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By Dr. Candace Haugtvedt

The OSU Student Health Services Pharmacy had a very successful Medication Disposal Day on Thursday, April 21, 2016 under the direction of Candace Haugtvedt, R.Ph., Ph.D. who coordinated the event. We reached 80 people who turned in 131.5 pounds of unused medications!  This included 1118 CII tablets or capsules and 370ml of CII liquids that are now off the streets and safely disposed of in an environmentally friendly way.  The OSU Police took 11 boxes for destruction by the Environmental Health & Safety Department in Facilities Operations and Development.  We handed out two adult Generation Rx educational handouts about how to Take Action to prevent drug misuse at home to each of the 80 people who dropped off unneeded drugs.  We had a steady flow of people and collected almost double the amount of drugs as we did the year before and reached almost double the amount of people as well.

OSU Police Officer Dave Ferimer, and P3 Pharm.D. students Andrea Haugtvedt and Lena Wu with boxes of unneeded drugs for destruction at the conclusion of the latest event. Photo courtesy of Candace Haugtvedt.

The OSU SHS Pharmacy has been having Drug Take Back Days since 2011. This event was staffed by Generation Rx initiative pharmacy volunteers and coordinated by volunteers from SSHP and student health services. 10TV News even featured a story on our Drug Take Back Day event at noon and 5pm.We will have another Drug Take Back Day here at the OSU Student Health Services Pharmacy on Thursday, October 27, 2016 from 9am to 2pm to coincide with the NOPE (Narcotics Overdose Prevention and Education) Candlelight Vigil in memory of those lost to and those suffering from substance abuse.

We are also working on having a permanent Drug Take Back Box installed at the OSU Police Station on campus. A group from the OSU Police Dept., Environmental Health & Safety in Facilities Operations & Development, the Council of Graduate Students and the OSU Student Health Services Pharmacy is working out the policy and procedure details and all of the logistics.  There will be an ongoing need for Generation Rx volunteer students to separate out the controlled from non-controlled drugs and provide an inventory for the disposal vendor on a weekly or bi-weekly basis throughout the year.  The ongoing costs of drug disposal are also an issue we have to work on finding a funding source for.  Hopefully we can work these and other issues out over the next several months to have the permanent Drug Take Back Box in place on campus by next May.

Guidelines for hosting a Medication Disposal Day are found at: http://www.generationrx.org/wp-content/uploads/2015/05/Medication-disposal-day-guidelines.pdf

Medication disposal days are extremely important to prevent the diversion of unneeded medications and to dispose of them in a safe, legal and environmentally friendly manner. Most teenagers who misuse prescription drugs obtain them from a friend or family member. It is very important to safely store medications, keeping them locked up and out of the reach of children. Safe disposal keeps toxic medications out of the groundwater and protects wildlife from harm. Medication disposal days are key to promoting public health and safety on campus and throughout the community.

Candace Haugtvedt is a pharmacist at OSU Student Health Services Pharmacy. She has a Ph.D. is in Pharmaceutical Administration/Preventive Medicine from Ohio State in 1998. Areas of expertise include health behavior/health promotion, public health advocacy and health care management. Professional experience includes 16 years as a decentralized Hospital Pharmacist at the University of Missouri-Columbia and Mount Carmel Health West in Columbus, and then 19 years as an Ambulatory Care Pharmacist in College Health at the Ohio State University Student Health Services Pharmacy.

By Sarah Nerad

My name is Sarah Nerad and I am a person in long-term recovery, which means I have not used alcohol or drugs since August 16, 2007. Recovery has given me the ability to be a leader on my campus and to give back to other students what was so freely given to me. One of the major ways I do this is through my role at Ohio State where I am the Program Manager for Student Life’s Collegiate Recovery Community (CRC). The CRC is a supportive peer community with specific programming for students in recovery to enable them to have an authentic college experience while maintaining their recovery.

The CRC at the 2015 NOPE Candlelight Vigil, where one of our members shared a recovery story (photo courtesy of Sarah Nerad).

Since the CRC began in March of 2013, the Ohio State College of Pharmacy and the Generation Rx Initiative have been tremendous supporters and partners of ours. Some of the ways we have worked together over the years include having a CRC member speak at the NOPE Candlelight Vigil, volunteer at and help promote the prescription drug take-back days, efforts to increase access to naloxone both on and off campus, sharing our recovery stories at their events and collaborating to include information about recovery in prescription drug misuse education.

