2. EAP Implications of Prescription Drug Use in the Workplace
Laurie Lovedale, MPH, CPS II
Prescription Drug Abuse Prevention Program Coordinator

3. Peer Assistance Services, Inc.
Mission: Dedicated to quality, accessible prevention and intervention services in workplaces and communities, focused on substance use and related issues. 
Serving Colorado since 1984

4. Prescription Drug Abuse Prevention Program
A State Priority Initiative funded by the Colorado Office of Behavioral Health
5-year funding cycle

5. 2010-2015 Program Objectives Increase awareness of the problem
Increase availability of medication disposal programs statewide
Encourage responsible prescribing practices
Encourage patient responsibility
Track data and trends

6. Agenda/Objectives Drug Free Workplace Data Typology of Abuse
Prescription Drug Abuse Overview
National/State/Local Data
Medication Overview
Prevention Strategies
Medication Take Back Event

7. Drug-Free Workplace
The rate of drug use among American workers has declined by 74 percent since the Drug-Free Workplace Act was passed 25 years ago.
Drug Testing Index Quest Diagnostics
The figures come from the latest annual Drug Testing Index from Quest Diagnostics. The analysis examined more than 125 million urine drug tests performed by the company’s forensic toxicology labs in the U.S. on private as well as government employers.
The positivity rate for the Combined U.S. Workforce declined 74%, from 13.6% in 1988 to 3.5% in 2012.
The positivity rate for the Federally Mandated, Safety Sensitive Workforce declined by 38%, from 2.6% in 1992 to 1.6% in 2012.
The positivity rate for the U.S. General Workforce declined by 60%, from 10.3% in 1992 to 4.1% in 2012.

8. Drug-Free Workplace
Positive rates for certain drugs, including opiates and amphetamines, have increased substantially.

9. Drug-Free Workplace Prescription opioids Hydrocodone (Vicodin)
Hydromorphone (Dilaudid)
Oxycodone (OxyContin)
Oxymorphone (Opana)
More than doubled
Up 71 percent

10. Drug-Free Workplace
Positivity rates for amphetamines, including amphetamine and methamphetamine, has nearly tripled (196% higher) in the combined U.S. workforce and, in 2012, were at the highest level since 1997.
The positivity rate for amphetamine itself, including prescription medications such as Adderall®, has more than doubled in the last 10 years.

11. Prescription Drug Misuse?
What is
Prescription Drug Misuse?
The use of a medication
(for a medical purpose)
other than as directed
or as indicated.

12. Prescription Drug Abuse?
What is
Prescription Drug Abuse?
The intentional
self-administration
of a medication
for a non-medical
purpose.
Abuse- “Use of medication without a prescription; in a way other than prescribed; or for the experience or feeling it causes” (NIDA 2011)
Includes “academic enhancement”

13. Why is there so much medication out there?
Culture of “Pain-Free” society
Blind Faith in medical system to cure anything
Direct to consumer marketing from pharmaceutical companies
Prescription medications are safe

14. The 3 R’s for Medication Safety
RISKS – All medicines have RISKS as well as benefits
RESPECT the power of your medicine and the value of medicines properly used
Take RESPONSIBILITY for learning about how to take your medication safely

15. Typology of Abuse Acquired Drug with Legitimate Prescription
Acquired Drug Without Legitimate Prescription
Used to Self-Treat
Self-treat other medical
condition with previous Rx
(off label use)
Self-treat
migraine with their own
medication
Use other person’s
medication (sharing)
Parent taking
child’s medication to be
productive
Used to Get High/Euphoria
May start off with
legitimate pain med, but
get addicted over time
Use current medication to
party/get high
Using their
own Rx, but taking it with
alcohol to keep party going
May have bought/traded
with others to get
medication used to get
high
Stealing
grandparent’s and getting
McCabe & Boyd, Retrieved from

