Jennifer Swift Lake Erie College of Osteopathic Medicine Wegmans Pharmacist, Pharm D. Stephen Tarbell University of Buf

1. Jennifer Swift Lake Erie College of Osteopathic Medicine Wegmans Pharmacist, Pharm D. Stephen Tarbell University of Buffalo Pharmacy Candidate 2011 Prescription and OTC Drug Abuse

2. Quick Quiz • Prescription Pain Medications • B. Marijuana • C. Chewing Tobacco 1 in 5 teenagers have tried this:

3. Examples: • Vicodin • Oxycodone/ Oxycontin • Morphine • Tylenol with Codeine Prescription Pain Medications

4. Quick Quiz • Acting Audition • B. Cocaine • C. Prescription Medication for Non-Medical Use 14% of teenagers have been offered this:

5. “Pharming” Parties • New form of a party • people bring in medications, dump them all into a bowl, and then you take a handful of pills and take them all at once. • Even if you only do this once you may possibly cause permanent damage to your body if not death. • CBS 4 News: Hollywood FL

6. Are Medications Safe? • Life saving remedies when used correctly • Very dangerous if used incorrectly

7. Who abuses Medications? • Abusers of prescription products can range from school age children to celebrities. • Suspicion of medication abuse has been alleged in the death of • Michael Jackson • Anna Nicole Smith • Elvis Presley

8. Medication Dangers • Between 1999 and 2004 nearly all POISON deaths were due to DRUGS, and the most coming from the abuse of PRESCRIPTION and ILLEGAL drugs. • In 1999  12,186 DEATHS • In 2004  20,950 DEATHS

9. Are prescription medications safer than illegal drugs? 41% of teens believe they are safer Prescription medications can be just as dangerous if not MORE DANGEROUS than illegal drugs Must be used only under supervision of a healthcare professional

10. On the label of a prescription: • “Caution:” Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.” • Medications are NOT to be shared!!!

11. What is the most commonly abused pain killer? • VICODIN • contains Hydrocodone/ APAP • most commonly abused pain killer at 18%

12. Vicodin • Hydrocodone causes • Dizziness • Drowsiness • Slows breathing • Hallucinations • Tylenol causes • Liver toxicity if >4,000mg/ day

13. Oxycodone/ Oxycontin • Uses • Control pain after an operation • Dental pain • Moderate to severe pain • How it works • In brain and spinal cord to block perception of pain

14. Oxycodone/ Oxycontin • Adverse Reactions • Slows heart rate • Increase or decrease blood pressure • Fainting • Dry mouth • Blurred vision • Cardiac arrest (heart stops)

15. Oxycodone/ Oxycontin • Adverse Reactions continued • Muscle twitching • Sweating • Hallucinations • Headaches • Circulatory depression • Slurred speech

16. Morphine MS Contin MSIR Avinza Kadian Oramorph Roxanol

17. Morphine • Acts in the brain and spinal cord to relieve pain • High likelihood for • addiction • tolerance • physical and psychological dependence

18. Morphine • Effects on the body • Slows heart rate • Shortness of breath • Confusion • Drowsiness • Kidney failure • Muscle twitches Nausea/ Vomiting Dry mouth Blurred vision Unconsciousness Death

19. Over-the-Counter (OTC) Medications • Cough and cold medications • Delsym/ Robitussin • Pain relievers • Tylenol • Ibuprofen • 1 in 10 teens have abused OTC cough medicine to get a high

20. Dextromethorphan • What is it? • morphine derivative • works in the cough center (medulla) of the brain • Side effects • altered time perception • visual hallucinations • brain damage • seizure • loss of consciousness • irregular heart beat

21. Dextromethorphan Normal dosage: 120 mg/day, 60mg/dose

22. Tylenol

23. Tylenol • Overdose • 4,000mg • Liver toxicity • Common cause of • liver transplants • Active ingredient • Acetaminophen • APAP • What is it? • Pain reliever • Fever reducer

24. Acetaminophen is found in many over-the- counter products Tylenol • Midol • Nyquil • Theraflu • Triaminic • Vicks • Zicam • Benadryl • Cepacol • Coricidin • Dayquil • Dimetapp • Excedrin

25. Tylenol • Endocet • Vicodin • Lortab • Ultracet • Percocet • Darvocet • Fioricet • Tylenol with Codeine Acetaminophen is also found in many prescription products

26. Liver

27. Advil/ Motrin • Active ingredient • Ibuprofen • What is it? • Anti-inflammatory • Pain reliever • Fever reducer • What is causes • GI bleeding

28. Common Street Names • OxyContin • Ocs, oxy, 40 (a 40mg tablets), 80 (an 80mg tablet), Blue, Hillbilly heroin, Kicker • Dextromethorphan • Dex, DXM, Skittles, Robo, Syrup, Triple-C, Tussin, Vitamin D

29. Effects of Drug Abuse • Short term drug abuse • feels “good” • seems harmless • Medication abuse may include • trouble sleeping • dependence • social withdrawal • trouble breathing • organ damage • death

30. Fact from Fiction • Easy to look at medications as the cure-all, especially watching TV commercials, but they are far from it. • Medications should only be used when necessary. • Media should be looked at cautiously • Important to listen to the quick talking at the end • side effects, precautions • If you ever have a question or wonder if a medication may be right for you, speak to your doctor or pharmacist.

31. How do you know if someone is abusing medications? Change in sleep patterns Change in attitude Social withdrawal Easily agitated Sudden weight loss/gain Out of the ordinary spending of money

32. Help is Available!!! www.checkyourself.com - allows teens to gauge their dependence and provides outlets of help www.dxmstories.com - discusses abuse of the OTC cough syrup Dextromethorphan www.drugfree.org 1-800-862-HELP(4357) - hotline that provides you with treatment programs in your area

33. Real Life Stories Eddie was a 22 year old young man who began abusing a prescription medication called Xanax. At times Eddie would take 15 pills at once. One time while waiting for friends he fell asleep on a street corner. Eddie was found and decided to go to rehab. After completing a 28 day rehab program Eddie relapsed and overdosed on 67 pills of Xanax. Eddie died at the age of 22, leaving his parents, girlfriend, and two young children.

34. Real Life Stories Mark Daniel Bauer was an avid weightlifter. He took prescription drugs, that were not prescribed to him to relieve his chronic back pain. Mark overdosed on morphine, oxycodone, and acetaminophen. Mark died on May 24, 2004. He was 18 years old.

35. Real Life Stories Nathaniel Bell was charged with committing first degree murder after stabbing Jose Felix-Martinez. The motive—Nathaniel had ingested large amounts of an OTC medication that contains dextromethorphan (Delsym) as well as cocaine and alcohol.

36. Real Life Stories Savannah Kissick was celebrating New Years Eve using painkillers and sedatives. She was rushed to the hospital that night and died soon after. Savannah was 22 years old. Savannah’s friend Sarah Shay also overdosed on prescription drugs while partying with friends. Her friends dropped her body off at a local hospital and fled the area. She had already passed away. She was 19 years old.

37. Take Home Point Don't Become Part of the Statistic!!!