Presentation on theme: "1 Nonmedical Use of Prescription Drugs Facts & Statistics Plus College Supplement."— Presentation transcript:
1 Nonmedical Use of Prescription Drugs Facts & Statistics Plus College Supplement
2 1. What is Nonmedical use of Prescription Drugs? Where do nonmedical users get prescription drugs? Which prescription drugs are abused? 2. What are the Myths about Prescription Drug Use? 3. What are Stimulants ? Basic Facts, Signs of Abuse, Addiction, Withdrawal, Overdose… 4. What are Depressants (Narcotics & Sedatives)? Basic Facts, Signs of Abuse, Addiction, Withdrawal, Overdose… How can one OxyContin pill kill you? 5. What are the drug delivery methods? 6. Are Over-the-Counter Drugs Dangerous? 7. What drugs are abused among college students? College Facts about Adderall® abuse. Where does marijuana and alcohol fit into the statistics? What are the consequences of substance abuse? 8. What is the reality of prescription drug misuse?
33 Office of Applied Studies, SAMHSA Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees November 13, 2008 Not prescribed for you OR You took the drug only for the experience or feeling it caused (Excludes Over-the-Counter) 1. What is Nonmedical use of Prescription Drugs?
4 Where do nonmedical users get pain reliever prescription drugs?
5 Stimulants Sedatives 4.7 million 0.3 million Narcotic Pain Relievers Anti-Anxiety Medication 1.1 million SOURCE: 2005 National Survey on Drug Use and Health (NSDUH), published Sept 2005 by Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA) 1.8 million In 2005, 6.4 million Americans Age 12+ used a prescription drug for nonmedical purposes in past month Which prescription drugs abused? Depressants Stimulants n+Americans+Age+12%2B+used+a+prescription+drug+for+nonmedical+purposes+in+past+ month&btnG=Search&aq=f&oq=&aqihttp://www.google.com/search?hl=en&rlz=1G1GGLQ_ENUS310&q=In+2005%2C+6.4+millio n+Americans+Age+12%2B+used+a+prescription+drug+for+nonmedical+purposes+in+past+ month&btnG=Search&aq=f&oq=&aqi=
6 SOURCE: 2004 National Survey on Drug Use and Health (NSDUH) published Sept 2005 by the Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA) Nonmedical use of prescription drugs ranks 2 nd only to marijuana as the most prevalent category of drug abuse. Depressants Stimulants
77 Prescription Drugs are much safer to use than illegal drugs. I think prescription drugs sound safer, even if they're not, just because they came from a company, and they were prescribed to someone for a legitimate reason. I don't know the laws regarding illegal pharmaceutical use, but it seems safer. Gilbert Quintero. Journal of American College Health. July-August 2009 v58 i1 p64(7). Theres nothing wrong with using prescription medicines without a prescription once in a while. Prescription Drugs are not addictive. There are fewer side effects than street drugs Partnership and Attitude Study (PATS) 2. What are the Myths about Prescription Drug Use?
