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