Prescription Drug Abuse: A Call to Protect Our People, Pets and Planet Notes: -Introduce yourself -Prescription drug misuse and abuse is a prevalent problem among Alaskans. Many people have a family member or know of someone who has struggled with prescription drug misuse, abuse and even death. -No one could imagine that a bottle coming home from the clinic to treat pain could lead to addiction or death. -We’re going to talk about the problem today, but more importantly we’re going to talk about solutions to help protect our Elders, Children and our Nations from prescription drug abuse.

Today’s Presentation Why YOU matter Why DO kids misuse prescription drugs What WE can do Notes: -During today’s presentation, we will talk about why your role is so important in preventing prescription drug abuse. -We’ll discuss some of the reasons why kids are misusing prescription drugs, and most importantly, we’ll address specific ways you can protect your child and children in your community. -We’ll give you tips on how to communicate with your kids, how to safeguard your medications, how to spot medicine abuse and we will discuss safe disposal methods of unused, unwanted or expired medications. Photo credit: Alaska Native Epidemiology Center | Healthy Portraits Project

Real Danger Abusing prescription (Rx) drugs can be just as dangerous, addictive and even deadly as using ‘street’ drugs. Notes: Play Video -While medications are helpful to those that they are prescribed to, abuse of prescription medication is a new and real danger to our kids. -According to the National Institute on Drug Abuse, prescription drugs can be as dangerous, addictive and deadly as the “street” drugs like cocaine, crack and heroin. There is a reason why pharmaceutical companies put all those warning labels on drug bottles. When they’re ignored, the user puts him or herself at great risk.

Opioid Drugs Prescription pain relievers – Legal opioids (narcotics) Hydrocodone (e.g., Vicodin) Oxycodone (e.g., OxyContin, Percocet) Morphine (e.g., Kadian, Avinza) Fentanyl (e.g., Actiq, Duragesic) Codeine and related drugs (e.g., diphenoxylate (Lomotil)) Illegal opioid – Heroin Source: Alaska Department of Health and Social Services | Division of Public Health | Prevention Notes: -What do we mean by just as dangerous, addictive and deadly as a street drug like heroin. -A person misusing and abusing prescription drugs can develop tolerance, physical and psychological dependence, suffer from withdrawal, potentially leading to addiction.

Notes: -This slide shows the likelihood of a person who is addicted to alcohol, marijuana, cocaine, or prescription analgesics and their likelihood of becoming addicted to heroin.

What is Prescription Drug Abuse? Definition: Among high school students in grades 9–12, prescription drug abuse is defined as having used a prescription drug (such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax) without a doctor’s prescription one or more times during their life. Notes: -The National Youth Risk Behavior Survey (YRBS) defines prescription drug abuse as having taken prescription drugs without a doctor’s prescription (such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax, one or more times during the 30 days before the survey). [ QN99: Percentage of students who currently took a prescription drug without a doctor's prescription(such as OxyContin, Percocet, Vicodin, codeine, Adderall, Ritalin, or Xanax, one or more times during the 30 days before the survey) ] -FROM SURVEY RESULTS Source: Alaska Native Epidemiology Center, Statewide Adolescent Prescription Drug Abuse

Alaska Data In 2015, 13.2% of Alaska Native high school students reported having used prescription drugs without a doctor’s prescription in their lifetime. Notes: Let’s take a look at how the prescription drug problem is impacting our kids and communities. We’ll begin with a look at a recent data analysis by the Alaska Native Epidemiology Center using the most recent results from: Alaska Division of Public Health, Alaska Youth Risk Behavior Surveillance System and the Center for Disease Control and Prevention, Youth Risk Behavior Surveillance System. http://anthctoday.org/epicenter/assets/data/statewide/Adolescent_PrescriptionDrugAbuse_statewide_12_29_2016.pdf _______________________________________________________________________________________________________ For statewide YRBS results visit: http://dhss.alaska.gov/dph/chronic/pages/yrbs/yrbs.aspx For nationwide YRBS results visit: https://www.cdc.gov/healthyyouth/data/yrbs/ Data Source: Alaska Native Epidemiology Center, Statewide Adolescent Prescription Drug Abuse

