Presented by E. Vicente Sanabria , Director Central MA Center for Healthy Communities (a program of LUK, Inc.) www.cmch

1. Worcester Department of Public Health Underage Drinking and Opioid Prevention Coalition Update Presented by E. Vicente Sanabria, DirectorCentral MA Center for Healthy Communities (a program of LUK, Inc.)www.cmchc.org508-762-3215

2. Who we are • The City of Worcester has received two grants from MA DPH that focus on reducing underage drinking and opioid overdoses • Community residents along with city departments – Health and Human Services, City Manager, Public Schools, Police • Other organizations – LUK, Inc., Central MA Center for Healthy Communities, Willis Center, Spectrum, YMCA and others

3. The Problem: Opioids • MA ranks #1 in the country for opioid overdoses • Opioid deaths exceed deaths from automobile accidents • Opioid Rx use among youth is on the rise • Opioid Rx often leads to cheaper and the more accessible heroin • Lifetime heroin use in Worcester is almost 5%, double MA and US as a whole

4. The Problem: Underage Drinking • 19% of youth binge drink vs 25% in MA • 21% of youth have ridden with a driver who was intoxicated in the past 30 days • 41% of youth had someone buy it for them • 29% were given alcohol by someone • Youth who who start drinking before age 15 years are five times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years

5. The Problem: Underage Drinking, The Consequences • Consequences of Underage Drinking • School problems, such as higher absence and poor or failing grades. • Social problems, such as fighting and lack of participation in youth activities. • Legal problems, such as arrest for driving or physically hurting someone while drunk. • Physical problems, such as hangovers or illnesses. • Unwanted, unplanned, and unprotected sexual activity. • Disruption of normal growth and sexual development. • Physical and sexual assault. • Higher risk for suicide and homicide. • Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning. • Memory problems. • Abuse of other drugs. • Changes in brain development that may have life-long effects. • Death from alcohol poisoning. • In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink.

6. Alcoholism and Alcohol Abuse • What is the difference between alcoholism and alcohol abuse? Alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work. Manifestations of alcohol abuse include the following: • Failure to fulfill major responsibilities at work, school, or home. • Drinking in dangerous situations, such as drinking while driving or operating machinery. • Legal problems related to alcohol, such as being arrested for drinking while driving or for physically hurting someone while drunk. • Continued drinking despite ongoing relationship problems that are caused or worsened by drinking. • Long-term alcohol abuse can turn into alcohol dependence. • Dependency on alcohol, also known as alcohol addiction and alcoholism, is a chronic disease. The signs and symptoms of alcohol dependence include— • A strong craving for alcohol. • Continued use despite repeated physical, psychological, or interpersonal problems. • The inability to limit drinking.

7. Worcester’s Answer for Opioid Overdoses • 911 Good Samaritan Bill – provides limited immunity to those at an OD scene who may have narcotics on their person. Goal is to encourage bystanders to call 911 during on overdose. • Narcan Pilot Sites – APW and UMass ED, training for users, co-users and family members on nasal narcan (reverses OD). There are eight other sites like these across the state. • Prescription Monitoring Program (PMP) – detects doctor shopping.

8. Worcester’s Strategies • Rx Drug Take Back Day: April 28th 10 AM – 2 PM • Rx Drug Kiosks: Holden & Millbury, more to come per DEA • Physician Education – safe opioid prescribing (to address pressure in medical community to treat pain)

9. More Worcester Strategies • Social norms curriculum and campaign at North High School designed to demonstrate perception vs. reality about how much youth’s peers are really drinking. • Parent social norms group – teaching parents in the North High quadrant how to set limits at home. • Compliance checks – in tandem with Worcester Police Dept Alcohol Enforcement Unit. • Policy – worked with HOPE Coalition and others to modify current sign ordinance (which will decrease alcohol, tobacco and junk food advertising density).

10. Sources • Worcester Regional Youth and Community Survey, 2010 • www.worcesterma.gov/healthofworcesterreport • Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85. • Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Pediatrics 2006;160:739–746. Office of Applied Studies. • The NSDUH Report: Alcohol Dependence or Abuse and Age at First Use. Rockville, MD: Substance Abuse and Mental Health Services Administration, October 2004. Available at http://www.oas.samhsa.gov/2k4/ageDependence/ageDependence.htm. Accessed March 31, 2008.

11. Sources • Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), published by the American Psychiatric Association, Washington D.C., 1994. • Presentation developed by the Central MA Center for Healthy Communities (a program of LUK, Inc.)