Prescription and Over-the-Counter Drug Use

Prescription and Over-the-Counter Drug Use
Evergreen Annual Conference March 24, 2011 Jay Jaffee Minnesota Department of Health Provide: -a sense of the prevalence of prescription and OTC drug abuse -information about the drugs including what they do and the harm they can cause -suggestions for preventing their abuse -identify resources Individuals - patients Parents and family members Merchants Pharmacists Health Care Providers Manufacturers Government Media

We will address… The extent of the problem. How we got here.
-With an emphasis on the 1990s to today What we have to do. -Everyone has a role in this. Individuals - patients Parents and family members Merchants Pharmacists Health Care Providers Manufacturers Government Media

1st Amphetamine epidemic 1929-1971

Alcohol was the most common drug reported, followed by marijuana.
Tobacco not asked for past year – past 30 day use was about 14.5% for 9th and 34.5% for 12th Prescription drug abuse was reported in a number of ways.

National Youth Prevalence
About 20 percent of teens report abusing a prescription medication at least once in their lives. About 15 percent of teens report abuse of a prescription pain reliever in the past year. About 8 percent of teens have abused OTC cough medications in the past year. 2009 Partnership for a Drug-Free America Parents and Teens Attitude Tracking Study Report About 1 in 5 to 10 teens report these abuses. 2006 report not released until they have 2007 data due to discrepancies.

National College Students
College students reporting past-year non-medical use: OxyContin – 3.6% Vicodin – 6.7% Amphetamines – 5.7% Ritalin – 3.2% Sedatives – 3.7% Tranquilizers – 5.0% 2009 Monitoring the Future Survey, University of Michigan

Prevalence of Use More than 1.6 million American teens and young adults misused ADHD drugs during a 12-month period 75,000 became addicted National Institute on Drug Abuse, February, 2006 This may be the result of the increased availability of these drugs. We know from alcohol availability research: The more it is available, the more it is consumed, the more problems that result.

ADHD Drugs According to National Institute on Drug Abuse research:1
More than 5 percent of students reported using ADHD medication without a prescription during the past six months. 9 percent reported doing this since they began college. Nearly 90 percent of these students felt it was effective in helping them study. About 2 percent of respondents said they frequently used nonmedical ADHD medication to get high. Most students using nonmedical ADHD medication tend to be white, belong to a fraternity or sorority, have lower GPAs and engage in substance use and other risky behaviors. A National Institutes of Health study of youth prescribed ADHD drugs found no relationship between having ever received stimulant treatment and the risk of future alcohol or other substance abuse.2 1. Journal of Attention Disorders, December 2008 2. American Journal of Psychiatry, March 2008

Prevalence of Use Of the 9.2 million current users of illicit drugs other than marijuana in 20091: - 7.0 million were non-medical users of psychotherapeutic drugs, of those; - 5.3 million were non-medical users of pain relievers Over 50 million people have used psychotherapeutic drugs non-medically in their lifetimes, of those2; - Nearly 35 million have used prescription pain relievers non-medically 1. National Survey on Drug Use and Health, 2009 (based on people aged 12 and older) 2. National Survey on Drug Use and Health, 2008 (based on people aged 12 and older) There were about 35.5 million people who used illicit drugs in 2008 Psychotherapeutic drugs affect brain action, opioids, stimulants, depressants Prescription drug abuse has always been a problem. It has increased significantly in the past years.

Prevalence of Use The number of people using prescription pain relievers non-medically for the first time increased from: -600,000 in 1990 -2.2 million in 2009 National Survey on Drug Use and Health, 2009

Risk Factors for Painkiller Addiction
People suffering from chronic pain who have been prescribed opioid painkillers - 65 years old or younger, Using psychiatric medications, Or with histories of drug abuse, Or depression were more likely to be addicted to the painkillers. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system, Addiction, September 2010

Prevalence of Use One third of drug abuse in the U.S. is prescription drug abuse. “More than 17 percent of adults over 60, wittingly or not, abuse prescription drugs.” Prevention Alert Volume 6, Number 4, Center for Substance Abuse Prevention, 3/7/03 This is a significant problem. Prescription and OTC use and abuse are not just a youth issue. Prescription and OTC abuse among older adults is of major concern Many falls, much depression and crashes may be related. Especially if alcohol is involved.

