Preventing Pharmaceutical Misuse and Abuse is Everyones Business: A Community Coalition Approach...

Preventing Pharmaceutical Misuse and Abuse is Everyone’s Business:

A Community Coalition Approach

June 20, 2006

Mary Elizabeth LarsonVice President, Communications and

Membership, CADCA

CADCA’s MissionTo strengthen the capacity

of community coalitions to create safe, healthy

and drug-free communities.

What is a Coalition?

A formal arrangement for cooperation and collaboration between groups or sectors of the community, in which each group retains its identity but all agree to work together toward a common goal of building a safe, healthy and drug-free community.

What is CADCA? • National, nonprofit, member-based organization• Founded in 1992; outgrowth of President Bush’s Drug

Advisory Council• Core program areas:

– Training & technical assistance, research & evaluation, communications, public policy, and meetings

What is CADCA?• CADCA is the national presence for coalitions. We

take the voice of coalitions to Capitol Hill.• CADCA is a strong advocate for programs that

support coalitions.• CADCA is a leader in training and technical

assistance for coalitions.

• Website—www.cadca.org• Coalitions Online—weekly e-news

– Subscribe at cadca.org

• Research Into Action—Coalition Institute’s semi-monthly newsletter– Subscribe at coalitioninstitute.org

CADCA’s Electronic Media:

Public Policy Issues: SDFSC

• Safe and Drug Free Schools and Communities Funding in Jeopardy– Primary source of federal funding for school- based prevention.– FY 2006 budget request eliminates entire $441 million for the

State Grants portion of the SDFSC program– Latest markup from House Appropriations Subcommittee

includes $400 million for the State Grants portion of the Safe and Drug Free Schools and Communities (SDFSC) program

Effective Prevention is Critical• According to the National Institute on Drug Abuse

(NIDA), addiction is a brain disease.• Addiction can begin as a developmental disorder in

adolescence, sometimes as early as childhood. • The younger a person first uses drugs, the higher

their chance of adult drug dependency and addiction.

Substance Abuse Prevention is a Good Investment

• Between 2000 and 2010, the youth population will grow by 10 % adding 8.4 million youth.

• Even if drug use rates remain constant, there will be a huge surge in drug-related problems

• According to the Journal of Primary Prevention, the savings per dollar spent on substance abuse prevention can be substantial and range from $2.00 to $19.64.

Why Do We Need Drug Prevention in Schools?

• Student substance use precedes, and is a risk factor for, academic problems, such as lower grades, absenteeism and high dropout rates.

• Those who begin using marijuana by age 13 are more likely to report lower income and lower level of schooling by age 29.

• School-based prevention programs provide teachers, parents & students with information and skills.

Past Month Use of Any Illicit Drug Has Decreased

19.418.2

17.316.1

10

12

14

16

18

20

22

8th, 10th and 12th Combined

2001 2002 2003 2004

19.418.2

17.316.1

10

12

14

16

18

20

22

8th, 10th and 12th Combined

2001 2002 2003 2004

No year-to-year differences are statistically significant.No year-to-year differences are statistically significant.

Percent of 12th Graders Reporting Nonmedical Use of OxyContin and Vicodin in the Past Year Remained High

Percent of 12th Graders Reporting Nonmedical Use of OxyContin and Vicodin in the Past Year Remained High

9.69.610.510.5

9.39.3

0.00.0

2.02.0

4.04.0

6.06.0

8.08.0

10.010.0

12.0

OxyContin OxyContin Vicodin Vicodin

20022002 20032003 20042004

4.04.0 4.54.5 5.05.0

Per

cen

tP

erce

nt

0

5

10

15

20

25

91 92 93 94 95 96 97 98 99 00 01 02 03 04

8th Grade 10th Grade 12th Grade

0

5

10

15

20

25

91 92 93 94 95 96 97 98 99 00 01 02 03 04

8th Grade 10th Grade 12th Grade

Percent of 8th Graders Reporting Lifetime Use of Inhalants Increased

Percent of 8th Graders Reporting Lifetime Use of Inhalants Increased

Per

cen

tP

erce

nt

P < .05P < .05**

**

NSDUH Highlights—PDA

• 6.3 million persons were current users of psychotherapeutic drugs taken non-medically (4.7 M using pain relievers, 1.8 M using tranquilizers, 1.2 M using stimulants, and 0.3 M using sedatives.)

• Significant increase in lifetime non-medical use of pain relievers between 2002 and 2003 among persons aged 12 or older, from 29.6 million to 31.2 million.

Commonly Abused Prescription Drugs

• Stimulants, CNS depressants (some used to treat anxiety and sleep disorders, barbiturates and benzodiazepines), opioid analgesics.

