Strategies to Reduce the Demand for Prescription Drugs -prevent... · Strategies to Reduce the Demand for Prescription Drugs April 13, 2017 Findings from the Research Literature Josh

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CAPT Webinar

Strategies to Reduce the Demand for Prescription Drugs

April 13, 2017

Findings from the Research Literature

Josh Esrick, Policy Analyst, SAMHSA’s CAPT

Shai Fuxman, Senior Training and Technical Assistance Associate, SAMHSA’s CAPT

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Facilitator

Molly LoweAssociate Director of Training and Technical Assistance

SAMHSA's CAPT

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This training was developed under the Substance Abuse and Mental Health Services Administration’s Center for the

Application of Prevention Technologies task order. Reference #HHSS283201200024I/HHSS28342002T.

The views expressed in this webinar do not necessarily represent the views, policies, and positions of the Substance Abuse and Mental Health Services Administration or the U.S.

Department of Health and Human Services.

This webinar is being recorded and archived, and will be available to all webinar participants. Please contact the

webinar facilitator if you have any concerns or questions.

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Preventing Prescription Drug Misuse: Strategies from the Research Literature

Strategies to Reduce Demand (Today!)

Strategies to Reduce Demand (Today!)

Strategies to Reduce Supply (April 27)

Strategies to Reduce Supply (April 27)

Strategies to Reduce Harm (May 30)

Strategies to Reduce Harm (May 30)

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Strategies to Prevent Non-medical Use of Prescription Drugs (NMUPD)

Strategies to Prevent Supply

Strategies to Prevent

Harm

Strategies to Prevent Demand

• Patient Education• Prescriber Education• Social Marketing

Campaigns• Information

DisseminationCampaigns

• Prescriber Education• Tracking and Monitoring• Retail Access

Restrictions• Enforcement Strategies• Proper Medication

Storage and Disposal

• NaloxoneEducation andDistribution

• OverdoseEducation

• PrescriberEducation

• Multicomponentstrategies

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Evidence-based Continuum1

Promising/Emerging/

Undetermined

Promising/Emerging/

Undetermined

Supported/Well-supported

Supported/Well-supported

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Objectives

• Identify the factors a community must consider prior toselecting and implementing a strategy to reduceprescription drug misuse and overdose

• Define the core components of strategies that seek toreduce the demand for prescription drugs fornonmedical use

• Describe some of the potential advantages anddisadvantages of strategies to reduce the demand forprescription drugs

• Identify CAPT resources that summarize strategies toreduce prescription drug misuse and overdose

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Presenters

Josh EsrickPolicy Analyst

SAMHSA’s CAPT

Shai FuxmanSenior T/TA Associate

SAMHSA’s CAPT

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Opioid Use and Misuse

A Strategic Approach to Selecting Strategies Guiding Questions for Prevention Practitioners

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Prior to Selecting Strategies

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Questions to Consider at SPF Step 1: Assessment

• What are the NMUPDproblems in the community?

• What is the existing politicallandscape surroundingNMUPD prevention legislation?

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Questions to Consider at SPF Step 2: Capacity

• What is the capacity of thecommunity (includingresources and readiness) toaddress these problems?

• Which communitystakeholders need to be onboard to address thecommunity’s NMUPDproblems?

• What are the best ways toengage these stakeholders?

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Questions to Consider at SPF Step 3: Planning

• What risk and protective factorsare associated with NMUPD in thecommunity?

• Does the community have thecapacity to address these factors?

• Does the community have thepartners needed to successfullyimplement selected strategies?

• Does the community have accessto the training and technicalassistance required to implementselected strategies?

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Where is your state, tribe,

jurisdiction, or community in

the SPF planning process?

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Risk and Protective Factors for NMUPD and Prescription Opioid Overdose

Having a prescription for a high-dosage opioid5

Societal

Community

Relationship

Individual

Parent’s favorable attitudes towards substance use4

Overprescribing of opioid prescription drugs3

Societally influenced perception of risks2

Experienced a non-fatal overdose6

HARM

SUPPLY

DEMAND

HARM

SUPPLY

DEMAND

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Desired Outcomes Associated with Preventing NMUPD and Opioid Overdose

HarmHarmDemandDemandSupplySupply

Decreasing availabilityDecreasing availability

Preventing dependency and

misuse

Preventing dependency and

misuse

Reducing nonfatal and fatal overdoseReducing nonfatal and fatal overdose

• Prescription drugdiversion

• Multipleprescriberepisodes (“doctorshopping”)

• Inappropriateprescribing (“pillmills”)