Data Regions Adolescent prescription drug abuse ranged from 11.4% to 31.2% by tribal health region. Notes: In this picture you can see the 12 different Tribal Health Regions in Alaska, and the percentage of prescription drug abuse among adolescents in the corresponding region between 2011-2013. Bristol Bay- 11.4% Northwest Arctic- 12.3% Yukon-Kuskokwim- 14.0% Norton Sound- 14.7% Arctic Slope- 15.8% Kodiak- 16.2% Anchorage/Mat-Su- 20.2% Kenai- 22.7% Southeast- 23.9% Interior- 31.2% Data Source: Alaska Native Epidemiology Center, Statewide Adolescent Prescription Drug Abuse

Prescription Drug Abuse Impacts Everyone Poisoning deaths among Alaska Natives – All ages #1 – Illicit or prescription drugs (51%) #2 – Alcohol (41%) #3 – Other or unspecified poisons (7%) Notes: Data Source: Alaska Native Injury Atlas: An Update (October 2014)

Other Medicine Being Abused Prescription stimulants (Adderall, Ritalin, Dexedrine) Prescription muscle relaxers (Flexeril, Cyclobenzaprine, Soma) Prescription tranquilizers/sedatives (Xanax, Valium) Sleep medicine (Ambein, Lunesta) Over-the-counter medicine NyQuil Liquid Cough Syrup (containing Dextromethorphan) Cough and Cold medicine Notes: These are some of the other medications be abused. Prescription stimulants for ADD or ADHD (Adderall, Ritalin) These drugs are stimulants and increase the heart rate for those that don’t have ADHD or ADD. Prescription muscle relaxers like Flexeril or Soma Prescription tranquilizers/sedatives (Xanax, Valium) – These drugs are used to treat anxiety and tension, stress reactions and panic attacks. Users can develop a tolerance and dependence to these drugs just like pain relievers. And just like pain relievers if these drugs are mixed with alcohol or other drugs it can lead to death. Sleep Medications Over The Counter medications such as: Nyquil liquid which can contain ~10% alcohol Cough Syrup and cough and cold medications have dextromethorphan as the active ingredient and can be abused.

Distribution of Painkillers in Alaska Distribution of painkillers greater than 100-mg (MED), per day 2014 2015 Change Adult 117 89 -24% Youth* 2 1 -50% Notes: According to the 2016 Alaska Prescription Drug Monitoring Program Report (AKPDMP), in 2014 there were 117 adults and 2 youths receiving opioid analgesics greater than 100-mg per day. In 2015, there were 89 adults and 1 youth receiving painkillers greater than 100-mg (MED), per day. YOUTH-patients who are under the age of 18 as of the date the prescription was filled. https://www.commerce.alaska.gov/web/portals/5/pub/PHA_PDMP_LegislativeReport.pdf Data Source: Alaska Prescription Drug Monitoring Program Report| 2016

Availability = Access 73% of teens said it is easy to access prescription drugs from their parents medicine cabinet. 38% of teens who have misused or abused prescription medication report to have obtained them from their parents’ medicine cabinet. 32% of teens report having friends that have misused and abused prescription opioids. Data Source: The Partnership Attitude Tracking Study | Teens & Parents | 2013 Notes: (Ask the audience) -Take a moment to think about your medicines at home right now. Are they left out in the open? Can anyone have access to them? Do you have leftover or expired prescription medication? ______ One of the key factors driving prescription misuse is ease of access medicine cabinets at home, at friends’ houses or by taking other people’s prescriptions. There is a strong relationship between the misuse and abuse of prescription opioids, having close friends who misuse and abuse prescription opioids, and the perception of accessibility to them (The Partnership Attitude Tracking Survey [PATS], 2013).

Signs of Abuse Slowed or slurred speech Loss of coordination Slowed thinking and reaction Disorientation Loss of appetite A drunk, dazed or dizzy appearance Missing money or valuables Missing Rx bottles For more information visit www.drugfree.org Notes: Though not an exhaustive list, here are some of the common warning signs of prescription drug abuse.