• Brand names include, but are not limited to: Lorcet®, OxyContin®, Percocet®, Ritalin®, Soma®, Valium®, Vicodin®, and Xanax®.

PDA Trends--Youth• Perception of risk is lower with prescription

drugs • OTC abuse--DXM• “Pharming”

– Raiding family medicine cabinets– OD victims in emergency rooms

• Internet sales• Real estate open houses

Legally produced drugs…

• Kill more people than all the illicit drugs (cocaine, heroin, MDMA, GHB, et al) combined!

• Tobacco, the deadliest drug of all, contributes to more than 400,000 deaths a year.

• Alcohol, contributes to over 100,000 deaths each year.

Coalition Role in PDA Prevention

• Education and awareness of parents, youth, coaches, teachers, the medical community, local law enforcement, clergy, etc.

• Collaboration among all interested parties.• Keep the issue before the media. • Become the “firehouse” in your community on

alcohol, tobacco and other drugs.

Use Data to Inform Strategies• Growing problem, and age of people abusing

prescription drugs is getting younger. • Problem is much higher among white

Americans. • Possible coalition actions:

– Q. Is this national data applicable to my community? – Talk about prescription drug abuse with parents &

kids.– Consider new places for messaging: professional,

social and civic clubs, workplaces, churches.

Coalition Building 101

• Define the problem.• Identify the key stakeholders.• Convene a meeting.• Share perspectives.• Discuss the reality vs. the ideal.• Create a vision for your community.• Keep up the momentum!

Roadblocks to Success• Lack of strong and consistent law enforcement

practices • New drug monitoring in some states, but not in

others• Ability to obtain medications via the Internet• The “Medicating of America”—

commercialization, normalization• Denial in the community

One Coalition’s Story

• Always lead with data!– According to Catherine Brunson, Exec. Director of the

Metropolitan Drug Commission, prescription drug abuse in TN is 4 times the national average.

– Prescription drug abuse represents the second most common treatment admission, second only to alcohol.

Metropolitan Drug Commission, Knoxville TN

• Helped to established a TN Prescription Drug Abuse Task Force

• Used DEA Automated Reports and Consolidated Orders System (ARCOS) database

• Pulled together TN Medical Foundation, Dept. of Health and Human Services, law enforcement, treatment

Coalitions Taking Action:Knoxville, TN

• Pharmacies– Local pharmacies agreed to include a brochure on abuse of

medications in every prescription filled

• Schools– Middle school program--original drama event with group

discussion afterwards– Called together all PTA presidents to talk about overall drug

strategy– Added question about prescription drug abuse to local youth

surveys

Coalitions Taking Action:Knoxville, TN

• Doctors– Agreement with the medical college of Univ.

of TN to train doctors during their residency– Must take 4 hours of drug-specific training

provided by the coalition to graduate

Coalitions Taking Action:Knoxville, TN

• Media– Coalition hosts a weekly radio broadcast on

Sunday mornings– Pitches stories to local media; ABC affiliate is

doing a 5-part series

Coalition Advice

• Engage the treatment community as a valuable resource of information and support.

• Find out what’s important to new partners to draw them in.

• Reach out to the medical community: work with local boards of health, doctors, dentists, pharmacists, nurses.

Coalition Advice

• Get real about your local drug problem!– Know your local medical examiner.– Spend a weekend night from 12:00-4:00 am in

a local emergency room.– Count your pills or lock your medicines up. – Learn to recognize the signs of misuse and

abuse

Parents: What to Look For• Changes in friends • Negative changes in schoolwork, missing school, or

declining grades • Increased secrecy about possessions or activities • Use of incense, room deodorant, or perfume to hide

smoke or chemical odors • Subtle changes in conversations with friends, e.g. more

secretive, using “coded” language • Change in clothing choices: new fascination with clothes

that highlight drug use • Increase in borrowing money

Parents: What to Look For• Evidence of drug paraphernalia such as pipes, rolling

papers, etc. • Evidence of use of inhalant products (such as hairspray,

nail polish, correction fluid, common household products); Rags and paper bags are sometimes used as accessories

• Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils

• New use of mouthwash or breath mints to cover up the smell of alcohol

• Missing prescription drugs—especially narcotics and mood stabilizers

CADCA is Here For You!

• For training and technical assistance, email training@cadca.org

• For public policy, contact Kelly Lieupo at klieupo@cadca.org

• For membership, contact Jennifer Zimmermann at jzimmermann@cadca.org

• For “all things CADCA,” contact Mary Larson mlarson@cadca.org; 703-706-0560, Ext. 247

Summary• Addiction is the #1 preventable public health

threat. • Prevention works, early intervention saves lives

and treatment and recovery is possible for everyone.

• Working through a coalition framework builds local capacity, reduces duplication and connects multiple sectors to work holistically.