• Prescription drugdiversion

• Multipleprescriberepisodes (“doctorshopping”)

• Inappropriateprescribing (“pillmills”)

• Lack ofknowledge aboutpotential dangersof prescriptionopioid misuse

• Mental healthdisorders

• Chronic pain

• Lack ofknowledge aboutpotential dangersof prescriptionopioid misuse

• Mental healthdisorders

• Chronic pain

• Loss of tolerance• Polysubstance

use

• Loss of tolerance• Polysubstance

use

OutcomesOutcomes

Example Risk

Factors

Example Risk

Factors

Strategy Strategy Strategy Strategy Strategy Strategy

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Target Populations for Strategies

Universal

Selective

Indicated

• General population

• All prescribers

• Individuals with Post-traumaticStress Disorder (PTSD)

• Individuals with depression

• Prescribers with a history ofoverprescribing

• Individuals who are misusingprescription drugs

• Individuals who have had anonfatal overdose

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Opioid Use and Misuse

Strategies to Reduce the Demand for Prescription DrugsFindings From the Research Literature

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Defining Demand Strategies

Efforts aimed at reducing the public’s desire for prescription drugs

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Categorization of Demand Reduction Strategies

Patient Education

Patient Education

Social Marketing

Campaigns

Social Marketing

Campaigns

Information Dissemination

Campaigns


Campaigns

Prescriber EducationPrescriber Education

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How familiar are you with these strategies?

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A Note About Evidence

• There is less evidence for NMUPDprevention strategies (compared tostrategies for preventing othersubstances)

• A lack of evidence does not meanthat a strategy is ineffective

• Practitioners should rely onexperience working with othersubstances

• It is important for practitioners tocollect evaluation data to build theevidence around strategies

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Patient Education7,8,9,10

Patient education strategies involve providing patients with information on the:

• Overdose potential ofprescription drugs and theireffects

• Importance of safeguardingprescriptions

• Risks and benefits of aparticular drug

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Target Populations and Common Partners

• Target Populations:Patients who may beprescribed a potentiallyaddictive drug

• Common Partners:Primary care centers,hospital emergencyrooms, pharmacies,trauma centers, andother community settings

Patient Education

Patient Education

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Typical Elements11,12,13,14

• Some patient education strategies train doctorsor nurses on how to discuss with patients therisks of prescription drugs

• Other patient education strategies providepatients who are prescribed opioids with writtenguidance on preventing misuse and overdose

Patient Education

Patient Education

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Potential Advantages and Challenges

+ -• Relatively affordable

• Low complexity (assuringgreater likelihood of fidelityand consistentimplementation)

• Has potential to reduce riskin individual patients ANDthose around them

• Likely to have a smalleffect size

• May require changes tohealthcare system inorder to be effective

• Most effective whendelivered by someonewith a prior relationship(for example, a physiciantalking to a patient)

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Prescriber Education15,16,17

Prescriber education involves teaching prescribers about the benefits and risks of prescribing opioids, including:

• Best prescribing practices andguidelines

• How and when to implementtracking and monitoringstrategies

• Alternate pain managementstrategies

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Venues

• Events sponsored bydrug manufacturers

• Continuing medicaleducation programs

• State-mandated trainingevents

• Coalition-led education events

• One-on-one interactions with prescribers

• Healthcare partner-driven programs (e.g.,hospitals)


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Delivery Methods18

• Interactive education

• Audit and feedback

• Reminders

• Academic detailing (andother outreach programs)

• Clinical practiceguidelines


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+ -• Potential to educate both

prescribers and theirpatients

• Potentially cost-effective

• Target population canbe busy and difficult toreach

• Often requirescollaboration with otherprescribers to besuccessful

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Participant Questions

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Information Dissemination Campaigns19,20

Information dissemination campaigns use mass media (TV, Internet, radio, newspaper, and billboard) to:

• Raise public awarenessof appropriateprescription drug use

• Promote safe use ofprescription drugs

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Target Populations and Delivery Methods

• Populations: Generalpublic, youth

• Delivery Methods: Vary byplatform (TV, Internet,radio, print, billboard,classroom) and contenttype (advertisement, shortfilm, lecture, interactivecourse)


Campaigns


Campaigns

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Typical Elements19

• Guided by three objectives:

o Warn

o Empower

o Support


Campaigns


Campaigns • Based on one of two theoretical

models:

o Health Belief Model

o Theory of ReasonedAction/Theory of PlannedBehavior

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+ -• Easy to replicate

• Can reach large numbers

• Can raise awareness

• Familiar strategy forprevention practitioners

• Messages are nottailored to specificsegments

• Difficult to measureeffectiveness

• Can be expensive

• Requires longer,extended campaigns tomaintain positive effects

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Social Marketing Campaigns21,22,23

Social marketing campaigns use techniques adapted from commercial marketing to encourage favorable and voluntary behavior change.Messages seek to:

• Influence community attitudes, norms, andbehaviors regarding NMUPD

• Minimize the perceived negative consequencestypically associated with behavior change

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Description (cont.)24

Some campaigns seek to address risk and protective factors directly.

