OPIOID EPIDEMIC IN CENTRAL OKLAHOMA YOUTH

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Jeremy May
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THE PULSE OPIOID EPIDEMIC IN CENTRAL OKLAHOMA YOUTH Checking our pulse is essential in monitoring our Vital Signs.

As of 2015, more than four out of five prescription-related overdose deaths in Oklahoma involved opioids like oxycodone, hydrocodone, codeine, fentanyl, Demerol, and/or Lortab.

2 In this issue of the Pulse, we focus our attention on how dramatic increases in prescriptions, coupled with social acceptance of opioid medications, is leading to the opioid epidemic among Oklahoma

DEFINITIONS Opioids 4 also known generically as prescription painkillers or pain relievers are natural or synthetic chemicals that reduce feelings of pain by blocking receptors in the brain.

1 THE PULSE OPIOID EPIDEMIC IN CENTRAL OKLAHOMA YOUTH Checking our pulse is essential in monitoring our Vital Signs. The Pulse highlights a specific indicator of human well-being that is contained in United Way of Central Oklahoma s Vital Signs report or is being noticed through United Way s work in the community. As of 2015, more than four out of five prescription-related overdose deaths in Oklahoma involved opioids like oxycodone, hydrocodone, codeine, fentanyl, Demerol, and/or Lortab. 1 Sadly, Oklahoma ranks sixth highest in the nation for nonmedical use of prescription drugs among youth ages 12 to 17 years. 2 In this issue of the Pulse, we focus our attention on how dramatic increases in prescriptions, coupled with social acceptance of opioid medications, is leading to the opioid epidemic among Oklahoma youth. We also provide best practice solutions that are available in central Oklahoma to meet this growing priority need. DEFINITIONS Opioids 4 also known generically as prescription painkillers or pain relievers are natural or synthetic chemicals that reduce feelings of pain by blocking receptors in the brain. 3 This includes heroin and the prescription pain relievers morphine, hydrocodone, oxycodone, codeine, fentanyl, Demerol and Lortab. Misuse 5 Taking a prescription in a different way than your doctor prescribed. Ex: taking a higher dose or taking it more often, mixing medications with alcohol or other drugs, snorting or injecting crushed pills, etc. Taking a prescription that is not yours, even for a medical reason. Taking a medication to get high. Addiction 6 a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. United Way of Central Oklahoma

UNITED STATES In the United States in 2015... over 33,000 people died due to opioid-related overdose the highest year on record.

1 OKLAHOMA COUNTY UNINTENTIONAL OVERDOSE DEATHS *8 32 % Illicit drugs ** Prescription drugs 70 % Opioids are the #1 drug involved in unintentional overdose deaths in Oklahoma - Hydrocodone and

2 UNITED STATES In the United States in over 33,000 people died due to opioid-related overdose the highest year on record. Almost 50% of opioid overdose deaths were due at least in part to a prescription opioid. 7 OKLAHOMA In Oklahoma as of out of 10 unintentional poisoning deaths include prescription drugs. 1 OKLAHOMA COUNTY UNINTENTIONAL OVERDOSE DEATHS *8 32 % Illicit drugs ** Prescription drugs 70 % Opioids are the #1 drug involved in unintentional overdose deaths in Oklahoma - Hydrocodone and oxycodone are involved in more overdose deaths than methamphetamines, cocaine, and heroin combined. 9 Misuse of prescription drugs before the age of 13 significantly increases risk of prescription drug abuse and dependence later in life. 10 RISK FACTORS FOR YOUTH SUBSTANCE ABUSE 11 Community factors Family factors School factors Peer/ individual factors Availability; low neighborhood attachment; community disorganization; and extreme economic and social deprivation Family history; family conflict; and favorable parent attitudes and involvement in the problem behavior Academic failure and lack of commitment to school Early initiation of drug use; early and persistent antisocial behavior; friends who use drugs; and gang involvement

OKLAHOMA RANKS 6 th in the nonmedical use of prescription drugs among youth aged 12 to 17. 2 HIGHEST IMPACT ON YOUTH 13.9 % 5.

12 of Oklahoma youth aged 12-17 years have used opioids for nonmedical reasons, higher than the 4.67% national average.

situations Making decisions Controlling emotions/desires Addiction Motivation Memory Learning Judgment Social behavior Poor academic performance Dropping out of

problems) Involvement with juvenile justice system HOW DO ADOLESCENTS GET THESE DRUGS?

