1. Megan E. Thompson, Pharm.D.
Director of Experiential Programs
Associate Professor of Pharmacy Practice and Administrative Sciences
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
(Title slide)
We are here to raise awareness about a serious and growing public health problem – the misuse and abuse of prescription medications.
This program was developed by the Generation Rx Initiative at the Ohio State University College of Pharmacy, with the support of Cardinal Health.

2. There’s a reason for the prescription
When sharing isn’t caring.
Generation Rx is prone to self-diagnosing and self-prescribing due to easy access to information about medications (e.g., on television and the Internet).
The Food and Drug Administration (FDA) is responsible for approving any medication for use in the United States. In some cases, medications are approved for non-prescription (or “over-the-counter”) use. In many other cases, approved medications require a prescription for use. This protection, which has evolved from U.S. laws and regulations since the beginning of the 20th Century, indicates that medical experts do not feel that it is safe for patients to use these particular drugs without professional supervision.
When we use prescription drugs without medical supervision, we circumvent this protection. So, giving your prescribed medications to others is irresponsible (“sharing isn’t caring”) and taking medications that you obtain from others can lead to serious harm or even death.

3. America’s biggest drug problem isn’t on the streets…
…it’s in our medicine cabinets.
The adverse effects from medications, especially when they are misused or abused, cost our healthcare system many billions of dollars every year. They are responsible for harming people, are the reason for many emergency department visits or hospitalizations, and can even lead to death. In fact, researchers have shown that we spend more in our healthcare system on drug-related problems than on drug products.
Most people who abuse medications like prescription painkillers get them from family members or friends, often from the medicine cabinet.
It is important that patients keep their medications in secure and locked locations, protected from others who may wish to abuse them.
When we are no longer using medications, it is also important to properly dispose of them. It is recommended that certain medications which are no longer needed be flushed down the toilet. Others should be mixed with noxious materials and put in the trash. The Food and Drug Administration provides guidance about proper medication disposal at

4. People who abuse prescription painkillers get drugs from a variety of resources*
Took from friend
or relative without asking 4.8%
Got from a drug dealer or stranger 4.4%
Other source 7.1%
*Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: volume 1: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; Available from URL:

5. Prescription medication abuse – on the rise
Between 6 and 7 million Americans have abused prescription medications in the past month.
Everyday, approximately 2,700 young people between 12 and 17 years of age abuse a prescription painkiller for the first time
3,000 young adults died from prescription drug overdose in This is a 250% increase from 1999
Americans, who represent less than 5% of the world's population, are by far the largest group of opioid users; 80% of the world's supply of opioids (and 99% of the hydrocodone available globally) are used by people in the United States
Data from the National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration, SAMHSA) indicate that the abuse of prescription medications exceeds that for all illicit “street” drugs combined, except marijuana. And for those first abusing a substance, the abuse of prescription painkillers is equivalent to that of marijuana.
Between six and seven million Americans have abused a prescription medication in the past month (SAMHSA).
The Office of National Drug Control Policy estimates that approximately 2,700 young people between 12 and 17 years of age abuse a prescription painkiller every day for the first time, one in three teens report knowing someone who abuses prescription drugs, and four of the top five drugs abused by 12th graders are prescription or non-prescription medications.

6. Prescription medication abuse – on the rise
There were over 22,000 overdose deaths in 2010 involving prescription medications. That is enough to fill 52 Boeing 747 jets to full capacity!
Data from the National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration, SAMHSA) indicate that the abuse of prescription medications exceeds that for all illicit “street” drugs combined, except marijuana. And for those first abusing a substance, the abuse of prescription painkillers is equivalent to that of marijuana.
Between six and seven million Americans have abused a prescription medication in the past month (SAMHSA).
The Office of National Drug Control Policy estimates that approximately 2,700 young people between 12 and 17 years of age abuse a prescription painkiller every day for the first time, one in three teens report knowing someone who abuses prescription drugs, and four of the top five drugs abused by 12th graders are prescription or non-prescription medications.

7. Scope of Problem in New Mexico (1999-2008)
Overdose Deaths Due to Opioid Pain Relievers (per 100,000)
Highest in the country
CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, MMWR 2011; 60: 1-6

9. Let’s take a look at 3 street drugs…

11. Opiate Intoxication effects: Heroin AND OxyContin®
Drowsiness
Constipation
Confusion
Sedation
Slowed breathing
Coma
Death

12. Rohypnol Valium® Depressant
(“Roofies”)
Valium®
(“Downers, nerve pills, V”)
Depressant
Act on specific receptors in the brain to cause sedation
Activates reward pathway

13. Depressant Intoxication effects: Rohypnol AND Valium®
Lowered blood pressure
Confusion
Impaired coordination, memory, judgment
Slowed pulse and breathing
Death

14. Ritalin® Cocaine Stimulant Enhances dopamine in the brain
(“coke, blow, nose candy”)
Ritalin®
(“Vitamin R, Study drugs”)
Stimulant
Enhances dopamine in the brain
Activates reward pathway

