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By: Marie Latsa

“Ohio #1 in the nation for overdose deaths” read the billboard near The Ohio State University’s campus. “Generation Rx Night at the Columbus Blue Jackets Game” read a flyer in the hallway of Parks Hall. Amazing Grace sang by nearly two hundred student pharmacists during a candlelight vigil in remembrance of those who have lost their battle to the disease of addiction. “Drug Take Back Day: Going on Now!” read a news segment headline on 10TV news. “Absolutely, I’ll be there,” stated a reply email from Councilman Stinziano when asked to collaborate for a Generation Rx teen toolkit presentation at Metro Early College High School.

Student pharmacists at The Ohio State University College of Pharmacy have been busy the past academic year educating the community about the misuse of prescription medications. In fact, we calculated an estimate of 91,573 people had in some way, shape or form been exposed to our promotional materials from January 2016 through April 2017. Throughout the course of the aforementioned timeline students gave a total of 17 Generation Rx presentations utilizing toolkits off of the generationrx.org website and conducted 18 non-presentation events such as working a booth at a local health fair, volunteering at The Pharmathon 5k in coordination with The Alumni Association or conducting a medication safety summer camp for kids.

Most recently, The Generation Rx Collaborative was recognized on the university level by The Office of Student Life for Excellence in Community Service Programming. None of our successes could’ve been obtained without the guidance of our mentors Dr. Hale and Dr. Kwiek, some resourcefulness, positivity, and, quite truthfully, a little bit of dumb luck. We would like to take the time to thank each and every one of our supporters for not only believing in us as student pharmacists but also in our cause: namely Lamar Advertising, The Columbus Blue Jackets, 10TV News, and The Lantern. We are humbled and thankful for a tremendous year, but know that our work is far from finished with regard to the opioid epidemic.

As for me, I am currently sitting in my room in my modest off-campus apartment with a purple carry-on stuffed to the brim and a cup of tea at my bedside. I will be taking that same purple carry-on with me tomorrow morning at 06:00 as I depart for Salt Lake City, Utah for the chance to attend The APhA Institute on Alcoholism and Drug Dependencies. How fitting it is for a cause that has been such a large part of past five years of my academic career to lead me into my fourth and final year of pharmacy school. It’s times like these when I wonder what I did to deserve the people and opportunities I’ve encountered at Ohio State. I am certain, though, that I am forever thankful.

Marie Latsa is a current fourth-year Doctor of Pharmacy Candidate at The Ohio State University College of Pharmacy. She served as Co-President of The Generation Rx Collaborative for the 2016-2017 academic year, but has been involved with Generation Rx since 2013. She will continue to work as a student lab assistant at The Generation Rx Lab at COSI throughout the duration of her academic career. Marie aspires to pursue a career in academia.

By: Joan Masters

Several years ago, our statewide coalition, Partners in Prevention was invited to take part in a project through our state Department of Mental Health to address prescription drug misuse of Missouri college students.  We were thrilled to take on this project.  We had been collecting data for several years on the health behaviors of Missouri college students and it was clear:  prescription drug misuse and abuse was on the rise.  What was even clearer:  students in Missouri didn’t think that prescription drug misuse and abuse was a problem.

In this day and age, it is pretty easy to convince a college student that drinking and driving is not a safe choice and most college students agree that the use of illegal drugs and the associated consequences of drug use don’t mix well with their academic goals and aspirations.  However, prescription drug abuse was a very different story.  They felt that “study drugs” as some students call prescription ADHD and ADD medications, did not interfere with their academic goals, and even more so, they saw these substances as a healthy and safe way to complete their academic work given the pressure of class, extracurriculars, and family obligations.  After looking closely at the data from our annual Missouri Assessment of College Health Behaviors (MACHB), we knew we had our work cut out for us:  Not only did we need to share with students that misuse of these drugs was illegal and against campus policy, we needed to provide them with alternative choices.

