“What You Need To Know About Prescription Drugs in York

County!”

January 11, 2012York County Prevention Collaborative

Presentation

National ProblemMore than 2.5 million Americans 12 and

older began nonmedical use of prescription drugs in 2008 -- outnumbering first-time users of marijuana by 300,000.

About 1 in 10 high school seniors used Vicodin for nonmedical reasons in the past year.

More than 1 million adolescents (12-17) and 2.7 million young adults (18-25) needed treatment for an illicit drug problem in 2008.

BUT, only about 11 percent of these received treatment at a specialty facility.

(www.whitehousedrugpolicy.gov); National Survey on Drug Use and Health, 2009)

York County YouthYork County Youth

23% of 9-1223% of 9-12thth graders have graders have used Rx drugs without doctor’s used Rx drugs without doctor’s permission at least once.permission at least once.

13% 9-12th graders have used Rx drugs without permission in past 30 days.

20% 9-12th graders think there is little or no risk to taking prescription drugs that are not prescribed to them.New data coming out by end of year

Maine Integrated Youth Health Survey, York County 9-12th graders 2009

23%22%

18%17%

16%15%

23%

20%

0%

5%

10%

15%

20%

25%

York County High Schools Maine High Schools

2004

2006

2008

2009

What is Misuse?Misuse = “Non-medical use” or any use that is outside of a medically prescribed regimen

Examples can include:Taking for psychoactive “high” effectsTaking in extreme dosesMixing pillsUsing with alcohol or other illicit substancesObtaining from non-medical sources

After marijuana, prescription drugs are the second most common form of illicit drug abuse among our nation's teens. Nearly 20 percent of Maine's high school seniors say they have abused prescription drugs, frequently taken from the home of a parent or grandparent.

Marijuana vs. Prescription RX’s

What drugs are being Misused?What drugs are being Misused?

Commonly Misused Rx Drugs Opiates: pain-killers:

Ex) Vicodin, Oxycontin, Tylenol Codeine

CNS Depressants (Sedatives/Tranquilizers): treat anxiety and sleep disorders

Ex) Xanax, Ativan, Valium, Soma

Stimulants: ADHD, weight lossEx) Aderall, Ritalin, Concerta, Dexedrine, Fastin

Rx Drug Misuse in the U.S.6.4 million aged 12+ used a

Rx drug (non-medically) in the past year

S edativ es

S timulants

T ranquiliz ersP ainkillers

4,700,000

1,800,000

1,100,000

272,000

SPLENDID FORWind, Colic, Griping in the Bowels, Diarrhea Cholera and Teething Troubles

Generation Rx• Rx/OTC med abuse has penetrated teen culture• 18% of teens have abused Vicodin• 20% tried Ritalin or Adderall without Rx• 9% abused OTC cough syrup to get high• Equal or greater abuse of OTC/Rx than cocaine, Ecstasy,

LSD, ketamine, heroin, GHB, ice• Believe that Rx Meds safer (50%), less addictive (33%)• Ease of access: medicine cabinets• “Drugs are fun” vs. “Drugs help kids when they are

having a hard time”

April 21, 2005. Partnership for a Drug Free America. 17th annual study of teen drug abuse. N= 7,300, error margin +/- 1.5%

Older Adults

An estimated one in five older adults are negatively affected by combined difficulties with

alcohol and Rx medication abuse.

RX Drug Abuse in Older Adults

• Older Adults account for 1/3 of all medications prescribed in the U.S.

• 7.2 million (21.7%) receive at least 1 Rx annually.

• Older adults use Rx drugs 3 times more than the general population.

• On average, older persons take 4.5 medications per day.

• 2.8 million older adults abuse Rx drugs in the last year.

SAMHSA, 2006; NIDA, 2005

Older Adults Risks Factors

• Prescribed multiple medications.

• Long-term prescriptions can lead to unintentional misuse - taking different doses.

• Prescribed inappropriately high doses.

Side Effects can be Lethal if…

• Combining Rx & OTC medications.• Taking Rx and OTC meds with alcohol.• Using Rx and OTC with other illicit drugs. • Interactions: Rx & OTC meds with other

physical medications (i.e., HIV or Hepatitis)

Overview

• Three classes of commonly abused Rx drugs

– What are they? • (opioids, sedatives, stimulants)

What are opioids?

