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Prescription

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1 in 5 teens have abused Vicodin. 1 in 5 teens have abused Oxycontin ... Increased abuse of Vicodin, Opioids, Stimulants, and Sedatives ... – PowerPoint PPT presentation

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Title: Prescription


1
Prescription OTC Drug Abuse What You Dont
Know Can Hurt You
  • Laura G. Leahy
  • MSN, APN, CNS, FNP, BC

2
Objectives
  • The purpose of this presentation is to provide
    information regarding the abuse of prescription
    and over-the-counter medications and offer
    solutions for treatment and prevention

3
By the end of the presentation, the
audience should be able to
  • Discuss the most widely abused OTC prescription
    medications
  • Identify the most vulnerable populations
  • Identify solutions for prevention and treatment
    of prescription OTC drug abuse

4
Profile of a Prescription Drug Abuser
  • Joey the 14 year old on Adderall for ADHD whose
    friends encourage him to share
  • Linda the 47 year old home maker who has been
    stressed and not sleeping

5
  • Pete the 32 year old roofer who complains of
    chronic back pain
  • Mr. Jones the 70 year old retiree whose physician
    recommended he take aspirin to decrease the risk
    of heart attack

6
  • Janie the 20 year old college student who feels
    uncomfortable in social settings
  • Frank the 23 year old med student who is getting
    behind in his work

7
Commonly Abused Prescription Drugs
  • Depressants
  • Dissociative Anesthetics
  • Opioids Morphine Derivatives
  • Stimulants
  • Anabolic Steroids

8
Depressants
  • Barbiturates
  • Amytal, Nembutal, Seconal, Phenobarbital
  • Schedule II III
  • Typically injected or swallowed
  • Benzodiazepines
  • Ativan, Klonopin, Xanax, Valium, Halcion
  • Schedule IV
  • swallowed
  • Flunitrazepam
  • Rohypnol
  • Schedule IV
  • Swallowed, snorted

9
Effects of Depressants
  • Decrease pain anxiety
  • Lowered inhibitions
  • Slowed pulse breathing
  • Poor concentration, confusion
  • Respiratory depression, arrest
  • Drowsiness, dizziness, depression
  • Unusual excitement
  • Memory loss, amnesia

10
Depressants In the Brain
  • Slow brain activity
  • Act on GABA Benzodiazepine receptors
  • Produce calming effect
  • Potential for physical dependence
  • Potential for addiction

11
  • Severe Withdrawal Effects
  • Seizures following rebound in brain activity with
    reduced dose or discontinuation
  • Do not use with
  • Alcohol
  • Opioids
  • Some OTC cold allergy preps

12
Dissociative Anesthetics
  • Ketamine
  • Vitamin K, Special K
  • Schedule III
  • Typically snorted or smoked

13
Effects of Ketamine
  • Increased heart rate
  • Increased blood pressure
  • Memory loss
  • Impaired motor function
  • Numbness
  • Delirium
  • Depression
  • Respiratory depression, arrest

14
Opioids Morphine Derivatives
  • Codeine
  • Empirin, Fiorinal, Fioricet, Robitussin A-C,
    Tylenol w/ Codeine
  • Schedules II, III, IV
  • Injected and swallowed
  • Fentanyl
  • Actiq pops, Duragesic, Sublimaze
  • Schedule II
  • Injected, smoked, snorted, lollipops
  • Morphine
  • Roxanol, Duramorph
  • Schedule II III
  • Injected, swallowed, smoked

15
  • Opium
  • Laudanum, Paregoric
  • Schedule II III
  • Swallowed smoked
  • Other opioid pain relievers
  • Oxycodone, Oxycontin, Percocet, Hydrocodone,
    Darvocet, Dilaudid, Viocodin, Lortab, Lorcet,
    Demerol
  • Schedule II, III, IV
  • Swallowed, chewed, injected, suppositories,
    crushed, snorted

16
Effects of Opioids
  • Pain relief
  • Euphoria
  • Drowsiness, sedation
  • Respiratory depression, arrest
  • Confusion
  • Unconsciousness, coma
  • High tolerance addiction

17
Opioids in the Brain
  • Attach to opioid receptors in the brain and
    spinal cord
  • Block perception of pain
  • High potential for tolerance
  • High potential for addiction

18
  • Severe respiratory depression or death following
    single large dose
  • Severe withdrawal symptoms
  • Do not use with
  • Alcohol
  • Antihistamines
  • Barbiturates
  • Benzodiazepines
  • General anesthetics

19
Stimulants
  • Amphetamines (all Schedule II)
  • Dexedrine, Adderall
  • Swallowed, smoked, snorted
  • Cocaine (including crack cocaine)
  • Injected, smoked, snorted
  • Methamphetamine
  • Desoxyn
  • Injected, swallowed, smoked, snorted
  • Methylphenidate
  • Ritalin, Concerta
  • Injected, swallowed, snorted

