November 2006 NACBHDD Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
NACBHD News
NACBHD Represented at the Carter Center Symposium
NACBHD President and CEO Melissa Staats attended the 22nd Annual Rosalynn Carter Symposium on Mental Health Policy: Disaster Mental Health in the Wake of Hurricane Katrina on November 8 and 9 in Atlanta. Highlights included a panel discussion with David Satcher, MD, Ph.D., Director of the Center of Excellence for Health Disparities, Morehouse School of Medicine, and others called "Disaster Response: Science to Practice," and a session presented by hurricane survivors including representatives from the New Orleans Police Department and Project Recovery (the FEMA crisis counseling program) as well as an individual in recovery from mental illness and substance abuse who also runs a peer program.
In addition, two half days were devoted to six working groups charged with developing recommendations for improving disaster preparedness for individuals with disabilities. The recommendations of the work groups will be synthesized into a report from the symposium. Look for more information on the symposium report in a future newsletter.
Save the Date: NACBHD Legislative Conference February 28 - March 2, 2007
NACBHD's annual Legislative Conference is scheduled for February 28 through March 2 at the Jurys Hotel in Washington, DC. This year's conference is an opportunity to hear first hand from federal representatives and national advocacy partners what those in the behavioral health and developmental disability fields may expect with the change in Congressional leadership.
An important note on the agenda, hotel, and registration fees and dates. Check the Conferences section of the NACBHD web site soon for an agenda, registration fees and deadlines, and other conference information. Also, members will soon receive a "save the date" postcard.
In very early October, NACBHD staff disseminated 2007 Membership Campaign materials. In the package, each member (and potential member) should have received notice about NACBHD's decision to move to a population base for dues determination. As mentioned in the notice, this change is not intended to increase dues--although this did occur in some cases. The change is intended to facilitate enrollment and to move the organization in line with NACo. Members are encouraged to contact NACBHD staff if the new dues structure creates a burden to continued participation. In anticipation, the NACBHD board has established a 2 year window, meaning that members can pay the same amount of dues paid in 2006 for 2007 and 2008--to allow sufficient time to obtain support (in the case of dues increases where they may have occurred).
NACBHD is pleased to announce that the following states now have 100% participation (all counties) in NACBHD: Pennsylvania, Kansas, Utah, Alabama, California, and Michigan. A special thanks to the state association directors who worked hard to make this happen in their respective states.
NACBHD is most appreciative of all its membership and anticipates a great year in 2007.
The New Congress: The Forecast
The latest Washington, DC Update was distributed to members November 27, and includes detailed information on the "lame duck" session, the agenda in the 110th Congress, the House and Senate leadership, legislation, Medicaid, Medicare, and SCHIP, and SAMHSA. To read the latest Update, click here.
NACBHD Senior Policy Analyst, Maeghan Gilmore discussed the information in the November 27 Update and provided news that has occurred since then.
Fiscal year 2007 budget
Congress passed a continuing resolution (CR) prior to leaving town in October for the mid term elections. This resolution expired November 17, and Congress is expected to return Monday, December 4, when they may pass an omnibus spending package (an unpopular course of action with some Republicans and Democrats), or pass another CR that would expire in early 2007. Another CR extension would be unpopular with many Democrats, as they would have to begin their majority rule in the 110th Congress by passing a fiscal year 2007 budget before addressing their agenda priorities.
With various issues to be addressed legislatively, it is unclear how the FY07 budget will be resolved. Sources indicate that a CR would allow Congress to adjourn by December 8, while an omnibus would likely extend the lame duck session until December 15. Most agree that finishing appropriations bills separately is not likely to happen; therefore, Congress will need to move in the direction of a CR or omnibus. However, the omnibus spending package route is getting less traction if a continuing resolution resumes. As the expiration date of the CR continues to fluctuate, some speculate a January/February 2007 date while others have heard a possible year long – September 30, 2007 expiration date. The year long CR would keep funding at the 2006 levels and not allow for additional dollars to be added to programs. Furthermore, the 110th Congress would be hard pressed to increase funding for discretionary programs as it tackles the FY08 budget due to their promise to initiate pay as you go rules (meaning any increases in mandatory spending programs—like Medicaid—must be offset by decreases in other mandatory programs). This would result in continued relatively low funding for programs of importance to NACBHD.
