Prescription and Over-the-Counter Drug Abuse Orange County

Acknowledgements

This comprehensive report presents the distilled research and critical thinking of a diverse group of local experts in the alcohol and other drug prevention field. The County of Orange Health

Care Agency’s Alcohol and Drug Education and Prevention Team (ADEPT) would like to thank these leaders for their dedication to the field and for their thoughtful insights throughout this process.

Orange County Prescription Drug Task Force

Prescription Drug Strategic Planning Session Attendees

In addition, a very special thanks to the following individuals and agencies for their contributions to this report:

Community Service Programs, Inc.

Project Positive Action Towards Health (PATH)

Erica Leary, MPH

North Coastal Prevention Coalition

Michelle Poisson

County of Orange Health Care Agency

Alcohol and Drug Education and Prevention Team (ADEPT)

National Council on Alcoholism and Drug Dependence-Orange County

Community Alliance Network (CAN)

Romeo Howe

Consultant

For more information regarding the County of Orange Health Care Agency’s Prescription and

Over-the-Counter Drug Abuse Prevention Initiative, please contact:

Stacey Zapanta, MPH, CHES

County of Orange Health Care Agency

Alcohol and Drug Education and Prevention Team (ADEPT)

405 W. 5 th

St., Suite 211, Santa Ana, CA. 92701

(714) 834-4369 or szapanta@ochca.com

A copy of this Report is available online at: http://ochealthinfo.com/adept/publications

Table of ConTenTs

I. Introduction ................................................................................ 1

II. Orange County Multidisciplinary Workgroup .............................. 2

III. Overview of Prescription and Over-the-Counter

Drug Abuse ................................................................................ 3

IV. Scope of the Problem in Orange County ................................... 11

V. Orange County Town Hall Meetings .......................................... 23

VI. Partnership for a Drug-Free Orange County..............................

44

VII. Strategic Planning Session ........................................................

45

VIII. Conclusion .................................................................................

50

IX. References................................................................................. 51

X. Appendix A: Orange County Prescription Drug Task Force ....... 53

XI. Appendix B: Description of Data Sources ..................................

54

XII. Appendix C: School Districts and Schools in Orange County

by Region ................................................................................... 57

XIII. Appendix D: Orange County Rx/OTC Lifetime Use Rates

by Region ................................................................................... 62

XIV. Appendix E: Orange County Rx/OTC Lifetime Use Rates by

Rx/OTC Drug ............................................................................. 65

XV. Appendix F: Strategic Planning Session Participants ................ 67

Orange County Comprehensive Report

Introduction

The nonmedical use and abuse of prescription and over-the-counter drugs to get high is a serious and growing public health problem throughout the Nation. While the use of illegal substances like methamphetamine, heroin, and marijuana has declined over the past decade abuse of prescription and over-the-counter drugs has increased sharply. According to the most recent Partnership for a Drug-Free America’s annual tracking survey, one in five teens report having abused a prescription drug to get high, and one in ten young people report having abused over-the-counter cough medicines to get high (PATS, 2009). In Orange County,

California, teen drug abuse of these drugs is either on par or higher than national trends.

In regard to prescription drugs, 17% of 11 th grade students report having used prescription painkillers at least once in their lifetime, whereas significantly more (19% or one in four) young people in Orange County report using or trying over-the-counter cough and cold medications at least once to get high (CHKS, 2008).

What is so troubling about the abuse of these drugs, is the ease of obtaining these medications and the misperception that these drugs provide a “safe” high – after all, these drugs are prescribed by your family physicians, are available over the counter from the pharmacy down the street, or they are simply sitting at home in your medicine cabinet. In 2007, the National

Survey on Drug Use and Health (NSDUH) found that over half (54%) of individuals reporting nonmedical use of psychotherapuetics got them “from a friend or relative for free” (SAMHSA,

2008). While the proper use of these drugs can be lifesaving, the consequences of their abuse can be as dangerous as those from illegal drugs, leading to emergency department visits and deaths. In fact, unintentional poisoning deaths involving psychotherapeutic drugs, such as sedatives and antidepressants, grew 84% from 1999 to 2004 (CDC, 2007).

In July 2008, based on this growing concern around the abuse and misuse of prescription and over-the-counter drugs, the County of Orange Health Care Agency’s Alcohol and

Drug Education and Prevention Team (ADEPT) received funding from the Tobacco

Settlement Revenue (TSR) Committee to identify the scope of the problem in Orange

County, raise awareness about the issue of prescription drug abuse, and identify prevention recommendations. The funding was a one-time amount given for a yearlong initiative.

ADEPT proposed to engage the three regional county-funded providers already doing work around alcohol and other drug abuse prevention in an effort to more efficiently and effectively address this issue on a countywide level. The subsequent Prescription Drug Initiative had five objectives to be completed by June 30, 2009, which included: (1) developing a multidisciplinary workgroup or task force to lead this countywide effort; (2) utilizing the workgroup/task force to identify the scope of the prescription drug abuse problem; (3) conducting at least three town halls to increase community awareness about the issue; (4) engaging local media; and

(5) conducting a Strategic Planning Session in which prevention recommendations for next steps could be developed. All five objectives have subsequently been completed and are described within this report.

Prescription and Over-the-Counter Drug Abuse 1

2


orange County Multidisciplinary Workgroup

In November 2008, the County of Orange Health Care Agency’s Alcohol and Drug Education and Prevention Team (ADEPT) convened a multidisciplinary group of county funded providers, community stakeholders, and other agencies involved in statewide or countywide prescription drug prevention or diversion efforts to begin addressing the issue of prescription and overthe-counter drug abuse in Orange County. The multidisciplinary workgroup was charged with completing the following objectives: (1) identify the scope of the problem in Orange County; (2) convene at least three town hall meetings to increase awareness amongst parents and youth about the problem; and (3) develop next steps and prevention recommendations for the County.

The workgroup met on a monthly basis for the year-long project and ultimately became the

Orange County Prescription Drug Task Force. The Task Force decided from the start that they would fold over-the-counter drugs into the scope, as the issues were so interrelated with prescription drug abuse. Additionally, even though the Task Force acknowledged that prescription and over-the-counter drug abuse was not just an issue amongst young people, in order to most efficiently address the year long project, that the focus would be on identifying the problem of prescription and over-the-counter amongst youth and young adults’ aged 12-25 years.

Appendix A identifies all individual members of the workgroup, but the following agencies were represented:

• Abbott Pharmaceuticals, Inc.

• Bureau of Narcotic Enforcement/Professional Diversion Investigators Network (BNE/PDIN)

• California National Guard – Drug Demand Reduction (DDR)

• Community Alliances for Drug Free Youth (CADFY)

• Community Service Programs, Inc. - Project Positive Action Towards Health (CSP-PATH)

• County of Orange Health Care Agency, Alcohol and Drug Abuse Services, Prevention Team

(ADAS-Prevention)

• County of Orange Health Care Agency, Alcohol and Drug Education and Prevention Team

(ADEPT)

• Fourth District Parent-Teacher-Association (PTA)

• National Council on Alcoholism and Drug Dependence-Orange County – Community Alliance

Network (NCADD-OC)

Prescription and Over-the-Counter Drug Abuse


overview of Prescription and over-the-Counter Drug abuse

Although many prescription drugs can be abused, the most common classifications of medications abused by youth include opiates, central nervous system depressants, and stimulants. In regards to over-the-counter drugs, the most commonly abused are cough and cold medications containing dextromethorphan (DXM).

Opiates

Opiates, sometimes referred to as narcotics, are a group of drugs which are used medically to relieve pain, but also have a high potential for abuse. Americans, constituting only 4% of the world’s population, consume

80% of the global supply of opiods and 99% of the global supply of hydrocodone (Califano, 2007). Prescriptions for opiates (hydrocodone and oxycodone products) have escalated from around 40 million in 1991 to nearly 180 million in 2007.

Opiates are made from opium, a white liquid in the poppy plant, similar to heroin, but these prescription drugs are produced in laboratories. Taken as directed, opiates are very effective analgesics or pain relievers, but they also create a quick, intense sense of euphoria.

The most commonly known prescription opiates are Vicodin

®

and Oxycontin

®

. Other examples include: morphine (Kadian

®

, Avinza

®

), codeine, oxycodone (Oxycontin

®

, Percodan

®

, Percocet

®

), hydrocodone (Lortab

®

, Lorcet

® , Vicodin ®

), propoxyphene (Darvon

®

), fentanyl (Duragesic), and hydromorphone (Dilaudid

®

). There are numerous slang terms for the various opiates. Some include: syzurp (codeine), oxy (Oxycontin), O.C.’s (oxycontin), and hillbilly heroin (oxycontin).

Central Nervous System (CNS) Depressants

CNS depressants slow down normal brain functioning, and are often referred to as sedatives.

There are two types of CNS depressants – barbiturates and benzodiazepines – and these are used primarily to treat anxiety and sleep disorders. In higher doses, some CNS depressants can be used as general anesthetics.

Common CNS depressants include: barbiturates, mephobarbital (Merbaral

®

), pentobarbital sodium

(Nembutal

®

), butalbital (Fioricet

®

), benzodiazapines, diazepam (Valium

®

), chlordiazepoxide HCI (Librium

®

), alprazolam (Xanaz

®

), triazolam (Halcion

®

), and estazolam (ProSom

®

). There are numerous slang terms for the various opiates – tranks (benzodiazepines), downers (benzodiazepines), V’s (valium

®

) and Z bars

(xanax

®

).

Stimulants

Stimulants are a class of drugs that enhance brain activity and increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. These medications


4

Orange County Comprehensive Report historically were used to treat asthma and respiratory problems, obesity, and a variety of other ailments, but as their potential for abuse and addiction became apparent, the medical use began to decrease. Now they are prescribed for a few health conditions, including treatment of narcolepsy and attention deficit hyperactivity disorder (ADHD). Common prescription stimulants include: adderall, dextroamphetamine (Dexedrine

®

), and methylphenidate. Slang terms for stimulants include: dexies (dextroamphetamine), and for adderall – addy, alls, bennies, amps, a-bombs, and “the A train.”