8 Amphetamines Methamphetamines Amphetamine Congeners Diet Pills Intended Use: Narcolepsy, Obesity, Attention-deficit hyperactivity disorder (ADHD), Milder stimulants to lose weight. Nonmedical use: Surge of pleasure, rush or flash, burst of energy, To stay awake, Anorexia, Euphoric Effect Physical effects: include increased blood pressure and pulse rates, insomnia, loss of appetite, and physical exhaustion. Drugs causing similar effects cocaine, crack, methamphetamine, khat 3. Prescription Drug: STIMULANTS
10 Prescription Drug STIMULANTS Amphetamines d,l amphetamines: Adderall Slangs: Crosstops, whites, speed, black beauties, bennies, pep pills, carwheels, addies Dextroamphetamine: Dexedrine Slangs: Brown & Clears, Christmas Trees, Oranges, Diet Pills, Dex, Dexies, Methamphetamine: Desoxyn ® (rarely prescribed) Slangs: Yaba (pills) Amphetamines Congeners Methylphenidate: Ritalin®, Focalin®, Concerta®, Methylin®, Day Trana Patch®, MetadateCD®, Slangs- Pellets, Vitamin R, JIF, MPH, R-ball, the smart drug, Skippy, West Coast Lisdexamfetamine: Vyvanse® Fenfluramine:Pondimin® (Banned in the US) Slangs: Fen/phen, Hearts, Cis, Goofy, Lude, Bama, Peaches Other abused stimulants Modafinil: Provigil® Sibutramine: Meridia® Over-the-Counter Dexatarim®, Acutrim®, Sudafed®, Super Toot® Caffeine, energy drinks, and nicotine Diet pills Phendimetrazine: Bontril® Phentermine: Adipex P® Slangs: Blasting Caps, Chi Powder, Diet Max, Diet Pep Ephedra, 850 Herbal Fuel, Mega Ripped, Mini thins, New Zest Now, Ripped Fuel
11 Signs of Abuse Nervousness, insomnia, over confident, aggressive, paranoid, loss of appetite, violent, euphoria, increased pulse rate & blood pressure. Signs of Withdrawal Apathy, long periods of sleep, irritability, depression, disorientation. Signs of an Overdose Agitation, increased body temperature, hallucinations, convulsions, apathy, long periods of sleep, depression, disorientation & possible death. Signs of Long-term Use Heart disease, mental imbalances, paranoid, aggressive, twitching, malnutrition, dehydration & psychotic, deplete energy sources & severe depression. Prescription Drug STIMULANTS
DATA Rates of Emergency Department visits, by drug, type of use and age
13 Cocaine- Slangs: Coke, Blow, Toot, Snow, Nose, Big C, Crack Cocaine – Slangs: Basa, Base, Basing, Black Rock, CDs, Twinkie. This form of cocaine comes in a rock crystal that can be heated and its vapors smoked. The term "crack" comes from the crackling sound made when it is heated. Methamphetamine- See next slide Methyldioxymethamphetamine- MDA,MDMA Slangs: Ecstasy, rave, love drug, XTC, Adam *No one other drug is quite like MDMA, but MDMA produces both amphetamine-like stimulation and mild mescaline-like hallucinations. *tweaking- severe paranoid, hallucinatory, hyper vigilant thinking, & greater suicidal depression Illegal Comparisons or Not considered legitimate for medical use: STIMULANTS Ecstasy CocaineCrack CocaineParaphernalia Crack Pipe
14 Methamphetamine (Desoxyn®) vs. Methamphetamine (Crank) Desoxyn®: There is only one product. Currently marketed in 5 mg tablets. Desoxyn® has very limited use in the treatment of obesity, and attention deficit hyperactivity disorder. Slangs: Yaba (pill form) Meth Illicit Use: Today's methamphetamine, several times more potent than its other forms, produces a reaction far more severe than even crack cocaine, with sleepless binges that last up to 15 days and end with sudden crashes. Meth abuse is also manifested by extreme anorexia, memory loss and severe dental problems. Slangs: Batu, Black Beauties, Chalk, Chicken Feed, Tina, Crank, Crystal, Glass, Go-Fast, Hiropon, Ice, Meth, Trash, Methlies Quick, Shabu, Poor Man's Cocaine, Shards, Speed, Stove Top, Tweak, Ventana, Vidrio, Yellow Bam Meth speed ball- Methamphetamine combined with heroin Crystal Meth Meth Powder Desoxyn®
