1. ART ADAMS, MSW, LCSW, LCAC, CADACIV

2. 1. 1/3 of people 12 and over who used drugs for the first time in 2009 began by using a prescription drug. Most came out of someone’s medicine cabinet. 2. In the military 12% of active duty service personnel are identified as engaging in non-medical use of prescription drugs (Office of National Drug Control Policy). 3. Prescription drugs are the second-most abused category of drugs in the United States, following marijuana (Results from the 2009 National Survey on Drug Use and Health (NSDUH): National Finding, SAMHSA (2010).

3. 4. The estimated number of ER visits linked to non-medical use of prescription pain relievers nearly doubled between 2004 and 2009 (Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings of Drug-Related Emergency Department Visits. SAMHSA (December 2010)). 5. Approximately 2,000,000 (2 million) adults age 50 and older (2.1% of adults in that age range) used prescription drugs non-medically in the past year. (NSDUH)

4. 6. Substance abuse treatment admissions for persons age 50 and older nearly doubled from 1992 to 2008, accounting for 12.2% of admissions for substance addiction. The primary reason for admission was for prescription drug abuse. (TEDS Report, Changing Substance Abuse Patterns among Older Admissions: 1992-2008, SAMHSA (2009). 7. I am getting more and more calls from Christians and congregations who are recognizing a problem among us.

5. The Bible addresses “pain and suffering” physically, mentally, and spiritually. A. Job – book on the problem of suffering. His “pain was not relieved” (Job 16:6) B. Jesus was acquainted with “pain” (Isa. 53:3). He refused a “pain killer” while on the cross (Matt. 27:34) C. Timothy had a stomach problem called “oft infirmities” (1 Tim. 5:23) D. Paul’s “thorn in the flesh” – God’s grace was sufficient (2 Cor. 12:7ff)

6. A. Luke was a physician. Sick people need a doctor (Matt. 9:12). The Bible endorses the legitimate use of the medical profession in these verses and condemns misuse of “alcohol and pharmekia and such like” in Galatians 5:19-21. B. In heaven “no pain” (Rev. 21:4).

8. Definitions – Stronghold (2 Cor. 10:4) Being devoured (1 Peter 5:8) Drunkenness (Gal. 5:19-21) Sorcery/witchcraft (Galatians 5:19-21) Snare of the devil (1 Timothy 3:7; 6:9) A deceiver (Prov. 20:1) Stronghold (2 Cor. 10:4) Being devoured (1 Peter 5:8) Drunkenness (Gal. 5:19-21) Sorcery/witchcraft (Galatians 5:19-21) Snare of the devil (1 Timothy 3:7; 6:9) A deceiver (Prov. 20:1)

9. Use Abuse Dependence They are viewed as progressive Criteria: — Increased/decreased tolerance — Withdrawal symptoms — Inability to control or quit — Using more over longer time than intended — Continued use despite consequences — Pre-occupation — Blackouts

10. Cravings Behaviors Psychological changes Progressive – “It’s my best friend.” – “Nothing else is important.” – “I have to have it to feel normal.” Gender differences The Path…

11. Change in body chemistry Tolerance Withdrawal

12. First Use Baseline/ Normal level Three Choices: 1.Ride it out 2.Increase the dosage 3.Add a stronger substance Three Choices: 1.Ride it out 2.Increase the dosage 3.Add a stronger substance Perceived as normal Perceived as normal

13. The Real Reason Not To Do Drugs They Damage Your Brain & Your Potential & They Limit Your Access to Yourself

14.  Use of medication as prescribed.  Use only for the condition indicated.  Use only for the duration needed. Most meds are not abused: Estimates of addiction within setting of chronic pain management: 3 to 19% (higher in training settings). Weaver M and Schnoll S, J Addiction Medicine, 2007

15.  Use of a medication for a reason other than that for which it was prescribed or in doses or frequencies other than prescribed.  Misuse is unintentional secondary to:  Ignorance  Confusion  Cognitive impairment  Visual impairment  Misuse is related to poor judgment in an attempt to gain relief: “pseudo-addiction”

16.  Using medication prescribed for one indication to treat other emotional or situational conditions or issues.  Coping with: Insomnia Mood: depression/lability/anger/anxiety Situational stressors Lack of energy/motivation Weaver W and Schnoll S, J Addict Med, 2007 “Chemical coping”

17.  Use of a medication outside the normally accepted standard for that drug.  Recurrent problems in multiple life areas.  Continued use in spite of negative consequences.  Preoccupation with the drug, drug seeking behavior, loss of control of use.  Tolerance or physical dependence may or may not be present. Adapted from DSM IV, APA,1994

18.  Withdrawal syndrome when the drug is withdrawn acutely.  May or may not be associated with increasing doses and increasing tolerance to the drug.  May or may not be associated with abuse of the drug.

19.  Aggressive complaining about dose  Drug hoarding during periods of reduced symptoms  Requesting specific drugs  Acquisition of similar drugs from other medical sources  Unsanctioned dose escalation 1-2 times  Unapproved use of the drug to treat other symptoms  Reporting psychic effects not intended by the clinician Passik and Weinreb. 2002

20.  Selling prescription drugs  Forgery of prescriptions  Stealing another person’s meds  Injecting / snorting oral preparations/ tampering with sustained-release preparations  Obtaining from non-medical sources  Concurrent abuse of related illicit drugs  Multiple unsanctioned dose escalations  Recurring prescription losses Passik SD, Weinreb HJ. Adv Ther. 2002

21.  Pattern of calling for refills after hours.  Prescriptions from multiple providers.  Frequent visits to the Emergency Room  Strong preference for specific drug (“allergic to everything but…”)  Repeatedly needing early refills.

