peer assistance services, inc. 2014 eap implications of prescription drug use in the workplace...

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.

Mission: Dedicated to quality, accessible prevention and intervention services in workplaces and communities, focused on substance use and related issues.

Serving Colorado since 1984


Prescription Drug Abuse Prevention Program

• A State Priority Initiative funded by the Colorado Office of Behavioral Health

• 5-year funding cycle


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


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


Drug-Free Workplace


Drug-Free Workplace

• Positive rates for certain drugs, including opiates and amphetamines, have increased substantially.


Drug-Free Workplace

• Prescription opioids– Hydrocodone (Vicodin)– Hydromorphone (Dilaudid)– Oxycodone (OxyContin)– Oxymorphone (Opana)

More than doubled

Up 71 percent


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.


The use of a medication

(for a medical purpose)

other than as directed

or as indicated.

What is Prescription Drug Misuse?


What is Prescription Drug Abuse?

Includes “academic enhancement”

The intentional self-administration of a medication for a non-medical purpose.


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


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


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


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


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)


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


National DataNational Data


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)


Colorado Data


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


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


2012 Rx Opioid Deaths by Gender


Prescription Opioid Deaths 2012

295 of the 807 drug poisoning deaths in Colorado involved prescription opioids


Prescription Opioid Hospitalizations 2012

1,131 of the 5,291 drug poisoning hospitalizations in Colorado involved prescription opioids

21%


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


DEPRESSANTS


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


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


Long term effects

• Addiction

• Respiratory depression and respiratory arrest

• Death

• Chronic fatigue

• Sexual problems

• Sleep problems.


CNS Depressants

• Combining with other CNS depressants (alcohol)– Affect heart rhythm– Slow respiration– Death

• Withdrawal (Work with provider)– Anxiety– Insomnia– Depression– Seizures


OPIOIDS


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.


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.


Short Term Effects

• Drowsiness

• Mental confusion

• Nausea

• Constipation

• Respiratory depression

• Euphoric response


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.


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


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


Similarities between Illicit

and Prescription medications


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


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


STIMULANTS


Stimulants

• Increase alertness, attention, and energy

• Elevate blood pressure, heart rate, and respirations

• Mainly used in the treatment of ADHD and narcolepsy


Stimulants

• Schedule II Medication

• High potential for abuse which may lead to severe psychological or physical dependence


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.


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.


Stimulants

• Withdrawal– Fatigue

– Depression

– Disturbance of sleep patterns


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


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


Take Back Event

April 26, 201410:00 – 2:00www.dea.gov


Take Back Events

Colorado 2013

39,608 lbs

Nationally 2013 695 Tons


Thank You!

Contact Us:

2170 S Parker Road #229

Denver, CO 80231

www.peerassist.org

Facebook: PreventRxMedicineAbuse

303-369-0039 x 203

[email protected]

peer assistance services, inc. 2014 eap implications of prescription drug use in the workplace...

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