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Brought to you by the Arizona Pharmacy Foundation Educating the public concerning the delivery Brought to you by the Arizona Pharmacy Foundation Educating the public concerning the delivery of pharmaceutical care www. azpharmacy. org

Mission Statement: AWARERX. ORG is an information source providing authoritative resources about medication safety, Mission Statement: AWARERX. ORG is an information source providing authoritative resources about medication safety, prescription drug abuse, medication disposal, and safely buying medications on the internet.

Prescription / Over-the-Counter Drugs Prescription / Over-the-Counter Drugs

Rx/OTC Abuse Every day, 2500 teens abuse a prescription drug for the first time. Rx/OTC Abuse Every day, 2500 teens abuse a prescription drug for the first time.

How Rx drugs are obtained Got it from a friend Medicine cabinet in my How Rx drugs are obtained Got it from a friend Medicine cabinet in my home Internet

Rx/OTC Medicines Abused §Rx pain relievers (Vicodin, Oxy. Contin, Soma) §Rx stimulants (Adderall, Ritalin) Rx/OTC Medicines Abused §Rx pain relievers (Vicodin, Oxy. Contin, Soma) §Rx stimulants (Adderall, Ritalin) §Rx tranquilizers/sedatives (Xanax, Valium) §Rx Sleep Aids (Ambien, Lunesta) §OTC cough/cold with ‘DXM’ (Robitussin, Coricidin)

Troubling Indicators of Medicine Abuse §Unintentional drug poisoning now second leading cause of accidental Troubling Indicators of Medicine Abuse §Unintentional drug poisoning now second leading cause of accidental death in US, after car crashes § 111% increase in ER visits concerning non medical use of narcotics (2004 -2008) §Rx drugs are now the most commonly abused drugs among 12 -13 year olds

Who Is It Affecting? ARIZONA YOUTH In 2010, 10. 4% of AZ youth reported Who Is It Affecting? ARIZONA YOUTH In 2010, 10. 4% of AZ youth reported current Rx drug misuse (the most commonly used substance after alcohol, tobacco and marijuana and a 69. 8% increase between 2006 and 2010) ◦ While rates of Rx type use were comparable to national levels for Sedatives and Stimulants, Arizona youth in all grades reported higher rates of Pain Reliever misuse (16. 8% lifetime use, 7. 7% current use) ◦ The majority of youth (92. 7%) reported obtaining them from everyday sources (e. g. friends and family/home) Sources of Rx Drugs for Arizona Youth (2010) 100 90 ◦ In 2010, 68. 6% of youth reported using both Rx drugs and alcohol in the past 30 days, with 27. 6% reporting Rx drug use and heavy (binge) drinking 80 Percent (%) Obtained 70 60 50 40 30 20 10 0 Everyday Sources 92. 7% Other, 22. 8%

What Is It Costing Us? Mortality & Morbidity ◦ Opioid-related cases in the ER What Is It Costing Us? Mortality & Morbidity ◦ Opioid-related cases in the ER have consistently increased A 34. 5% increase between 2008 -2010 ◦ 442 deaths involved Rx narcotic drugs in AZ in 2010 (A 53. 5% increase between ‘ 06 -’ 10) 11% were youth & young adults ages of 1524 years Opioid Analgesics accounted for 64. 3% ◦ Health insurance and AHCCCS costs 52. 5% of opioid-related AZ ER cases in 2010 were paid for by AHCCCS/Medicaid CDC estimates Rx Pain Relievers cost health insurers up to $72. 5 billion annually Increase in Crime Arizona Rx Narcotic Related Deaths 350 2006 2007 2008 2009 2010 300 250 Number of Deaths 200 150 100 50 0 Opioid Analgesics Methadone Synthetic Narcotics

Key Factors Driving Teen Medicine Abuse Misperceptions that abusing medicine is not dangerous (safer Key Factors Driving Teen Medicine Abuse Misperceptions that abusing medicine is not dangerous (safer than “street drugs”) Ease of access via medicine cabinets at home or friend’s house, own or other person’s prescriptions

