Post on 22-Jun-2020
Practices to Prevent Youth Prescription Drug Abuse
ADP Leadership Conference
August 23, 2012
Presented by:
Jennifer Drader, M.P.H., CHES, Program Supervisor
Ronann Reeves, Health Educator
Community Service Programs, Inc. – Project PATH
Lisa Garbrecht, Ph.D., Evaluator
EVALCORP Research & Consulting
Funded by the County of Orange Health Care Agency –
Alcohol and Drug Education and Prevention Team
Presentation Overview
• Prescription and Over-the-Counter (Rx/OTC) Drug Abuse Project
• Overview of Initiative
• Health Professional Education
• Practices to Reduce Rx/OTC Drug Abuse
• Health Professional Evaluation Findings
• Impacts of Initiative
• Challenges and Lessons Learned
Prescription and Over-the-Counter Drug Abuse Project
Prescription & Over-the-Counter Drug Abuse Project
• 3-Year Initiative: 2009-10, 2010-11, 2011-12
• Implemented by CSP Project PATH
• Funded by the County of Orange Health Care Agency – Alcohol and Drug Education and Prevention Team
• Served Orange County
• Targeted the cities of Fullerton, Mission Viejo, Newport Beach and Orange, as well as Anaheim in the 3rd year
Goal & Objectives
• Goal: Reduce Rx/OTC drug abuse
• Incremental objectives across 3 years:
• Increased awareness/knowledge of the problems, prevalence, and adverse consequences of Rx/OTC drug abuse among youth
o Knowledge that Rx/OTC drugs are not safer than street drugs
• Knowledge of methods to reduce Rx/OTC drug abuse among youth
• Actions taken to reduce Rx/OTC drug abuse among youth (year 3)
• Objectives specific to target audience and prevention strategy
Approach to Prevention
• Community-based, environmental approach
• Provided education in schools, colleges, and faith-, community- and health-based organizations
• Created working partnerships to address Rx/OTC drug abuse among youth
• Developed a media campaign
• Mobilized communities, raised awareness and partnered with health care professionals to improve prevention efforts
Prevention Strategies
• Comprehensive media campaigns in 4 cities each year
Prevention Strategies
• Educational workshops to:
• Youth in 4 cities
o High schools, faith- and community-based organizations, youth programs
• Adults in 4 cities
o Parents, school- and youth-serving personnel
o School and PTA meetings, family resource centers, community centers, and organizational meetings
o Follow-up with adults in year 3
• Town hall meetings in year 1
• Town hall meeting and merchant education in year 2
Prevention Strategies
• Educational workshops to health professionals
• Professionals in hospitals/health centers, schools/colleges, law enforcements/social services and nursing/medical students
• In 4 cities in years 1 and 2; Anaheim in year 3
• Reinforcing prevention messages and follow-up in year 3
Health Professional Education
The Rx/OTC Problem
• 1 out of 5 teens have abused a prescription drug to get high in their lifetime
• 1 out of 10 teens have abused an over-the- counter drug to get high in their lifetime
• More people die from abusing prescription pain relievers than from cocaine and heroin combined
Source: The Partnership Attitude Tracking Study, 2011;
CDC Morbidity and Mortality Weekly Report, November 4, 2011
Sources: The Partnership Attitude Tracking Study, 2011;
CDC Morbidity and Mortality Weekly Report, November 4, 2011
Concerning Trends
• Adolescents 12-13
• Teen Females
• Young Adults 18-24
National Survey on Drug Use and Health (NSDUH), 2010
3 million people started using drugs in 2010
Drug Associated With First Time Use Among People Who Started Using Illicit Drugs in the Past Year
Source: NSDUH, 2010
Trend in Emergency Department Visits Involving the Nonmedical Use of Narcotic Pain Relievers
166,338
425,247
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
2004 2010
ED V
isit
s
Year
Source: SAMHSA Drug Abuse Warning Network (DAWN), 2010
0%
5%
10%
15%
20%
25%
17%
4%
7%
20%
5% 8%
17%
3%
7%
22%
7% 7%
Pe
rce
nta
ge
Types of Medications
Orange County
California
Source: California Healthy Kids Survey, 2009-2010
Prevalence Rate of Non-Medical Rx and OTC Drug Use among 11th Graders
California vs. Orange County 2009-2010
Drug Trends in Orange County
0
5
10
15
20
25
30
35
40
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Nu
mb
er
of
De
ath
s
Year
