National Summit. Coalition to Prevent ADHD Medication Misuse (CPAMM) Executive Summary. Table of contents

Transcription

1 2015 Coalition to Prevent ADHD Medication Misuse (CPAMM) National Summit Executive Summary Table of contents The Issue of ADHD Medication Misuse...2 The CPAMM National Summit...3 The Coalition Participants Other Participants...6 Key Takeaways: Research Presentations...7 Key Takeaways: The Student Panel and Perspectives Actionable Recommendations Summary...14

2 the issue of adhd MeDiCation Misuse Despite press and media coverage of prescription drug abuse, the misuse, abuse and diversion of ADHD prescription stimulant medication remains a serious issue, especially among college students. Though recent research has revealed varying rates of misuse, a 2013 study at one large public university found that nearly 10 percent of college students reported nonmedical use of prescription stimulant medication in the past year 1. Meanwhile, questions remain about whether students recognize not only the health risks but the legal and academic consequences of misusing or diverting ADHD prescription stimulant medication. 1. Source: McCabe, S.E., West, B.T., Teter, C.J. & Boyd, C.J., Trends in Medical Use, Diversion, and Nonmedical Use of Prescription Medications among College Students from 2003 to 2013: connecting the Dots, Addictive Behaviors (2014), doi: /j.addbeh the Coalition to Prevent adhd MeDiCation Misuse In an effort to address the issue, organizations representing the medical community, pharmaceutical community, mental health advocacy groups, college administrators and student leaders formed the Coalition to Prevent ADHD Medication Misuse or CPAMM. The Coalition works to help prevent the misuse, abuse and diversion of ADHD prescription stimulant medication, specifically among college students, and strives to be a trusted source of information on the issue by raising awareness and taking action through the development of programs, tools and tactics to prevent misuse, abuse and diversion. Partner organizations include: American Academy of Family Physicians (AAFP), BACCHUS Initiatives of NASPA, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), The JED Foundation, NASPA Student Affairs Administrators in Higher Education, and Shire. Shire is the sole funder of CPAMM. Since the announcement of its formation in August 2014, CPAMM has launched a website approved and funded CPAMM partner project proposals; and aligned on strategic initiatives including research and educational programs and ongoing collaboration. Within these initiatives, CPAMM conducted a market research survey with Harris Poll which revealed that college students perceptions and attitudes toward the misuse, abuse and diversion of ADHD prescription stimulant medications are complex 2. The survey represents one of many milestones for CPAMM and served as a key step in the Coalition s effort to understand the attitudes, motivation, perceptions and misperceptions among college students regarding the issue. 2. Harris Poll survey conducted on behalf of the Coalition to Prevent ADHD Medication Misuse (CPAMM). The survey was administered online within the United States among 2,056 U.S. college students aged Following the coalition to Prevent adhd medication misuse (cpamm) National Summit, students and cpamm representatives met with legislative staff and members of the u.s. House and Senate to share research on the issue of prescription stimulant misuse, abuse and diversion, information on the work of CPAMM, insights from the Summit, and the perspective of the students. Pictured (Left to Right): kaaren ruth, Director, Patient advocacy at Shire; alexandra zandra Hoffman, a rising sophomore at ringling college of art and Design and a native of Mansfi eld, Texas; Hannah Jones, a rising junior at the University of Kentucky and a native of Lexington, k.y.; kevin kruger, President of NaSPa Student affairs administrators in Higher Education; and representative andy Barr (ky-6). 2

3 THE CPAMM NATIONAL SUMMIT CPAMM hosted its first-ever National Summit on July 13-15, 2015, to convene a group of engaged organizations and individuals and help determine the best way to reach college students regarding this issue. The Summit featured insightful presentations from leading researchers, conversations involving college students and breakout sessions that reported out actionable recommendations for preventing ADHD prescription stimulant medication misuse, abuse and diversion. The Summit convened representatives from more than 15 organizations and included a panel of students, some with ADHD and some without ADHD. Robin Koval, President and CEO of The Truth Initiative (formerly the American Legacy Foundation), was among the keynote speakers at the CPAMM National Summit. She discussed effective approaches for reaching students, highlighting the organization s award-winning Truth Youth Tobacco Prevention Campaign as a model for success. 3

