1. Prescription Drug Abuse …an invisible epidemic MPH 500 By Cyrina Allen February 24, 2014

2. Prescription Drug Abuse  Currently in the United States, is the fastest growing problem(Centers for Disease Control and Prevention [CDC], 2012)  Since 2007 there are more deaths of women annually from prescription drugs than from car accidents (CDC, 2013a)  Men and women, teens and adults, and loved ones of the victims are affected  Every ethnicity, race, and class are involved

3. Prescription drug abuse and women…  The use among women is rising significantly in the U.S. and Montana  Even though more men suffer from overdose, more women die of prescription drug use (CDC, 2013d)  Thousands die yearly, 6,600 reported deaths in 2010 from prescription painkiller overdoses (CDC, 2013d)

4. Prescription drug abuse and women… Age Statistics  National Institute of Drug Abuse (NIDA) (2011) reports most common age for prescription drug abuse is between 18 and 25  Ages 25-54 are most likely to visit emergency room for prescription drug use (CDC, 2013a)  Ages 45-54 have highest incidences of overdose deaths (CDC, 2013a)

5. Prescription drug abuse and women…  Increased emergency room visits means an increase in prescriptions written  In 2010 there were a reported 943,365 emergency room visits by women (CDC, 2013b)  prescription painkillers are most common in overdoses (Montana Dept. of Justice, 2013b)  Lortab and Vicodin are the most prescribed (Montana Dept. of Justice, 2013b) “every 3 minutes, a woman goes to the emergency department for prescription painkiller misuse or abuse.”(CDC,2013d, para. 14)

6. Q: Why women? A: Suceptibility  More women suffer from mental health issues such as anxiety, shame, and depression (The National Council on Alcoholism and Drug Dependence, 2014)  Women are more likely to suffer from chronic pain issues (CDC, 2013a)  As primary caregivers women learn the medical system and are at risk for manipulating physicians and prescriptions (CDC, 2013a)

7. Prescription drug problem in Montana…  more than 300 prescription deaths per year among Montanans, an “invisible epidemic” (Montana Dept. of Justice, 2013a)  352 deaths between January 2008 and August 2013 related to prescription drugs, heroin, or cocaine (Uken, 2013)  2010 reports show that in Montana the rate of deaths among women were 5 times more than in 1999 (Uken, 2013)

8. The rise of prescription drug use…  The National Survey on Drug Use and Health noted about 2.4 billion first-time users in 2010 (NIDA, 2011)  ½ of these first-timers were women  One-third were between the ages of 12 and 17  Ethnicity rates as reported in 2012 by the Substance Abuse and Mental Health Services Administration(SAMSHA)(2013) were12.7% American Indian, 9.2% White, 8.3% Hispanic, and Asians 3.7% “more than 5 times as many women died from prescription painkiller overdoes in 2010 as in 1999 (CDC, 2013d, para.7)

9. The rise of prescription drug use…  The Drug Abuse Warning Network (DAWN) (2011) noted that the total number of prescription drug abuse rose by 132% from 2004-2011  The number of men using prescriptions for non- medical reasons grew by 265% between 1999 and 2011;the use by women grew by 400% in that same timeframe (CDC, 2013d)  In 2007-2008 31% of Americans reported using two or more prescription drugs where in1999-2000 the number was 25% (CDC, 2013c)

10. More trends in prescription drug use  Tripling in the last two decades-more than 15,000 overdose deaths (CDC, 2013c)  1 in 10 ratio of involvement with suicide (CDC, 2013d)  Emergency room visits doubled in the last 5 years (CDC, 2013e)  $72.5 billion in medical costs for prescription drug abuse (CDC, 2013e)

11. Prescription drug abuse- ” the use of a medication without a prescription, in a way other than as prescribed, or for the experience or feelings elicited.” (NIDA, 2011) Addiction -a chronic disease of the brain that requires reward and motivation, can be easily obtained in those who use prescription drugs (American Society of Addiction Medicine [ASAM], 2011)

12. Biological and Molecular characteristics of prescription drug abuse… Prescription drugs AddictionRewardEuphoriaMotivation  Prescription drug abuse becomes an addiction Addiction (ASAM, 2011) Relationship s Inability to abstain From drugs Dysfunctional emotions Impaired behavior

13. Biological and Molecular characteristics of prescription drug abuse…  Addiction of prescription drugs affects several areas of the brain (ASAM, 2011)  Direct neurological link between prescription drugs and the brain (ASAM, 2011)  Neurotransmitters (chemical signals of brain) are affected by happiness and pleasure triggering the want for more (addiction) (ASAM, 2011)

