4.9%
2011
5.7%
4.6%
Nonmedical Use of Prescription Psychotherapeutics,
General Population Ages 12+, Indiana and U.S., National
Survey on Drug Use & Health (NSDUH)
Lifetime
Nonmedical Use
Indiana
U.S.
All Psychotherapeutics
Past-Year
Nonmedical Use
Indiana
U.S.
Past-Month
Nonmedical Use
Indiana
U.S.
20.7%
19.9%
7.6%
5.7%
2.7%
2.4%
Pain Relievers
15.0%
13.3%
6.1%
4.3%
2.0%
1.7%
Tranquilizers
9.1%
8.4%
2.8%
2.0%
0.8%
0.7%
Sedatives
3.9%
2.9%
0.4%
0.2%
0.1%
0.1%
Stimulants
8.3%
7.9%
1.7%
1.0%
0.8%
0.4%
Note: U.S. rates are based on 2011 NSDUH results. Indiana rates are estimated based on annual NSDUH averages from 2002-2004; this is the
most recent estimate, since these rates are not continuously computed at the state level.
Source: Substance Abuse and Mental Health Services Administration, 2013
Past-Year Nonmedical Prescription Pain
Reliever Use, by Age Group, in Indiana,
2004-2011, NSDUH
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
12 to 17
18 to 25
26 or Older
2004
8.3%
14.4%
3.4%
2005
8.5%
14.2%
3.4%
2006
7.9%
16.0%
3.8%
2007
7.7%
15.5%
4.4%
2008
7.7%
14.2%
4.4%
2009
8.2%
13.9%
4.0%
2010
7.6%
14.8%
3.9%
2011
7.0%
14.4%
4.0%
Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2013
Lifetime Prescription Drug Use without a
Doctor’s Prescription, 2011, Youth Risk
Behavior Survey (YRBS)
Indiana
Rate 95% CI
Gender
Male
21.4 (18.3–24.8)
Female 21.5 (18.7–24.5)
Race/Ethnicity White
21.7 (18.5–25.3)
Black
18.4 (13.8–24.1)
Hispanic 19.9 (15.5–25.2)
Grade
9th
13.8 (11.3–16.7)
10th
23.2 (20.1–26.7)
11th
24.8 (18.6–32.4)
12th
24.7 (19.2–31.1)
Total
21.4 (18.3–24.8)
Source: CDC, 2011 Youth Risk Behavior Survey.
U.S.
Rate 95% CI
20.7 (19.2–22.2)
19.8 (17.8–21.9)
22.9 (21.1–24.8)
14.7 (12.3–17.5)
19.4 (16.4–22.6)
16.5 (14.2–19.1)
18.2 (16.1–20.6)
23.3 (20.8–26.1)
25.6 (23.4–28.0)
20.7 (19.2–22.2)
Percentage of Indiana College Students Reporting Use
of Prescription Drugs in the Past Year, 2012, Indiana
College Substance Use Survey
Rx not prescribed to Rx prescribed to
student
student, but misused
Gender
Male
Female
Age Group Under 21
Ages 21+
Institution Private
Public
Total
15.8%
11.1%***
11.7%
14.1%***
8.1%
14.4%***
12.8%
4.9%
2.7%***
3.1%
4.0%*
1.9%
4.0%***
3.5%
Statistically significant differences between groups: *p < .05, **p < .01, ***p < .001
Source: Indiana Collegiate Action Network, 2012
Controlled Substances, Schedules II-V,
Dispensed in Indiana, 2008-2011, INSPECT
2008
Opioids
CNS Depressants
Stimulants
Others
Total
5,849,460
(50.3%)
3,558,007
(30.6%)
1,149,939
(9.9%)
1,077,686
(9.3%)
11,635,092
(100.0%)
2009
2010
2011
6,376,664 5,591,679 5,830,367
(50.2%)
(49.3%)
(45.8%)
3,902,414 3,514,361 3,889,652
(30.7%)
(31.0%)
(30.5%)
1,353,939 1,309,265 1,419,003
(10.6%)
(11.5%)
(11.1%)
1,080,914
926,234 1,604,214
(8.5%)
(8.2%)
(12.6%)
12,713,931 11,341,539 12,743,236
(100.0%)
(100.0%)
(100.0%)
Source: Indiana Professional Licensing Agency, Board of Pharmacy. INSPECT 2008-2011.
