Two Days in May 2010 - 33 - Epidemic of Prescription Drug Overdose Victims

Ohio Department of Health
Violence and Injury Prevention Program
Alarming Rise in
Unintentional
Drug Overdose
Deaths in Ohio
1
For More Information…
ODH Drug Poisoning Website

http://www.healthyohioprogram.org/diseaseprevention/dpois
on/poison.aspx
Or…
http://www.odh.ohio.gov/
Go to “I”
Select “Injury Prevention”
Select “Drug Poisoning” on the left menu bar
2
What do these people
have in common?
3
A GROWING
PROBLEM:
CHANGES OVER
TIME IN
U.S. & OHIO
4
Percentage change in number of annual deaths for leading
causes of injury, by mechanism and intent - Ohio, 1999 to 20081
1Source: Ohio Dept of Health, Office of Vital Statistics
unt fall 110%
unt poisoning 319%

Increase from
unt MV traffic -14% 369 deaths in 1999
to 1,568 in 2008
all unintentional 51%
Amounts to 4.3
suicide 21% deaths per day
in 2008
homicide 27%
firearm-related* 14%
Unt=unintentional
*all intents Percent change in death rate
5
Overdose = Drug/Medication Poisoning
(result of exposure to poison)
Unintentional = “Accidental” vs.

Intentional (Suicide or Homicide)
6
Poison death rates (per 100,000) of Ohio residents
by manner, year, 1999-2008*
16
14
12
Rate per 100,000
10
8 Unintentional
6 Suicide
Undetermined
4
0
1999 2000 201 2002 2003 2004 2005 2006 2007 2008
Year
*Source: Ohio Department of Health, Vital Stats 7
Proportional distribution of unintentional poisoning
deaths by type of poison, Ohio 2003-06*
96% of all unintentional poisoning deaths were due to drugs/medications.
Alcohol
Other/unsp. Drugs, 33 – 1%
1,810
Hydrocarbons &
45%
solvents, 18
ANS Acting
1
Other Gases & Vapors
179 105
Nonopiod
Sedatives, NEC, Analgesics
Narcotics & 165, 4% 31
hallucinogens,
1,836
46% Other & unspec
chemicals
23
*Source: Ohio Dept of Health, Office of Vital Statistics
8
Number of deaths from MV traffic, suicide and
unintentional drug poisonings by year, Ohio 1999-2008*
*Source: ODH Office of Vital Statistics
For first time, in 2007 unintentional drug poisoning exceeds MV traffic

and suicide as the overall leading cause of injury death in Ohio.
1500 1,473
1,422 1,402
1200
1,242
Number of deaths
1,144
900
600
suicide
327 unt mv traffic
300
unt drug poisoning
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
9
Ohio deaths and death rates per 100,000 due to
unintentional drug poisoning by year, 1999-2008*
12.8
1600 13
11.8
350% increase in number of 12
11.0
1400 deaths from 1999 to 2008 1,473
11
1,351
1200 8.9 1,261 10
Number of deaths
Deaths 4
Rate per 100,000

7.9 deaths
9
1000 Death Rate per 8
1,020
6.2 day 7
800 5.8 904
4.9 6
600 702 5
658
3.6
2.9 555 4
400 3
411
327 2
200
~1 per 1
day
0 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
*Source: ODH Office of Vital Statistics 10
US deaths and death rates due to unintentional
drug poisoning by year, 2000-06*
30,000 8.8 9
7.6
Number Deaths
25,000 6.8 26,400
Death Rate 6.3
22,448 72
Number of deaths
20,000 5.7 deaths 6
Rate per 100,000

19,838 per
4.6 18,294
day
15,000 4 4.2 16,394
13,024
10,000 11,155 11,712 3
31
5,000 deaths
per
day
0 0
1999 2000 2001 2002 2003 2004 2005 2006
Year
*Source: CDC WONDER 11

Number of U.S. deaths due to
unintentional drug overdoses
in 2006 exceeds that of
a large jet crash killing 350 people
every day for 2.5 months in a row.
12
Ohio1 and US2 unintentional drug poisoning death
rates per 100,000 population, 1999-2006 (2008 for OH)
14
12
Rate per 100,000
10
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
1Source: ODH Office of Vital Statistics; 2Source: CDC WONDER:

13
Drug Overdose Death Rates by State, 2006.
U.S. rate – 8.8
Source: Len Paulozzi, MD, MPH, Division of Unintentional Injury Prevention, National Center for Injury
Prevention and Control, Centers for Disease Control and Prevention. Prepared August 2009..
14
Number of deaths due to HIV/AIDS and unintentional drug
poisonings by year, Ohio, 1979-2006 (2008 for poisoning)1,2,3
1600
1400
HIV Unt Drug Poisoning
number of deaths
1200
1000
800
600
400
200
0
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Source: 1WONDER (NCHS Compressed Mortality File, 1979‐1998 & 1999‐2005) 22006‐8 ODH Office of Vital Statistics,
3Change from ICD‐9 to ICD‐10 coding in 1999 (caution in comparing before and after 1998 and 1999) 15
Epidemics of unintentional drug overdoses in Ohio, 1979-20081,2,3
1600
1400 Prescription
Drugs
1200
1000
800
600
Crack Cocaine
400
Heroin (1973-75)
200
0
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: 1WONDER (NCHS Compressed Mortality File, 1979‐1998 & 1999‐2005) 22006‐2008 ODH Office of Vital Statistic
3Change from ICD‐9 to ICD‐10 coding in 1999 (caution in comparing before and after 1998 and 1999) 16
US military deaths in Iraq (2003-present)1 vs.
unintentional drug overdose deaths in Ohio (2003-08)2
As of March 8, 2010:
4,383 members of the 6,921
U.S. military had died in
the Iraq war since it 4,383
began in March 2003.
6,921 deaths due to

unintentional US military deaths in Ohio unintentional
drug/medication Iraq, 2003-present drug poisoning, Ohio,
poisoning in Ohio. 2003-2008
Sources: 1http://www.cnn.com/SPECIALS/2003/iraq/forces/casualties/, accessed 3/8/10;

2ODH Office of Vital Statistics
17
Number of daily Ohio ED visits for “drug overdose” or
“symptoms of drug overdose” as chief complaint on
admission, August 2007-July 2008*
July ’08 - 50-80 ED visits

