Generation rx

Generation rxPreventing the misuse and abuse of prescription medications

Introductions

http://medicineabuseproject.org/resources/out-of-reach-medicine-abuse-through-the-eyes-of-a-teenhttp://www.youtube.com/watch?v=UAdU38PozHg&list=UUQr_wgyFUxVhvITONsOXjew&index=106http://www.youtube.com/watch?v=UAdU38PozHg&index=106&list=UUQr_wgyFUxVhvITONsOXjew

(X-year pharmacy student at UW-Madison SOP)Were here with the organization Generation Rx.1A Growing public health problem

WhatWhoWhyWhat can you do?Were here today to raise awareness about a serious and growing public health problem the misuse and abuse of prescription medications.

During our time with you today, well spend about 30 minutes presenting information, then go through several case studies, and close with time for questions.

You can see on the screen what well talk about in this presentation. Essentially, were going to talk about the statistics and myths surrounding prescription drug abuse and misuse. Our goal is to raise awareness about the risks and dangerous consequences that can result from the abuse of prescription drugs.

Please ask questions if you have them! We will do our best to answer them, but as pharmacy students we are unable to give clinical judgment on your own medications. For those questions, we encourage you to ask your pharmacist!2WhatWhat is abuse?What medications are abused?

What do you think?Prescription drug abusePrescription drug misuse

Ask the students what they think you mean by prescription drug abuse and misuse.4Prescription drug Abuse and mIsuseTaking a drug that was not prescribed for youTaking more of a drug than youre supposed toTaking a drug for a reason other than youre supposed to

When taken as written, prescription medications benefit a lot of people. What were talking about with abuse and misuse is either using someone elses prescription OR not following the directions of your own.

Im guessing that its not a surprise to you that prescription drug abuse is a growing problem in this country. 5What do you think?Commonly abused medicationsCommonly abused medication classes

Ask the students what they think some commonly abused medications are.6What happens?

Ask the students what they think some commonly abused medications are.7Commonly abused prescription drugsOpioid analgesics (painkillers)Examples: Oxycontin, Oxycodone, Morphine, VicodinStimulantsExamples: Ritalin, AdderallSedativesExamples: Valium, Xanax, Ambien, LunestaDextromethorphan (cough medicine)Examples: Robitussin, NyQuil, DelsymOTC

Most prescription drugs of abuse fit into one of four categories.

You guys listed some examples of prescription painkillers. (adjust if no class input on previous slide) Another name for these is opioids. These medications are used to treat severe pain, but they also have some serious side effects that well talk more about later. The most important thing to know about these medications is that it is VERY dangerous to mix them with alcohol. (if asked: because it slows your breathing).

Another class of commonly abused prescription drugs is stimulants. These medications are used to treat ADHD and narcolepsy (a sleep disorder). Again, the side effects of can be serious when you take them outside the care of a health care practitioner.

Some abused medications are sedatives. These are used to treat sleep disorders as well as anxiety and panic attacks. Lastly, dextromethorphan is an ingredient found in both prescription and over the counter cough medicines. When taken in quantities larger than what is recommended on the bottle, abuse of these drugs has very serious health risks as well. 8OpioidsEffects on breathing center in brainRespiratory depression Respiratory=lungs / breathingDepression=slowingSlow down or stop breathingUnconsciousnessConstipationNausea / VomitingConvulsions

(Source: http://www.cdc.gov/homeandrecreationalsafety/rxbrief/)(www.cdc.gof/drugoverdose/data/overdose.html)Of the four classes that we talked about, one sticks out. There is a growing, deadly epidemic of prescription painkiller abuse. The 12 million people that reported abusing opioids constitutes 1 in 20 Americans. However, think about what the real number might be 12 million is only the reported number of abusers.Not only are opioids widely abused, their abuse is deadly. They cause almost 75% of prescription drug overdoses, totaling 14,800 deaths in 2008. Thats more than cocaine and heroin combined.9Sedatives (Benzodiazepines)SedationMuscle relaxationRespiratory DepressionLike opioidsBut also with muscle relaxationCardiac problems (if already present)Cardiac = heartDependence

StimulantsInsomniaAnxiety / PanicIrritabilityDependenceTremorsCerebral hemorrhage due to increase Blood PressureCognitive ImpairmentCognitive = Mental function/ normal thought processImpairment = destroy / decreaseDextromethorphanSame effects as Opioids Nausea / VomitingDizzinessConstipation

Rx abuse and alcoholEffects of Drugs alone are badEffects of Drugs WITH Alcohol are DEADLYAdditive EffectsDepressed RespirationSedationComa

(Source: http://www.cdc.gov/homeandrecreationalsafety/rxbrief/)

This figure helps us get a feel for what that underreported number might actually look like. In 2008, 14,800 people died from prescription painkillers. For each death, 10 people were admitted to treatment for abuse and 32 visits were made to emergency rooms. Also, for each death, 130 people are abusing or dependent, and there are a total of 825 people abusing prescription painkillers.14

WhoWho abuses prescription drugs?

