1 Missoula Prescription Drug Task ForceGeneration RX Missoula Prescription Drug Task Force

2 Medications can help us when used as directed by a healthcare professionalLet’s begin by establishing the beneficial impact of prescription medications. Prescription medications can help us lead longer and healthier lives when used under the supervision of a healthcare professional, like a pharmacist or doctor. Our life expectancy is the longest in history, and people are now able to live with many diseases that were once fatal. We are preventing or curing many illnesses and relieving troublesome symptoms, in part, because of prescription medications. Transition: Medications can help us, but only when used as directed by a healthcare professional. Medications can be harmful, especially when misused.

3 Think About It: Some people misuse medication by taking them for a different reason than prescribed. What reasons do teens give? Transition: Some people misuse prescription medications by taking them for a reason different than prescribed. What reasons do teens give for misusing prescription medications? By yourself or working with a partner, brainstorm why teens misuse prescription medications. I’ll give you a few minutes to do this. Note to facilitator: encourage each team to share one reason with the entire group. You may wish to list these reasons on a whiteboard or a large sheet of paper for all participants to see. Possible reasons include: To manage stress To improve academic performance or help in school To cope with feelings of depression To deal with a physical injury in order to perform in an athletic event (“play through the pain”) To have fun To have something to do (i.e. boredom) or try something new (i.e. curiosity)

4 What do you think? Prescription medications are safer than street drugs. There can be legal consequences for misusing prescription drugs. I can do whatever I want with my own prescriptions. Important to discuss depending on the prescription it’s illegal to share, give for free or sell – money does not have to be exchanged!

5 Which scenario represents prescription drug misuse?Transition: Before we move forward, let’s define “prescription drug misuse”. Here are three scenarios. Scenario 1: an individual takes medication to help them study. Scenario 2: an individual prescribed an opioid pain medication is in severe pain—the patient takes more than instructed to manage their pain. Scenario 3: an individual shares their prescription medication with a friend. Which scenario do you think represents prescription drug misuse? Note to facilitator: Encourage participants to discuss amongst themselves which scenario(s) represent prescription drug misuse. When ready, poll the audience. Correct! Each scenario represents prescription drug misuse. In Scenario 1, the individual is taking a medication for a different reason than prescribed (medications are not prescribed to aid in studying). In Scenario 2, the individual is taking more of the medication than prescribed. It’s often the case that people misusing are not doing it on purpose. However, these actions can still be harmful. Lastly, in Scenario 3, the individual is sharing their prescription medication with someone else. Even if your intention is to help a friend or family member, sharing prescription medication can be dangerous.

6 Misusing medications is:Taking medication for a reason different than prescribed Taking more than prescribed Sharing or taking someone else’s medication Transition: Therefore, we define prescription drug misuse as engaging in primarily three behaviors. Taking more of a prescription medication than prescribed. Taking a prescription medication for a reason different than prescribed. Sharing or taking someone else’s prescription medication. And as we noted on the previous slide, regardless of our intentions, engaging in any of these behaviors is misuse. Note for facilitator: If asked, the National Institute of Health drafted and currently supports these definitions of prescription drug misuse. Regardless of intentions…

7 Name the PrescriptionsPropofol Oxycodone, hydrocodone, temazepam, diazepam, alprazolam, doxylamine

8 A little difference goes a long way…Heroin Morphine Hydrocodone

9 Rollercoaster to AddictionDependency Addiction is a dease that is effected by many things: Genetics, situation (people you hang around with, family, etc. ) and Behavioral/Coping Skills No one is immune to addiction and no one ever thinks they will become an addict. The Rollercoaster of addiction: Ask this question: What is the best preventative measure to assure you do not become addicted to something? Answer: Never take it The first line represents your normal – how you feel everyday What happens the first time you take a prescription or drug to get high – how high will you get? As high as possible Once that high wears off – where will you fall back to? Normal That’s right you fall back to normal – that’s why people are willing to try the drug again because often times the first time there are no consequences so they think why not try it again. How high will you get the second time? Right not as high Where will you fall back to when the high wears off? Just a little below normal Then not as high, fall below normal Then you are getting high just to make it back to normal This is when addiction starts and the red dash represents your new normal that you will accept to keep getting high Addiction