15. Stimulant Intoxication effects: Cocaine AND Ritalin®
Rapid or irregular heart rate
Increased blood pressure
Nervousness
Insomnia
Heart failure

16. Example of frequently abused prescription medications
Painkillers
OxyContin®, Vicodin®
Sedatives/Hypnotics
Ambien®, Valium®, Xanax®, Haldol®
Stimulants
Adderall®, Ritalin®
Prescription painkillers (e.g., OxyContin and Vicodin), sedatives/tranquilizers (e.g., Valium & Xanax), and stimulants (e.g. Ritalin & Adderall) are most prone to abuse. These drugs are referred to as “controlled substances,” and there are strict prescribing and dispensing regulations for their use. Federal laws prohibit the possession of these drugs without a prescription.
Non-prescription medications can also be abused. Cough and cold preparations are of particular concern. These preparations which contain dextromethorphan (or DXM) can cause intoxication and even hallucinations at high doses.

17. Case Report
Julia is 16-years old. She does well in her classes and has a lot of friends. She wants to be a veterinarian when she grows up. Julia is involved with after-school activities and just got a well- paying job babysitting. She is excited because she just got a new car and her parents are letting her drive it to prom next week.

18. Case Report, cont.
A few days ago, Julia attended a party at a friend’s house. Alcohol and prescription medications were available at the party and several of Julia’s friends were experimenting, or “pharming” with the pills. Julia’s friends who were “pharming” did not know the names of the medications they were taking; they were waiting to see what would happen when they took a few pills at a time and chased them with alcohol. Many of the other kids there got the pills from their parent’s and grandparent’s medicine cabinets.

19. Case Report, cont.
One of Julia’s friends asked her if she wanted to take a few pills and “chase it with a beer.” She grabbed a few pills and swallowed them with alcohol.
What happened next?

20. Other medications frequently found in medicine cabinets are for:
High blood pressure
Diabetes
Infections
Supplement use (i.e., vitamins)
Cough and Cold
Headache/Fever
Heartburn/Upset Stomach/Diarrhea

21. Which pills did Julia take?
There is no way to know what she took nor how they will affect her. Different medications affect people differently. The same pill that helps you with headaches may make your classmate have a seizure. Or the medication you took for an infection may cause a deadly allergic reaction for someone else.

22. All medications have side effects
Examples can include:
Headache
Upset stomach
Drowsiness
Anxiety
Constipation
Diarrhea
Vomiting
Loss of bladder/bowel function
Unconsciousness
Addiction
Cardiac arrest
Respiratory arrest
Seizure
Coma
Death

23. What will happen to Julia?
Discuss how this choice will affect her future goals (being a veterinarian, her after-school activities, her going to prom, driving her new car, her job, etc.)

24. Signs of prescription drug abuse
Complaining of vague symptoms to get more medication
Lack of interest in treatment options other than medications
Mood swings
Seeing several doctors/visiting several pharmacies to get more pills
Past history of addiction
On and off relief from anxiety
Using more than what is prescribed
Using prescription pills prescribed for someone else

25. Mixing drugs can have fatal outcomes
Heath Ledger ( )
OxyContin and Vicodin (opiates)
Valium, Xanax, Restoril (depressants)
Doxylamine (sedating antihistamine)
Brittany Murphy
Hydrocodone (opiates)
Acetaminophen (analgesic)
L-methamphetamine (amphetamine)
Chlorpheniramine (sedating antihistamine)
Michael Jackson ( )
Propofol and Lidocaine (anesthetics)
Ativan, Versed, Valium (depressants)
Ephedrine (stimulant)
Elvis Presley ( )
Morphine, Codeine, Demerol (opiates)
Valium and Ethchlorvynol (depressants)
The abuse of prescription drugs may lead to many serious consequences, including health, social, legal, and professional development concerns. And, as we know from the many celebrities we have lost to prescription drug overdoses, this misuse or abuse can be fatal. This slide shows the combination of medications which led to the deaths of Anna Nicole Smith, Elvis Presley, Heath Ledger, and Michael Jackson.

26. MYTH- prescription medications are safer than street drugs
Majority of teens report that prescription drugs are easier to get than illegal drugs.
Many believe that abusing prescription drugs is much safer than illegal “street” drugs.
TRxUTH – this myth is DEAD WRONG!
Unintentional drug poisonings are now the LEADING cause of accidental death in the U.S.
“The Partnership Attitude Tracking Study” reports that: the majority of teens agree strongly or somewhat that prescription drugs are easier to get than illegal drugs; many also agree strongly or somewhat that prescription drugs (even if they are not prescribed by a doctor) are much safer that illegal drugs, that there is nothing wrong with using prescription drugs without a doctor’s prescription once in a while, and that prescription painkillers (even if they are not prescribed by a doctor) are not addictive.
These myths are dead wrong! For example, unintentional drug poisonings (the majority of which are due to prescription painkillers) are now the second leading cause of accidental death in the U.S. (Centers for Disease Control and Prevention). In some states, it is the leading cause of accidental death.