Our MoSafeRx program was three fold.  We provided places for students and staff to dispose of unused prescription medications and provided students with prescriptions the opportunity to lock their medicines up in a safer way.  Some students in Missouri felt that they were pressured to give their ADHD medications to other students or they were in fear that they would be stolen.  Providing locking caps and other education about safe storage and disposal was very important. Secondly, we used peer education and a social media campaign to get our message out to students.  Students at colleges throughout Missouri were trained in peer education tactics by NASPA, BACCHUS Initiatives and they used Generation RX materials to provide education to their fellow students.  They had two talking points:  using prescription drugs without a prescription is illegal and dangerous and there are other alternatives to using prescription drugs to sleep, study, or relieve pain.

These strategies were supported by poster campaigns and social media messages that didn’t just share the bad news, but rather gave students information about using the student health resources on campuses, rather than using pain medications without a prescription.  Students were given sleep strategies and information about balancing college life with healthy sleep.  These messages were promoted so that students could learn that the use of prescription sleeping aids was not the answer, unless that medication was prescribed.

Our project also spent a great deal of time in outreach and media messaging to students about using study groups, planning for study in advance, time management, and using campus learning support resources.  By sharing these study resources, we hoped students would turn to “studying” before “study drugs”.

Overall, we considered our project to be a success.  We are grateful for the support from the Missouri Department of Mental Health for their foresight for this important project.  Over the course of the three year project, use rates remained steady, but consideration of risk and other injunctive norms related to prescription drug use improved.  While national rates of illegal prescription drugs rise among the collegiate population, we feel that our project succeeded at keeping rates at minimal levels, rather than following the national trend.

Check out more about our project at http://rx.missouri.edu or find us on Facebook and Twitter at @MoSafeRx.

Joan Masters is the Senior Coordinator of Partners in Prevention and has worked with PIP since 2001. Joan is responsible for the training and technical assistance that PIP provides, provides oversight to the Partners in Prevention projects such as the Missouri College Health Behavior Survey and the problem gambling and suicide and mental health grants. She is able to assist campuses with coalition building, building peer education programs, and strategic planning. Joan is a Missouri Advanced Certified Substance Abuse Prevention Provider and received both her Master’s and Bachelor’s degrees from the University of Missouri. In addition to her work with PIP, Joan is currently serving as the Area Consultant for The BACCHUS Network.

By: Dr. Kathy McKee

As a physician who has worked with addiction, I have seen people struggle with the physical and psychological effects of maintaining sobriety after opioid withdrawal. Many months of triggering situations, and stress of rebuilding a healthy life can be overwhelming, and in many cases, lead to relapse and shame.

The medical community has recognized that addiction is a disease state, much like diabetes, in that it is chronic and relapsing in nature.  Opioid addiction is the most difficult addiction to overcome.  There is a very high relapse rate. Many people who are addicted have responded best to treatments that combine pharmacological and behavioral interventions. Increasingly, the medical community in addiction recognizes the need to treat the opioid addicted individual with medication, at least for a short while, to control physical symptoms. The person in early recovery can then focus on learning life skills, repairing relationships, developing community support and getting treatment for other mental and physical health concerns.

Experts are working on new treatment options and protocols. The best option would be for a medication that relieves physical symptoms and cravings, is not addictive or habit forming, has few side effects, is not expensive and has a flexible protocol so that it can be tailored to specific patient needs. Currently, the two most commonly used medications for opioid addiction treatment are: buprenorphine (Suboxone) and naltrexone (Vivitrol).

Suboxone is an opioid agonist, meaning that it acts just like an opioid. It is great at relieving symptoms, but just like the problem opioids, it can be abused and tapering off the medication can be slow and somewhat difficult. It is a small film that is dissolved under the tongue, usually once daily. People using this medication can continue work or go to class, and feel “back to normal”.

Naltrexone is an opioid antagonist. It blocks all opioid activity. If an opioid is used while the naltrexone is in the person’s body, it will have absolutely no effect. It controls cravings and the person feels satisfied. Naltrexone is available in daily tablet or monthly injectable forms. Most people find the monthly injectable form to be the most effective as they avoid the daily decision or opportunity not to take the medication. However, the injectable form is very expensive.

Probably the best opioid addiction treatment scenario for young, college-age students, at this time is to begin detoxification and early maintenance treatment with Suboxone. After several weeks or months of stable recovery, they would then switch to the naltrexone injectable. However, every treatment plan must be carefully tailored and monitored for each person.