16. Examples of Drugs Covered
DEA Schedule
Abuse Potential
Examples of Drugs Covered
Effects
Medical Use 1
Highest
Heroin, LSD, Marijuana, Bath Salts
High potential for abuse, severe psychological or physical dependence, death
No accepted use 2
High
Morphine, Hydromorphone, Methadone, Oxycodone, Fentanyl, Adderall, Ritalin
High potential for abuse which may lead to severe psychological or physical dependence
Accepted use with restrictions 3
Medium
Vicodin, Tylenol with codeine, Suboxone and Subutex
Potential for abuse less than 1 and 2, may lead to moderate or low physical dependence or high psychological
Accepted use 4
Low
Xanax, Klonopin, Valium, Ativan, Halcion
Low potential for abuse relative to Schedule III’s 5
Lowest
Over the counter of prescriptions with codeine, Robitussin AC
Low potential for abuse relative to Schedule IV’s

17. Main Types of Abused Prescription Medications
Depressants used to treat sleep disorders and severe anxiety (Xanax & Valium)
Stimulants used to treat behavior disorders such as ADHD (Ritalin & Adderall)
Opioids used to treat pain (Oxycontin & Vicodin)

18. Why Prescription Drugs?
Easy Access
70% from a friend or relative 2011 National Survey on Drug Use and Health
Easier to get Rx drugs than beer
Young Adults feel they are “safer” than illicit drugs

19. National Data

20. Center for Disease Control
Poisoning is now the leading cause of death from injuries in the United States and nearly 9 out of 10 poisoning deaths are caused by drugs. (Centers for Disease Control 2008)

21. Data are from a random sample of households in the 48 continental states who had a person ages 12 to 17 living in the household. Computer-assisted telephone interviews were conducted between April 18 and May 17, 2012 with 1,003 youths who were randomly selected from the nationally representative household sample frame. The margin of error is +/-3.1 percent at a 95 percent confidence level (unadjusted for weighting).
SOURCE: Adapted by CESAR from The National Center on Addiction and Substance Abuse at Columbia University (CASA), National Survey of American Attitudes on Substance Abuse XVII: Teens, Available online at

22. 2012 NSDUH

23. CDC January 13, 2012/61(01): 10-13

24. Colorado Data

26. In 2012 more than twice as many people in Colorado died from poisoning due to opioid analgesics (295) than from
drunk-driving related crashes (133).
Department of Public Health and Environment, Health Statistics Section

27. 2012 Prescription Opioid Deaths by Age

28. 2012 Rx Opioid Deaths by Gender

29. Prescription Opioid Deaths 2012
295 of the 807 drug poisoning deaths in Colorado involved prescription opioids

30. Prescription Opioid Hospitalizations 2012
1,131 of the 5,291 drug poisoning hospitalizations in Colorado involved prescription opioids
21%

31. Youth Risk Behavior Survey
Colorado
National
Fall 2011
9th grade – 12.4%
10th grade – 17%
11th grade – 19.1%
12th grade – 29.2%
Sept – Dec. 2011
9th grade – 16.5%
10th grade – 18.2%
11th grade – 23.3%
12th grade – 25.6%

32. DEPRESSANTS

33. Depressants (CNS depressants)
Also referred to as sedatives and tranquilizers
Benzodiazepines
Alprazolam (Xanax) & Diazepam (Valium)
Treat anxiety, acute stress reactions and panic attacks
Triazolam (Halcion) Short-term treatment of sleep disorders
Inhibit brain activity which produces a drowsy or calming effect

34. Short Term Effects Short term Slowed pulse and breathing
Slurred speech
Drowsiness
Lowered blood pressure
Poor concentration, fatigue and confusion
Impaired coordination, memory and judgment.
Suppress respiration/death
Addiction

35. Long term effects Addiction
Respiratory depression and respiratory arrest
Death
Chronic fatigue
Sexual problems
Sleep problems.