Over-the-Counter (OTC) Medications

The most commonly abused over-the-counter medications that young people are abusing are cough and cold medications which contain the ingredient dextromethorphan or DXM. DXM is a semisynthetic narcotic, and is found in well over 100 brand-name and store-brand OTC cough medicines. When used according to label directions, DXM is a safe and effective cough suppressant. At much higher doses (typically more than 360 milligrams), DXM produces dissociative effects similar to those of PCP (phencyclidine) and ketamine and can have serious health effects which can vary from vomiting to rapid heart rate to slowed breathing and even death (Bobo et al, 2006). Additionally, of concern, are the adverse reactions from overdosing on other ingredients in the cold remedies with DXM, such as acetaminophen, pseudoephedrine and antihistamines, which can cause liver damage, irregular heart beats, high blood pressure and seizures (Bryner et al, 2006).

DXM is available in syrups, capsules, gel caps, lozenges, and the powder form (pure DXM) can be bought via the internet. There are numerous slang names for DXM, such as CCC, triple C,

Dex, Poor Man’s PCP, skittles and robo, which often refer to particular brand name products.

About two-thirds of abusers now take Coricidin HBP Cough & Cold, whose candy-red tablets are nicknamed red devils, triple C and skittles. “Robotripping” takes its name from Robitussin, the second most abused cold medicine (Banerji et al, 2001).

Polydrug Use

A common practice of young people when taking prescription or over-the-counter drugs is to combine them with each other and/ or other drugs, such as alcohol. This is called “polydrug use” and the setting in which this can take place is called a “pharming party.” At these parties or gatherings young people trade or exchange prescription medications to get “high,” by tossing all the prescription drugs they can acquire into a communal bowl (aka

“trail mix”) and then they down them “by the fistful” to get high.

This practice can be extremely harmful and even deadly. The most frequent substance found in combination with prescription and over-the-counter drugs is alcohol, but no matter what the drug, the consequences can be extremely harmful, slowing both heart and respiration, and could even lead to death (DAWN,

2004).



Prevalence of Use

National surveys and research reports have identified youth prescription and over-the-counter drug abuse as a growing concern in the United States. The abuse of prescription drugs has outpaced the use of all illegal drugs except marijuana among teens – in fact, there are more teens that abuse prescription drugs than cocaine, heroin, and methamphetamine combined

(ONDCP, 2008). While the abuse of many illicit drugs has declined in recent years, abuse rates of prescription and over-the-counter drugs have increased or remained steady at peak rates

(MTF Survey, 2008).

Although prescription and over-the-counter drugs are generally viewed as safe, the misuse of these drugs is not without consequences. Across the nation there has been a dramatic increase in the number of poisonings and deaths attributed to the abuse of these drugs (ONDCP, 2008).

These national trends indicate that prescription and over-the-counter drug abuse poses a threat to public health and safety.

National Prevalence

In 2008, 4.7 million teens, or about 19%, reported that they had abused prescription drugs at some point in their lives. Figure 1 shows the lifetime use rate qualifies prescription drugs as the second most commonly abused substance among teens (PATS, 2008).

Source: Partnership Attitude Tracking Study, 2008

Additionally, national trends in the misuse of prescription drugs among teens do not coincide with trends seen for other commonly abused substances. While the abuse of illicit drugs, alcohol, and cigarettes among teens has significantly decreased in recent years, the abuse of prescription drugs has remained relatively steady (PATS, 2008). Prescription and OTC medications were the most commonly abused drugs by high school students after marijuana. In addition, they represent 6 of the top 10 illicit drugs reported by 12 th

graders (MTF, 2008).

Research reveals that painkillers are the most commonly abused prescription drugs among teens, with approximately 10% of teens reporting lifetime use (PATS, 2008). In 2008, 9.7% of

12 th

graders reported having used a prescription painkiller within the past 12 months, compared


Orange County Comprehensive Report to 6.7% of 10 th

graders and 2.9% of 8 th

graders. Vicodin

®

and Oxycontin

® are the most frequently abused prescription painkillers. While the use of Vicodin® has remained relatively constant at historically high levels since 2002, the number of teens reporting past year abuse of

Oxycontin® increased 30% between 2002 and 2007 (MTF, 2007).

6

Source: Monitoring the Future, 2007

In addition to prescription drugs, teens are abusing over-the-counter (OTC) cough and cold medications to get high. In 2008, 10% of youth (or 2.4 million young people) in the United States reported having used cough and cold medicines to get high at some point in their lives, and 28% report knowing someone else who has tried it (PATS, 2008). This is identical to rates of lifetime use reported in 2006 and 2007. Data from the 2008 Monitoring the Future study estimates the past year use of cough medicine among 8 th

, 10 th

, and 12 th

graders is at 3.6% , 5.3%, and 5.5%, respectively (MTF, 2008).

Statewide Prevalence: California

In California, statewide norms are provided by the biennial statewide California Student

Survey (CSS), sponsored by the Office of the Attorney General. The current (2007-2008) CSS combines for the first time alcohol, illicit drugs, diverted prescription drugs and cold/cough medications (used to get high) into a total percentage of respondents who tried at least one such drug in their lifetime. The result is that 60% of 9 th

and 74% of 11 th grade students reported using one of the substances at least once. The most recent survey identified the top 3 major substance abuse trends in the state of California. Of these 3 trends, 2 were directly related to prescription and over-the-counter substance abuse.

The survey found that prescription drug abuse by California youth was occurring at an alarming rate, with 37% of 9 th

grade and 50% of 11 th grade respondents reported using to get high

(“without a doctor’s order to get high or stoned”) at least once in their lifetime either an illicit/ illegal drug or a diverted prescription drug such as painkillers, sedatives or diet pills. The prescription drugs used most frequently are prescription painkillers, such as Oxycontin

® or



Vicodin ®

. Twelve percent of 9 th

and 18% of 11 th graders reported using them at least once, making this by far the second most widely used category of drugs after marijuana. Also, overthe-counter drug abuse data indicates that large numbers of California teens have tried these products to get high, with 9 th

graders reporting at a slightly higher rate than 11 th

graders (26% vs.

25%) (CSS, 2008) (Figure 3).

Source: California Student Survey, 2008

In comparison with other states, California ranked 3 rd highest in overall misuse of prescription psychotherapeutic drugs – a class including prescription pain relievers, tranquilizers, stimulants, and sedatives (Table 1).

Source: National Survey on Drug Use and Health, SAMSHA, 2007

Although the combined prescription drug abuse rate is among the highest in the nation,

California’s rates of abuse in individual subcategories, such as prescription sedatives, tranquilizers, and painkillers, were not ranked among the nation’s highest or lowest

(SAMHSA, 2007).

Consequences

Misuse of prescription and over-the-counter drugs can lead to serious health risks. Nationwide, unintentional overdose deaths involving prescription painkillers increased 117% between

2001 and 2005 from 3,944 to 8,541. Over the same 4-year period, treatment admissions for


8

Orange County Comprehensive Report painkiller addictions increased 74% (USDOJ, 2009). In 2006, data submitted from hospitals across the nation show that there were approximately 741,425 Emergency Department visits involving nonmedical use of prescription and over-the-counter drug and dietary supplements.

Additionally, 92% of drug-related suicide attempts in 2006 involved misuse of pharmaceuticals

(SAMHSA, 2006).

The consequences of prescription and over-the-counter drug abuse extend beyond the personal health of those who abuse them. Violent and property crimes associated with prescription drug diversion and abuse increased nationally between 2003-2007. The Drug Enforcement Agency reported that the amount of prescription drugs stolen in armed robberies doubled from 0.5 million quantities in 2002 to nearly 1.1 million in 2007 (SAMHSA, 2009). In addition to safety risks, prescription and over-the-counter drug diversion and abuse pose financial liabilities to the public as well. Nationally, the estimated cost of prescription drug abuse to public and private medical insurers is $72.5 billion per year (SAMHSA, 2009).

Contributing Factors

A number of factors contribute to the high rates of prescription and over-the-counter drug abuse among teens and young adults. First, many teens tend to view these “legal” drugs as safer than using street drugs (ONDCP, 2008). Additionally, many parents are not aware of teen prescription drug abuse – only 24% of teens reported that their parents had talked to them about the dangers of abusing prescription and over-the-counter drugs. The vast majority of parents feel unprepared to prevent their children from abusing these types of drugs (PATS, 2008). Lastly, prescription and over-the-counter drugs are viewed as easy to obtain and inexpensive by teens and young adults (ONDCP, 2008).

Perception of Harm

Many teens abuse prescription and over-the-counter drugs because they believe they are a safe way to get high (ONDCP, 2008). The dangers of prescription and over-the-counter drugs are not well understood by many teens and young adults. Forty-one percent of teens indicated that they believe prescription drugs were “much safer” to use than illegal drugs (PATS, 2008).

Nearly 1/3 of teens (31%) believe that there is “nothing wrong” with using prescription medicines with a prescription every once in a while. Additionally, 32% of teens say they abuse prescription painkillers because they believe there are fewer side effects than street drugs (PATS, 2008).

The perception of harm from abuse of over-the-counter cough and cold medicines is increasing among teens – in 2008, 48% agreed that abusing cough medicine is risky versus 40% in 2004

(PATS, 2008). Despite this positive trend, the majority of teens (52%) still do not believe that abusing these medicines is dangerous.

Parental Awareness

Research has demonstrated that parents play an important role in preventing their children from using drugs. A study by SAMHSA showed that youth ages 12-17 whose parents express strong disapproval of drug use are far less likely to engage in substance abuse (SAMHSA, 2007). Yet, parents often do not address the issues of prescription and over-the-counter substance abuse with their children. Only 24% of teens reported having prescription drug abuse discussions with their parents; 18% reported having cold and cough medicine abuse discussions (PATS, 2008)

(Figure 4).