22. Excuses: “I lost the prescription. I left it on the plane” “It was stolen out of my car/purse/bedroom.” “The dog ate the prescription.” “I spilled the bottle in the toilet.” Fears / complaints: “That dose doesn’t work anymore. I used a few of my mom’s” “I can’t sleep without it. I need it for my nerves” “I can’t get through the day without it.”

23.  Non-specific and potentially stigmatizing  Important as a “red flag” requiring further assessment  Assess for: Pseudo-addiction: inadequate management Tolerance / hyperanalgesia Chemical coping Characterologic or emotional issues Abuse / dependence Diversion / illegal activity

24. Be prepared to intervene for:  Inappropriate use or misuse  Pseudoaddiction  Chemical coping  Physical dependence  Abuse or addiction  If the patient responds to intervention  If the patient is unwilling / unable to comply  Diversion

25.  Express your concern in terms of patient’s well- being  State that the particular medication is no longer safe or indicated and you will not continue to prescribe it (arrange taper or referral)  Explore other therapeutic options  Assess for withdrawal risk  Refer for specialized addiction treatment

27. A. Government is God’s “minister”. B. Obey the laws of the land. (Rom. 13:1-7) C. Respect (Titus 3:1; I Peter 2:13-15)

28. Nonmedical Use of Prescription Medications Specific penalties will vary from state to state…see your state’s statutes for details.

30. In today’s economy finding a job and/or getting accepted into a college is more competitive than previous years. Do you really want to limit your choices?

31. Being convicted of a crime often involves jail time, fines, and possibly a lifelong criminal record. Jail: Felony terms often range from 5-30 years.

32. Fine: Often range from $5,000 to $15,000 when convicted of a felony. Even if you have your conviction record “expunged” or erased there is still evidence that you had a record. The court judge has the final decision as to the exact length of prison time and other penalties.

33. Specific penalties will vary from state to state…see your state’s statutes for details.

35. 1. It is O.K. to share prescription medications with your friends. FALSE

36. 1. It is illegal to share prescription medications. It is unlawful: To possess a prescription which has not been completed and signed by the practitioner whose name appears printed thereon. Minimum charge Felony

37. 2. It is O.K. to possess prescription medicines that do not have your name prescribed on the bottle. FALSE

38. 2. It is illegal to possess Rx drugs not prescribed specifically for your use. If you are with friends and it can’t be proven who the pills belong to you may be charged with illegal possession of prescription drugs. Minimum charge Felony

39. 3. If you are a minor when you reach 18 your “record” will automatically be wiped clean. FALSE

40. 4. Minor’s records are not automatically wiped clean at 18. The records are not automatically sealed, but there are numerous confidentiality restrictions relating to juvenile cases. In general, there is a one-time expungement on cases, if the charge qualifies. There is an additional expungement procedure for diversion on juvenile cases. The final decision is made by the judge overseeing your case.

41. 4. If you are convicted with a crime as long as it is a first offense your records will be wiped clean. FALSE

42. 4. Even if you get your legal records expunged (erased) there is still evidence that you had a record. Your future employer may ask you specific details of what was expunged or just seeing that something was there may be enough for someone not want to hire you. This may be true for college applications, government jobs, and even volunteer positions.

44. Being convicted of a felony may limit your job opportunities, career choices, college options and even where you live.

45. Many government (state & federal) positions limit job opportunities for felons. Jobs that require security clearances may not employee felons. Some options may be gone forever… doctor, lawyer, police officers, firemen, military, teachers and coaches…

46. Most employers ask about criminal convictions and some even inquire about arrest records. In many states if you are driving while impaired you could be charged with a DUI even if it is your prescription. Some apartment complexes will not accept people convicted of a felony or with a DUI on their record.

47. Many volunteer positions such as scouting, Little League and other community organizations… will may not accept felons. The potential for addiction may lead to increase in drug use…which may lead to burglary, violence or other crimes in pursuit of drugs.

48. The CHOICES You Make Today

49. Will Affect Your FUTURE Forever.

50. If you suspect someone is abusing and/or addicted to drugs be proactive and persistent… addicts tend to lie and be dishonest as a means of continuing their habit, and as a defense mechanism. They are often even lying to themselves that they have a problem. Seek Professional and Medical advice. Don’t regret ignoring the problem. For additional information on prescription drug abuse, addiction, support groups, and recovery please visit www.StopRxDrugAbuse.org

51. “DO NOT SHARE IN THE SINS OF OTHERS” (NIV) OR

52. Acts 5 I Timothy 5:22

54. Stoning of Stephen

55. Jeremiah

56. Do not be a Stumblingblock

59. I Cor. 6:12 - “…I will not be brought under the power of any.” II Cor. 10:4 – “The weapons we fight with are not weapons of the world. On the contrary, they have divine power to demolish strongholds.”

60. Rom. 13:1,2 – “Everyone must submit himself to the governing authorities, for there is no authority except that which God has established…Consequently, he who rebels against the authority is rebelling against what God has instituted, and those who do so will bring judgment on themselves.”