Prescription Drug Misuse Among School Aged Youth Effective Prevention Strategies

1. Prescription Drug Misuse Among School Aged YouthEffective Prevention Strategies Division of Prevention and Health PromotionInjury Prevention Program

2. Objectives • • Characterize PDM as a public health problem • • Detail the impact of PDM on School-Age Youth • • Identify prevention strategies and discuss how these can be applied to this population

3. Drugs

4. Winslow's Soothing Syrup for infants Active Ingredient: Morphine

5. Greater use of opioids • Pain Patient Groups • Professional Societies • The Joint Commission • The Federation of State Medical Boards

6. Dr. Thomas FreidenDirector of the Center for Disease Control “When I was in medical school…I was told…if you give opiates to a patient who’s in pain, they willnot get addicted. Completely wrong..A generation of us grew up being trained that these drugs aren’t risky. In fact, they are risky.” REPORT: PBS NEWSHOUR AIR DATE: April 30, 2013 Pain and Consequences for Those Taking Too Much Pain Medicine

7. Misuse, Abuse, Diversion • Misuse: • When a schedule II – V substance is taken by an individual for a non-medical reason. • Abuse: • When an individual repeatedly takes a schedule II – V substance for a non-medical reason. • Diversion: • When a schedule II – V substance is acquired and/or taken by an individual for whom the medication was not prescribed. Source: Cabinet for Health and Family Services

8. Why is this a problem? • Precisely calculated • Adverse health effects • Misconceptions of Safety • Overdose

9. Commonly Abused Drugs Source: www.CDC.gov

10. Rx Drug Abuse Source: www.CDC.gov

11. Primary non-heroin opiates/synthetics admission rates, by State (per 100,000 population aged 12 and over)

12. Primary non-heroin opiates/synthetics admission rates, by State (per 100,000 population aged 12 and over)

13. Primary non-heroin opiates/synthetics admission rates, by State (per 100,000 population aged 12 and over)

14. Primary non-heroin opiates/synthetics admission rates, by State per 100,000 population aged 12 and over)

15. Primary non-heroin opiates/synthetics admission rates, by State (per 100,000 population aged 12 and over)

17. Virginia Deaths • Drug/Poisoning Death rate • 9.6 per 100,000 • Motor Vehicle Traffic Death rate • 9.4 per 100,000 • Source: Office of Chief Medical Examiner, Western District, 2011 Data

18. Opiate analgesic overdose deaths by age group: Virginia, 2008-2012 Data source: Virginia vital records database, 2008-2012

19. School Aged Youth Nationwide • One in fourschool aged youth have taken a prescription drug that was not prescribed for them by a doctor • Every day, 2,500 school aged youth take a prescription pain reliever for a non-medical use for the first time • More teens abuse prescription medication than illegal drugs, except marijuana • Source: 1. The Partnership of DrugFree.org and MetLife Foundation. (2011). 2. 2010 Partnership Attitude Tracking Study (PATS) Key Findings, • 3. White House Office of National Drug Control Policy. (2008). 4. Prescription for Danger: A Report on the Troubling Trend of Prescription and • Over-the- Counter Drug Abuse Among the Nation’s Teens.

20. School Aged Youth Nationwide • One in three school aged youth reports knowing someone who abuses Rx drugs • School aged youth who are not regularly monitored by their parents or caregivers are four times more likely to use drugs Source: 1. Office of National Drug Control Policy, 2008. 2. Metzler, Rusby and Biglan. (1999). Community builders for success: monitoring after- school activities. Oregon Research Institute. 3. The Partnership for drugfree.org: Medicine Abuse Project Fact Sheet (2012).

21. Sources of Prescription Drugs for School Aged Youth • 64% percent reporting getting prescription drugs from friends or relatives • Source: White House Office of National Drug Control Policy. (2008). Prescription for Danger: A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens.

