Community Prevention:

A Tulsa Coalition’s Approach to Reducing

Non-Medical Use of Prescription Drugs

Coalition Against Prescription and Substance Abuse of Tulsa (CAPSAT)

Conflict of Interest:

Attestation

None of the presenters of this power point have a

financial relationship with any commercial or proprietary

entity that produces health-care related products and/or

services relevant to the content in this presentation. This

includes any financial relationship within the last 12

months, as well as known financial relationships of our

spouses/partners.

Presenters

Lead Presenter: Whitney Kemp Education Coordinator, Oklahoma Center for Poison and Drug Information

Co-Presenter: Floyd Long Transition Coordinator Prisoner Re-Entry Specialist Oklahoma Department of Corrections

Co-Presenter: Matt Condley Prevention Specialist Tulsa Health Department

FUNDING SOURCES

Strategic Prevention Framework

State Incentive Grant

Coalition Against Prescription and Substance

Abuse of Tulsa (CAPSAT)

Mission : To bring diverse organizations/stakeholders and individuals together to change policies, systems, and environments for the prevention of substance abuse

Objective: The prevention of non-medical prescription drug and opiate/opioid abuse and misuse through education, research, training, intervention, treatment, and enforcement

Mission and Objective

Learning Objectives

Magnitude of prescription drug abuse

Consequences of use

What is CAPSAT doing?

What can you do?

Magnitude of the Problem

A closer look at the epidemic of

non-medical use of prescription

drugs facing our nation, state,

county, and city.

Increasing use of Rx drugs-particularly

opiate/opioid painkillers

In the 1970s/1980s – 2 deaths/100,000 population in U.S.

By 2007 – 1 death every 19 minutes

Rx drugs deaths are second only to motor vehicle accidents

16 States (including Oklahoma by 2009) Rx drug deaths have exceeded motor vehicle crashes

Centers for Disease Control, 2010

A closer look at the non-medical use of

prescription drug epidemic facing the

State of Oklahoma and Tulsa County

Oklahoma

Oklahoma opioid analgesic overdose death rate (age-adjusted)-

12.3/100,000 (National Vital Statistics Surveillance System 2011)

From 2007-2012 Oklahoma had nearly 3,900 overdose deaths (OSDH 2014)

4 out of 5 of these deaths involved at least one prescription drug (OSDH 2014)

Unintentional Poisoning Death Rates Involving at Least One Prescription Opioid by

County of Residence1, Oklahoma, 2007-20122

Cimarron Texas

Beaver Harper

Ellis

Beckham

Woodward

Woods Alfalfa

Major

Dewey

Custer

Washita

Kiowa

Blaine

Caddo

Grant

Garfield

Kingfisher

Kay

Noble

Logan

Canadian Oklahoma

Cleveland

Grady

Osage

McClain

Jackson

Tillman

Comanche

Cotton

Murray

Bryan

Pushmataha

Choctaw

Muskogee

Ottawa

Washington

Nowata

Craig

Mayes

Harmon

Top 5 counties

16.0. – 24.2

11.6 – 15.9

9.6 – 11.5

4.4 – 9.5

<5 deaths

Roger Mills

Greer

Tulsa

Okmulgee

Creek

Okfuskee

Payne

Lincoln

Wagoner Cherokee

Adair

Rogers

Delaware

Carter

Pontotoc

Johnston

Garvin

Love Marshall

Le Flore

Pittsburg

Atoka

Hughes

McIntosh

Latimer

Haskell

Sequoyah

Seminole Potta-

watomie

Rates per 100,000

population

State rate2: 11.9

1County of residence was unknown for 14 persons. 22007-2012 Medical Examiner data

Pawnee

Stephens Coal

Jefferson McCurtain

Tulsa County: A Closer Look 2014

In Tulsa County there are 35.94 prescription painkiller

pills/person (OBNDD 2014)

The most common substances in Tulsa County in overdose

deaths are: Alprazolam, Oxycodone, Methadone,

Hydrocodone, Alcohol, Morphine, Methamphetamine, Cocaine,

Diazepam, and Fentanyl (OSDH 2014)

Tulsa County

Intentional Analgesic Exposure by Age (Poison Control Center 2013)

0.0% 0.4%

8.5%

24.2%

21.2%

17.8%

19.5%

3.8%

1.7% 0.4% 0.0%

2.5%

0.0%

10.0%

20.0%

30.0%

<6 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >=90 Unknown(adult)

Intentional Analgesic Exposure by Age in Tulsa County (1/1/13-3/31/13)

At Risk At what grade are Tulsa County youth reporting using prescription

drugs for non-medical purposes?