Aug ‘07- 40-70 ED visits
*Source: EpiCenter (Ohio ED chief complaint on

admission data using “drug OD” as chief complaint)
18
WHO’S AT GREATEST RISK?
NOT WHO YOU MIGHT EXPECT
19
Number and average rate per 100,000 of fatal unintentional
drug/medication-related poisonings by age group Ohio, 2005-07*
1400 25
22.7
20.9 Deaths
Death rate per 100,000 population

1200
1,179 rate 20
1000
Number of deaths
15.9 1,014
15
800
600 696
8.3 10
7.0
400
332 314 5
200 2.0 1.6
0.2
14 47 36
0 0
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+

Average unintentional drug/medication poisoning death
rate per 100,000 by sex, age group, Ohio, 2005-07*
30
female
25 1,279
males
Male
per 100,000
20 females 2,353
15
100,000
Rate
10
1per
0
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+
Age group
Proportional distribution of unintentional drug poisoning deaths by
age group, year, Ohio, 1999 - 2008*
100%
90%
80%
27% 27% 28% 28% 30% 31% 31% 33% 33% 31%
number of deaths
70%
75+
60% 65 to 74
30% 28% 55 to 64
50% 43% 41% 37% 36% 30% 29% 27% 25%
45 to 54
40%
35 to 44
30% 25 to 34
20%
15 to 24
18% 16% 18% 18% 16% 20% 19% 19% 21%
14% 0 to 14
10%
0%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
What drugs are
responsible for rise
in Fatal overdoses?
23
Drugs of Potential Abuse
CNS Depressants:
à Opioid analgesics (narcotics*) - pain medications & heroin
Most associated with overdoses nationally & in Ohio*
Methadone
Fentanyl – often used as a patch (transdermal application)
Oxycodone (OxyContin®)
Hydrocodone (Vicodin®)
à Benzodiazepines – anxiety/sleep - Diazepam (Valium®),
alprazolam (Xanax®), etc.
Stimulants – Cocaine, amphetamine, methamphetamine
Anti-depressants
*not necessarily in order of number of deaths Source: SAMHSA

24
Proportion of all unintentional drug poisoning
deaths involving selected drugs, Ohio, 20081,2**
1Source: ODH Office of Vital Statistics
barbiturates 0% 2Multiplesubstances are often
involved in one death.
hallucinogens 1%
benzodiazepines 10%
alcohol 12% Prescription opioids include other opioids,
methadone, other synthetic narcotics, and
cocaine 17% other/unspecified narcotics
heroin 16%
opioids (includes heroin) 47%
prescription opioids 37%
other unspecified only* 32%
other unspec multiple substances 75%
**preliminary data for 2008; does not include out of state deaths of Ohio residents
*includes only cases where no other drug/medicament than other/unspecified is listed as contributing
cause of death 25
Prescription Opioids/Narcotics
Other Opioids (most commonly-prescribed opioids)
à Hydrocodone (Vicodin®, Lortabs®)
à Oxycodone (OxyContin®, Percocet®)
à Morphine
à Codeine
à Hydromorphone (Dilaudid®)
Methadone
Other Synthetic Narcotics

à Fentanyl (Duragesic®)
à Propoxyphene
à Meperidine (Demerol®)
à Buprenorphine
Other and Unspecified Narcotics

26
Proportion of all unintentional drug poisoning
deaths involving selected opioids, Ohio, 20081,2**
Includes fentanyl, propoxyphene, meperidine

other synthetic narcotics 6% (Demerol), Buprenorphine
methadone 11%
Includes oxycodone, hydrocodone,

other opioids 19% morphine, codeine, hydromorphone)
Identified prescription narcotic but

other unsp narcotics 4% no specific narcotic listed on DC.
Prescription opioids
prescription opioids 37% include opioids
listed above.
opioids (includes heroin) 47%
heroin 16%
**preliminary data for 2008; does not include 2Multiplesubstances are often
out of state deaths of Ohio residents involved in one death. 27
Number of fatal unintentional drug poisonings
involving selected drugs, Ohio, 2000-20081,*
barbiturates 40 2Multiplesubstances are often
involved in one death.
hallucinogens 68
benzodiazepines 785 Prescription opioids include other opioids,

alcohol 679 other/unspecified narcotics
cocaine 1,799
heroin 1,093
opioids (includes heroin) 3,859
prescription opioids 3,005
other unspecified only* 2,409
other unspec multiple substances 6,005
*includes only cases where no other

**preliminary data for 2008; does not include drug/medicament than other/unspecified
out of state deaths of Ohio residents is listed as contributing cause of death 28
Number of fatal unintentional drug poisonings by year with
specific drug involvement, Ohio, 2000-20081,2
600
Number of deaths by drug involvement
Prescription opioids include other opioids, heroin

500 other/unspecified narcotics
methadone
400
300 cocaine
200
other and unspecified
drugs only*
100
prescription opioids
0
2Multiplesubstances can
be involved in one death.
*includes only cases where no other drug/medicament than

other/unspecified is listed as contributing cause of death
1Source: ODH Office of Vital Statistics **preliminary data for 2008 (numbers may increase) 29
Number of fatal unintentional drug poisonings by year
involving heroin and methadone, Ohio, 2000-20081,2
Number of deaths by drug involvement
250
229
heroin
200
methadone
161
150
100
71
50
14
0
2000 2001 2002 2003 2004 2005 2006 2007 2008**
2Multiplesubstances can
be involved in one death. *includes only cases where no other drug/medicament than
other/unspecified is listed as contributing cause of death
1Source: ODH Office of Vital Statistics **preliminary data for 2008 (numbers may increase) 30
Risk by Race,
Sex for Specific Drugs
31
Unintentional poisoning death rates per 100,000 population
involving opioids1, by race, sex, year, 2000-2006, Ohio*
8 7.5
white females rate
7 white males rate
black females rate
Rate per 100,000 population
6 black males rate

5.0
5 4.5
3 2.6
3.2
2
0.8 1.9
1
0.8
0
2000 2001 2002 2003 2004 2005 2006
1heroin,other opioids, methadone, other synthetic
*Source: ODH Office of Vital Statistics narcotics and other unspecified narcotics
32
Percent change in unintentional poisoning death rates
involving opioids1, by race, sex, from 2000 to 2006, Ohio*
black
males 11%
black
females 123%
White males have the highest
death rates from unintentional
opioid overdose.
white
males 183% White females represent the

fastest growing group at risk.
white
females 285%
1heroin,other opioids, methadone, other synthetic