15 Currently, methamphetamine is primarily produced by utilizing diverted pseudoephedrine combination products. (Now behind the counter at stores.) Smurfing is a method used by some methamphetamine and precursor chemical traffickers to acquire large quantities of pseudoephedrine. Traffickers often enlist the assistance of several associates in smurfing operations to increase the speed with which chemicals are acquired. Methamphetamine causes increased heart rate and blood pressure and can cause irreversible damage to blood vessels in the brain, producing strokes. Other effects of methamphetamine include respiratory problems, irregular heartbeat, and extreme anorexia. Its use can result in cardiovascular collapse and death. Meth changes brain chemistry, and after extended use, the brain can no longer respond to dopamine (feel-good chemical produced by the brain). Chronic abuse produces a psychosis that resembles schizophrenia. Psychotic symptoms can persist for months and even years after use of these drugs has ceased and may be related to their neurotoxic effects Methamphetamine (Desoxyn®) vs. Methamphetamine (Crank) pg. 2
16 Sedative-Hypnotics and Narcotics/Opiates Physical Effects: With the exception of pain relief and cough suppression, most central nervous system depressants (like opiates, benzodiazepines and alcohol) have similar effects, including the slowed breathing, tolerance and dependence. ** Alcohol is a depressant and illegal for people under the age of 21 in the United States. 4. Prescription Drug Depressants
17 4. Prescription Drug Depressants- Sedative/Hypnotics Intended Use: Anxiety, Tension, Panic attacks, Acute stress reactions, Seizures, Sleep disorders, Epilepsy, Anesthesia (at high doses), Muscle Relaxants. Nonmedical Use: To relieve agitation, induce mild euphoria, lower inhibitions. Often use in conjunction with other drugs. Very similar to the emotional and physical effects of alcohol. Blackout, brownouts, suicide attempts. Date Rape Drug
20 Signs of Abuse Slurred speech, disorientation, drunken behavior without odor of alcohol, impaired memory of events, interacts with alcohol. Signs of Withdrawal Headaches, tremors, muscles twitching, nausea and vomiting, anxiety, restlessness, yawing, inability to focus, sleep disturbance, dizziness, delirium, convulsions, possible death. Signs of an Overdose Shallow respiration, clammy skin, dilated pupils, weak and rapid pulse, coma, possible death. Signs of Long-term Use Disrupt the transfer of information from short to long-term memory. Benzodiazepines: impair the ability to learn new information. Prescription Drug Depressants- Sedative/Hypnotics
21 Benzodiazepines: Flunitrazepam- Rohypnol® (banned in the US but legal in over 60 countries) Slangs- Forget-me pill, Mexican Valium, R2, Roche, roofies, roofinol, rope, rophies A small white tablet with no taste or odor when dissolved in a drink. Short Term effects: The drug creates a sleepy, relaxed, and drunk feeling that lasts 2 to 8 hours. Other effects may include blackouts, with a compete loss of memory, dizziness and disorientation, nausea, difficulty with motor movements and speaking. Illegal Comparisons or Not considered legitimate for medical use: Sedative/Hypnotics
22 Prescription Drug Depressants-Narcotics/Opiates Intended Use: Postsurgical pain relief, Management of acute or chronic pain, Relief of cough and diarrhea Nonmedical Use: Deaden emotional pain, Get a rush, Induce euphoria Prevent withdrawal symptoms. There is no limit to the development of opiod tolerance.
23 Lifetime Nonmedical Use of Selected Pain Relievers, Age 12 or Older: Percent Using in Lifetime Ultram ® Methadone Morphine Demerol ® OxyContin ® Codeine Hydrocodone Percocet ®, Percodan ®, or Tylox ® Darvocet ®, Darvon ®, or Tylenol ® with Codeine Vicodin ®, Lortab ®, or Lorcet ® Hydrocodone Oxycodone Office of Applied Studies, SAMHSA Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees November 13, 2008 Propoxyphene (Darvocet and Darvon) Oxycodone Hydrocodone
24 Office of Applied Studies, SAMHSA Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 13, Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Sub state Region: Percentages, Annual Averages Based on
26 Prescription Drug Narcotics/Opiates Natural Codeine: Slangs: Number 4s, Loads, sets, 4s, and doors. Tylenol ® w/codeine Fioricet ® w/codeine Morphine: Infumorph®, Kadian®, Avinza® Slangs: Murphy, orph, M, Miss Emma Opium: Laudanum ®, Slangs:O, Black stuff Block, poppy, Big O Semi-synthetic Hydrocodone & acetaminophen : Vicodin®,Lortab®,Lorcet®,Zydone®, Tussionex® Slangs: Vike, Vic, Watson 387, Tuss Oxycodone: Percodan® (w/aspirn) Percocet® & Tylox® (w/acetaminophen) Combunox® (w/ibuprofen ),OxyFAST ®, OxyContin® (time-released) Slangs: Percs, hillbilly heroin, ocs, oxy, oxy-80s, oxycotton, kicker, blues, Roxi. Meperidine: Dermol® Hydromorphone: Dilaudid®, Hydal® Slangs: Dillies, drugstore heroin, Big D, Lords, Delats Synthetic Methadone : (long-acting) Dolophine® Slangs: Juice, Wafers, Amidone, Chocolate Chip Cookies, Fizzies, Maria, Pastora Propoxyphene (w/acetaminophen ): Darvon®, Darvocet® Fentanly: Duragesic ® Sublimaze ® Slangs: Murder, Bear, China white, Apache, Good fellas, TNT B uprenorphonine : Suboxone®, Puprenex® Slangs: Bupe, sub
