EAP Implications of Prescription
Drug Use in the
Workplace
Laurie Lovedale, MPH, CPS II
Prescription Drug Abuse Prevention
Program Coordinator
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc.
Mission: Dedicated to quality, accessible
prevention and intervention services in
workplaces and communities, focused on
substance use and related issues.
Serving Colorado since 1984
Peer Assistance Services, Inc. 2014
Prescription Drug Abuse Prevention
Program
• A State Priority Initiative funded by the
Colorado Office of Behavioral Health
• 5-year funding cycle
Peer Assistance Services, Inc. 2014
2010-2015 Program Objectives
• Increase awareness of the problem
• Increase availability of medication disposal
programs statewide
• Encourage responsible prescribing practices
• Encourage patient responsibility
• Track data and trends
Peer Assistance Services, Inc. 2014
Agenda/Objectives
• Drug Free Workplace Data
• Typology of Abuse
• Prescription Drug Abuse Overview
– National/State/Local Data
– Medication Overview
• Prevention Strategies
• Medication Take Back Event
Peer Assistance Services, Inc. 2014
Drug-Free Workplace
• The rate of drug use
among American
workers has declined
by
since the Drug-Free
Workplace Act was
passed 25 years ago.
•
Drug Testing Index Quest Diagnostics
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Drug-Free Workplace
• Positive rates for
certain drugs,
including opiates
and amphetamines,
have increased
substantially.
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Drug-Free Workplace
• Prescription opioids
–
–
–
–
Hydrocodone (Vicodin)
Hydromorphone (Dilaudid)
Oxycodone (OxyContin)
Oxymorphone (Opana)
More than doubled
Up 71 percent
Peer Assistance Services, Inc. 2014
Drug-Free Workplace
• Positivity rates for amphetamines, including
amphetamine and methamphetamine, has
nearly tripled (196% higher) in the combined
U.S. workforce and, in 2012, were at the
highest level since 1997.
• The positivity rate for amphetamine itself,
including prescription medications such as
Adderall®, has more than doubled in the last
10 years.
Peer Assistance Services, Inc. 2014
What is
Prescription Drug Misuse?
The use of a medication
(for a medical purpose)
other than as directed
or as indicated.
Peer Assistance Services, Inc. 2014
What is
Prescription Drug Abuse?
The intentional
self-administration
of a medication
for a non-medical
purpose.
Includes “academic enhancement”
Peer Assistance Services, Inc. 2014
Why is there so much medication
out there?
• Culture of “Pain-Free”
society
• Blind Faith in medical
system to cure anything
• Direct to consumer
marketing from
pharmaceutical
companies
• Prescription
medications are safe
Peer Assistance Services, Inc. 2014
The 3 R’s for Medication Safety
• RISKS – All medicines have RISKS as well
as benefits
• RESPECT the power of your medicine and the
value of medicines properly used
• Take RESPONSIBILITY for learning about
how to take your medication safely
Peer Assistance Services, Inc. 2014
Typology of Abuse
Used to Self-Treat
Acquired Drug with
Legitimate Prescription
Acquired Drug Without
Legitimate Prescription
Self-treat other medical
condition with previous Rx
(off label use)
Use other person’s
medication (sharing)
Self-treat
migraine with their own
medication
Used to Get High/Euphoria
Parent taking
child’s medication to be
productive
May start off with
legitimate pain med, but
get addicted over time
May have bought/traded
with others to get
medication used to get
high
Use current medication to
party/get high
Stealing
grandparent’s and getting
high
Using their
own Rx, but taking it with
alcohol to keep party going
McCabe & Boyd, 2010 . Retrieved from
http://captus.samhsa.gov/sites/default/files/capt_resource/paw
-prescriptiondrug.pdf
Peer Assistance Services, Inc. 2014
DEA
Schedule
Abuse Potential
Highest
Effects
Medical Use
Heroin, LSD, Marijuana,
Bath Salts
High potential for abuse,
severe psychological or
physical dependence,
death
No accepted
use
Morphine, Hydromorphone,
Methadone, Oxycodone,
Fentanyl, Adderall, Ritalin
High potential for abuse
which may lead to severe
psychological or physical
dependence
Accepted use
with
restrictions
Vicodin, Tylenol with
codeine, Suboxone and
Subutex
Potential for abuse less
than 1 and 2, may lead to
moderate or low physical
dependence or high
psychological
Accepted use
Low
Xanax, Klonopin, Valium,
Ativan, Halcion
Low potential for abuse
relative to Schedule III’s
Accepted use
Lowest
Over the counter of
prescriptions with codeine,
Robitussin AC
Low potential for abuse
Accepted use
relative to Schedule IV’s
Peer Assistance Services, Inc. 2014
1
High
2
Medium
3
4
5
Examples of Drugs
Covered
Main Types of Abused
Prescription Medications
1. Depressants used to treat sleep disorders and
severe anxiety (Xanax & Valium)
2. Stimulants used to treat behavior disorders
such as ADHD (Ritalin & Adderall)
3. Opioids used to treat pain (Oxycontin &
Vicodin)
Peer Assistance Services, Inc. 2014
Why Prescription Drugs?