The majority of parents do not feel prepared to handle situations involving prescription drug abuse and over-the-counter substance misuse, with only 34% of parents reporting that they feel

“extremely prepared” to safeguard their medicine cabinets to prevent their child from abusing prescription drugs (PATS, 2008).

Access and Availability

Young people are able to acquire prescription and over-the-counter drugs easily and rather quickly. A recent national survey asked 12-17 years old, “which is easiest for someone your age to buy: cigarettes, beer, marijuana, or prescription drugs such as OxyContin, Percocet,

Vicodin or Ritalin, without a prescription?” Nineteen percent of questioned teenagers reported that it’s easier to buy prescription drugs than cigarettes, beer, and marijuana. This is a significant increase compared to 13% teens reporting the same a year ago (CASA, 2009).

Another study reported even higher rates, with approximately 6 out of 10 teens agreeing that prescription drugs are easier to get than illegal drugs (PATS, 2008). More than 1/3 of teens (8.7 million) also reported that they can get prescription drugs to get high within the day; nearly 1 in 5 teens (4.7 million) can get them within the hour (CASA, 2009). When asked where they would get prescription drugs, the most common sources were home, parents, and other family members or friends. In fact, the NSDUH found that half of individuals reporting nonmedical use of psychotherapuetics got them “from a friend or relative for free” (Figure 5). In a follow-up question, the majority of these respondents indicated that their friend or relative had obtained the drugs from one doctor (SAMHSA, 2008).



Source: National Survey on Drug Use and Health, 2007

Other common sources include obtaining medication from a physician, purchasing the medications over-the-counter or through rogue internet sites, and theft (usually from friends or relatives). Of note in regards to internet sales, in a June 2006 CASA report, the internet was found as a growing source of drugs with increased prescription drug abuse. They also found that there were no controls on blocking the sale to children and substantial shipments were from within the United States. (CASA, 2006). Yet, due to the tragic death of a local teen Ryan

Haight – who died at the age of 18 from an overdose of painkillers, including Vicodin

® that he ordered off the internet at age 17 without a legitimate prescription – and the continued advocacy of his family and the support of several law enforcement and prevention agencies, Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act in 2008 to combat these illegal online pharmacies.

10 Prescription and Over-the-Counter Drug Abuse


scope of the Problem in orange County

Data from the Orange County California Healthy Kids Survey (CHKS) confirms that prescription and over-the-counter substance abuse is a prevalent issue in Orange County as well. In recognition of this growing problem, WestEd expanded the CHKS instrument from measuring only prescription painkiller abuse trends to measuring trends in other prescription and over-thecounter products, including barbiturates, sedatives, stimulants, and cold medicine, in 2007.

Lifetime Use Rates in Orange County

The 2007-2008 California Healthy Kids Survey analyzed the prevalence of specific prescription and over-the-counter drug abuse rates at a local level. Figure 6 shows lifetime use rates among 9 th

and 11 th

grade students, as well as students at nontraditional school, which include continuing education, community day schools, and other alternative school types.

Source: California Healthy Kids Survey, 2007-2008

As seen above, the most commonly abused prescription and over-the-counter products in

Orange County are cough and cold medicines and prescription painkillers. With the exception of the barbiturates, lifetime use of each drug increases between 9 th

and 11 th

grade.

In addition to the lifetime use differences between grade levels in Orange County schools, differences in lifetime use rates are also evident between traditional and nontraditional schools, with students reporting significantly higher rates of use.

Lifetime Use Rates: Local vs. State

Lifetime use rates of prescription drugs in Orange County, including painkillers, barbiturates, sedatives, and stimulants, are relatively similar to those of the state of California among 9 th and 11 th

grade students (Figure 7-8). Among 9 th

and 11 th

graders in Orange County, the abuse of prescription painkillers is slightly below that of the state. In particular, 9 th grade students in

Orange County have a slightly higher lifetime usage rate of barbiturates, but this difference


Orange County Comprehensive Report disappears by the 11 th

grade. State and local lifetime use rates of sedatives and stimulants are remarkably similar among 9 th

grade students. However, there is a more distinct difference in these rates among 11 th

grade students, with Orange County 11 th graders demonstrating higher rates of lifetime use (California Healthy Kids Survey, 2008).

Sources: County - California Healthy Kids Survey, 2007-2008; State – California Student Survey, 2008


Despite the similarities in prescription drug abuse rates, abuse rates of over-the-counter cold medicines in Orange County are considerably different from those of the state (Figure 9). Data from the California Healthy Kids Survey indicate that abuse rates of cough and cold medicine in

Orange County are significantly lower than those of the state in both 9 th

and 11 th

grade students.



Sources: County - California Healthy Kids Survey, 2007-2008; State – California

Student Survey, 2008

Among prescription and over-the-counter substances, another distinction occurs between state and local trends. With the exception of barbiturates, Orange County demonstrates larger increases in lifetime use rates between 9 th

and 11 th grade students than those of the state

(Table 2). This may indicate that a greater proportion of Orange County students experience their first lifetime use between 9 th

and 11 th

grade.




Regional Prevalence

ADEPT divides Orange County into three service provider areas, identified as: North, Central, and South. Within each region, data is reported by school district. Appendix C provides a detailed list of the school districts within each region, as well as the schools within each school district. Appendix D contains reported lifetime use rates of painkillers, barbiturates, sedatives, cough medicines, diet pills, and stimulants for each school district in Orange County, grouped by regions. Appendix E lists the percentage of students across Orange County reporting lifetime use for each prescription drug and over-the-counter category, including painkillers, barbiturates, tranquilizers/sedatives, stimulants, inhalants, diet pills, and cold/cough medicines.

Overall, among 9 th

grade students in Orange County, the two substances with highest lifetime use rates were cold medicines and prescription painkillers. This trend is true of all school districts in Orange County with the exception of Santa Ana Unified School District (SAUSD) in the Central Region of Orange County, where lifetime use rates of diet pills exceeds those of painkillers (California Healthy Kids Survey, 2007-2008). Of all 9 th

grade students in Orange

County, those in the Brea-Olinda Unified School District (BOUSD) reported the highest rates of lifetime painkiller use at 17%, while students in the Tustin Unified School District (TUSD) reported the lowest rates of lifetime painkiller use at 6% (Figure 10).

14




Santa Ana Unified School District (SAUSD), Orange Unified School District (OUSD), Garden

Grove Unified School District (GGUSD), and Anaheim Union High School District (AUHSD) all reported the highest rates of lifetime cold medicine use among 9 th

grade students in Orange

County, at 23%. The Tustin Unified School District (TUSD) reported the lowest lifetime use rates of cold medicine among 9 th

grade students in Orange County at 7% (Figure 11).

Source: California Healthy Kids Survey, 2007-2008

Among 11 th

grade students in Orange County, the two substances with the highest lifetime use rates are cold medicines and painkillers. This trend holds for 11 th

grade students in every school district with the exception of the Laguna Beach School District (LBUSH) in the South Orange

County Region, where lifetime stimulant use surpasses that of cold medicine (California Health

Kids Survey, 2007-2008). Of all 11 th

grade students in Orange County, those at Capistrano

Unified School District (CUSD) in the South Region reported the highest rates of lifetime painkiller use at 27%. At 12%, students at Irvine Unified School District (IUSD), Tustin Unified

School District (TUSD), and Anaheim Union High School District (AUHSD) reported the lowest rates of lifetime painkiller use among 11 th

graders in Orange County (Figure 12).




Students at Santa Ana Unified School District (SAUSD) of the Central Region reported the highest rates of lifetime cold medicine abuse among Orange County 11 th

graders at 28%. At

10%, 11 th

grade students at Irvine Unified School District (IUSD) in the South Region reported the lowest rates of cold medicine abuse (Figure 13).

16




Local Consequences

Data from two primary sources were obtained to analyze the effects of prescription and overthe-counter drug abuse on the health of Orange County residents – the State of California’s

Office of Statewide Health Planning and Development (OSHPD) – Orange County Emergency

Department and Hospital Discharge Data, 2005-2007 and Orange County Sheriff’s Department,

Coroner Division – Drug Overdose Death Data, 2005-2007 (See Appendix B for Description of

Data).

Emergency Department Visits

The number of emergency department visits in Orange County attributed to prescription and over-the-counter drugs remained relatively stable between 2005 and 2007 (Table 3).

Source: California Office of Statewide Health Planning and Development

In 2005, 2006, and 2007, the ratio of females vs. males visiting Orange County emergency departments for prescription or over-the-counter drug-related issues was close to 2:1 (Figure

14). Females age 12 – 25 consistently have higher rates of emergency department visits than males age 12 – 25.



Figure 15 compares the rates of prescription and over-the-counter drug-related emergency department visits among two different age groups: youth ages 12-17 and youth ages 18-25.

While rates do not drastically differ between the two age groups, youth ages 18-25 have had slightly higher numbers of emergency department visits in 2005, 2006, and 2007.

Inpatient Treatment

The total number of youth ages 12-25 treated for prescription and over-the-counter drugrelated issues, measured by Orange County hospital inpatient discharges, increased each year between 2005 and 2007 (Table 4).

Table 4. RX/OTC-Related Inpatient Discharges

Orange County (12-25 year olds)

Source: California Office of Statewide Health Planning and Development

Inpatient treatment trends for prescription and over-the-counter drug-related issue among females as compared to males in Orange County are similar to those seen in emergency department data. In 2005, 2006, and 2007, the ratio of female inpatient treatment versus male inpatient treatment was nearly 2:1 (Figure 16). Females consistently have higher rates of prescription and over-the-counter drug-related inpatient treatment instances.