Legislation
Gilmore provided highlights on legislation of interest to members:
Combating Autism Act
The bill, which addresses research, training, and education related to autism, was passed by the Senate in July 2006. The Autism Society of America is optimistic that the legislation could pass during the lame duck session. And, during a briefing with Senate Health, Education, Labor and Pensions staff, it was indicated that passage of the bill in the House could potentially take place during the lame duck session.
Mental Health Parity
The Paul Wellstone Mental Health Parity Act will likely be given floor time sometime next year. NACBHD staff was briefed by Connie Garner, Senate HELP staff to Senator Ted Kennedy, incoming Senate HELP Committee Chairman, who reported that mental health parity is on Kennedy's agenda and his office has been working with Senator Domenici on a bill that they believe is stronger than the original. It appears that bill may be ready to go in January.
Agenda in the 110th Congress
The 110th Congress will open on January 4, 2007. The first 100 legislative hours will include:
County programs and the 110th Congress
It is uncertain how the Democrats' agenda will affect NACBHD priorities. The incoming majority has indicated its desire not to increase the deficit and initiate pay as you go rules. These rules do not allow for new spending unless offsets are realized in another part of the budget, which would make it difficult for expansion or increased spending for discretionary programs, particularly those that are of NACBHD interest.
A $160 billion Iraq supplemental spending bill may be forthcoming. This amount has not been budgeted and will likely span over 2007 and 2008, and create further budgetary pressure on Congress. There will be considerable pressure to address the deficit, and fiscally guarded moderate and conservative Democrats may be watchful of their leadership and budget activities. In addition, many expect to see more oversight and hearings from House Energy and Commerce, House Government Reform, and Senate Finance Committees.
Medicaid and SCHIP
Medicaid
It is uncertain how the new political environment will affect Medicaid and other entitlement programs. It is likely that the President's FY 2008 budget will include recommendations from the Medicaid Commission (see Medicaid Update). Some speculate that the continued concern around the Deficit Reduction Act (DRA) may result in legislative "fixes." Proposed Administrative changes (e.g. rehabilitation option) remain a topic of conversation for many in DC.
Both targeted case management (TCM) and rehabilitative option regulations have yet to be released. During the National Association of State Medicaid Directors conference, Dennis Smith – Director, Center for Medicaid and State Operations CMS, indicated that there was not a target date set for either release. As NACBHD understands, the rehabilitative option changes will be released as a notice of proposed rulemaking (NPRM). It is thought that the NPRM will be released at the beginning of 2007. This change will allow for a longer comment period and may provide more room for influence on restructuring of those regulations.
SCHIP
There will be significant emphasis on SCHIP, with seventeen states experiencing SCHIP shortfalls in fiscal year 2007. During the first week of the lame duck session, Congress did not address SCHIP funding shortfalls. Senator Rockefeller (D-WV) and Representative Barrow (D-GA) have introduced legislation that would address the SCHIP shortfalls for fiscal year 2007. Senators Snowe (R-ME) and Menendez (D-NJ) are circulating a Senate colleague sign on letter that asks Majority leader Senator Bill Frist (R-TN) to allow the Senate to enact legislation before adjourning in December. Further, Senator Smith (R-OR) circulated a Republican only Senate colleague sign on letter urging President Bush to ensure sufficient SCHIP funding in his FY 2008 budget, which has been signed by 10 Senators – Smith, Snowe, Roberts, Collins, Cochran, Bond, Isakson, Specter, Chambliss and Warner.