20
Effects of Stimulants
  • Increased heart rate blood pressure
  • Increased metabolism
  • Exhilaration
  • Increased energy
  • Increased mental alertness/concentration
  • Decreased appetite, weight loss
  • Hallucinations, paranoia, delirium, psychosis
  • Aggression, irritability, impulsivity

21
Stimulants in the Brain
  • Enhance brain activity through dopamine
    norepinepherine pathways
  • Increase alertness, attention, energy
  • Potential for physical dependence
  • Potential for addiction

22
  • Cardiovascular failure
  • Lethal seizures
  • No significant withdrawal
  • Rebound depression upon withdrawal
  • Do not use with
  • OTC decongestants
  • Antidepressants (unless monitored closely)
  • Some asthma medications

23
Anabolic Steroids
  • Steroids
  • Anadrol, Equipoise, Durabolin
  • Depo-Testosterone, Oxandrin
  • Schedule III
  • Swallowed, injected, topical

24
Effects of Steroids
  • Increased Blood Pressure
  • Hostility, aggression
  • Acne
  • Growth suppression
  • Reduced sperm production (males)
  • Gynecomastia (males)
  • Beard growth, facial hair (females)
  • Menstrual irregularities (females)

25
Over-the-Counter Drugs
  • Sleep aids
  • Cough suppressants
  • Pain relievers

26
Sleep Aids
  • Psychoactive effects in large doses
  • Antihistamines
  • The PMs, Benadryl, Sominex
  • Doxylamine
  • Unisom
  • Dimenhydrinate
  • Gravol, Dramamine

27
Cough Suppressants
  • Dextromethorphan Based Products
  • Over 125 available
  • Caplets, liquid form
  • Doses 360mg
  • Hallucinations, dissociation, amnesia, numbness
  • effects similar to ketamine PCP
  • May last 6-8 hours
  • Found under various other names
  • Cold flu prep
  • Cough cold prep

28
Pain Relievers
  • Aspirin
  • Increased risk of bleeding, ulcers
  • NSAIDs
  • Ibuprofen, Motrin, Alleve
  • Increased risk of bleeding, ulcers, GI issues
  • Increases Lithium levels
  • Acetominophen
  • Tylenol, the PMs
  • Risk of liver damage, failure with over use
  • Avoid with Hepatitis C patients

29
Vulnerable Populations
  • Teens
  • Ages 12-18
  • College Students
  • Ages 18 to 25
  • Elderly
  • Over 65

30
Generation Rx
  • 2004 Teen Studies
  • 1 in 5 teens have abused Vicodin
  • 1 in 5 teens have abused Oxycontin
  • 1 in 10 teens have abused Ritalin or Adderall
  • 1 in 11 teens have abused OTC Cough Preps

31
  • Teens view prescription OTC drugs as much
    safer than illicit street drugs
  • Ease of access is major factor
  • More sophisticated familiar

32
  • Use of MJ down since 1998
  • Use of MDMA (Ecstasy) among teens is down 25
    since 2001
  • In 2001 12 of teens reported abuse
  • In 2004 9 reported abuse of Ecstasy

33
Generation Rx Drugs of Abuse
  • Marijuana 8.7 million 37
  • Inhalants 4.4 million 19
  • Vicodin 4.3 million 18
  • Oxycontin 2.3 million 10
  • Ritalin/Adderall 2.3 million 10
  • Cough Suppressants 2.2 million 9
  • Cocaine/Crack 2.2 million 9

34
  • Ecstasy 2 million 9
  • Methamphetamine 1.5 million 8
  • LSD 1.4 million 6
  • Ketamine 1.1 million 5
  • Heroin 1 million 4
  • GHB 1million 4

35
College Students
  • Increased abuse of Vicodin, Opioids, Stimulants,
    and Sedatives

36
  • Highest Abuse Rates for College Students
  • Whites 4.9
  • 1.6 Blacks, 1.3 Asians
  • Fraternity/Sorority Members
  • 8.6 members vs 3.5 non-members
  • Lower grade earners
  • 5.2 GPA 3.0
  • Northeastern Universities

37
Campus Stimulant Abuse
  • Admission Criteria
  • More competitive 5.9
  • Competitive 4.5
  • Less Competitive 1.3
  • Geographical Region
  • Northeast 6.3 South 4.6
  • West 3.2 North Central 2.8
  • Commuter Status
  • Residing on campus 4.6
  • Commuting to school 1.2

38
Elderly
  • High risk for prescription OTC abuse
  • Polypharmacy
  • Multiple providers
  • Decreased metabolism, nutrition
  • Discontinued medications not disposed of
  • Changes in memory, cognition
  • Account for 1/3rd of all prescriptions in US

39
Consequences of Abuse in Elderly
  • Increased hospitalizations
  • Risk of falls
  • Cardiac and/or respiratory failure
  • Dehydration
  • Change of mental status
  • Coma
  • Death

40
Recognizing Abuse
  • Multiple participants
  • Practitioners
  • 70 visit PCP at least 1x every 2 years
  • Screen for abuse, ask the questions
  • Monitor usage refill requests
  • Adequately treat symptoms (especially pain)
  • Pharmacists
  • Monitor multiple rxs from multiple practitioners
  • Patients
  • Take meds as prescribed (
  • Be honest with your practitioner about ALL drugs
  • Families
  • Monitor rxs in home including OTCs
  • Friends

