Preventing Pharmaceutical Misuse and Abuse is Everyone’s Business: A Community Coalition Approach

1. Preventing Pharmaceutical Misuse and Abuse is Everyone’s Business: A Community Coalition Approach June 20, 2006 Mary Elizabeth Larson Vice President, Communications and Membership, CADCA

2. CADCA’s Mission • To strengthen the capacity of community coalitions to create safe, healthy and drug-free communities.

3. What is a Coalition? A formal arrangement for cooperation and collaboration between groups or sectors of the community, in which each group retains its identity but all agree to work together toward a common goal of building a safe, healthy and drug-free community.

4. What is CADCA? • National, nonprofit, member-based organization • Founded in 1992; outgrowth of President Bush’s Drug Advisory Council • Core program areas: • Training & technical assistance, research & evaluation, communications, public policy, and meetings

5. What is CADCA? • CADCA is the national presence for coalitions. We take the voice of coalitions to Capitol Hill. • CADCA is a strong advocate for programs that support coalitions. • CADCA is a leader in training and technical assistance for coalitions.

6. CADCA’s Electronic Media: • Website—www.cadca.org • Coalitions Online—weekly e-news • Subscribe at cadca.org • Research Into Action—Coalition Institute’s semi-monthly newsletter • Subscribe at coalitioninstitute.org

7. Public Policy Issues: SDFSC • Safe and Drug Free Schools and Communities Funding in Jeopardy • Primary source of federal funding for school- based prevention. • FY 2006 budget request eliminates entire $441 million for the State Grants portion of the SDFSC program • Latest markup from House Appropriations Subcommittee includes $400 million for the State Grants portion of the Safe and Drug Free Schools and Communities (SDFSC) program

8. Effective Prevention is Critical • According to the National Institute on Drug Abuse (NIDA), addiction is a brain disease. • Addiction can begin as a developmental disorder in adolescence, sometimes as early as childhood. • The younger a person first uses drugs, the higher their chance of adult drug dependency and addiction.

9. Substance Abuse Prevention is a Good Investment • Between 2000 and 2010, the youth population will grow by 10 % adding 8.4 million youth. • Even if drug use rates remain constant, there will be a huge surge in drug-related problems • According to the Journal of Primary Prevention, the savings per dollar spent on substance abuse prevention can be substantial and range from $2.00 to $19.64.

10. Why Do We Need Drug Prevention in Schools? • Student substance use precedes, and is a risk factor for, academic problems, such as lower grades, absenteeism and high dropout rates. • Those who begin using marijuana by age 13 are more likely to report lower income and lower level of schooling by age 29. • School-based prevention programs provide teachers, parents & students with information and skills.

11. Past Month Use of Any Illicit Drug Has Decreased

12. Percent of 12th Graders Reporting Nonmedical Use of OxyContin and Vicodin in the Past Year Remained High 12.0 10.5 9.6 9.3 10.0 8.0 Percent 6.0 5.0 4.5 4.0 4.0 2.0 0.0 OxyContin Vicodin 2002 2003 2004 No year-to-year differences are statistically significant.

13. Percent of 8th Graders Reporting Lifetime Use of Inhalants Increased * Percent * P < .05

14. NSDUH Highlights—PDA • 6.3 million persons were current users of psychotherapeutic drugs taken non-medically (4.7 M using pain relievers, 1.8 M using tranquilizers, 1.2 M using stimulants, and 0.3 M using sedatives.) • Significant increase in lifetime non-medical use of pain relievers between 2002 and 2003 among persons aged 12 or older, from 29.6 million to 31.2 million.

17. Commonly Abused Prescription Drugs • Stimulants, CNS depressants (some used to treat anxiety and sleep disorders, barbiturates and benzodiazepines), opioid analgesics. • Brand names include, but are not limited to: Lorcet®, OxyContin®, Percocet®, Ritalin®, Soma®, Valium®, Vicodin®, and Xanax®.

18. PDA Trends--Youth • Perception of risk is lower with prescription drugs • OTC abuse--DXM • “Pharming” • Raiding family medicine cabinets • OD victims in emergency rooms • Internet sales • Real estate open houses

19. Legally produced drugs… • Kill more people than all the illicit drugs (cocaine, heroin, MDMA, GHB, et al) combined! • Tobacco, the deadliest drug of all, contributes to more than 400,000 deaths a year. • Alcohol, contributes to over 100,000 deaths each year.