1.9%

5.7%

6.8% 7.0%

1.8%

4.5%

6.2%

7.2%

5.0%

11.2%

13.4%

16.6%

4.2%

9.6%

14.0%

17.4%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

6th Grade 8th Grade 10th Grade 12th Grade

30 Day Non-medical Use vs. Lifetime Use

30-Day Use 30-Day Use Lifetime Use Lifetime Use

2008-2012 Oklahoma Prevention Needs Assessment (OPNA)

Tulsa County Non-Medical Use of

Prescription Drugs: Consequence Data

From 2005-2012 Tulsa County had an average rate of 83.95 persons per 100,000 population admitted to treatment for opioid prescription medicines ODMHSAS 2014

There was an increasing admission trend from 2006-2010. In 2006 there were 315 treatment admission for painkiller addiction. By 2010 there were 722 admissions. ODMHSAS 2014

There was a 66.7% increase in treatment for the misuse of painkiller prescription drugs from 2005-2010. ODMHSAS 2014

Opioid Treatment Rates/100,000

2009-2012 Oklahoma and Tulsa County

2009 2010 2011 2012

Tulsa County 104.99 119.31 89.22 104.53

Oklahoma 83.25 88.16 74.65 80.11

ODMHSAS 2014

OKLAHOMA:

An Expensive Problem

$6.7 billion

That is $1,900 for each man, woman, and child in the state

It is enough to create 273,000 median income jobs

It is enough to build 9 skyscrapers

State of Addiction 2012

Tulsa County Non-Medical Use of Prescription

Drugs Consequence Data (continued)

From 1999-2007, Tulsa County opiate overdose deaths was 17.0 deaths per 100,000 population. The state rate was 12.9. (ODMHSAS)

Tulsa County had the 18th highest age-adjusted opiate overdose death rate in the entire US (2010) (ODMHSAS)

Tulsa County ranked 16th in the entire nation for the number of opiate overdose deaths (2010) (ODMHSAS)

In Tulsa County from 2007-2012, there were 552 opiate overdose deaths – an average of 7.67 deaths each month (OSDH)

Tulsa County – Adults ages 45-54 were 2.5 times more likely to die of overdoses than teens and young adults ages 15-24 (OSDH 2007-2012)

Drug Overdoses in Comparison to Motor

Vehicle Accidents in Tulsa County 2009-2011

YEAR MVA DRUG OVERDOSES Rx PAINKILLER OVERDOSES

2009 696 756 547

2010 680 817 500

2011 696 703 456

ODMHSAS 2014

A closer look at the non-

medical use of

prescription drug

epidemic facing the City

of Tulsa

Number of opioid prescriptions filled

City of Tulsa Zip Codes (2013)

Oklahoma Bureau of Narcotics and

Dangerous Drugs, 2013

Number of opioid prescriptions (by doses)

filled: City of Tulsa Zip Codes (2014) (Oklahoma Bureau of Narcotics & Dangerous Drugs 2014)

Oklahoma Bureau of Narcotics and

Dangerous Drugs, 2014

2013-2014 Opioid painkiller consumption by

zip code (Comparison)

2013 (# of prescriptions) 2014 (# of pills)

CAPSAT’s

Target Zip Codes

74105

74115

74133

74136

What are some of the consequences

of Rx use/misuse/abuse?

Health: Addiction, death, brain damage,

major depression, neo natal issues, etc.

Social: loss of family and friends, family

problems, etc.

Financial: Lack of employment, loss of

employment, increased missed days from

employment, lack of finances, etc.

Legal: theft and unauthorized sale of Rx

drugs, jail/prison, attorney fees, etc.

Consequences

Tulsa Police Dept. 2014

Self Reported Use of Opiates for Persons

Screened by Oklahoma Department of

Corrections (2012)

01-10 11-25 26-50 50+ 01-10 11-25 26--50 50+

Lifetime 6 Month

Tulsa County 38.1% 16.9% 10.1% 34.9% 48.2% 24.7% 14.1% 12.9%

Oklahoma 33.4% 15.9% 11.2% 39.5% 45.8% 19.0% 11.2% 23.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

What is the State of Oklahoma doing to

combat this epidemic?

Oklahoma Prescription Monitoring

Program (PMP)

Enacted into law by the Oklahoma Anti-Drug Diversion Act

(63 O.S. Section: 2-309, 1990)

Oklahoma is credited as the first state to begin using a prescription monitoring program back in the early 90’s. Now Oklahoma has raced to the top again with its high

tech, electronic PMP that boasts real time prescription data sharing beginning this year (2014)

“The PMP application provides continuity between practitioners, pharmacies, and state law enforcement to help prevent prescription fraud in Oklahoma.”

“Designed to deter the abuse of prescription drugs, the statute requires all dispensers of Schedule II, III, IV, and V controlled substances to submit prescription dispensing information to OBNDDC using the ASAP 2007, Version 4, Release 1 standard within 24 hours of dispensing a scheduled narcotic.”