41
Treating Addiction
  • Abuse is a Behavioral Issue
  • Addiction is a BRAIN DISEASE

42
Treatment Components
  • Detoxification
  • Counseling/Behavioral Therapies
  • Pharmacological Therapies

43
Detoxification
  • Medical Intervention to safely withdrawal from
    addictive medications
  • May require inpatient hospitalization
  • With Benzos it may take months to fully detox
    from the drugs
  • May require pharmacologic interventions

44
Counseling
  • Multiple Modalities
  • Individual
  • Group such as NA or AA
  • Family therapy
  • Cognitive Behavioral Therapy
  • Contingency management

45
Pharmacotherapies
  • Counter effects of the abused drug on the brain
    and behavior
  • Used to relieve withdrawal symptoms
  • Used to treat overdose
  • Used to overcome drug cravings

46
Treating Opioid Addiction
  • Combination Treatment
  • Detoxification
  • First line to treatment
  • Behavioral Interventions
  • Pharmacotherapy
  • Naltrexone
  • Blocks effects of opioids
  • Methadone
  • Synthetic opioid, blocks the effects, relieves
    cravings
  • Buprenorphine
  • Decreased side effects, both agonist antagonist
    at opioid receptor site in brain

47
Treating CNS Depressant Addiction
  • Medically Supervised Withdrawal
  • Very slow taper of drugs
  • Abrupt withdrawal can be life threatening
  • Risk of seizures
  • CBT
  • Modifying thinking, expectations, behaviors while
    increasing skills to cope with lifes stressors

48
Treating Stimulant Addiction
  • Taper of drug dosage to ease withdrawal symptoms
  • Behavioral Therapies
  • CBT Group Therapy
  • Contingency management
  • Earn vouchers for drug free urine tests that can
    be exchanged for items that promote healthy living

49
Prevention of Drug Abuse
  • Talk, Talk, Talk

50
  • Parents talk with your kids
  • Educators talk with your students
  • Couples talk with one another
  • Patients talk with your practitioner
  • Seek out friends and family

51
  • Dispel the myths
  • Prescription drug abuse is NOT safer than
    illicit/street drug abuse
  • More is not better
  • Your kids/spouse/loved one will not hate you for
    intervening

52
  • Monitor the drug cabinet
  • More kids, friends, and family obtain the
    prescription drugs they abuse right from your own
    medicine cabinet

53
  • Dispose of unused, unneeded, expired prescription
    and OTC drugs per the new federal guidelines

54
Drug Disposal Guidelines
  • Take out of original container
  • Mix with undesirable substance
  • Coffee grounds, sand, kitty litter
  • Put in impermeable, nondescript containers
  • Empty cans, sealable bags
  • Throw containers in the trash
  • Only flush down the toilet if patient info
    instructs it is safe to do so
  • Return unused, unneeded, expired prescription
    drugs to pharmaceutical take-back locations for
    safe disposal

55
  • Set an example
  • Be aware
  • Offer Support
  • Offer Encouragement

56
Conclusions
  • Prescription and Over-the-Counter Drug Abuse is
    on the rise
  • Youth are among the highest abusers today,
    choosing whats at home to whats on the street

57
  • Commonly prescribed medications are frequently
    the target of abuse and misuse
  • Common OTCs such as cough suppressants, cold
    preps, and pain relievers can contribute to
    serious adverse events when abused

58
  • Prevention of Prescription and OTC drug abuse
    starts at home by monitoring the medicine cabinet
  • Observation and Awareness can be the best
    preventative medicine

59
  • Addiction is a Brain Disease in need of treatment
  • The most effective treatments include therapies
    and occasionally pharmacotherapy

60
  • Keep an eye out for the elderly
  • They are at high risk for prescription and OTC
    drug abuse and complications

61
Questions Comments
62
References
  • Generation Rx (11-16-05) retrieved from
    www.drugfree.org
  • Legal but Lethal retrieved from
    http//www.family.samhsa.gov/get/otcdrugs.aspx?pri
    ntid1
  • Selected Prescription Drugs with Potential for
    Abuse (4-05) retrieved from www.drugabuse.gov
  • National Institute on Drug Abuse Research Report
    Series (8-05) retrieved from NIDA website
    www.drugabuse.gov

63
  • Community Drug Alert Bulletin (8-05) retrieved
    from NIDA website www.drugabuse.gov
  • Over the Counter Drug Facts (2006) retrieved from
    http//www.justthinktwice.com/drugfacts/otc.cfm.
  • Getting High on Prescription and Over-the-Counter
    Drugs is Dangerous brochure retrieved from
    www.drugfree.org
  • What Every American can do to Prevent Misuse of
    Prescription Drugs (2-20-07) retrieved from
    http//www.whitehousedrugpolicy.gov/news/press07/0
    22007.html
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