1 June 20, 2006 Medicine Misuse /Abuse Montgomery County, Maryland Safe & Drug Free Schools 2006...

1

June 20, 2006

Medicine Misuse /Abuse

Montgomery County, Maryland

Safe & Drug Free Schools

2006 Symposium

University of MD

Shady Grove Campus

-----------------------

Wm. Ray Bullman

National Council on Patient Information and Education

Objectives: Medicine Misuse / Abuse

Define the problem Review National Data

Licit and illicit drug use Review the 2004 MD State Dept of Ed.

Maryland Adolescent Survey Licit and illicit drug use

Discuss next steps: In search of solutions!

PharmingKids “getting high” using Rx or OTC drugs

Creatine

Andro

Vicodin

GHB

Desired: Appropriate Drug Use

Over the Counter (OTC) Medicines High margin of safety (but surprises happen)

Through prescription by licensed provider For Indicated Use

Listed on the FDA regulated package insert For “Off-Label” Use

By regulated prescription (with DEA number) for known drugs of potential abuse

Desired: Shared Decision Making

Provider-patient shared decision for drug use Provider believes drug useful for treatment

Communicates rationale to patient Benefits outweigh the risks

Patient agrees that drug will be useful Understands rationale Accepts risks for desired benefit

Patient takes medicine as directed Provider gets patient feedback

Problem: Medicine Misuse

Drugs not taken as intended Provider prescribes for “wrong reason” Patient does not take drug as directed

Unintentional: forgetfulness, too many drugs, mind-altering drug interactions

Intentional: patient doesn’t feel need or believes drug not working and doesn’t discuss with the provider

Drugs diverted to another person Potential problem & illegal (with prescribed

drugs)

Problem: Medicine Abuse

Interactions affecting decision-making

Individual - a voluntary decision to use Psychologically pleasurable Physically enhancing for specific outcomes

Environmental – friends & groups affect decision

Drug is available at a “reasonable” price Drug enhances group bonding Drug connected to desired group activities

"Generation Rx“

Today's teenagers are more likely to have abused medications than a variety of illegal drugs like Ecstasy, cocaine, crack, and methamphetamine.

Nearly one in five teens (19 percent or 4.5 million) report abusing prescription medications to get high

One in 10 (10 percent or 2.4 million) report abusing cough medicine to get high.

(Partnership for a Drug-Free America, 2005 Partnership Attitude Tracking Study)

"Generation Rx“

1 in 4 teens report having a fried who abuses medicines to get high

1 in 3 report being offered an Rx or OTC medicine for the purpose of abuse

Teen abuse of Rx & OTC medicines is greater than the combined abuse of ecstasy, meth, and heroin.

Every day, 2,700 teens try an Rx medicine to get high for the first time*

This suggests: Rx & OTC abuse has penetrated teen culture and become “normalized.”

(Partnership for a Drug-Free America, 2005 Partnership Attitude Tracking Study; * 2004 National Survey on Drug Use and Health)

Any Illicit Drug Use in Past Month among Youths Aged 12 to 17, by State

(Percentages, Annual Averages Based on 2003 and 2004 NSDUHs. SAMHSA)

Teen Drug Abuse – We’re all in it together….

Any Illicit Drug Use Other Than Marijuana in Past Month among Youths

Aged 12 to 17

(Percentages, Annual Averages Based on 2003 and 2004 NSDUHs, SAMHSA)

Some Even Worse than Others…

Non-medical Use of Pain Relievers in Past Year

among Youths Aged 12 to 17 (Percentages, Annual Averages Based on 2003 and 2004 NSDUHs, SAMHSA)

For Both Illicit & Licit Drugs…

New Landscape of Substance Abuse

# of Teens Who Have Ever Tried: (in millions)

Marijuana 8.6 millionInhalants 4.7 millionRx Medicine 4.5 millionCough Medicine 2.4 millionCrack/Cocaine 2.4 millionEcstasy 1.9 millionMeth 1.9 millionLSD 1.3 millionHeroin 1.1 millionKetamine 1 millionGHB 1 million

(Partnership Attitude Tracking Study, 2005)

Rx Abuse: ? on the Continuum Abuse of Rx medicines falls in the middle of the teen drug use continuum – less common than marijuana and more common than other drugs:

Lifetime Use %Marijuana 37Inhalants 30Prescription Medicine 19 (not prescribed for them)

Cough Medicine 10Cocaine / Crack 10Methamphetamine 8Ecstasy 8LSD 6Heroin 5Ketamine (Special K) 4GHB 4


Thank Goodness it’s only Pot ….Drugged Driving As Common As Alcohol-Impaired Driving Among

Teens Each day 9,000+ new driver's licenses are issued to

16- and 17-year-olds, those @ greatest risk for marijuana use. These same teens say that cars are the second most popular place for smoking marijuana. Monitoring the Future survey reports that approximately one in six (15%) teens reported driving under the influence of marijuana, a number nearly equivalent to those who reported driving under the influence of alcohol (16%).