Teen perceptions of safety Sanitized Sanctioned Safe Created in a medical laboratory for healing Teen perceptions of safety Sanitized Sanctioned Safe Created in a medical laboratory for healing purposes Accepted by society as a “positive” Certified by FDA

What about parents’ perceptions? §Street drugs are generally considered more dangerous §Parents are less What about parents’ perceptions? §Street drugs are generally considered more dangerous §Parents are less familiar with “pills” – they often have no frame of reference since these types of drugs of abuse didn’t exist in their youth §There’s a lack of urgency around Rx-OTC

Parent/Kid Conversation Only 1 in 5 (20%) teens report that their parents have never Parent/Kid Conversation Only 1 in 5 (20%) teens report that their parents have never talked to them about alcohol or illegal drugs Half of teens (51%) say their parents have never talked to them specifically about prescription drug abuse

Why AWARx. E? • Tragic Events at Local Level • Helps Address Public Perception Why AWARx. E? • Tragic Events at Local Level • Helps Address Public Perception Gap • • Value of pharmacists & other health professionals. • • Medicine is more than a commodity. Personal Responsibility in Health Care Proactive on Issues of Importance to the Public and the Pharmacy Profession

Focus Areas: § § § Illicit Online Pharmacies Counterfeit Drugs Prescription Drug Abuse & Focus Areas: § § § Illicit Online Pharmacies Counterfeit Drugs Prescription Drug Abuse & Recovery OTC Abuse by Kids Medication Disposal Medication Misuse/Patient Safety & Adherence

Obtaining Medications Obtaining Medications

Ordering Medications Online §Does the website require a prescription? §Where does the company ship Ordering Medications Online §Does the website require a prescription? §Where does the company ship their medications from? §Do they keep the medication in a controlled environment? §Who is monitoring the company to make sure it provides REAL medication?

Illicit Online Pharmacies §Eighty-five percent of anchor sites (135) do not require a prescription Illicit Online Pharmacies §Eighty-five percent of anchor sites (135) do not require a prescription in order to purchase controlled prescription drugs online. §Of those sites not requiring prescriptions: • 42 percent (57) explicitly stated that no prescription was needed; • 45 percent (61) offered an “online consultation; ” and, • 13 percent (17) made no mention of a prescription. Source: The National Center on Addiction and Substance Abuse at Columbia University White Paper, “You’ve Got Drugs!” V: Prescription Drug Pushers on the Internet, July 9, 2008

Illicit Online Pharmacies Of the 159 identified websites offering controlled prescription drugs for sale Illicit Online Pharmacies Of the 159 identified websites offering controlled prescription drugs for sale in 2008: § 24 percent (38) indicated that the drugs would be shipped from a U. S. pharmacy; § 40 percent (63) indicated that they would be coming from outside the U. S. ; and, § 36 percent (58) gave no indication of the geographic source of the drug. Source: The National Center on Addiction and Substance Abuse at Columbia University White Paper, “You’ve Got Drugs!” V: Prescription Drug Pushers on the Internet, July 9, 2008

Use Caution When Purchasing Medications on the Internet Some websites you visit: §Are not Use Caution When Purchasing Medications on the Internet Some websites you visit: §Are not licensed in the U. S. or do not have a licensed pharmacist working at the dispensing facility §Will sell you medication that is medically unnecessary for you §Won’t verify the medication they are sending you will not interact with any other current medications you are taking §Won’t secure your personal information

Use Caution When Purchasing Medications on the Internet Some of the medications distributed on Use Caution When Purchasing Medications on the Internet Some of the medications distributed on the internet: §Are counterfeit (look real, but are fake) §Are not the correct dose for your condition (too strong or weak) §Are not approved by the FDA §Are not stored properly in the shipping process §Contain unsafe ingredients §Have expired

