Prescription Drug Misuse and Abuse in the States
SACs Aid Efforts to Monitor Prescription Drug Abuse
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Karen F. Maline, Editor
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SACs Aid Efforts to Monitor Prescription Drug Abuse
A recent JRSA Executive Committee survey of SAC directors asked, among other questions, if the SAC were involved in any efforts to deal with abuse of prescription drugs in their state. Most SACs were aware of their state's work in this area, and some were involved in some way in the effort. These replies are summarized below.
The Alabama SAC (part of the Alabama Criminal Justice Information Center) reports that it is not specifically involved in the Prescription Drug Monitoring Program (PDMP) in the state, but the agency has been designated to provide Alabama law enforcement with access to the National Precursor Log Exchange (NPLEx). NPLEx is a real-time, electronic logging system used by pharmacies to track sales of over-the-counter cold and allergy medications containing precursors to the illegal drug methamphetamine.
Between 2009 and 2011, approximately 10 million Class II-IV prescriptions were written each year in Arizona, with prescription (Rx) pain relievers accounting for over half of these controlled substances. In 2010, 13% of Arizona adults reported some type of Rx drug misuse in the past 30 days, with half of the misuse related to Rx pain relievers. Likewise, in 2010, 10.4% of Arizona youth reported some type of Rx drug misuse in the past 30 days, with an alarming 76.7% of the misuse involving Rx pain relievers. Arizona has seen a corresponding, and dramatic, increase in opioid-related cases in the emergency departments and drug poisoning deaths involving Rx drugs. To address the growing concern over Rx drug misuse in Arizona and the related consequences, the Arizona Substance Abuse Partnership endorsed a Prescription Drug Reduction Initiative. As a first-step, the Governor's Office for Children, Youth and Families and the Arizona Criminal Justice Commission, which houses the Statistical Analysis Center (SAC), hosted an Rx Drug Expert Panel in February 2012 that involved local experts from law enforcement, the prevention field, and the medical community. Using strategies proposed by the National Office of Drug Control Policy (ONDCP) as a starting point, the experts and attendees formulated a set of data- and research-driven strategies to be used in a multisystemic, multiagency approach to reduce prescription drug misuse in Arizona. In order to maximize return-on-investment, the proposed strategies will be conducted as a feasibility study, or pilot project, implemented in three counties. Over the course of 18 months, the strategies will be implemented in each of the counties in stages. The start date for the three counties will be staggered, with the goal of having each successive wave (i.e., county) incorporate the lessons learned from the preceding wave or waves. Both process and outcome evaluation measures will be tracked as a way of monitoring success and for determining the feasibility of implementing the model on a statewide basis.
The Florida SAC (FSAC) has been asked to mine arrest data for references to prescription drugs last year and this year as well. It provides arrest data for the Florida Attorney General's Rx Drug Task Force via the Florida Department of Law Enforcement's (FDLE's) Office of Statewide Intelligence on an ongoing basis as well as arrest data in support of several research projects addressing mental health and drug abuse to the Florida Mental Health Institute at the University of South Florida. The FSAC 2012 State Justice Statistics funding is for developing a methodology and ongoing data sets to support statewide strategic planning and trend monitoring for human and drug trafficking as a model for future operational data mining endeavors in support of FDLE's Office of Statewide Intelligence. FSAC staff will evaluate case histories for human and drug trafficking arrests with an emphasis on pharmaceuticals to document which events are captured in the state's criminal history records. The FSAC will obtain data from the Florida Department of Corrections to determine if its operational data capture these crimes, in a similar or different manner. Previous experience in data matching to other state operational information systems will be drawn upon to explore potential gaps in Florida's criminal history files for these crimes, and once the individuals are matched across information systems, the completeness of the records will be assessed.
The Idaho SAC (ISAC) is involved in a prescription drug workgroup headed by one of the state's senators. The group also has members from the state board of pharmacy, public prevention, and prescriber education. The ISAC's efforts are aimed at supplying drug-related research to the group. The request from the workgroup is that the ISAC try to determine if law enforcement follows up with cases brought to them and whether or not prosecutors follow through.