20. Coalition Role in PDA Prevention • Education and awareness of parents, youth, coaches, teachers, the medical community, local law enforcement, clergy, etc. • Collaboration among all interested parties. • Keep the issue before the media. • Become the “firehouse” in your community on alcohol, tobacco and other drugs.

21. Use Data to Inform Strategies • Growing problem, and age of people abusing prescription drugs is getting younger. • Problem is much higher among white Americans. • Possible coalition actions: • Q. Is this national data applicable to my community? • Talk about prescription drug abuse with parents & kids. • Consider new places for messaging: professional, social and civic clubs, workplaces, churches.

22. Coalition Building 101 • Define the problem. • Identify the key stakeholders. • Convene a meeting. • Share perspectives. • Discuss the reality vs. the ideal. • Create a vision for your community. • Keep up the momentum!

23. Roadblocks to Success • Lack of strong and consistent law enforcement practices • New drug monitoring in some states, but not in others • Ability to obtain medications via the Internet • The “Medicating of America”—commercialization, normalization • Denial in the community

24. One Coalition’s Story • Always lead with data! • According to Catherine Brunson, Exec. Director of the Metropolitan Drug Commission, prescription drug abuse in TN is 4 times the national average. • Prescription drug abuse represents the second most common treatment admission, second only to alcohol.

25. Metropolitan Drug Commission, Knoxville TN • Helped to established a TN Prescription Drug Abuse Task Force • Used DEA Automated Reports and Consolidated Orders System (ARCOS) database • Pulled together TN Medical Foundation, Dept. of Health and Human Services, law enforcement, treatment

26. Coalitions Taking Action:Knoxville, TN • Pharmacies • Local pharmacies agreed to include a brochure on abuse of medications in every prescription filled • Schools • Middle school program--original drama event with group discussion afterwards • Called together all PTA presidents to talk about overall drug strategy • Added question about prescription drug abuse to local youth surveys

27. Coalitions Taking Action:Knoxville, TN • Doctors • Agreement with the medical college of Univ. of TN to train doctors during their residency • Must take 4 hours of drug-specific training provided by the coalition to graduate

28. Coalitions Taking Action:Knoxville, TN • Media • Coalition hosts a weekly radio broadcast on Sunday mornings • Pitches stories to local media; ABC affiliate is doing a 5-part series

29. Coalition Advice • Engage the treatment community as a valuable resource of information and support. • Find out what’s important to new partners to draw them in. • Reach out to the medical community: work with local boards of health, doctors, dentists, pharmacists, nurses.

30. Coalition Advice • Get real about your local drug problem! • Know your local medical examiner. • Spend a weekend night from 12:00-4:00 am in a local emergency room. • Count your pills or lock your medicines up. • Learn to recognize the signs of misuse and abuse

31. Parents: What to Look For • Changes in friends • Negative changes in schoolwork, missing school, or declining grades • Increased secrecy about possessions or activities • Use of incense, room deodorant, or perfume to hide smoke or chemical odors • Subtle changes in conversations with friends, e.g. more secretive, using “coded” language • Change in clothing choices: new fascination with clothes that highlight drug use • Increase in borrowing money

32. Parents: What to Look For • Evidence of drug paraphernalia such as pipes, rolling papers, etc. • Evidence of use of inhalant products (such as hairspray, nail polish, correction fluid, common household products); Rags and paper bags are sometimes used as accessories • Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils • New use of mouthwash or breath mints to cover up the smell of alcohol • Missing prescription drugs—especially narcotics and mood stabilizers

33. CADCA is Here For You! • For training and technical assistance, email training@cadca.org • For public policy, contact Kelly Lieupo at klieupo@cadca.org • For membership, contact Jennifer Zimmermann at jzimmermann@cadca.org • For “all things CADCA,” contact Mary Larson mlarson@cadca.org; 703-706-0560, Ext. 247

34. Summary • Addiction is the #1 preventable public health threat. • Prevention works, early intervention saves lives and treatment and recovery is possible for everyone. • Working through a coalition framework builds local capacity, reduces duplication and connects multiple sectors to work holistically.