Psychotherapeutic Drugs
“drugs that have an effect on the function of the brain and are often used to treat psychiatric disorders.” They include: Opioids – prescribed for pain relief Central Nervous System Depressants – prescribed for anxiety or sleep problems Central Nervous System Stimulants – prescribed for ADHD, obesity and sleep disorders National Institute on Drug Abuse (NIDA) All have the capacity for tolerance and addiction.

Psychotherapeutic Drugs -Opioids-
Codeine, fentanyl, morphine, opium, oxycodone, meperidine, hydromorphone, hydrocodone Include such brand name drugs as: Darvon, OxyContin, Tylox, Percoset, Percodan, Demerol, Vicodin, Dilaudid Street names: China white (fentanyl), M (morphine), gum (opium), percs (Percodan/Percoset), hillbilly heroin (OxyContin), juice (Dilauadid), demmies (Demerol), etc. National Institute on Drug Abuse (NIDA) Recent reports of overdose deaths involving people mixing heroin and fentanyl. Also reports of people biting into fentanyl patches to extract the drug and getting quite ill. Darvon is Propoxyphene Demerol is meperidine Dilaudid is hydromorphone Percodan is aspirin and oxycodone Percoset is acetaminophen and oxycodone

Consequences -Opioids-
Tolerance – need progressively higher doses to achieve the same effects Physical dependence and addiction Severe respiratory depression that can lead to death Withdrawal can include: cold flashes, diarrhea, insomnia, muscle and bone pain and restlessness National Institute on Drug Abuse (NIDA)

Psychotherapeutic Drugs -Central Nervous System Depressants-
Barbiturates, benzodiazepenes, fluntrazepan Include such brand name drugs as: Mebaral, Nembutal, Seconal, Tuinal, Halcion, Valium, Librium, and Rohypnol Street names: barbs (barbiturates), reds (Seconal), phennies (Phenobarbital), tooies, rainbows, Christmas trees (Tuinal), downers (any depressant), tranks (tranquilizers), roofies & rope (Rohypnol), etc. National Institute on Drug Abuse (NIDA) Barbiturates - from mild sedation to coma, and have been used as sedatives, hypnotics, anesthetics, and anticonvulsants Nembutal is Pentobarbital Mebaral is mephobarbital Seconal is secobarbital Tuinal is amobarbital/secobarbital Benzodiazepenes - produce sedation, induce sleep, relieve anxiety and muscle spasms and to prevent seizures. Halcion is triazolam Valium is diazepam Librium is Chlordiazepoxide Xanax is Alprazolam (a diazepene) Rohypnol is flunitrazepam (not allowed for prescription in U.S) for treating insomnia

Consequences -Central Nervous System Depressants-
Lowered inhibitions, confusion, dizziness, impaired judgment, memory and coordination and drowsiness Tolerance Physical dependence and addiction Severe respiratory depression that can lead to death Withdrawal can include seizures National Institute on Drug Abuse (NIDA)

Psychotherapeutic Drugs -Central Nervous System Stimulants-
Amphetamines, cocaine, methamphetamine, methylphenidate Include such brand name drugs as: Dexedrine, Biphetamine, Desoxyn, Ritalin, and Adderall Street names: bennies (benzedrine), crosses & speed (any stimulant), black beauties (Biphetamine), blow, candy, rock & snow (cocaine); crank, crystal & ice (methamphetamine); skippy & vitamin R (Ritalin), etc. National Institute on Drug Abuse (NIDA) Some stimulants used to be prescribed for alertness and weight loss. Even today, military pilots may be given amphetamines for long missions. Biphetamine is Amphetamine/Dexamphetamine Desoxyn is Methamphetamine Hydrochloride Dexedrine is dextroamphetamine Ritalin is Methylphenidate (less potent than amphetamine) Adderall is amphetamine-dextroamphetamine Benzedrine is amphetamine