Orange County Accidental Poisoning by Drugs Ages 15 - 24
Source: CA Dept. of Public Health, Vital Statistics Section, Death Statistical Master file 2000 – 2010
Top OTC Drugs Being Abused
Cold and Flu Medications Containing
Dextromethorphen (DXM)
• Coricidin, Robitusin, Nyquil, Tylenol Cold & Flu
• The high: Feelings of euphoria and psychoactive effects
Source: Parents the Anti-Drug, 2011
Top Rx Drugs Being Abused
Pain Relievers • Codeine, Fentanyl, Morphine, Hydrocodone, Oxycodone • The high: euphoria and feelings of being relaxed
Stimulants • Ritalin, Adderall • The high: euphoria, stay awake, increased alertness, boost of energy • Often taken with alcohol
Depressants • Xanax, Valium • The high: drowsy or calming effect, state of intoxication • Life-threatening withdrawal symptoms
Source: Parents the Anti-Drug, 2011
Methods of Abuse
Ingesting excessive amounts
“Robo-Fizzing”
“Sizzurp” / “Purple Drank”
“Pharming” / “Trail Mix”
Cocktail/Bowling Parties
“Crushing”/ Snorting
Local Stories
Irvine Youth: Tristan, 18
Drug: Opana
Anaheim Hills Youth: Lucia, 15
Drug: DXM
Prescription Drug Access Through The Healthcare System
Doctor Shopping
• Unlawful means of procuring a controlled drug through prescriptions authorized by multiple doctors for treatment of the same affliction
• Alternating doctors to obtain overlapping prescriptions
• Most commonly done to obtain painkillers such as OxyContin
Source: Dictionary.com/doctor shopping
Targeted Physicians
• Physicians known to prescribe prescriptions with little or no assessment or follow-up
• Physicians sympathetic to patients’ medical conditions
• Patients commonly travel a long distance to see physician
Source: Diversion of Controlled Substances: What Every Pharmacist Should Know, 2011
Prescription Drug Access Through The Healthcare System
Cappers/Handlers
Organized Crime
Cappers/ Handler
Medicare Recipient
Pill Mill
Pharmacies
Cappers/ Handler
Source: http://www.kcet.org/shows/socal_connected/content/health/rx-dangers.html
Guidelines for Combating Rx Drug Abuse and Fraud
From the California Department of Justice Bureau of Narcotic Enforcement
• Potential Indicators of Rx Drug Abuse and Fraud
• Practices to Reduce Rx Drug Abuse
• Prescribing practices
• Patient assessment and pain management practices
• Prescription drug monitoring programs
Source: California Department of Justice Bureau of Narcotic Enforcement, Guidelines for Combating Rx Drug Abuse and Fraud
CURES
Controlled Substance
Utilization
Review and
Evaluation
System
CURES
• Allows pre-registered users access to real-time patient controlled substance history information
• CURES users can quickly access and review controlled substances information via the automated patient activity report (PAR)
Source: http://ag.ca.gov/bne/cures.php
– Healthcare Prescribers – Pharmacies
– Law Enforcement – Regulatory Boards
Patient Activity Report
Source: BNE Presentation, 2009
Screening and Intervention
• Utilize screening tools to help identify at-risk patients early
• Help patients recognize the problem
• Refer to treatment or recovery centers
• Help patients set recovery goals
Patient Education
Where People Get Rx Drugs
• Over 70 percent of people who abused Rx pain relievers got them from friends or relatives:
• For free (55%)
• Bought them (11.4%)
• Took them without asking (4.8%)
Source: The National Survey on Drug Use and Health, 2010
Steps to Prevent Rx/OTC Drug Abuse at Home
MONITOR
• Count medications from the pharmacist and as you use them
• Take note of missing and quickly used medications
SECURE
• Lock your medications
DISCARD
• Remove, unwanted/expired meds from the home
Properly Discard Expired and Unwanted Medications at Home
1. Pour unwanted/expired medications out of their original containers into a zip baggie
2. Pour hot water (over 110° F — about as hot as a cup of coffee) into the baggie
3. Insert kitty litter into the baggie. Seal baggie. Place in trash bin.
These steps are intended for Orange County, CA residents.
National Take-Back Events
Sponsored by the Drug Enforcement Administration (DEA)
Provide local drop sites for people to safely dispose of unwanted medications
Visit dea.gov to find the closest drop site
Next Take-Back Event: September 29
Resources
National Institute on Drug Abuse
www.nida.nih.gov
Do It Now!
