peer assistance services, inc. 2014 eap implications of prescription drug use in the workplace...
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Peer Assistance Services, Inc. 2014
EAP Implications of Prescription EAP Implications of Prescription Drug Use in theDrug Use in the Workplace Workplace
Laurie Lovedale, MPH, CPS IIPrescription Drug Abuse PreventionProgram Coordinator
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc.
Mission: Dedicated to quality, accessible prevention and intervention services in workplaces and communities, focused on substance use and related issues.
Serving Colorado since 1984
Peer Assistance Services, Inc. 2014
Prescription Drug Abuse Prevention Program
• A State Priority Initiative funded by the Colorado Office of Behavioral Health
• 5-year funding cycle
Peer Assistance Services, Inc. 2014
2010-2015 Program Objectives
• Increase awareness of the problem
• Increase availability of medication disposal programs statewide
• Encourage responsible prescribing practices
• Encourage patient responsibility
• Track data and trends
Peer Assistance Services, Inc. 2014
Agenda/Objectives
• Drug Free Workplace Data
• Typology of Abuse
• Prescription Drug Abuse Overview– National/State/Local Data– Medication Overview
• Prevention Strategies
• Medication Take Back Event
Peer Assistance Services, Inc. 2014
Drug-Free Workplace
Peer Assistance Services, Inc. 2014
Drug-Free Workplace
• Positive rates for certain drugs, including opiates and amphetamines, have increased substantially.
Peer Assistance Services, Inc. 2014
Drug-Free Workplace
• Prescription opioids– Hydrocodone (Vicodin)– Hydromorphone (Dilaudid)– Oxycodone (OxyContin)– Oxymorphone (Opana)
More than doubled
Up 71 percent
Peer Assistance Services, Inc. 2014
Drug-Free Workplace
• Positivity rates for amphetamines, including amphetamine and methamphetamine, has nearly tripled (196% higher) in the combined U.S. workforce and, in 2012, were at the highest level since 1997.
• The positivity rate for amphetamine itself, including prescription medications such as Adderall®, has more than doubled in the last 10 years.
Peer Assistance Services, Inc. 2014
The use of a medication
(for a medical purpose)
other than as directed
or as indicated.
What is Prescription Drug Misuse?
Peer Assistance Services, Inc. 2014
What is Prescription Drug Abuse?
Includes “academic enhancement”
The intentional self-administration of a medication for a non-medical purpose.
Peer Assistance Services, Inc. 2014
Why is there so much medication out there?
• Culture of “Pain-Free” society
• Blind Faith in medical system to cure anything
• Direct to consumer marketing from pharmaceutical companies
• Prescription medications are safe
Peer Assistance Services, Inc. 2014
The 3 R’s for Medication Safety
• RISKS – All medicines have RISKS as well as benefits
• RESPECT the power of your medicine and the value of medicines properly used
• Take RESPONSIBILITY for learning about how to take your medication safely
Peer Assistance Services, Inc. 2014
Typology of AbuseAcquired Drug with Legitimate Prescription
Acquired Drug Without Legitimate Prescription
Used to Self-Treat Self-treat other medical condition with previous Rx (off label use)Self-treat migraine with their own medication
Use other person’s medication (sharing) Parent taking child’s medication to be productive
Used to Get High/Euphoria May start off with legitimate pain med, but get addicted over time Use current medication to party/get high Using their own Rx, but taking it with alcohol to keep party going
May have bought/traded with others to get medication used to get high Stealing grandparent’s and getting high McCabe & Boyd, 2010 . Retrieved from http://captus.samhsa.gov/sites/default/files/capt_resource/paw-prescriptiondrug.pdf
Peer Assistance Services, Inc. 2014
DEA Schedule
Abuse Potential Examples of Drugs Covered
Effects Medical Use
1Highest Heroin, LSD, Marijuana,
Bath SaltsHigh potential for abuse, severe psychological or physical dependence, death
No accepted use
2High Morphine, Hydromorphone,
Methadone, Oxycodone, Fentanyl, Adderall, Ritalin
High potential for abuse which may lead to severe psychological or physical dependence
Accepted use with restrictions
3Medium Vicodin, Tylenol with
codeine, Suboxone and Subutex
Potential for abuse less than 1 and 2, may lead to moderate or low physical dependence or high psychological
Accepted use
4Low Xanax, Klonopin, Valium,
Ativan, HalcionLow potential for abuse relative to Schedule III’s
Accepted use
5Lowest Over the counter of
prescriptions with codeine, Robitussin AC
Low potential for abuse relative to Schedule IV’s
Accepted use
Peer Assistance Services, Inc. 2014
Main Types of Abused Prescription Medications
1. Depressants used to treat sleep disorders and severe anxiety (Xanax & Valium)
2. Stimulants used to treat behavior disorders such as ADHD (Ritalin & Adderall)
3. Opioids used to treat pain (Oxycontin & Vicodin)
Peer Assistance Services, Inc. 2014
Why Prescription Drugs?