4 The Coalition Participants In addition to being active participants at the National Summit, CPAMM partners are finalizing plans to implement the following projects to help further address the issue of misuse, abuse and diversion of ADHD prescription stimulant medication: AAFP is spearheading research to distinguish current approaches to prevention of ADHD prescription stimulant medication misuse in primary care of teens and young adults. The research will help guide the identification of potentially impactful primary-care based strategies that reduce ADHD prescription stimulant medication misuse, abuse and diversion and reinforce appropriate use. BACCHUS Initiatives of NASPA plans to engage collegiate peer educators to assist campus efforts to help prevent the misuse, abuse and diversion of ADHD prescription stimulant medication. CHADD will continue working to improve the lives of people diagnosed with ADHD through education, advocacy and support. This mission includes addressing the unique challenges students with ADHD face on college campuses, gaining a greater understanding of why they might choose to share their medicine and developing strategies to prevent diversion. 4

5 The Coalition Participants The JED Foundation will continue inspiring a national dialogue on mental health, encouraging millions of young people to speak up and take action, helping academic institutions create healthier campus communities, preventing substance abuse and self-harm, and educating students that there are healthier and safer ways to cope with stress. NASPA is collaborating with BACCHUS Initiatives of NASPA and the University of Washington to conduct quantitative and qualitative research among college students and administrators to try to gain a better understanding of how the college environment affects the issue and what kind of programmatic efforts and messages might be the most effective. Shire, through its funding of CPAMM, will support the Coalition s launch of an educational campaign reaching key influencers, specifically physicians and college administrators, and will continue to be a partner in designing educational initiatives and programming to help prevent ADHD prescription stimulant medication misuse, abuse and diversion. 5

6 Other Participants summit research presentations/keynote speakers Amelia Arria, Ph.D., Director of the Center on Young Adult Health and Development, University of Maryland Congressman Gus Bilirakis (R-FL) Robyn Bell Dickson, Research Director, Harris Poll Nicole Fossos-Wong, Research Coordinator Supervisor/Lead, University of Washington Jason Kilmer, Ph.D., Assistant Director of Health and Wellness for Alcohol and Other Drug Education Division of Student Life, University of Washington Robin Koval, CEO, The Truth Initiative (formerly American Legacy Foundation) David Rabiner, Ph.D., Associate Dean at the Trinity College of Arts and Sciences, Psychology and Neurosciences, Duke University Student panel Alexandra Zandra Hoffman, Ringling College of Art and Design Hannah Jones, University of Kentucky Josh Ratner, University of Maryland Jason Reimer, San Francisco State University Amanda Whitecotton, University of Alabama-Tuscaloosa additional attendees American Professional Society of ADHD and Related Disorders (APSARD) Edge Foundation Partnership at DrugFree.org A selection of government agencies 6

7 key takeaways: research presentations Many of the key takeaways are already being addressed by existing CPAMM initiatives. The following may help to inform new opportunities for CPAMM as well as other stakeholders interested in preventing ADHD prescription stimulant medication misuse on college campuses. dispel the smart drug myth. Recognize that the issue of misuse & the profile of the misuser is complex which requires multiple approaches. ENGAGE & EDUCATE parents as influencers. Identify WHat happens when a Student with ADHD is asked to divert, & how we can Support THEM IN NOT SHARING THEIR MEDICATION. HELP COLLEGE ADMINISTRATORS understand THE PROFILE OF THE MISUSER & THE NEED TO INTERVENE TO HELP THEM SUCcEED ACADEMICALLY. Promote & celebrate students (and their schools) that are able to achieve academic success & a healthy balance of extracurricular & social activities through on-campus support programs & initiatives. 7