27 Signs of Abuse Pinpoint pupils, sluggishness, shallow breathing and suppressed cough, slow pulse, low blood pressure, constipations, dryness of mouth, euphoria, numbness, slurred speech, sunken eyes. Signs of Withdrawal Flu-like symptoms, muscle cramps, dilated pupils, coughing, high blood pressure, rapid pulse, diarrhea, sweating, runny nose, anxiety, severe depression, loss of appetite, irritability, tremors, panic and vomiting Signs of an Overdose Slow and shallow breathing, clammy skin, convulsions, coma, possible death. A single dose can be lethal to an inexperienced user. Signs of Long-term Use Severe constipation, womens period delayed, sexual desire dulled. Heavier users- eyelids droop and the head nods forward, coordinating slowed. High tolerance and addiction. Prescription Drug Narcotics/Opiates
28 Illegal Comparisons: Heroin Slangs: Smack, junk, tar, Mexican brown, cheese, Harry, skag, Rufus, Perze,H, hourse, dava, boy Vick, Vic, Watson 387 Related Terms: Agua de chango (liquid heroin administered nasally) Bindle (small packet of drug powder; heroin); Coffee (brown heroin); Chasing the dragon or chasing the tiger (to smoke heroin) Nose drops (liquified heroin); P-dope (20-30% pure heroin) Punk Rocker (with cocaine, with crack, with Ecstasy (MDMA), or with LSD and marijuana) Shabanging (heroin dissolved in liquid & taken through the nose using a nasal spray bottle) Heroin is processed from morphine (a naturally occurring substance extracted from the seed pod ). It comes in several forms, the main ones being "black tar" from Mexico (primarily sold in the western United States) and white heroin from Colombia (primarily sold on the East Coast.) Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the CNS. Prescription Drug Narcotics/Opiates
29 Taking a large single dose could cause severe respiratory depression or death. Typically, they should not be used with alcohol, antihistamines, barbiturates, or benzodiazepines. Because these other substances slow breathing, their effects in combination with opioids could lead to life-threatening respiratory depression. *There is always the factor that someone has an lethal reaction to any drug. How can one OxyContin pill kill you?
30 Under normal conditions, excitatory and inhibitory signals are in balance, resulting in controlled, regular breathing. Excitatory signal Inhibitory signal Heroin increases the inhibitory effects of GABA. (Increases the calming effect.) Alcohol decreases the excitatory effects of glutamate Under the influence of alcohol or heroin, excitatory and inhibitory signals are out of balance, suppressing the impulse to breath rd/pathways.html A combination of heroin and alcohol can be especially dangerous. Heroin and alcohol both suppress breathing, but by different mechanisms. Many of the drugs of abuse affect either glutamate or GABA or both to exert tranquilizing or stimulating effects on the brain. Over half of all brain synapses release glutamate, and 30-40% of all brain synapses release GABA. (gamma-amino butyric acid) Neurotransmitters brain's major "workhorse"
31 5. What are the drug delivery methods? The fastest way to get a drug to the brain is by smoking it. When a drug like tobacco smoke is taken into the lungs, nicotine (the addictive chemical in tobacco) seeps into lung blood where it can quickly travel to the brain. This fast delivery is one reason smoking cigarettes is so addicting. Injecting a drug directly into a blood vessel is the second fastest way to get a drug to the brain, followed by snorting or sniffing it through the nose. The slowest mode of delivery is by ingestion, such as drinking alcohol. The effects of alcohol take many minutes rather than a few seconds to cause behavioral and biological changes in the brain. The euphoric effects usually occur when they are crushed and then snorted or injected.