3 OKLAHOMA RANKS 6 th in the nonmedical use of prescription drugs among youth aged 12 to HIGHEST IMPACT ON YOUTH 13.9 % 5.33 % of Oklahoma 9th through 12th graders have used prescription drugs without a doctor s prescription. 12 of Oklahoma youth aged years have used opioids for nonmedical reasons, higher than the 4.67% national average. 13 NEGATIVE EFFECTS OF DRUGS IN THE DEVELOPING ADOLESCENT BRAIN INCLUDE DISRUPTION IN THE AREAS OF BRAIN FUNCTION AND SOCIAL BEHAVIOR 6 Brain function Assessing situations Making decisions Controlling emotions/desires Addiction Motivation Memory Learning Judgment Social behavior Poor academic performance Dropping out of school At risk for unplanned pregnancies Increased risk of violence Social and family problems Health issues (including infectious disease and mental health problems) Involvement with juvenile justice system HOW DO ADOLESCENTS GET THESE DRUGS? Oklahoma students reveal most common sources for obtaining prescription drugs to get high: 9 6th grade friends, followed by doctor/pharmacy and then by family/relatives 8th grade friends, followed by home (e.g. medicine cabinet) and then at parties 10th grade friends, followed by parties and home (e.g. medicine cabinet) 12th grade friends, followed by parties and then by home (e.g. medicine cabinet)

OVERPRESCRIBING CONTRIBUTES TO YOUTH ACCESS Although the amount of pain Americans

OKLAHOMA RANKED 5 th for prescribing rate of opioids in 2012 and 8th for high-dose

Oklahoma in 2015 12 OPIOID OVERDOSE SYMPTOMS CAN OCCUR WITH MEDICAL OR NONMEDICAL USE!

skinned people or grayish or ashen tones for darker skinned people Slow, shallow,

THE EVENT OF AN OVERDOSE EMERGENCY Call 9-1-1 and give naloxone, an over-the-counter

If no reaction in three minutes, give second naloxone dose. Do rescue breathing.

4 OVERPRESCRIBING CONTRIBUTES TO YOUTH ACCESS Although the amount of pain Americans report has not changed since 1999, the amount of opioids prescribed was three times higher in 2015 compared to UNFINISHED opioid prescriptions are often available in home medicine cabinets OKLAHOMA RANKED 5 th for prescribing rate of opioids in 2012 and 8th for high-dose opioids 15 Oklahoma County had ONE OF THE HIGHEST opioid prescription rates in Oklahoma in OPIOID OVERDOSE SYMPTOMS CAN OCCUR WITH MEDICAL OR NONMEDICAL USE! KNOW THE SYMPTOMS Won t awaken when aroused Bluish purple skin tones for lighter skinned people or grayish or ashen tones for darker skinned people Slow, shallow, erratic or absent breathing Snore-like gurgling or choking sounds Pinpoint pupils IN THE EVENT OF AN OVERDOSE EMERGENCY Call and give naloxone, an over-the-counter medication used to reverse the effects of emergency opioid overdose. If no reaction in three minutes, give second naloxone dose. Do rescue breathing. Follow dispatcher instructions. Stay with the person until help arrives. Naloxone wears off. A person who has overdosed may experience symptoms again. Always also seek emergency care.

PROTECTIVE FACTORS AGAINST YOUTH SUBSTANCE ABUSE Community factors Family factors School factors Peer/ individual factors Opportunities for social involvement (e.g.

5 PROTECTIVE FACTORS AGAINST YOUTH SUBSTANCE ABUSE Community factors Family factors School factors Peer/ individual factors Opportunities for social involvement (e.g. sports league participation, leadership development programs, etc.). Family attachment; given responsibilities and participate in meaningful family activities; and rewarded through praise, encouragement and attention when things are done well. Opportunities for social involvement (i.e. meaningful participation in important school activities) and recognized and rewarded for those contributions. Have a moral code (i.e. what is right or wrong) and associate with peers who engage in positive social behaviors. WHAT CAN YOU DO? SAFE USE Tell your healthcare provider all medications and supplements you are taking. Do not take more medicine or take medicine more often than instructed. Never mix opioids with alcohol, benzodiazepines, sleeping pills or any illicit substance. SAFE STORAGE Store prescription opioids in a secure place, such as a locked medicine cabinet. SAFE DISPOSAL Dispose of medications promptly and properly. NEVER flush them down the toilet! CALL to find your nearest FREE disposal site. CONCERNED ABOUT ADDICTION OR OVERDOSE FOR YOURSELF OR A LOVED ONE? National Helpline HELP Call or go to takeasprescribed.org Naloxone is available and FREE in locations throughout the OKC metro and surrounding areas, go to takeasprescribed.org to find a location near you. VOLUNTEER REVIEWERS: Terri White, Commissioner, Oklahoma Department of Mental Health and Substance Abuse Services; Carrie Daniels, State Epidemiological Workgroup Coordinator, Oklahoma Department of Mental Health and Substance Abuse Services; Avy Redus, Project Coordinator, Injury Prevention Services, Oklahoma State Department of Health; and Claire Nguyen, Epidemiologist, Injury Prevention Service, Oklahoma State Department of Health. UNITED WAY STAFF: United Way of Central Oklahoma staff Debby Hampton, CEO and President; Crystal Stuhr, Vice President of Strategies and Community Investment; Amanda Templeton, PhD, Director of Research and Advocacy; Anna Moorhead, Research Assistant; and Kimberly Vautrin, Creative Design Manager.

