Teen Drug Abuse in the Formative Years of 12- 18

1. Teen Drug Abuse in the Formative Years of12-18 Ernest Mrazik, Jr. RPh, MBA Generation RX Champion 2012

3. Real Danger “Abusing prescription (RX) and over-the-counter (OTC) drugs can be just as dangerous, addictive and even deadly as using ‘street’ drugs” National Institute on Drug Abuse, 2008

4. Troubling Indicators of Medicine Abuse • Unintentional drug poisoning now the leading cause of accidental death in US, overtaking car crashes • Emergency room visits related to Rx/OTC abuse now almost equal to ER visits due to all “street drugs” • Rx drugs are now the most commonly abused drugs among 12-13 year olds Centers for Disease Control and Prevention, The Three Leading Causes of Injury Mortality in the United States, 1999-2005, 2008; Drug Abuse Warning Network; Substance Abuse and Mental Health Services Administration, National Study on Drug Use and Health, 2007

5. Columbia University National Center on Addiction and Substance Abuse • 12 to 17 years olds abuse prescription drugs more than they abuse ecstasy, crack/cocaine, heroin, and methamphetamine combined. • 60% of teens who abused Rx pain killers did so before 15. • There are as many new abusers (initiates or first-time users) age 12-17 of prescription drugs as there are of marijuana. • 90% of all adults with substance abuse disorder started using under age of 18 and half under age of 15. • Children who first smoke marijuana under age of 14 are 5 times more likely to abuse drugs as an adult than those use marijuana at age 18.

7. Rx New Step in Drug Ladder heroin,meth, crack cocaine shrooms,Ecstasy Prescription/over-the-counter drugs (Rx/OTC) liquor, marijuana cigarettes, beer/wine Rx abusers are more likely to add a 3rd rung in the progression

10. The Teen – Rx Abuse Connection Rx Medications are All Around Us…and Teens Notice • Patients leave the doctor’s office with a prescription in hand in 7 out of 10 visits. • Direct-to-consumer advertising on TV and in magazines is pervasive. • Many people don’t know how to safely use these medications or ignore their doctor’s instructions. Rx Abuse Prevention Toolkit - from awareness to action

11. As a result… Rx drugs are part of teen culture. Teens: • Normalize this form of drug abuse. • Take these meds for legitimate reasons – with or without a prescription – to stay awake, remain alert or to go to sleep. • Purposely abuse these drugs to get high. They participate in “pharming” and “bowling” parties. • Are often unaware that these activities can lead to disastrous results. Rx Abuse Prevention Toolkit - from awareness to action

12. Teenagers don’t know that abusing Rx drugs can: • Increase blood pressure or heart rate. • Damage the brain and other organs. • Lead to accidental overdose / poisonings. • Cause physical dependency and / or addiction. • Disrupt breathing (respiratory depression). • Lead to risks associated with mixing multiple drugs or combining with alcohol. • Cause seizures and even death. Rx Abuse Prevention Toolkit - from awareness to action

13. Parent/Child Conversation • Most teens (62 percent) report that their parents have talked to them about drugs and alcohol in the past year. • But only 17 percent of teens say their parents have talked to them about prescription drug abuse. The Partnership at Drugfree.org, Partnership Attitude Tracking Study, 2011

17. Postings on Social Networks • Detailed instructions and conversations about DXM abuse; • Blogs and videos with postings of how and when kids will take DXM-containing cough medicines; • Footage of kids while “high.”

21. Opiate Withdrawal • Dilated pupils, rhinorrhea (runny nose) • Tachycardia, hypertension • Nausea, Vomiting, diarrhea, abdominal cramps • Goose bumps, sweats, muscle/bone/joint aches • Insomnia, anxiety, headache

26. Sedative-Hypnotic Withdrawal • Tremors, diaphoresis (sweats), nausea • Anxiety, hyperreflexia, seizures • Insomnia • Hallucinations (seeing or feelings things, not hearing voices) • Delirium tremens

30. Opana and Oxycontin users switching to Heroin • Oxycontin new safe tablet arrived on the market August 2010 and Opana formulation change soon followed. • Researchers found the percentage of Oxycontin users fell from 35.6% before the new formulation was introduced to 12.8% almost 2 years later. • Primary abuse of other powerful opioids such as fentanyl, hydromorphone, oxymorphone, and heroin (doubled). • Almost a quarter of drug users (24%) said they found a way around the tamper-resistant mechanism in Oxycontin (microwave), but the vast majority (66%) said they switched to another opioid instead.

35. Marijuana Potency

38. Effects of Synthetic Marijuana • Onset: Three to five minutes • Length of duration: One to eight hours • Short-term effects: In addition to physical signs of use, users may experience: • Dysphoria – the opposite of euphoria • Paranoia – similar to PCP/Angel Dust • Delusions, hallucinations and increased agitation • Long-term effects: Unknown Source: Prosecuting Attorneys Association of Michigan

40. CONNECTICUT PACT360 • CT one of top 10 states for dependence on illicit drugs among young adults ages 18-25. • Heroin is the most commonly cited drug by the CT DEA. • Once the supply of prescription opioids is cut off or the abuser’s tolerance requires very high doses, abusers move on to Heroin, since it is much cheaper. • Example: Oxycontin 80mg tablet cost $80 but a day’s worth of Heroin is only $20. • Heroin is readily available in the suburbs.

47. SAFEGUARD Keep track of your meds • Parents (and other family members) are in the best position to reduce access to prescription drugs by locking up medicines and properly disposing of expired or unused medicines. • Monitor all medications in the home—prescription and OTC medicines. • Safely store medicines out of children’s reach and sight. Consider locking them up. • Get rid of old or unused medicines. Rx Abuse Prevention Toolkit - from awareness to action

48. SAFEGUARD Guidelines for Rx drug disposal • FEDERAL GUIDELINES • Refer to October 15, 2009 FDA Guidelines for Disposal by Flushing. • Do not flush down toilet or drain unless label or accompanying patient information specifically instructs you to do so. • Dispose of Rx drugs not labeled to be flushed through community drug take-back programs. If a program is not available, dispose of medications appropriately: • Take medication out of its original packaging and place it into a disposablecontainer with a lid or into a sealable bag. • Mix drugs with an undesirable substance (e.g., cat litter or used coffeegrounds). • Place sealed container with the mixture and original packaging (be sure toremove all personal information from the packaging) in the trash. Office of National Drug Control Policy. Proper Disposal of Prescription Drugs. 2009. Available at: www.whitehousedrugpolicy.gov/publications/pdf/prescrip_disposal.pdf Rx Abuse Prevention Toolkit - from awareness to action