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Not long after Narcotic Overdose Prevention and Education (NOPE) Task Force was created in 2002, we decided to bring our anti-drug messages to college campuses.

The reason was simple.

Both the national data (ACHA Surveys) and our anecdotal experience in partnering with law enforcement and other agencies indicated that college students were at high risk for overdose death.

We were aware that college students were misusing prescription drugs, but most concerning was the number of students who were hospitalized for combining these drugs with alcohol— which created particularly dangerous situations.

Often, as a result of students’ privacy concerns, the students’ parents were not made aware of these near-death experiences. As a result, NOPE decided to tackle the problem by raising awareness within the college population directly.  We set out to present at colleges across Florida and beyond. We needed to bring our messages to the students on their campuses and on their terms.

Our first presentation was in 2007 at Lynn University in Boca Raton during National Collegiate Alcohol Awareness Week (NCAAW). To date, we have done presentations at nearly 15 colleges, including Florida Atlantic University, Barry University, Florida Gulf Coast University, and University of North Florida.

We also have presented at American College Health Association’s (ACHA) Annual National Conference in Philadelphia, the Generation Rx University Conference at The Ohio State University, and National Association of Behavioral Intervention Team (NABITA) National Conference in Naples.

The life-threatening overdose incidents at colleges were the impetus for nationwide College Amnesty policies and eventually the 911 Good Samaritan law in Florida and other states.

Over the years, our presentations at colleges have been mostly well-received. We work hard to steer away scare tactics in favor of providing straight-forward, data-driven messages and real life cases/circumstances without judgment.  We strive to provide answers to tough questions such as the following (see the answers here):

• How quickly can I become addicted to a drug?
• How do I talk to my parents about getting help? What should I say?
• Isn’t becoming addicted to a drug just a character flaw?
• Shouldn’t treatment for drug addiction be a one-shot deal?
• If drug addiction is a disease, is there a cure?

At our presentations, students often open up deeply about their friends’, their family members’, or their own experiences with drugs. When that happens, we offer them information and support to get the help they need.

Still, getting students to attend our presentations is challenging. As a result, at schools like Lynn University, trained students have delivered similar messages to their peers.

While prescription drug misuse and overdose deaths remain a national health and safety issue, we’ve made tremendous in-roads at educating thousands of college students about the dangers of drugs. NOPE will continue delivering our messages to college students for as long as the disease of addiction remains a problem in the communities we serve.

Gary Martin is Vice President of NOPE Task Force and Dean of Students at Lynn University. 

Photo courtesy of moritzlaw.osu.edu

I am very favorably impressed by the work that the Generation Rx groups are doing. Through my study of the neurobiology of addiction, I am convinced that education and life skills are crucial activities for optimizing use of medications to enhance wellness and to minimize addiction.

In this opinion piece, I will share some thoughts relative to the history of regulation of non-medical drug use.

By many measures, the most restrictive regulation in the United States was the 18^th amendment to the US Constitution, enacted in January 1919. Manufacture, sale, and distribution of alcohol were prohibited. While the law initially decreased use of alcohol somewhat, the overall effect of Prohibition was a black market for manufacture and distribution of alcohol and a substantial expenditure of dollars and manpower to attempt to enforce the law. This law was repealed in 1933 by the 21^st amendment to the constitution. An important lesson from this social experiment is that enterprising individuals will find a way (legal or illegal) to make money by meeting demand for a product.

The current law regulating non-medical use of drugs sets up regulatory schedules for drugs with abuse potential. Drugs that do not have a Food and Drug Administration-approved therapeutic use and that have high addiction potential are assigned to Schedule I. It is illegal to possess these drugs without special permission from the Drug Enforcement Administration. A strategy to skirt the law is to make designer drugs. These are pharmacologically active analogs that are chemically similar but not identical to the illegal drug. The “bath salt” drugs are designer drugs that are chemically similar, but not identical, to amphetamine and ecstasy. The major known “bath salt” drugs were assigned as Schedule I drugs in 2011. The number of seizures/arrests associated with these drugs has been declining since that time. However, this is offset by an increase in seizures of new designer drugs. The pharmacology of these drugs is currently under study. Results to date suggest a high probability that these drugs have similar addiction potential to those they are replacing. These events reinforce the concept that enterprising individuals will find a way (legal or illegal) to make money by meeting demand for a product. Thus, lessons from history inform us that regulations have their place but do not eliminate demand for drugs.

The question then arises as to what activities might decrease demand for non-medical use of drugs. This is a difficult question. Despite increased regulation over the last 44 years, the percent of the US population identified as having an addiction to an illicit drug has remained constant. What has changed is the particular drug(s) in highest demand. For example, 35 years ago, methaqualude (Sopors) was the most commonly used illicit drug on campuses. Few students in my recent classes have ever heard of this drug. This suggests that desire to use drugs for non-medical purposes has more to do with human behavior than the “captivating” power of a particular drug or class of drugs. This brings us back to the activities of Generation Rx groups. High quality, accurate information presented in ways that capture the attention of recipients has the potential to decrease demand for non-medical use of drugs. Furthermore, these same activities have the potential to help people be smarter in their medical use of drugs.

Lane Wallace is a professor and chair of pharmacology at The Ohio State University College of Pharmacy. He specializes in neuropharmacology and mechanism of action of addicting drugs.

Prescription drug-related overdose deaths claimed more than 16,000 lives in 2011,¹ prompting the U.S. Centers for Disease Control and Prevention (CDC) to deem prescription drug abuse an epidemic.² This epidemic does not discriminate – it has affected Americans of all ages, education, income level, gender, and ethnic background.