Figure 17 illustrates the number of inpatient treatments among different age groups in Orange

County: youth ages 12-17 and youth ages 18-25. The 18-25 year-old age group made up the majority of prescription and over-the-counter drug-related inpatient treatments in Orange County in 2005, 2006, and 2007.



Overdose Deaths

Between 2005 and 2007, there were 42 deaths in Orange County due to overdoses of prescription and/or over-the-counter drugs among teens and young adults, ages 12 through 25.

Nine of these deaths occurred amongst residents of the North Region of Orange County, 16 occurred among residents of the Central Region, and 17 occurred among residents of the South

Region. Figure 18 shows the distribution of prescription and over-the-counter drug-related deaths among the three regions of Orange County.

Source: Orange County Coroner

Data from the Orange County Coroner suggest that there are several noteworthy trends concerning prescription and over-the-counter drug abuse in Orange County. First and foremost, deaths due to prescription and over-the-counter drug overdose appear to be on the rise (Figure

19). Between 2005 and 2006, the number of deaths increased from 10 to 12 – a 20% increase.

In 2007, the number of deaths increased to 20 – a 67% increase from 2006 and double the number of deaths that occurred in 2005.




Coroner data also indicates that, among youth ages 12 through 25, deaths attributed to prescription and over-the-counter drug abuse outpaced deaths attributed to illicit drug abuse between 2005 and 2007 (Figure 20). The top prescription and over-the-counter drugs contributing to overdose deaths were Hydrocodone and Acetaminophen (Vicodin

(OxyContin

®

), Methadone, Diphenhydramine (Benadryl ®)

®) ), Oxycodone

) and Morphine*. The most common illicit drugs contributing to overdose deaths were heroin, cocaine, methamphetamine, and morphine. The Orange County Coroner includes overdose data attributed to the drug Morphine in dual categories, as both a legal prescription drug and as an illicit drug.



21


Additionally, the majority of prescription and over-the-counter drug-related deaths among youth in Orange County (69%) involved multiple substances. Twenty-nine of the 42 deaths occurring between 2005 and 2007 were attributed to a combination of two or more substances, including prescription drugs, over-the-counter drugs, and alcohol* (Table 5).


* Data does NOT include substance combinations involving illicit drugs

Lastly, Coroner data indicate that deaths resulting from prescription and over-the-counter drug abuse are disproportionally higher among males in Orange County than females. Of the 42 prescription and over-the-counter related deaths among youth ages 12 through 25 between

2005 and 2007, 29 deaths (69%) occurred among males, while only 13 deaths (31%) occurred among females.



orange County Town Hall Meetings

As part of Orange County’s Prescription Drug Initiative, three town hall meetings were conducted at three different high schools throughout the County. The main purpose of these town hall meetings was to promote student and parent awareness of issues surrounding prescription and over-the-counter drug abuse among youth in Orange County. The meetings also aimed to encourage future participation in drug prevention efforts.

One town hall meeting was conducted in each region of Orange County – North, Central, and

South. Table 6 provides an overview of each town hall meeting.

North Region Town Hall Meeting: Canyon High School

The North Region town hall meeting was conducted on March 25, 2009 at Canyon High School in Anaheim. There were approximately 200 attendees present, including students and parents representing Canyon High School and El Rancho Middle School.

Several strategies were employed to inform local community members about this town hall meeting and to encourage them to attend, including:

• A press release was submitted to the Orange County Register prior to the event.

• The event was published in the Canyon High School Newsletter.

• Promotional fliers were disseminated with online pre-registration forms.

• The event was published in the Anaheim Hills section of the Orange County Register.

• Multiple presentations were given to student and parent groups to advertise the event.

• On the morning of the event, school principals at Canyon High School and El Rancho Middle

School called each student’s home to inform parents of the event.



The town hall meeting at Canyon High School was divided into two separate sections. Time in the first section was dedicated to a speaker’s panel presentation for meeting attendees. Panel speakers included:

• Law enforcement: Sara Simpson, Special Agent in Charge, California Bureau of Narcotic

Enforcement

• School Administration: Frank Boehler, recently retired Director with the Orange Unified School

District’s Office of Child Welfare and School Attendance

• Community member: Agatha Martino

Sara Simpson presented to the audience on the parallels between prescription and illegal street drugs. Frank Boehler discussed the implications of prescription and over-the-counter drug abuse on academics. Agatha Martino presented her personal experience with the consequences of over-the-counter cough medicine abuse that led to the death of her teenage daughter – a former student at Canyon High School.

During the second section of the town hall meeting, students and adults were divided into two separate breakout groups. The adult breakout group attended a lecture by Frank Boehler, who gave an educational presentation about high-tech drug crimes and how current technology may be misused by teens to obtain prescription drugs illegally. He also spoke about how to navigate social networking tools commonly used by teens, such as MySpace and Facebook. The purpose of the breakout adult group session was to help parents become more educated about interfacing with the technology their children use.

The student breakout group session aimed to both educate youth about the dangers of prescription and over-the-counter drug abuse and to seek their feedback about effective ways to communicate these dangers to their peers. During this breakout session, students were divided into smaller groups of 6 to 10. They began with a brainstorming session during which they were presented with two questions:

1. What specific words, phrases, and messages would you include in an awareness and prevention campaign to communicate a clear message about:

• The dangers of use prescription and over-the-counter drugs for non-medical use; and

• The fact that prescription and over-the-counter drugs are NOT safer than illegal street drugs.

2. What is the best way to communicate these messages to students at your school?

Students were then asked to create a prescription/over-the-counter drug abuse prevention poster using the messages, slogans, and words they generated during their brainstorming session.

At the end of the adult and student breakout sessions, a survey was given to each town hall meeting participant to access satisfaction with the meeting and knowledge/attitude toward prescription and over-the-counter drug abuse.



Findings: Student Breakout Session

The following is a summary of responses and ideas generated during the student breakout session:

1. What specific words, phrases, and messages would you include in an awareness and prevention campaign to communicate a clear message about the dangers of prescription and over-the-counter drugs/safety compared to illegal street drugs?

• They are just as bad • Don’t jump off a roof because you think you can fly

• RX are narcotics

• They can kill you

• Death

• They are bad

• They are really bad

• They are uncool

• Don’t do it, it will change your life

• Consider what you think as a living

• Use it don’t abuse it

• We all know how it’s going to end

• Why even start?

• It’s not worth it

• Don’t over do it!

• Don’t do it

• Don’t do drugs

• Loss of intellectual stability

• Don’t use it – life abuse


• MySpace

• YouTube

• Chain e-mails

• Poetry

• Posters on campus

• Facebook

• Drawings & posters

Findings: Survey

A total of 117 completed surveys were collected at the end of the town hall meeting. The 117 survey respondents included 52 students (44.4%), 64 parents (54.7%), and 1 community member (0.9%)

As seen in Table 7, more than three quarters of the respondents said they are very or extremely likely to a) use the information or ideas shared by the panel members, as well as b) tell others about the dangers of prescription and over-the-counter drugs. The majority of the respondents

(59.8%) also reported being very or extremely likely to attend a prescription and over-thecounter drug abuse prevention activity in the future.



After attending the town hall meeting at Canyon High School, nearly all of the respondents agreed or strongly agreed that prescription drugs and over-the-counter drugs are just as dangerous as street drugs (97.5%). The majority of respondents also agreed or strongly agreed that a) they feel it’s easy for students to get prescription and over-the-counter drugs (84.6%), b) they know more about the dangers of prescription and over-the-counter drug abuse among youth as a result of this meeting (86.3%), and c) they found this town hall meeting to be very educational (88%) (see Table 8).



In response to an open-ended item, about a third (n=38) of the town hall participants said the meeting increased their awareness or understanding about drugs. A relatively large number of respondents (n=27) also made comments about the usefulness of the personal stories and experiences, often mentioning the story about the woman’s daughter. Additional responses and example quotes related to this item can be seen in Table 9.

Table 10 summarizes the respondents’ suggestions for improving the town hall meeting. The most frequently mentioned suggestions include a) using more or better examples and stories

(n=23), b) having a better audio visual system (n=9), c) including more information (n=7), and d) making the meeting more exciting (n=5). Other suggestions and comments can be seen in the Table 10.



Participants were also asked about what other topics they would like to learn more about at future town hall meetings. There were a wide variety of responses; however, the most common topics include a) alcohol/drinking and driving (n=11), b) street drugs (n=6), and c) steroids (n=4)

(see Table 11).





The final table for the town hall meeting at Canyon High School provides all additional comments made by participants (see Table 12).



Data Limitations

• The use of self-administered questionnaire surveys may be subject to participants reporting more favorable responses than actually experienced. This practice, known as “self-report bias” or “social desirability effect,” occurs when respondents report what they believe the surveyor wants to know rather than what they really think or how they really behave.

Central Region Town Hall Meeting: Huntington Beach High School

The Central Region town hall meeting was conducted on April 1, 2009 at Huntington Beach

High School in Huntington Beach. The meeting was sponsored by the Friday Night Live Chapter at Huntington Beach High School – a student group committed to addressing important youth issues and developing leadership. This group, consisting of 9 th

through 12 th graders, focuses on creating meaningful projects addressing issues around alcohol, tobacco, and drug use and violence prevention. The primary purpose of this meeting was to increase participants’ knowledge about prescription and over-the-counter drug abuse among youth. There were approximately 50 attendees present, including students, parents, and teachers. Approximately

20 of the attendees were monolingual, Spanish-speaking adults. Bilingual audience members translated the meeting for these adults.


• Fliers advertising the event were posted around the high school campus.

• The event was promoted during the daily Huntington Beach High School announcements in the days leading up to the town hall meeting.