Consequences -Central Nervous System Stimulants-
Hostility, paranoia, panic, high body temperatures, digestive problems, irregular heartbeat, loss of coordination, possible hallucinations, psychotic episodes, cardiovascular failure, lethal seizures, Tolerance Addiction National Institute on Drug Abuse (NIDA)

Over-the-Counter (OTC) Drugs
Including: Cough and cold medications containing dextromethorphan, alcohol and pseudoephedrine Allergy and sleep aids containing alcohol diphenhydramine and chlorpheniramine maleate. Motion sickness medication containing dimenhydrinate. Weight loss, body-building and alertness products containing caffeine, ephedra, ephedrine and other stimulants Diphenhydramine is an antihistamine and a sedative and a hypnotic in larger doses. Dimenhydrinate, a combination of diphenhydramine and chlorotheophylline ( a stimulant like caffeine) can cause hallucinations. Gravol is brand name for dimenhydrinate Ephedra is ma huang, ephedrine and pseudoephedrine are active ingredients, stimulant effect Outlawed in 2004, reinstated in 2005 by lawsuit and then banned again in 2006 ban is on alkaloids of ephedrine, ephedra viridis (green ephedra or Mormon tea) Ephedrine is similar in structure to amphetamine and methamphetamine Epehdrine (bronchial dialator and pseudoephedrine a decongestant are very similar. There is a trend to make more prescription drugs available over-the-counter. Recent concerns over methamphetamine have increased attention on many OTC drugs Especially ones containing ephedrine and pseudo-ephedrine OTC drugs are very accessible. There are few if any regulations on the marketing or sale of OTC drugs Dietary supplements and cosmetics can be marketed without FDA approval

OTC Slang Over-the-counter cough medicine with dextromethorphan called Dex, syrup, triple-C, robo, vitamin D or tussin. Use may be called robo-ing, robo-tripping and users may be called robo-cops (reference to Robitussin DM). Taking cold and cough pills and tablets called “skittling” (reference to the Skittles). Cough syrup abuse goes back several decades. Codeine cough syrups were originally OTC.

Consequences Possible side-effects of excessive DXM* use:
Loss of balance Increased pulse Cerebral hemorrhages Stroke Permanent coma Hypothermia Loss of consciousness Brain damage Loss of muscle control Seizures Severe high blood pressure Mania *Dextromethorphan Some are obtaining straight DMX and snorting, smoking or injecting it. Hypothermia – temperature drop

Consequences Many cough and cold medications also contain acetaminophen. Large doses can cause liver damage. From 1998 to 2003, acetaminophen was the leading cause of acute liver failure in the United States, with 48% of acetaminophen-related cases associated with accidental overdose.* In January 2011 the FDA asked drug manufacturers to limit the strength of acetaminophen in prescription drug products (usually with opioids) to 325 mg. per dosage unit. No recommendation for OTC products. Acetaminophen is not recommended for people who have more than three alcoholic drinks per day. * Drs. Larson, Davern, et al, Hepatology, December, 2005 Acetaminophen is one of the leading causes of overdose deaths (poisoning) Last year an college student in Oklahoma died from taking it (as much as nine extra-strength Tylenol/day) for a toothache.

Consequences Recommended adult daily dose of acetaminophen is 4000 milligrams or 4 grams. A 6 ounce bottle of NyQuil contains 6 grams of acetaminophen. NyQuil also contains 180 milligrams of dextromethorphan. The recommended adult daily dose is 120 milligrams FDA advisory panel recommended 2600 mg June 2009

Consequences Some allergy, cold and skin rash medications contain chlorpheniramine maleate - can cause brain damage or death in large doses. Motion sickness medications like Dramamine contain dimenhydrinate - can cause hallucinations in large doses.