• Easy Access
– 70% from a friend or relative
– Easier to get Rx drugs than beer
2011 National Survey on Drug Use and Health
Young Adults feel they are “safer” than illicit
drugs
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National Data
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Center for Disease Control
Poisoning is now the leading cause of death from
injuries in the United States and nearly 9 out of 10
poisoning deaths are caused by drugs.
(Centers for Disease Control 2008)
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Colorado Data
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Peer Assistance Services, Inc. 2014
In 2012 more than twice as many people
in Colorado died from poisoning due to
opioid analgesics (295) than from
drunk-driving related crashes (133).
Department of Public Health and Environment, Health Statistics Section
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2012 Prescription Opioid Deaths
by Age
90
77
80
Number of Deaths
70
62
64
60
46
50
40
30
23
20
15
6
10
0
18-25
26-34
35-44
45-54
55-64
Age (years)
65-74
75+
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2012 Rx Opioid Deaths by Gender
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Prescription Opioid Deaths 2012
295 of the 807
drug poisoning
deaths in
Colorado
involved
prescription
opioids
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Prescription Opioid
Hospitalizations 2012
1,131 of the
5,291 drug
poisoning
hospitalizations
in Colorado
involved
prescription
opioids
21%
Peer Assistance Services, Inc. 2014
Youth Risk Behavior Survey
Colorado
•
•
•
•
•
Fall 2011
9th grade – 12.4%
10th grade – 17%
11th grade – 19.1%
12th grade – 29.2%
National
•
•
•
•
•
Sept. 2010 – Dec. 2011
9th grade – 16.5%
10th grade – 18.2%
11th grade – 23.3%
12th grade – 25.6%
Peer Assistance Services, Inc. 2014
DEPRESSANTS
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Depressants
(CNS depressants)
• Also referred to as sedatives and tranquilizers
• Benzodiazepines
– Alprazolam (Xanax) & Diazepam (Valium)
– Treat anxiety, acute stress reactions and panic
attacks
– Triazolam (Halcion) Short-term treatment of sleep
disorders
• Inhibit brain activity which produces a drowsy
or calming effect
Peer Assistance Services, Inc. 2014
Short Term Effects
• Short term
–
–
–
–
–
–
–
–
Slowed pulse and breathing
Slurred speech
Drowsiness
Lowered blood pressure
Poor concentration, fatigue and confusion
Impaired coordination, memory and judgment.
Suppress respiration/death
Addiction
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Long term effects
• Addiction
• Respiratory depression and respiratory
arrest
• Death
• Chronic fatigue
• Sexual problems
• Sleep problems.
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Peer Assistance Services, Inc. 2014
CNS Depressants
• Combining with other CNS depressants
(alcohol)
– Affect heart rhythm
– Slow respiration
– Death
• Withdrawal (Work with provider)
–
–
–
–
Anxiety
Insomnia
Depression
Seizures
Peer Assistance Services, Inc. 2014
OPIOIDS
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Opioids
• Relieve pain by reducing the intensity of pain
signals reaching the brain and affect those brain
areas controlling emotion, which diminishes the
effects of a painful stimulus.
– Hydrocodone (Vicodin)- most commonly prescribed
for a variety of painful conditions, including dental
and injury-related pain.
– Oxycodone (OxyContin, Percocet)
– Morphine (Kadian, Avinza)- often used before and
after surgical procedures to alleviate severe pain.