*Source: ODH Office of Vital Statistics narcotics and other/unspecified narcotics
33
34
Ohio Counties with Highest Unintentional
Drug Poisoning Death Rates, 2004-08*1 1based on county of residence
Number of Annual Deaths Total # deaths Avg annual rate Ratio County:

2004 2005 2006 2007 2008 2004‐’08 from 2004‐08 State Rate
MONTGOMERY 127 116 125 130 145 643 23.8 2.3

VINTON** 2 4 3 4 2 15 22.6 2.2
JACKSON** 4 4 14 7 8 37 22.3 2.1
SCIOTO 14 17 15 19 17 82 21.5 2.1
CRAWFORD 4 10 9 12 9 44 19.8 1.9
ROSS 7 14 11 19 20 71 18.8 1.8
BROWN 8 5 5 10 12 40 18.3 1.8
TRUMBULL 38 29 30 58 40 195 18.2 1.7
CLINTON 12 4 6 8 8 38 17.9 1.7
HARDIN** 4 2 10 6 6 28 17.6 1.7
ADAMS** 1 6 6 5 6 24 17.0 1.6
JEFFERSON 9 12 12 9 14 56 16.1 1.6
Ohio 904 1020 1261 1351 1438 5974 10.4
**Rates may be unstable due to small numbers; should be interpreted with caution
*Source: Ohio Vital Statistics; 2008 does not include out of state deaths of Ohio residents
Unintentional Fatal Overdose Cases Testing Positive for
Prescription Opioids, N=96, Montgomery County, 20071,2
Methadone 45
Hydrocodone 29
Oxycodone 24
Fentanyl 14
Morphine 12
Tramadol 11
Propoxyphene 8
Codeine 3
2Note: A case can test positive
Hydromorphone 2 for more than one opioid.
Pentazocine 1
1Source: OSAM: Surveillance of Drug Abuse Trends in Ohio, Jan 2008

36
Comparison of
Pain Medication
Use in Ohio
Two Regions
Source: The Columbus Dispatch,

02/07/2010 (from Ohio State Board of
Pharmacy, OARRS data)
Regional Comparisons of
Death rates and opioid
prescription rates, 20081,2,3,4,5
70
60 Northwest Region(4) 62.1

50 Southern Region(5)
Ohio
40
41.7
30 32.0 34.3
20 23.8
19.2
10 12.5 14.1
6.4
0
2008 Death Rate per Hydrocodone prescription Oxycodone prescription
100,000 population rate per 100 population rate per 100 population
Sources: 1ODH Office of Vital Statistics; 2US Census Bureau; 3Ohio State Board of Pharmacy, Ohio Automated Rx Reporting System
4includes Clinton, Brown, Highland, Adams, Ross, Pike, Scioto, Hocking, Vinton, Jackson, Gallia, Lawrence
5includes Williams, Defiance, Paulding, Van Wert, Mercer, Fulton, Henry, Putnam, Allen, Auglaize, Hancock, Hardin
Regional Comparisons: Ratio of
death rates and opioid prescription
rates, Southern to Northwest
Region, 20081,2,3,4,5
3.0 3.0
2.3 2.4
1.9
Death rate Hydrocodone Hydrocodone Oxycodone Oxycodone

prescription rate dose rate prescription rate dose rate
Sources: 1ODH Office of Vital Statistics; 2US Census Bureau; 3Ohio State Board of Pharmacy, Ohio Automated Rx Reporting System
4includes Clinton, Brown, Highland, Adams, Ross, Pike, Scioto, Hocking, Vinton, Jackson, Gallia, Lawrence
5includes Williams, Defiance, Paulding, Van Wert, Mercer, Fulton, Henry, Putnam, Allen, Auglaize, Hancock, Hardin
Why is Drug Problem Bad in Appalachia?
Poverty: Scioto County's unemployment rate hovers around 15
percent, and the drug trade can be lucrative.
Location:
à Rt. 23 provides a pipeline to and from Columbus.
à Border states of Kentucky and West Virginia have significant amounts of
prescription-drug abuse. Their proximity allows for doctor- and pharmacy-
shopping across state lines, which is harder to detect.
Disempowered Area: The area has a track record of limited

resources.
Exploitation and Drug Trafficking:
à The area has been flooded with opioids through unscrupulous
pharmaceutical companies and providers (e.g., pill mills). E.g., In Scioto
County alone, there are 8 or 9 such “pain management clinics”.
à Drug pipeline from South Florida trafficking drugs in southern Ohio.
Costs of the problem
41
Estimated average annual costs of
unintentional drug overdose in Ohio1
Non‐fatal, hospital
Type of Costs Fatal Costs2
admitted costs3
Medical $4.9 million $19.1 million
Work loss $1.2 billion $5.2 million

Quality‐of‐Life
$2.2 billion $7.6 million
loss
Total $3.5 Billion $31.9 Million
1Source: Children's Safety Network Economics & Data Analysis Resource Center, at Pacific Institute for Research and Evaluation,
2005; 2Year2004 Dollars, Based on 2004-2007 average Ohio incidence 3Year 2005 Dollars, Based on Year 2003 Ohio incidence
42
Costs of Opioid Abuse
Studies:
à National evaluation of insured populations
found opioid abusers had mean annual direct
health care costs 8X higher than non-abusers.
à Total costs for opioid abuse was $9.5 billion in
2005 $.
Costs expected to be significantly higher in 2009
due to increasing overdose rates.
à Source: ASTHO (Association of State and Territorial Health Officials).

