Editor’s Note: The Times Record continues its series of reports on prescription drug abuse. Next: Overprescription can add to problem.
FORT SMITH — As Arkansas health and human services leaders work to reduce prescription drug abuse, they use statistics from a variety of sources to guide their decisions and measure their progress.
Drug Director Fran Flener with the Department of Human Services said her office uses research from the Arkansas State Crime Laboratory, the Arkansas Department of Health, the Arkansas Crime Information Center and — perhaps most of all — from Pride Surveys, which conducts the Arkansas Prevention Needs Assessment, an annual survey of public school students across the state.
"It does guide us in our policy and public education efforts," Flener said.
Through a newly formed coalition called Arkansas TakeBack, Flener and other state leaders in 2010 developed the Monitor, Secure, Dispose education program and organized the state’s participation in the National Prescription Drug Take-Back initiative.
In five take-back days since September 2010, Arkansas has collected more than 23 1/2 tons of medications — an estimated 66 million pills — and ranks No. 4 in the nation in pounds collected per person, according to Arkansas TakeBack.
In that same time frame, prescription drug abuse by young people in Arkansas has decreased significantly, Flener said.
The latest Arkansas Prevention Needs Assessment figures, collected in fall 2012, show that only 7.9 percent of the surveyed students statewide reported using prescription drugs over their lifetime, compared to 10.4 percent in fall 2010, the year the Take-Back program started. Students claiming they used prescription drugs in the previous 30 days totaled 3.5 percent, compared to 4.4 percent in 2010.
Flener said the downward statistical shift is no coincidence.
"Twenty-three tons has got to make a difference," she said. "That’s 66 million pills that we have safely and effectively destroyed — pills that will never get into the wrong hands to be abused or be accidentally ingested or cause an overdose."
So far, the education and take-back efforts have been centered on drug abuse by young people.
"The reason we focus on youth is because we have the data," Flener said.
The APNA surveys Arkansas public school students in the sixth, eighth, 10th and 12th grades about their risk behaviors, and since 2008 the studies have included data on the use of prescription drugs.
"They survey 90 percent of the public schools in Arkansas," Flener said. "We have a group of school-age people that we can survey in the fall of every year during a one-hour class period. We have done this for six years, so those who are seniors now were in the sixth grade when we started. … And we’re very fortunate to have regional and county-level data as well."
Steve Varady, DHS drug policy coordinator, said reliable information such as that found in the APNA reports also has helped guide efforts to develop the new state Prescription Drug Monitoring Program, which was launched March 1.
Another data source — DAWN, or Drug Abuse Warning Network, which monitors drug-related deaths and emergency-room visits — provides national and metropolitan-level figures that Varady said can be "extrapolated" for state use.
Ed Barham, public information officer with the state Department of Health, said the Prescription Drug Monitoring Program aims to "stem the tide on the fastest-growing drug problem in America," prescription drug abuse, largely by reducing doctor shopping, a phenomenon he said is revealed in ER data supplied by hospitals.
Also based on ER data, Barham said his department has developed a protocol for prescribing pain medication and opioids. Hospitals can download and post the protocols in their emergency rooms.
Unlike the APNA data, some statistics can be difficult to use effectively, especially if they come from sources that aren’t dedicated to collecting the desired information.
"Analyzing data is always a challenge," Flener said. "It always seems like it’s very hard to drill down and answer the questions you want to ask."
Health Department statistician Dorene Harris said that based on requests from reporters or government offices, she has compiled ad hoc reports listing specific drugs, including alcohol and over-the-counter medications, that are mentioned on death certificates as the underlying cause of death.
Because most drug fatalities involve multiple substances — she has seen as many as 16 listed on one death certificate — the total number of drug "mentions" exceeds the total number of drug deaths.
"The reports cannot show if the drug was prescribed to the person who took it, or if they took it purposely or were confused and took too much, or if they got it illegally," Harris said.
For 2008, the latest year for which an ad hoc report was available, 355 drug deaths were reported, including 191 accidental deaths, a homicide, 63 suicides and 100 deaths of undetermined intent.
The state crime lab reported that of 1,250 autopsies performed in 2011, drug intoxication was reported as the primary cause of death in one out of nine cases. And in one out of four deaths, drugs were listed as a contributory cause, meaning drug intoxication may have led to the primary cause, such as a car accident.
Like Flener, Barham said the numbers aren’t always as enlightening as one might wish.
"We’re not particularly proud of the numbers we have," he said.