Elizabeth Agius, Wayne State University
Su Min Oh, Office of Recovery Oriented Systems of Care
Theresa Webster, Southeast Michigan Community
Alliance (SEMCA)
Presentation to the SUD Conference
Traverse City, MI
September 16, 2013
Introduction
 Purpose: To explore three facets of prescription drug
use with data and information
 National and state data - Su Min Oh
 Survey Data -
Elizabeth Agius
 Local Perspectives – Theresa Webster
 Key Theme: Prescription drug misuse and abuse is a
rapidly growing and complex problem
The Basics
 Prescription drug misuse can be defined as the use of
prescription medications in a manner not prescribed
and/or by someone for whom the medication was not
prescribed (MDCH, 2010).
 NIDA most commonly misused/abused prescription
medications are opioids – pain medications;
depressants/sedatives – for anxiety and sleep; and
stimulants – for ADHD, obesity and narcolepsy.
 SAMHSA estimates that 16.42 million adults (>18 y/o) in
the United States abused prescription drugs in 2010,
representing greater prevalence than heroin,
methamphetamines, cocaine, and other illicit drugs.
Number of deaths
Number of Unintentional Drug Poisoning
Deaths, Michigan, 1999-2010
Year
Age-Adjusted Unintentional Drug Poisoning
Death Rates by Gender, Michigan,
1999–2010
Rate per 100,000 population
Male
Total
Female
Year
Rate per 100,000 population
Unintentional Drug Poisoning Death Rates by
Age Groups, Michigan, 1999–2010
45 – 54 years
35– 44 years
25– 34 years
55-64 years
15-24 years
65+ years
Year
Crude Rate per 100,000 population
Unintentional Drug Poisoning Deaths by
Major Drug Type, Michigan, 1999–2010
Unspecified
Other specified
Opioid analgesic
involvement
Heroin only
Cocaine only
Cocaine and heroin
Year
Crude rate per 100,000 population
Unintentional Drug Poisoning Deaths involving
Opioid Analgesics, Michigan, 1999–2010
Total
Only opioid
analgesic
With cocaine
Year
With heroin
Heroin &
cocaine
Unintentional Drug Poisoning Death
Rates by Region, Michigan, 1999
Detroit
Unintentional Drug Poisoning Death
Rates by Region, Michigan, 2004
Unintentional Drug Poisoning Death
Rates by Region, Michigan, 2004
How did we get here?
 Prior to 2000, physicians were
under prescribing for chronic pain
 Positive benefits of treating
chronic pain with high dose levels
of pain medication discovered
 Physicians became more liberal in
prescribing patterns
 Pharmaceutical industry pushed
pain medications as the preferred
method of treating chronic pain
How did we get here?
 The number of opioid analgesic
prescriptions filled at
pharmacies increased from 175
million in 2000 to 254 million in
2009.

Executive Office of the President of the United States. Epidemic
Responding to America’s Prescription Drug Abuse Crises, 2011
Why Focus on Pharmacists?
 Pharmacist have a professional
responsibility to prevent the
abuse and diversion of
prescription drugs
 Pharmacist are trained to
recognize common patient
behaviors and characteristics
 Pharmacists are in a position to
observe patterns of prescribing
Perceptions of Pharmacists
 Two surveys of pharmacists
 SEMCA Pharmacist survey


As part of 2010-2011 Needs Assessment
Michigan Pharmacist Association professional org members
living or working in Southeast Michigan; 372 responses
 BSAAS Pharmacist survey