Prescription Drug Overdose: State Health Agencies Respond, 2008
43
Contributing factors:
Pandora’s Box
44
Contributing Factors
Supply Demand
Substance
“Legal”
Misuse/Abuse
à Growth in Overall Rx Drug Use
à Diversion
à New Clinical Rx Pain Management
Guidelines in 1997 – compassionate à Doctor Shopping
chronic pain management
à General over prescribing
à Pressure to satisfy “customers” in HC
“Illegal”
à Widespread Diversion of Rx Drugs
through multiple channels:
Internet “pharmacies”
“Pill mills” and unscrupulous prescribers
45
Growth in Rx Expenditures
New and better medicines, including a range of
preventive drugs.
Insurers promoted use of Rx drugs to reduce more

expensive hospital stays.
Employers picked up a large share of drug costs.
Generation Rx- Self-medicating habits of aging baby

boomer population
Advertising by drug manufacturers drove demand,

especially for lifestyle drugs such as Viagra and Celebrex
Source: Drugstory.org (This article appeared in the Washington Post on October 20, 2003.
Copyright 2003, Washingtonpost.Newsweek Interactive and The Washington Post. All
Rights Reserved. www.washingtonpost.com.
46
Rx Culture
"Americans want their Lipitor. They want to be able to
take it on their way to McDonald's.“
à David B. Nash, MD, Director, Office of Health Policy and
Clinical Outcomes at Thomas Jefferson University in
Philadelphia. “
Washington Post on October 20, 2003.Copyright 2003, Washingtonpost.Newsweek

Interactive and The Washington Post. All Rights Reserved. www.washingtonpost.com.
47
Changing Marketing of Rx’s*
Shift in marketing from prescribers to patients
Direct-to-Consumer (DTC) advertising has
become the leading form of Rx marketing
used by pharmaceutical companies
Many new drugs advertised through DTC may
not be appropriate for a consumer’s specific
condition or illness and can lead to
inappropriate or excessive medication use.
48
*Source: Institute for Safe Medication Practices
Medication Marketing*
Results of a survey published in the
February 2007 issue of Consumer
Reports magazine show that:
à 78% of primary care physicians are asked
by their patients for specific drugs they
have seen advertised on television
à 67% concede that they sometimes grant
patients’ requests for medications that are
not clinically indicated.
49
Increase in Medication Use & Misuse*

Two out of every three patients who visit a doctor
leave with at least one prescription for medication
nearly 3.4 billion prescriptions dispensed in 2005
Increase of almost 60% since 1995.
Close to 40% receive prescriptions for four or

more medications.
Half of the prescriptions taken each year in the US
are used improperly
96% of patients nationwide fail to ask questions
about how to use their medications.
50
Opioid Prescribing
Trends from late
1990’s to present
51
Changes in Clinical Pain Management
Prescribing Practices in 1997*
Change occurred in 1997 as a result of pain
management advocates.
Pain relief laws were pushed down to states
à Ohio Revised Code 4731.052 Drug Treatment of
Intractable Pain
Resulted in availability of potent pain
medications in the community setting that
had been previously restricted to hospital use
for pain (e.g., end-stage cancer) patients.
*Intractable Pain Relief Act
52
Distribution of scheduled opioids1 in grams per 100,000
population by drug, Ohio, 1997 to 20072
2Source: DOJ, DEA, ARCOS reports
21000
18000
Grams per 100,000 population
15000 1997
2007
12000
9000
6000
3000
1In oral morphine equivalents using the following assumptions: (1) All drugs other than fentanyl are taken orally; fentanyl is applied
transdermally. 2) These doses are approximately equianalgesic: morphine: 30 mg; codeine 200 mg; oxycodone and hydrocodone:
30 mg; hydromorphone; 7.5 mg; methadone: 4 mg; fentanyl: 0.4 mg; meperideine: 300 mg. 53
2008 Ohio Pain Medication Prescriptions
2.7 million 4.8 million

prescriptions in 2008 prescriptions for
for Oxycodone hydrocodone
(ingredient in (e.g., Vicodin)
OxyContin and
One for every 2½
Percocet)
people in the state.
Nearly one for every
four people in the
state.
Ohio Board of Pharmacy, OARxRS
Figure 4. Unintentional fatal drug poisoning rates1 and distribution
rates of prescription opioids2,3 in grams per 100,000 population4 by
year, Ohio, 1997 -2007 (1999-2007 for opioids)
Sources: 1ODH Office of Vital Statistics, 2DOJ-DEA ARCOS
80,000 14
opioid analgesics distributed
70,000 12
Death rate per 100,000 population

Unintentional drug poisoning death
60,000
opioid analgesic grams distributed
rates 10
per 100,000 population
50,000
8
40,000
6
30,000
4
20,000
10,000 2
0 -
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
3Codeine, buprenorphine, oxycodone, hydromorphone, hydrocodone, meperidine, methadone, Morphine, fentanyl base (transdermal)
in opioid equivalents (morphine 30mg) 55
OSAM Rapid Response Report:
Prescription Analgesic Abuse, 2003
“A powerful paradox surrounds the great benefit from
the appropriate use of prescription analgesics to
relieve pain versus the potential for abuse. Medical
professionals are particularly frustrated by the
persistence and audacity used by some to obtain
these drugs. A deep concern is the potential for
powerful medications such as OxyContin® to result
in accidental overdose.”
An important issue for policy-makers nationwide is how to control

the diversion of prescription drugs while maintaining their
availability for legitimate use.
56
Use of OARxRS (as of February 2010)
Only 13% (about 5,500) of Ohio's

42,022 licensed doctors and dentists
have voluntarily registered for OARRS
- a database, which allows them to see
whether a particular patient has visited
multiple doctors or filled multiple
prescriptions.
Ohio Board of Pharmacy, OARxRS

What is Diversion?
The unlawful channeling of regulated
pharmaceuticals from medical sources to the
illicit marketplace.
Can occur along all points in the drug
delivery process
à Manufacturing site
à Wholesale distributor
à Physician/prescriber
à Dispensing institution
à Retail Pharmacy
à Hospitals
à Patient
58
Methods of Diversion
Theft from Manufacturers, Pharmacies,
Homes, Hospitals, Nursing homes, etc.
Internet Sales
Doctor's Office or Phone Service scam
Phony Prescription Call-In
Prescription Forgery / Alteration
Illicit Drug Prescribing (e.g., “Pill Mills”)
Deception of Prescribers
Doctor-Shopping
Emergency Room Hopping
Deception by Prescribers
Theft by healthcare professionals in hospitals, etc.
59
Diversion: A Lucrative Business
Pharmacy Price Street Value
$.09 to $.13 per mg $1 per mg
$7-8 per 80-mg tablet $80 per 80-mg tablet
$750 for 100 80-mg $6,000-8,000 for 100
tablets 80-mg tablets
OxyContin®
Source: DrugStory Factsheet: Abuse of Prescription Painkillers 60

Thefts of OxyContin®: Pharmacies
Increasingly the Target of Robbers,
10/25/08 The Columbus Dispatch
• There have been almost twice as many

pharmacy robberies this year in Columbus as
bank robberies, and police say OxyContin is the
main target.
• As of 10/24/08, there were a record 56 pharmacy

robberies in 2008 compared with 29 bank
robberies.
"It's just that the street value of OxyContin is so high;

it's just become a lucrative target," Columbus Police
Sgt. James Jardine said.
From: http://www.dispatch.com/live/content/local_news/stories/2008/10/25/Pharmacy.ART_ART_10-
25-08_B1_3LBMSJQ.html 61
Pill Mills
Term used primarily by investigators to describe a
doctor, clinic or pharmacy prescribing or dispensing
powerful drugs inappropriately or for non-medical reasons.
HOW DO THEY WORK?

