Prescription Drug Abuse Prevention

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The Peer Assistance Services Prescription Drug Abuse Prevention Program is a statewide effort  to reduce prescription drug abuse by increasing awareness of the issue following the Office of National Drug Control Policy’s four-pronged plan: education, monitoring, disposal and enforcement. The program includes:

  • Outreach to communities
  • Advocacy of the Prescription Drug Monitoring Program (PDMP)
  • An annual education event to encourage dialogue and strategize solutions among diverse audiences
  • Collaboration with community organizations to create coalitions that broaden reach
  • Education to healthcare professionals encouraging responsible prescribing practices

The Prescription Drug Abuse Prevention Program provides exhibits and presentations to community organizations including schools, parent/teacher organizations, businesses, healthcare providers and others.  If you are interested in a presentation on this topic, please contact us at 303.369.0039 or  info@peerassist.org.


PRESCRIPTION DRUG ABUSE FACTS

Prescription Drug Abuse in Colorado
  • Yearly deaths in Colorado due to drug-related poisoning more than doubled from 351 in 2000, to 807 in 2012. Deaths involving the use of opioid analgesics such as morphine, codeine, oxycodone, hydrocodone, methadone and fentanyl more than tripled from 87 in 2000, to 295 in 2012.
  • In 2012, 36% of the drug poisoning deaths in Colorado were due to opioid analgesics.2
  • In 2012, 21% of the drug poisoning hospitalizations in Colorado were due to prescription opioid poisoning.3
  • In 2012, more than twice as many people in Colorado died from poisoning due to opioid analgesics (295) than from drunk-driving related fatalities (133).4
  • According to the Prescription Drug Monitoring Program, oxycodone prescriptions for Colorado residents increased 54.3% from the 3rd quarter of 2007 through the 3rd quarter of 2013.5
  • According to the 2012 National Survey on Drug Use and Health, 5.05% of Coloradans reported using pain relievers non-medically in the past year.  This is down from 6% in 2011.  The age range with the highest misuse rates is still 18-25 year olds at 12.18%.6
  • During two National Take-Back Initiative events in 2013, hosted by the U.S. Drug Enforcement Administration and local law enforcement agencies, Coloradans turned in more than 39,000 pounds of unused medication.7
  • A 2011 Youth Risk Behavior Survey conducted in Colorado revealed that 29.2% of 12th graders had taken a prescription medication without a doctor’s prescription at least once in their lifetime.  This is higher than the national average of 25.6%.8
  • Many teens feel that prescription drugs are “safer to use” than street drugs since they are prescribed by a physician.  Teens state that they are “easier to get than beer” because prescription medications are easily obtained from friends and family medicine cabinets.9
1.Colorado Department of Public Health and Environment, Health Statistics Section (2012)
2. Ibid
3. Ibid
4. Ibid and National Highway Traffic Safety Administration, Traffic Safety Facts Colorado (2012)
5. Colorado Prescription Drug Monitoring Program, Colorado Department of Regulatory Agencies, Division of Registrations, Board of Pharmacy
6. National Survey on Drug Use and Health (2012(
7. U.S. Drug Enforcement Administration, Denver Field Division (October 2013)
8. Youth Risk Behavior Survey, Colorado High School Survey Summary (Fall 2011)
9. Johnston, L.D., O’Malley, P.M., Bachman, J.G., and Schulenberg, J.E. (2011). Monitoring the Future national survey results on drug use, 1975-2012; Volume I, Secondary school students. Ann Arbor: Institute for Social research, The University of Michigan

Medication Disposal/Safe Storage

Prescription medications are often taken from a friend or family’s medicine cabinet for the purpose of abuse. According to the 2012 National Survey on Drug Use and Health, 70% of individuals who used prescription medications non-medically got them from a friend or relative. Safe storage, medication monitoring, and proper disposal are an important part of preventing prescription drug abuse.

Safe Storage of Medicines

  • Do not share your medications with anyone. Sharing medications is illegal.
  • Keep medications in their original container.
  • Never combine different medications into one bottle.
  • Make sure all bottles are tightly closed.
  • Keep your medications in a cool, dry place out of reach of children.
  • Store medications in a locked cabinet or box.
  • Monitor medications to ensure no one else is taking them.
  • Check the expiration date on the bottle and dispose of expired medications.

Proper Disposal of Medicines

Approximately 20% of all prescription medications are unused. Theft of these medications is a serious problem. By disposing of unused medications, you can help keep them out of the hands of those that shouldn’t have them.

Take Back programs in your community are the safest way to dispose of medications. Contact the Colorado Department of Public Health and Environment or the Office of Diversion Control for more information regarding locations and procedures.

If a Take Back program is unavailable in your area, proper trash disposal is the next best option.

  • Medications should be taken out of their original containers.
  • Remove or black out any private patient information on the label.
  • Mix the medication with an undesirable substance (like used coffee grounds or kitty litter).
  • Put this in a nondescript container and throw it in the trash.