• Opiate: derivative of opium poppy– Morphine– Codeine

• Opioid: any compound that binds to opiate receptors– Semi synthetic (including heroin)– Synthetic – Oral, transdermal and intravenous formulations

• Narcotic: legal designation

Morphine

• Routes: oral, intramuscular, intravenous, rectal• Sustained release preparations:

– MS Contin– Oramorph– Kadian– Avinza

Codeine

• Opiate (naturally occurring in poppy)• Low potency • Pain relief via 10% conversion to morphine• Most commonly prescribed opioid in the

world• Probably the most widely used analgesic

– (Excluding aspirin)

Semi synthetic Opioids

• Hydrocodone with Tylenol:– Norco – Lortab – Vicodin – Lorcet

• Hydrocodone with ibuprofen: Vicoprofen• Hydromorphone: Dilaudid • Oxycodone with Tylenol: Percocet • Oxycodone with aspirin: Percodan • OxyContin

OxyContin

• Used to treat pain associated with arthritis, lower back injuries, and cancer

• Most commonly in tablet form: 10mg, 20mg, 40mg, 60mg, and 80mg tablets

• Dosed every 12 hours, half-life 4.5 hours• Abuse: may be chewed, crushed, snorted or injected

– Eliminates time-release coating– Enhances euphoria, “rush” – Increases risk for serious medical consequences

Synthetic Opioids• Methadone• Demerol (meperidine)• Fentanyl• Suboxone/Subutex (buprenorphine)• Tramadol

– Complex mechanism of action– Nonscheduled, less abuse potential

Dextromethorphan

• Over-the-counter cough suppressant• Structurally related to morphine• Also known as Robitussin

Sedative-Hypnotics

• Benzodiazepines– Librium (chlordiazepoxide HCL)– Valium (diazepam)– Restoril (temazepam) – Klonopin (clonazepam)– Ativan (lorazepam)– Xanax (alprazolam)

• Non-benzo hypnotics– Ambien (zolpidem)– Sonata (zaleplon)– Lunesta (eszopiclone)

• Soma (Carisoprodol)• Cross-tolerance with alcohol

Prescription Stimulants• Stimulants (i.e., amphetamines) are often prescribed

to treat individuals diagnosed with attention-deficit hyperactivity disorder (ADHD).

• Substantial amounts of pharmaceutical amphetamines are diverted from medical use to non-prescription use.

• Amphetamines increase wakefulness and alertness and have been used by:– The military, pilots, truck drivers, and other workers to keep

functioning past their normal limits

Source: Erowid.org

Ritalin• When used to treat ADHD, patients may report

increased attention, decreased impulsivity, and decreased hyperactivity.

• Milder stimulant that works by affecting the levels of chemicals (neurotransmitters) in the nervous system.

• May also be used in the treatment of depression in certain cases

• Long-acting form: Concerta

* WebMD

Adderall

• Adderall is used to treat attention deficit hyperactivity disorder (ADHD).

• Adderall is a combination of stimulants (amphetamine and dextroamphetamine).

• It increases the ability to pay attention, focus, and control behavior problems.

• This drug may also be used to treat certain sleeping disorders (narcolepsy).

Proper Disposal of

Prescription Drugs

Unused Drugs

• It is estimated that 40 percent of prescription drugs - particularly pain-killers, antibiotics, and cardiovascular medicine - that are prescribed outside of hospitals go unused every year. Left in the home, they present a serious health and safety hazard. Flushed down the drain, they contaminate our waters and harm wildlife.

Drug Take Back Day• April and 0ctober• In conjunction with National and Maine DEA• Disposal paid for by DEA• Coordinated and run by police with help from community

groups/HMPs• Added evaluation component – survey results• Maine collected more unused Rx drugs than any other state

per capita - 14,140 pounds on Oct 29th

• Next Drug Take Back Day is April 28, 2012 10:00 AM - 2:00 PM• Please go to the US DEA website this March for a Drug Take Back site near you .