Researchers are working to develop more understanding of the science of addiction, so as to develop better more effective medications for treatment in the near future. Medication is simply another “tool” to assist in recovery and building a healthier life. Recovery involves counseling and community support. Some people need a more prolonged medication treatment plan as there is more “work” to do.

There are many triggers and pitfalls to avoid in college life. The “people, places and things” of college life often involve casual and formal situations where drugs and alcohol are available, and expected. Medical professionals may unknowingly contribute as they prescribe pain medications or cough suppressants. There are stressors of academia and relationships which can cause a student to “search out” a familiar comfort from the past. College students trying to pursue their education while in recovery need every available “tool in our toolbox” to assist them in their journey.

Dr. Kathy McKee is a physician working at The Ohio State University Student Health Services. She is board certified in Family Medicine and Addiction Medicine and has worked in drug and alcohol rehabilitation, public and occupational health, as well as private practice.

By: Danielle Powall

It was February 10^th, 2015 I was sitting in an organic chemistry lecture listening to my professor go on and on about something I honestly wasn’t that interested in.  As I was checking the time, I noticed that my mom was calling me. Naturally, I let the call go to voicemail and sent her the text “I’m in class, is it important?” knowing that every time I’ve sent this text to her I immediately get a response back “No babes, call me after class” but this time she responded “Yes, call me asap.” A slight panic arose over me, wondering what it could be about.  I stepped into the hall to call my mother. She answered the phone with a calm tone and told me that my cousin Nicholas had had an overdose, I initially wasn’t sure exactly what this meant, so I paused and asked if he was in the hospital. She replied with “no honey, I’m sorry he’s gone” as she said those words I heard her voice trail off as she was about to cry. I felt like I had been hit by a truck. I remember leaning on the wall I was standing next to, not believing the words my mother had just spoken to me.

In the days to follow losing Nick there were a whirlwind of emotions that passed through my head. I was devastated over the fact of losing someone I loved so much, I was heartbroken by the hurt it caused my family but I was also angry. I was angry that this happened, that these tears and broken hearts quite possibly could have been prevented. I felt regret, running through the memories in my head trying to see if there was a point where I should have said something, reached out more or tried to help. But that’s what you do when you lose someone you love, you look back and try to see if you could have done something differently. The unfortunate reality is that the time had passed and no matter how badly I wanted to go back in time and change things I couldn’t. What I learned I can do, is try to help others from feeling the same gut wrenching pain that my family felt.

You see, Nicholas’s story didn’t start with his death, it started with a happy kid, who enjoyed life and those around him. He had good parents and a loving family whose support for him never wavered no matter the circumstance. He wasn’t perfect, but who could say they are? As a young adult, Nick starting working for a fortune 500 company in shipping and receiving. Due to his work, he had been experiencing some lower back pain. He expressed this to his friend’s mother who then offered him the rest of her opioid prescription pain killers to treat his back. This is where Nick’s struggle with addiction truly began. Nick was blessed with all the components of a happy life before he got addicted. I watched Nick suffer through this disease. I saw how he felt helpless, how desperately he wanted to be better but couldn’t, how hard he tried to fight it, yet continued to go back. When Nick initially became addicted my family tried to do everything in their power to help him from counseling, detox centers and long term residential facilities, but quickly learned that the resources will extremely limited.

This is where we come in, where nights like the NOPE  candlelight vigil can make a difference, and our voices can help prevent another family from feeling the same way mine has. My family and I will forever have a hole in our hearts from losing Nicky way too soon, but like I said before, we can’t dwell on what we should have done, we can only focus on what we can do as pharmacists and as a community. Through collaborations like Generation Rx, you can make a difference, you can go out and educate the public. Tell them how easily prescription drugs can be misused or abused. Educate them on things like drug give back days, that could help prevent anyone from giving their old prescription medication to someone who wasn’t prescribed it.  Help society transition from thinking that addiction is a choice and not a disease. Help them understand that our nation is experiencing an Opioid epidemic and it is taking our loved ones away from us. According to the Ohio Department of Health, on any given day in Ohio, eight people will pass away from a heroin overdose, just from heroin, not alcohol, not another illicit drug, heroin. It is a problem and it needs to be talked about. You can use your voice to make a difference and you should, because I never thought I would lose someone to this epidemic and let me tell you, it hurts like hell. So help me prevent another family from feeling the way mine does, go out and make a difference in your community and in our country, use your voice and together we can fight to help stop this epidemic.