• May be disguised as independent pain-management centers.
• Open and shut down quickly in order to evade law enforcement.
SIGNS:
• Accept cash only
• No physical exam is given
• No medical records or x-rays are needed
• Customer can pick their own medicine, no questions asked
• Customer directed to “their” pharmacy
• They treat pain with pills only
• Dispense set number of pills and give specific date to come back for more
• Have security guards
• There may be huge crowds of people waiting to see the doctor
Source: http://www.cbsnews.com/blogs/2007/05/31/primarysource/entry2872835.shtml 62
Pill Mills and Unscrupulous Prescribers
• In a Kentucky case, a Dr. set up a clinic that was a

major supplier of prescription pain medications
from1996 to 2002. After pleading guilty, the doctor
testified that he saw more than 80 patients daily and
made nearly $1 million per year.
• The profits enjoyed by these unscrupulous

physicians are at the expense of taxpayers.
• In Florida, 61 overdose deaths were connected
to 16 physicians each billing Medicaid for $1
million or more over 3 years.
Source: Drug Abuse in America: Prescription Drug Diversion. Trend Alert: Critical Information for State Decision-
makers. The Council of State Governments. April 2004 http://www.csg.org/pubs/Documents/TA0404DrugDiversion.pdf
63
Pill Mills and Unscrupulous Prescribers
There are 8 or 9 such illegitimate pain
management clinics (“pill mills”) in Scioto
County alone: a county of only 76,000
people.
Scioto County pumps out roughly 35 million
oxycodone and hydrocodone pills per year.
This figure represents equals 46 pills for
every Scioto County resident.
64
Access: Percentages of Reported Method** of Obtaining
Prescription Pain Relievers for Their Most Recent Nonmedical Use
in the Past Year among Persons Aged 18 to 25: 2005 NSDUH
More Than One
Doctor
Some Other 1% Other
Way Unknown
Stole from 3%
Friend/Relative 10%
4%
Bought from
Drug Free from
Dealer/Stranger Bought from a Friend/Relative
5% 53%
Friend/Relative
11%
from One
Doctor
13%
Substance Abuse and Mental Health Services Administration. (2006). Results from the 2005 National Survey on Drug Use and Health: National
Findings. (Office of Applied Studies, NSDUH Series H‐30, DHHS Publication No. SMA 06‐4194). Rockville, MD.
www.oas.samhsa.gov/nsduh/2k5nsduh/2k5Results.pdf
PMP Linking Study with the Ohio State Board of
Pharmacy (BOP), Ohio Automated Rx Reporting
System (OARRS): Methods
ODH identified Ohioans who died from
poisoning from January 2008 to
December 2008
BOP matched decedents by name, date of
birth, and/or address
à OARRS data included filled prescriptions from
1/1/2006 to 8/6/20091
à Analysis limited to prescriptions filled prior to
2009
1. A subset of decedents had a record of prescription drugs filled AFTER date of death
PRESCRIPTION HISTORY: UNINTENTIONAL DEATHS
(2008)3
Category Percent
Filled at least one OPIOID prescription 67%
Filled at least one BENZODIAZEPINE 49%