The CRC at our 3rd Annual CRC Graduation Dinner where we recognize our members that are graduating from Ohio State clean and sober by presenting them with purple honor cords (photo courtesy of Sarah Nerad).

We have also partnered to deliver educational presentations to students on prescription drug misuse prevention on campus. Having a CRC student come and share their story humanizes the addiction and recovery journey for the audience and makes the message more relatable. We are able to leave the audience with resources if they or someone they know needs help as well as leave them with hope that people can and do recover.

One of the things I’ve enjoyed most about our partnership with the Ohio State College of Pharmacy and Generation Rx Initiative is that it’s an “outside of the box” partner. To marry prescription drug misuse prevention messages with recovery messaging is a powerful way to reach new audiences and bring hope to those that have been impacted by addiction. It’s also important that we work together because we need more people to understand the reality that addiction is treatable and people can recover. By getting outside of our silos and working together to reach new audiences, we are able to have the collective impact that we want.

Sarah Nerad has made it her life purpose to create the same opportunities that she had to enter and sustain recovery for young people across the country. She was a founding member of Young People in Recovery, a Substance Abuse and Mental Health Services Administration (SAMHSA) intern in the Center for Substance Abuse Treatment Department of Consumer Affairs, and a past board member of The Association of Recovery Schools and Ohio Citizen Advocates for Addiction Recovery. She helped create the Collegiate Recovery Community at Ohio State and currently serves as the Program Manager. She also helped establish OSU’s Higher Education Center for Alcohol and Drug Prevention and Recovery and serves as its Director of Recovery. Additionally, she was appointed to serve on the SAMHSA Advisory Committee for Women’s Services to represent the needs of women and girls in recovery.

by Ann Quinn-Zobeck

Image courtesy of cpamm.org

Despite the increased awareness of prescription drug abuse nationwide, 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. Meanwhile, questions remain about whether students recognize the risks, including the legal, medical and academic consequences, of misusing or diverting ADHD prescription stimulant medication.

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 (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.

The 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. Peer education is essentially a program where trained students interact with their peers in meaningful ways to disseminate information and make referrals to on-campus services. Peer educators spread important health and safety information. Peer education has become a preferred method for communicating with students and is an important part of an overall prevention strategy. Trained peer can be instrumental in addressing stimulant medication misuse and abuse on college campuses.

What Peer Educators Can Do to Address Stimulant Medication Misuse and Abuse
The results of a Harris Poll survey conducted on behalf of CPAMM found that college students are busy and feel stressed, and ADHD prescription stimulant misuse is seen by many as a way to keep up with their academic demands and non-academic activities. Many college students feel pressured to succeed – at any cost. Sixty-four percent of survey respondents said they would do anything to get an A.

Students overestimate the misuse and abuse of prescription stimulants. While the majority of college students are not abusing these medications, many students believe misuse is somewhat common and that ADHD prescription stimulants are easy to obtain without a prescription and no more harmful than a cup of coffee or energy drink.

Image courtesy of cpamm.org

With proper training, peer educators can provide factual information about ADHD medication and reduce the misperception of wide spread abuse. Through presentations, peer theater, social media messaging, and skill building trainings, peer educators can reach out to their fellow students to

• teach healthy study and stress reduction skills
• present facts about the actual rate of misuse to combat social norming of the issue (e.g., everyone is not doing it)
• educate on perceived short-term benefits (e.g., achieving academic success) vs. potential long-term effects
• dispel the myth of the “smart drug” as there is no evidence that students who misuse stimulant medication do better academically
• address misinformation or lack of awareness about the misuse and diversion of ADHD medication (e.g., it’s a Schedule II controlled substance, illegal to divert or misuse, how it helps the ADHD student).

As part of CPAMM, NASPA and its BACCHUS Initiatives are partnering with the University of Washington to research what messages about prescription stimulant medication misuse and abuse resonate with college students. The results of this research will be used to develop peer-to-peer interventions for use by college students to help prevent the non-medical use of ADHD stimulant medication.

If you would like to know more about CPAMM, visit cpamm.org. To find out how to start a peer education group and for other peer education resources, visit naspa.org/BACCHUS.

