Understanding the Cultures of Prescription Drug Abuse, Misuse, Addiction and Diversion

1. Michael O’Neil, Pharm.D Director , Center of Excellence for the education and Prevention of Drug Diversion and Substance Abuse Consultant State BCI / Federal D.E.A. Pain Management Expert Addiction Specialist Understanding the Cultures of Prescription Drug Abuse, Misuse, Addiction and Diversion

2. Objectives • Discuss the general “cultures” of prescription drug abuse • Review the common agents of abuse • Review methods of prescription drug abuse deterrence

3. Understanding the Cultures of Prescription Drug Abuse The first rule to NEVER forget about drug diversion and substance abuse is ..NEVER CONFUSE THE ISSUES WITH FACTS!

4. Prescription Drug Abuse, Misuse, Addiction, Diversion • The Addiction Culture Active Addicts Sharing Culture Sharing Culture The Income Driven Culture Substance Abuse Culture The “Bridging”Population Adult Adolescent to Adult / Adolescent Individual or Patient Experimenters Recovering Addicts In MaintenanceTherapy Mood Modifiers Practitioner Adult to Child Addicts in Abstinence

5. Prescription Drug Abuse in the Community: The “Sharing” Culture Sharing Culture Adult Adolescent to Adult / Adolescent Adult to Child Perception that Rxs are safe for everyone -Drug -Dose -Route - “Helping” - “Self Medicating” Availability of left-over “Scripts”

6. Prescription Drug Abuse in the Community: The “Income” Culture The Income Driven Culture Individual or Patient Practitioner The disabled patient The disabled economy The Schemes - Doctor shopping - Using kids - Theft Prescriber Driven Income

7. Prescription Drug Abuse in the Community: The “Substance Abuse” Culture Experimenters • “Pharming” Parties -Social Perception / Acceptance -Peer pressure • Planned Events • Relaxation • Work driven problems • Home driven problems • Society driven problems -Anxiety -Depression -PTSD -Bipolar -Coping Substance Abuse Culture Mood Modifiers

8. Prescription Drug Abuse in the Community: The “Addiction” Culture • The Addiction Culture Active Addicts The “Bridging” Population Recovering Addicts In Maintenance Therapy Addicts in Abstinence Maintaining the “high” - The more you use the more you need Bridging the gaps between the “highs” *** Treatment-Maintenance Therapy ****

9. “The Wicked Web”

10. Motivation for use of inappropriate substances • Physical Performance enhancers • Mental Performance enhancers • “Social” performance enhancers • Self Medication for injuries, stressors, mental disease (depression, anxiety, bipolar, etc)

11. What’s Being Abused and Why

12. What’s Being Abused and Why

13. Categories of Prescription Drug Abuse Opiates Benzodiazepines Clonazepam Alprazolam Diazepam Lorazepam • Hydrocodone • Oxycodone • Hydromorphone • Codeine • Morphine • Fentanyl • Methadone • Buprenorphine

14. Categories of Prescription Drug Abuse Antipsychotics Stimulants Methylphenidate Dextrose-amphetamines • Seroquel • Haloperidal • Risperadal

15. Categories of Prescription Drug Abuse Antidepressants Antihypertensive Clonidine Lopressor Atenolol Propranolol Anticonvulsants Neurontin Carbamazepine pregabalin • Zoloft • Lexapro • Cymbalta • Prozac • Effexor • Paxil Muscle Relaxants • Flexeril • Skelaxin

16. Categories of Prescription Drug Abuse Antidepressants Antihypertensive Clonidine Lopressor Atenolol Propranolol • Zoloft • Lexapro • Cymbalta • Prozac • Effexor • Paxil

17. Categories of Prescription Drug Abuse Antiemetics • Phenergan • Benadryl • Atarax • Zofran Sex Enhancers • Viagra • Cialis • Levitra

18. OTCs (Previous Rx Drugs) Tagamet Zantac

19. There are “cocktails” and THEN there are “Cocktails”

20. Outcomes + =

21. Questions