10 Fact: 1 out of 7 teens misuse prescription drugsTransition: But the reality is that 6 out of 7 teens do NOT misuse prescription medications. DON”T DO IT BECAUSE YOU THINK EVERYONE ELSE IS BECAUSE THEY ARE NOT. Although not everyone is misusing the concern is that even misusing once can be very dangerous or deadly. This suggests that only 1 in 7 teens, or roughly 15%, have misused prescription medications in the past year. Even fewer do so regularly. This certainly isn’t the majority! Never feel like you are “not normal” or you won’t “fit in” with your peers if you don’t misuse…this simply isn’t true. Note to facilitator: Across the leading national surveys, discrepancies exist amongst prevalence estimates. The statistic reported in this slide represents past year misuse from 2014 surveys (data collected in 2013), and is a conservative estimate based on the following data: Past year misuse: National Survey on Drug Use and Health: 6.2% Monitoring the Future Study: 13.9% The Partnership Attitude Tracking Study: 16% The Partnership Attitude Tracking Study (2014) reports lifetime misuse amongst teens at 24%. 10

11 Missoula Teens Missoula 8th, 10th, 12th graders reported that in their lifetime have used these prescriptions that were not prescribed to them 6% Narcotics 9% Sedatives 5% Stimulants Montana Prevention Needs Assessment 2016 – taken in the Spring of 2015 – a very reliable study that has been used in Missoula High Schools for over 20 years. 11

12 Dangerous CombinationAlcohol is a depressant Mixing alcohol & prescription drugs can have unpredictable and even deadly effects What happens when you mix alcohol with… Other sedatives? (Ambien, Valium) Stimulants? (Adderall, Ritalin) Opiates? (morphine, codeine) Sedatives: alcohol can intensify the drug’ sedative effects causing drowsiness and dizziness which can make falls and accidents more likely Stimulants: stimulants may make you less likely to notice the sedative effect of alcohol, which can cause you to drink more than you normally would; this may lead to alcohol poisoning, and can also cause unpredictable effects like irregular heart rate and blood pressure Opiates: most dangerous combination; both alcohol and these painkilers have side effect of respiratory depression, and when mixed the effect is greatly increased; slows/stops breathing, possible death

13 Alcohol On average, underage drinkers consume more drinks per drinking occasion than adult drinkers. 16% of Missoula teens reported that they have binged drink within a two week period of time. Binge drinking can lead to alcohol poisoning. Alcohol is the drug of choice for teens and adults Ask: What is binge drinking? SAMHSA defines heavy drinking as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days. CDC and Montana Prevention Needs Assessment 2016 CDC: Underage Drinking Alcohol is the most commonly used and abused drug among youth in the United States.1 Excessive drinking is responsible for more than 4,300 deaths among underage youth each year, and cost the U.S. $24 billion in economic costs in ,3 Although drinking by persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the United States.4 More than 90% of this alcohol is consumed in the form of binge drinks.4 On average, underage drinkers consume more drinks per drinking occasion than adult drinkers.5 In 2010, there were approximately 189,000 emergency rooms visits by persons under age 21 for injuries and other conditions linked to alcohol.6 Drinking Levels among Youth The 2015 Youth Risk Behavior Survey7 found that among high school students, during the past 30 days 33% drank some amount of alcohol. 18% binge drank. 8% drove after drinking alcohol. 20% rode with a driver who had been drinking alcohol. Other national surveys In 2015, the National Survey on Drug Use and Health reported that 20% of youth aged 12 to 20 years drink alcohol and 13% reported binge drinking in the past 30 days.8 In 2015, the Monitoring the Future Survey reported that 10% of 8th graders and 35% of 12th graders drank during the past 30 days, and 5% of 8th graders and 17% of 12th graders binge drank during the past 2 weeks.9 Consequences of Underage Drinking Youth who drink alcohol 1,5,10 are more likely to experience School problems, such as higher absence and poor or failing grades. Social problems, such as fighting and lack of participation in youth activities. Legal problems, such as arrest for driving or physically hurting someone while drunk. Physical problems, such as hangovers or illnesses. Unwanted, unplanned, and unprotected sexual activity. Disruption of normal growth and sexual development. Physical and sexual assault. Higher risk for suicide and homicide. Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning. Memory problems. Abuse of other drugs. Changes in brain development that may have life-long effects. Death from alcohol poisoning. In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink.10 Youth who start drinking before age 15 years are six times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years.8

14 You CAN make a difference!GOOD NEWS! You CAN make a difference! Transition: The good news is that you can make a difference! Note to facilitator: Consider allowing participants to brainstorm and share ideas on how they can make a difference. You may wish to summarize these ideas on a whiteboard, if available.

15 Use Medications SafelyProperly Use Properly Store Be a good role model Transition: How can you make a difference? You can easily make a difference by incorporating three safe medication practices into your daily life: Follow instructions, keep for yourself, serve as a good role model Let’s discuss these practices in more detail. We’ll start with “keep for yourself”.

16 Sharing can have harmful even fatal consequences.Why can’t I share? The right prescription for you may not be the right prescription for someone else. Sharing can have harmful even fatal consequences. Ask the audience why they think sharing medication can be dangerous or why they should not share medication? Allergies Possible drug interactions if you are on other medications When a doctor gives a prescription they take into account a persons medical history, age, weight, heigh, genetics, and medial needs This is not the same for everyone USE ADHD and Aderal as an example: It might work great for someone who has ADHD but could be harmful if you take it and you do not have ADHD Remind them that sharing even with out the exchange of money can be illegal!!!!!

