ITAC 12/13/2016

Narcotic Abuse & Drug Disposal

National Survey on Drug Use and Health (NSDUH) IT ITAC 2014 Narcotic Abuse TAKES Substance Abuse and Mental Health Services Administration (SAMSA) A › Survey published by SAMSA on the use of illegal drugs, alcohol Drug Disposal COMMUNITY Drug and Alcohol and tobacco by the civilian, noninstitutionalized population of PREVENTION the US aged 12 and over. COALITION › 27 million people aged 12 and older used an illicit drug in the past 30 days (10.2%) – Aged 12 to 17 2.3 million (9.4%) – Aged 18 to 25 7.7 million (22.0%) – Aged ≥ 26 17 million (8.3%) Karl Fiebelkorn, MBA, RPh Senior Associate Dean Clinical Associate Professor of Pharmacy Practice & Administration University at Buffalo School of Pharmacy & Pharmaceutical Sciences

National Survey on Drug Use and Health (NSDUH) Deaths from Prescription 2014 CDC Statistics Substance Abuse and Mental Health Services Administration (SAMSA) › 1999 ‐ 2014 › 27 million people aged 12 and older used an illicit drug in the – 165,000 deaths past 30 days. – Aged 25‐54 most common – 4.3 million Americans reported current non‐medical use of – Overdose rates highest prescription pain relievers › Non‐Hispanic whites › Deaths Men > women – Approximately 1.9 million Americans met criteria for prescription pain reliever use disorder based on their use of prescription pain relievers › 2014 in the past year. – 14,000 deaths › 1.4 million people used prescription painkillers non‐medically › Most common drugs in prescription overdose for the first time in the past year. – – – The average age for prescription painkiller first‐time use was 21.2 in – the past year. http://www.cdc.gov/drugoverdose/data/overdose.html Accessed October 27, 2016

NYS Drug Overdoses NYS Crisis: Statistics › 1.4 million New Yorkers suffer from a substance abuse › Nearly 80% of recent uses started with opioid disorder › Upstate NY had a 222% increase in admissions to OASAS certified treatment programs among 18‐24 year old for heroin and other opioids › 2014 – 2,028 New Yorkers died of a drug overdose › 30% in New York City Jones, CM (2013). Heroin Use and Heroin Use Risk Behaviors among Nonmedical Users of Prescription Opioid Pain Relievers: United States, 2002 -2004 and 2008- 2010. Retrieved September 27, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/23410617

NYS Heroin and Opioid Task Fore Report June 9, 2016

Karl D. Fiebelkorn, MBA, RPh 1 ITAC 12/13/2016

Narcotic Abuse & Drug Disposal

Narcotic Abuse Deaths in Erie County Due to Overdose of Opioids › NYS Combatting the Heroin and Opioid Crisis › 2014 127 – Heroin and Opioid Task Force Report › 2015 256 › June 9, 2016 › 2016 320‐350* › 31 page report by governor’s task force – *estimate by Erie County Department of Health › https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/HeroinTas kForceReport_3.pdf › Typical overdose victim › Heroin overdose is now the leading cause of accidental death – 38 y.o. white male in NYS › is behind sharp rise in overdose deaths

http://www.wgrz.com/news/projected‐opiate‐overdose‐deaths‐down/362428788 http://buffalonews.com/2016/09/01/fentanyl‐behind‐sharp‐rise‐overdose‐deaths/

New York State Office of Alcoholism and Substance Abuse Services (2016)

Fentanyl et al (CHINA WHITE) Analogs include: Acetylalphamethyl‐fentanyl Acetyl fentanyl Alphamethylfentanyl Alphamethylthiofentanyl Betahydroxy‐fentanyl Beta‐hydroxy‐3methylfentanyl Fentanyl 3‐methylfentanyl 3‐methylthio‐fentanyl Parafluoro‐fentanyl Thiofentanyl http://www.wsj.com/articles/this‐is‐u‐47700‐once‐a‐lab‐experiment‐now‐a‐killer‐opioid‐ 1478269461: accessed 11/4/2016 http://www.cdc.gov/vitalsigns/heroin/index.html, accessed 10/30/2016 http://www.emcdda.europa.eu/publications/drug‐profiles/fentanyl: accessed 11/10/2016

This is U‐47700, Once a Lab Experiment (1973 Upjohn) , Now a Killer Opioid

“It’s hard to keep track of what’s killing people,” says Karl Williams, chief medical examiner in Allegheny County, which includes Pittsburgh. OPIOID OVERDOSE PREVENTION TRAINING ERIE COUNTY http://www.wsj.com/articles/this‐is‐u‐47700‐once‐a‐lab‐experiment‐now‐a‐killer‐opioid‐ DEPARTMENT OF HEALTH 1478269461: accessed 11/4/2016

Karl D. Fiebelkorn, MBA, RPh 2 ITAC 12/13/2016

Narcotic Abuse & Drug Disposal

Recalled: Mucosal Atomization Device (MAD) Availability of in NYS

› The affected MAD300 lot numbers are: 160108, 160117, 160126, 160145, › Listing of pharmacies by county who are listed on the 160146, 160200, 160219, 160225, 160231, 160300, 160313, 160327, 160400, 160409, 160422, 160432, 160440, 160500, 160518, 160602, 160611, 160621, NYS Naloxone Standing Order 160631, 160701, 160708, 160718, 160728, 160800, 160804, 160814, 160816, 160823. › http://www.health.ny.gov/diseases/aids/general/opioid_over dose_prevention/docs/pharmacy_directory.pdf