More than 2.9 million driving-age teens reported lifetime use of marijuana, and last year more than 750,000 16- and 17-year-olds reported driving under the influence of illicit drugs. According to the 2004-2005 PRIDE Surveys, when asked where they use, approximately one in seven (14%) high school seniors cited "in a car," making cars the second most popular location after at "a friend's house" (20.4%).

Marijuana impairs many of the skills required for safe driving, such as concentration, coordination, perception and reaction time, and these effects can last up to 24 hours after smoking the drug-It is critical that parents know the dangers associated with drugged driving and are vigilant in monitoring their teen drivers.

(Alliance for Consumer Education)

Gentlemen, don’t start Your engines……

Attitudes – Rx Medicine Abuse

% Agree strongly / somewhat

Rx drugs easier to get than illegal drugs 56

Rx drugs, even if not prescribed by doctor, 40are much safer to use than illegal drugs

There is nothing wrong with using Rx drugs 31w/out a doctor’s prescription once in a while

Rx pain relievers, even if they are not prescribed 29by a doctor, are not addictive.


% Great Risk

’04 ‘05

Trying Rx pain relievers (Vicodin, 48 44Oxycontin, Tylox) that a doctor did not prescribe for you

Trying the Rx drugs Ritalin or Adderall 5451 that a doctor did not prescribe for you


Good News / Not So Good News

2005 Partnership Attitude Tracking Study shows that substance abuse among 7th -12th graders continues to decline. After years of adolescent drug use seen in the mid 90’s, the trend continues to reverse. The two exceptions are: inhalant and Prescription (Rx) medicine abuse.

The use of alcoholic beverages has generally been in decline among American teens for the last several years, and that decline continued (in all three grades) in 2005.

(Sources: Partnership for a Drug-Free America, 2005 Partnership Attitude Tracking Study; 7,300 teens in grades 7–12; Univ. of MI, Monitoring the Future, Dec. 2005)

Rx Abuse = Entrenched Behavior (1)

Teen smoking & drinking continue to , but teenage abuse of Rx drugs has become "an entrenched behavior" that many parents fail to recognize (May 2006)

For a third straight year, PD-FA study showed that about 1 in 5 teens have tried Rx painkillers such as Vicodin or OxyContin to get high -- about 4.5 million teens. (Univ. of MI study showed 1 in 10 H.S. seniors had experimented with Rx painkillers)

Many teens feel experimenting with Rx drugs is safer than illegal highs.

(Partnership for a Drug-Free America, 2005 Partnership Attitude Tracking Study; 7,300 teens in grades 7 – 12)

Rx Abuse = Entrenched Behavior (2)

40% said Rx medicines were "much safer" than illegal drugs, while 31% said there was "nothing wrong" with using prescription drugs "once in a while."

The study further found that 29% of teens believe Rx pain relievers are non-addictive.(Partnership for a Drug-Free America, 2005 Partnership Attitude Tracking Study)

Reasons for Rx Pain Reliever Abuse?

Widespread availability and generally easy access.

Generally cheap

Less of a stigma attached to their use (than others)

Relatively easy to get on the Internet

Generally regarded as safer than “street drugs”(Partnership for a Drug-Free America, 2005 Partnership Attitude Tracking Study)

Past Month Illicit Drug Use among Persons Aged 12 or Older,

by Age (2004 National Survey on Drug Use and Health, SAMHSA)

Past Month Use of Selected Illicit Drugs among Youths Aged 12 to

17 (2002 - 2004 National Survey on Drug Use and Health, SAMHSA)

Youths Aged 12 to 17 Among 12 or 13 year olds: 1.7% used Rx-type drugs non-medically, 1.2% used

inhalants, and 1.1% used marijuana.

Among 14 or 15 year olds: Marijuana was the dominant drug used (7.3%), followed by Rx-type drugs used non-medically (4.1%) and inhalants (1.6%).

Among 16 or 17 year olds: Marijuana also was the most commonly used drug (14.5%), followed by Rx-type drugs used non-medically (5.1%), hallucinogens (1.7%), and cocaine (1.1%). Only 0.9% of youths aged 16 or 17 used inhalants.