17 Why follow instructions?1 How much & how often Transition: You may be thinking, “but why?”. “Why do I need to follow instructions?” Consider this prescription label for the opioid pain medication, Vicodin. As mentioned earlier, prescription opioid pain medications are among the most commonly misused prescription drugs. The instructions state: take 1-2 capsules by mouth every 8 hours as needed for arm pain. Instructions on prescription medications consist of two parts: Part 1—how much of the medication (dose) and how often you take the medication (frequency); Part 2—the reason for taking the medication (indication). Some times the reason may not appear on the instructions, but the prescription was written by a doctor to provide a specific intended effect…like to relieve pain, in this example. Instructions are provided to keep us safe. When we don’t follow instructions, we increase the likelihood that negative side effects, including developing a dependency on some medications, can occur. 2 Reason for medication

18 Use Medications SafelyProperly Use Properly Store Be a good role model Transition: How can you make a difference? You can easily make a difference by incorporating three safe medication practices into your daily life: Follow instructions, keep for yourself, serve as a good role model Let’s discuss these practices in more detail. We’ll start with “keep for yourself”.

19 Proper Storage Lock them up at home, school, traveling, lockerFollow school policy about your own prescriptions at school If in vehicle keep the vehicle locked and in secure location Know what prescriptions you have and the quantities. Keep a medication log!

20 Use Medications SafelyProperly Use Properly Store Be a good role model Transition: How can you make a difference? You can easily make a difference by incorporating three safe medication practices into your daily life: Follow instructions, keep for yourself, serve as a good role model Let’s discuss these practices in more detail. We’ll start with “keep for yourself”.

21 Proper Disposal DON’T FLUSH!Instead combine with kitty litter, coffee grounds, or saw dust and throw away. Medication drop-off located at the Missoula Police Station

22 Think About It: What could teens do instead of misusing? Identify a few positive alternatives. Transition: Now that we’ve identified common reasons for misusing, let’s consider some positive alternatives. Note to facilitator: Encourage participants to brainstorm positive alternatives for the identified reasons. Consider listing these alternatives next to your list of “reasons” on the same whiteboard. Below are talking points for some alternatives that teens might suggest. To help with school: it may be tempting to misuse prescription drugs as a “quick fix” to help you cram for an upcoming exam. However, this isn’t a sustainable approach for earning good grades. Try studying with friends, work with a tutor, or meet with your teacher before or after school. To cope with depression: if your mood feels depressed, confide in a trusted adult. Resorting to misusing prescription medications or using other substances will only prolong your feelings of depression. To deal with an injury: if you are an athlete experiencing an injury, you may feel pressure to “play through the pain”. However, the possible consequences from misusing a prescription opioid pain medication are far more devastating than not performing in an athletic event. If you are dealing with an injury, work with an athletic trainer or a healthcare professional to safely plan your recovery. To handle boredom: boredom can affect all of us…try curing your boredom by engaging in something you enjoy (like art, sports, helping others, etc). To handle stress: stress will always be present in life. Try adopting healthy habits for dealing with stress like exercising, watching TV or a movie, or taking a nap.

23 Summary In terms of abuse, prescription drugs are as dangerous as street drugs Addiction can occur just as easily with prescription drugs as it does with street drugs. Possessing some Rx drugs without a prescription can be illegal and/or a felony offense (punishable by jail time). As can be sharing or selling.

25 Use Medications SafelyProperly Use Properly Store Be a good role model Transition: Let’s recap…you can make a difference and prevent prescription drug misuse by keeping medications for yourself, following instructions, and lastly by being a good role model. This includes modeling these practices at home, and encouraging your family and friends to do the same. 25

26 Help Others Visit: GenerationRx.org Learn more Share the informationTalk with a trusted adult Transition: In addition to serving as a good role model, we encourage you to share this information and help others. How can you help others? First, you (and other adults) can learn more about this issue by visiting the ‘Learn’ section on GenerationRx.org. Second, you can share these messages with others. This may consist of discussing these messages with family and friends, or sharing these messages through peer-to-peer education. Visit our website, GenerationRx.org, to access free, ready-to-use resources designed to educate teens. You could present this program, or a different activity. You could also present similar educational programs to other audiences, like young children, using our age-appropriate resources. Lastly, if you are concerned about someone you care about, we encourage you to talk to a trusted adult. In addition, we’ve identified additional resources for helping others on GenerationRx.org. Note to facilitator: you may consider assisting teens with identifying adults they can discuss concerns with, as well as providing local resources where teens or adults can find help. Visit: GenerationRx.org