14. Social and behavioral factors…the transtheoretical model  Focus on changing one’s behavior (Schneider, 2014)using 5 stages:  Precontemplation-subject discovers they have an addiction to prescription drugs but no change (UMBC, 2011)  Contemplation-subject understands they need help but fearful of the process (Schneider, 2014)  Preparation-a plan is made for change (UMBC, 2011)(Schneider, 2014)  Action-subject will refrain from taking prescription drugs (Schneider, 2014)  Maintenance-maintain clean behavior and prevent relapse (Schneider, 2014)

15. Social and behavioral factors…the ecological model of behavioral health  Focuses on the relationship of prescription drug abuse and the subjects social environment, 5 influences:  Intrapersonal factors-relates to personality, behavior, and skills of the subject (Schneider, 2014)  Interpersonal relations-family, friends, and coworkers of the subject (Schneider, 2014)  Institutional settings-workplace policies, drug-free zones, school campus rules and regulations (Schneider, 2014)  Community-area surrounding subjects personal life, has great impact on subject (Schneider, 2014)  Public policy- law and/or ordinances that affect the subject (Schneider, 2014)

16. Public health and Prescription drug abuse…in conclusion...  Prescription drug abuse is a huge problem in Montana and the entire United States  Biggest concern is the increasing numbers in women  Strategies and solutions are needed immediately to fix this public health issue

17. Thank you!

18. References  American Society of Addiction Medicine. (2011). Definition of addiction. Retrieved February 2, 2014 from http://www.asam.org/  Centers for Disease Control and Prevention. (2012) CDC grand rounds: Prescription drug overdoses — a U.S. epidemic. Retrieved February 23, 2014 from http://www.cdc.gov/http://www.cdc.gov/  Centers for Disease Control and Prevention. (2013a). Deaths from prescription painkiller overdoses rise sharply among women. Retrieved January 19, 2014 from http://www.cdc.govhttp://www.cdc.gov  Centers for Disease Control and Prevention. (2013b). Morbidity and mortality weekly report. Vital signs: overdoses of prescription opioid pain relievers and other drugs among women — United States, 1999–2010. Retrieved February 23, 2014 from http://www.cdc.govhttp://www.cdc.gov  Centers for Disease Control and Prevention. (2013c). Prescription drug use continues to increase: U.S. prescription drug data for 2007-2008. Retrieved on January 26, 2014 from http://www.cdc.gov/http://www.cdc.gov/  Centers for Disease Control and Prevention. (2013d). Prescription painkiller overdoses. Retrieved February 23, 2014 from http://www.cdc.govhttp://www.cdc.gov  Centers for Disease Control and Prevention. (2013e). Saving lives and protecting people: Preventing prescription painkiller overdose. Retrieved on January 26, 2014 from http://www.cdc.gov/http://www.cdc.gov/  Drug Abuse Warning Network. (2009). National estimates of drug-related emergency department visits: Nonmedical use of pharmaceuticals. Retrieved January 26, 2014 from http://www.samhsa.gov/data/DAWN.aspxhttp://www.samhsa.gov/data/DAWN.aspx  Montana Department of Justice. (2013a). Invisible epidemic. Retrieved January 19, 2014 from https://doj.mt.govhttps://doj.mt.gov

19. References cont.  Montana Department of Justice. (2013b). Percs, oxys & sprinkles. Retrieved January 19, 2014 from https://doj.mt.govhttps://doj.mt.gov  National Council on Alcoholism and Drug Dependence. (2014) Women and Drugs. Retrieved February 23, 2014 from http://www.ncadd.org/  National Institute on Drug Abuse. (2011). What is prescription drug abuse? Retrieved February 23, 2014 from http://www.drugabuse.gov/ http://www.drugabuse.gov/  Schneider, M.J. (2014) Introduction to Public Health. How psychological factors affect health behaviors. (pp. 221-236). Burlington, MA. Jones & Bartlett Learning.  Substance Abuse and Mental Health Services Administration. (2013b). Results from the 2012 national survey on drug use and health: Summary of national findings. Retrieved February 23, 2014 from http://www.samhsa.gov/  Uken, C. (2013, December 29). Death rates soar among women using prescription drugs. Billings Gazette. Retrieved January 19, 2014 from http://billingsgazette.com  University of Maryland Baltimore County (2011) The transtheorethical model of behavior change. Retrieved February 9, 2014 from http://www.umbc.edu/ http://www.umbc.edu/