Danielle Powall is a first year student pharmacist at The Ohio State University. She recently graduated from Ohio University where served as the pre-pharmacy club president for three years. Danielle currently serves as the P1 liaison for the Generation Rx Collaborate and the American Pharmacist Association-Academy of Student Pharmacists.

By: Cindy Clouner, LSW, OCPS I

Prescription drug misuse is an issue that college campuses face everyday.  According to the 2015 College Prescription Drug Survey , 1 in 4 undergraduate students have misused a prescription medication at some point in their lifetime.  Although often perceived as benign, the misuse of prescription medications can have social, academic, and financial consequences, as well as increase the risk for developing a substance use disorder.  The Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery (HECAOD) understands the need for addressing this issue and the resource constraints, in both time and money, that campuses face.  To combat this, HECAOD developed ScreenU, a web-based screening, brief intervention, and referral to treatment (SBIRT) tool to identify students at-risk of experiencing negative consequences for prescription drug misuse and connect them with resources on their campus that can support their success.

SBIRT is an evidence-based practice supported by the Substance Abuse and Mental Health Administration (SAMHA) and the World Health Organization (WHO) and ScreenU was designed using these principles.  Students begin by answering questions from a brief screening tool specifically designed with college students in mind.  These questions will identify a person’s behaviors that would be considered prescription drug misuse and their level of risk of developing dependence to prescription drugs. Through unbiased motivational interviewing techniques, participants have an opportunity to reflect on the potential impact of their misuse and consider if they are ready to change their behavior.  Participants then receive strategies that can help support the safe use of medications.  Students who screen at a high risk for dependence receive a recommendation to treatment services.  ScreenU closely mirrors this process, identifying a student’s risk level for experiencing negative consequences from prescription drug misuse and connecting them not just with strategies, but also resources local to their campus and community.

Historically SBIRT has taken place in clinical settings, such as emergency rooms, trauma centers, and student health centers on college campuses with professionals trained in motivational interviewing.  This causes a significant barrier to campuses working to implement SBIRT.  However, ScreenU takes these steps and digitizes them, allowing students to complete the screening and intervention on their laptops, tablets, and smart phones.  Additionally, ScreenU doesn’t require special training for staff, allowing for campuses to reach students in a variety of settings, including, but not limited to, academic advisors, conduct officers, Greek life, athletics, and first year orientation.

ScreenU is brief, taking only 5-10 minutes to complete, making it conducive to being repeated multiple times while a student is on campus. Currently 26 campuses across the country are implementing ScreenU with their students and HECAOD is excited about making ScreenU Rx, along with ScreenU Alcohol and ScreenU Marijuana, available to all institutions of higher education.

Colleges and universities have a unique opportunity to reach young adults, at the average age of first misuse of prescription medications, and identify students at risk of developing a substance use disorder and intervene before dependence occurs.  ScreenU can make this simple for campuses, providing a pro-active approach that supports a healthier campus life.

Cindy is a Prevention Specialist for the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery. She has spent 10 years working in alcohol and other drug prevention.

By: Larissa Morgan

3 AM. The first big exam of her junior year is in 5 hours. Why did she wait until the last minute to start preparing for six weeks of dense material? Not to mention, the exam is worth a considerable portion of her overall grade. She texts her friend: I’m going to fail this exam. Goodbye, grad school. She waits for a reply to bring a morsel of understanding to her current state of hopelessness.

The phone dings. Why worry yourself to death? It’s only taking away from your chance to study now. Come to my room. My roommate has stuff that’ll help you focus.

3:39 AM. She scratches her eyebrows and stares blankly at the flashcard. What did that word mean again? She shuffles through her notes looking for the answer. Nothing. She opens her drawer and sees the pills. Her friend’s voice infiltrates her thoughts: They’re like magic. Trust me. One time won’t hurt.

The pill goes down with a swig of water. She looks at the pile of flashcards. “Let’s do this.”