Oklahoma Bureau of Narcotics and Dangerous Drug Control

PMP Quick Facts:

Provides data in real time

Has a greater effect when universal, i.e., all prescribers use it

When actively managed, PMP alerts prescribers when problems are detected, i.e., doctor shopping

Oklahoma Legislation

House Bill 1783

“Effective November 1, 2013, prescriptions for any medication containing hydrocodone may not be refilled.” Oklahoma State Board of Pharmacy

Oklahoma’s Significant Timeline

September 2012- Governor Mary Fallin’s Prescription Drug Task Force Created

February 2013- Finalized State Prescription Plan

October 2013- Distributed Opioid Prescribing Guidelines

December 2013- Governor’s Launch of Rx Plan and Take As Prescribed Media Campaign

April 2014- Naloxone Program Begins (Tulsa Naloxone Pilot Project)

Naloxone

Senate Bill 457

“Allows first responders to administer opiate antagonists without a

prescription when encountering a person exhibiting signs of a drug

overdose; includes prescribing an opiate antagonist to an individual

for use by that individual when encountering a family member

exhibiting signs of an opiate overdose; provides for the Good

Samaritan Act; includes law enforcement, emergency medical

technicians, firefighters and medical personnel at secondary schools

and institutions of higher education.”

Naloxone

Naloxone is a medication called an “opioid antagonist” used to counter the

effects of opioid overdose, for example morphine and heroin overdose.

Specifically, naloxone is used in opioid overdoses to counteract life-

threatening depression of the central nervous system and respiratory

system, allowing an overdose victim to breathe normally.

Naloxone is a nonscheduled (i.e., non-addictive), prescription medication.

Naloxone only works if a person has opioids in their system; the medication

has no effect if opioids are absent.

Naloxone comes in a kit and is administered by being sprayed into the nose. It

is a temporary drug that wears off in 20-90 minutes. As part of an new

initiative, naloxone will be available to first responders as well as available to

the general public. Individuals and family members can contact their family

physician to learn more about access and obtain a prescription.

Oklahoma Department of Mental Health and Substance

Abuse Services (ODMHSAS)/Take As Prescribed Campaign

4 people in Tulsa have been saved

because first responders used

Naloxone

First responders throughout Tulsa

County now carry Naloxone

http://www.newson6.com/clip/1032

7188/increase-in-heroin-use-has-tpd-

officers-carrying-life-saving-kit

Oklahoma Department of Mental Health and

Substance Abuse Services (ODMHSAS)/TPD

Naloxone Quick Facts:

What is CAPSAT?

Composed of Tulsa citizens who have an interest in reducing the non-medical

use of prescription drugs.

Funded by ODMHSAS, SAMHSA, and CSAP with Strategic Prevention Framework

State Incentive Grant

Tasked with developing a plan to reduce prescription drug abuse and reduce

opiate analgesic (painkillers) overdose deaths

Conducted an assessment in Tulsa County to determine areas in which the

problem appeared to be centered

Developed a work plan and strategies to fight this epidemic. Strategies use

the public health approach of population change through changing the

environment which may be conducive to substance use/abuse

CAPSAT STRATEGIES

Proper storage of prescription drugs through educational presentations,

distribution of lock boxes, use of media to develop awareness

Proper disposal of prescription drugs through educational presentations, take-

back events, distribution of disposal bags, increasing awareness of permanent

drop off sites

Awareness campaign, including Naloxone

What is CAPSAT doing? Community Education/Presentations

- Safe/Secure Storage of Prescription Drugs (Pact 360 Rx Video,

Distribution of Rx Lock Boxes w/Individual Pledge & Policy to Safely Store Rx Meds,

Pre/Post Survey, Rx handouts/information)

- Proper Disposal of Prescription Drugs (Pact 360 Rx Video, Distribution of

Personal Rx Disposal Bags w/Individual Pledge & Policy to Properly Store Rx Meds,

Pre/Post Survey, Rx handouts/information, creating awareness of OBNDD Permanent

Disposal Boxes)

Rx Take Back Days for the community-partnership with OBNDD,DEA, Walgreens, Reasors, Save A

Lot, etc. (Fall & Spring)

Community Surveys

Safe Storage & Proper Disposal Policy Advocacy

Rx Data Collection - ongoing

Media Awareness Campaign (Rx Safe/Secure Storage & Proper Disposal of Rx Drugs)

CAPSAT Website (www.capsat.org)

Media Awareness-

Tulsa Transit Ads (in target zip codes: 74105, 74115, 74133,

74136)

Problem # 1

Easy

Access

OKLAHOMA ADULT PRESCRIPTION DRUG

SURVEY (TULSA COUNTY) 2012

What do you do with your left over prescription

drugs?