FORCASTING THE IMPACT OF
RX ABUSE ON INDIANA
Percentage of Indiana Treatment Episodes with Heroin Use and
Nonmedical Opioid Use Reported at Admission (TEDS, 2001-2010)
25%
20%
15%
10%
5%
0%
IN Heroin
IN Opioids
2001
2.6%
6.0%
2002
2.8%
6.4%
2003
2.6%
7.5%
2004
3.0%
7.9%
2005
3.3%
9.1%
2006
3.2%
10.2%
2007
2.9%
11.3%
Source: Substance Abuse and Mental Health Data Archive, 2010
2008
4.1%
13.7%
2009
5.5%
13.6%
2010
6.6%
15.2%
Number of Arrests for Possession and Sale/
Manufacture of “Other Drugs” (Barbiturates &
Benzedrine) in Indiana, 1999–2010, Uniform Crime
Reports (UCR)
4,500
4,000
3,500
Number of Arrests
3,000
2,500
2,000
1,500
1,000
500
0
Possession
Sale
1999
1,617
316
2000
1,255
528
2001
1,493
537
2002
1,621
476
2003
1,688
556
2004
2,191
659
2005
2,620
746
2006
2,643
767
2007
2,720
690
2008
3,511
815
2009
3,994
930
2010
3,426
931
Source: National Archive of Criminal Justice Data, Inter-university Consortium for Political and
Social Research, University of Michigan, 1999-2010 UCR
Number of Arrests for Possession and Sale/
Manufacture of Cocaine & Opiates in Indiana,
1999–2010, UCR
6,000
Number of Arrests
5,000
4,000
3,000
2,000
1,000
0
Possession
Sale
1999
2,872
2,585
2000
3,185
1,885
2001
3,410
1,803
2002
3,964
1,977
2003
3,856
2,207
2004
4,317
2,464
2005
5,020
2,617
2006
5,608
3,227
2007
3,937
2,668
2008
3,301
2,336
2009
2,617
2,425
2010
2,397
2,028
Source: National Archive of Criminal Justice Data, Inter-university Consortium for Political and
Social Research, University of Michigan, 1999-2010 UCR
Percentage of Indiana and U.S. Treatment Episodes with
Nonmedical Prescription Drug Use Reported at Admission,
2000–2010, Treatment Episode Data Set (TEDS)
22%
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Indiana
U.S.
2000
11.6%
7.7%
2001
10.9%
9.0%
2002
11.6%
9.6%
2003
12.6%
10.0%
2004
12.8%
10.9%
2005
14.5%
11.0%
2006
15.5%
10.8%
2007
16.5%
12.4%
2008
18.9%
14.0%
2009
19.1%
16.2%
Source: Substance Abuse and Mental Health Data Archive, 2000-2010 TEDS
2010
20.2%
19.1%
Drug Overdose Deaths by Intent,
U.S., 1999-2010
Unintentional
Suicide
Undetermined
35,000
30,000
Number of Deaths
25,000
20,000
15,000
10,000
5,000
0
1999
2000
2001
2002
2003
2004
2005
Year
Source: National Vital Statistics System. 1999-2010
2006
2007
2008
2009
2010
Number of Drug Overdose Deaths Involving
Opioid Pain Relievers and Other Drugs
U.S., 1999-2010
18,000
Any opioid analgesic
16,000
Number of deaths
14,000
12,000
10,000
8,000
Specified drug(s)
other than opioid
analgesic
Only non-specified
drug(s)
6,000
4,000
2,000
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Source: CDC/NCHS, National Vital Statistics System
Deaths with a Contributing Cause of Poisoning
by Narcotics and Hallucinogens in Indiana, 20082011, Indiana State Department of Health
(ISDH) Mortality Data Set
Included in T codes for contributing causes
2008
2009
2010
2011
Opium
Heroin
Other opioids (codeine, morphine)
Methadone
Other synthetic narcotics
Other and unspecified narcotics
Cocaine
Cannabis (derivatives)
Lysergide (LSD)
Other & unspecified psychodysleptics (hallucinogens;
e.g., Mescaline, Psilocin, Psilocybine)
0
57
112
76
55
51
55
5
0
0
66
158
78
67
21
49
5
0
0
57
145
60
50
20
46
7
0
0
64
183
58
41
50
40
8
0
1
0
0
0
Total
412
444
385
444
Source: Indiana State Department of Health, Epidemiology Resource Center, Data Analysis Team, 2013
CONCLUSIONS
• Prescription drug abuse has emerged as a major
iatrogenic epidemic both in Indiana and across the
United States.
• The demand for addiction treatment will increase
significantly over the next few years due both to
increasing rates of abuse and expanding efforts to
identify and screen individuals in need of care.
• To slow or reverse these trends, we will need to
develop and implement a comprehensive statewide plan that addresses both the demand and
supply for prescription drugs.
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Status Report of the Prescription Drug Abuse Problem in Indiana