– Codeine- often prescribed for mild pain.
Peer Assistance Services, Inc. 2014
Opioids
• Attach to proteins called opioid receptors
located in the brain, spinal cord, GI tract, and
other organs in the body.
• When opioids attach to receptors, they reduce
the perception of pain.
Peer Assistance Services, Inc. 2014
Short Term Effects
•
•
•
•
•
•
Drowsiness
Mental confusion
Nausea
Constipation
Respiratory depression
Euphoric response
Peer Assistance Services, Inc. 2014
Long term effects
•
•
•
•
•
Addiction
Severe lethargy
Sleep apnea
Falls and fractures in the elderly.
As dose increases, pain patients also become
susceptible to a condition known as
hyperalgesia, in which they feel more, not
less pain.
Peer Assistance Services, Inc. 2014
Opioids
• Withdrawal (Work with provider when
weaning off of opioids)
–
–
–
–
–
–
–
Restlessness
Muscle and bone pain
Insomnia
Diarrhea
Vomiting
Cold flashes with goose bumps
Involuntary leg movements
Peer Assistance Services, Inc. 2014
Tolerance to Opioids
• Tolerance develops rapidly to the sedating, and
euphoric effects of opioids
• It develops more slowly to their analgesic
effects
• Tolerance can be characterized as decreased
sensitivity to opioids
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Similarities between
Illicit
and
Prescription medications
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Opioid Induced Hyperalgesia
• Increased sensitivity to
pain resulting from
opioid use
• Hard for clinicians to
know if pain increase
due to opioids or if the
condition has worsened
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Pseudoaddiction
• Results from the misinterpretation of relief
seeking behaviors as though they are drugseeking behaviors that are commonly seen
with addiction
• The relief seeking behaviors resolve upon
institution of effective analgesic therapy
SAMHSA, Tip
54, Managing Chronic Pain in Adults with or in Recovery From Substance Use Disorders, 2012
Peer Assistance Services, Inc. 2014
STIMULANTS
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Stimulants
• Increase alertness, attention, and energy
• Elevate blood pressure, heart rate, and
respirations
• Mainly used in the treatment of ADHD and
narcolepsy
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Stimulants
• Schedule II Medication
• High potential for abuse which may lead to
severe psychological or physical dependence
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Short term effects
• Stimulants increase the amount of
norepinephrine and dopamine in the brain,
which increases blood pressure and heart rate,
constricts blood vessels, increases blood
glucose, and increases breathing.
• Effects can feel like an increase alertness,
attention, and energy along with a sense of
euphoria. There is also the potential for
cardiovascular failure (heart attack) or lethal
seizures.
Peer Assistance Services, Inc. 2014
Long term effects
• Addiction
• Taking high doses of some stimulants
repeatedly over a short time can lead to
feelings of hostility or paranoia.
• Taking high doses of a stimulant may result
in dangerously high body temperatures and
an irregular heartbeat.
• Cardiovascular failure (heart attack) or
lethal seizures.
Peer Assistance Services, Inc. 2014
Stimulants
• Withdrawal
– Fatigue
– Depression
– Disturbance of sleep
patterns
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Patient Responsibility
• Monitor all medications in their home
• Don’t stock pile
• Lock up or hide medications
– Do NOT store medications in the “medicine cabinet”
• Dispose of medications properly
• Talk to friends and family (even grandparents) about
securing their medications
• Understand the dangers of mixing medications and
alcohol
• Lead by example
Peer Assistance Services, Inc. 2014
Just because they are prescribed by a
health professional does NOT mean
they are safe
Prescription medications are only safe
• for the prescribed patient
• for the prescribed reason
• for a prescribed time
Peer Assistance Services, Inc. 2014
Take Back
Event
April 26, 2014
10:00 – 2:00
www.dea.gov
Peer Assistance Services, Inc. 2014
Take Back Events
Colorado 2013
39,608 lbs
Nationally 2013
695 Tons
Peer Assistance Services, Inc. 2014
Thank You!
Contact Us:
2170 S Parker Road #229
Denver, CO 80231
www.peerassist.org
Facebook:
PreventRxMedicineAbuse
303-369-0039 x 203
llovedale@peerassist.org
Peer Assistance Services, Inc. 2014