What’s the best way to keep a youth drug free? Take Action! What’s the best way to keep a youth drug free? YOU! Notes:

Talk with Your Kids Over two-thirds of parents with high school aged children say they have never talked with their children about prescription drug abuse. Data Source: The Partnership Attitude Tracking Study | Teens & Parents | 2013 Notes: Kids care what their parents say. They listen to the parent’s concern more than they don’t.

Safeguard Medicine at Home Take a look at the medicine and number of pills in your home. Keep track of refills. Don’t leave medicine in open or obvious places. Store medicine up and away. Put them in a secure location Ask your friends and family to do the same. Notes: -Next, take steps to safeguard medications that you have in your home.

Follow Doctor’s Medicine Instructions Ask questions. Remember your medicine is just for you. If you suspect that someone has taken too much medicine Call 911 Poison Control 1-800-222-1222 or Your local provider. Notes: -When prescribed medication by your doctor it’s a good time to ask questions -For instance, how long you will you be on the medication, how it should be taken and if there are any side effects. -Do not share medication. Your medication has been prescribed by the doctor based on your symptoms and your medical history. -Do not take more than prescribed

Take Medicine As Directed Photo credit: www.womenshealth.gov Notes: -When taking prescription medication, it’s really important to read the drug label for instructions. -Not following the instructions can hurt your health. -Read the label each time you pickup a new bottle of drug, in case there have been changes since your past refill. -Every prescription has an expiration date. That date is listed on the bottom right of the prescription.

Read Warning Labels Warning labels may include: May cause drowsiness. Do not use this medicine if you are pregnant or plan to become pregnant. Do not drink alcohol while taking this medicine. Taking more than recommended or prescribed may cause breathing problems. Notes: -All medication comes with instructions and some medication comes with warning labels. -The warning labels may be in a different color, they may be a separate sticker, but if your medication has a warning it should appear on the bottle. -Be sure to read and follow these labels. Photo Credit: www.drugfree.org

Dispose of Medicine Safely Do NOT flush medicine down the toilet or throw it in the garbage. Use prescription mail back envelopes for unused, expired or unwanted medicine. Use drug deactivation bags before disposal. Participated in the National Take-Back Initiative (DEA). Notes: -If you have unused or expired medication that you don’t need anymore, it’s important to dispose of it in a way that’s safe. -The one thing you do not want to do is flush the medications down the toilet. The medications can get into the water system and can lead to contamination.

Dispose of Medicine Properly ANTHC can provide your clinic or tribal health organization with prescription mail back envelopes or drug deactivation systems. Also, check with your local law enforcement to see if your community participates in DEA drug take-back days. ANMC hospital pharmacy now has a receptacle for you to dispose of your unused, expired or unwanted medicine, available during normal business hours. Notes: April 29, 2017 – 10AM to 2PM The National Prescription Drug Take-Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse and medications. Please check back on April 1, 2017 to locate collection sites near you. DEA Website: www.deadiversion.usdoj.gov/drug_disposal/takeback/ The main ANMC hospital pharmacy now has a receptacle for you to dispose of your unused, expired or unwanted medications. This is the best option for safely disposing of your medications, ensuring they are safely disposed of and do not get into the wrong hands. To use this new service, please visit the ANMC Pharmacy during business hours. The Pharmacy is located in the main hospital at 4315 Diplomacy Drive. You must go to the counter and let the staff know you would like to dispose of medications. They will direct you to the disposal receptacle.

What is O.K.? Expired or unused pills Over-the-counter medicine Samples Pet medicine Patches Vitamins/Supplements Liquid (see bag for amount) NO sharps or creams Notes: -Depending on form of disposal, what is acceptable and what is not will depend on your form of disposal. -Be sure to read instructions.

Prescription Drug Checklist Share stories and talk with the children/youth in your life about taking medicine safely. Secure medicine and alcohol beverages. Dispose of unused, unwanted or expired medicine. Remember your prescription medicine is just for you. Notes:

Educate, Communicate, Safeguard, Dispose Notes:

To order safe medicine items www.iknowmine.org/safemedicine Contact Information: Lakota Holman Substance Abuse Prevention Initiative Phone: (907) 729-3547 Email: lrholman@anthc.org