What do you think? About how many Americans (age 12 or older) abused a prescription medication in one year?A. 70,000B. 700,000C. 7 millionD. 70 million

Correct answer: 7 million

Is this number surprising to you?

17DemographicsPrescription drug misuse falls into every age range, among both men and women, and across all socioeconomic linesIts not just young people: 1 in 4 adults 50 and over abuses a psychoactive medication (a drug with effects in the brain)Prescription drug abuse affects every state in the US, from small towns to big cities

Read slide

Prescription drug abuse is hard to predict since it occurs in so many different groups of people butThe reason that were here today is that a large percentage of this abuse does happen with people in your age group.

Its important for you all to have all of the information about the serious risks that accompany prescription drug abuse before you are confronted with the choice to do so.18

http://medicineabuseproject.org/the-problem19

(http://medicineabuseproject.org/the-problem)20

http://www.drugfree.org/join-together/growing-number-workers-abusing-stimulants-stay-competitive/ 21WhyWhy is the potential for prescription drug abuse so high?

What do you think?Approximately how many prescriptions are purchased in the US each year?A. 3.9 millionB. 10.2 millionC. 1.3 billionD. 3.9 billionE. 7 billion

- 259 Million prescribed for Pain Medications alone!

(http://kff.org/other/state-indicator/total-retail-rx-drugs/)(United States Census Bureau)Correct answer: 3.9 billion

3.8 billion prescription drugs are purchased in the US alone every year. That comes out to 12.3 prescriptions per person (12 per person in Wisconsin)

259 Million Rx for pain killers alone

Does that number seem high to you?A lot of medications are being prescribed in the US each year, which plays a huge role in the American epidemic of prescription drug abuse. Now that you know just how many prescriptions are out there, lets think about why they get abused in the first place.23

(http://medicineabuseproject.org/the-problem)24Abuse & teensWhy do teens abuse prescription drugs?A. To get highB. To relieve painC. To improve gradesD. To fit in E. All of the above

Correct answer: All of the above

Were guessing that most of these reasons dont surprise you. One that might is to improve grades.

Why do you think that is a reason? (wait for answers)This reason is a rapidly growing problem in both high schools and colleges. Many students are abusing stimulants so that they can stay focused for long periods of time and cram for an exam. 25Consequences - stimulantsStimulant use vs AbuseWhy is it bad to use stimulants to study?What consequences could result?

What some people dont know is that using stimulants to study is considered a form of cheating.

Why is it bad to use stimulants to study? ~ Its illegal you can go to jail~ The health consequences can be serious you can overdose or have serious interactions with medical conditions or other medications you are taking~ Its not really you doing the studying you cant feel proud of your accomplishmentsRemember that unless you have a prescription, any of these reasons are considered abuse26Statistics: StimulantsResearch has shown that stimulants do not improve academic performance in teens that dont have ADHDNo evidence that these drugs improve grades even in teens that do have ADHD

(Source: http://teens.drugabuse.gov/drug-facts/prescription-drugs)

We now know that stimulants dont actually make students perform better academically, even if the student has ADHD. These medications help people with ADHD manage their symptoms, but thats it. 27Statistics: stimulantsThe typical person who abuses prescription stimulants:On average has lower grades than those who dontIs more likely to drink alcohol heavily and use other illicit drugs.

The bottom line: while stimulants might help you focus, they wont help you learn better, and they wont improve your grades

(Source: http://teens.drugabuse.gov/drug-facts/prescription-drugs)

Read bullets

Getting good grades and being a smart student is all about improving your ability to master new skills and concepts. Your brain is like a muscle, and gets stronger with exercise. Learning makes connections in your brain stronger, which enhances your cognition, or smartness, over your lifetime. Prescription stimulant abuse is a shortcut that skips exercising your brain.28Prescription for dangerSide effects of prescription medications can be shockingly similar to illicit drugsIn situations of abuse, prescription medications are often taken in alternate ways, like crushing or snortingCrushing opioids increases the chance of overdoseExtra ingredients from crushed stimulants can block small blood vessels

(Source: PATS, 2006)

Why do you think this is the case?The making and selling of prescription drugs is regulated, they are prescribed by a doctor, the intended purpose is to make you better, no stigma of being a drug addict

Just like illicit drugs, prescription medications have powerful effects on the mind and body. For example, opioid painkillers (such as oxycodone) act on the same part of the brain as heroin.