The Town hall meeting at Huntington Beach High School featured a speaker’s panel presentation. Panel speakers included:

• Law enforcement: Detective McCain, Huntington Beach Police Department

• School Administration: Jason Ross, Assistant Principal at Huntington Beach High School

• Medical personnel: Dr. Schermerhorn, MD – Psychiatry and Neurology

• Community member: Francine Haight, R.N., prescription drug abuse educator and activist

• Huntington Beach High School Student: Cree Chavez

• Research Analyst/Consultant: Sue Donelson, Community Service Programs, Project PATH

Sue Donelson opened the discussion with an overview of prescription and over-the-counter drug abuse statistics and trends nationally and locally. Assistant Principal Jason Ross then addressed the issue of prescription and over-the-counter drug abuse on the Huntington Beach

High School campus. Detective McCain presented to the audience on legal consequences of prescription and over-the-counter drug abuse and shared several local cases dealing with this issue. Dr. Schermerhorn, MD, discussed medical and neurological consequences of prescription and over-the-counter drug abuse. Francine Haight presented her personal experience with the consequences of prescription drug abuse that led to the death of her teenage son in 2001. Lastly, Cree Chavez – a 12 th

grade student at Huntington Beach High

School – spoke about her experiences as a recovering prescription-drug addict.



At the end of the speaker’s panel presentations a question and answer session was conducted to address audience concerns. After the question and answer session, a survey was given to the town hall meeting participants to access satisfaction with the meeting and knowledge/ attitude toward prescription and over-the-counter drug abuse.


A total of 24 completed surveys were collected at the end of the town hall meeting. The 24 survey respondents included 7 students (29.2%) and 17 parents (70.8%).

As seen in Table 13, over 95% of the respondents said they are very or extremely likely to a) use the information or ideas shared by the panel members, as well as b) tell others about the dangers of prescription and over-the-counter drugs. Slightly fewer respondents (83.3%) reported being very or extremely likely to attend a prescription and over-the-counter drug abuse prevention activity in the future.

After attending the town hall meeting at Huntington Beach High School, all (100%) of the respondents agreed or strongly agreed that they a) believe prescription drugs and over-thecounter drugs are just as dangerous as street drugs, b) know more about the dangers of prescription and over-the-counter drug abuse among youth as a result of this meeting, and c) found this town hall meeting to be very educational. The majority of respondents also agreed or strongly agreed that they feel it’s easy for students to get prescription and over-the-counter drugs (95.8%) (Table 14).



In response to an open-ended item, nearly 30% (n=7) of the town hall participants said the meeting increased their awareness or understanding about drugs. Respondents also made comments about the usefulness of the personal stories and experiences and having a child present. Additional comments and example quotes related to this item can be seen in Table 15.

Table 16 summarizes the respondents’ suggestions for improving the town hall meeting. The suggestions include a) increasing attendance of the meeting (n=4), b) using more or better examples and stories (n=2), c) having a separate meeting for those who speak English (n=2), and d) making the meeting more exciting (n=1).



Participants were also asked about what other topics they would like to learn more about at future town hall meetings. These responses are summarized below in Table 17.

The final table for the town hall meeting at Huntington Beach High School provides all additional comments made by participants (see Table 18).




• The use of self-administered questionnaire surveys may be subject to participants reporting more favorable responses than actually experienced. This practice, known as “self-report bias” or

“social desirability effect,” occurs when respondents report what they believe the surveyor wants to know rather than what they really think or how they really behave.

• The majority of survey respondents were adults, thus the data reflects more adult than youth perspective regarding town hall meeting content and learnings.

• Although there was a large proportion of monolingual, Spanish-speaking adults at the town hall meeting, surveys were only provided in English. Thus, these survey results may not reflect the opinions and learnings of a large proportion of adults at the meeting.

South Region Town Hall Meeting: Tesoro High School

The South Region town hall meeting was conducted on April 14, 2009 at Tesoro High School in

Rancho Santa Margarita. There were 105 attendees present, including students, parents, and school counselors representing Tesoro High School, Arroyo Vista Middle School, Las Flores

Middle School, Ladera Ranch Middle School, and Marco Forster Middle School.


• A press release was submitted to the Orange County Register prior to the event. The event was announced in the Our Towns section of the Orange County Register on April 8, 2009, as well as on the Orange County Register website calendar of events.

• The event was announced in the Tesoro High School PTSA Newsletter.

• Promotional fliers were disseminated to surrounding local schools, including Tesoro High School,

Arroyo Vista Middle School, Law Flores Middle School, Ladera Ranch Middle School, Marco

Forster Middle School, the Ladera Ranch Public Library, the Capistrano Unified School District, and local Starbucks coffee shops.

• The event was announced on Tesoro High School Listserv Announcements on two separate

occasions.

• The event was published in the Rancho Santa Margarita section of the Orange County Register.

The town hall meeting at Tesoro High School was divided into two separate sections. Time in the first section was dedicated to a speaker’s panel presentation for meeting attendees. Panel speakers included:

• Law enforcement: Jennifer Doss and Dan Harward, Special Agents from the California Bureau of

Narcotics Enforcement

• Medical personnel: Dr. Michael Ritter, Emergency Department Physician at Mission Hospital

Regional Medical Center

• Community member: Francine Haight, R.N., prescription drug abuse educator and activist

Law enforcement speakers presented to the audience on the parallels between prescription and illegal street drugs. The physician discussed the prevalence of youth seeking emergency medical treatment for prescription and over-the-counter drug-related issues. Francine Haight presented her personal experience with the consequences of prescription drug abuse that led to the death of her teenage son in 2001.



During the second section of the town hall meeting, students and adults were divided into two separate breakout groups. The adult breakout group attended a lecture by Registered

Pharmacist Mark Horowitz, who gave an educational presentation including slang terms for prescription and over-the-counter drugs, signs and symptoms of use, and the “sizzurping” phenomenon. This was followed by a second presentation by Deputy Lance Christiansen, who spoke about his personal experiences as a School Resource Officer with prescription and overthe-counter drug abuse issues among youth at the Tesoro High School campus. The purpose of the breakout adult group session was increase awareness, further educate, and affect attitudes of parents regarding prescription and over-the-counter drug abuse trends among youth.

The student breakout group session aimed to both educate youth about the dangers of prescription and over-the-counter drug abuse and to seek their feedback about effective ways to communicate these dangers to their peers. During this breakout session, students were divided into smaller groups of 6 to 10. They began with a brainstorming session during which they were presented with two questions:

1. What specific words, phrases, and messages would you include in an awareness and prevention campaign to communicate a clear message about:

• The dangers of use prescription and over-the-counter drugs for non-medical use

• The fact that prescription and over-the-counter drugs are NOT safer than illegal street drugs


Students were then asked to create a prescription/over-the-counter drug abuse prevention poster using the messages, slogans, and words they generated during their brainstorming session.

At the end of the adult and student breakout sessions, a survey was given to each town hall meeting participant to access satisfaction with the meeting and knowledge/attitude toward prescription and over-the-counter drug abuse.

Findings: Student Breakout Session

The following is a summary of responses and ideas generated during the student breakout session:

1. What specific words, phrases, and messages would you include in an awareness and prevention campaign to communicate a clear message about the dangers of prescription and over-the-counter drugs/safety compared to illegal street drugs?

• Just Don’t Do It

• Harmful

• Effects everybody differently

• Hugs Not Drugs

• They [Rx] Kill

• Drugs R drugs

• Multiple drugs can lead to death

• Just as dangerous as illegal



• Overdose

• Death

• Coma

• Pharmacies

• Symptoms: Constipation

• OTC meds: Little do you know…

• They [Rx] are still drugs

• Drugs and die

• Stay off pills that thrill

• Don’t fill your life with drugs, just fill your life with hugs

• Rx drugs are for slugs

• Lock bottles


• Text messaging

• Posters

• Bulletins

• Cool song

• Concerts

• Pot lucks

• Chat rooms

• Presentations in class

• Meebo

• AIM

• Skype • Myspace

• Twitter

• Facebook

• School website

• Personal stories

• People who have experienced in

• Commercials

The following items are a few examples of posters that were developed in the second portion of the student breakout session:




A total of 90 completed surveys were collected at the end of the town hall meeting. The 90 survey respondents included 69 students (76.7%), 20 parents (22.2%), and 1 community member (1.1%).

Table 19 illustrates the participants’ response to the town hall meeting. Overall, the participants reported the likelihood of sharing information learned from the town hall meeting. Approximately

3 out of 4 participants reported that they are very or extremely likely to “use the information or ideas shared by the panel members” followed by “tell others about the dangers of prescription and over-the-counter drugs” (64.4%). Over half of the participants (52.8%) reported being very or extremely likely to attend a prescription and over-the-counter drug abuse prevention activity in the future.

The participants were asked to respond to various questions regarding their knowledge of prescription drugs following the training (Table 20). The participants’ strongly agree and agree responses were aggregated. Over four out of five participants reported that their knowledge increased in the following statements: “I believe prescription and over-the-counter drugs are just as dangerous as street drugs” (86.4%), “I feel it is easy for students to get prescription and overthe-counter drugs” (80.7%), and “I know more about the dangers of prescription and over-thecounter drug abuse among youth as a result of this meeting” (79.5%). Overall, the participants felt the town hall meeting was informative (96.6%).



The participants were asked various open-ended questions in response to the town hall meeting. Table 21 illustrates the participants response to what they felt was most useful. A total of 83 participants commented. Over 22% of the town hall participants (n=19) reported that the most useful information of the town hall meeting was that prescription drugs are just as bad as street drugs. The participants (n=16) reported that the second most useful piece of information from the town hall meeting was general information about drugs. Specific quotes are illustrated in Table 21.



Table 22 summarizes the respondents’ suggestions for improving the town hall meeting. A total of 60 participants responded. Approximately three out of eight participants (35%) (n=21) stated that more personal stories and youth stories should be utilized. Additional suggestions succeeding that included more food (n=7), more graphics and pictures (n=7), more exciting and fun activities (n=4), more activities in general (n=3), and better advertising (n=3). Other suggestions and specific quotes are illustrated in Table 22.