December 2012 – February 2013
Sample – CAs & Michigan Primary Care emails, then SEMCA
list; only 72 responses
SEMCA Pharmacist Survey
Severity and Seriousness of Substance Abuse (N=372)
Drug
Alcohol
Abuse
(N=327)
Illicit drugs
(N=327)
Prescription
s drugs
(N=372)
OTC drugs
(N=324)
Opioid drugs
(N=326)
Not at all/
Not too
serious
Some
what
serious
Very
ser
Ious
4%
27.5%
68.5%
3.7%
14.1%
68.5%
.6%
13%
86.2%
15.4%
50.6%
34%
1.5%
13.5%
85%
 Respondents saw High
Potential for abuse for
Opiods (95%), Amphetamines(91%), Cocaine
and Heroin (90%)..
 Compared to 72% for
Alcohol & 69% for
Marijuana
Observations of Behaviors
OPIODS
Monthly Weekly 1 –2x wk Daily
Falsified Rx
64
19
10
7
Rx from multiple sources
44
23
17
17
Excessive # Rx from one
doc
47
17
17
17
Excessive Rx at short
interval
41
34
14
24
Rx non local source
42
21
15
22
Family members scam Rx
53
26
11
11
Inappropriate combo of
drugs
25
29
15
19
After hours purchase
36
20
15
30
In their words..
Pharmacist Open-ended Question Comments (Total N=71)
 Doctors contributing to problem/need to be held
accountable (over-prescribing, RX mills, not saying “no” to
patients) (n=31)
 Need stricter laws for prescribing and reporting abuse
(triplicate blanks, greater regulations/penalties, patients
identify doctors abusing, checklist to prescribers, doctors
using MAPs) (n=13)
 Identifying prevalent or increased opioid and sedative use
and abuse- (docs prescribing and patients asking for
oxycontin, opana, hydrocodone, soma) (n=12)
 No steps pharmacists can take to combat the abuse
problem (hold doctors accountable, law enforcement not
helpful) (n=11)
Community Perspectives
 Community Survey asked 563 adults in out-Wayne
County how easy it would be to get rx drugs.. 61% say
“easy”.. Most (44%) would get it from Medical
Professional, 21% from friends, 12% from family
 13.3% of the sample reports some lifetime use of nonmedical rx drug use
 Perceived risk of harm from non-medical use of rx
drugs
 Occasional use – 80% High risk, Regular use 96% HR
Youth Use
 Monitoring the Future 2010
 Ritalin past year 2.7% for 10th & 12th graders
 Other rx drugs - est of 15% for past 30 days
 MiPhy 2010 (non generalizable sample)
 7% Out-Wayne County used rx drugs (Ritalin, Adderall,
Xanax); 16% had used painkillers without Dr. script
BSAAS Pharmacist Survey
 Smaller survey, but similar results
 75% SA: prescription drug abuse is a serious problem
(100% with agree added)
 76% SA: Prescribers have major responsibility in
helping to prevent prescription drug abuse
 Prescription drugs, Heroin, Cocaine most serious – in
this order
Use of MAPS
 42% felt MAPS was very useful, 43% felt it was
somewhat useful, 12% felt it was a little useful and
3% felt MAPS was not useful at all.
 Estimate % of customers served where you also
reviewed their controlled substance prescription
records using MAPS (N=68)
 1-9% of customers
56%
 10-19% of customers
31%
 20% or more
13%
Perceived Responsibilities
I believe the responsibilities of a community pharmacist with regard to
prescription drug abuse are: (N=281) Multiple responses per individual
Educate the consumer about the potential for addiction and harm of
mood and mind altering substances
84%
Counseling the consumer about the potential for addiction and
harm of mood and mind altering substances
83%
Discuss alternative medications and/or measures
64%
Refusing to fill prescription when I suspect an illegal prescription or
inappropriate use
91%
Refusing to fill prescriptions for medications with abuse potential if I
suspect the medication will be used inappropriately
62%
Notifying law enforcement when I suspect the potential for illegal
use of prescription drugs
64%
Training Needs
Strongly
Agree
Agree
Neither Agree
nor Disagree
Disagree
Strongly
Disagree
I feel the need for additional training in
substance abuse. (N=69)
16%
45%
22%
17%
0%
I feel the need for additional training in
mental health. (N=69)
23%
53%
12%
12%
0%
I am willing to participate in training
from the local substance abuse/mental
health in SBIRT. (N=68)
21%
48%
23%
6%
2%
I am interested in receiving additional
training in pain management. (N=68)
23%
54%
15%
6%
2%
I am interested in receiving training in
identifying prescription drug abuse/
addiction (N=68)
27%
57%
10%
2%
4%
How did we respond?
 Safe Medication Disposal Campaign
 Resources for your community
 Permanent Medication Disposal Drop Box
 How to get one in your area
How did we respond?
 Responsible Opiate
Prescribing for Physicians
 Medication Use Safety
Training
 Resources
 Pharmacists Tool Kit
 Medication Monitoring
Inventory
 Prescription Bag Tags
Wrap up
 Questions about materials presented
 Information to share about your community
Contact Information
• Elizabeth Agius

Wayne State University School of Social Work; 313-5775251, eagius@wayne.edu
• Su Min Oh
•
MDCH Office of Recovery Oriented Systems of Care;
517-241-2957, ohs@michigan.gov
• Theresa Webster
• SEMCA Prevention Coordinator; 734-229-3500,
theresa.webster@semca.org