A Safer Way to Order Online NABP’s VIPPS Accreditation (Verified Internet Pharmacy Practice Sites) A Safer Way to Order Online NABP’s VIPPS Accreditation (Verified Internet Pharmacy Practice Sites) For more information visit the following links: http: //www. awarerx. org/temp 3/online. Pharmacies. html http: //www. nabp. net/index. html? target=/vipps/intro. asp& http: //www. fda. gov/buyonline/

Safety At Home Safety At Home

What to Do… AT HOME §Keep medications in original containers §Never take someone else’s What to Do… AT HOME §Keep medications in original containers §Never take someone else’s medication §Read the label every time you take a dose §Keep a current list of your medications §List your allergies (food, herbal, drugs) §Place medication in a safe location

Lock Up Your Medicines §Prescription pain killers §Anti-anxiety medications §Medications for sleep You play Lock Up Your Medicines §Prescription pain killers §Anti-anxiety medications §Medications for sleep You play a big role in keeping these powerful medicines out of the hands of those who shouldn’t have them

Disposal of Unused/Expired Meds §Take medication as directed, including length of time. §Discard medications Disposal of Unused/Expired Meds §Take medication as directed, including length of time. §Discard medications when too old or no longer needed §See expiration date, beyond use date, or “EXP” on Rx label or OTC package. §Do not flush unused medications unless directed to do so on the label or patient instructions.

Disposal of Medications 1. Take your prescription drugs out of their original containers 2. Disposal of Medications 1. Take your prescription drugs out of their original containers 2. Mix drugs with undesirable substance, such as cat litter, or used coffee grounds. 3. Put this mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag. http: //www. alliancehealthcard. com/freerx/54167%20 own%20 orange%20 pills%20 square. JPG

Disposal of Medications 4. Conceal or remove any personal information, including Rx number, on Disposal of Medications 4. Conceal or remove any personal information, including Rx number, on the empty containers by covering it with black permanent marker or duct tape, or by scratching it off. 5. Place the sealed container with the mixture, and the empty drug containers, in the trash. http: //proteus. pca. state. mn. us/publications/w-hhw 4 -54. pdf

How to Avoid Excess Medications §Finish entire prescription of antibiotics §These are prescribed in How to Avoid Excess Medications §Finish entire prescription of antibiotics §These are prescribed in exact quantities and are meant to be taken until all pills are gone even if you feel better before this point §Left over antibiotics can lead to bacteria resistant to that antibiotic in the future

How to Avoid Excess Medications §New Prescriptions or As Needed Prescriptions §You can have How to Avoid Excess Medications §New Prescriptions or As Needed Prescriptions §You can have your pharmacy fill a partial prescription (less than what is written by doctor) to test medication §Or fill only what you need §The rest of the prescription will be saved at the pharmacy for future fills

Ensuring Safe Medication Use Ensuring Safe Medication Use

Safety Recommendations • Participate in your health care • Keep records of your allergies, Safety Recommendations • Participate in your health care • Keep records of your allergies, medications and conditions • Know your health care goals • Use pharmacies you trust • Ask your pharmacist and doctor when you have questions http: //www. pharmacist. com/Content/Navigatio n. Menu 3/Newsroom/American. Pharmacists. Month /American_Pharmacists. htm

§Talk Take Action! about this alarming trend §Safeguard medications at home (and ask friends §Talk Take Action! about this alarming trend §Safeguard medications at home (and ask friends to do the same) §Dispose §Order of medications properly prescriptions only from an approved internet site

References http: //proteus. pca. state. mn. us/publications/w-hhw 4 -54. pdf http: //www. smarxtdisposal. net/ References http: //proteus. pca. state. mn. us/publications/w-hhw 4 -54. pdf http: //www. smarxtdisposal. net/ http: //drugfreeaz. org/ http: //www. awarerx. org/ http: //nabp. org/

For More Information. . . The Arizona Pharmacy Foundation is a licensee of the For More Information. . . The Arizona Pharmacy Foundation is a licensee of the AWARx. E program, in collaboration with the National Association of Boards of Pharmacy (NABP). For more information please contact the Arizona Pharmacy Association 480 -838 -3385, www. azpharmacy. org