Consequences Some weight-loss products contain sibutramine, an appetite suppressant that's a chemical cousin of amphetamines. -It can cause heart attacks, strokes and heart palpitations, especially in people with a history of high blood pressure or heart problems. Some contain phenolphthalein, a laxative, which is now being withdrawn from the market because of cancer risks. Some weight-loss and body building products contain hydroxycitric acid, linked to liver problems in at least one medical journal study. -The FDA has recalled at least 14 Hydroxycut products Food and Drug Administration, 2009 FDA banned ephedra products in 2004 and lifted the ban in 2005 under pressure from the industry. And reinstated in 2006

Poly-drug Use Prescription or OTC drugs and alcohol, marijuana and other drugs Stimulants with depressants – “Speedball” Even Viagra with alcohol or illicit drugs Alcohol is a depressant, very dangerous to mix with other depressants, not to mention opioids and stimulants. Causes synergistic depressant effects when mixed with a depressant Speedballs used to be heroin and cocaine, now often methamphetamine and OxyContin. The combination of stimulants and depressants provides opposite messages to the brain and heart and can cause death. Many OTC products contain alcohol, e.g NyQuil

Why the Increase in Use? Many people want a quick fix!
Many experience a high demand for performance: - At school - In athletics - In the business world… They are perceived as “safe and legal” products They are readily available and accessible There is extensive marketing of these products We will address each individually. Societal, familial, peer and workplace demands or perceived demand on performance help create a market for these products.

Safe and Legal Products
In a survey of the perceptions of over 1200 college freshmen: Nonmedical use of prescription painkillers and stimulants is safer than taking cocaine but riskier than smoking marijuana or drinking alcohol Those who perceived use as relatively harmless were 10 times more likely to use them as those who viewed them as highly hazardous Prevention Science Journal, September 2008

Readily Accessible More than half of all insured Americans are taking prescription medicines regularly for chronic health problems Americans buy much more medicine per person than any other country Medco Health Solutions Inc, 2008

Readily Accessible – Families, Friends and Homes
Prescription and OTC drugs are in most of our homes. Many young people taking them from their own or other people’s homes. There are reports of visitors to real estate open houses and garage sales taking them. Many people offer remedies to others There are increasingly frequent stories of young people obtaining their prescription and OTC drugs from their own or other’s homes. A real estate agent in Minnetonka was arrested for stealing prescription drugs from homes in July, 2008. You have a headache, your back hurts, you’re stuffed up…often someone with the best intentions will offer their medications to someone else to relieve their suffering.

Readily Accessible - Stores
Many OTC medications are prominently displayed, depending on the season. They are easily purchased or stolen. Medications containing ephedrine and pseudo-ephedrine are now behind the counter by federal law. Oregon and Mississippi require a prescription for any drugs containing pseudo-ephedrine. Some states have considered putting medications containing dextromethorphan behind the counter. One Maryland supermarket chain banned sales of medications containing dextromethorphan to people under age 18. These products are sold in numerous kinds of stores including drug stores, convenience stores, grocery stores and “big box” stores as well as health and wellness stores. They are often displayed on end caps depending on the store and the season, e.g., cold and cough medications during the winter, allergy medications in the spring and summer. MN law on ephedrine and pseudo-ephedrine went into effect July 1, 2005. -Products are behind the counter, -purchases are registered and -quantities are limited. National law in 2006

Readily Accessible - Prescriptions
Physicians report that half of the requests they receive for advertised drugs are inappropriate choices for the patients. Yet physicians fill about two-thirds of such requests, including about 6% that might actually be harmful.1 Spending on prescription drugs in the U.S. increased from $40.3 billion in 1990 to $234.1 billion in From 1999 to 2009 the number of prescriptions dispensed rose 39% (from 2.8 billion to 3.9 billion) compared to a U.S. population growth of only 9% over the same period.2 1. FDA Weighs Limits for Online Ads, Journal of the American Medical Association, January 2010 2. Kaiser Family Foundation, 2010

More than 40 percent of physicians did not ask about prescription drug abuse when taking a patient’s health history. One-third did not regularly call or obtain records from the patient’s previous (or other treating) physician before prescribing controlled (substances). 47.1 percent said that patients commonly tried to pressure them into prescribing a controlled drug. Controlled Prescription Drug Abuse at Epidemic Level, Center on Addiction and Substance Abuse, July, 2005 Patients are asking for drugs by name.

