“Good Drugs… Gone Bad”

1. “Good Drugs… Gone Bad” Laura Smith-Creaser, RN State University of New York Institute of Technology July 2013

2. Well, maybe it is NOT the drugs going bad as much as the users of the drugs… • But, hopefully my objective will be clearer when you understand the focus points of my project / paper: • A look at the growing problem of illicit use / abuse of prescription drugs and why this is such an important PRIMARY PREVENTIONtarget. • The intentional sale of prescription drugs (particularly psychotropic medications) on “the street…” • Drug seeking behaviors of patients / clients • Diversion (for personal use or sale) by medical personnel, pharmacists, etc. For Sale!! Primary Prevention – a program of activities directed at improving general well being while also involving specific protection for selected diseases… Mosby’s Medical Dictionary, 8th Edition (2009) Elsevier

3. The “Community” My clinical experience(s) were actually spent with one preceptor, but in two service locations – one site was a state-operated adult mental health outpatient facility and the other was state-licensed substance abuse services clinic operated by a private agency. One interesting fact about the community being served by these sites it that the mental health patients quite frequently had accompanying substance abuse disorders and the substance abuse patients often had accompanying mental health diagnoses. We served people of all walks of life - homemakers, professionals, students, “street” people, and the severely addicted. While one would “expect” substance abuse to include abuse of alcohol and a variety of street drugs, a noticeable number of the patients (from both sites) were actually abusing over-the-counter products, prescription pharmaceuticals, and were actually addicted to medications that, at one time, they (or someone in their household / social circle) had a prescription for. These substances included prescription pain medications, prescribed psychotropic medications, and excessive doses of products one can purchase of the shelves of pharmacies and grocery stores. What I found additionally intriguing was that while most of the intake assessments now included assessment for this newly recognized form of drug abuse [this was not true historically] but that many of the clients were not being told why the information is necessary or important (thus, they disregard it on the forms.) My idea for a project to educate the clients on the dangers of prescription drug abuse was born out of recognizing that many clients do not see such behavior as abusive, dangerous or, sometimes, illegal.

4. Drugs… (and drug dealers) aren’t what they used to be (or were once thought to be!) There’s a new “game” hitting towns and cities all over the U.S. and the globe… only in this game there is only losers!

5. What’s The Problem? March 1st, 2007 “Abuse of prescription drugs is about to exceed the use of illicit street narcotics worldwide… Prescription drug abuse already has outstripped traditional illegal drugs such as heroin, cocaine and Ecstasy in parts of Europe, Africa and South Asia.. In the United States alone, the abuse of painkillers, stimulants, tranquilizers, and other prescription medications has gone beyond ‘practically all illicit drugs with the exception of cannabis’ with users increasingly turning to them first… The number of Americans abusing prescription drugs nearly doubled from 7.8 million in 1992 to 15.1 million in 2003 the Narcotics Control Board said. Among their prescription drugs of choice: the painkillers oxycodone (Oxycotin) and hydrocodone (Vicodin) and used by 7.4 percent of college students in 2005.” • So, what do you think this does to the mission / agenda of preventing drug abuse?

6. MYTHS Where prevention has to start… Drugs from a pharmacy are not like “street drugs”… I can tell if someone has a drug problem by the way they look… Drugs from a pharmacy are safer, they can’t hurt you… Primary Prevention – a program of activities directed at improving general well being while also involving specific protection for selected diseases… Mosby’s Medical Dictionary, 8th Edition (2009) Elsevier

7. Only “kids” do drugs…

8. In the United States alone, the abuse of painkillers, stimulants, tranquilizers, and other prescription medications has gone beyond ‘practically all illicit drugs with the exception of cannabis’ with users increasingly turning to them first…

9. FACTS Drugs from a pharmacy are not like “street drugs”… …if taken exactly as prescribed… “but when taken in different quantities or when symptoms are not present, they may affect the brain in ways very similar to illicit drugs.” NIDA Drug Facts I can tell if someone has a drug problem by the way they look… Prescription drug abusers can be (and often are) the student sitting beside you in class, that energetic co-workers, or even your doctor! Drugs from a pharmacy are safer, they can’t hurt you… Any drug – even cough syrup – can be potentially deadly if abused. Deaths from drugs like prescription pain killers are on the rise!

10. Not Just for “Street Addicts” Anymore… “The percentage of U.S. women overdosing on prescription painkillers has increased sharply in recent years, according to the Centers for Disease Control and Prevention. Between 1999 and 2010, the proportion of deaths from painkiller overdose increased 400 percent among women, while rising 265 percent among men. “Prescription painkiller deaths have skyrocketed in women," Dr. Tom Frieden, director of the CDC, said at a news conference today (July 2). "Mothers, wives, sisters and daughters are dying of overdoses at rates we have never seen before," Frieden said. While men remain more likely to die of a prescription painkiller overdose, deaths among women have increased at a higher rate, and are catching up to those of men, Frieden said. In 2010, more than 6,600 women died from prescription painkiller overdose, which is four times the number of women who died from cocaine and heroin overdoses combined, the CDC says. Most of these deaths are accidental. The death rate was highest among women ages 45 to 54. There were also more than 200,000 emergency department visits for opioid abuse among women in that year. Research suggests women are more likely to experience chronic pain and migraines, and to be prescribed prescription painkillers than men, the CDC says. Women may also become dependent on the drugs more quickly than men, the agency said. Because women often weigh less than men, they may experience life-threatening events at lower doses of painkillers, Frieden said. Rates of death from prescription painkiller overdose have increased at the same time as prescriptions for the drugs have increased. "These are dangerous medications," Frieden said. "In many other situations, the risks fair outweigh the benefits."

11. SO, WHAT DO WE DO ABOUT IT? Educate? Punish?

12. Taking someone else’s prescription to self-medicate. Taking a prescription medication in a way other than prescribed. Taking a medication to get high. Sometimes it is too late to call it anything…

13. CHANGES IN SCREENING We have to explain why this is important!! • Determinants of health (prescription drug abuse affects all social and economic groups) • Ecological (linkages and relationships of multiple factors) • Surveillance (collecting and USING the information collected to effect and disseminate solution information) • Prioritizing (paying as much attention to the cough syrup abuser as we do the heroin addict)

14. REFERENCES Prescription Drug Abuse Exceeds Illicit Street Drug Use Worldwide (2007). Retrieved 6/17/13 from http://www.foxnews.com/story/0.2933.255758.00.html National Institute on Drug Abuse (2011). Prescription Drugs: Abuse and Addiction Research Report Series. U.S. Department of Health, National Institutes of Health. Retrieved 6/17/13 from http://www.drugabuse.gov/sites/default/files/rrprescription.pdf National Institute on Drug Abuse (2013). Drug Facts: Prescription and Over-The-Counter Medications. U.S. Department of Health, National Institutes of Health. Retrieved 6/17/13 from http://www.drugabusee.gov/sites/default/files/drugfacts_rx_otc_5_2_13_ew2-0.pdf Mosby’s Medical Dictionary, 9th Edition (2013) Elsevier. Center for Disease Control (2011). Deaths from Opiod Pain Relievers Exceed Those From All Illegal Drugs. Morbidity and Mortality Weekly Report, 60(43); 1489. University of Michigan (2012). Past Year Use of Illicit Drugs and Pharmaceuticals Among 12th Graders. Monitoring the Future Study.