Also, the altered ways of taking prescription medications in situations of abuse, such as crushing and snorting, can have dangerous side effects. Crushing opioids (pain killers) increases the chance of overdose. When stimulants are crushed and snorted, extra ingredients in the pills can block small blood vessels (the extra ingredients are only meant to be digested).29What do you think?When justifying their prescription drug abuse, what reasons do teens give? A. Prescription drugs cant be dangerousB. Prescription drugs cant be addictiveC. Its legalD. All of the above

Correct answer: All of the above30The truth about prescription drugsPrescription drug abuse is dangerous!Prescription drugs can be addictivePrescription drug use is illegal

Its important for you to know that prescription drug abuse is extremely dangerous, illegal, and can easily become an addiction.31Aarons Story

The Medicine Abuse Project

Its important for you to know that prescription drug abuse is extremely dangerous, illegal, and can easily become an addiction.32

Who matters in your life?Who can you go to?Who cares about YOU?(http://medicineabuseproject.org/the-problem)33Dont forgetPrescription drug addiction can happen to you Prescription drug abuse is extremely dangerousDont only think about yourself think about the people that you care about

Read top two bulletsIf you are confronted with the choice to abuse prescription drugs, think about the people you love, and how they will be affected by your actions and decisions. Thinking of the people around you is a good way to make sure that you make decisions youre proud of. 34What Can I do?How can I prevent or help the situation?

PreventionWhat can you do to prevent prescription drug abuse?

What are some realistic strategies you can use to prevent the abuse and misuse of prescription drugs?~ Dont abuse them (likely the first answer)~ Encourage friends not to do so~ Support friends struggling with prescription drug addiction~ Remove old/expired medications from home36Medication disposalOld, expired, or unused medications at home are a risk for abuse removing them from your home is extremely important!Responsible disposal dont flush medications!

While its important to dispose of your old medications to get them out of the house, its also important to do so responsibly. Flushing medications or throwing them in the garbage means that they will end up in our groundwater. While this has negative consequences for us, hormones and other drugs in the water is extremely harmful to animals as well. They will disrupt the natural flora in lakes and streams.

The best way to dispose of medications37Medication disposalwww.ocdrugdrop.orgPrevent abuse70% of those reporting abuse get drugs from homes of family or friendsPrevent poisoningsEnsure medications used are effectiveProtect environment

Appleton Police Department222 S. Walnut St AppletonOPEN 24/7New London Police Department700 Shiocton St New LondonOPEN 8AM-Midnight dailySeymour Police Department306 N. Main St SeymourOPEN Mon-Fri 8AM-4PM onlyWhat is the best way to dispose of medications?Call your local pharmacy they might be having a collectionIf not, theyll be able to direct you to MedDrop boxes (locations can also be found at the website on the screen)

MedDrop boxes are found at local police departments(if asked: they are then sent to an incinerator for disposal)38Who Can Help?PharmacistsDoctorsYOU!Learn & SHARE what you knowDispose old medications properlyNotice signs

http://medicineabuseproject.org/assets/documents/parent_talk_kit.pdf39

http://www.drugabuse.gov/sites/default/files/stop_rx_abuse.pdf

40SummaryPrescription drugs are not safe alternatives to illicit drugsAddiction can occur just as easily with prescription drugs as it does with illicit drugsPossessing a prescription drug without a prescription is illegal and a felony offense (punishable by jail time, and on your permanent record)Responsibly removing old and expired medications from your house is very important in fighting this public health issue!

Read slideWhat questions do you have for us before we transition to the case study activity?41Medication case study activity5-10 minutes4 small groupsRead caseBrainstorm answers to questionsPresent case to large group

Explain activityWe will be walking around feel free to ask us any questions that you come up with as you work.42Medication class: benzodiazepinesMedical uses: anti-anxiety, anti-convulsant, anti-panic, sedativeSide effects: dependence (drug is needed to function normally), sedation (sleepiness), memory impairment, and cognitive difficulties (trouble thinking)

Patient situation:JP is a 17 year old who works for a sub shop delivering orders in his car. He is a good student and is on the swim team. He is planning a few college visits in the upcoming weeks.

43Medication class: stimulantsMedical uses: attention deficit hyperactivity disorder (ADHD), narcolepsySide effects: agitation, insomnia (difficulty sleeping), tachycardia (increased heart rate)

Patient situation:EZ is a 17 year old with an underlying heart condition that is undiagnosed (she is unaware of it). She is taking AP Biology and hopes to go to medical school.

Medication class: opioid analgesicsMedical uses: postoperative moderate to severe painSide effects: tolerance (higher doses needed with continued use for the same effect), dependence, respiratory depression (trouble breathing), constipation, psychotic events

Patient situation:RC is an 18 year old girl who just moved to the area. She is planning to go to a house party this evening after being invited by a friend she met in one of her classes.

Medication class: dextromethorphan cough suppressantsMedical uses: antitussive (anti-cough)Side effects: tolerance, dependence, respiratory depression, constipation, psychotic events

Patient situation:DC is a 16 year old boy attending a high school dance with a girl he really likes. He just recently got up the nerve to ask her out. He has a history of depression and is taking an antidepressant.

Questions or commentsKAYLA HUEBNER : khuebner@wisc.edu

Faculty Advisor: Orly Vardeny, PharmD, MSorly.vardeny@pharmacy.wisc.eduCo-Chairs: Daniel BrucbauerBrianna Jacques