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From the symposium: "Epidemic of Prescription Drug Overdoses: A Call to Action".
This resource document was produced to be used in a symposium sponsored by the Ohio Department of Health Injury Prevention Program and the Poison Action Work Group of the Ohio Injury Prevention Partnership (co-sponsored by the Ohio Department of Alcohol and Drug Addiction Services). It provides examples of state and national campaigns aimed at reducing the misuse and abuse of prescription drugs.
State & National Campaigns Aimed at Parents
Not Worth the Risk — Even If It’s Legal
The National Council on Patient Information and Education (NCPIE) and the Substance Abuse and Mental Health Services Administration (SAMHSA) partnered on this campaign to provide outreach resources to prevent prescription medication abuse. Their resources, offered in both Spanish and English, encourage parents to talk to their teens about prescription
drug abuse.
http://www.talkaboutrx.org/not_worth_the_risk.jsp
Five Moms Campaign: Stopping Cough Medicine Abuse
Five Moms literally joined together to start a campaign against cough medicine abuse. They encourage all parents to talk to their children about the dangers of cough medicine abuse, and they work to reach people through their website, social networks and other media outlets.
http://fivemoms.stopmedicineabuse.org/page/protect/
Partnership for a Drug-Free America: Time To Talk
“Time To talk” encourages parents to talk to their children about the dangers of drugs and alcohol. The program’s resources include a “talk kit” to aid parents in difficult conversations with their children about drugs. The kit includes scripts for such conversations, advice on “teachable moments” and advice on how to teach kids to turn down drugs.
http://www.timetotalk.org/AboutTimeToTalk/
Parents. The Anti-Drug.
The National Youth Anti-Drug Media Campaign encourages parents to talk to their teens about drugs and alcohol. The campaign’s website includes sections on drug information, parenting advice and additional resources. It also sponsors commercials and other media campaigns relating to drug abuse. Other resources include prescription drug abuse reports, tips for safeguarding prescription medication, and an “Rx Wallet Card” to help people keep track of their prescription medications.
http://www.theantidrug.com/resources/teen-rx.aspx
Not In My House
Sponsored by The Partnership for a Drug-Free America and Abbot Laboratories. Describes “what to do” in terms of monitoring, securing and disposing prescription medications. Discusses “Teen Culture: Talking to Your Teen,” and provides insight into “What the Experts Say.”
http://www.drugfree.org/notinmyhouse/default.aspx
Prescription for Disaster: How Teens Abuse Medicine
The Drug Enforcement Agency’s resource to raise awareness about prescription medication abuse. The Guide presents prescription drug basics, includes information about commonly abused drugs, lists steps parents can take to keep their teens drug free, and more.
http://www.getsmartaboutdrugs.com/people_of_dea/
prescription_for_disaster_how_teens_abuse_medicine.html
Campaigns Aimed at Teens and their Mentors
NCPIE/SAMHSA’s Teen Influencers Project
This program aims to protect teens by reducing prescription drug abuse. The initiative encourages educators, healthcare providers, parents and other “teen influencers” to talk to teens about prescription drug abuse. The program provides easy-to-use materials to help mentors reach out to teens. [To be launched in 2009.]
D.A.R.E. America: Helping Communities Respond to Prescription and Over-the-Counter Abuse
D.A.R.E. America provides several resources to help raise awareness about prescription and over-the-counter drug abuse. These include lesson plans geared toward high school students, as well as a parents/ community presentation. A DVD is provided to assist instructors with the delivery of these lessons. The program’s resources also include pamphlets for parents and high school students.
http://www.dare.com/home/features/story460a.asp?FeaturesID=1
Smart Moves, Smart Choices
The National Association of School Nurses, in collaboration with Pri-Cara® (Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.), created this program to educate teens on the risks of prescription drug abuse. The program provides a four-part video series to educators. Each video is accompanied by science and language arts curricula. It also includes an additional video and guide for parents. The campaign also provides a “school assembly kit” with resources and tips for hosting a school assembly on the risks of prescription drug abuse.
