Policy Recommendations for Prevention of Prescription Drug Abuse

Trust for America’s Health’s (TFAH) latest report, Prescription Drug Abuse: Strategies to Stop the Epidemic, illustrates the magnitude of the public health problem created by misuse of prescription drugs, and examines the methods that states are employing to address the disturbing trend.  According to the authors, the number of deaths by prescription drug overdose is larger than those by cocaine and heroin combined. With sales of prescription painkillers 4 times higher in 2010 than in 1999, the increase in the abuse of these substances should not come as a surprise.

Some of the findings from the report:

  • In 2010, West Virginia was the state with the highest rate of deaths by overdose, at 28.9 for every 100,000 residents (an increase of 605 percent increase from 1999).  North Dakota had the lowest at 3.4 for every 100,000 residents.
  • 22 states require by law specific education for doctors and other healthcare professionals who can prescribe pain medication.
  • 17 states have laws giving some protection from criminal charges (or consider it a mitigating factor) to people attempting to get medical assistance for an overdose victim, including themselves.

Pennsylvania is ranked 14th in amount of deaths by drug overdose and, according to the report, has in place 4 of 10 evidence-based indicators that work to reduce prescription drug abuse and overdose deaths. Policy and practice recommendations such as educational outreach and more variety in treatment options, as well as data snapshots for all fifty states are included in the complete report available at the Trust for America’s Health’s website.

 

Young, Pregnant and Using

Data from a new TEDS report from the Substance Abuse and Mental Health Services Administration examines the differences between pregnant and non-pregnant teenagers admitted to substance abuse treatment. What may be of interest to providers and policymakers are the differences between the groups, and how those characteristics could inform prevention programming and public health campaigns.

Findings from the May 2013 brief, The TEDS Report: Characteristics of Pregnant Teen Substance Abuse Treatment, include the following,

  • The majority of referrals of pregnant teenagers using alcohol or drugs were from the justice system (41.4 percent) and community agencies (23 percent), both higher than among non-pregnant female teens admitted in the same time period.
  • Among pregnant teenage users, self-referrals to treatment were lower than among their non-pregnant peers (18.5 percent versus 22.9 percent). Also, schools were less likely to refer pregnant students (4.5 percent compared to 10 percent) to treatment.
  • Pregnant teens more likely to report methamphetamine or amphetamine use than non-pregnant peers (16.9 percent versus 8.4 percent) at the time of admission.
  • Poverty, as measured by public assistance as main source of income and use of Medicaid as the primary payor, was higher among pregnant teenagers.

The series of TEDS reports are available at the SAMHSA website.

Lessons on Systems Change from The Center on Substance Abuse and Child Welfare

The impact of parental substance abuse on children’s stability and well-being is a concern that crosses systems.  Data suggests that parental drug and alcohol use is related to abuse and neglect and increases the likelihood of a parent’s involvement in the justice system – including the possibility of incarceration. The National Center on Substance Abuse and Child Welfare (NCSACW) provides In-Depth Technical Assistance (IDTA) to a handful of sites across the country in the areas of substance abuse, child welfare and the courts to result in better outcomes for families involved in these systems.  For approximately 18 months, the IDTA team works with local, state or tribal entities to coordinate strategy and services across systems through the use of evidence-based programs and on-site technical assistance in order to grow capacity for improved child and family outcomes.

The report, In-Depth Technical Assistance (IDTA) Final Report 2007-2012 provides an overview of the IDTA program model, related site accomplishments, and the lessons of system change at various levels. Some findings include,

  • 50 percent of the sites implemented (or enhanced) a recovery specialist model in their programs;
  • 68 percent developed and/or implemented cross-system training plans;
  • 60 percent developed and/or implemented screening protocols that resulted in lowers costs, reduced redundancy and a more efficient referral process;
  • 27 percent used cross-system data collection and tracking processes, such as case reviews and drop-off analysis, to inform policy and program decisions. (Note: according to the SAMHSA website, a Drop-Off Analysis is “a method used to assess linkages among child welfare, treatment agencies and courts. The method helps to identify connections that families need to make between systems to obtain services and achieve their child welfare case goals.”)

In addition to program findings, the brief discusses numerous lessons learned around systems change, particularly: issues in achieving long-term policy and practice changes and avoiding the fracture of collaborative relationships post-project,  leadership focused on engaging and sustaining partners,  use of data to identify areas of and opportunities for change, and realistic timelines for implementing system change and shared accountability.

Is Prescription Drug Abuse on the Decline?

Recreational use of controlled prescription drugs is second only to marijuana in popularity among drug-using Americans, and accounts for tens of thousands of substance abuse treatment admissions over the past decade.  Psychiatric medications (benzodiazepines) oft prescribed for anxiety, insomnia, seizures, and other medical conditions and pain-killers were the most common duo of prescription drugs reported by those seeking addiction treatment, resulting in a 570 percent increase in patient intakes between the years of 2000 and 2010.  However, a new report from the  Substance Abuse and Mental Health Services Administration (SAMHSA) indicates a national decrease in nonmedical use of prescription drugs.

According to the report, State Estimates of Nonmedical Use of Prescription Pain Relievers, based on data from The National Survey on Drug Use and Health (NSDUH), seven states with the highest rates of nonmedical prescription drug use were in the western region of the country, while states from the midwest and south made up the majority of those with the lowest rates.  Pennsylvania was slightly below (4.2 percent) the 2011 national rate of 4.6 percent of residents reporting past year recreational use of controlled pain relievers. Both rates decreased between 2009 and 2011.  Percentages by state and age group are available on the SAMHSA website.

Initiatives focused on medical staff and patient education and enforcement strategies may be having an impact on the prevalence of prescription drug abuse.  If adopted, recently proposed regulations to the Secure and Responsible Drug Disposal Act of 2010 aimed at enhancing the ease and security of medication disposal may also contribute to a further decline of usage rates.  But is it merely an issue of easy access, or are prescriptions from doctors assumed to be safer than “street” drugs?  

 

 

 

 

 

 

 

 

Study Citation: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (January 8, 2013). The NSDUH Report: State Estimates of Nonmedical Use of Prescription Pain Relievers. Rockville, MD.