prescription
Filled at least one OPIOID and one 47%

BENZODIAZEPINE
Filled at least one OPIOID script per month1 42%

(average)
Filled at least two OPIOID scripts per month1 18%

(average)
Doctor Shoppers2 16%
1. Among decedents with at least one opioid prescription filled between 1/1/2006 and 12/31/2008
2. At least 5 unique OPIOID prescribers per year, on average
3. Source: ODH Office of Vital Statistics and Ohio State Board of Pharmacy, OARRS
Average rate of prescriptions among 2007 Ohioans and 2008
Unintentional Poisoning Decedents1,2,3
2007 Ohioans 2008 Unintentional Ratio of age
(n=11,477,641) Poisoning Decedents adjusted rate
(Scripts filled in 2007)2 (n=1488) of decedent
(Scripts filled in 2007) scripts/Ohio
scripts3
Number of Average Number of Age
Scripts Scripts per Scripts Adjusted3
Filled Person Filled Average
Scripts per
Person
Hydrocodone 4,617,154 0.40 4,497 2.00 5.0
Oxycodone 2,499,724 0.22 4,652 2.11 9.59
Tramadol 1,067,438 0.09 772 0.38 4.22
Carisoprodol 236,939 0.02 990 0.50 25.0
Methadone 167,389 0.02 572 0.31 15.5
1Prescriptions filled in Ohio 2 Source: 2007 Ohio State Board of Pharmacy OARRS Data
3Decedent age distribution adjusted to match age distribution of state of Ohio. 68
Proportion of opioid prescription fill history among
2008 unintentional poisoning decedents1 by number of
unique opioid types2 filled from 2006-08 and gender3,4
%
50 Of those with at least one opioid prescription filled, nearly 50%of females and
31%of males filled prescriptions for at least four different types of opioids
in the two years prior to their death.
Percent of Decedents
40 43
Males (n=576) Females (n=428)
30
27 28
20 24
21
19 19
10 13
3 4
0
1 2 3 4-6 7-9
Number of unique opioid prescriptions filled
1. Included decedents with at least one opioid script filled from 1/1/06-12/31/08
2. Opioid types included: Buprenorphine, butorphanol, codeine, fentanyl, hydrocodone, hydromorphone,
meperidine, methadone, morphine, oxycodone, oxymorphone, pentazocine, propoxyphene, tramadol
3. Prescriptions filled outside of Ohio not included 4Source: ODH Vital Stats and Board of Pharmacy OARRS69
Percent of 2008 unintentional poisoning deaths with
specific opioid prescription filled between 2006-081,2,3
%
69
70
58 Males (n=949) Females (n=539)
60
49
50
40
Percent
40
32 32 29
30
20
20 15 13 13 12 11
10 7 7 8
Opioid Type
1. At least one prescription from 1/1/06 to 12/31/08
2. Decedents may have filled prescriptions for multiple opioid types
3. Prescriptions filled outside of Ohio not included
4.Source: ODH Office of Vital Statistics and Ohio State Board of Pharmacy, OARRS
Diversion and Illicit drug use
Prescription Narcotic Diversion
Percent of 2008 unintentional poisoning decedents with
% prescription narcotics on death certificate
and no opioid prescription filled from
70
2006 to 2008 by age and gender1,2,3
61
60 55
50 Males (n=334) Females (n=174)
41
38
Percent
40
30 25
19 21 20
20 15 17
10 9
10
0
15-24 25-34 35-44 45-54 55-64 65+
Age Group
1. Analysis confined to decedents 15 years and older
3. Sources: ODH Office of Vital Statistics and Ohio State Board of Pharmacy, OARRS
Methadone Diversion
Percent of 2008 unintentional drug poisoning
decedents with methadone on death certificate and
no script filled for methadone since 2006
% by age and gender1,2
100
90
Percent of Decedents
80
72 70
60 63 62
50 50
40
20
0
0
15-34 35-44 45-54 55+
Age group
1. Analysis confined to decedents 15 years and older
Illicit Drug Use
Percent of 2008 Decedents with Opioid Script who
had Illicit Drug Use on Death Certificate1,2,3
70 63
60 Males Females
51
50
Percent
40
30 25 25 27
24 24
21
20 18 17
12 14 13 11 10
10 5 6
0
0
Opioid Type
1. Illicit drug use: Heroin, cocaine, or hallucinogen on death certificate
2. Decedent filled at least one prescription for opioid type. Decedent may have filled prescriptions for
more than one opioid type.
DOCTOR SHOPPING
Doctor Shopping
Percent of 2008 unintentional poisoning decedents
who doctor shopped between 2006-08 by age
% group and gender 1,2,3,4
40
35
31
30 29
25
Percent
20
20
16 15
15 13
11 10
10
6
5 2
0
15-24 25-34 35-44 45-54 55-64
Age Group
1. Average 5 prescribers per year from 1/1/06 to 12/31/08.
2. No doctor shoppers over age 65 for males or females
4. Included decedents with at least one script filled 1/1/06-12/31/08
5. Sources: ODH Office of Vital Statistics and Ohio State Board of Pharmacy, OARRS 76
Doctor Shopping by Region1,2,3
11% 7%
15%
Doctor shopping rate

among Ohio 12% 18%
unintentional drug 8%
poisoning decedents
(2008): 16%
16%
16%
18%
19%
21%
21%

2. Included decedents with at least one script filled 1/1/06-12/31/08
3. Sources: ODH Office of Vital Statistics and Ohio State Board of Pharmacy, OARRS 77
More Consequences…
78
Estimated numbers of new nonmedical users in past year by
type of drug, US, 1990-2003 1
3000
Pain relievers
2500
Tranquilizers
Numbers in 1000's
Cocaine
2000
Stimulants
1500 Heroin
1000
500
0
90 91 92 93 94 95 96 97 98 99 00 01 02 03
1National Survey on Drug Use and Health (NSDUH) 2002-2004

Number of admissions for substance abuse treatment for
prescription opioids, Ohio, 1993-20081
6000
no. of treatment admissions
4915
5000
More than 300% increase from 1998 to 2008
4000
3000
2000
1000
Year
1 Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set
(TEDS), Ohio. Data received through 3.12.10. 80
Prescription Drug Misuse and Abuse
Prescription drug abuse accounts for almost 30% of
the overall drug problem in the United States,
representing a close challenge to cocaine addiction.1
Many abusers become addicted after being
prescribed and using prescription medications for
legitimate medical purposes.1
Drug treatment admissions for prescription
painkillers increased more than 300 percent from
1995 to 2005 in US.2
Sources: 1DEA 2SAMHSA

81
Consequences Changing Rx
Pain
Management
Guidelines
(Increased use
of Rx Opioids)
Exposure
Rx Drug
Misuse/Abuse
Fatal Overdose
82
OSAM Rapid Response Report:
Prescription Analgesic Abuse, 2003
“A powerful paradox surrounds the great benefit from
the appropriate use of prescription analgesics to
relieve pain versus the potential for abuse. Medical
professionals are particularly frustrated by the
persistence and audacity used by some to obtain
these drugs. A deep concern is the potential for
powerful medications such as OxyContin® to result
in accidental overdose.”
An important issue for policy-makers nationwide is how to control

the diversion of prescription drugs while maintaining their
availability for legitimate use.
83
Risk Groups for Overdose:
What do we know?
84
Study of Rx drug overdose deaths in WV using ME,
PDMP and substance abuse treatment data1
Recent study suggests that fatal overdose problem is

mixed.
93% of Rx drug deaths involved opioids
à Of these, only 44% had prescriptions for these drugs
79% had used multiple substances (mean of 2)
contributing to their fatal overdose.
Other findings:
à 21% obtained drugs from “Dr. Shopping”
à 63% obtained drugs through “Diversion” (no prescription)
à Differences found by gender and age group
95% had indicators of substance abuse
1Source: Hall et al. Patterns of abuse among unintentional pharmaceutical
overdose fatalities. JAMA 2008; 85
Study of overdose deaths in WV using ME, PDMP and
substance abuse treatment data1
Among all deaths:

à Opioids were involved in 93%
à Psychotherapeutic drugs (benzodiazepines/anti-
depressants) were involved in 49%.
Of the 61 (21%) single-drug deaths, only 1 was due to a

psychotherapeutic drug (amitryptiline) - fatal overdose is
less likely with a single psychotherapeutic drug than with a
single opioid.
Methadone was responsible for more single-drug deaths

and was involved in far more deaths than any other drug.
1Source: Hall et al. Patterns of abuse among unintentional pharmaceutical

overdose fatalities. JAMA 2008 86
Risk Groups for Opioid Overdose*
1. Pain patients:
à Taking high doses of medication.
à Taking medications incorrectly.
2. Nonmedical pain medication users and those with a

history of substance abuse
à WV study: 95% had indicators of substance abuse
3. Persons who have already experienced a drug

overdose.
4. Persons taking multiple medications, especially
multiple CNS depressants, simultaneously
à WV study: 79% used multiple substances that contributed to OD
*Sanford K. Findings and Recommendations of the Task Force to