http://www.nasn.org/Default.aspx?tabid=506
Community Anti-Drug Coalitions of America
CADCA partnered with the Office of National Drug Control Policy to develop Strategizer 52, “Teen Prescription Drug Abuse: An Emerging Threat” to provide facts about prescription drug abuse, strategies for teen influencers in the community, and best practices from communitybased anti-drug coalitions from across the country.
http://www.cadca.org
Preventing Drug Abuse Among Children and Adolescents
“Preventing Drug Abuse Among Children and Adolescents” is a researchbased guide for parents, educators, and community leaders. It presents prevention principles, an overview of program planning, and critical first steps for those learning about prevention.
http://www.nida.nih.gov/Prevention/Prevopen.html
Safe Medication Disposal Campaigns
Safe Medicine Disposal for Maine Program
The Safe Medicine Disposal for ME program provides Maine's residents with a safe disposal option for unused and unwanted medicine. Free medicine mail-back envelopes are available at participating sites. This program is funded through a grant from the United States Environmental Protection Agency's Aging Initiative.
http://www.safemeddisposal.com/
Smart Disposal: A Prescription for a Healthy Planet
This campaign provides instructions on how to safely dispose of prescription medication in order to protect the environment and prevent prescription drug abuse. Campaign resources include fact sheets, bookmarks, magnets, and PowerPoint presentations related to the subject.
http://www.smarxtdisposal.net/
Other Campaigns
Los Angeles Overdose Prevention Task Force
With a mission to “bring together individuals and specialists in the fields of public health, law and law enforcement, corrections, emergency services, medicine, needle exchange, homeless services, drug treatment and research to create coordinated opiate overdose prevention programs and policies,” this organization offers classes and training to its members in addition to its efforts to raise awareness.
http://www.odptf.org/index.htm
The Prescription Pain Medication Management and Education Program
The Prescription Pain Medication Management and Education Program is sponsored by the Utah Department of Health. Its goal is to reduce the number of unintentional prescription pain medication overdose deaths by 15% in 2009. It provides resources for parents, seniors, other adults, teens, and healthcare providers, including an information kit with a fact sheet, PowerPoints, brochures, etc.
http://www.useonlyasdirected.org/
Be MedWise
A National Council on Patient Information and Education (NCPIE) initiative to promote the wise use of over-the-counter medications. It provides resources to help patients better understand OTC labeling as well as brochure’s and public service announcements.
http://www.bemedwise.org/
Stop Medicine Abuse
The Stop Medicine Abuse Campaign is a resource primarily targeted toward over-the-counter drug abuse. Its resources include a “Take Action Checklist” in addition to brochures and other materials.
http://www.stopmedicineabuse.org/
Grandma’s Stash
An award-winning media campaign using newspapers, radio stations, billboards, buses and trains sponsored by
The Partnership for a Drug-Free New Jersey. Sends a message to parents, grandparents and other care givers
that young people have easy access to dangerous misused medications in home medicine cabinets.
http://www.drugfreenj.org/nj_nmam/
AWARxE
Inspired by the death of a St. Cloud, MN resident from a prescription drug overdose and founded by the Minnesota Pharmacists Foundation, believing pharmacists have a critical role in providing medication safety information and helping raise awareness about the dangers of abusing medications. Provides resources for “getting inspired,” “getting informed,” and “getting involved.”
http://www.awarerx.org/main.html
A Dose of Prevention
A partnership between the Consumer Healthcare Products Association, CADCA, D.A.R.E. America, and the Partnership for a Drug-Free America to engage community members and local media in the prevention of cough medicine abuse. Its toolkit provides an overview of the problem and information for parents, educators, retailers, healthcare professionals, and law enforcement personnel. Also included is a sample town hall presentation and media materials.
http://www.stopmedicineabuse.org/take-action/dose-of-preventiontoolkit/
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Selected Literature
Paulozzi LJ, Budnitz, DS, Yongli, X. “Increasing Deaths from Opioid Analgesics in the United States.” Pharmacoepidemiology and Drug Safety 2006; 15:618-627. <http://www.ncbi.nlm.nih.gov/pubmed/16862602>
This report compares the increase in unintentional drug poisoning mortality to the increase in sales of opioid analgesics nationwide. From 1994 – 2001, U.S. prescription audits have shown two to five-fold increases in the number of prescriptions written for hydrocodone, oxycodone, fentanyl and morphine. In correlation with this increase in opiate prescribing, by 2002 licit drugs replaced illicit drugs as the most common cause of fatal drug poisoning in the U.S.