8 key takeaways: the student Panel CPAMM accepted applications from across the country and invited five students to participate in a panel discussion at the Summit to share their college perceptions relating to ADHD prescription stimulant medication misuse, abuse and diversion. The students perspectives were essential in helping to shape the actionable recommendations and next steps identified by the Summit workgroups, as they offered valuable insight into what types of strategies and messaging may help prevent misuse, abuse and diversion among their peers, those with ADHD and without ADHD. The Coalition to Prevent ADHD Medication Misuse (CPAMM) convened a panel of students for its fi rst-ever National Summit in Washington, D.C., on Tuesday, July 14, 2015, to learn more about the issue of ADHD prescription stimulant medication misuse and identify ways to prevent the issue on college campuses. Pictured (Left to Right): Hannah Jones, a rising junior at the University of Kentucky and a native of Lexington, K.y.; Alexandra Zandra Hoffman, a rising sophomore at Ringling College of Art and Design and a native of Mansfi eld, Texas; Josh Ratner, a rising senior at the University of Maryland and a native of great Neck, N.y.; Jason Reimer, a rising junior at San Francisco State University and a native of Saratoga, Calif.; and Amanda Whitecotton, a rising sophomore at the University of Alabama-Tuscaloosa and a native of allen, texas. 8

9 Key Insights: The Student Panelist Perspective The panel of students with ADHD shared that students will sometimes hide their condition out of fear of being targeted, and will hide their medication in a lock box or in a prescription bottle with a different label to avoid having their medication stolen. There was agreement among the student panelists that the misuse of ADHD prescription stimulant medication on college campuses creates a variety of unintended consequences, including a misperception among peers that students with ADHD have an academic advantage because they take prescription stimulants. The misperception further stigmatizes the condition. There s a perception that there is no harm in taking the medication if you don t have ADHD, and students aren t thinking about the potential long-term effects of misusing. And students never see anyone get in trouble for doing it. There s no enforcement. There s a misperception among students that it s a magic smart pill. From a social standpoint, you think about how your peers will think about you if you say no, I won t give you my medication. You think it will affect your relationship with your friends. So, a lot of people give away medication because they think it will help them maintain those relationships. When people first asked me to give them my medication, I just gave different excuses. I wish I was more prepared with how to handle the situation when I got to college. The student panelists shared the belief that students mainly misuse ADHD prescription stimulant medication because they believe it will enhance their academic performance, or help them stay up longer or party more. In their experience, ADHD prescription stimulant medication misuse is viewed as the norm among their peers, especially during mid-terms and final examinations.one potential reason for the misuse and diversion of ADHD medication misuse on college campuses: Students don t see the consequences for misusing ADHD prescription stimulant medication. In offering solutions, the student panelists suggested universities enforce their drug policies, but said that educating students about the issue and correcting misperceptions is critical. They also recommended educating the physicians and parents of students with ADHD about the issue, and providing them with information that will prepare students for what they might face when they arrive on campus. 9

10 Actionable Recommendations strategy Considerations After reviewing the notes from both workgroups (preventing misuse and preventing diversion), areas of strategic focus are as follows: Secure additional collaboration from key campus influencers and groups. Engage, educate and provide the support students with ADHD need to not divert. Formalize future engagement of our student panel and other students. Identify opportunities to collaborate with federal agencies. Messaging Considerations Peer-to-peer messaging will be developed as a result of the research from the NASPA-BACCHUS-University of Washington partnership. That messaging will inform many of the next steps detailed below. However, the workgroups did recommend exploring or testing the following messages: Present facts about the actual rate of misuse to combat social norming of the issue (e.g., everyone is not doing it). Focus on perceived short-term benefits (e.g., achieving academic success) vs. potential long-term impact of misuse (e.g., lack of ability to cope in the real world, risks). Address misinformation or lack of awareness about the misuse and diversion of ADHD prescription stimulant medication (e.g., it s a Schedule II controlled substance, illegal to divert or misuse, how it helps the student with ADHD). Insert the voice of the student with ADHD to better raise awareness of the condition and build respect and support for the student with ADHD (recommended by the student panel). Take a more positive approach to messaging, recognize the students who are working hard and studying the right way, or celebrate schools that are working to reduce pressure on today s college student. 10