27. TRxUTH and consequences
Health, legal, social and personal development problems.
Thousands of emergency department visits every year are related to prescription medication misuse or abuse.
Drug treatment admissions for prescription drug addictions have increased dramatically in recent years.
Hundreds of thousands of emergency department visits each year relate to the misuse and abuse of prescription and non-prescription medications.
Drug treatment admissions for addictions to prescription drugs have increased dramatically in recent years.
It is against federal laws to obtain “controlled” prescription substances like painkillers, sedative/tranquilizers and stimulants without a prescription.
Abusing any substance can have a negative effect on your relationships with family members and friends.
Relying on any substance to be academically or professionally successful (e.g., so-called “cognitive enhancers”) without medical supervision can impede the development of healthy habits and behaviors which lead to long-term professional success.

28. New Mexico has taken action
The good news?
Most teens are NOT abusing prescription drugs!
Most teens DO make good choices – keep encouraging good behavior
Giving accurate information → more informed decisions
New Mexico has taken action
Only about 7.4% of teens age report abuse of prescription medication
You know that drugs and alcohol can have harmful effects; remember, just because a medication is prescribed by a doctor, if it’s not for you it’s not safe no matter what your friends tell you or how it affects them.

29. Scope of Problem in New Mexico (1999-2008)
Overdose Deaths Due to Opioid Pain Relievers (per 100,000)
Highest in the country
CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, MMWR 2011; 60: 1-6

30. Scope of Problem in New Mexico Scope of Problem in New Mexico - 2010
West Virginia now highest 28.9 (25.8)
New Mexico decreased to 23.8 (27)
Prescription Drug Abuse: Strategies to Stop the Epidemic finds that 28 states and Washington, D.C. scored six or less out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Two states, New Mexico and Vermont, got the highest score, receiving all 10 possible indicators, while South Dakota scored the lowest with two out of 10.
Score Summary: For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. Data for the indicators were drawn from a number of sources, including the National Alliance for Model State Drug Laws, Centers for Disease Control and Prevention, the Alliance of States with Prescription Drug Monitoring Programs, the National Conference of State Legislators, the Network for Public Health Law, the Kaiser Family Foundation and a review of current state legislation and regulations by TFAH. In August 2013, state health departments were provided with opportunity to review and revise their information.
10 out of 10: New Mexico and Vermont 9 out of 10: Kentucky, Massachusetts, New York and Washington 8 out of 10: California, Colorado, Connecticut, Delaware, Illinois, Minnesota, North Carolina, Oklahoma, Oregon, Rhode Island and West Virginia 7 out of 10: Florida, Nevada, New Jersey, Tennessee and Virginia 6 out of 10: Arkansas, District of Columbia, Georgia, Hawaii, Iowa, Louisiana, Maryland, Michigan, North Dakota, Ohio, Texas and Utah 5 out of 10: Alaska, Idaho, Indiana, Maine, Mississippi, Montana, New Hampshire and South Carolina 4 out of 10: Alabama, Arizona, Kansas, Pennsylvania, Wisconsin and Wyoming 3 out of 10: Missouri and Nebraska 2 out of 10: South Dakota
Note: Rates include total drug overdose mortality rates, the majority of which are from prescription drugs; data from CDC's National Center for Health Statistics, WONDER Online Database, The numbers are based on the number of people per 100,000.

31. New Mexico – Taking Action!
Existence of Prescription Drug Monitoring Program (PDMP)
Mandatory utilization of PDMP by prescribers
Doctor shopping laws
Support for Substance Abuse Treatment Services
Prescriber Education Required or Recommended
Good Samaritan Laws
Rescue Drug Laws
Physical Exam Requirement
ID Requirement
Lock-In Programs

32. Key Recommendations to combat prescription drug abuse in our community†
Educate the public to understand the risks of Rx abuse to avoid misuse in the first place
Ensure responsible prescribing practices, including increased education of prescribers
Increase understanding of safe medication storage and disposal
Ensure patients receive the pain and other medications they need, and that patients have access to safe and effective drugs
Improve PDMP programs
Make rescue medications readily available for at-risk individuals
Expand access to and availability of effective treatment options
† Key Areas of Concern and Recommendations. Results from the Prescription Drug Abuse 2013: Strategies to Stop the Epidemic; Trust for America’s Health, HealthyAmericans.org, October 2013 Issue. (accessed October 22, 2013).

33. What can you do?
Tell someone if you think your friend/family member is using
LOCK UP YOUR MEDICINES!
Get rid of old/expired medicines
Spread the message about the dangers of prescription drug abuse

34. Where can I learn more?
National Council on Patient Information and Education (
National Institute on Drug Abuse (
Office of National Drug Control Policy (
Parents.The Anti-Drug (
Partnership for a Drug-Free America (
Stop Medicine Abuse ( created by the Consumer Healthcare Products Association
Substance Abuse and Mental Health Services Administration (
The Ohio State University College of Pharmacy Generation Rx Initiative (
These websites are provided on the accompanying presentation handout:

35. Developed by The Ohio State University College of Pharmacy
This program is made possible with a grant from the Cardinal Health Foundation