Centers for Disease Control and Prevention. Prescription Drug Overdose: State Health Agencies Respond (2008). Arlington,
VA: Association of State and Territorial Health Officials. <http://www.cdc.gov/HomeandRecreationalSafety/pubs/
RXReport_web-a.pdf>
This report addresses prescription drug abuse as a public health problem. The authors interviewed nine different state health organization representatives to assess their awareness of prescription drug overdoses as a growing concern, learn about their responses to the problem, and identify barriers to addressing the problem. The authors of this report believe state governments need to find a “home” for coordinating the response to prescription drug overdoses. Currently, state health agencies do not have the capacity for injury prevention in general, and drug overdoses have to compete for attention with other injury priorities.
Centers for Disease Control and Prevention. “Unintentional Poisoning Deaths – United States, 1999-2004.” MMWR 2007;
56:93-96. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a1.htm>
This report summarizes data from the National Vital Statistics System. Poisoning mortality rates in the United States increased
each year from 1999 to 2004, rising a total of 62.5% during the 5-year period. The increase in poisoning mortality occurred most
frequently for deaths coded as “unintentional drug poisonings.” In 2004, drug poisonings resulted in 19,838 deaths, 94.7% of
which were unintentional. This report supports the idea that a more aggressive response to this problem is needed.
Droz, Danna. “OARRS: Ohio’s Prescription Monitoring Program.” Ohio Pharmacist 2009; 58(6):14-18.
This article describes the prescription monitoring program in Ohio. The Ohio Automated Rx Reporting System (OARRS) is a dispensing
database of all schedules of controlled substances and any non-controlled substances that are required by rule of the
Board of Pharmacy. All pharmacies licensed by Ohio that dispense these medications are required to submit information to the
Board of Pharmacy every week. Health professionals and law enforcement personnel with an active case can access the database
and request patient-specific drug profile reports.
Hall AJ, Logan JE, Toblin RL, et al. “Patterns of Abuse Among Unintentional Pharmaceutical Overdose Fatalities.”
JAMA 2008; 300(22):2613-2620.
This article evaluates the risk characteristics involved in unintentional pharmaceutical overdoses in West Virginia (which experienced
the nation’s largest increase in drug overdose mortality rates during 1999-2004). This study confirmed that almost all unintentional
drug overdose deaths in West Virginia involved prescription drugs. Among the 295 decedents in 2006, 93% involved
opioid analgesics.
Lipman, J. “The Methadone Poisoning ‘Epidemic’: Increasing Use of Methadone as a Pain Killer May Be Fueling a Disturbing
Increase in Death Related to this Potent Drug.” The Forensic Examiner 2008; 17(2):38(9).
This article addresses deaths due to methadone treatment, which are more prevalent than with any other prescription analgesic.
Methadone has a pain-relieving effect that lasts 4-6 hours. Patients who increase their dose once this effect wears off may reach
toxic levels that can lead to death. Patients need to be placed on a tailored dosing regimen with monitoring and educational diligence
to prevent toxicity.
McLellan AT, Turner B. “Prescription Opioids, Overdose Deaths, and Physician Responsibility.” JAMA 2008; 300
(22):2672-2673. <http://jama.ama-assn.org/cgi/content/full/300/22/2672>
This article addresses three important questions about the physician’s obligation to relieve pain and prevent addiction/drug overdoses.
First, do the reported findings of death due to overdose suggest excessive opioid prescribing practices? Second, what do
recent studies suggest about the role of addiction in overdose deaths and about the physician’s responsibility for addiction?
Third, what do recent data suggest about the role of prescription diversion and overdose deaths and the physician’s responsibility
to prevent this diversion?