SAMHSA
President Bush has nominated a new SAMHSA Administrator, Terry Cline, PhD. Dr Cline is currently serving as both Oklahoma's Secretary of Health and Mental Health and Substance Abuse Director. At this time, there is no indication how the nomination process will go and whether he will begin at the agency before official confirmation. The overall reaction from the DC advocates has been positive. They believe he brings many assets to the position and look forward to working with him during the remainder of the Administration. Although there is no word on the confirmation timeline, it is unlikely that hearings regarding the nomination will be necessary.
Many expect to see SAMHSA reauthorization bills in 2007. Committees with reauthorization oversight include the Senate Health, Education, Labor and Pensions (HELP) committee and House Energy and Commerce. At this time, it appears reauthorization is part of Senator Kennedy's HELP agenda; however, there has been no word as to whether reauthorization is a part of the Energy and Commerce (Representative Dingell) agenda priorities.
The Medicaid Commission convened its final meeting in late November and voted final recommendations, which will be released in a report at the end of the year. Some analysts predict very little action, if any at all, will be taken on the Commission's work. Many believe the report will be dead on arrival to Congress.
Medicare Update: 2007 Enrollment Period Is November 15 through December 31
On November 20, CMS released the following information to advocates:
Dear Partners:
The Centers for Medicare & Medicaid Services (CMS) announced the start of the 2007 open enrollment period for Medicare health and drug coverage. Generally, Medicare beneficiaries have six weeks to change or add coverage to their current Medicare health and prescription drug plans during the annual Open Enrollment Period, which runs from November 15 through December 31, 2006.
In addition, CMS released on the Medicare Prescription Drug Finder an additional tool to assist beneficiaries in comparing plans and choosing one that meets their needs. Plans are rated on how well they perform in the following five different categories:
For the publication "Make the Most of Your Medicare Drug Plan Options by Comparing Plan Performance," click here.
For "New Plan Performance Information Now Available on the Personal Plan Finder,"click here.
For the press release, click here.
Update on the Campaign for Mental Health Reform
Bill Emmet, who has been serving as Interim Director of the Campaign, has been appointed permanent Director. The Campaign will hold part two of its retreat on December 5, when partners will complete the planning process and develop the 2007 agenda. Look for more information on the Campaign activities in the December newsletter.
Ohio Board Grants Highest Level of Certification to NACBHD Members
In September, the Ohio Association of County Behavioral Health Authorities (OACBHA) awarded Board certification to the Alcohol Drug Addiction and Mental Health Services Board for Montgomery County and the Lorain County Mental Health Board. The award, the first ever, is the highest level of certification that an Ohio behavioral health Board can be granted.
Cheri Walter, Chief Executive Officer of OACBHA, talked with NACBHD about the award granted by the independent association of county alcohol, drug addiction and mental health boards. The award involves a three-year certification for Boards that comply with over 140 standards.
As far as Walter knows, the OACBHA is the first and only entity doing this. When asked what drove this process, Walter says there used to be three associations that represented their Boards, and they all merged into one. Subsequently, there was concern in the field about what they could do to insure that public money is used to provide good services. They held numerous focus groups with major constituencies, including providers and Medicaid, and received a lot of constructive feedback, resulting in a decision that there needed some kind of process to evaluate how the Boards are doing business. Until this process, Ohio did not have a mechanism for evaluating a Board's performance.
Walter notes that one of the strengths of Ohio government is local flexibility, but they still wanted consistency. She said in a press release, "Through this certification process, we hope to send the message to Ohio's taxpayers that behavioral health boards are operating effectively and efficiently to meet the needs of those with alcohol, drug addiction, and mental health disorders. . . and we can prove it!"
Culture of Quality
Certified Boards comply with the Culture of Quality Statewide Board Standards, which have 142 standards in ten domains. There is a peer certification process, and peer surveyors evaluate Boards to determine if they are meeting the standards. In addition, resources have been developed to assist Boards in the process.
