1. The Rx Epidemic: Prescription and Over the Counter Drug Abuse Karen Moeller, PharmD, BCPP and Jana Shults, PharmD, BCPP

2. Objectives Identify dangers associated with abuse of prescription and over-the-counter medications. Recognize characteristics that may suggest that one is abusing substances Implement strategies to reduce drug abuse

3. True or False Prescription medications are the most abuse substances in the United States?

4. True or False It is safer to abuse prescription medications than street drugs?

5. Dangers of Prescription Drug Abuse 1 DEATH every 15 minutes from accidental overdose 110% rise in ER visits from 2004-2008 due to prescription drug abuse More DEATHS from accidental drug overdose than car accidents

6. Dangers of Prescription Drug Abuse Increase blood pressure or heart rate Damage the brain and other organs Lead to accidental overdose / poisonings Cause physical dependency and/or addiction Disrupt breathing (respiratory depression) Cause seizures and even death

7. True or False Prescription medications are NOT addictive?

8. What our Youth Think About Rx Drugs COMMUNITY RX CRISIS – Balance and Perspective on Prescription Drug Abuse, NADDI.

9. True or False Most people who abuse prescription drugs get them from a drug dealer?

10. Where do People Obtain Prescription Drugs? 70% of people who abuse prescription medicine get them from a FRIEND or RELATIVE

11. What is Drug Abuse Use is for recreational purposes not medical Use of drugs in a manner inconsistent with medical and social beliefs –Administration of a drug in a disapproved manner –Amount of drug and frequency of administration Leads to disability / dysfunction / adverse consequences

12. Risk Factors for Addiction Family history Male Peer pressure Psychiatric illness Lack of family involvement Taking a highly addictive drug The average age prescription drug abuse starts is approximately 21

13. Why do People Abuse Prescription Drugs? Getting high Pain relief, anxiety and increase alertness Peer pressure Easy access Cheap, pure “Less harmful” Less likely risk of arrest

14. Why is Prescription Drug Abuse on a Rise? Consumer Pharmaceutical Industry Physician Society

15. Signs and Symptoms of Drug Abuse (What should I watch out for?) Frequent mood changes Changes in groups of friends Frequently late or missed work/school days Frequent bathroom breaks Unexplained disappearances during work for a long period of time Avoiding eye contact Decreased performance at work/school Borrowing money or having extra cash Visiting and even purchasing from pro-drug abuse (illegal) web sites

16. Common Rx Drugs of Abuse Opiates Stimulants Benzodiazepines

17. Other Rx or OTC Drugs of Abuse Antipsychotics Cold medicines Synthetic Drugs

18. Prescription (RX) Medications

19. Prescription drugs are: –Prescribed by a doctor –Bought at a pharmacy –Prescribed for one person –Intended to be used by one person –Regulated by the U.S. Food and Drug Administration (FDA)

20. Opiates Examples –OxyContin® (oxycodone) –Percocet® (oxycodone) –MS Contin® (morphine) –Duragesic® (fentanyl) –Lortab® (hydrocodone) –Vicodin® (hydrocodone) –Norco® (hydrocodone) –Codeine

21. Opiates – Signs of Abuse Sedation –Fatigue –Confusion –Unconscious –Coma Nausea Constipation Pinpoint pupils Slowed breathing Death

22. Stimulants Examples –Adderall® (mixed amphetamine salts) –Concerta® (methylphenidate) –Ritalin® (methylphenidate) –Dexedrine® (dextroamphetamine)

23. Stimulants – Signs of Abuse Dilated pupils Fast heart rate Fever Increased activity Aggression Panic Paranoia Psychosis Heart problems

24. Benzodiazepines Examples –Xanax® (alprazolam) –Valium® (diazepam) –Ativan® (lorazepam) –Klonopin® (clonazepam) –Librium® (chlordiazepoxide) –Restoril® (temazepam)

25. Benzodiazepines – Signs of Abuse Drowsiness Clumsiness Fatigue Slowed thinking Slowed speech Memory problems Depression Slowed breathing Benzodiazepines

26. Atypical Antipsychotics Seroquel® (quetiapine) Abuse potential –Calming –Sedating –May be prescribed for sleep or mood Side Effects –Stiff muscles –Muscle spasms –Abnormal movements