Among all youths aged 12 to 17 in 2004, 10.6% were current illicit drug users: 7.6% used marijuana, 3.6% used Rx-type drugs non-medically, 1.2% used inhalants, 0.8% used hallucinogens, and 0.5 % used cocaine.

The rate of current illicit drug use among youths aged 12 to 17 gradually declined between 2002 and 2004. The rate was 11.6% in 2002, 11.2% in 2003, and 10.6% in 2004. This represents a statistically significant change between 2002 and 2004, but not between 2002 and 2003 or between 2003 and 2004.

(2004 National Survey on Drug Use and Health, SAMHSA)

Q: What types of Rx medications are teens abusing?

A: The National Survey on Drug Use and Health identifies 4 types of Rx medications that are commonly abused:

Pain relievers Stimulants

Sedatives Tranquilizers

11% of teens aged 12-17 reported lifetime non-medical use of pain relievers and 4% reported lifetime non-medical use of stimulants.

They’re Getting them from Somewhere!

% ‘04 ‘05

Use Rx pain relievers such as Vicodin, 37 37Oxycontin, Tylox, that a doctor did notprescribe for them

Use the Rx drugs Ritalin or Adderall 29 29that a doctor did not prescribe for them


…Meet Willie Sutton…

Willie Sutton (aka "The Actor" & "Slick Willie“) for his ingenuity in executing robberies in various disguises. Fond of expensive clothes, Sutton was described as being an immaculate dresser. Although he was a bank robber, Sutton had the reputation of a gentleman; people present at his robberies stated he was quite polite. One victim said witnessing one of Sutton's robberies was like being at the movies, except the usher had a gun. When asked why he robbed banks, Sutton simply replied, "Because that's where the money is.“

…May I Use Your Bathroom?…

The source of drugs is now the family medicine cabinet more than any dealer.

PD-FA found 62% of teens said Rx pain relievers are easy to find at home. And 52% say Rx pain relievers are "available everywhere."


“Because That’s Where the Drugs Are ”

%Easy to get from parents’ medicine cabinet 62Are available everywhere 52They are not illegal drugs 51Easy to get through other people’s Rxs 50Teens can claim they have a prescription if caught 49They are cheap 43Safer to use than illegal drugs 35Less shame attached to using 33Easy to buy over Internet 32Parents don’t care as much if you get caught 21


OTC Medicine Abuse

“Chugging cough medicine for an instant high certainly isn't a new practice for teens… recent coverage of the dangerous, potentially deadly practice of intentionally overdosing on cough and cold medicine has put parents, educators, and emergency departments on the alert.”

Why Are Kids Abusing Cough and Cold Remedies?

Before the FDA replaced the narcotic codeine with dextromethorphan as an OTC cough suppressant in the 1970s, teens were simply guzzling down cough syrup for a quick buzz. Over the years, teens have discovered they could get high by taking mass quantities of any of the multitude of OTCs containing DXM. Found in tablets, capsules, gel caps, and lozenges, as well as syrups, dextromethorphan-containing products are labeled DM, cough, cough suppressant, or Tuss (or contain "tuss" in the title).

Medicines containing dextromethorphan are easy to find, affordable for cash-strapped teens, and perfectly legal. And because it's found in over-the-counter medicines, many teens are naively assuming that DXM can't be that dangerous.

(http://kidshealth.org/parent/positive/talk/cough_cold_medicine_abuse.html

What Happens When Teens Abuse DXM?

Taking mass quantities of products containing DXM can cause hallucinations, loss of motor control, and "out-of-body" (disassociative) sensations.

Other possible side effects of DXM abuse include: confusion, impaired judgment, blurred vision, dizziness, paranoia, excessive sweating, slurred speech, nausea, vomiting, abdominal pain, irregular heartbeat, high blood pressure, headache, lethargy, numbness of fingers and toes, redness of face, dry and itchy skin, loss of consciousness, seizures, brain damage, and even death.

Large quantities can also cause a high fever. This is a real concern for teens who take DXM while in a hot environment or while exerting themselves at a rave or dance club, where DXM is often sold and passed off as similar-looking drugs like PCP.

(http://kidshealth.org/parent/positive/talk/cough_cold_medicine_abuse.html)

Q: What cough medicines are target for abuse (contain dextromethorphan, or

DXM?)

There are over 100 OTC medicines that contain DXM, either as the only active ingredient or in combination with other active ingredients, including:

-Alka-Seltzer Plus Cold & Cough Medicine -Vicks NyQuil LiquiCaps-Dayquil LiquiCaps -Coricidin HBP Cough/Cold -Dimetapp DM -Robitussin cough Products -Sudafed cough products -Triaminic cough syrups -Tylenol Cold products -Vicks 44 Cough Relief

products

There also are a number of store brands that contain DXM.

