1. 1 Your Company’s Commitment to a Drug-Free Workplace Employee Education Prescription Drugs: The Hidden Problem © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07

2. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 2 What’s the big deal? “How could it be bad if it’s medicine?” “But my doctor told me to take it.” “They’re legal and certainly not as dangerous as street drugs.” Prescription (Rx) drugs are so powerful that we have controls on who can prescribe them and how they should be used.

3. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 3 Scope of the Problem Between 1992 – 2002, the US population increased 13% and the number of Rx prescriptions filled increased 154% 1 In 2005, 32.7 million people in the U.S. had used pain relievers non-medically in their lifetimes 2 Today, more adults and teens report abusing these drugs than the number abusing all illicit drugs combined – except marijuana

4. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 4 Problem, continued Nearly 1.3 million ER visits in 2004 were associated with drug misuse/abuse -- nearly half involved Rx drug abuse 3 o 31.9 % - opiates o 29.1 % - benzodiazepines o 5.7 % - muscle relaxants Among youth … o The word “pharming” has been coined to describe the abuse of Rx drugs to get high o 1 in 5 teens admit abusing Rx drugs in their lifetimes 1

5. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 5 Problem, continued Among Older Adults o Persons 65+ years comprise only 13% of the population, yet account for approximately 1/3 of all Rx drugs prescribed in the U.S. o Older patients are more likely to be prescribed long- term and multiple prescriptions, which could lead to unintentional misuse Pharmaceutical drug abuse crosses all age, race, and socio-economic boundaries.

6. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 6 The “Visible” Abusers Elvis Presley Sonny Bono Nicole, Lindsey & Paris Bret Favre Anna Nicole Stevie Nicks Elizabeth Taylor Matthew Perry Rush Limbaugh Melanie Griffith Barry Bonds (?) McCauley Calkin The Osbournes (well … at least 3 of them) On and on …

7. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 7 Why Rx drugs? For some, there is less risk of overdose (strength/purity are known and predictable) Often paid for by insurance Cheaper than cocaine and heroin Less risk of detection Lack of enforcement More accepted by society Easier to obtain legally

8. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 8 Kids Say Rx Drugs 4 … Are easy to get from parents’ medicine cabinets Are available everywhere Are not illegal drugs Are easy to get though other people’s prescriptions Are cheap Are safer to use than illegal drugs Are less shameful to use Are easy to purchase over the Internet Have fewer side effects than street drugs Can be used as study aids “Parents don’t care as much if you get caught”

9. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 9 Most Commonly Abused Rx Drugs 1. Opiates 2. Depressants 3. Stimulants

10. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 10 Opiates/Opioids EXAMPLES: OxyContin ®, Darvon ®, Vicodin ®, Demerol ® Prescribed for management of acute or chronic pain, relief of cough, etc. Possible negative effects: tolerance, respiratory depression or death following a large single dose High prevalence of addiction o After prolonged use, nerve cells in brain -- which would otherwise produce natural painkillers (endorphins) -- cease to function o Body stops producing endorphins

11. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 11 Depressants EXAMPLES: Barbiturates -- e.g. Nembutal ®, Mebaral ® Benzodiazepines -- e.g. -- Valium ®, Librium ®, Xanax ®, Halcion ® Often referred to as “sedatives” or “tranquilizers” Prescribed for anxiety, tension, panic attacks and sleep disorders Possible negative effects: tolerance and seizures after reducing or discontinuing use Probability of addiction after prolonged use is high

12. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 12 Stimulants EXAMPLES: Dexedrine®, Ritalin® Prescribed for narcolepsy, ADHD, depression, obesity and asthma Possible negative effects: addiction, irregular heart beats, seizures, and feelings of hostility or paranoia Treatment of stimulant addiction is based on strategies proven effective for treating cocaine or methamphetamine addiction

13. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 13 Mixing Rx Drugs: RECIPE FOR DISASTER Rx drugs should be used in combination only under a physician's close supervision Combining Rx drugs with herbal remedies (e.g. echinacea, St. John’s Wort) can cause interactions that are potentially dangerous Don’t forget about over-the-counter meds that you are taking, too (including creams and salves – they enter the bloodstream, too)

14. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 14 Mixing Rx Drugs with Alcohol SAFETY: Rx drugs can have a multiplying effect when used with alcohol (1 + 1 doesn’t always equal 2) HEALTH: Alcohol + Rx drugs can damage bodily systems (e.g. Tylenol + alcohol can affect kidneys) EFFECTIVENESS: Alcohol can wipe out intended effects of the Rx drugs (e.g. antidepressants and antibiotics)

15. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 15 Where do abusers get Rx drugs? 59.8% - from a friend or relative for free 16.8% - from a single physician 4.3% - from a drug dealer or other stranger 0.8% - from the Internet

16. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 16 Benefits of Internet Rx Drug Sales Access for the disabled or otherwise homebound Convenience of shopping 24/7 Wide selection of pharmaceutical products Cheaper Privacy for those who don’t want to discuss medical needs in a public place

17. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 17 But there are MANY concerns In 2007, there was a 70% increase in the number of websites that advertise or sell Rx drugs 84% Internet sales are made without a prescription 1 The Internet provides a marketplace for unapproved drugs Ordering Rx drugs over the Internet w/o a valid prescription is likely to be illegal (“pill-mills”) Buyers may receive counterfeit, contaminated, or adulterated products

18. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 18 Concerns, continued There needs to be a legitimate “doctor-patient” relationship. Without it … o person is apt to “self-diagnose” o may be increased chance of allergic reaction to medication o necessary and on-going follow-up may not occur (especially important if drug is being taken for the 1 st time) Purchasing online is one of the major sources for Rx drugs being abused by young people

19. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 19 Tips for (legitimately) Buying On-Line Check with the National Association of Boards of Pharmacy (NABP) to see if provider is legitimate and in good standing (www.nabp.net)www.nabp.net Look for a seal identifying the site as a “Verified Internet Pharmacy Practice Site” (VIPPS)

20. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 20 Tips, continued Look for easy to understand privacy and security policies Be aware of sites that advertise a “new cure” for a serious disorder or a quick cure-all for a wide range of ailments Talk to your health care provider before using medications for the first time

21. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 21 Tips, continued Don’t buy from those who … o offer a Rx drug for the 1 st time without a physical exam o sell without a prescription o sell drugs not approved by the FDA o do not provide access to a registered pharmacist to answer questions o do not provide a U.S. address and phone number to contact if there’s a problem

22. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 22 Impact on the Workplace Excessive absenteeism Decreased productivity Danger to self and co-workers on the job Damage to personal and work relationships Excessive use of medical benefits

23. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 23 How does addiction begin? Often starts “innocently” Person is prescribed a Rx drug for a legitimate ailment Tolerance to the drug develops He/she begins using it for “non-medical” reasons – not for the reason it was prescribed User experiences behavioral, physical, social and emotional changes An overwhelming need for the Rx drug develops The addiction progresses similarly to alcoholism

24. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 24 Signs of Addiction Preoccupation with getting it and using it Requesting refills before the quantity prescribed should have been used Needing more to get desired effects Being under the influence at inappropriate times Repeatedly trying to cut back or stop

25. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 25 Signs, continued Engaging in “doctor shopping” – moving from doctor to doctor to get multiple prescriptions Experiencing withdrawal Continued use despite social, emotional or physical pain Doing whatever it takes to get it and use it

26. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 26 You might notice a friend or family member … Cutting back on social & recreational activities Trying to avoid you Lying to you about their use Changing his/her eating patterns Not seeming to care about other people or things

27. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 27 If there is a problem … Recognize and “own” the problem and you’re half-way home! Reach out for professional help o Check resources in company policy o Consult your Program Administrator Seek help for a friend, family member or co-worker

28. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 28 Prevention Tips With your doctor … Provide a complete medical history to him/her Be sure your doctor and pharmacist are aware of ALL Rx (and OTC) drugs you are taking Ask questions about what you are being prescribed and why Learn about the effects that the drug could have – especially as your body is adapting to the drug Tell your doctor your specific job responsibilities and ask about workplace safety

29. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 29 Tips, continued When taking the medication … Carefully follow dosing instructions Read & follow warning labels on the bottle Do not increase or decrease doses or abruptly stop taking without speaking with your doctor Remember … mixing meds can be a recipe for disaster

30. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 30 Tips, continued In general … Understand and carefully follow your company’s rules about Rx drug use NEVER use another person’s Rx drug NEVER give yours away to someone else (not even to a family member) Unless you are a doctor, you can’t diagnose or prescribe Clean your medicine cabinet & discard: o outdated drugs o those that are no longer needed for the condition that they were originally prescribed for

31. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 31 EPA Disposal Guidelines (released Feb. 2007) 1. Take unused, unneeded or expired Rx drugs out of their original containers 2. Mix with an undesirable substance (e.g. used coffee grounds, kitty litter) 3. Put in impermeable, non-descript containers (e.g. empty cans or sealable bags) 4. Throw containers in trash 5. Flush down toilet ONLY if the accompanying patient information specifically says it is safe 6. Return unused, unneeded or expired Rx drugs to pharmaceutical take-back locations

32. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 32 Remember … When used correctly, Rx drugs play a very important role in the management of pain & other health-related conditions Addiction rarely occurs among those who use as prescribed The risk for addiction exists primarily when Rx drugs are used in ways other than prescribed Selling or buying controlled substances without a legitimate doctor’s prescription is a violation of law Think workplace safety When in doubt … ask! o Doctor o Pharmacist o Program Administrator Take advantage of your helping resources!

33. © Copyright 2007 by D. Mason. All rights reserved. REVISED 09/07 33 Citations 1 –White Paper, “You’ve Got Drugs! IV: Prescription Drug Pushers on the Internet,” released at a US Senate Judiciary Committee hearing on rogue online pharmacies, 2007 2 – National Survey on Drugs Use and Health, 2005 3 – National Drug Abuse Warning Network (DAWN) report, 2005 4 - The Partnership Attitude Tracking Survey (PTS): Teens in grades 7 – 12, 2005 5 – Quest Diagnostics – Drug Testing Index, 2007