Peer surveyors and the survey process
Peer surveyors go out to each Board that applies for certification to determine if the Board is meeting standards and to determine if policies and procedures are in place. Peer surveyors, who receive a three-day training, are members other Boards. A cultural quality administrator also participates in the survey. Each Board goes through a standards checklist and there is information the Board must supply to demonstrate it is meeting each standard. The review is full two-day process to demonstrate that the Board is doing all the things to be a quality Board.
Standards are in ten domains:
Resources
Culture of Quality resources were developed to assist Boards in the survey process, including a Behavioral Health Handbook, a Board Directors' Resource Manual, and an online Culture of Quality Resource Library.
Certification
Five directors review the recommendations of the peer surveyors, and a Board is either given a three-year certification or a one-year provisional certification. Boards given a provisional one-year certification must then be given a three-year certification to be recertified. There are 55 Boards, and Walter says they hope to certify 15-20 Boards a year, with all 55 certified in three years; then they will start the process of recertifying those who were certified at the beginning.
For more information on the Culture of Quality
For more information on the Culture of Quality,click here.
Positive feedback on the certification process
Walter reflects that the process is strict and labor intensive, but that "it is important to note that they have received recognition from the state auditor who thinks it is a great process. Really hard work came to fruition." And she says, legislators have been "thrilled" with the accountability and flexibility of the process that at the same time, allows for local flexibility.
In describing what the process is like for the Boards, she says, "It's not a ‘gotcha process;' it's really about quality and helping Boards have all they need to be strong Boards." She adds, "The Board directors have been helpful and the Board system is coming together in an exceptional way."
The Ohio Department of Mental Health and Ohio Drug Addiction and Substance Abuse Services helped to provide funding.
To view a press release about the award and certification process, click here.
Chesterfield County, Virginia Receives BJA Grant
Chesterfield County, Virginia recently was awarded the 2006 Justice and Mental Health Collaboration Program grant from the U.S. Department of Justice's Bureau of Justice Assistance. The program is intended to improve the criminal justice system's response to people with mental illness. The program, created by the Mentally Ill Offender Treatment and Crime Reduction Act of 2004, includes nearly $4 million to 27 states, counties, and communities through 13 Planning, 8 Planning and Implementation and Expansion grants. NACBHD recently talked with David Mangano, Mental Health Support Services; Glen Peterson, Community Corrections Services; and Kristina Bryant, Community Corrections Services, about the grant.
Chesterfield County is a suburban county of Richmond, Virginia with a population of about 300,000. It is a growing county in terms of its population and in terms of the increased need for mental health services in the areas of serious persistent mental illness, substance abuse, and mental retardation. There is much more demand than access in all three areas. The county population is growing three percent a year, with service requests growing six percent a year. This is significant in terms of general behavioral health in the county and in terms of the decision to apply for the grant.
Mangano, Peterson, and Bryant wrote the grant together, and they came to the project with a previous relationship between the Chesterfield Community Services Board and Chesterfield Community Corrections Services. Chesterfield Community Corrections Services is a collection of criminal justice based services including pretrial, probation supervision, domestic violence, day reporting center, dual treatment program, and supervision for adult drug court. It serves Chesterfield County and the city of Colonial Heights (population 17,000), which is part of the judicial circuit.
There are 1,000 individuals incarcerated in the Chesterfield County jail system. There was a survey a year ago to get a snapshot of a day in the criminal justice system. In the Chesterfield jail, about 11% of those incarcerated have mental illness, and about 5% have co-occurring disorders. The Riverside Regional jail, where most individuals are sent who are acting out, has 29% with mental illness and 13% with co-occurring disorders. Officials estimate a need for 60 additional mental health beds. In the juvenile justice system, 37% of those incarcerated have a mental illness, 25% received psychotropic medication, and 6% were on suicide watch on any given day. $350,000 a year comes out of the jail budget for psychotropic medications.
Fifty to sixty stakeholders will be involved in developing an action plan over the next two to five years. There has been a relationship between the two agencies around service delivery systems, but it became apparent that a much more comprehensive plan is needed than focusing on one narrow point of intervention.