11 Actionable Recommendations Secure additional collaboration from key campus influencers and groups There is opportunity to implement recommendations from the Summit in conjunction with key campus influencers and groups. Specifically, the Coalition would like to identify ways to collaborate on solutions to prevent misuse and diversion with the following groups: College administrators & academic affairs officers: In addition to discussing the insertion of strong language condemning the misuse and diversion of ADHD prescription stimulant medication in Codes of Conduct or similar student conduct policies, one of the new concepts discussed included monitoring for at-risk students who might be more likely to misuse because they are under academic pressure or misuse for other reasons (e.g., partying). How can we intervene to make sure they don t misuse? College Orientation & Freshman Year: The Summit workgroups recommended starting the conversation with first-year students about how to study, manage their time and academic assignments, providing them with tools to cope with stress, and making it clear that ADHD prescription stimulant medication misuse is counterproductive to a successful academic or future career. Bystander intervention, the idea of being able to identify those at risk and report them, could also be included here to teach students the skills needed to identify the risks and how they apply to ADHD prescription stimulant medication misuse. These professionals could also collaborate with CPAMM on ways to communicate to the parents of these students when they are a captive audience during orientation. College health, counseling & disabilities offices: These professionals are in a unique position to educate students on the issue of ADHD prescription stimulant medication misuse, counsel students with ADHD on the dangers of diversion and provide them with the tools to protect their medications, and intervene if they suspect a student has misused or diverted. What information and tools do we need to provide them? Further, if a campus is involved in the diagnosis of ADHD and is prescribing prescription stimulant medications to students with ADHD, we may recommend exploring the idea of a signedcontract with those students pledging that they will not divert. The workgroup also discussed the idea of mentoring students with ADHD, pairing freshman with upper classmen. National fraternity & sorority organizations: The peer-to-peer messaging that results from the research of NASPA-BACCHUS-University of Washington could help inform additional programming, specifically targeting the students involved in fraternities and sororities who research suggests may be most at risk to misuse ADHD prescription stimulants. Bystander intervention could also be included here. 11

12 Actionable Recommendations Engage, educate and support Students with ADHD to prevent diversion In addition to CPAMM s influencer campaign and the research of AAFP, there were other recommendations from the Summit to help engage, educate and support students with ADHD. Tap into cpamm-sponsored research For key insights: CPAMM heard from students with ADHD on the panel about their perceptions of why college students with ADHD divert, but there was agreement that we need to know more and understand the motivation of the student who diverts so we can identify the right messaging and design the proper interventions by tapping into NASPA-BACCHUS-University of Washington research. Find opportunities to share the voice of the college student with ADHD: In addition to testing some of the messaging discussed at the Summit, workgroups recommended further engaging students. Create resources to support Students with ADHD & their parents: Channels such as CPAMM.org, CHADD s National Resource Center and others should share helpful information for students such as how to protect your meds; why you should not divert; how to talk to your peers about the condition; why diversion is not the solution for students without ADHD struggling academically, etc. Also, educate parents and enlist their support in educating their collegebound son or daughter with ADHD. Tips could include helping a student with ADHD understand the importance of taking their medication as prescribed, taking a lock box to school to protect their meds and understanding the social, health and legal risks of diverting. In addition, student mentoring programs could be powerful for students with ADHD. 12

13 Actionable Recommendations Formalize future engagement of student panel & other students Ongoing input and collaboration with students will be critical to the success of CPAMM, and all of the student panelists (those with ADHD and those without ADHD) asked to continue to be involved with CPAMM following the Summit. Formalizing the students role within CPAMM could include creating a Student Ambassador program with the following components: Sharing perspectives on the website: Profile the Ambassadors, share their perspectives, and give them an opportunity to enlighten others on the issue of ADHD prescription stimulant medication misuse and diversion (e.g., photos and brief narrative or Q&A format). Creating a student pledge: Create a formal pledge for students (including our Ambassadors) to sign and share, taking a stand and making a commitment not to divert or misuse ADHD prescription stimulant medication. Leveraging social networks: Engage our Ambassadors to share news and information regarding CPAMM with their friends and family. Utilizing them as a focus group: As CPAMM works to develop education and programming, utilize the students as an informal focus group, sharing the work and enlisting their feedback. Identify opportunities to collaborate with federal agencies No specific next steps came out of the Summit, but we found that some organizations have existing programs where CPAMM messaging, education and programming could be inserted. 13

14 summary The CPAMM strategy considerations noted above will be further informed by upcoming research through AAFP and NASPA-BACCHUS, but the Coalition will align on additional next steps in the planning process for sign up for the cpamm newsletter at CPAMM.org/ -signup join the conversation today. #cpammorg visit cpamm.org for more information. 1/16 S