www.doitnow.org
California Security Prescription Program
securityprinter@doj.ca.gov
Guidelines for Combating Rx Drug Abuse and Fraud
https://pmp.doj.ca.gov/pdmp/index.do
Stop Medicine Abuse
www.stopmedicineabuse.org
A Drug Free World
www.drugfreeworld.org
A Dose of Prevention
www.doseofprevention.com
The Anti-Drug
www.theantidrug.com
Evaluation Findings for Health Professionals
Evaluation Methods
• (Years 1-3) Rx/OTC Drug Abuse Health Professional Survey assessing impact on:
• Awareness of problems/prevalence of Rx/OTC drug abuse
• Knowledge of adverse consequences of Rx/OTC drug abuse
• Knowledge of methods to reduce Rx/OTC drug abuse
• Likeliness of implementing methods to reduce Rx/OTC drug abuse
• (Year 3) Rx/OTC Drug Abuse Health Professional Follow-up Survey assessing impact on:
• Actions taken to reduce Rx/OTC drug abuse
Health Professional Survey Findings
Impact of Workshops on Health Professionals’ Awareness and Knowledge
As a result of this workshop …
Year 1 2009-10
Year 2 2010-11
Year 3 2011-12
N=278 N=210 N=259
Increased awareness of prevalence (or problems associated with) Rx/OTC drug abuse among youth
99% 100% 99%
Increased knowledge of adverse consequences of Rx/OTC drugs among youth
97% 99% 98%
Increased knowledge of drug disposal programs in Orange County
98% 100% 97%
Health Professional Survey Findings
Impact of Workshops on Health Professionals’ Knowledge and Behaviors
As a result of this workshop …
Year 1
2009-10
Year 2
2010-11
Year 3
2011-12
N=278 N=210 N=259
Increased knowledge of methods to reduce Rx/OTC drug abuse among youth
98% 98% 98%
Are more likely to implement methods to reduce Rx/OTC drug abuse among youth
98% 98% 98%
Health Professional Survey Findings
What health professionals found most valuable about the educational workshops:
• Learning about the prevalence and increasing trend of Rx/OTC drug abuse among youth
• “I was shocked at all the statistics from our county”
• “Learning about the rise in abuse of Rx/OTC drugs with youth, prevention, and what to look for”
• “Knowing what drugs teens are doing”
• “How much OTC drugs and prescription drugs are abused, I didn’t know how much they were abused”
Health Professional Survey Findings
What health professionals found most valuable about the educational workshops (cont.):
• Materials and resources
• Drug disposal information
• Gaining the ability to discuss Rx/OTC drug abuse
• “It gave me the education I need to feel more comfortable approaching the subject with parents and teens”
Follow-up Survey Findings Actions Taken by Health Professionals Since the Workshop
• 71% of Health Professionals took at least one preventative action
Actions Taken to Prevent Rx/OTC Drug Abuse %
(N=96)
Encouraged patients to secure their medications 70%
Talked with patients about discarding unused, unneeded, and expired medications
64%
Talked with patients about the dangers of Rx/OTC medication abuse
63%
Provided patients with information and/or tips to discuss Rx/OTC medication abuse with their family and friends
54%
Note: Percentages do not add to 100% as respondents were asked to check all that apply.
Follow-up Survey Findings Actions Taken by Health Professionals Since the Workshop
(cont.)
Actions Taken to Prevent Rx/OTC Drug Abuse %
(N=96)
Provided a safe and open environment for patients to talk about Rx/OTC medication abuse
53%
Spoke to patients about monitoring Rx/OTC medications (i.e., keeping track of medications)
51%
Taught patients how to look for negative side effects of Rx/OTC medication abuse
49%
I have not taken any actions to reduce Rx/OTC medication abuse
29%
Note: Percentages do not add to 100% as respondents were asked to check all that apply.
Children’s Hospital of Orange County (CHOC)
Nursing Grand Rounds Workshop – 2009
• Two nurses in attendance took action:
• Developed a medication tracking tool for doctors and an educational handout
• Trained other nurses to educate their patients
• Presented their work at two national conferences in 2011-12
Successes
CHOC Grand Rounds – February 2012
Successes
• 100% of participants reported an increased awareness of:
• Abuse methods
• Types of drugs and prevalence
• Methods to prevent abuse
• Participants indicated an intention to take actions:
• Educate patients
• Investigate/enroll in CURES
• Create and revise protocols, policies and procedures
Successes
Summit College Nursing Program
• Received initial education in October 2011
• Since then, PATH staff has been invited to present to 7 classes (educating 181 students)
• PATH staff sees an opportunity to integrate Rx/OTC prevention into the curriculum
Challenges & Lessons Learned
Challenges to Implementation
Health Professionals
• Health care organizations’ limited awareness of the problem of Rx/OTC drug abuse
• Reluctance to allow outside agencies to provide educational workshops to their staff
Lessons Learned
Health Professionals
• Important to build strong relationships with healthcare organizations
• Partner with community/satellite clinics
• Serve as a resource
• Present the problem in a way that’s relevant and practical to the organization
Lessons Learned
Health Professionals
• Provide resources that benefit the organization
• Provide tools/materials, best practices
• Provide CMEs
• Follow-up
Questions & Discussion
Connect with Us on Facebook
www.facebook.com/goodmedsbadbehavior
Thank You!
Contact Us
Jennifer Drader, Program Supervisor jdrader@cspinc.org
Ronnie Reeves, Health Educator
rreeves@cspinc.org
Lisa Garbrecht, Program Evaluator lgarbrecht@evalcorp.com