32 Some over-the-counter (OTC) drugs, primarily cough and cold remedies that contain dextromethorphan (DXM), a cough suppressant, are used to get high. Products with DXM include NyQuil®, Coricidin®, and Robitussin®, among others. Slangs: CCC, Dex, DXM, Poor Man's PCP, Robo, Rojo, Skittles, Triple C, Velvet Illicit use of DXM is referred to on the street as "Robo-tripping," "skittling or dexing." Hallucinogenic: Drugs causing similar effects: Depending on the dose, DXM can have effects similar to marijuana or Ecstasy. In high doses its out-of- body effects are similar to those of Ketamine or PCP. In 2006, about 3.1 million people aged 12 to 25 had used an OTC cough and cold medication at least once to get high, and nearly one million had done so in the past year. (SAMHSA, 2008) Are Over-the-Counter Drugs Dangerous?
33 6. Are Over-the-Counter Drugs Dangerous? Retailers are required of non-prescription products containing pseudoephedrine, ephedrine and phenylpropanolamine to place these products behind the counter or in a locked cabinet. (Methamphetamine is primarily produced by utilizing diverted pseudoephedrine combination products.) Pseudoephedrine products include- Drixoral, Zyrtec-D 12-Hour, Advil Allergy Sinus, Mucinex D, Childrens Motrin Cold, Sine-Aid IB, Claritin-D 24 Hour, Sudafed 24 & 12 Hours, Afrinol. Photo shows chemicals, waste materials, & empty pseudoephedrine blister packs.
% binge drink (alcohol) 33.3% of College students smoke pot 20.9% abuse prescription and/or illegal drugs 22.9% of College Students (1.8 Million) Meet Medical Criteria for Alcohol, Drug Abuse or Dependence- compared to 8.5% of the general population Abuse prescription opioids 3.1% or 240,000 students Source: CASAs analysis of the 2005 National Survey on Drug Use and Health 7. What drugs are abused among college students?
35 At the college level, the prevalence of nonmedical opioid use co-occurred with a high prevalence of marijuana use and nonmedical use of prescription stimulants; and to a lesser extent with binge drinking. Nonmedical use of prescription opioids among U.S. college students: Prevalence and correlates from a national survey Sean Esteban McCabea,*, Christian J. Teterb, Carol J. Boyda,John R. Knightc, Henry Wechslerd Addictive Behaviors 30 (2005) 789–805 Colleges with the highest rates of marijuana use and other illicit drug use calculated in 1993 had the highest rate of NMPD in every study year between 1993 and Trends and college-level characteristics associated with the non-medical use of prescription drugs among US college students from 1993 to 2001 Sean Esteban McCabe1, Brady T. West2 & Henry Wechsler3
36 Marijuana Slangs: Blunt, Pot, Grass, Reefer, Ganja, Joint, Weed, Mary Jane, Sinsemilla, Roach, Thai Sticks, Smoke, and Dope. Is a greenish-gray mixture of the dried, shredded leaves, stems, seeds, and flowers of Cannabis sativa, the hemp plant. Most users smoke marijuana in hand-rolled cigarettes called joints, among other names; some use pipes or water pipes called bongs. Marijuana cigars called blunts have also become popular. To make blunts, users slice open cigars and replace the tobacco with marijuana, often combined with another drug, such as crack cocaine. Marijuana frequently is combined with other drugs, such as crack cocaine, PCP, formaldehyde, and codeine cough syrup, sometimes without the user being aware of it % of College Students Smoke Pot Blunt Bong Joints & Pipe Roach Clips
37 Within a few minutes after inhaling marijuana smoke, an individuals heart begins beating more rapidly, the bronchial passages relax and become enlarged, and blood vessels in the eyes expand, making the eyes look red. The heart rate, normally 70 to 80 beats per minute, may increase by 20 to 50 beats per minute or, in some cases, even double. This effect can be greater if other drugs are taken with marijuana. June Marijuana potency increased last year to the highest level in more than 30 years, posing greater health risks to people who may view the drug as harmless, according to a report released by the White House.