 Colorado Consortium for Prescription Drug Abuse Prevention

The abuse of prescription drugs is the fastest growing drug problem in the United States, particularly among adolescents.  To address this issue, the National Governors Association (NGA) hosted a year-long Policy Academy in 2013, to reduce prescription drug abuse.  The Policy Academy, co-chaired by Governors Hickenlooper (Colorado) and Bentley (Alabama) supported the development of comprehensive state strategic plans to reduce prescription drug abuse.

As the result of this year-long Policy Academy and the collaboration of numerous stakeholders at both the state and community level, the Colorado Plan to Reduce Prescription Drug Abuse was created with the goal of preventing 92,000 Coloradans from abusing opioids by 2016.  Through this plan, the Colorado Consortium for Prescription Drug Abuse Prevention was established.  The Consortium provides a statewide, inter-university/inter-agency network and serves as the strategic lead for the Colorado Rx plan with active participation from the Governor’s Policy Office and various stakeholders throughout the state.  The Consortium houses six focus-area workgroups, with each workgroup focusing on action steps identified in the strategic planning process.  The workgroups are as follows:

Provider Education
  • Change state board policies for all DORA-licensed prescribers to include pain management guidelines
  • Increase educational opportunities for prescribers
  • Enlist and support DORA to provide education about the existence and utilization of the Prescription Drug Monitoring Program (PDMP) as part of the licensing processes for prescribers and pharmacists
PDMP
  • Examine use of the PDMP as a public health tool
  • Improve usability and appropriate accessibility of the PDMP system through the use of information technology and increased stakeholder access
Disposal
  • Expand take-back program in law enforcement agencies – develop permanent drop-off sites with law enforcement
  • Establish Colorado guidelines on disposal
Public Awareness
  • Develop social marketing campaign that targets the general public and overcomes existing obstacles and misperceptions
Data and Analysis
  • Map out sources of data related to prescription drug use, misuse and overdose in the state to monitor trends, educate the public and inform decision making by multiple stakeholders
  • Identify other efforts that successfully use crosswalks between diverse data sources and successfully standardize their data collection tools across agencies
Treatment
  • Identify the current landscape of treatment in Colorado and any gaps in services

Resources

For Parents

Parents and caregivers have real power in influencing the decisions teens make for themselves. According to the 2012 Partnership Attitude Tracking Survey, teens are more likely to use prescription (Rx) drugs if they believe their parents are more lenient toward prescription drug misuse or abuse compared to illegal drug abuse.oxy and heroin label

  • Misuse is use of medication (for medical purpose) other than as directed or as indicated by the prescriber.
  • Abuse is the intentional self-administration of a medication for a non-medical purpose.
National Data*
  • One in four teens (24%) reports having misused or abused a prescription drug at least once in their lifetime (up from 18% in 2008).
  • Of those kids who said they abused Rx drugs, one in five (20%) has done so before age 14.
  • Almost one in four teens (23%) say their parents don’t care as much if they are caught using Rx drugs without a doctor’s prescription, compared to getting caught with illegal drugs.
  • More than four in ten teens (42%) who have misused or abused a prescription drug obtained it from their parent’s medicine cabinet.

*PATS Key Findings: Released April 23, 2013, 2012 Partnership Attitude Tracking Study, sponsored by MetLife Foundation

Colorado Data
  • In 2012, more than twice as many people in Colorado died from poisoning due to opioids (295) (pain medications) than from drunk-driving related fatalities (133).*
  • A 2011 Youth Rish Behavior Survey conducted in Colorado revealed that 29.2% of 12th graders had taken a prescription medication without a doctor’s prescription at least once in their lifetime. This is higher than the national average of 25.6%.

*Ibid and National Highway Traffic Safety Administration, Traffic Safety Facts Colorado 2012

Resources

Partnership at Drugfree.org

Toolkit for Parents

Pill Identifier Website

How to talk to your teens about drugs

National Institute on Drug Abuse

For Health Care Providers

“Patients in pain who rely on opioids for analgesia and improved function deserve access to safe and effective medication; to deprive them of optimal pain-relief certainly does them harm.  Yet these same life-restoring medications carry the potential to do grave harm to patients who may be at risk for addiction and abuse.  Physicians cannot single-handedly eliminate the diversion and abuse of prescription opioids.  But we have a solemn responsibility-to our patients and to society-to be vigilant in reducing these risks”. Scott Fishman, MD (Responsible Opioid Presribing) 2007 pgs. 1-2.

opioid slide2
opioid slide
Who is most at risk?