• Easy Access– 70% from a friend or relative 2011 National Survey on Drug Use and Health
– Easier to get Rx drugs than beer
Young Adults feel they are “safer” than illicit drugs
Peer Assistance Services, Inc. 2014
National DataNational Data
Peer Assistance Services, Inc. 2014
Center for Disease Control
Poisoning is now the leading cause of death from injuries in the United States and nearly 9 out of 10 poisoning deaths are caused by drugs. (Centers for Disease Control 2008)
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Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc. 2014
Colorado Data
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Peer Assistance Services, Inc. 2014
In 2012 more than twicemore than twice as many people in Colorado died from poisoning due to opioid analgesics (295) than from drunk-driving related crashes (133).
Department of Public Health and Environment, Health Statistics
Section
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23
62 64
77
46
15
6
0
10
20
30
40
50
60
70
80
90
18-25 26-34 35-44 45-54 55-64 65-74 75+
Num
ber o
f Dea
ths
Age (years)
2012 Prescription Opioid Deaths by Age
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2012 Rx Opioid Deaths by Gender
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Prescription Opioid Deaths 2012
295 of the 807 drug poisoning deaths in Colorado involved prescription opioids
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Prescription Opioid Hospitalizations 2012
1,131 of the 5,291 drug poisoning hospitalizations in Colorado involved prescription opioids
21%
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Youth Risk Behavior Survey
Colorado
• Fall 2011
• 9th grade – 12.4%
• 10th grade – 17%
• 11th grade – 19.1%
• 12th grade – 29.2%
• Sept. 2010 – Dec. 2011
• 9th grade – 16.5%
• 10th grade – 18.2%
• 11th grade – 23.3%
• 12th grade – 25.6%
National
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DEPRESSANTS
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Depressants(CNS depressants)
• Also referred to as sedatives and tranquilizers
• Benzodiazepines– Alprazolam (Xanax) & Diazepam (Valium)– Treat anxiety, acute stress reactions and panic
attacks– Triazolam (Halcion) Short-term treatment of sleep
disorders
• Inhibit brain activity which produces a drowsy or calming effect
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Short Term Effects
• Short term– Slowed pulse and breathing– Slurred speech– Drowsiness– Lowered blood pressure– Poor concentration, fatigue and confusion– Impaired coordination, memory and judgment. – Suppress respiration/death– Addiction
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Long term effects
• Addiction
• Respiratory depression and respiratory arrest
• Death
• Chronic fatigue
• Sexual problems
• Sleep problems.
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc. 2014
CNS Depressants
• Combining with other CNS depressants (alcohol)– Affect heart rhythm– Slow respiration– Death
• Withdrawal (Work with provider)– Anxiety– Insomnia– Depression– Seizures
Peer Assistance Services, Inc. 2014
OPIOIDS
Peer Assistance Services, Inc. 2014
Opioids
• Relieve pain by reducing the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus.– Hydrocodone (Vicodin)- most commonly prescribed
for a variety of painful conditions, including dental and injury-related pain.
– Oxycodone (OxyContin, Percocet)– Morphine (Kadian, Avinza)- often used before and
after surgical procedures to alleviate severe pain.– Codeine- often prescribed for mild pain.