Nearly thirty percent of pharmacists did not regularly validate the prescribing physician’s information (DEA number) when dispensing controlled drugs. Three-fifths (61 percent) did not regularly ask if the patient is taking any other controlled drugs when dispensing a controlled medication. From 1992 to 2002, prescriptions written for controlled drugs increased more than 150 percent Controlled Prescription Drug Abuse at Epidemic Level, Center on Addiction and Substance Abuse, July, 2005 40% of patients could not name drugs they are taking 60% for those with low health literacy

Over the past 10 years, drug and device companies have increased their funding medical education meetings by over 300 percent, according to industry figures. Companies now provide more than half of the $2.5 billion spent annually on medical education. Companies can see a return of $3 in sales for every $1 spent on medical education, according to an industry study. U.S. Department of Health and Human Services, July 2009

We All Have a Role in This!
Among persons aged 12 or older who used pain relievers non-medically in the past 12 months: 55.3 percent reported in that they got them from a friend or relative for free. 9.9 percent bought the drugs from a friend or family member. 5.0 percent stole them from a friend or relative. 17.6 percent reported they got the drugs from just one doctor. Only 4.8 percent got the pain relievers from a drug dealer or other stranger, and Only 0.4 percent reported buying the drug on the Internet. National Survey on Drug Use and Health, 2009 70.6% from friends or relatives one way or another

We All Have a Role in This!
According to recent research in Utah: 97 percent of individuals who misused painkillers like Vicodin and OxyContin said that they got the drug from a friend or relative with a prescription. 85.2 percent said friends or relatives gave them the drug willingly. 9.8 percent said they took the drug from friends or relatives without their knowledge. 4.1 percent of those surveyed said they had bought the drug. Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, Feb. 19, 2010

Extensive Marketing Advertising Print Broadcast – even “info-mercials”
First appeared in magazines in doctors’ offices Then in magazines and newspapers for the public Broadcast – even “info-mercials” U.S is one of two industrialized countries allowing broadcast ads for prescription drugs Pharmaceutical companies have increased their spending on direct-to-consumer advertising 330 percent since 1996* They spend almost $30 billion annually to promote their products FDA has been issuing fewer warnings to pharmaceutical firms about their ads. In 2006, only 21 warning letters were issued, compared to 142 in 1997. FDA announced it will study whether style of ads distracts consumers from warnings about the drugs' risks (August, 2007) *The New England Journal of Medicine, August 2007 From early twentieth century until late in the century there was not direct advertising to consumers. Direct-to-consumer drug advertising, approved by the Food and Drug Administration in 1997, has sent the message that pills offer a cure for any ill. Which ones to take, many advertisements suggest, is largely a matter of personal choice. Watch evening network national news broadcasts and pay attention to the ads. Many prescription and OTC drug ads. Cable TV infomercials for weight-loss and body building products Look at the displays at health food stores You have a headache, your back hurts, you’re stuffed up…often someone with the best intentions will offer their medications to someone else to relieve their suffering.

FDA Draft Guidelines on Advertising and Promotion
Television ads for drugs and medical devices should: Avoid distracting images and music that can reduce viewers' comprehension of potential side effects Use similar type styles and voice-overs when conveying benefits and risks Not use contrasting colors to highlight information, nor alter the location and timing of risk details and other factors that can influence how well viewers understand a product Not use busy scenes, frequent scene changes and moving camera angles “(that) can misleadingly minimize the risks of the product being promoted by detracting from the audience's comprehension” Not speed up an announcer's description of risks Draft Guidance for Industry Presenting Risk Information in Prescription Drug and Medical Device Promotion , FDA, May 2009 This guidance document is being distributed for comment purposes only for 90 days

