1. Summary Report and Recommendations on Prescription Drugs: Misuse, Abuse and Dependency Presentation for the County Alcohol and Drug Program Administrators’ Association of California May 28, 2009 1

2. Process ADP identified Prescription Drug Misuse (PDM) as a major problem – largely not addressed. ADP convened Task Force: 37 members. Broad representation. Task Force ‘met’ six times from March 2008 to January 2009. Prepared report: Identifying scope of problem. Presenting 18 recommendations. 2

3. Summary of Findings National Profile – National Survey on Drug Use and Health (NSDUH) Youth Young Adults Adults California Youth Key Issues 3

4. National Findings – General 2006 NSDUH estimated 16 million Americans aged 12 or older misused prescription drugs in past year. Pain relievers accounted for 75%. PDM is closely associated with age. Increases (as an overall percent) with youths – peaks among young adults (18-25). Very low rates among elderly. Problem seen more among white population (74% of pain relievers misused were by whites). Prescription drugs are most abused category of drugs following marijuana (and alcohol). 4

5. National Findings – Youth Abusing prescription drugs before 16 leads to greater risk of dependency. Numbers of teens going into treatment for prescription drug use has increased 300% in the past 10 years. Teen girls more likely to use than boys. Prescription drug use second to marijuana (and alcohol). 5

6. National Findings – Young Adults Approximately 15.6% of young adults 18-25 (5,121,000) misused prescription drugs (2006). Unintentional poisonings (among 15-24) more than doubled between 1999-2004. Pain relievers most misused. Selected studies indicate emerging problem among college students. (Over 40% among fraternity/sorority members.) 6

7. National Findings –Adults & Older Adults Nearly 5% of adult population engage in PDM. While rates are lower, numbers larger (9-plus million Americans). Elderly are vulnerable to PDM – Over 80% of individuals 60 and older take prescription drugs. Prescription Drug Abuse is present in 12-15% of elderly seeking medical attention. 7

8. California Findings– Youth California Student Survey (CSS) Data Source documents: Lifetime use among 9 th graders up from 9% (2006-2007) to 11.6% (2007-2008). Lifetime use among 11 th graders up from 15% (2006-2007) to 17.6% (2007-2008). (Note: Not tracked before the 2006-07 Survey.) 8

9. Summary 1. Problem is clearly getting worse. 2. All segments of society are impacted. However, youth and young adults are increasing their use rates. 3. Nonmedical use of cough/cold Over-the-Counter (OTC) is also increasing among youths. 4. Easy availability – most prescription drugs come from family/friends. 5. Considerable lack of knowledge about PDM dangers. 6. No PDM-specific prevention curriculum, minimally addressed in general prevention approaches. 7. Increased need for training/information across many professional groups (e.g., teachers, physicians). 9

10. Developing Recommendations Preliminary Summary Report prepared and submitted to Task Force members. Focus on soliciting recommendations: Lack of Awareness. Training and Education. Availability. Tracking Information on Prescription Drug Use. Policies for Identifying and Treating Prescription Drug Use. All populations at risk considered. (Go to Handout) 10

11. Recommendations Lack of Awareness (#1-6) Approach: Information Awareness Targeting: Caregivers. Middle/High School Students. College Students. Pharmacists. Physicians. Controlled Substance Utilization Review and Evaluation System (CURES). Veterans. 11

12. Recommendations Training and Education (#7-12) Approach: Develop Audience-Specific Training Programs. Targeting: Public Health System (General). Public Health System (Specific to Brief Intervention(BI)). AOD Workforce (Treatment, BI, Drug Effects). Addiction Treatment Workforce (Proper Client Evaluation). California Physicians (PDM Awareness and Prescription Practices). Student Health Centers (Identification and Services). 12

13. Recommendations Availability (#13-14) Strengthen State Prescription Drug Monitoring System (CURES). Explore Enforcement Options: Industry Marketing. Retail Pharmacy Practices. Internet Access. Doctor Shopping Practices. 13

14. Recommendations Tracking Information on Prescription Drug Use (#15) Implement Comprehensive System to Monitor PDM and Consequences: State Survey. Hospitalization Data. 14

15. Recommendations Policies for Identifying and Treating Prescription Drug Use (#16-18) Medical Reimbursements for: Suboxone Screening and Brief Intervention. Support for Senate Bill (SB) 966 on Appropriate Prescription Drug Disposal Practices. 15

16. Implementation – Phase II Step I: Partner and Prioritize Efforts. Seek Partners (e.g., Task Force members, impacted agencies, Departmental resources). Prioritize Recommendations. Cost. Implementation feasibility. Partner involvement. Develop Action Plan(s). Department’s TA & Training Providers: (e.g., Community Prevention Initiative – CPI). Roles and Responsibilities. Step II: Implementation. Step III: Report Results (12 Month Timeline). 16