National Institute on Drug Abuse. Screening for Drug Use in General Medical Settings Resource Guide (2009). Bethesda,
MD: NIDA. <http://nida.nih.gov/nidamed/screening/>
The prescribing of opioid analgesics and psychotherapeutics requires close oversight. NIDA has provided this resource guide to
help physicians manage pain and prevent prescription drug abuse. The guide suggests physicians ask patients about alcohol and
drug abuse. Patients with a history of substance abuse or mental health problems should receive special attention, such as druguse
monitoring and routine drug screenings in the primary care setting.
Paulozzi LJ, Yongli X. “Recent Changes in Drug Poisoning Mortality in the United States by Urban-Rural Status and by
Drug Type.” Pharmacoepidemiology and Drug Safety 2008; 17:997-1005.
This article quantifies recent changes in drug poisoning rates in rural areas and the drugs which are responsible. Studies showed
a 51% increase in non-suicide drug poisoning mortality rates in U.S. metropolitan counties versus a 159% increase in nonmetropolitan
counties. Deaths due to heroin decreased by 9% and deaths due to cocaine increased 35%, while deaths due to
prescription opioids increased 142% between 1999 and 2004.
Other Resources
Unintentional prescription drug poisonings, now the second leading cause of accidental death in the United States and the leading cause of accidental death in Ohio, have become a serious public health problem. For more information on the nation’s call to action, visit the following web sites:
DEA – Drug Enforcement Agency http://www.usdoj.gov/dea/index.htm
FDA – Food and Drug Administration – Misuse of Prescription Pain Relievers
http://www.fda.gov/Drugs/ResourcesForYou/ucm080368.htm
NADDI – National Association of Drug Diversion Investigators http://www.naddi.org/
NASCSA – National Association of State Controlled Substance Authorities http://www.nascsa.org/
NIDA – National Institute on Drug Abuse http://nida.nih.gov/index.html
NSC – National Safety Council – Unintentional Poisoning from Overdoses http://nsc.org/resources/issues/poison.aspx
ONDCP – Office of National Drug Control Policy http://www.whitehousedrugpolicy.gov/index.html
Parents. The Anti-Drug http://www.theantidrug.com/
Partnership for a Drug-Free America http://www.drugfree.org/
SAMHSA – Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention
http://prevention.samhsa.gov/
State health officials have responded differently to this growing epidemic. Common responses have included the formation of state
task forces and the implementation of prescription drug monitoring programs. Several state campaigns were highlighted in previous
sections of this document (MN, UT, NJ). For more information on state-level responses, visit the following web sites:
Drug Abuse in America: Prescription Drug Diversion. Trend Alert: Critical Information for State Decision-makers. The Council of
State Governments. 2004.
http://www.csg.org/pubs/Documents/TA0404DrugDiversion.pdf
Poisoning and Drug Overdose. Washington State Department of Health.
http://www.doh.wa.gov/hsqa/emstrauma/injury/pubs/icpg/DOH530090Poison.pdf
Opioid Overdose Prevention & Reversal (Information Sheet 2008). Massachusetts Department of Public Health.
http://www.mhsacm.org/PDFs/ODPrevReversal050208.pdf
Prescription Drug Overdose: State Health Agencies Respond. Association of State and Territorial Health Officials. 2008.
http://www.cdc.gov/HomeAndRecreationalSafety/Poisoning/prescription_overdose.html
The rise in drug overdose mortality due to prescription medications is largely due to the misuse of opioid analgesics, powerful painkillers
with severe abuse potential. For drug specific information about opioid (and other) medications, visit the following web sites:
DEA OxyContin information http://www.justice.gov/dea/concern/oxycontin.html
FDA Fentanyl Public Health Advisory http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm051257.html
FDA Methadone Public Health Advisory http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm124346.htm
FDA Index to Drug-Specific Information
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111085.htm
NIDA Drugs of Abuse – Prescription Medications http://www.nida.nih.gov/drugpages/prescription.html
ONDCP Drug Facts http://www.whitehousedrugpolicy.gov/drugfact/index.html
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