27 Support Teacher Counselor ANY trusted adultNational Suicide Prevention Lifeline ( TALK) Treatment Referral Helpline ( HELP)

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29 Missoula Prescription Drug Task ForceTransition: Does anyone have any questions or comments? Before we end, we encourage you to stay connected by following (Twitter) and MyGenerationRx on Instagram. Also, we encourage you to take a survey evaluating today’s program on generationrx.org. You can find a link to this survey at the bottom of the home page. We value your feedback to help us assess the impact of this work and continually improve Generation Rx materials. Note to facilitator: we encourage you, as the presenter, to also complete this survey. Thank you for advocating safe medication practices in your community! We also encourage you to share your experience with us. Consider submitting your tips and personal experiences about how you advocate safe medication practices at home or in your community. To do this, visit the ‘Contact’ section of GenerationRx.org. In this same section, you can also submit any questions you may have regarding how to use these educational resources. Missoula Prescription Drug Task Force

30 Prescription Drug DiversionMission: Ensure the supply of controlled substances and listed chemicals are made available for legitimate medical needs through the legitimate necessary channels, while preventing illegal use of the substances

31 Three circles of addictionSituation Genetics Behavioral / Coping Skills

32 Our Partners Cardinal Health ®Montana College of Health Professions and Biomedical Sciences APhA - Academy of Student Pharmacists Missoula Underage Substance Abuse Prevention Missoula Boys and Girls Club Missoula Police Department Clark-Fork Coalition Open AID Alliance Missoula Aging Services

33 Why would someone misuse medication?

34 What is prescription drug misuse?Taking a medication that was not prescribed to you- or sharing your prescription with anyone else Purposefully taking the wrong dosage of a prescribed medication to get high Taking a prescribed medication for something other than its intended purpose. Changing the medication from it’s original form

35 What do you think? Which behavior(s) is considered prescription drug abuse? Taking a prescription drug that was not prescribed for you. Taking more of a prescription drug than you’re supposed to Taking a prescription drug for a reason other than you’re supposed to Changing the drug from its original form. So when I say ABUSE of drugs, what behaviors do you think would be considered abuse of prescription drugs? why is that considered abuse? Depending on the drug- its illegal! So, if you have a written prescription from your doctor, and you take that medication as prescribed, that is not abuse. When taken as written, prescription drugs have helped cure diseases for a lot of people. What I’m talking about when I say prescription drug abuse is: repeat answers 1-4. Make sure the students understand the difference. Define inappropriate route of administration… ex. Snorting or injecting Ok, now that we all understand that prescription drug abuse is a growing problem in our country and we know the behaviors that are considered abuse…(transition)

36 Name the prescription drug of abuseAdderall Codeine

37 Misuse of Pain Relievers* Source: SAMHSA, 2005, National Survey on Drug Use and Health, September

38 Can YOU spot the difference?methamphetamine dextroamphetamine

39 Therapeutic Use vs. Abuse74 Overdoses in 72 Hours: Laced Heroin May be to Blame- October 2015 5 Maryland Students Overdose on Prescription Drugs at High School- March 2015 The overdose happened to 5 female students who decided to take Adderall with ambien. They were provided these by another student. Luckily all 5 lived

40 Stats and Trends Nearly 1 in 5 teens report abusing medications that were not prescribed to them. 1 in 3 teens reports knowing someone who abuses Rx drugs Every day, 2,500 youth (aged 12-17) abuse a prescription pain reliever for the very first time In 2007, nearly 7 million people abused prescription medications. This exceeds that for ALL street drugs (except marijuana) combined.

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43 Generation Rx 50 YEARS AGO A TYLENOL WAS A GOOD ENOUGH PAIN RELIEVER….. Now we have “Pharmaceutical Populism” …a growing culture of self-diagnosis and prescription

44 What do you think? Which behavior(s) is considered prescription drug abuse? Taking a prescription drug that was not prescribed for you. Taking more of a prescription drug than you’re supposed to Taking a prescription drug for a reason other than you’re supposed to Changing the drug from its original form.

45 By the numbers 300 prescription drug deaths/year in Montana190 automobile accident deaths 7 firearm deaths in Montana 24 skydiving deaths in USA 49 lightning strikes deaths in USA 5 shark attack deaths worldwide

46 Questions? I’m Ron Burgundy?

47 Come on down and name-that-product!Based on the logo, name the company or brand represented: Now try these ones:

48 Catchy, isn’t it? Based on the slogan, name the product or company represented: “Just do it” Nike “I’m lovin’ it” McDonald’s “Where’s the beef?” Wendys “Like a good neighbor…” State Farm “Depression hurts, _____ can help” Cymbalta “The little blue pill” Viagra