Participants were also asked what other topics they would like to learn more about at future town hall meetings. A total of 44 participants responded. The most common topics suggested by the participants included all drugs, marijuana, street drugs, alcohol, “angel dust,” and methamphetamines (see Table 23).



A total of 24 comments were made of which all, but one, were positive. Specific quotes were:




• The use of self-administered questionnaire surveys may be subject to participants reporting more favorable responses than actually experienced. This practice, known as “self-report bias” or

“social desirability effect”, occurs when respondents report what they believe the surveyor wants to know rather than what they really think or how they really behave.

• The majority of survey respondents were students, thus the data reflects more youth than adult perspective regarding town hall meeting content and learnings.

Summary

Each of the three town hall meetings were successful in their goal to promote student and parent awareness of issues surrounding prescription and over-the-counter drug abuse among youth in Orange County. Surveys completed by attendees at all three town hall meetings showed that the vast majority of parents and students both learned more about the dangers of prescription and over-the-counter drug abuse and would share this knowledge with others.



Partnership for a Drug-free orange County

Research suggests that another effective strategy to address prescription and over-the-counter drug abuse in one’s community is to engage the local media; so this became another focus of the Orange County initiative. Recognizing the great success of the Partnership for a Drug-

Free America (PDFA) and its award winning advertisements, the County of Orange Health

Care Agency’s ADEPT program contacted PDFA to see how Orange County could utilize their research-based national public education program addressing prescription and over-the-counter drugs.

The result of this contact is a new alliance between the Health Care Agency’s ADEPT and the PDFA which will allow ADEPT and various alcohol and other drug community partners to work directly with local media to disseminate the Partnership’s prescription drugs messages, as well as other media creatives on reducing illicit drug and alcohol use among children and teens in the communities of Orange County. The campaign aims to provide families with the tools, information and support they need to help their children lead healthy, drug-free lives.

The new alliance entitled “Partnership for a

Drug-Free Orange County,” encourages parents to have regular conversations with their children regarding the dangers of alcohol and other drug use. Research consistently shows that teens who learn a lot about the risks of drugs at home are up to 50% less likely to use than those who do not get that crucial message at home. Yet many parents have difficulty talking with their kids about drugs and alcohol and the campaign strives to equip parents with the tools they need to begin and keep the dialogue open around substance abuse.



strategic Planning session

The final objective of the yearlong Prescription Drug Initiative was to convene a Strategic

Planning Session, which brought together the members of the Task Force along with other community stakeholders to review data, other promising strategies to address prescription and over-the-counter drug abuse, and to develop recommendations for next steps in Orange County

(Appendix D lists individuals who attended the session).

On Tuesday, May 5, 2009 the Prescription Drug Strategic Planning Session was held in the auditorium of the Pacific Coast Recovery Center, and was facilitated by Erica Leary, MPH,

Program Manager for the North Coastal Prevention Coalition in north San Diego County. Ms.

Leary was hired as a consultant to assist with the facilitation of the session and to assist the group with the prioritization of the prevention recommendations.

The session was based on a model of change developed by the Community Anti-Drug

Coalitions of America (CADCA) which utilizes the Strategic Planning Framework (SPF). This process that CADCA suggests is aimed at assisting community coalitions to implement the planning elements of the SPF, which ultimately produces strategic goals, objectives, outcomes, a logic model, a theory of change, a strategic plan, and an action plan (CADCA, 2007). Due to time constraints, the Strategic Planning Session was only able to address a few of these items, but the Task Force plans to build upon the recommendations from the Session and develop a more comprehensive approach to addressing the issue.

Problem Statements, Contributing Factors (But Why? and But Why

HERE?)

The session began with a welcome and introductions, and then jumped into developing problem statements. Participants agreed on the following problem statements:

• Too many young people are abusing prescription drugs; and

• Too many young people are abusing over-the-counter (OTC) medications.

The following global contributing factors were identified:

• Perceived harm (Rx and OTC are viewed as less harmful than illicit drugs);

• Easy access (Rx and OTC medications are easy for youth to get);

• Lack of parental awareness (parents don’t know that Rx and OTC medications are abused by youth); and

• Less shame/stigma (abusing Rx or OTC medications is not viewed as negatively as illicit drug use).

As for local contributing factors (But Why HERE?), the participants were divided into four groups and asked to brainstorm how the above contributing factors impacted residents of Orange

County. Following the small group brainstorm, the large group was asked to “vote” on what they believed to be the priority issues. Each participant was given 5 dots to vote. The numbers indicate the total votes for each local contributing factor. The following are the suggested factors, with local contributing factors ranked below them.



Perceived harm (Rx and OTC are viewed as less harmful than illicit drugs)

• Social norm (Rx drugs are FDA approved and prescribed by doctors who ‘do no harm’ – not the same as illicit drugs) [15]

• Technology [1]

• Social acceptability (lots of people take medicine) [6]

• Media/advertising (medicine will solve everything)

Easy access (Rx and OTC medications are easy for youth to get)

• In the home [12]

• Lack of pharmacy coordination/communication re: Rx drugs [5]

• Physician over-prescribing [2]

• Internet access [2]

• No age or quantity limit on OTC medications [2]

• Easily purchased at store (OTC) [2]

• Fewer legal consequences than illicit drugs [2]

• Over the border

• Relatively inexpensive

• Doctor shopping and Medicaid fraud

• Easy to find someone else selling it

• Other peoples’ homes (friends, grandparents), “pharming” parties

Lack of parental awareness (parents don’t know that Rx and OTC medications are abused by youth)

• Lack of knowledge [16]

• Denial [6]

• Media normalizing use of meds (ads, magazines) [3]

• Belief that Rx and OTC are safer [1]

• Some parents might be using/supplying

• Not knowing how they are used to get high

• Unsuspecting

Less shame/stigma (abusing Rx or OTC medications is not viewed as negatively as illicit drug use)

• No stigma with use, compared to illicit drug use [13]

• Use of Rx drugs is normalized due to widespread prescribing [4]

• So many people use Rx drugs they are viewed as less harmful [1]

• Media/Hollywood influence, Rx drug abuse not as shamed in celebrity news



• Higher socioeconomic status

• Legitimate uses for Rx drugs make them more acceptable

• Can get from home medicine cabinets (not a drug dealer)

Brainstorming Prevention Strategies

The next step was to brainstorm prevention strategies to target the top local contributing factors.

After consulting with the group, the facilitator suggested combining the perception of harm and lack of stigma into one small group to discuss the social norm surrounding prescription drug abuse because the strategies would likely be very similar.

The groups were divided to brainstorm prevention strategies to address only the top local contributing factors identified. These included:

Perceived Harm

Social norm (Rx drugs are FDA approved and prescribed by doctors who “do no harm” – not the same as illicit drugs)

Prevention Strategies

•

More presentations for youth and PTAs, town halls [7]

• Cough syrup policy change to be sold like Sudafed behind the counter (identify retail/corporate partner) [5]

• Partnership with pharmacies (provide info, enhance skills, physical design) including posters and inserts, award/reward incentive [4]

• Electronic communication [2]

• Media/Partnership For a Drug Free America

Lack of Parental Awareness

Lack of knowledge on behalf of parents


•

Engage parents in prevention – catch earlier [9]

• Media ad campaigns [4]

• Increase awareness of social network sites/misperception and safety [2]

• Increase awareness of signs and symptoms/teach dangers [2]



• Access points – lock medications or monitor drop off sites [1]

• Town halls [1]

• Parent newsletters

• Provide resources and talking points

• Increase and encourage alternative family activities

Easy Access

In the home


• Provide information – parent education [2], PSAs, brochures, information on Rx bags and/or

grocery bags when getting medication [7], school listservs, town halls/community meetings [2]

• Changing consequences – offer incentives for turning in unused medications [3]

• Enhancing skills – trainings, facebook fans, train the trainers (schools and administrators),

strategic planning, school resources – websites, on-line workshops, PTAs [1]

• Physical design – physical lock on medicine cabinets

• Increase cultural sensitivity in linguistical language

Lack of pharmacy coordination/ communication re: Rx drugs


• Enforce existing laws (i.e. show ID for scheduled drugs); work with pharmacies to clarify policies with all staff; increase education in pharmacy schools and pharmacy tech programs [8] –

changing consequences

• Precaution signs in pharmacies (educate at the source); similar program in Kentucky [7] – provide information

• Fax Alert (doctor shoppers, stolen Rx pads); similar program operating in San Diego [3] –

decrease barriers

• CURES (program done by BNE – Bureau of Narcotics Enforcement); increase pharmacy

knowledge of this program [2] – decrease barriers

• Educate pharmacists on how to spot signs of abuse

SWOT Analysis – Strengths, Weaknesses, Opportunities, Threats

After small groups brainstormed prevention strategies for the selected local contributing factors, the entire group was given sticker dots to vote on which strategies they believed would be most important to address. Each participant voted for one strategy per small group. The small groups then reconvened and were asked to conduct a SWOT analysis for the strategy that received the most votes. The members of one small group (perceived harm – conduct more presentations for youth and PTA’s) could not stay for the added time of the session and were unable to conduct this step. The following summarizes the discussion for the remaining three groups:



Lack of Parental Awareness → Lack of Knowledge → Engage Parents in Prevention

STRENGTHS

WEAKNESSES

• Family Day Campaign (event already in existence to build upon)

• Parents want the best for their kids

• Solidarity of parents together

• We do some of this work already

• Hard to get parent involvement

• Parents are busy

• Childcare issues

THREATS OPPORTUNITIES

• PTA meetings

• School drop off/pick up locations to reach parents

• Pride hours

• Sporting events, gymnastics

• Buy prevention banner

• No childcare

• No food

Easy Access → Availability in the Home → Implement Pharmacy Bag Campaign

STRENGTHS

WEAKNESSES

• Relatively inexpensive

• Reach large numbers (specific to those filling Rx)

• People don’t look at campaign

• Message can be improperly targeted

OPPORTUNITIES

• Get more pharmacies on board

• Teachable moment

• Pharmacy to promote self

• Get message across

THREATS

• Resistance from pharmacies

• Funding

• Environmental concerns (move away from bags)

Easy Access → Lack of Pharmacy Communication/Coordination →

Enforce/Educate about Existing Laws

STRENGTHS

WEAKNESSES

• Already existing laws (don’t need to make new ones)

• Education and training are what we do

(coalition/task force expertise)

OPPORTUNITIES

• Lack of agency recognition

THREATS

• Develop stronger relationships with pharmacies and healthcare providers

• New partnerships and alliances

• Opportunity to find alliances with outside healthcare organizations (i.e. schools)

• Pharmacies that are not on board

• Pharmacies understaffed/lack of time for training

• Lack of incentive



Conclusion

The abuse of prescription and over the counter drugs is a public health issue of concern, particularly among teens, both locally and throughout the United States. More young people ages 12-17 abuse prescription drugs than any other illicit drug except marijuana – more than cocaine, heroin, and methamphetamine combined (SAMHSA, 2008). Prescription and over-thecounter drug abuse has many dimensions, and causes and no single program can address the magnitude of the issue or the diverse factors underlying it. It is a complex problem that requires a comprehensive approach and participation from stakeholders in multiple sectors.

