“What You Need To Know About Prescription Drugs in York County!”

1. “What You Need To Know About Prescription Drugs in York County!” January 11, 2012 York County Prevention Collaborative Presentation

2. National Problem • More 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)

3. York County Youth • 23% of 9-12th graders have used Rx drugs without doctor’s 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

5. 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” effects • Taking in extreme doses • Mixing pills • Using with alcohol or other illicit substances • Obtaining from non-medical sources

6. Marijuana vs. Prescription RX’s • 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.

7. What drugs are being Misused?

8. 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 loss • Ex) Aderall, Ritalin, Concerta, Dexedrine, Fastin

9. Rx Drug Misuse in the U.S. 6.4 million aged 12+ used a Rx drug (non-medically) in the past year

12. SPLENDID FOR Wind, Colic, Griping in the Bowels, Diarrhea Cholera and Teething Troubles

13. 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%

14. Older Adults

15. An estimated one in five older adults are negatively affected by combined difficulties with alcoholandRx medication abuse.

16. 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

17. Older AdultsRisks Factors Prescribed multiple medications. Long-term prescriptionscanlead to unintentional misuse -taking different doses. Prescribed inappropriately high doses.

18. 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)

19. Overview Three classes of commonly abused Rx drugs What are they? (opioids, sedatives, stimulants)

20. 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

21. Morphine Routes: oral, intramuscular, intravenous, rectal Sustained release preparations: MS Contin Oramorph Kadian Avinza

22. 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)

23. 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

24. 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

25. Synthetic Opioids Methadone Demerol (meperidine) Fentanyl Suboxone/Subutex (buprenorphine) Tramadol Complex mechanism of action Nonscheduled, less abuse potential

26. Dextromethorphan Over-the-counter cough suppressant Structurally related to morphine Also known as Robitussin

27. 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

28. 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

29. 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

30. 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).

31. Proper Disposal of Prescription Drugs

32. 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.

33. 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

34. Drug Take Back Day, October 29th Totals

35. Evaluation Results 209 people responded (North Berwick and Berwick not included) 58 have 1 or more children under 21 in home

36. “Reducing Prescription Drug Abuse in York County: From Awareness to Action” A York County Grant funded by the Department of Public Safety

37. 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.

38. 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.

39. Project Activities ~ Not Begun or Need More Effort • Community awareness campaign poster for your service area, photographs and youth. • 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. • Provide a minimum of 2 parent education opportunities (PTA presentation, adult ed., school parent nights, etc. web sites, emails, phone, youth sports). • 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. • Assist Project Leaders with disseminating an educational module for middle and high school teachers in on the dangers of prescription drug abuse.

40. Choose To Be HealthyPartnership at York Hospital serves the Berwicks, Eliot, Kittery, Lebanon, Ogunquit, York and Wells Coastal Healthy CommunitiesCoalition at University of New England serves Kennebunk, Arundel, Kennebunkport, Biddeford, Saco, Old Orchard Beach, Dayton, Buxton, Hollis Partners for Healthier Communities at Goodall Hospital servesSanford, 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.

41. Project Coordinators/ Contacts William 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 Hospital 25 June Street, Sanford, Me 04073 Phone 207-490-7704, ext. 311 croux@goodallhospital.org