• http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

Drug Take Back Day, October 29th Totals

Participant Name CityCollection Site

Total LTCFTotalAGENCY

TOTAL

April

2011 Totals

Berwick Police Department Berwick 16.9 0 16.9 23.5

Biddeford Police Department Biddeford 145.9 20.4 166.3 _

Buxton Police Department Buxton 54.5 0 54.5 78.6

Eliot Police Department Eliot 79.5 0 79.5 81.3

Kennebunk Police Department Kennebunk 86.4 11.1 97.5 114.1

Kennebunkport Police Department Kennebunkport 51.2 0 51.2 46.7

Kittery Police Department Kittery 38.4 38.2 76.6 50.1

North Berwick Police Department North Berwick 54.8 0 54.8 62.9

Ogunquit Police Department Ogunquit 15.9 0 15.9 7.8

Old Orchard Beach Police Department

Old Orchard Beach 150.3 0 150.3 106.2

Saco Police Department Saco 110.4 0 110.4 123.7

Sanford Police Department Sanford 100.9 0 100.9 73.3

South Berwick Police Department South Berwick 29.4 11.9 41.3 39.6

Wells Police Department Wells 74.1 0 74.1 108.7

York County Sheriff's Office Alfred 61 0 61 101

York Police Department York 250.8 39 289.8 152.6

TOTAL Pounds 1320.4 120.6 1441 1170.1 2611.1+

Evaluation Results

209 people responded (North Berwick and Berwick not included)

58 have 1 or more children under 21 in home

“Reducing Prescription Drug Abuse in York

County: From Awareness to

Action”

A York County Grant funded by the Department of Public Safety

Project Update

• Facilitate 3 meetings of the York County Rx Regional Group. 2

• Provide ongoing oversight and support to 3 groups (Sanford area, York Area, Saco area) as needed to insure each will be able to successfully implement activities.

• Develop and distribute information and press releases for local and regional media outlets in York County that cover prescription drug abuse issues and prevention efforts being undertaken by the Rx Task Force Groups and stakeholders in York County.

• Research, compile and provide materials to Rx Task Force groups that will be used in community, parent and youth education and awareness initiatives.

Project Update• Design and print 3 regional community awareness campaign

posters in collaboration with the Rx Task Force groups. Rx Task Force groups will develop concept, use fact-based content, oversee final layout, print and distribute.

• Coordinate the fall DITEP Training. (Dec 8 and 9, 38 people registered)

• Provide 4 trainings to a minimum of 100 healthcare providers on prescription drug abuse and their role in prevention at York Hospital, Goodall Hospital, Southern Maine Medical and tentatively the medical students at UNE.

Project Activities ~ Not Begun or Need More Effort1. Community awareness campaign poster for your service area,

photographs and youth.

2. Petition the town council or board of selectmen to adopt a prepared resolution supporting prescription drug abuse prevention and declaring a Prescription Drug Abuse Awareness Week.

3. Provide a minimum of 2 parent education opportunities (PTA presentation, adult ed., school parent nights, etc. web sites, emails, phone, youth sports).

4. Recruit up to 10 educators and law enforcement personnel in your service area to participate in a York County Drug Impairment Training for Education Professionals* (DITEP) in Fall 2011.

5. Assist Project Leaders with disseminating an educational module for middle and high school teachers in on the dangers of prescription drug abuse.

Choose To Be Healthy Partnership at York Hospital serves the Berwicks, Eliot, Kittery, Lebanon, Ogunquit, York and Wells

Coastal Healthy Communities Coalition at University of New England serves Kennebunk, Arundel, Kennebunkport, Biddeford, Saco, Old Orchard Beach, Dayton, Buxton, Hollis

Partners for Healthier Communities at Goodall Hospital serves Sanford, Alfred, Lyman, Action, Shapleigh, Waterboro, Springvale, Parsonsfield, Cornish,

Limington

• Comprehensive community coalitions part of state wide system that promote health and wellness through policy and environmental change.

• HMP’s work to reduce the incidence of chronic diseases: cardiovascular disease, diabetes, cancer, chronic lung disease and substance abuse.

• Supported by the Fund for a Healthy Maine, Office of Substance Abuse, federal and local grants.

Project Coordinators/ ContactsWilliam L. Paterson, M.Ed., C.P.E.

Project Director, Substance Abuse and Chronic Disease Prevention Coastal Health Communities Coalition at

the University of New England call 602-3589

email: wpaterson@une.edu

Sally Manninen, M.A. Substance Abuse Prevention Coordinator, Choose To Be Healthy Partnership

at York Hospital call 439-2936

email : smanninen@yorkhospital.com

Connie Roux, Prevention Coordinator, Partners for Healthier Communities at Goodall

Hospital25 June Street, Sanford, Me 04073

Phone 207-490-7704, ext. 311croux@goodallhospital.org