1 Alcohol and Substance Abuse Council of Jefferson County, Inc. 167 Polk Street, Suite 320 Watertown, New York Voice: ; Fax: ; Web: Blog:

 Use of a medication without a prescription  Use in ways other than as prescribed  Use for the experience or feelings elicited 2 Source:

 Type of poisoning  Prescription drugs used in AMOUNTS or IN WAYS NOT recommended  No harm intended by user  Limited number of ingestions by young children or innocent mistakes by patients 3 Source: Public Health Grand Rounds, February 17, 2011, Center for Disease Control and Prevention

 Types of Drugs  Drugs that depress breathing ▪ Opioid pain medication ▪ Sedative/hypnotics  Usually multiple drugs involved  Frequently combined with illicit drugs  Reasons for use  Original use: relief of pain and anxiety  Development of tolerance  Escalated use for “high” Source: Public Health Grand Rounds, February 2011, Center for Disease Control and Prevention 4

OPIOIDS – INDICATED FOR PAIN  Hydrocodone (Vicodin)  Oxycontin  Propoxyphene (Darvon)  Diphenoxylate (Lomotil)  Fentanyl DEPRESSANTS – INDICATED FOR ANXIETY AND SLEEP DISORDERS  Barbiturates  Pentobartil sodium (Nembutal)  Benzodiazepines  Diazepam (Valium)  Alprazolam (Xanax)  Corvalolum 5 Source:

6 Source: s/research-reports/prescription- drugs/what-are-some-commonly- abused-prescription-drugs s/research-reports/prescription- drugs/what-are-some-commonly- abused-prescription-drugs

 Because of the increase in the number of prescriptions drugs, more medications are available for misuse/abuse and diversion  Prescription drug misuse/abuse and diversion have tremendous impacts on the individual, the community, and the healthcare and judicial systems 7

 2008 – 15,000 fatal overdoses  1999 – 4,000 fatal overdoses  in 20 people age 12> reported using prescription painkiller for nonmedical reasons in the past year  2009 – Approx. 500,000 ER visits due to misuse or abuse of prescription medication  1 Month – Enough prescription painkillers were prescribed in 2010 to medicate every American adult 24/7 for a month  More men than women die of overdoses from prescription painkillers  People in rural counties are 2 times as likely to overdose on prescription painkillers Source: CDC Vital Signs, November

9

In 2008, 14,800 prescription pain medication deaths  For every 1 death there are ▪ 10 treatment admissions for abuse ▪ 32 emergency department visits for misuse or abuse ▪ 130 people who abuse or are dependent ▪ 825 nonmedical users 10 Source: Report_24638_FIN_Digital_ /PDF%20MI3040_PDM%20Report_24638_FIN_Digital_ pdfhttp:// Report_24638_FIN_Digital_ /PDF%20MI3040_PDM%20Report_24638_FIN_Digital_ pdf

11 Source: Report_24638_FIN_Digital_ /PDF%20MI3040_PDM%20Report_24638_FIN_Digital_ pdfhttp:// Report_24638_FIN_Digital_ /PDF%20MI3040_PDM%20Report_24638_FIN_Digital_ pdf

12

13 Source: Center for Disease Control, Public Health Grand Rounds, National Center for Health Statistics. Vital Health Stat 13 (163). 2006;

Source: Public Health Grand Rounds, February 2011, National Survey on Drug Use and Health. Summary of national findings, , 14

Source : JEFFERSON COUNTY PUBLIC HEALTH SERVICE, MEDICAL EXAMINER PROGRAM, Numbers of Deaths from Total Overdoses; Opiates Overdoses, 2012:. Through September 2012, there have been 8 confirmed overdoses, with another 3 suspected (under review). Of the confirmed cases, 6 are opiates overdoses. 15

16

17 SOURCE: Adapted by CESAR from Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Detailed Tables, Available online at

 Education  Increase Awareness  Safe medication use, storage, and disposal  Education for health care providers  Appropriate prescribing  Adverse events and drug interactions  Identifying those at risk for abuse  Counseling on proper storage and disposal  Screening, intervention, and referral for those misusing or abusing prescription drugs 18 Source: Source: Public Health Grand Round, February 17, 2011, Center for Disease Control and Prevention;

 Tool to identify  Inappropriate prescribing, dispensing, and drug- seeking behavior  Drug interactions and therapeutic duplication  Goals  All states have operational PDMPs  Mechanisms in place for communication between states  High utilization among health care providers ▪ Regular part of office visit like checking insurance coverage 19 Source: Public Health Grand Rounds, February 2011, Center for Disease Control and Prevention

 Goals  To be easily accessible and an environmentally friendly method of drug disposal  To be cost-effective and not a burden on consumers  To reduce the amount of prescription drugs available for diversion and abuse 20 Source: Public Health Grand Round, February 17, 2011, Center for Disease Control and Prevention

 Assist in addressing doctor and pharmacy shopping  Support prescription drug abuse-related training programs for law enforcement 21 Source: Public Health Grand Round, February 17, 2011, Center for Disease Control and Prevention

 Signed into effect on September 18, 2011  Rationale: To save lives; to grant limited shield from charge and prosecution  In 2008, 900 people died from accidental drug overdoses in New York State  

 Discussions  Who needs to be at the table but is not?  Who will invite that person or entity?  Other 23