Others seek to improve responses to overdoses, like those that provide information on Good Samaritan Laws (which protect individuals who report an overdose).2

Social Marketing

Campaigns

Social Marketing

Campaigns

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Best Practices21

Prevention practitioners who implement social marketing campaigns should:

Social Marketing

Campaigns

Social Marketing

Campaigns

• Identify a target population, conduct audienceresearch, and design messages based on thisresearch

• Test the target population’s response to themessage (for example, by using a focus group)

• Deliver the message frequently, using multiplecommunication channels

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+ -• Can be broad and reach

large numbers or cantarget specificpopulations

• Familiar strategy forprevention practitioners

• Requires intensivedevelopment

• Possible to have negativeeffects

• Can be expensive

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Participant Questions

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Additional Strategies of Note

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Abuse-Deterrent Drug Formulations26

Designed to inhibit the abusive properties of prescription drugs.1 Alterations can be:

• Physical (for example, changing thecomposition of the drug to prevent crushing)

• Pharmacological (for example, adding an activeingredient to prevent the “high” associated withmisuse)

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Direct-to-Consumer Advertising Restrictions27

Regulations placed on pharmaceutical companies that use advertising to:

• Market their products

• Educate the general public about the benefitsand risks of prescription drugs

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Where to Find Out MoreAdditional Resources on Strategies to Reduce Prescription Drug Misuse and Overdose

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Revised NMUPD Decision-Support Tools

• Overview of Factorsand Strategies

• Understanding Who isat Risk

• Programs andStrategies

Available atsamhsa.gov/capt/

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Online Portal of Environmental Strategies

Available to CSAP prevention Grantees at captconnect.edc.org/

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Addressing Opioid Overdose: Understanding Risk Factors and Prevention Strategies

Available to webinar participants at the conclusion of today’s event (and at captconnect.edc.org/)

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Prevention Resources from the CDC

Available at cdc.gov/

drugoverdose/

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Final Thoughts and Questions?

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Contact Information

If you have questions or comments about this webinar, please don’t hesitate to contact:

Amanda DoughertyTraining and Technical Assistance Associate

[email protected]

312-962-4558

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Evaluation

Please take the time to complete a brief feedback form: https://www.surveymonkey.com/r/feedback-

CAPT-1781

Thank you for sharing your thoughts!

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References1. Puddy, R. W. & Wilkins, N. (2011). Understanding Evidence Part 1: Best Available Research Evidence. A Guide to the

Continuum of Evidence of Effectiveness. Atlanta, GA: Centers for Disease Control and Prevention.

2. Schroeder, R. D., & Ford, J. A. (2012). Prescription drug misuse: A test of three competing criminological theories. Journal of Drug Issues, 42(1), 4–27. Retrieved from http://doi.org/10.1177/0022042612436654

3. Garg, R. K., Fulton-Kehoe, D., Turner, J. A., Bauer, A. M., Wickizer, T., Sullivan, M. D., & Franklin, G. M. (2013). Changes inopioid prescribing for Washington workers’ compensation claimants after implementation of an opioid dosing guideline for chronic noncancer pain: 2004 to 2010. The Journal of Pain, 14 (12), 1620-1628.

4. Ford, J. A., & Rigg, K. K. (2015). Racial/Ethnic differences in factors that place adolescents at risk for prescription opioid misuse. Prevention Science: The Official Journal of the Society for Prevention Research, 16(5), 633–641.

5. Koyyalagunta, D., Bruera, E., Aigner, C., Nusrat, H., Driver, L., & Novy, D. (2013). Risk stratification of opioid misuse among patients with cancer pain using the SOAPP-SF. Pain Medicine, 14(5), 667–675.

6. Sullivan, M. D., Edlund, M. J., Fan, M.-Y., Devries, A., Brennan Braden, J., & Martin, B. C. (2010). Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and Medicaid insurance plans: The TROUP Study. Pain, 150(2), 332–339.