Opioid use tripled the past two years. Benzodiazepines, particularly, Xanax® and Valium® use quadrupled the past two years. (CASA, 2007). College Students: Prescription Drug Abuse
39 Of concern, 89.5 percent of the college students who used Adderall® non-medically also reported past-month binge drinking, and more than half were heavy alcohol users.
40 Full-time college students aged 18 to 22 were twice as likely as their counterparts who were not full-time college students to have used Adderall® non-medically in the past year (6.4 vs. 3.0 percent)
41 Tranquilizers Sedatives OxyContin® Pain Relievers Full-time college students who used Adderall ® non-medically in the past year were more than twice as likely to use Marijuana (79.9 vs percent) and almost FIVE times more likely to use OxyContin non-medically (44.9 vs. 8.6 percent).
42 Where does marijuana fit into the statistics? In the past year, 84 percent used illicit drugs, two-thirds used marijuana, and two-thirds abused prescription drugs. Source: CASAs analysis of the 2005 National Survey on Drug Use and Health
43 Tragic Consequences of Alcohol Abuse 1,717 students died from alcohol-related injuries (2001) This is 5 students/day 97,000 students victims of alcohol-related sexual assaults or rape (2001) 696,000 students assaulted by other students who were drinking (2001) 78% of college students who use illicit drugs have sex compared with 44% of those who never use drugs Source: CASAs analysis of the 2005 National Survey on Drug Use and Health
44 There was no gender difference in the nonmedical use of opioid analgesics, which is consistent with other national samples of college students (Johnston et al., 2003a). Higher rates of substance use and other risky behaviors and lower grade point averages found among nonmedical users of prescription opioid analgesics provides evidence that nonmedical use of prescription opioid analgesics is part of a pattern of polydrug use and likely represents part of a larger cluster of problem behaviors among college students (Jessor, Donovan, & Costa, 1991). Nonmedical use of prescription opioids among U.S. college students: Prevalence and correlates from a national survey Sean Esteban McCabea,*, Christian J. Teterb, Carol J. Boyda,John R. Knightc, Henry Wechslerd Addictive Behaviors 30 (2005) 789–805
45 8. What is the Reality of Prescription Drug Misuse?
46 According to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, unintentional overdose deaths* involving prescription opioids increased 114 percent from 2001 (3,994) to 2005 (8,541), the most recent nationwide data available. Narcotic Prescription Drugs Only -Unintentional Overdose Deaths *Does not include people prescribed drugs who died nor intentional overdoses (suicides).
47 The reality is that brothers, grandparents, friends, moms, uncles… are dying everyday due to misuse of prescription drugs. Dont regret ignoring the problem.
48 At the age of 22, Josh was prescribed OxyContin after a back injury. He got hooked and overdosed three times, before a he took a combination of three prescribed drugs that killed him -one day before his 25th birthday. Joshs doctors were aware of his addiction problem and continued to prescribed him narcotic drugs.
49 On August 18th, 2006, Emily, only eighteen years of age and three days from her first day in college, was killed accidentally when she consumed OxyContin that had been prescribed for a relative. Emily was not an experienced drug user, and all it took was one encounter with this drug. She had no chance to learn from this one-time experience. Had she any idea how deadly this drug was, she would still be alive.
50 Patrick Stewart died on July 9, 2004 at 24 years of age after ingesting just one OxyContin ®. He had no other drugs in his system and only a small amount of alcohol. He was a SDSU graduate, a graphic designer and a certified personal trainer. His friends described Patrick as "the one who puts you back on your bicycle after you fall off". He made the tragic mistake of believing someone at a 4th of July celebration when he was told that OxyContin was "sort of like a muscle relaxant, that it was prescription and FDA approved, so therefore safe". Close friends say that Patrick had never before taken an OxyContin, did not know it was equivalent to "heroin in a pill".
51 Robby L. Garvin 24 years old Died Death caused by Methadone toxicity. Robby died 40 hours after he took his first dose of this drug that was prescribed to him for pain. Robby was never informed by the prescribing doctor or the pharmacy that filled this prescription of the dangers and possible death that Methadone may cause.
52 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. Dont regret ignoring the problem. For additional information on prescription drug abuse, addiction, support groups, and recovery please visit