Although most Villanova students do not abuse prescription medications, anyone can relate to the feeling of immense pressure during periods of high stress, which can often be the trigger for initiating prescription drug abuse. In moments similar to the scenario described above, the temptation to take a medication can become a plausible reality, especially if one perceives that others are also using prescription drugs to cope with their circumstances. The perceived normalization of prescription drug use is consequential, as it could lead to a more prevalent drug culture on campus.

The most striking aspect of prescription drug abuse and misuse at Villanova is the distinction between perception and reality, and its potential implications for students’ decisions. Most Villanova students do not abuse prescription medications. Specifically, 93% of Villanova students report that they have never abused a prescription stimulant, and 97% report having never abused a prescription painkiller. However, Villanova students believe that more than 40% of their peers have abused a prescription medication. While I am incredibly encouraged to know that prescription drug dependency is not a pervasive issue on Villanova’s campus, most of my peers with whom I’ve spoken suggested that it wouldn’t be difficult to acquire someone else’s prescription medication, particularly Adderall, should they so choose. After speaking with some peers to gain individual perspectives on this issue, most of them expressed that they believe using Adderall before exams is a common phenomenon at a competitive, academic school like Villanova. Their thoughts were quite on par with the statistics that Villanova’s prescription drug culture is more common than in reality.
The biggest lesson we can take away from Villanova’s prescription drug climate is that we must pay attention to the reality of the issue because it could be different from what we think is happening. This can potentially change a student’s behavior surrounding prescription drug use. While Villanova students are motivated and driven for future success, most do not cope with the pressures that come with high achievement through prescription drugs. This implies that prescription drug abuse is not as common of a cultural phenomenon as students perceive. In order to mitigate the vast distinction between the reality of prescription drug use at Villanova and students’ perceptions, we should strive for more candid discussions surrounding this health issue. The Office of Health Promotion and the University Counseling Center have comprehensive education, prevention, and intervention programs, but awareness and support must also be cultivated among the student body. POWER, Peers Offering Wellness Education & Resources, is an organization of peer educators who are focused on promoting health awareness on campus. As a member, I believe POWER has the capacity to ignite these discussions throughout campus through forums, programs, panels, and other engaging events. Through peer-to-peer outreach, we can paint a realistic picture of prescription drug abuse at Villanova, while supporting those who are struggling with this issue to seek help through our incredible community.

Larissa Morgan is a senior at Villanova University with a double major in Psychology and Political Science. At Villanova, Larissa serves as Social Media Publicity Co-Director of POWER. She is passionate about encouraging her peers to make healthy choices and fostering an environment of support and respect. In addition to her involvement in POWER, Larissa also serves as President of BRIDGE Society and works as a peer tutor at the Villanova Writing Center. Larissa aspires to attend law school to pursue a career in mental health law and policy in order to advocate for the destigmatization of mental illness in society.

By: Ann Addington

When it first came to my attention that students were misusing prescription drugs in hopes of improving their grades or to get high, I must admit that like many other university professionals, I did not see it coming. We were utilizing our time and resources addressing the use of “street drugs” by our students.  You know the ones that are dangerous and illegal. Our minds were as vulnerable as our students, altered by the myth that the inclusiveness of the word “prescription” was surrounded by a safety net. Then bad things started to happen.  Universities nationwide started seeing an increase in student emergency department visits that were related to prescription drug misuse. This got our attention and we knew we had to do something.  We quickly found ourselves knee-deep in the familiar adage:  Houston we have a problem.

Photo courtesy of Ann
Addington.

At OHIO University, a multi-faceted approach is used to address the non-medical use of prescription drugs. Several grants from Cardinal Health have allowed us to conduct poster campaigns to bring awareness to the problem. The posters utilize social norming messages and outline the health and legal consequences associated with the misuse of prescription drugs. One popular poster features a job application that is red stamped “denied” because the applicant listed a felony charge for selling his prescription medication.