Prevent Deaths from Unintentional Drug Overdoses in North Carolina, 2003. 87
Risk Groups for Opioid Overdose1
5. Persons with chronic health problems such as:

à COPD, emphysema, respiratory illness, heart problems,
renal dysfunction or hepatic disease.
6. Using after a period of abstinence (e.g., after

SA treatment or recently released prisoner
population)
7. Patients newly starting methadone for pain
control and patients who have switched to
methadone after treatment with other strong
opioid pain relievers
1Sanford K. Findings and Recommendations of the Task Force to
Prevent Deaths from Unintentional Drug Overdoses in North Carolina, 2003.
88
Other Risk Factors
Low income
à Medicaid recipients are more likely to be prescribed narcotics
and to die from prescription drug overdoses1
à Lower educational attainment and increased poverty in
decedent's county of residence were both associated with
greater death rates in a dose-response fashion.2
Lack of substance abuse treatment
Gender
à Males- Most deaths3
à Females – Fastest growing group
Drug/medication poisoning death rates for females increased
133% from 1999 to 2005 in the U.S, versus 75% for males.4
Sources: 1ASTHO (Association of State and Territorial Health Officials) Report: Prescription Drug
Overdose: State Health Agencies Respond http://www.astho.org/pubs/RXReport_Web.pdf
2Hall et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 2008.
3Ohio Vital Statistics 4CDC WONDER
89
Summary and Response
90
What we know so far..
Regulated prescription drugs taken mostly by mouth can
produce a larger overdose epidemic than illicit drugs of
uncertain strength taken intravenously.
Ohio’s rates are greater than US; particularly in southern
OH
Increased access to opioid medications from late‘90’s on
White males at highest risk for opioid OD but white females
are the fastest growing group.
Males aged 45-54 have the highest death rates of all.
91
What we know so far..
Most deaths are associated with opioids/narcotics.
Most rapid increases associated with methadone.
Multiple substance use (polypharmacy) is a factor in
many of these deaths, complicating issue.
Polypharmacy is a risk factor for fatal overdose.
Single drug overdoses more likely to be opioids
(especially those with long half-life or extended release)
Diversion of RXs, Dr. shopping & substance abuse play
a large role.
We need additional information about the substances
responsible and how they are being used.
92
Strategies for ODH
Prioritize as an emerging public health threat
Form a Poison Action Group as part of the Ohio Injury Prevention

Partnership (OIPP) and recruit other stakeholders
Determine drugs of abuse/responsible for increasing death
rates/access issues
Examine statewide data and produce report, fact sheets, press
releases, news articles
Research existing local/regional/state programs/policies
Conduct statewide and regional forums in high risk areas to present

data and discuss solutions
Develop recommendations and strategies for a state plan
Raise awareness of this issue in the media/public
Conduct pilot prevention programs in high risk areas.

93
Drug Medication Partners Needed
Medical
Practice Law and
Toxicology Criminal
Justice
Law
Pharmacy
Enforcement
Task
Medical Force Public
Examiners Health
Substance
Mental
Abuse
Health
Services
Injury Epidemiologic
Prevention Surveillance
94
Partners on the Poison Action Group/New Emerging
Drug Trends Workgroup (PAG/NEDTW)*
Community organizations ODMH

Poison Control Centers Mental health and substance
Pharmacists/Pharmacy Board abuse professionals
Coroners/Medical Examiners ADAMH Boards
Toxicologists Emergency Nurses
Association
Researchers/Academics
Hospital Association
Law enforcement Osteopathic Association
Local Health Departments Medical Associations and
Hospitals/Trauma Centers physicians groups
EMS Pharmacists Associations
ODADAS Pain and palliative care
specialists/advocates
ODPS
Others…
*partial list of members 95

Next Steps: Collaboration with ODADAS
Continue the work of the Poison Action Group/New and

Emerging Drug Trends Workgroup to implement the
new recommendations to be released April 2010.
The recommendations They will include:
are structured around: • Prevention
• Consumers • Policy/Legislation
• Policy Makers • Communication/Public
Education
• Prescribers
• Access to Treatment
• Data/Surveillance
96
Epidemic of Prescription Drug Overdoses:
A Call to Action Symposium Goals
Raise awareness and provide data on the growing

epidemic of deaths in Ohio from prescription drug
overdoses.
Identify factors contributing to this epidemic.
Highlight programs and promising practices from other

states that address this epidemic.
Present strategies for local and state policy and program
initiatives.
Discuss next steps for state and local action to address
the issue.
97
Next Steps: Build Capacity
through Pilot Projects
à The IPP solicited applications from high risk counties

for pilot projects to address this issue based on the
public health model.
à Projects in Montgomery and Scioto Counties will be
funded for 4 years (2010-2013).
à They will be required to address:
Coalition Building
Surveillance and Needs Assessment
Policy Change
Environmental and Systems Change
Training and Education
Media Advocacy and Social Marketing 98
Next Steps: Build Awareness and
Capacity in High‐Risk Areas
à The IPP is working with a firm to implement a comprehensive

social marketing and coalition building program in high risk areas
of Ohio.
Ross
Adams
Vinton
Jackson
Cuyahoga
à PSA and Educational Material Development and Distribution

à Coalition Building in at-risk Communities
à Grassroots Campaign
à Employer Outreach
à Drop-Off Events
à Peer-to-Peer High School Outreach
99
Next Steps: Improved Data Collection
Continue to work with Ohio’s PDMP (Ohio

Automated Rx Reporting System) to link death
certificate data.
Explore feasibility of Poison Death Review in
counties with high death rates to gain a better
understanding of OD deaths.
Encourage Ohio coroners to report more details
about the drugs involved in the deaths on the DC.
100
Other State Strategies
101
State Health Agency Responses
See the early steps that nine states took in a
CDC/NCIPC – ASTHO joint report:
à Prescription Drug Overdose: State Health Agencies
Respond
Available at
http://www.astho.org/?template=innovative_programs.html
102
National Meetings and Presentations:
Legal Approaches
Promising Legal Responses to Epidemic of