Understanding the groups at highest risk for overdose can help target interventions. Research shows that some groups are particularly vulnerable to prescription painkiller overdose:

  • People who obtain multiple controlled substance prescriptions from multiple providers – a practice known as “doctor shopping.”
  • People who take high daily dosages of prescription painkillers and those who misuse multiple abuse-prone prescription drugs. View Graph
  • Low-income people and those living in rural areas. People on Medicaid are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkillers overdose.  One Washington state study found that 45% of people who died from prescription painkiller overdoses were Medicaid enrollees.
  • People with mental illness and those with a history of substance abuse.
Warning signs of potential misuse and abuse
  • Previous history of drug abuse/misuse
  • Losing Rx’s or requesting early refills regularlyPLS-00005873-001
  • Requesting drugs by name and strength
  • Suspiciously allergic to effective OTC drugs or all recommended alternatives
  • Numerous visits to ER for pain meds
  • Taking doses larger than those prescribed or increasing dosage without consulting clinician
  • Insisting that higher doses are needed or multiple dose escalations despite warnings
  • Resisting changes to opioid therapy
  • Obtaining medications illegally
  • Attempting unscheduled visits, typically after office hours or when the clinician is unavailable
  • Paying in cash or requesting insurance not be billed
  • Lack of medical history records or avoid medical exams/tests
Resources

CDC Website Policy Impact: Prescription Painkiller Overdoses

Colorado School of Public Health: Pain Management CME

AMA Online Learning Center

PCSS-O.org

ACPOnline.org

DrugAbuse.gov

For Seniors

200287343-001Prescription drug abuse is not just something that happens to young people.  Individuals over age 65 are also at risk for drug abuse, because Americans age 65 and older make up 13% of the population but consume about one third of all prescription drugs.  Older individuals also take more potentially addictive medications than any other age group.

  • Drug interactions are especially common in older adults due to the use of multiple medications.  You should routinely talk to your health care provider, including your pharmacist, to learn about your medicines and ensure you understand how to take them appropriately.
  • Age-related changes can impact how a drug works in the body and often necessitates dosage adjustments and careful monitoring.  Experts recommend a “Medication Check Up” at least once a year to review all of your medications and determine whether all are needed, if dosage adjustments are needed, or if there is the potential for drug interactions.
  • Older adult’s medicine cabinets can be a source of “free” drugs for those who may be abusing.  Follow these important steps to protect your medications.

1. Do not share your medications with anyone.  Sharing medications is illegal.

2. Store your medications in a locked cabinet or box.  70% of individuals who abuse medications state they get them from the medicine cabinets of friends or family.

3. Monitor your medications to ensure no one else is taking them.

4. Properly dispose of all unused medications.


For Youth

Many people believe that taking prescription medications is safer than illegal drugs. This misconception has contributed to increased use in Colorado and in turn, more drug related deaths and hospitalizations. When medications are taken without a prescription or used in a way not prescribed by a doctor, they can be dangerous and addictive. When taken at too high a dose or along with alcohol or other drugs, there can be long-term and deadly consequences.

Type
Risk
Side Effects
PAINKILLERS 

(Oxycodone, Hydrocodone, Diphenoxylate, Morphine, Codeine, Fentanyl, Propoxyphene, Hydromorphone, Meperidine, Methadone)

Prescription painkillers are powerful drugs that can be dangerous, or even deadly.  This is especially true when taken at high doses or combined with alcohol. A single large dose can cause breathing difficulty that can lead to death.
  • Lack of energy
  • Inability to concentrate
  • Nausea/Vomiting
  • Addiction
  • Accidental overdose
DEPRESSANTS

(Barbiturates: Mebaral, Nembutal, Benzodiazepines: Valium, Xanax, ProSom, Sleep Medications: Ambien, Sonata, Lunesta)

In teens, depressants can cause short and long-term side effects. Depressants work by slowing the brain’s activity so abuse can lead to diminished heartbeat and dangerously low respiration levels. This is especially true when depressants are combined with alcohol or over the counter (OTC) medications. These combinations can even lead to death.
  • Depression
  • Confusion
  • Irritability
  • Addiction: increases chances of overdose, slowed breathing and heart rate
  • Withdrawal symptoms: anxiety, insomnia, muscle tremors
  • Going “cold turkey”: can lead to seizures, convulsions, and death
STIMULANTS

(Dextroamphetamine: Dexedrine and Adderall, Methylphenidate: Ritalin and Concerta)

Abusing drugs that are prescribed to treat specific medical conditions is never a good idea. Without a doctor’s supervision or monitoring, side effects can become harmful, or even dangerous. When taken at high doses, with alcohol or with over-the-counter medicines, stimulants can lead to seizures or heart failure.
  • Vomiting
  • Tremors
  • Sweating
  • Anxiety
  • Irregular heartbeat
  • Dangerously high body temperatures
  • Suicidal/homicidal tendencies
  • Paranoia
  • Cardiovascular collapse
RESOURCES

Rise Above Colorado

AboveTheInfluence.com

National Institute on Drug Abuse for Teens

The Medicine Abuse Project: Stories

KidsHealth.org

Self-Screening and Referral Resources – LinkingCare.org

The Prescription Drug Abuse Prevention program is funded by the Colorado Department of Human Services, Office of Behavioral Health