Peer Assistance Services, Inc. 2014
Opioids
• Attach to proteins called opioid receptors located in the brain, spinal cord, GI tract, and other organs in the body.
• When opioids attach to receptors, they reduce the perception of pain.
Peer Assistance Services, Inc. 2014
Short Term Effects
• Drowsiness
• Mental confusion
• Nausea
• Constipation
• Respiratory depression
• Euphoric response
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Long term effects
• Addiction
• Severe lethargy
• Sleep apnea
• Falls and fractures in the elderly.
• As dose increases, pain patients also become susceptible to a condition known as hyperalgesia, in which they feel more, not less pain.
Peer Assistance Services, Inc. 2014
Opioids
• Withdrawal (Work with provider when weaning off of opioids)– Restlessness– Muscle and bone pain– Insomnia– Diarrhea– Vomiting– Cold flashes with goose bumps– Involuntary leg movements
Peer Assistance Services, Inc. 2014
Tolerance to Opioids
• Tolerance develops rapidly to the sedating, and euphoric effects of opioids
• It develops more slowly to their analgesic effects
• Tolerance can be characterized as decreased sensitivity to opioids
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Similarities between Illicit
and Prescription medications
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Opioid Induced Hyperalgesia
• Increased sensitivity to pain resulting from opioid use
• Hard for clinicians to know if pain increase due to opioids or if the condition has worsened
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Pseudoaddiction
• Results from the misinterpretation of relief seeking behaviors as though they are drug-seeking behaviors that are commonly seen with addiction
• The relief seeking behaviors resolve upon institution of effective analgesic therapy SAMHSA, Tip
54, Managing Chronic Pain in Adults with or in Recovery From Substance Use Disorders, 2012
Peer Assistance Services, Inc. 2014
STIMULANTS
Peer Assistance Services, Inc. 2014
Stimulants
• Increase alertness, attention, and energy
• Elevate blood pressure, heart rate, and respirations
• Mainly used in the treatment of ADHD and narcolepsy
Peer Assistance Services, Inc. 2014
Stimulants
• Schedule II Medication
• High potential for abuse which may lead to severe psychological or physical dependence
Peer Assistance Services, Inc. 2014
Short term effects
• Stimulants increase the amount of norepinephrine and dopamine in the brain, which increases blood pressure and heart rate, constricts blood vessels, increases blood glucose, and increases breathing.
• Effects can feel like an increase alertness, attention, and energy along with a sense of euphoria. There is also the potential for cardiovascular failure (heart attack) or lethal seizures.
Peer Assistance Services, Inc. 2014
Long term effects
• Addiction
• Taking high doses of some stimulants repeatedly over a short time can lead to feelings of hostility or paranoia.
• Taking high doses of a stimulant may result in dangerously high body temperatures and an irregular heartbeat.
• Cardiovascular failure (heart attack) or lethal seizures.
Peer Assistance Services, Inc. 2014
Stimulants
• Withdrawal– Fatigue
– Depression
– Disturbance of sleep patterns
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc. 2014
Patient Responsibility
• Monitor all medications in their home • Don’t stock pile • Lock up or hide medications
– Do NOT store medications in the “medicine cabinet”
• Dispose of medications properly• Talk to friends and family (even grandparents) about
securing their medications• Understand the dangers of mixing medications and
alcohol• Lead by example
Peer Assistance Services, Inc. 2014
Just because they are prescribed by a health professional does NOT mean
they are safePrescription medications are only safe
• for the prescribed patient
• for the prescribed reason
• for a prescribed time
Peer Assistance Services, Inc. 2014
Take Back Event
April 26, 201410:00 – 2:00www.dea.gov
Peer Assistance Services, Inc. 2014
Take Back Events
Colorado 2013
39,608 lbs
Nationally 2013 695 Tons
Peer Assistance Services, Inc. 2014
Thank You!
Contact Us:
2170 S Parker Road #229
Denver, CO 80231
www.peerassist.org
Facebook: PreventRxMedicineAbuse
303-369-0039 x 203