Save them for use later 51.6%

Flush them/Throw in trash 48.4%

Take to a drug drop box 9.3%

Take to a drug take back event 4.7%

OKLAHOMA ADULT PRESCRIPTION DRUG

SURVEY (TULSA COUNTY) 2012

When asked:

“Do you keep your prescription medicines in a

locked, secure cabinet?”

57.4% said No

DO NOT SHARE PRESCRIPTIONS

THE LIFE YOU SAVE MAY BE YOUR OWN

Problem # 2 – Improper Disposal of Rx

Drugs

CAPSAT’S RECOMMENDATION

Tulsa County

Permanent Drug Drop-Off Sites Tulsa Police Department, Gilcrease Division 3436 N. Delaware, Tulsa 74110

Tulsa Police Department, Mingo Valley Division, 10122 E. 11th Street, Tulsa 74128

Tulsa Police Department, Riverside Division, 7515 S. Riverside Drive, Tulsa 74136

Tulsa County Sheriff, 303 W. 1st Street, Tulsa 74103

Bixby Police Department, 116 W. Needles, Bixby 74008

Broken Arrow Police Department, 1101 N. 6th , Broken Arrow 74012

Collinsville Police Department, 1023 W. Center, Collinsville 74021

Glenpool Police Department, 14536 S. Elwood, Glenpool 74033

Jenks Police Department, 211 N. Elm, Jenks 74037

Owasso Police Department, 111 N. Main, Owasso 74055

Skiatook Police Department, 220 S. Broadway, Skiatook 74070

Sand Springs Police Department, 100 E. Broadway, Sand Springs 74063

What can be done?

Media Campaign to inform public on the epidemic of prescription-related

deaths

Encourage presentations to educate on proper storage and disposal of prescription

drugs

Promote public reporting of drug diversion to Oklahoma Bureau of

Narcotics and Dangerous Drugs Control

Promote 211 information helpline to public to obtain referrals for addiction

treatment

Individuals & Communities Can

Create Environmental Change

Everyone can: Secure your prescription medications; especially opiates, in a safe manner. (Our

recommended method is a prescription drug lock box)

Avoid taking prescription painkillers more often than prescribed.

Dispose of medications properly, as soon as the course of treatment is done, and avoid keeping prescription painkiller or sedatives around “just in case.” (Our recommended method is personal disposal bags or OBNDD permanent disposal boxes-located at your local police department/sheriff’s office.

Help prevent misuse and abuse by not selling or sharing prescription drugs.

Never use another person’s prescription drugs.

Get help for substance abuse problems 2-1-1 or 1-800-662-HELP.

Call Oklahoma Poison Control Center 1-800-222-1222 if you have questions about medicines.

WHAT HAS CAPSAT DONE?

Achievements

146 lock boxes distributed

150 individual pledges/policies

10 community presentations – in FY 14

Hispanic Outreach (Presentations at Saints Peter & Paul, St. Xavier, Catholic Charities)

2 community surveys

Rx Take Back Events (1 of which had the largest amount of meds taken back in the State) 2013- 411 pounds

Only Rx Prevention Coalition w/in Tulsa *community mobilization w/in a short period of time

Future CAPSAT Events

Rx/opiate water study

Upcoming Rx Take Back Day (October 18, 2014 at

Reasor’s, 71st & Sheridan)

Upcoming Community Events

Mayor Bartlett’s Rx Summit (Oct. 17, 2014)

Expected Outcomes

Change in attitudes and behavior with respect to storage and disposal of prescription drugs

Increased knowledge of permanent disposal sites

Please join CAPSAT in our

efforts!

CAPSAT meets the second Wednesday of every month at

1:30pm

October 8, 2014 (Hardesty Library, Pecan Room)

November 12, 2014 (North Regional Health & Wellness Center, Rm

210)

December 10, 2014 (Hardesty Library, Pecan Room)

IS THERE LIGHT AT THE END OF THE TUNNEL?

TULSA COUNTY AND OKLAHOMA STATE OPIOID

TREATMENT RATES/100,00, 2012-2013

2012 2013

TULSA COUNTY 104.53 77.12

OKLAHOMA 80.11 62.64

Could that light be getting brighter?

Opioid Analgesic Overdose Death Rate/100,000

2009-2011

Tulsa County Oklahoma

2009 18.8 15.0

2010 17.9 13.6

2011 11.5 12.3

A big thank you to our partners. You

make everything possible with your help

and dedication.

CAPSAT Partners

“Local People Solve Local Problems”

McGee Enterprises

For more information, please contact:

Whitney Kemp, CAPSAT Co-Chair

405-522-0075

whitney-kemp@ouhsc.edu

Stephanie Tillman, SPF SIG Coordinator

918-595-4468

stillman@tulsa-health.org

Website: www.capsat.org