OTC Abuse – Be on the Lookout

If you suspect that a child may be abusing OTC medicines or if your teen often attends raves or dance clubs where DXM can likely be found in abundance, it might be a good idea to:

Lock your medicine cabinet, or keep those OTC medicines that could potentially be abused in a less accessible place.

Avoid stockpiling OTC medicines. Having too many OTC medications at your teen's disposal could make abusing them more tempting.

Keep track of how much is in each bottle or container in your medicine cabinet.

OTC Abuse – Be on the Lookout

Keep an eye out for not only traditional-looking cough and cold remedies in your teen's room, but also strange-looking tablets (DXM is often sold on the Internet and at raves in its pure form in various shapes and colors).

Look for possible warning signs of DXM abuse.

Monitor your child's Internet usage. Be on the lookout for suspicious websites and emails that seem to be promoting the abuse of DXM or other drugs, both legal and illegal.

Combating Abuse: 3-Step Approach for Parents

1. Educate themselves about the medicines that kids are abusing.

2. Communicate with their kids about the medically appropriate use of medications, & the harmful consequences of intentionally abusing them.

3. Safeguard their own medications & ask their

friends to do the same.

4. Flush / Don’t Flush? Pharmacy return? (Depends)

36

1994 - 2004

Drug Abuse in the Montgomery County Public

Schools (MCPS)

Source: Maryland Department of Education

Maryland Adolescent Survey

Data specific to Montgomery County

MCPS Beer, Wine, Coolers Use

0

10

20

30

40

50

60

70

6th grade 8th grade 10th grade 12th grade

% Use in Prior 12 mos

199419961998200120022004

Source: 1994, 1996, 1998, 2001, 2002, 2004 Maryland Adolescent Survey

MCPS “Hard” Liquor Use

0

10

20

30

40

50

60

70



199419961998200120022004


MCPS 5+ Drinks/Same Occasion

0

10

20

30

40

50

60

70



199419961998200120022004


MCPS Cigarette Use

05

101520253035404550



199419961998200120022004


MCPS Smokeless Tobacco Use

0123456789

10



199419961998200120022004


MCPS Steroids for Body Building

0

0.5

1

1.5

2

2.5



199419961998200120022004


MCPS Marijuana or Hashish Use

05

101520253035404550



199419961998200120022004


MCPS LSD Use

02468

101214161820



199419961998200120022004


MCPS Mescaline, ‘shroom Use

02468

101214161820



199419961998200120022004


MCPS PCP Use

0123456789

10



199419961998200120022004


MCPS Amphetamine Use

0123456789

10



199419961998200120022004


MCPS Methamphetamine Use

0123456789

10



199419961998200120022004


MCPS Cocaine (not crack) Use

0123456789

10



199419961998200120022004


MCPS Designer Drugs -- MDMA, Ecstasy Use

0123456789

10



199419961998200120022004


MCPS Narcotic (not Heroin) Use

0123456789

10



199419961998200120022004


MCPS Barbit. or Tranquilizer Use

0123456789

10



199419961998200120022004


Discussion

Montgomery County (like all other counties), has a drug use problem Misuse, abuse, and dependence

Who chooses to become an addict? (rhetorical question)

What can we do? (prevention strategies) Primary – healthy community, social norms Secondary – identify high risk, early intervention,

prescription drug monitoring Tertiary – effective treatment easily accessed

Next steps?

Web-Based Resources

www.bemedwise.org (NCPIE)www.drugfree.org (PD-FA)www.methwatch.com (CHPA)www.drugabuse.gov (NIDA)www.teens.drugabuse.gov (NIDA)www.rx.samhsa.gov (SAMHSA)www.monitoringthefuture.org (Univ. of MI)www.inhalant.org (ACE)

Contact Information

Wm. Ray Bullman, M.A.M.

Executive Vice President

National Council on Patient Information and Education

4915 Saint Elmo Ave., Suite 505

Bethesda, MD 20814-6082

(301) 656-8565 - Phone

[email protected] - Email

www.talkaboutrx.org

www.bemedwise.org

1 June 20, 2006 Medicine Misuse /Abuse Montgomery County, Maryland Safe & Drug Free Schools 2006...

Documents

Transcript of 1 June 20, 2006 Medicine Misuse /Abuse Montgomery County, Maryland Safe & Drug Free Schools 2006...