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DEA Drug Take Back Programs Prescription Drop Boxes /Locations Twice a Year / 35 sites in WNY https://www.health.ny.gov/professionals/narcotic/medication_drop_boxes/ › April 30, 2016 › October 22, 2016 › 32 sites › 35 sites › 13,348 pounds › 4,842 pounds › 4,666 car › 1,537 cars › 55 degrees/mild/sun › 37 degrees/windy/rain

List of Drop Boxes in Erie County List of Drop Boxes in Erie County https://www.health.ny.gov/professionals/narcotic/medication_drop_boxes/erie.htm https://www.health.ny.gov/professionals/narcotic/medication_drop_boxes/erie.htm

› Kenmore Police Department › Erie Community College South Public › Erie County Sheriff Substation › Erie County Sheriff's Substation Elma 2395 Elmwood Avenue Safety Springville 1600 Bowman Road Kenmore, NY 14217 4041 Southwestern Blvd Bldg # 5 65 Franklin Street Elma, NY 14059 Orchard Park, NY 14127 Springville, NY 14141 › New York State University Police › Erie County Sheriffs Office Bissell Hall › Medialle College Public Safety Office › Erie County Community College North 10 Delaware Avenue Lobby Buffalo, NY 14260 2 Agassiz Circle Public Safey Buffalo, NY 14202 Buffalo, NY 14214 6205 Main Street › Erie County Sheriff's Substation Williamsville, NY 14221 › Canisius College Clarence › Depew Police Department 2001 Main Street Bosch Building Public 6185 Goodrich Road 85 Manitou Street › Erie Community Public Safety Security Clarence, NY 14031 Depew, NY 14043 121 Ellicot Street Buffalo, NY 14208 Buffalo, NY 14260 › Erie County Substation Colden › Erie County Sheriff Substation Grand › Lancaster Police Department 8812 State Road Island › Town of Hamburg Police Criminal Justice Bldg. Lancaster Town Colden, NY 14033 1856 Whitehaven Road S6100 South Park Avenue Bldg. 529 Pavement Road Grand Island, NY 14072 Hamburg, NY 14075 Lancaster, NY 14086

Karl D. Fiebelkorn, MBA, RPh 3 ITAC 12/13/2016

Narcotic Abuse & Drug Disposal

Drug Disposal DEA Rule Federal Register September 9, 2014 Receptacle › Pharmacies are now allowed to take back › Must be in area where employee can be vigilant prescription medications – Community › – Community, & Hospitals for households when pharmacy is open – Hospital – Nursing homes for nursing home residents only › not in emergency department –Must be registered – Nursing home –Disposal regulations › For resident’s medications only › Must get approval from resident › No questions asked › May not look at what is being destroyed.

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Karl D. Fiebelkorn, MBA, RPh 4 ITAC 12/13/2016

Narcotic Abuse & Drug Disposal

Drug Disposal Systems: UBSPPS $50,000 In‐kind Grant Narcotic Dispensing Regulations › Prescriber 7 day’s supply for acute, non‐chronic, non cancer pain › SECTION 3331, 5. (b), (c). A practitioner may not initially prescribe more than a 7‐day supply of an opioid medication for acute pain. Acute pain is defined as pain, whether resulting from disease, accidental or intentional trauma, or other cause, that the practitioner reasonably expects to last only a short period of time. › This rule SHALL NOT include prescribing for chronic pain, pain being treated as a part of cancer care, hospice or other end‐of‐life care, or pain being treated as part of palliative care practices. › Upon any subsequent consultations for the same pain, the practitioner may issue, in accordance with existing rules and regulations, any appropriate renewal, refill, or new prescription for an opioid.

Office of Alcoholism and Substance Abuse NYS Combat Heroin and Prescription Drug Abuse Services (OASAS) › http://www.combatheroin.ny.gov/ › Governor’s Task Force ›1‐877‐8‐HOPENY › Kitchen Table Toolkit –(1‐877 846‐7369) › Recognizing warning signs and symptoms › Offering help and hope 24 hours a day, 365 days a year › Availability of treatment for alcoholism, drug abuse and problem gambling. › Paying for treatment › Key steps to prevention

Pharmacy Required Information Sheet Erie County Crisis Services Controlled Substances October 22, 2016 › Every patient dispensing on or after October 22, 2016 the pharmacists “Buck slip” must provide the patient with information about the › 1. Dangers of misuse and potential risk for addiction to prescription controlled substances › 2. The physical and behavior warning signs of addiction › 3. Available alcohol and drug addiction treatment resources › 4. Proper disposal guidelines for unused prescription controlled substances

› Information must be provided in languages other than English as deemed appropriate by the NYS Commissioner of Health (up to the 10 most common languages in NYS). › May be provided to the patient electronically if requested by the patient. › Appendix

Karl D. Fiebelkorn, MBA, RPh 5 ITAC 12/13/2016

Narcotic Abuse & Drug Disposal

Physician & Patient Expansion Contact Information › Licensed physicians who have had a waiver to treat Karl D. Fiebelkorn 100 patients for at least 1 year can become eligible for Senior Associate Dean the patient limit of 275 UB School of Pharmacy & Pharmaceutical Sciences – New waiver 282 Kapoor Hall – Effective August 8, 2016 Buffalo, NY 14214 › https://www.samhsa.gov/medication‐assisted‐ 716 645 2824 treatment/physician‐program‐data/treatment‐ [email protected] physician‐locator

Federal Register July 8, 2016

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Karl D. Fiebelkorn, MBA, RPh 6