We have been fortunate to forge collaborations across campus to spread our message and further educate students, faculty, and staff about the misuse of prescription drugs. During midterms and finals we post flyers in the bathroom stalls of the university library that target the misuse of prescription stimulants. Last spring we collaborated with several student groups, POWER/GAMMA and the Pre-Pharmacy Club, to deliver two Generation Rx collegiate programs, The Adderall Dilemma and It’s Drug Abuse. We provide inserts for prescription bags at our campus pharmacy that explain the importance of taking medications as prescribed,  keeping medications safe, and disposing of unused medications properly.

Prevention efforts at OHIO University appear to be working. Between 2014 and 2015, the percentage of students reporting the use of someone else’s prescription medication dropped from 18% to 13.6% (OHIO AOD Survey, 2014, 2015). In the coming year, we plan to continue our poster campaigns and deliver more Generation Rx programs. We will be implementing ScreenU for prescription drugs, along with the alcohol and marijuana components. We also plan to present to first year students through learning communities.

With increased education and prevention efforts in place, we are cautiously optimistic that the OHIO University campus will continue to see a reduction in the non-medical use of prescription drugs. We recognize that this is a complex problem that challenges universities nationwide to establish best standards in the field of prevention. As professionals, our first step is to institutionally move beyond the credulous myths associated with the misuse of prescription medications.  Only then are we able to brainstorm and implement solutions that positively affect the well-being and safety of our students.

 Ann Addington is the Assistant Director for Tobacco, Other Drugs, and Recovery at Ohio University.  She oversees the collegiate recovery program, R.I.S.E. (Recovery to Inspire, Share, and Empower).  She is a tobacco cessation educator and a certified SMART Recovery® facilitator. Through risk reduction programs, she coordinates campaigns on prescription drug abuse, tobacco and other drugs.  She is a member of the university Tobacco-Free Committee, the University Hearing Board and provides risk reduction psychoeducation for students with alcohol and drug violations.

By: Kelsea Gallegos

The University of Utah School on Alcoholism and Other Drug Dependencies (the Utah School) was established in 1941. This program was a multi-disciplinary program that focused on increasing awareness of health and social problems of alcoholism and drug dependencies. The Pharmacy Section was created in 1983, and after 32 years of successfully helping thousands of individuals, the Utah School came to an end. But the American Pharmacists Association (APhA) knew the importance of carrying the message, and in 2015, the program transformed into what is now known as the APhA Institute on Alcoholism and Drug Dependencies. I had the esteem honor of attending not only the last official year of the Utah School, but also the inaugural and second year of the APhA Institute. Even though I attended the same meeting three years in a row, each experience was completely different and even more wonderful.

Kelsea Gallegos with members of the APhA-ASP National Executive Committee. Photo courtesy Kelsea Gallegos.

As student pharmacists we develop a certain idea of what an ideal professional meeting should look like. It would consist of activities revolving around networking, professional development, and education. The APhA Institute has all of that and so much more. The 5 days you spend in Salt Lake City will change not only how you view addiction, but it will also completely change your outlook on life. The APhA Institute creates an emotional component and bond to the other attendees that give this meeting a caliber of its own. Attendees at this meeting are pharmacists, student pharmacists, faculty, and pharmacy technicians. Some are in recovery, battling addiction themselves, or have loved ones with this disease. Some are leaders in Generation Rx, passionate about fighting the misuse and abuse of prescription drug abuse, or simply want to learn more. No matter how you look at it, this meeting has something for everyone. I know that for myself, it was a chance to attend an Alcoholics Anonymous meeting and see firsthand the program that has improved the life of so many including loved ones of my own.

I was a first-year student pharmacist when I first heard about this meeting through a student who had attended previously and I knew immediately that I wanted, that I needed, to be in Salt Lake City the next June. Even though I was inspired to go by others, my experience was different than that of the students who presented to my class, just as your experience will be unique from any picture I can paint for you. Any way you look at it, you will not regret attending the APhA Institute and creating your very own Utah Experience.

Kelsea Gallegos is the current American Pharmacists Association Academy of Student Pharmacists National President. As APhA-ASP National President, she actively represents the voice of student pharmacist members and new practitioners from across the country. Originally from Belen, New Mexico, a small rural town, she is now a final-year student pharmacist at the University of New Mexico College of Pharmacy in Albuquerque, New Mexico. She is a pharmacist intern at Walgreens and upon graduation, she plans to complete a pharmacy residency program.