27. Over the Counter (OTC) Medications

28. Over the Counter drugs are: –Drugs that do not require a doctor’s prescription –Bought off the shelf in stores –Regulated through the FDA

29. Dextromethorphan (DXM) Commonly found in cough and cold medications Examples –Robitussin® –Dimetapp DM® –Nyquil® –Coricidin® Will usually have “tuss” in the name or end in “DM”

30. DXM – Signs of Abuse Loss of coordination Slurred speech Disassociation Headache Nausea Vomiting Fast heart beat Numbness of fingers and toes

31. Pseudoephedrine Major ingredient used to make methamphetamine Produces stimulant effects –Increased blood pressure –Fast heart beat –Feeling nervous –Restlessness

32. Synthetic Legally Intoxicating Drugs

33. Some compounds are now illegal Labeled “not for human consumption” to avoid FDA regulations Sold as bath salts or incense Were readily available at quick marts, head shops, and online

34. Synthetic Cannabinoids Usually contain shredded plant matter Plant matter is treated with chemicals Plant matter usually has no psychoactive effects Smoked as an alternative to marijuana Can be made into tea May be sold as ‘incense’

35. Synthetic Cannabinoids – Signs of Abuse From poison control data –Vomiting –Fast heart beat –Agitation –Hallucinations and psychotic episodes –Confusion –Seizures –Suicidal and other harmful thoughts and/or actions Calls to Poison Control Centers About Synthetic Marijuana

36. Synthetic Cathinones More commonly referred to as “bath salts” Similar to West African stimulant khat Usually a white or brown powder Can be drank, inhaled, or eaten Some reports of rectal and vaginal insertion

37. Synthetic Cathinones – Signs of Abuse Paranoia and violent behavior Hallucinations Delusions Suicidal thoughts Seizures Panic attacks Increased blood pressure and heart rate Nausea and vomiting

38. Ways you can Help Prevent Drug Abuse Do NOT share your medications Store medications in a safe place Dispose of your medications

39. Store your Medications in a Safe Place Keep track of your medications Consider locking medications up

40. Drug Disposal Medication take back days –Usually in April and October of each year

41. Drug Disposal Look for disposal bins at your police department Envelopes at local pharmacies

42. Drug Disposal Do not flush down toilet Mix medications with undesirable substance –Used kitty litter –Used coffee grounds FDA Consumer Health Information April 2011

43. Parent/Caregivers Roles to Prevent Prescription Drug Abuse Be an involved caregiver Communicate with them the risks Let them know, you will be disappointed Teach them how to say NO  “No, thanks – not into it.”  “Not today.”  “I’m not interested.” Never give up

44. Where to Find Help SAMHSA – Treatment Locator –http://findtreatment.samhsa.gov/http://findtreatment.samhsa.gov/ SAMHSA Treatment Referral Helpline –1-800-662-HELP (4357)

45. Summary Be Smart Only use prescription or OTC medications as directed by your medical professional Never share your medications Dismiss the pressure! Prescription drugs can help us live longer and healthier lives – but only if they are used properly under medical supervision.

46. What to Learn More? ABOVE THE INFLUENCE http://www.abovetheinfluence.com/facts/drugs- prescription-otc.aspx# COMMUNITY ANTI-DRUG COALITIONS OF AMERICA www.cadca.org THE DRUG TAKE-BACK NETWORK http://www.takebacknetwork.com/ NATIONAL CONCIL ON PATIENT INFORMATION AND EDUCATION www.talkaboutrx.org NATIONAL ASSOCIATION OF DRUG DIVERSION INVESTIGATORS www.naddi.org NATIONAL INSTITUTE ON DRUG ABUSE, PRESCRIPTION DRUGS http://www.nida.nih.gov/drugpages/prescription.html PARTNERSHIP FOR A DRUG-FREE AMERICA www.drugfree.org WHITE HOUSE OFFICE OF NATIONAL DRUG CONTROL POLICY, EFFORTS TO REDUCE PRESCRITION DRUG ABUSE http://ofsubstance.gov/blogs/pushing_back/archive/2010/07/06/51426.aspx

47. The Rx Epidemic: Prescription and Over the Counter Drug Abuse Karen Moeller, PharmD, BCPP and Jana Shults, PharmD, BCPP