The planning grant is a one year grant from January 2007 to December 2007. The end product is a one year action plan of shorter, low cost fixes, and a five year plan with longer initiatives requiring funding streams. Rather than a service expansion grant, it made more sense to put together comprehensive planning grant. As Bryant says, "It is almost like taking two steps back and putting together a stronger foundation to build upon. We see it almost as a necessary step to build a better partnership with all stakeholders."
In applying for the grant, they adapted a mapping strategy that can look at all the agencies and stakeholders that touch someone who has mental health issues in the criminal justice system; they wanted to cast a wide net to look at service agencies, state interest, and family members. They modeled their plan on Policy Research Associates, Inc.'s "Action:Steps to Community Change Program Description." The organization is known nationally for its work in relation to criminal justice and people with mental illness and co-occurring substance use disorders.
Mangano, Peterson, and Bryant all agreed that the project takes leadership and would not have happened if both agencies weren't champions of the effort. While they did take note of the activity around mental illness and criminal justice at the national level, they characterize Chesterfield as a county "immersed in doing the right thing," and they note that the project is really one of local collaboration.
NACBHD will update members on two pieces of important legislation in the December newsletter, the Combating Autism Act and the Developmental Disability Act.
Resources From the National Institute of Drug Abuse
New Resource on Prescription Drug Abuse Available From NIDA
The National Institute on Drug Abuse (NIDA) is offering a Community Drug Alert Bulletin covering the latest scientific research on the non-medical use of prescription drugs of abuse and addiction. Parents, teachers, counselors, school nurses, and health professionals will find useful information on the increasing incidence of non-medical use of prescription drugs. The publication is intended as a resource for communities to address prescription drug abuse among youth.
NIDA's "Research Report Series on Prescription Drugs Abuse and Addiction" and the companion "Commonly Abused Drugs" chart, a laminated reference card with information about major drugs of abuse, their commercial street names, their short-and long-term effects, their modes of administration, and their Drug Enforcement Administration (DEA) controlled substances schedules. The consequences of prescription drug abuse and reviews of recent research are also included.
To order these free resources, visit http://www.drugabuse.gov, and see the right-hand column, "Drugs of Abuse" and click on "Prescription Medications," or call (800) 729-6686. Members can also find other publications and information of interest at the site, including information on fentanyl, which is of concern is some localities.
NIDA Study Demonstrates Incentive Based Therapy is Effective Methamphetamine Treatment
A new research study supported by NIDA reveals that an incentive-based behavioral therapy program, contingency management (CM or Motivational Incentives), combined with psychosocial therapy is more effective in treating methamphetamine abuse than psychosocial therapy alone. The results of the research have been published in the November 2006 issue of the American Journal of Psychiatry.
CM treatment, which involves contingencies or rewards, has previously been shown to be effective as a treatment for stimulant abuse, primarily cocaine. The methamphetamine study required drug-free urine samples, and the rewards were plastic chips that could be exchanged for prizes. More chips are earned as the rules are followed, and not following the rules causes loss of chips. Results demonstrated that CM can help methamphetamine abusers reduce or stop meth abuse for longer than those who receive the standard treatment with CM. In addition, CM combined with the Matrix Model may be an even more effective tool in fighting meth abuse.
Patrick Fleming, MPA, LSAC, of the Salt Lake County Division of Substance Abuse Services and a NACBHD member who has testified before Congress on the methamphetamine crisis facing counties around the country, says "this kind of approach is very helpful, especially in dealing with the triggers to re-use. Chronic, long-term meth users can be at the point in their brain's rejuvenation after meth use where a scripted response to any stimulus or prompt is helpful. After the initial therapy more sophisticated therapies can be used. This is another tool to put in the clinicians toolbox."
For more information on the study, see http://cadca.org/CoalitionsOnline/article.asp?id=1305.
