A Dose of Prevention : Combating Medicine Abuse in Your Community

1. A Dose of Prevention: Combating Medicine Abuse in Your Community

2. Abuse of Rx and OTC Medicines Recent studies indicate that the abuse of prescription (Rx) and over-the-counter medicines (OTCs) to get high is a growing concern— particularly among young people between the ages of 12-17.

3. Trends in Substance Abuse Among 8th Graders • % 26 vs. ‘96 21 Alcohol 15 17 -38% Cigarettes Illicit Drugs 7 -67% 7 -53% Source: Monitoring the Future Study (2007); Past Month Use Institute of Social Research, University of Michigan

4. Vicodin GHB The Bad News • Generation Rx Inhalants Cough medicine

5. Overview of the Problem Marijuana 8.6 million Inhalants 4.7 million 4.5 million Prescription Medicine 2.4 million Cough Medicine Crack/Cocaine 2.4 million Ecstasy 1.9 million Meth 1.9 million LSD 1.3 million Heroin 1.1 million Ketamine 1 million GHB 1 million Source: Partnership Attitude Tracking Study (PATS), Teens 2007

6. Understanding Cough Medicine Abuse

7. More Than 100 Cough & Cold Remedies Contain DXM

8. Dextromethorphan (DXM) is… • … a safe and effective ingredient approved by FDA in the 1950s and found in well over 100 over-the-counter cough medicines. • …the most widely used cough suppressant in the U.S. • …also being abused by taking extreme—sometimes as much as 20 to 50 times beyond the recommended dose—amounts of cough medicine to get high.

9. Alka-Seltzer Plus Cold & Cough Medicine Coricidin HBP Cough and Cold Dimetapp DM Robitussin cough products Sudafed cough medicines Triaminic cough syrups Tylenol Cold products Vicks 44 Cough Relief products Vicks NyQuil and Dayquil Medicines Generic/store brands Sample of Products with DXM

10. Understanding Medicine Abuse Key Factors Driving Teen Medicine Abuse • Misperception that abusing medicine is not as dangerous as “street drugs” • Ease of access via medicine cabinets at home or friend’s house, other person’s prescriptions, Internet, stores

11. Inside the Cough Medicine Abuse Subculture

12. Cough medicine abuse “code names” • Dex or DXM • Robo • Triple Cs or CCC • Skittles • Syrup or Tussin • Roboing • Robo-tripping Robo-fizzing • Skittling

13. The “High” • Similar to an ecstasy-like high • Experience mild distortions of color and sound • Strong visual hallucinations • “Out-of-body" sensations • Confusion • Slurred speech • Loss of motor control

14. Delusions Panic attacks Memory problems Blurred vision Stomach pain, nausea, and vomiting High blood pressure and rapid heart beat Numbness of fingers and toes Drowsiness and dizziness Fever and headaches Rashes and itchy skin Loss of consciousness The “Lows”

15. Side effects can be worsened if… • The DXM-containing cough medicine being abused also contains other ingredients to treat more than just coughs; • Taken with alcohol and illegal drugs; • Used in combination with prescription drugs and/or other medications.

16. There are many web sites and online communities that advocate and promote the abuse of DXM-containing cough medicine The Internet

17. “Teens looking to the web for a cheap way to get high,”CBS Evening News, March 21, 2008

18. Web sites provide information about… • How to achieve a high based on user’s height and weight; • How to combine DXM-containing medicines with other drugs, alcohol, etc. • What effects are to be expected at specific dosage levels.

19. Combating Cough Medicine Abuse Online

20. StopMedicineAbuse.org: Online resource on cough medicine abuse • StopMedicineAbuse.org, comprehensive site featuring all educational programming aimed at addressing medicine abuse • FiveMoms.com—a social networking site where parents can interact with other parents, read blog entries, and learn more about medicine abuse • DXMstories.com— an interactive website where you can view testimonials on medicine abuse. • DoseOfPrevention.org, —engage groups in your communities to prevent medicine abuse with the toolkit created by CADCA and CHPA

21. A Dose of Prevention Campaign

22. Dose of Prevention Campaign Over the past few years, CADCA members were reporting increased incidents of abuse involving over-the-counter medicines, but there was little evidence of a national trend. In December 2006, for the first time NIDA’s Monitoring the Future included cough and cold medicines containing dextromethorphan (DXM) in their survey. In it, 4.2 percent of eighth graders, 5.3 percent of 10th graders, and 6.9 percent of 12th graders reported taking cold or cough medicines containing DXM during the past year to get high.

23. CADCA Survey Highlights 80 percent said they were aware of cough medicine abuse. 77 percent said the abuse of medicines—both prescription (Rx) and OTC—is, or likely is, a major problem in their community. 66 percent said cough medicine abuse was a particular problem among youth in their communities.

24. Survey Highlights on Parents 73 percent of coalition members said they do not think parents in their communities are aware that OTC medicine abuse is a problem among youth. 75 percent responded that parents do not talk to their children and teens about the dangers of abusing OTC cough meds.

25. Survey Highlights on Schools • Many coalition leaders also felt that schools were not adequately addressing the issue. • More than half said school surveys in their community do not include questions about the abuse of cough medicines.

26. Dose of Prevention Campaign In response, CADCA partnered with the Consumer Healthcare Products Association (CHPA), which represents the makers of over-the-counter medicines, and launched the Dose of Prevention campaign, to educate communities about cough medicine abuse.

27. “Education is the most effective tool we have to fight substance abuse—including cough medicine abuse—at the community level.” General Arthur T. Dean CADCA Chairman and CEO

28. A Dose of Prevention Toolkit Online in downloadable format to be replicated and modified for local use. www.DoseOfPrevention.org

29. Our Objective: Educate communities about cough medicine abuse A Dose of Prevention Toolkit: • Provides materials to localize and replicate; • Offers strategies to integrate and implement.

30. What’s in the Toolkit • An Overview • Targeted Outreach Fact Sheets • Parents • Educators • Healthcare Providers • Retailers • Law Enforcement • An Internet Alert • Sample Media Outreach Materials • Op-Ed • Press Release & Media Advisory • Statistics and Quotes Sheet

31. A Dose of Prevention: Combating Medicine Abuse in Your Community

32. OTC and Rx Medicine Abuse Projects • CADCA, in partnership with CHPA and PhRMA to produce a Newspapers in Education supplement. • National Medicine Abuse Awareness Month is August. • Continuing with Community Forums on Rx and OTC abuse. (Recently in Clinton, Iowa.) • New “Dose of Prevention Award” for coalitions to be awarded at the 2009 Forum.

33. National Medicine Abuse Awareness Month • Last year, the U.S. Senate passed resolution naming August National Medicine Abuse Awareness Month. • CADCA and CHPA worked with coalitions across the country to hold town hall meetings in August. • Doing that again this year.