Prescription Drug Overdoses in US
December 2-3, 2008, Atlanta, Georgia
Sponsored by the CDC's NCIPC and the Public Health
Law Program of the CDC
http://www.stipda.org/displaycommon.cfm?an=1&subarticlenbr=203
103
National Meetings and Presentations:
Other “Non-legal” Responses
State Strategies for Preventing Prescription Drug

Overdoses
January 13-14, 2008, Atlanta, Georgia
Sponsored by the CDC's NCIPC
http://www.stipda.org/displaycommon.cfm?an=1&subarticlenbr=204
104
Prescription Drug Overdose: State Health
Agencies Respond: State Strategies
Prescription Drug Monitoring Programs (PDMPs)- Ohio Automatic Rx
Reporting System (OARRS) – Ohio Board of Pharmacy
PDMP Data Sharing
Single copy, Non-serialized paper prescription forms
E-prescribing
Doctor Shopping Statutes
Return of Unused Pharmaceuticals
Pain Clinic Laws
Drug Courts
Patient Review & Coordination (PRC) or “Lock-in” Medicaid Programs
Clinical Guidelines for Chronic and/or Acute Pain Management
ED Programs to Reduce Frequent Visitors
Naloxone Distribution and Harm Reduction
Education and Social Marketing Campaigns 105
Ohio Drug Poisoning Website
.
http://www.healthyohioprogram.org/diseaseprevention/dpoison/poison.aspx
Data and Resources PAG Information

Factsheet Member Agencies
Powerpoint Strategies
presentation
Presentations and Or…
recording of July 29th http://www.odh.ohio.gov/
symposium
Go to “I”. Select “Injury
Resource List Prevention”
Select “Drug Poisoning” on
the left menu bar
106
Ohio Department of Health –
Violence and Injury Prevention Program
Judi Moseley
Poison Action Group Coordinator
Judi.moseley@odh.ohio.gov
614-728-8016
Christy Beeghly, MPH

Program Administrator
Christy.Beeghly@odh.ohio.gov
614-728-4116
107

Two Days in May 2010 - 33 - Epidemic of Prescription Drug Overdose Victims

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Two Days in May 2010 - 33 - Epidemic of Prescription Drug Overdose Victims

Uploaded by

Copyright:

Available Formats

Ohio Department of Health

Violence and Injury Prevention Program

ODH Drug Poisoning Website

unt fall 110%

unt poisoning 319%

Unintentional = “Accidental” vs.

For first time, in 2007 unintentional drug poisoning exceeds MV traffic

Rate per 100,000

20,000 5.7 deaths 6

Rate per 100,000

*Source: CDC WONDER 11

1Source: ODH Office of Vital Statistics; 2Source: CDC WONDER:

 6,921 deaths due to

Sources: 1http://www.cnn.com/SPECIALS/2003/iraq/forces/casualties/, accessed 3/8/10;

July ’08 - 50-80 ED visits

*Source: EpiCenter (Ohio ED chief complaint on

NOT WHO YOU MIGHT EXPECT

Death rate per 100,000 population

*Source: ODH Office of Vital Statistics 20

*not necessarily in order of number of deaths Source: SAMHSA

 Other Synthetic Narcotics

 Other and Unspecified Narcotics

Includes fentanyl, propoxyphene, meperidine

Includes oxycodone, hydrocodone,

Identified prescription narcotic but

opioids (includes heroin) 47%

benzodiazepines 785 Prescription opioids include other opioids,

opioids (includes heroin) 3,859

prescription opioids 3,005

other unspecified only* 2,409

other unspec multiple substances 6,005

*includes only cases where no other

Prescription opioids include other opioids, heroin

*includes only cases where no other drug/medicament than

6 black males rate

males 183% White females represent the

1heroin,other opioids, methadone, other synthetic

Number of Annual Deaths Total # deaths Avg annual rate Ratio County:

MONTGOMERY 127 116 125 130 145 643 23.8 2.3

1Source: OSAM: Surveillance of Drug Abuse Trends in Ohio, Jan 2008

Source: The Columbus Dispatch,

60 Northwest Region(4) 62.1

Death rate Hydrocodone Hydrocodone Oxycodone Oxycodone

 Disempowered Area: The area has a track record of limited

Medical $4.9 million $19.1 million

Work loss $1.2 billion $5.2 million

à Source: ASTHO (Association of State and Territorial Health Officials).

 Insurers promoted use of Rx drugs to reduce more

 Employers picked up a large share of drug costs.

 Generation Rx- Self-medicating habits of aging baby

 Advertising by drug manufacturers drove demand,

Washington Post on October 20, 2003.Copyright 2003, Washingtonpost.Newsweek

Increase in Medication Use & Misuse*

 Increase of almost 60% since 1995.

 Close to 40% receive prescriptions for four or

 2.7 million  4.8 million

Death rate per 100,000 population

An important issue for policy-makers nationwide is how to control

 Only 13% (about 5,500) of Ohio's

Ohio Board of Pharmacy, OARxRS

Source: DrugStory Factsheet: Abuse of Prescription Painkillers 60

• There have been almost twice as many

• As of 10/24/08, there were a record 56 pharmacy

"It's just that the street value of OxyContin is so high;

6,921 deaths due to

Other Synthetic Narcotics

Other and Unspecified Narcotics

Disempowered Area: The area has a track record of limited

Insurers promoted use of Rx drugs to reduce more

Employers picked up a large share of drug costs.

Generation Rx- Self-medicating habits of aging baby

Advertising by drug manufacturers drove demand,

Increase of almost 60% since 1995.

Close to 40% receive prescriptions for four or

2.7 million 4.8 million

Only 13% (about 5,500) of Ohio's

Recent study suggests that fatal overdose problem is

Among all deaths:

Of the 61 (21%) single-drug deaths, only 1 was due to a

Methadone was responsible for more single-drug deaths

Form a Poison Action Group as part of the Ohio Injury Prevention

Conduct statewide and regional forums in high risk areas to present

Raise awareness of this issue in the media/public

Conduct pilot prevention programs in high risk areas.

Community organizations ODMH

Raise awareness and provide data on the growing

Highlight programs and promising practices from other

Continue to work with Ohio’s PDMP (Ohio

Promising Legal Responses to Epidemic of

State Strategies for Preventing Prescription Drug