Methamphetamine Resources
November 30 was National Meth Awareness Day, an educational effort sponsored by SAMHSA regarding the dangers of methamphetamine. While the newsletter was released after National Meth Awareness Day, resource material on methamphetamine is available from the SAMHSA web site at http://www.samhsa.gov. And, for information from the White House Office of National Drug Control Policy on methamphetamine availability, use, effects, enforcement activities, and treatment data, see http://www.jointogether.org/resources/ondcp-fact-sheet.html.
In addition, those with questions about meth or having a problem with meth can call the following numbers weekdays 8 a.m. to 8 p.m. EST for information or help: 1-888-8NO-METH (1-888-866-6384), 1-800-487-4889 (TDD).
From a November 17 SAMHSA press release:
SAMHSA-funded Study Shows Receiving Substance Abuse Treatment within 30 Days Following Detoxification Lengthens the Time to Subsequent Relapse
More than one-quarter of patients receiving publicly funded substance abuse detoxification will have a second detoxification readmission within a year. But if patients receive substance abuse treatment on two or more days within 30 days of discharge from a detoxification admission, time to subsequent relapse and readmission lengthens by 40 percent according to findings revealed in a study sponsored by SAMHSA and published in the September 2006 issue of the Journal of Substance Abuse Treatment.
About 25 percent of all admissions to substance abuse specialty facilities are for detoxification (about 440,000 admissions). Detoxification is designed to help clients stop the use of alcohol or other drugs relatively quickly, while minimizing withdrawal symptoms. However, detoxification in itself does not constitute treatment for substance use disorders. Comprehensive treatment entails rehabilitation and recovery services.
The study also showed that only about one-forth of patients are engaged in substance abuse treatment within a month following discharge from detoxification. Further, the study emphasizes that engaging patients in treatment immediately following detoxification is a critical step in preventing relapse and cycling in and out of detoxification.
This study used a unique database to track patients who received detoxification or other substance abuse services in Medicaid- or public agency-funded facilities in three states. The database was developed by researchers from Thomson Medstat under the direction of SAMHSA.
The SAMHSA-funded study was conducted under the SAMHSA Spending Estimates Project and was written by Dr. Tami L. Mark of Thomson Medstat, Rita Vandivort of SAMHSA, and Leslie Montejano of Thomson Medstat. The complete article can be accessed at http://www.journals.elsevierhealth.com/periodicals/sat.
From a November 3 SAMHSA press release:
1,000,000+ Client Records Provides Insight into Substance Abuse Treatment
Episodes
SAMHSA has released a new report "Treatment Episode Data Set (TEDS) 2004: Discharges
From Substance Abuse Treatment." The report provides information on treatment completion, length of stay in treatment, and demographic and substance abuse characteristics of approximately 1,000,000 discharges from alcohol or drug treatment facilities that report to individual State administrative data systems. The report analyzes episodes of care from eight different treatment modalities: Intensive and regular outpatient care; short-term, long-term and hospital residential care; detoxification; and methadone detoxification and outpatient treatment. Client characteristics studied included age, gender, race/ethnicity, education, employment, and prior experience with substance abuse treatment. TEDS is one component of the Drug Abuse Services Information System and includes admissions and discharges from facilities that are licensed or certified by the State substance abuse agency. TEDS is an admissions-based system, and TEDS admissions do not represent individuals. Therefore, an individual admitted to treatment twice within a calendar year would be counted as two admissions. In general, facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds, including the SAMHSA-administered Substance Abuse Prevention and Treatment Block Grant. The report is available on the web at http://oas.samhsa.gov/dasis.htm#teds2 or through the National Clearinghouse on Alcohol and Drug Information at http://ncadi.samhsa.gov/.