Extensive Marketing Internet In-Store
Many prescription and over-the-counter ads on a variety of websites In-Store End caps, positioning on shelves, displays Marketing to youth including social media sites like Facebook, and text messaging Word-of-mouth

One Example: The Marketing of OxyContin
Purdue Pharma introduced OxyContin in1996 Targeted the highest prescribers for opioids across the country Bonus system for sales reps ranging from $15,000 to nearly $240,000 ($40 million total in 2001) Distributed 34,000 “starter” coupons Branded promotional items for physicians (fishing hats, stuffed toys and music CDs) The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy, American Journal of Public Health, February, 2009 They aggressively promoted OxyContin in the “non-malignant” pain market which is much larger than the cancer market. All the while there was little or no evidence that it was any better than generic oxycodone given four times a day And they minimized the worries about the risk of addiction. On May 10, 2007, Purdue Frederick Company Inc, an affiliate of Purdue Pharma, along with 3 company executives, pled guilty to criminal charges of misbranding OxyContin by claiming that it was less addictive and less subject to abuse and diversion than other opioids, and will pay $634 million in fines

The Marketing of OxyContin
From 1996 to 2000, increased internal sales force from 318 to 671 Sales grew from $48 million in1996 to almost $1.1 billion in 2001 In 2001, the company spent $200 million to market and promote OxyContin. By 2004 OxyContin had become a leading drug of abuse in the United States The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy, American Journal of Public Health, February, 2009

Aggressively promoted OxyContin in the “non-malignant” pain market which is much larger than the cancer market. Minimized the worries about the risk of addiction. From 1995 to 2001, the number of patients treated for opioid abuse in Maine increased 460 percent. The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy, American Journal of Public Health, February, 2009

On May 10, 2007, Purdue Frederick Company Inc, an affiliate of Purdue Pharma, along with 3 company executives, pled guilty to criminal charges of misbranding OxyContin by claiming that it was less addictive and less subject to abuse and diversion than other opioids, and They were ordered to pay $634 million in fines. The 3 executives have been barred from doing business with Medicare or any taxpayer-funded healthcare program for 12 years. The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy, American Journal of Public Health, February, 2009

And the Results Are… The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores in 2005 enough to give more than 300 milligrams of painkillers to every person in the country Hydrocodone with acetaminophen was the most commonly prescribed drug in million retail prescriptions.2 1. Associated Press analysis of Drug Enforcement Administration data, August 2007 2. IMS National Prescription Audit, IMS Health, 2010

And the Results Are… US residents have more than tripled their spending on prescription pain killers for outpatient use from $4.2 billion in 1996 to $13.2 billion in The average amount spent per pain killer purchase more than doubled during the same period, from $26 to $571. The percent of treatment admissions involving prescription pain relievers more than quadrupled from 2.2% in 1998 to 9.8% in 1. Agency for Healthcare Research and Quality, Published in JAMA, March 25, 2009 2. Treatment Episode Data Set (TEDS); Substance Abuse and Mental Health Services Administration, 2010

And the Results Are… More than 19 million prescriptions for ADHD drugs were filled in 2002 -up 72 percent from Use of antidepressant drugs in the United States doubled between 1996 and 2005, 6% or 13 million people in 1996 10% or 27 million people in 20052 1. Prevention Alert Volume 6, Number 4, Center for Substance Abuse Prevention, 3/7/03 2. Archives of General Psychiatry, August 2009

And the Results Are… From prescription use of ADHD drugs among adults ages doubled. During the same period prescription use of ADHD drugs rose: 113 percent among women 20-44, 104 percent among women 45-64, 56 percent among youth, and Sales increased from $759 million to $3.1 billion. Medco Health Solutions, September 2005 Advertising of the drugs has greatly increased It has been targeted at parents of children with ADHD in magazines and on TV