6 The Pulse is a product of Vital Signs; Oklahoma s only broad-based community evaluation with over two decades of trend data in five key areas important to our quality of life. Interested in printed copies of our research publications or a presentation? Contact United Way of Central Oklahoma s Community Impact Department at info@unitedwayokc.org or NOTES AND CITATIONS 1. Oklahoma State Department of Health. Injury Prevention Services. Unintentional Poisoning [Online] Substance Abuse and Mental Health Services Administration National Survey on Drug Use and Health: Model-Based Prevalence Estimates (50 States and the District of Columbia). Substance Abuse and Mental Health Services Administration. [Online] Centers for Disease Control and Prevention. Guideline Information for Patients: Safer, More Effective Pain Management. Centers for Disease Control and Prevention. [Online] March American Society of Addiction Medicine. Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine. [Online] National Institute on Drug Abuse. Prescription Pain Medications (Opioids). National Institute on Drug Abuse for Teens. [Online] July Drug Abuse and Addiction. Drugs, Brains, and Behavior: The Science of Addiction. [Online] July Centers for Disease Control and Prevention. Opioid Overdose. Centers for Disease Control and Prevention. [Online] July Oklahoma State Department of Health, Injury Prevention Services. Unintentional overdose deaths of Oklahoma County Residents By Substance. [Data file] Oklahoma State Department of Health. Reducing Prescription Drug Abuse in Oklahoma. OSDH Web Document Server. [Online] Does Early Onset of Non-medical Use of Prescription Drugs Predict Subsequent Prescription Drug Abuse and Dependence? Results From a National Study. Sean E. McCabe, Brady T. West, Michele Morales, James A. Cranford, Carol J. Boyd. 12, 2007, Addiction, Vol. 102, pp Oklahoma Department of Mental Health and Substance Abuse Services Oklahoma Prevention Needs Assessment Survey. Oklahoma Department of Mental Health and Substance Abuse Services. [Online] GP Guy, K Zhang, MK Bohm, J Losby, B Lewis, R Young, LB Murphy, and D Dowell. Vital Signs: Changes in Opioid Prescribing in the United States, Morbidity and Mortality Weekly Report (MMWR). [Online] Centers for Disease Control and Prevention, July SAMHSA: Arthur Hughes, Matthew R. Williams, Rachel N. Lipari, and Jonaki Bose and Kroutil, RTI International: Elizabeth A. P. Copello and Larry A. Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. [Online] September Leonard J. Paulozzi, MD, Karin A. Mack, PhD, Jason M. Hockenberry, PhD. Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines--United States, CDC Morbidity and Mortality Weekly Report (MMWR). [Online] July Centers for Disease Control and Prevention. Opioid Prescribing: Where You Live Matters. CDC Vital Signs. [Online] July Opioid Prescribing. Vital Signs. [Online] July Oklahoma Department of Mental Health and Substance Abuse Services. State Comparisons on Menath Health, Substance Abuse and Other Related Topics. [Online] OK2Share. Nonmedical Use of Prescription Drugs. [Data file] * Numbers are not mutually exclusive decedents may have died of an overdose from both prescription and illicit drugs. These individuals are counted in both categories. ** Illicit drugs includes methamphetamine, cocaine, heroin, and/or PCP. United Way of Central Oklahoma PO Box 837 Oklahoma City, OK unitedwayokc.org United Way of Central Oklahoma

Mark Edlund, MD, PhD RTI International. Photo courtesy of The Herb Museum, Vancouver, BC

Opioid Use Disorders and Their Treatment Mark Edlund, MD, PhD RTI International Photo courtesy of The Herb Museum, Vancouver, BC Acknowledgements Funded by NIDA R01 DA022560-01 NIDA R01 DA034627 NIDA R01