From a November 9 SAMHSA press release:
Ingredient in Cough Medicine Results in More Than 12,000 Visits to Hospital Emergency Departments in 2004; More Than 5,000 Visits Involved Nonmedical Use
Dextromethorphan (DXM), an ingredient commonly found in over-the-counter cough and cold remedies, was a contributing factor in an estimated 12,584 visits to hospital emergency departments during 2004, and 5,581 of those visits were attributed to nonmedical use, says a study from the SAMHSA. Emergency Department Visits Involving Dextromethorphan, the latest report from SAMHSA's Drug Abuse Warning Network (DAWN), shows that of those visits related to nonmedical use, almost half (48 percent) involved patients ages 12 to 20. Nonmedical use of DXM in this report includes those taking more than a prescribed or recommended dose, as well as other forms of drug misuse or abuse, and does not include accidental ingestion, suicide attempts, or medical use. DXM is generally recognized as safe when marketed according to FDA's regulations. But when taken in large amounts, it can produce hallucinations and a "high" similar to psychotropic drugs, such as phencyclidine (PCP). Serious side effects have included blurred visions, loss of physical coordination, abdominal pain, and rapid heartbeat.
"This report shows that there can be severe, even life-threatening, consequences associated with the misuse of some over-the-counter cough medicines," said Assistant Surgeon General Eric Broderick, D.D.S., M.P.H., SAMHSA Acting Deputy Administrator. "When it comes to our children, parents play a key role in ensuring the responsible use of this widely available medication." To support parents, SAMHSA has developed educational information about dextromethorphan at http://www.family.samhsa.gov/get/otcdrugs.aspx.
The rate of emergency department visits resulting from nonmedical use of this product was 7.1 visits per 100,000 people ages 12 to 20, compared with 2.6 visits or fewer per 100,000 people in other age groups. Alcohol was also implicated in 36 percent of those same nonmedical use visits for patients ages 18 to 20, and 13 percent of visits for patients ages 12 to 17. About 30 percent of all DXM-related visits to the emergency department in 2004 were attributed to adverse reactions to medical use—when the DXM products were used as prescribed or according to directions. Patients aged 12 to 20 constituted only 17 percent of these visits. The rates of these visits ranged from 0.8 to 2.2 visits per 100,000 people across all age groups. Suicide attempts accounted for 14 percent of DXM-related emergency department visits and ranged from 1.4 to 1.7 per 100,000 people ages 12 to 34.
In May 2005, the Food and Drug Administration (FDA) issued a warning against the abuse of dextromethorphan after five reported deaths of teenagers that might have been associated with the consumption of pure, powdered DXM sold in capsules.
The report is available on the web at http://dawninfo.samhsa.gov. DAWN collects data from emergency departments in a national sample of short-term, general, non-Federal hospitals and publishes estimates of emergency department visits involving illicit drugs, alcohol, and nonmedical use of pharmaceuticals.
From an October 27 SAMHSA press release:
Federal Report Shows New Nonmedical Users of Prescription Pain Relievers Outnumbered New Marijuana Users between 2002 and 2004
Misuse of prescription drugs is second only to marijuana as the nation's most prevalent drug problem, and the annual average number of people using pain relievers non-medically for the first time exceeds the number of new marijuana users according to a study released today by SAMHSA. Most young people aged 12 to 17 get these drugs from friends or family members, not the Internet.
The report, Misuse of Prescription Drugs: Data from the 2002, 2003 and 2004 National Surveys on Drug Use and Health, covers four broad classes of prescription psychotherapeutics including pain relievers, tranquilizers, stimulants, and sedatives—and the specific drugs OxyContin (a pain reliever) and methamphetamine (a stimulant). Nonmedical use (or misuse) is defined as use of these medications without a prescription or simply for the experience or feeling the drug caused. The report shows that among specific age groups, young adults aged 18 to 25 tended to have the highest rates of nonmedical use in the past year, followed by youths 12 to 17. Pain relievers, for example, were used nonmedically in the past year by 11.8 percent of young adults compared to 7.5 percent of youths and 3.1 percent of adults aged 26 or older. Among adults aged 18 or older, the risk of dependence or abuse for psychotherapeutics was greater for persons who initiated nonmedical use before age 16 compared with those who initiated use at age 16 or older. "While marijuana continues to be the most commonly used illicit drug, the misuse of prescription drugs is clearly a growing national concern that requires action from multiple segments of our society," said Assistant Surgeon General Eric Broderick, D.D.S., M.P.H., SAMHSA Acting Deputy Administrator. "We know that 70 to 80 percent of those 12 years or older said they got their drugs from a friend or relative and, very likely, those came from the family medicine cabinet. Only 4.3 percent got the pain relievers from a drug dealer or other stranger and only 0.8 percent reported buying the drug on the Internet. Parents and other caregivers should store their prescription drugs carefully and dispose of any unused drugs before they can fall into the wrong hands."