Ann Quinn-Zobeck is the Senior Director of BACCHUS Initiatives and Training at NASPA – Student Affairs Administrators in Higher Education.

by Jason Anderson

Emergency department visits in 2011 related to drug misuse or abuse and other causes

As a fourth-year student practicing in the pharmacy, I see the face of addiction every week. The signs of drug addiction are no longer presented as shady drug deals in a dark alley but are now disguised as early refill requests for opioid pain medication and stimulant ADHD medications. The description of the stereotypical drug abuser has changed drastically over the last few years. For example, the highest rate of emergency department visits in 2011 related to drug misuse or abuse was between the age range 18-29. This, coincidentally, is the demographic of the college population. Fifty-one percent of these cases involved non-medical use of pharmaceuticals. The real question is this: how do we overcome these biological changes of addiction to alter prescription drug misuse behaviors?

In order the overcome the biological and physical changes associated with addiction, we need to change how we address prescription drug misuse. It is imperative to incorporate innovative ways to change college students’ behaviors. Before we are able to change their behaviors, we need to first change their perceptions regarding prescription drug misuse. Let’s examine an example of prescription stimulant use without a medical indication such as ADHD. In a study conducted by Lookatch et. al in 2014, the researchers found that non-medical use of stimulants for “studying purposes” was perceived as more acceptable by college students than the need “to get high.” This generally accepted, albeit irrational, thought process, validates prescription drug misuse in the minds of college students because the anticipated outcome of higher grades can positively impact their academic achievements. Changing these deeply rooted perceptions is the first step required to reverse the ingrained behaviors of college students towards prescription drug misuse.

Let’s continue our example of prescription stimulant misuse and look at innovative ways to change behaviors long term. Since prescription drug misuse is a growing problem on college campuses, we will need to attack the issue from multiple angles. One strategy, which is currently used at Miami University in Ohio, involves minimizing abuse by maximizing care. All students who seek medication for ADHD must first attend a “brain boosting” workshop. In this workshop, students are taught integral attention skills such as time management, distraction minimization and procrastination reduction. In addition to this workshop, prescribing of medication for ADHD is addressed in a step-wise function. Students are first prescribed medications without addictive potential, such as Strattera® (atomoxetine)‎. This reduces the exposure of the college population to stimulant ADHD medications. In addition to maximizing care, we could also add in social media or universal text messages to engage the entire student body. These text messages would be sent around the time frame when student would be most at risk for abusing prescription stimulants, such as finals week. While text messaging alone has not been shown to be effective in changing student behavior (Quanbeck et al., 2014), this strategy, when used in combination with other methods to combat prescription drug abuse, might be beneficial. Lastly, attention must be focused on preventing the diversion of prescription medications. This could be achieved by educating those with prescription medications about the dangers of theft and the consequences of sharing prescription medications. Providing students with a lockbox for their medications is one proposed strategy for reducing theft.

As the face of addiction changes, we have to change the way prescription drug misuse on the college campus is addressed. We need to develop and implement novel ways to alter behavior. These innovative methods could include maximizing non-pharmacological care, engaging students via text messaging or social media and decreasing diversion with lockboxes. Prescription drugs have the ability to make a drastic medical impact on those who truly need the medication but also deter bright college students, who are the creators of our future, from obtaining their highest potential. The age range of emergency department visits is a gloomy statistic. However, it also holds potential for us to make a drastic impact via innovative interventions that will help change the face of addiction for future generations.

References

Lookatch SJ, Moore TM, Katz EC. Effects of gender and motivations on perceptions of nonmedical use of prescription stimulants. J Am Coll Health. 2014;62(4):255-262. doi:10.1080/07448481.2014.891593.

Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

Quanbeck A, Chih M-Y, Isham A, Johnson R, Gustafson D. Mobile Delivery of Treatment for Alcohol Use Disorders. Alcohol Res. 2014;36(1):111-122.

Jason Anderson is currently a fourth-year student in the PharmD/PhD program at The Ohio State University College of Pharmacy. For his PhD, Jason works on a National Institute of Health research project at OSU regarding inhibitors of HIV integrase. He spent the month of November doing an Advanced Pharmacy Practice Experience rotation at the Center of Science and Industry (COSI) in Columbus, Ohio, teaching the museum visitors about prescription drug safety.