37. CNS Depressants Combining with other CNS depressants (alcohol)
Affect heart rhythm
Slow respiration
Death
Withdrawal (Work with provider)
Anxiety
Insomnia
Depression
Seizures

38. OPIOIDS

39. Opioids
Relieve pain by reducing the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus.
Hydrocodone (Vicodin)- most commonly prescribed for a variety of painful conditions, including dental and injury-related pain.
Oxycodone (OxyContin, Percocet)
Morphine (Kadian, Avinza)- often used before and after surgical procedures to alleviate severe pain.
Codeine- often prescribed for mild pain.

40. Opioids
Attach to proteins called opioid receptors located in the brain, spinal cord, GI tract, and other organs in the body.
When opioids attach to receptors, they reduce the perception of pain.

41. Short Term Effects Drowsiness Mental confusion Nausea Constipation
Respiratory depression
Euphoric response

42. Long term effects Addiction Severe lethargy Sleep apnea
Falls and fractures in the elderly.
As dose increases, pain patients also become susceptible to a condition known as hyperalgesia, in which they feel more, not less pain.

43. Opioids Withdrawal (Work with provider when weaning off of opioids)
Restlessness
Muscle and bone pain
Insomnia
Diarrhea
Vomiting
Cold flashes with goose bumps
Involuntary leg movements

44. Tolerance to Opioids
Tolerance develops rapidly to the sedating, and euphoric effects of opioids
It develops more slowly to their analgesic effects
Tolerance can be characterized as decreased sensitivity to opioids

45. Similarities between Illicit and Prescription medications

46. Opioid Induced Hyperalgesia
Increased sensitivity to pain resulting from opioid use
Hard for clinicians to know if pain increase due to opioids or if the condition has worsened

47. Pseudoaddiction
Results from the misinterpretation of relief seeking behaviors as though they are drug-seeking behaviors that are commonly seen with addiction
The relief seeking behaviors resolve upon institution of effective analgesic therapy SAMHSA, Tip 54, Managing Chronic Pain in Adults with or in Recovery From Substance Use Disorders, 2012

48. STIMULANTS

49. Stimulants Increase alertness, attention, and energy
Elevate blood pressure, heart rate, and respirations
Mainly used in the treatment of ADHD and narcolepsy

50. Schedule II Medication
Stimulants
Schedule II Medication
High potential for abuse which may lead to severe psychological or physical dependence

51. Short term effects
Stimulants increase the amount of norepinephrine and dopamine in the brain, which increases blood pressure and heart rate, constricts blood vessels, increases blood glucose, and increases breathing.
Effects can feel like an increase alertness, attention, and energy along with a sense of euphoria. There is also the potential for cardiovascular failure (heart attack) or lethal seizures.

52. Long term effects Addiction
Taking high doses of some stimulants repeatedly over a short time can lead to feelings of hostility or paranoia.
Taking high doses of a stimulant may result in dangerously high body temperatures and an irregular heartbeat.
Cardiovascular failure (heart attack) or lethal seizures.

53. Stimulants
Withdrawal
Fatigue
Depression
Disturbance of sleep patterns

55. Patient Responsibility
Monitor all medications in their home
Don’t stock pile
Lock up or hide medications
Do NOT store medications in the “medicine cabinet”
Dispose of medications properly
Talk to friends and family (even grandparents) about securing their medications
Understand the dangers of mixing medications and alcohol
Lead by example
MONITOR: Count, know what types, expiration dates, etc.
ALL: Include pet medications

56. Just because they are prescribed by a health professional does NOT mean they are safe
Prescription medications are only safe
for the prescribed patient
for the prescribed reason
for a prescribed time

57. Take Back Event
April 26, 2014
10:00 – 2:00

58. Colorado 2013 39,608 lbs Nationally 2013 695 Tons
Take Back Events
Colorado 2013
39,608 lbs
Nationally 2013
695 Tons

59. Thank You! Contact Us: www.peerassist.org
2170 S Parker Road #229
Denver, CO 80231
Facebook: PreventRxMedicineAbuse
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