Non Medical Use of Prescription Drugs October 2016

Nonmedical Use of Prescription Drugs (NMUPD)Betsy Jones, MPA, APS

Coalition Coordinator Partnership for Success Grant Circles of San Antonio Community Coalition

coalition@sacada.orgwww.circlesofsa.org

210-225-4741

The Growing Problem• The US has 4.6% of the world’s

population, and we consume 80% of the world’s opioids. 83% of the world has no access to these drugs.• In 1997, drug distribution was the

equivalent of 96 mg of morphine per person. In 2007, it was >700 mg per person, an increase of over 600%.

The Growing Problem• The demographic most likely to die from Rx misuse is adults, 45-65.• More pain• More diagnosed mental health issues• More access to prescriptions• More types = more danger of fatal combinations

• 1 in 15 adults and teens who take Rx drugs without a prescription will try heroin within 10 years.• According to cdc.gov, over 28,000 people died in 2014 as a result of opioid

use, and at least half of those deaths involved prescription painkillers.• Over 20% of Americans have used prescription drugs for nonmedical

reasons.

Most-Abused Types of Rx Drugs

• Narcotic painkillers (Oxycontin, Vicodin, Codeine)• Sedatives (Xanax, Valium, Ativan)• Stimulants (Adderall, Ritalin)

• They belong to someone else.• They are taken in a way the doctor didn’t recommend, or

for a different reason.• They are taken to get high.

Three ways prescription drugs are abused:

Myths• Prescription drugs are safe because they’re legal• It’s okay to share if…• It’s only once in a while• They don’t need it anymore• I take it for the prescribed reason• It was prescribed for me in the past

Among teens• Illicit drug abuse is declining among

teens but Rx abuse is rising dramatically.• Teens abuse Rx drugs more than any

illicit drug except marijuana.• And teens abuse Rx drugs more than

cocaine, heroin, and methamphetamines combined.

Teen perceptions• 41% believe Rx drugs are safer (than illicit drugs)• 37% see less shame in abusing Rx drugs • 31% perceive fewer side effects in Rx drug use • 20% say their parents would mind less if they got caught with Rx

drugs

Universal Precautions• Take only as prescribed.• Do not share. (Sharing is not caring!)• Do not hoard.• Lock them up, even if you live alone.• 40% of houseguests admit to snooping • 50% of those arrested for burglary say

they are on the lookout for Rx drugs when they break into a home.

Stimulants• ADHD drugs are abused to boost mental and physical performance,

gain energy, lose weight, or for euphoric effects.• Little evidence that “study drugs” are effective.• Dangers:• Elevated temp/heart rate• Tolerance• Hostility• Paranoia• Aggression

Sedatives• Used to treat anxiety or sleep disorders• Slow brain activity; depress central nervous system• Abused to experience euphoria, relaxation, or to enhance other drugs• Sometimes used to lessen withdrawal from other drugs• Negative effects include amnesia, reduced reaction time, impaired

judgment, confusion, tolerance, loss of coordination, seizures on withdrawal

Opioidsany natural or synthetic substances that produce opium-like

effects

Opiatesnatural pain relieving substances derived from the opium poppy

How effective are opioids?• Studies have found that opiate pain relievers are often no more

effective than ibuprofen or acetaminophen-based painkillers.• In prescriber surveys, however, doctors answer overwhelmingly that

they believe opioids are the most effective way to relieve pain.• Opioids affect the emotional aspect of pain more than the physical

and we must develop a healthy respect for that if we are to use them effectively.

Prescriber Knowledge• The average medical school provides

9 hours of education on pain, and negligible education on addiction or opioids.• 40-60% of people with back pain will

receive a prescription for opioids at some point, even though--• The American Academy of Neurology

recommends AGAINST using opioids for back pain.

The Addiction Process• Initiation

• Energy, determination, confidence, well-being

• Body’s reaction• Decreases opioid receptors, serotonin, norepinephrine, dopamine• Increase in pain, anxiety, depression, isolation

• Ongoing• More pills needed – whether prescribed or illegally obtained• Continued changes in neurotransmitters and receptors, cells making new connections• After one month, MRI will show noticeable difference in brain activity• Adaptations lead to worse feelings, physical and emotional, when not taking the pills

Physical withdrawal: after one week• Pain is much worse• Anxiety (fear)• Depression• Emotional instability• Rapid heart rate• Sweating, diarrhea, vomiting• Restlessness

Withdrawal: after longer periods

• Depression• Anxiety• Craving opioids• More pain• No “life motivation”• Only motivation is to get the drug• Drug use is the only activity that can stimulate the dopamine and give

them pleasure

Rates of opioid overdose deaths, sales, and treatment admissions, 1999-2010

For every death in 2010:

Unused prescription drug disposal• Do not throw away or flush

medications!• Take them to a drop box or take-back

event. Encourage your pharmacy and local law enforcement to host an event.

What we’re doing in San Antonio• DEA Takeback events • San Antonio Water Systems Med Drop events• Billboards• Chasing the Dragon collaboration• Circles of San Antonio Rx Workgroup• Permanent droboxes

Resources• National Institute on Drug Abuse (NIDA). Advancing Addiction Science. http://

www.drugabuse.gov• Alarm.org. Home Safety FAQs. http://www.alarm.org • Potter, Dr. J. (2016, June 9). Think health science: Advances in pain management. Lecture

presented at TPR Presentation in UT Health Science Center, San Antonio, TX.• Teater, Dr. J. (2016, Sept 22). The illusion of opiates. Lecture presented at When the

Prescription Becomes the Problem, Challenge of Tarrant County, Hurst, TX.• National Vital Statistics System. DEA’s Automation of Reports and Consolidated Orders

System,SAMHSA.• Coalition Against Insurance Fraud. Prescription for Peril. http://

www.insurancefraud.org/downloads/drugDiversion.pdf , 2007.• WISQARS, 2000 & 2010; CDC and NCHS, National Vital Statistics System. https://

www.cdc.gov/drugoverdose/