Through this unique funding opportunity, Orange County has been able to better position itself to address the prescription and over-the-counter drug abuse problems within the County. Many partnerships, resources, and opportunities have been identified and there is an eagerness to review and discuss next steps, including identifying joint opportunities for community awareness and advocacy, and the exploration of more coordinated strategies to prevent prescription and over-the-counter drug abuse. By building on the accomplishments of this past year of research, data collection, education, and strategic planning, Orange County can collectively build a local movement to address the issue by sharing this report and findings with key community stakeholders, leaders and task force members in an effort to increase motivation and willingness to participate in future drug abuse prevention efforts.



References

Banerji S and Anderson IB. (2001). Abuse of Coricidin HBP Cough and Cold Tablet: episodes recorded by a poison center. Am J Health Syst Pharm.; 58: 1811-1814.

Bobo WV and Fulton RB. (2004). Commentary on: severe manifestations of Coricidin intoxication. Am J Emerg Med.; 22: 624-625.

Bryner JK, Wang UK, Hui JW, Bedodo M, MacDougall C, Anderson IB. (2006)

Dextromethorphan Abuse in Adolescent: An Increasing Trend: 1999-2004. Arch Pediatr Adolesc

Med.; 160: 1217-1222.

Califano JA. (2007). High Society: How Substance Abuse Ravages America and What to Do

About It. Perseus Publishing, New York, 2007.

California Healthy Kids Survey (2008). Technical Report Secondary 2007-2008 Orange County,

Core Module A. http://www.wested.org/chks/pdf/rpts_dl/fo6s_30_30000_ca.pdf

California Student Survey (2008). California’s Office of the Attorney General. http://www.

wested.org/chks/pdf/cssinchksformat07_08.pdf

Centers for Disease Control (CDC) (2007). Unintentional Poisoning Deaths, United States,

1999-2004. MMWR; 56(05); 93-96. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a1.

htm

Community Anti-Drug Coalitions of America. (2007). Planning Primer: Developing a Theory of

Change, Logic Models, and Strategic and Action Plans. http://www.coalitioninstitute.org/SPF_

Elements/Planning/PlanningPrimer-01-2007.pdf

Drug Abuse Warning Network (DAWN) Report (2004). Oxycodone, Hydrocodone, and Polydrug

Use, 2002. http://www.oas.samhsa.gov/2k4/oxycodone/oxycodone.pdf

Monitoring the Future (MTF) Survey (2008). National Institute of Drug Abuse. http:// monitoringthefuture.org/

National Center on Addiction and Substance Abuse (CASA) (2009). National Survey of

American Attitude on Substance Abuse XIV: Teens and Parents. http://www.casacolumbia.org/ absolutenm/articlefiles/380-2009%20Teen%20Survey%20Report.pdf

National Center on Addiction and Substance Abuse (CASA) (2006). “You’ve got drugs!”

Prescription drug pushers on the internet. 2006 update. A CASA White paper. http://www.

casacolumbia.org/pdshopprov/files/you_ve_got_drugs.pdf

Office of National Drug Control Policy (ONDCP) (2008). “Prescription for Danger: A Report on Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens.” http://www.

theantidrug.com/pdfs/prescription_report.pdf

Partnership Attitude Tracking Study (PATS) Teens 2007 Report. (2008). Partnership for a Drug

Free America. http://italy.usembassy.gov/pdf2008/other/ParentsSurvey.pdf



Partnership for a Drug Free America (2009). The Partnership Attitude Tracking Study (PATS)

Teens 2008 Report. http://www.drugfree.org/Files/full_report_teens_2008

Substance Abuse and Mental Health Services Administration (SAMHSA) (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings. Office of Applied Studies,

NSDUH Series H-34, DHHS Publication No. SMA 08-4343. Rockville, MD.

Substance Abuse and Mental Health Services Administration (SAMHSA) (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies,

NSDUH Series H-34, DHHS Publication No. SMA 08-4343. Rockville, MD.

US Department of Justice (USDOJ). (2009) National Prescription Drug Threat Assessment.

National Drug Intelligence Center. http://www.usdoj.gov/ndic/pubs33/33775/33775p.pdf



appendix a - orange County Prescription Drug Task force

4

Carol Barnes th

District Parent Teacher Association

Celeste Bentley, MPH, CHES

Community Service Programs, Inc.

Project PATH – North

Marianne Cadiz, MPH


Project PATH – Central

Sue Donelson, MPH



Gwen Drenick, MPH, CHES

National Council on Alcoholism and Drug

Dependency, Inc.

Community Alliance Network

Phil Falcetti, MPH


Dependency, Inc.


1 st Lt. Ruel Fuentecill, MPA

California National Guard

MSG. Scott Gaukel


Terah Glass, CHES


Dependency, Inc.


Dan Gleason, MPH


Project PATH

Joyce Gore, MPH



Francine Haight, RN

Ryan’s Cause, Inc.

Aimee Hendle

Community Alliances for Drug Free Youth

Romeo Howe

Consultant

Clarice Kavanaugh

Abbott Pharmaceuticals, Inc.

Marianne Mullen


Dependency, Inc.



County of Orange Health Care Agency

Alcohol and Drug Education and Prevention Team

Chip Pope


Alcohol and Drug Abuse Services,

Prevention Team

Rebeka Sanchez, MPH, CHES



Sara Simpson

Bureau of Narcotic Enforcement

Irene Umipig, MPH








appendix b – Description of Data sources

National

•

Monitoring the Future (MTF)

– conducted by the

U.S. Department of Health and Human

Services: National Institute on Drug Abuse (NIDA) o MTF is a nationwide survey conducted annually since 1975 as part of a long-term study. It is designed to generate data on current trends of smoking, drinking, and drug use in American youth and young adults. MTF includes information on trends of legal and illegal drug use, as well as trends in perceived risk and personal disapproval associated with each drug.

•

National Survey on Drug Use and Health (NSDUH)

– conducted by the

U.S. Department of

Health and Human Services: Substance Abuse and Mental Health Services Administration (SAMHSA) o NSDUH has been conducted by the Federal Government since 1971 and measures the use of illegal drugs (including non-medical use of prescription drugs) alcohol, and tobacco by the

U.S. population. The Survey provides yearly data on a national and state level.

•

Partnership Attitude Tracking Study (PATS)

– conducted by

Partnership for a Drug Free

America o PATS is an annual study that is the largest drug-related attitudinal tracking study in the country. The survey is conducted within two samples in the United States: students in grades

7 through 12 and parents.

• Youth Risk Behavior Survey (YRBS) – conducted by the

U.S. Department of Health and

Human Services: Centers for Disease Control and Prevention (CDC) o YRBS is a national school-based survey that reports on six categories of priority health-risk behaviors among youth and young adults, including tobacco use, drug/alcohol use, sexual behaviors, unhealthy dietary behaviors, and physical activity, and behaviors contributing to injuries and violence.

Statewide

• California Healthy Kids Survey (CHKS): Aggregate Report – conducted by the

California

Department of Education o CHKS is conducted to collect data on the health risks and resilience of students in the State of California. CHKS is a comprehensive youth self-report survey that provides health risk assessment information to assist schools and community groups in preventing youth healthrisk behaviors, including alcohol, tobacco, and drug use. The 2007-2008 CHKS Aggregated

Report includes data from 667,610 students in 7 th

, 9 th

, and 11 th grades in traditional and nontraditional schools across the state of California.

•

California Student Survey (CSS)

– conducted by the California Attorney General’s Office:

Crime and Violence Prevention Center

54 o CSS is a statewide biennial research survey that collects data on substance use from

California students in grades 7, 9, and 11. The survey is a mandated statewide project conducted since 1985. It provides a snapshot of student’s health-related and risk-taking behaviors, including drug, alcohol, and tobacco use. The 12 th

biennial CSS includes feedback from 13,930 students from 115 public middle and high schools.



Local

• California Health Kids Survey (CHKS): Orange County – conducted by the California

Department of Education o The 2007-2008 CHKS Orange County Report includes data from 73,212 students in 7 th

, 9 th , and 11 th

grades in traditional and nontraditional schools across Orange County.

o Data Limitations:

■ Due to the CKS reporting formats, data is available by school district and not by city. Data cannot be broken down by city due to school district boundaries that cross multiple city borders.

■ With the exception of the inhalant category, the data collected on prescription and over-the-counter drugs are limited to lifetime use prevalence and does not include information such as past 30 day use or whether or not the respondents report ever being high off the prescription or over-the-counter substance.