22. SAFE-2012 Prevention Assessment Survey • Purpose of Survey • Reported misuse • 8th grade reports • 12th grade reports

23. To get high To relieve pain To improve grades To “fit in” To escape All of the above Why Do School Aged Youth Misuse? Source: Generation Rx; The Ohio State University ; 2013

24. Myths and Truths • Myth: Prescription drugs are safer than street drugs • Truth: Prescription drugs are not safe alternatives to street drugs • Myth: Addiction doesn’t occur when using prescriptions • Truth: Addiction can occur just as easily with prescription drugs as it does with street drugs • Myth: Possessing an Rx drug without a prescription is ok • Truth: Possessing an Rx drug without a prescription is illegal and a felony offense Source: Generation Rx: The Ohio State University; 2013

25. Source: http://teenbrain.drugfree.org/science/behavior.html Youth Behaviors and Brain Development • Age of full development • Impulse control and judgment • Risky behavior

26. Warning Signs in School Aged Youth • Excessive sweating or thirst • Nausea and vomiting • Drowsiness, dizziness and insomnia • Loss of consciousness • Sudden mood changes • Changes in groups of friends or hangout locations • Losing interest in personal appearance • Poor performance at school • Borrowing money Source: Partnership at drugfree.org; 2014

27. Pregnancy and Prescription Drugs • Risk taking behavior • NAS • Long term effects • Protective Factors Source: 1. CDC Teen Pregnancy Prevention. Retrieved from: http://www.cdc.gov/teenpregnancy/ 2. Patrick, S. W. et al. JAMA 2012;307:1934-1940

28. Median Length of Stay for Neonatal Abstinence Syndrome Births: Virginia, 1999-2012 Data Source: Virginia Health Information, 1999-2012

29. Payment Source for Neonatal Abstinence Syndrome Births: Virginia, 1999-2012 Data Source: Virginia Health Information, 1999-2012

30. School nurses have a unique opportunity to raise awareness of the risks of prescription drug misuse School Nurses

31. National Association of School Nurses • “Coordination of care, communication and collaboration are standards of nursing practice.  The school nurse serves in a leadership position by providing school health services to students, communicating with families, health care providers and the community” (American Nurses Association (ANA) and National Association of School Nurses (NASN), 2011). • Source: NASN Position Statement: Coordinated School Health: 2013

32. American Academy of Pediatrics • “As the case manager for students with • health problems, the school nurse ensures that there • is adequate communication and collaboration among • the family, physicians, and providers of community • resources. This is a crucial interface for the • Pediatrician and the school nurse to ensure consistent, • Coordinated care” (AAP, Pediatrics, 2008).

33. Prevention for School Aged Youth • Primary Prevention- Proper screening, effective monitoring, safe storage and secure disposal, outreach and education • •Secondary- Crisis management referrals and placement • Tertiary - Acute management and reporting Adapted from: Centers for Disease Control and Prevention MMWR. (1992).

34. Proper Screening • Review H&P tools and evaluate the need for standardization across your school system • Documentation and clinical support tools • Look for opportunities to standardize assessment tools (SBIRT, CRAFFT) • Review policies and procedures with your school system health advisory board

35. Effective Monitoring • Work with your pediatric medical advisor to develop a clinical liaison plan between your school and students medical home • Educate prescribing medical advisors and community medication case management workers in the Virginia Department of Health Professions Prescription Monitoring Program • Review your current documentations clinical decision support tools for ways to track for clinical visit trends

36. Safe Disposal and Storage • Work with your school resource officer and local law enforcement agencies to host a community “Take Back” Day • Review your school system’s policy and procedure for evidenced based safe disposal of medications and standardize practice across your system • Evaluate current transport and storage medication concerns and work to mitigate risk

37. Outreach and Awareness • Assemble • Bring Stakeholders Together • Communicate and Collaborate

38. Smart Moves, Smart Choices Curriculum

39. Opportunities for Virginia • Build and nurture school based collaborative screening, monitoring, and treatment models within their own system and medical home networks • Share data sources, methodologies, and outcome results to strengthen program development • Improve health outcomes for the school-age population through evidenced based prevention strategies

40. In Summary: • Prescription drug misuse is a concern across the Commonwealth for school aged youth • Coalition survey data shows that school aged youth in grades 8, 10, and 12 are using prescription drugs above the national average • Schools nurses are in a unique position to effectively employ primary prevention strategies and emerge as policymakers within their school systems to reduce the misuse of prescription drugs by youth

41. Contact • JoAnn Wells, RDH • Injury Prevention Outreach Coordinator • Virginia Department of Health, Division of Prevention and Health Promotion, Injury Prevention Program • Joann.wells@vdh.virginia.gov • (804) 864-7743