7. American College of Preventive Medicine. (2011). Use, abuse, misuse & disposal of prescription pain medication clinical reference. Retrieved from http://www.acpm.org/?UseAbuseRxClinRef

8. Health Team Works. (2011). SBIRT guideline supplement: Prescription drug abuse prevention. Retrieved from http://improvinghealthcolorado.org/wp-content/uploads/2014/09/HealthTeamWorks-SBIRT-Rx-Drug.pdf

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References9. Pennsylvania Medical Society. (2014). Pennsylvania guidelines on the use of opioids to treat chronic noncancer pain.

Retrieved from https://www.pamedsoc.org/PAMED_Downloads/PA%20Guidelines,%20on%20the%20Dispensing%20of%20Opioids.pdf

10. Haegerich, T. M., Paulozzi, L. J., Manns, B. J., & Jones, C. M. (2014). What we know, and don’t know, about the impact ofstate policy and systems-level interventions on prescription drug overdose. Drug and Alcohol Dependence, 145, 34–47.

11.Hero, J. O., McMurtry, C., Benson, J., & Blendon, R. (2016). Discussing opioid risks with patients to reduce misuse and abuse: Evidence from 2 surveys. Annals Of Family Medicine, 14(6), 575-577.

12.Costello, Margaret. (2016). Patient opioid education: Research shows nurses' knowledge of opioids makes a difference.MEDSURG Nursing. 25, no. 5: 307-333.

13.McCarthy, D. M., Wolf, M. S., McConnell, R., Sears, J., Chevrier, A., Ahlstrom, E., & ... Courtney, D. M. (2015). Improving patient knowledge and safe use of opioids: a randomized controlled trial. Academic Emergency Medicine: Official Journal Of The Society For Academic Emergency Medicine, 22(3), 331-339.

14.Johnson, E. M., Porucznik, C. A., Anderson, J. W., & Rolfs, R. T. (2011). State-level strategies for reducing prescription drug overdose deaths: Utah's prescription safety program. Pain Medicine, 12 Suppl 2S66-S72.

15. Franklin, G. M., Mai, J., Turner, J., Sullivan, M., Wickizer, T., & Fulton-Kehoe, D. (2012). Bending the prescription opioid dosing and mortality curves: Impact of the Washington State opioid dosing guideline. American Journal of Industrial Medicine, 55(4), 325-331.

16.Cochella, S., & Bateman, K. (2012). Provider detailing: an intervention to decrease prescription opioid deaths in Utah. PainMedicine, 12(Suppl 2) S73–S76.

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References17.Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR

Recomm Rep 2016;65(No. RR-1):1–49.

18.Bloom, B. S. (2005). Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. International Journal Of Technology Assessment In Health Care, 21(3), 380-385

19.Ferri, M., Allara, E., Bo, A., Gasparrini, A., & Faggiano, F. (2013). Media campaigns for the prevention of illicit drug use inyoung people. 6The Cochrane Database of Systematic Reviews, Article No. CD009287. Retrieved from http://researchonline.lshtm.ac.uk/967502/1/ferri_Cochrane2013.pdf

20.Fang, L., Schinke, S. P., & Cole, K. C. (2010). Preventing substance use among early Asian-American adolescent girls: Initial evaluation of a web-based, mother-daughter program. Journal of Adolescent Health, 47(5), 529–532. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964276/pdf/nihms191591.pdf

21.Grier, S., & Bryant, C. A. (2005). Social marketing in public health. Annual Review of Public Health, 26(1), 319-339.

22.Media Campaign. (2009). Effectiveness of a mass media campaign for parents on teen prescription drug use. Drug Prevention and Social Marketing Brief, 4, 1–3. Retrieved from http://www.keeprxsafe.com/documents/Rx%20campaign.pdf

23.Johnson, E. M., Porucznik, C. A., Anderson, J. W., & Rolfs, R. T. (2011). State-level strategies for reducing prescription drug overdose deaths: Utah’s prescription safety program. Pain Medicine, 12(Suppl 2), S66–S72.

24.Davis, C. (2016). Legal interventions to reduce overdose mortality: Naloxone access and overdose Good Samaritan laws. Robert Wood Johnson Foundation. Retrieved from https://www.networkforphl.org/_asset/qz5pvn/naloxone_FINAL.pdf

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References25.Use only as directed. (2014). Retrieved from http://useonlyasdirected.org/

26. U.S. Food and Drug Administration. (2013). Abuse-deterrent opioids—evaluation and labeling: Guidance for industry. Retrieved from https://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm334743.pdf

27.Ventola, C. L. (2011). Direct-to-consumer pharmaceutical advertising: Therapeutic or toxic? Pharmacy and Therapeutics, 36(10), 669–674, 681–684. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278148/

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