And the Results Are… More than 164 million prescriptions were written in 2008 for antidepressants, totaling $9.6 billion in U.S. sales, according to IMS Health Promotional spending for antidepressants increased slightly between 1999 ($0.98 billion) and 2005 ($1.02 billion), But, there was a marked increase in the percentage of spending on direct-to consumer advertising, from 3.3 percent ($32 million) to 12 percent ($ million) Archives of General Psychiatry, August 2009

And the Results are… 81 percent of American children who visited a doctor for help combating sleep problems were given some form of prescription medication, despite the fact that no sleeping pills are currently approved for use in children 7 percent of the patients were recommended diet and nutritional counseling, 22 percent were offered behavioral therapy 17 percent of patients were offered mental health and stress management treatment Milap C. Nahata, Pharm.D., Gregg Jacobs, M.D., Sleep, Aug. 1, 2007

And the Results are… ED visits caused by misuse of pharmaceuticals are rapidly increasing while visits caused by illicit drugs remain steady. Estimated ED visits from all drug use was: 1.6 million in 2004 1 million were from illicit drugs 2.3 million in 2009 Substance Abuse and Mental Health Services Administration (SAMHSA) 2011

And the Results are… Unintentional poisoning deaths (95% are drug overdoses) increased from 12,186 in 1999 to 26,389 in 2006. During that time, prescription drugs overtook cocaine and heroin combined as the leading cause of lethal overdoses Opioid painkillers were involved in more than half the deaths, but deaths from drugs such as sleeping pills, antidepressants, and tranquilizers increased 84 percent during the same period. Centers for Disease Control and Prevention, 2008 and 2010

And the Results are… The leading cause of accidental poisonings among American children can be found in the family medicine cabinet. More than 71,000 children 18 and younger are seen in emergency rooms annually for unintentional overdoses of prescription and over-the-counter drugs. More than two-thirds of emergency department visits are due to poisoning from prescription and over-the-counter medications -- more than double the rate of childhood poisonings caused by household cleaning products, plants and the like. American Journal of Preventive Medicine , September 2009 Immunosupressive drugs, anti-inflammatory, antibodies

And the Results Are… A vast array of pharmaceuticals -- including antibiotics, anti-convulsants, mood stabilizers and sex hormones -- have been found in the drinking water supplies of at least 41 million Americans The presence of prescription drugs -- and over-the-counter medicines such as acetaminophen and ibuprofen could have long-term consequences for human health. Bottled water and home filtration systems don't necessarily avoid exposure. They do not typically treat or test for pharmaceuticals, according to the industry's main trade group. Analysis of scientific reports and public water system databases by Associated Press, March 2008

Prevention Strategies
Primary prevention – A drug is a drug is a drug! Use a comprehensive approach Educate everyone Youth, families, older adults, providers, pharmacists, merchants Use consistent and persistent messages Make substances less accessible Secure prescription and OTC medications at home and in stores Encourage and make easy disposal of unused medications Address Internet availability Examine norms Implement and enforce policies Enforce laws about use and possession including operating vehicles under the influence The primary prevention of all mood-altering substances is essentially the same Need to use a comprehensive approach reaching everyone with consistent and congruent messages address norms look at policies including enforcement Physicians, pharmacists, merchants and parents need to understand the problem and realize the roles they can play to reduce it. It may be hard to do anything about what is available on the Internet, but parents can play a role in reducing their children’s ability to obtain things from the Internet.

Prevention Strategies
Address issues like mental health, obesity, stress and performance in healthy, appropriate ways: Treatment and therapy Healthy choices Older adult use including: Alcohol use and drugs Mixing drugs – contraindications Right dose

Resources Minnesota Prevention Resource Center
or 800/ or National Institute on Drug Abuse Prevention Online Minnesota Department of Health

Resources Do the Right Dose http://asyouage.samhsa.gov/dotherightdose/
Minnesota Pharmacists Association Medline Plus (drugs, supplements, and herbal information)

Contact Information Jay Jaffee Or go to our website:

Prescription and Over-the-Counter Drug Use

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