1. IDAHO RURAL PARTNERSHIP BOARD MEETING THURSDAY, JANUARY 7, 2010

2. Why are Unused/Expired Prescriptions and Over-the-Counter Medications a Concern? Health Consequences Prescription Drug overdose due to non-medical use is now the second leading cause of accidental death in the U.S. behind only car crashes. In some States it has risen above car crashes. Admissions to substance abuse centers doubled for abuse of pain relievers is yet another clear indication of the growing scope of the problem. LOST LIVES Health Consequences Prescription Drug overdose due to non-medical use is now the second leading cause of accidental death in the U.S. behind only car crashes. In some States it has risen above car crashes. Admissions to substance abuse centers doubled for abuse of pain relievers is yet another clear indication of the growing scope of the problem. LOST LIVES Economic Impact Per-patient health care costs of opioid abusers are estimated at $15,884 per year, compared with only $1,830 for non-abusers. “PRESCRIPTION FOR PERIL 2007” How Insurance Fraud Finances Theft and Abuse of Addictive Prescription Drugs” estimates that drug diversion costs all U.S. insurers about $72.5 billion each year. LOST RESOURCES Economic Impact Per-patient health care costs of opioid abusers are estimated at $15,884 per year, compared with only $1,830 for non-abusers. “PRESCRIPTION FOR PERIL 2007” How Insurance Fraud Finances Theft and Abuse of Addictive Prescription Drugs” estimates that drug diversion costs all U.S. insurers about $72.5 billion each year. LOST RESOURCES CRIMINAL ACTIVITY Law enforcement estimates range from 60% to 80% of the enforcement cases involve substance abuse. Where you find drug abuse you will find crime! LOST SAFETY CRIMINAL ACTIVITY Law enforcement estimates range from 60% to 80% of the enforcement cases involve substance abuse. Where you find drug abuse you will find crime! LOST SAFETY

3. HOW THEY WORKABUSED BY TEENS TODRUG NAMES STRONG PAIN RELIEVERSUsed to relieve moderate-to-severe pain, these medications block pain signals to the brain To get high, increase feelings of well being by affecting the brain regions that mediate pleasure Vicodin, OxyContin, Percocet, Lorcet, Lortab, Actiq, Darvon, codeine, morphine, methadone STIMULANTSPrimarily used to treat ADHD type symptoms, these speed up brain activity causing increased alertness, attention, and energy that comes with elevated blood pressure, increased heart rate and breathing Feel alert, focused and full of energy—perhaps around final exams or to manage coursework, lose weight Adderall, Dexedrine Ritalin, Concerta, Desoxyn SEDATIVES OR TRANQUILIZERS Used to slow down or “depress” the functions of the brain and central nervous system Feel calm, reduce stress, sleep Valium, Xanax, Ativan, Klonopin, Restoril, Ambien, Lunesta, Mebaral, Nembutal, Soma, Ketamine Teens Rx Drugs of Choice for Abuse

4. ANSWERS: Obtained free from someone they know (56%) One doctor (20%) Bought or stole from someone they know (15%) “Street drug” dealer (4%) More than one doctor (2%) Internet (1%) QUESTIONS: One doctor “Street drug” dealer Internet Bought or stole from someone they know Obtained for free from someone they know More than one doctor WHERE DO ABUSERS GET PRESCRIPTION PAINKILLERS? Methods/sources in order of most common to least common: WHERE DO ABUSERS GET PRESCRIPTION PAINKILLERS? Methods/sources in order of most common to least common: One-third of 12- to 17-year-olds report obtaining prescription drugs in their own homes (Natl. Center on Addiction & Substance Abuse, 2008) One-third of 12- to 17-year-olds report obtaining prescription drugs in their own homes (Natl. Center on Addiction & Substance Abuse, 2008)

5. FLUSH IT TODAY….. DRINK IT TOMORROW!

6. Meds to Patient Home Medicine Cabinet Unused and Expired Meds Personal Disposal Method Community Law Enforcement staffed and DEA approved Take Back Program Idaho State Police to transport for out of state incineration

7. Protect children, pets, and the environment by… 1. POUR MEDICATION INTO SEALABLE PLASTIC BAG. 2. IF MEDICATION IS A SOLID, CRUSH IT OR ADD WATER TO DISSOLVE.

8. ADDING KITTY LITTER, SAWDUST, COFFEE GROUNDS (ANYTHING TO MAKE MEDICATION LESS APPEALING TO EAT) TO THE PLASTIC BAG.

9. REMOVE AND DESTROY ALL PERSONAL IDENTIFICATION FROM THE MEDICATION CONTAINER REMOVE AND DESTROY ALL PERSONAL IDENTIFICATION FROM THE MEDICATION CONTAINER SEAL THE PLASTIC BAG COMPLETELY AND DISPOSE IN THE TRASH.

10. 200815,144,571 Prescriptions filled at Idaho Pharmacies 2,260,702 Prescriptions were controlled substances 384Mail Order Pharmacies listed on the Idaho Board of Pharmacy Website 1.SIMPLIFY  Require a single prescription format 2.SECURE  Allow only authorized prescribers to order  Require document security features  Require secure production & distribution 3.VALIDATE  Require automated point of sale validation FRONT DOOR OPPORTUNITIES

11. Schematic Demonstrating how Medications Leaked into Environment

12. PHYSICIANS PHARMACISTS HOSPITALS LONG TERM CARE HOSPICE VETERINARIANS IDAHO MEDICAL ASSOC. POISON CONTROL POLICY DEVELOPMENT EXECUTIVE BRANCH LEGISLATIVE BRANCH BOARD OF PHARMACY LAW ENFORCEMENT PUBLIC AWARENESS EDUCATION MEDIA STRATEGY BUILD COMMUNITY COALITION NETWORK ORGANIZE APPROVED UNUSED AND EXPIRED PRESCRIPTION TAKE BACK PROGRAM LAW ENFORCEMENT STAFFED COLLECTION EVENTS UNIQUE PUBLIC AND PRIVATE PARTNERSHIPS DISPOSAL IDAHO NATIONAL LABORATORY WILL LEND ITS EXPERTISE TO HELP GOVERNMENT AND PRIVATE INDUSTRY DEVELOP SUCCESSFUL SOLUTIONS TO THIS COMPLEX CHALLENGE.