In Kentucky, the SAC is currently working with the Kentucky Office of Drug Control Policy to implement the expanded Drug Overdose Death Report required under state law. The report will be completed by the SAC research team on an annual basis, and will help to document the incidence of drug-related deaths within Kentucky. Although this is a new project for the SAC, existing evidence suggests that overdose-related deaths within the state are primarily the result of prescription drug misuse. In addition, the Kentucky Sourcebook of Criminal JusticeStatistics in the Commonwealth began tracking prescription drug-related criminal offenses, sentencing and commitment trends, dispensing, and overdoses within the state in the 2007 edition. This information has been included in each subsequent edition. As a member of the Kentucky Justice and Public Safety Cabinet, the SAC remains an important component of efforts to document and quantify prescription drug abuse and related offenses within the commonwealth.
The Louisiana SAC director is a member of the State Epidemiology Workgroup (SEW), which has begun gathering data on prescription drugs. The group is very active, with members from colleges and universities, other state agencies, law enforcement, and education. The SEW is currently only working in select southern parishes of Louisiana, but has used its dollars to target the problems of the specific areas with television, radio, print, and billboard ads.
In Maine, the SAC is developing a data book on drug arrest trends and drug offender recidivism, and is including trend analysis on self-reported arrest trends by persons in substance abuse treatment for a broad audience within Maine. Though not specific to prescription drug abuse, this report on drug trends and outcomes may lead to ventures within the justice community that are more on point.
The Maryland SAC has done some research on Prescription Drug Monitoring Programs (PDMPs) around the country. Its parent agency, the Governor's Office of Crime Control and Prevention (GOCCP) championed a PDMP during the 2011 legislative session, and such a program was launched in August 2011.
Also in 2011, the North Carolina SAC issued a report (part of the "Grant Update" series) on prescription drug abuse. The report can be found at: http://www.nccrimecontrol.org/. The SAC continues to see this as an issue and anticipates further studies on the topic.
In Ohio, a governor's task force on opiate abuse was created that involves several state agencies, including the Department of Public Safety, where the Office of Criminal Justice Services (and thus the SAC) is housed. The SAC works with the state's drug task forces to gather data and write an annual Drug Task Force report. This report includes prescription drug data (drugs seized and diverted). SAC Director Lisa Shoaf is a member of the National Association of Drug Diversion Investigators (NADDI), which allows her to keep on top of issues related to prescription drug abuse. She also interacts with other state agencies, such as the Department of Health, which keeps statistics on prescription drug overdoses, and the Department of Alcohol and Drug Addiction Services, which keeps statistics on drug use trends across Ohio.
With funding from the Bureau of Justice Statistics, in 2011 the Wyoming Survey & Analysis Center (WYSAC) examined statewide prescribing patterns of Schedule II and above drugs as recorded through the Wyoming Prescription Drug Monitoring Program (PDMP). The Office of National Drug Control Policy warns that "prescription drugs account for the second most commonly abused category of drugs… ahead of cocaine, heroin, methamphetamine, and other drugs."
The Wyoming PDMP data include nearly 4 million prescriptions filled for 477, 515 unique Wyoming persons during the period 2004-2009. Almost one third of the total Wyoming population in each year of the study filled at least one prescription for a scheduled drug. By a broad margin, the most prescribed scheduled drugs were opioid analgesics-opioids alone accounted for over half of all prescriptions in the PDMP each year. Substantial differences were found in per capita prescriptions at the county level, with one Wyoming county filling more than 3.5 times the number of prescriptions for opioid analgesics (per 1,000 population) in 2009 than the county with the lowest rate. Zolpidem (a sedative sleep aid sold under the trade name Ambien and others) and alprazolam (an anti-anxiety drug commonly known as Xanax) were second and third in percent of all prescriptions filled, behind the opioid analgesics. The average per prescription tablet quantity for zolpidem increased by 48% from 2004 to 2009, as did the average per prescription days of supply. Overall, during the period from 2005 to 2009, opioid analgesic prescriptions per 1,000 population statewide were up 21%, sedative/hypnotics up 37%, and anxiolytic prescriptions were up 33%.