Based on combined data from the 2002 through 2004 National Survey on Drug Use and Health, an annual average of 2.7 million persons aged 12 or older first misused any prescription psychotherapeutic drug in the past year while an annual average of 2.1 million people 12 years or older started using marijuana. An annual average of 11.3 million persons aged 12 or older were using prescription pain relievers nonmedically in the past year compared with an annual average of 25.5 million past-year users of marijuana. This includes new users and users who had started more than 12 months previously.
Although overall patterns for misuse of any prescription psychotherapeutic drug and for specific classes of psychotherapeutics continued to show stable rates, significant increases in the prevalence of lifetime misuse from 2002 through 2004 were observed for some specific types of drugs. Among persons aged 12 or older, nonmedical use of pain relievers in the hydrocodone category (e.g., Vicodin) anytime in the individuals' lives increased from 5.9 percent in 2002 to 7.4 percent in 2004. And use of medications in the oxycodone category (e.g., Percocet or OxyContin) increased from 4.3 percent to 5.0 percent over that period. Males generally had higher rates than females for misuse of pain relievers, stimulants and methamphetamine among the overall population aged 12 or older. Among youths aged 12 to 17, however, the rates of nonmedical use in the past year were higher among females than males for any prescription psychotherapeutic drug (9.9 percent for females versus 8.2 percent for males), pain relievers (8.1 percent for females versus 7.0 percent for males), tranquilizers (2.6 percent for females versus 1.9 percent for males), and stimulants (2.6 percent for females versus 1.9 percent for males.
Almost 2 million people aged 12 or older met criteria for past-year dependence or abuse of prescription drugs, including 1.4 million people for pain relievers, 573,000 for tranquilizers, 470,000 for stimulants, and 128,000 for sedatives. Only 12.5 percent of those with a prescription drug use disorder in the past year received specialty treatment for drug problems in that period. Specialty treatment includes treatment at a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or a mental health center. Persons aged 12 or older who were living in small metropolitan areas with populations of fewer than 250,000 persons had the highest rates by
population density for misuse of any prescription psychotherapeutic drug (7.1 percent), pain relievers (5.4 percent), tranquilizers (2.6 percent), and stimulants (1.7 percent). Colorado, Kentucky, and Washington State ranked among the states with the highest prevalences of nonmedical prescription pain reliever use among persons aged 12 or older. The District of Columbia and the Midwestern states of Iowa, Nebraska, and South Dakota were among the states with lower prevalences of pain reliever misuse for persons aged 12 or older. While the prevalence of methamphetamine use appeared in this report to remain stable from 2002 to 2004, patterns noted in another SAMHSA report on treatment admissions indicated that the number of those seeking treatment for methamphetamine use increased from 44,000 admissions recorded in 1994 to approximately 150,000 in 2004. (A complete copy of that report is located at http://wwwdasis.samhsa.gov/teds04/tedsad2k4web.pdf. Misuse of Prescription Drugs: Data from the 2002, 2003 and 2004 National Surveys on Drug Use and Health is based on an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years or older. The National Survey on Drug Use and Health (NSDUH) is sponsored by SAMHSA and is planned and managed by SAMHSA's Office of Applied Studies. Misuse of Prescription Drugs is available on the web at http://oas.samhsa.gov/prescription/toc.htm.