■ The use of a self-administered questionnaire may be subject to participants reporting more favorable responses than actually experienced. This practice is known as selfreport bias or social desirability effect. This means that respondents may report what they think the surveyor wants to know rather than what they really think or how they really behave.

• State of California’s Office of Statewide Health Planning and Development (OSHPD) –

Orange County Emergency Department and Hospital Discharge Data, 2005-2007 o Data Parameters:

■ Date of Emergency Department visit or Hospital Discharge between January 1, 2005 –

December 31, 2007

■ Age 12 – 25 years

■ Resident of Orange County

■ Principal diagnosis ICD-9 code 965.09, 965.4, 965.8, 967.8, 967.9, 969.4, 969.7, 970.1,

970.9 or 975.4 (refer to Appendix A) o Data Limitations:

■ Due to small sample size, caution should be taken in making inferences or generalizations to the larger population of 12 to 25 year-olds in Orange County.

■ Data are included based on ICD-9 code and may include cases in which the individual ingested prescription and/or over-the-counter drug(s) without the intention of abuse

(i.e.; substance taken in error, accidental overdose, etc.)

■ Data are provided by each hospital in Orange County. In some instances, an Orange

County hospital may have provided treatment to a non-resident. Likewise, there may be instances in which an Orange County resident received treatment for a prescription or over-the-counter drug-related issue in a hospital outside of Orange County. Thus, the total number of emergency department visits and hospital discharges does not necessarily reflect the exact number of Orange County residents who received treatment for prescription or over-the-counter drug-related issues.



• Orange County Sheriff’s Department, Coroner Division – Drug Overdose Death Data,

2005-2007 o Data Parameters:

■ Date of Death between January 1, 2005 – December 31, 2007

■ Age 12 – 25 years

■ Hospital in Orange County

■ Cause of death involved prescription and/or over-the-counter drug(s) o Data Limitations:

■ Due to small sample size, caution should be taken in making inferences or generalizations to the larger population of 12 to 25 year-olds in Orange County.

■ Data are sorted by cause of death only, thus there is no method to determine intentions or actions of the individual leading up to the event of death. (i.e.; data may include cases of suicide, accidental overdose, etc.)



appendix C – school Districts and schools in orange

County by Region

North Region of Orange County

The North Region of Orange County consists of the following five (5) school districts:

1. Anaheim Union High School District (AUHSD)

The cities of Anaheim, Cypress, and La Palma are served by AUHSD:

Anaheim

• Anaheim High School

• Katella High School

• Loara High School

• Magnolia High School

• Savannah High School

• Western High School

Cypress

• Cypress High School

La Palma

• J.F. Kennedy High School

2. Brea-Olinda Unified School District (BOUSD)

The city of Brea is served by BOUSD:

• Brea High School

3. Fullerton Joint Union High School District (FJUHSD)

The cities of Fullerton, Buena Park, and La Habra are served by FJUHSD:

Fullerton

• Fullerton Union High School

• Sunny Hills High School

• Troy High School

Buena Park

• Buena Park High School



La Habra

• La Habra High School

• Sonora High School

4. Los Alamitos Unified School District (LAUSD)

The city of Los Alamitos is served by LAUSD:

• Los Alamitos High School

5

Placentia-Yorba Linda Unified School District (PYLUSD)

The cities of Placentia, Yorba Linda, and Anaheim are served by PYLUSD:

Anaheim

• Esperanza High School

Placentia

• El Dorado High School

• Valencia High School

Yorba Linda

• Yorba Linda High School

Central Region of Orange County

The Central Region of Orange County consists of the following six (6) school districts:

1. Huntington Beach Union High School District (HBUHSD)

The cities of Huntington Beach, Fountain Valley, and Westminster are served by HBUHSD:

Huntington Beach

• Huntington Beach High School

• Edison High School

• Marina High School

• Ocean View High School

Fountain Valley

• Fountain Valley High School

Westminster

• Westminster High School



2. Garden Grove Unified School District (GGUSD)

The cities of Garden Grove, Westminster, and Fountain Valley are served by GGUSD:

Garden Grove

• Bolsa Grande High School

• Garden Grove High School

• Pacifica High School

• Rancho Alamitos High School

• Santiago High School

Westminster

• La Quinta High School

Fountain Valley

• Los Amigos High School

3. Newport-Mesa Unified School District (NMUSD)

The cities of Newport Beach and Costa Mesa are served by NMUSD:

Newport Beach

• Corona del Mar High School

• Newport Harbor High School

Costa Mesa

• Costa Mesa High School

• Estancia High School

• Early College High School

• Middle College High School

4. Orange Unified School District (OUSD)

The cities of Orange, Anaheim, and Villa Park are served by OUSD:

Orange

• El Modena High School

• Orange High School

Anaheim

• Canyon High School



Villa Park

• Villa Park High School

5. Santa Ana Unified School District (SAUSD)

The city of Santa Ana is served by SAUSD:

• Century High School

• Cesar Chavez High School

• Godinez Fundamental High School

• Lorin Griset Academy

• Middle College High School

• Saddleback High School

• Santa Ana High School

• Segerstrom High School

• Valley High School

6. Tustin Unified School District (TUSD)

The cities of Tustin, Santa Ana, and Irvine are served by TUSD:

Tustin

• Tustin High School

Santa Ana

• Foothill High School

Irvine

• Arnold Beckman High School

South Region of Orange County

The South Region of Orange County consists of the following four (4) school districts:

1. Capistrano Unified School District (CUSD)

The cities of San Clemente, Dana Point, San Juan Capistrano, Laguna Niguel, Aliso Viejo, and Rancho Santa Margarita are served by CUSD. Additionally, the communities of Las

Flores, Coto de Caza, Dove Canyon, Ladera Ranch, and Wagon Wheel are served by

CUSD. The following high schools are a part of CUSD:

• Aliso Niguel High School

• Capistrano Valley High School

• Dana Hills High School



• San Clemente High School

• San Juan Hills High School

• Tesoro High School

2. Saddleback Valley Unified School District (SVUSD)

The cities of Mission Viejo, El Toro, Laguna Hills, Lake Forest, Rancho Santa Margarita,

Foothill Ranch, and Trabuco Canyon are served by SVUSD. The following high schools are a part of SVUSD:

• El Toro High School

• Laguna Hills High School

• Mission Viejo High School

• Mira Monte High School

• Trabuco Hills High School

3. Laguna Beach Unified School District (LBUSD)

The city of Laguna Beach is served by LBUSD. The following high school is part of LBUSD:

• Laguna Hills High School

4. Irvine Unified School District (IUSD)

The cities of Irvine and Tustin are served by IUSD. The following high schools are part of

IUSD:

• Creekside High School

• Northwood High School

• Irvine High School

• San Joaquin High School

• University High School

• Woodbridge High School



appendix D – orange County Rx/oTC lifetime Use by Regions

62






63


64




appendix e –orange County Rx/oTC lifetime Use by Rx/ oTC Drugs

In relation to prescription and over-the-counter drugs, the California Healthy Kids Survey

(CHKS) asks students – “During your life, how many times have you used or tried…” The following tables reflect the results of the 2007-2008 Orange County CHKS survey in percentiles.

lifetime use

0 times

1 time

2-3 times

4 or more times

7 th

Grade n/a n/a n/a n/a

Prescription Pain Killers

9 th

Grade

90

3

3

4

11 th

Grade

83

4

5

8

Nontraditional

65

6

9

20 lifetime use

0 times

1 time

2-3 times


7 th Grade n/a n/a n/a n/a

Barbiturates

9 th Grade

97

1

1

1

11 th Grade

97

1

1

1

Nontraditional

90

2

4

4 lifetime use

0 times

1 time

2-3 times


7 th


Tranquilizers or Sedatives

9 th

Grade

96

1

1

2

11 th

Grade

93

2

2

3

Nontraditional

81

4

5

9 lifetime use

0 times

1 time

2-3 times



Ritalin or Adderall (RX Stimulants)

9 th Grade

96

1

1

2

11 th Grade

93

2

2

3

Nontraditional

81

4

5

10


Orange County Comprehensive Report life ti me use

0 ti mes

1 ti me

2-3 ti mes

4 or more ti mes

7 th


Cold/Cough Medicines

9 th

Grade

83

3

5

9

11 th

Grade

81

4

5

11 life ti me use

0 ti mes

1 ti me

2-3 ti mes

4 or more ti mes


Diet Pills

9 th Grade

94

1

2

3

11 th Grade

94

1

1

3

Nontradi ti onal

66

7

10

18

Nontradi ti onal

87

2

3

7



appendix f - strategic Planning session Participants

Marianne Cadiz, MPH



Teri Christensen

Partnership for a Drug-Free America

Ryan Crowdis, MSW, PPS

Orange County Department of Education,

Alternative, Correctional, Community Educational

Schools & Services

Sue Donelson, MPH


Project PATH – North/Central

Gwen Drenick, MPH

National Council on Alcoholism & Drug

Dependency, Inc.


Suzanne Etheridge, MFT

County of Orange Health Care Agency, Alcohol &

Drug Abuse Services – Prevention Team

Cheri Fleming


Ruel Fuentecilla, 1st Lt, USAF, MPA


Terah Glass, CHES


Dependency, Inc.


Martha Espiritu



Dan Gleason, MPH


Project PATH – North / Central

Francine Haight, RN

Ryan’s Cause

Frank Hernandez, MPH, CHES

California State University of Long Beach

Romeo Howe

Consultant

Erica Leary, MPH (Facilitator)

North Coastal Prevention Coalition

Anthony Pang

University of California at Irvine



Alcohol & Drug Education & Prevention Team

Leigh Poirier, MEd

University of California at Irvine

Rebeka Sanchez, MPH, CHES



Fabiola Soto



Pauline Stauder, MPH, CHES



Grace Tan, MPH


Dependency, Inc.





Aimee Hendle



DTP310