The epidemic has been particularly widespread on college campuses. Between 1993 and 2005, the number of college students abusing opioid pain medications like oxycodone and hydrocodone increased by 343 percent, while stimulant abuse (e.g., Adderall) increased by 93 percent.³ A recent news report found that about 2 in 3 college students are offered prescription drugs by their senior year, with approximately one-third of them abusing prescription drugs during their college career.⁴ Furthermore, nearly one out of five college-aged (18-25) Americans has a past-year substance use disorder.⁵

Policy makers in Washington and state capitals across America are addressing prescription drug diversion and abuse through legislation and regulations, but this alone will not be the panacea. Local, peer-to-peer support organizations focused on prevention, treatment, and recovery play a critical part of a unified effort to reducing prescription drug abuse. Collegiate recovery communities are taking a leading role in doing just that. Collegiate recovery communities are campus-based, student-run organizations that focus on prevention as a public health initiative.

Although cultural norms view drinking and drug use in college as a “rite of passage,” many young adults do not age out of their substance use disorder. Collegiate recovery communities’ peer and professional support and other services such as counseling, substance-free housing, and social activities have helped to prevent enormous personal, social, and economic harm one person at a time. According to the not-for-profit Association of Recovery in Higher Education, the average national relapse rate of collegiate recovery program participants is 5 percent, which means that approximately 95 percent of the students who participate in these programs maintain their recovery through complete abstinence from drugs and alcohol.⁶ This data is a credit to collegiate recovery programs as relapse rates among the general population range between 40 and 60 percent.⁷

In society at large, dozens of collegiate recovery communities nationwide are promoting prevention and treatment through raising awareness of substance use risks and the harmful stigma and stereotypes around the disease of addiction, treatment, and recovery. Beyond promoting prevention, treatment, and recovery on campuses, it is incumbent upon collegiate recovery community members to mobilize and gain influence to break stereotypes and stigma.

Not unlike the AARP, arguably the most powerful senior citizens interest group totaling 37 million members, collegiate recovery communities have the enormous potential to expand beyond campuses and effectively change our culture to value prevention and health-focused norms. The expansion of the collegiate recovery community model into a larger scale organization that mirrors the AARP’s capacity and represents people in recovery and their allies has the potential to upend cultural norms and save lives.

So how do you do it? Start by sharing your story, whether it is among peers on campus or with policy makers. Personal testimonials are an effective way to compel action from others, and real stories increase your credibility as you seek to make a difference in the lives of others. By using your voice, you have the potential to build a grassroots movement that will grow the footprint of your collegiate recovery community and inspire others to step up to the plate and be leaders on substance use and addiction beyond graduation.

Collegiate recovery communities are fostering a healthier and more prosperous future for America one person at a time. It is time to expand collegiate recovery communities into a national recovery community organized to promote programs and policies advancing prevention, treatment, and recovery so that no more lives are lost due to substance use disorders.

Kyle Simon is Director of Policy and Advocacy for the Center for Lawful Access and Abuse Deterrence (CLAAD).

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October is Talk about Your Medicines Month, giving us the opportunity to recognize the importance of addressing prescription drug abuse. The National Council on Patient Information and Education (NCPIE) has long been about addressing prescription drug abuse and the role of treatment and a recovery-oriented system of care – as well as developing educational resources to support engagement at the community level.  We’ve learned that it’s not enough to say, “Don’t abuse these medicines,” which marginalizes consumers, not giving them the credit they deserve. 

HBCU Campus Dialogue on Prescription Drug Abuse Prevention, Treatment & Recovery

In March 2014, NCPIE convened the Historically Black College and University (HBCU) Campus Dialogue on Prescription Drug Abuse Prevention, Treatment & Recovery, an opportunity to gain a better understanding of this issue from faculty, staff and students. With support from the Substance Abuse and Mental Health Services Administration, we convened over 40 participants for this two-day meeting. Attendees affirmed that the abuse of certain prescription medications has been normalized on some college campuses.

While the Campus Dialogue represented a microcosm of colleges and universities, we suspect that you may likely find similar findings on your campus. See if you observe yourself nodding, “yes” to the following cycles of influence that participants attributed to prescription drug abuse and addiction.

• Misaligned Economic Incentives: When young adults enter college they are keenly aware of our country’s challenging financial conditions. There is a perception of a financial gain to selling medications. “A pill can sell for $30-$40, and a bottle of Promethazine with codeine can go for $400-500.00. Money now trumps problems later.”
• Availability or Overprescribing: “There’s a pill for every ill. We’ll give you something to fix you, and we’ll fix you from the inside out.”
• Misinformation: The integration of images and words, portraying drug abuse as “big fun,” can give students the mistaken impression that, “Everyone is doing it; why not try it; how could these medicines be so bad?”
• Peer pressure: “When students find themselves at parties, and everyone is getting high, some may think that they are outside of the loop if they are not using.”
• Transitional stress: Parental and personal pressure of making good grades, being independent, fear of the unknown, being in a fast-paced environment and absence of treatment and recovery services can make medication abuse a “go-to solution.”
• Racial disparity: Drug abuse and addiction are taboo. “Families are closed about drug abuse and addiction, and there are perceptions of denial.”

Bring Prescription Drug Abuse and Addiction Out of the Shadows

What began as a discussion about prescription drug abuse on HBCU campuses provided a platform for students, staff and faculty to address much bigger challenges including transitional stress, cultural disparity, poor economy, the role of social media and institutional bias. These academic and social pressures are reinforced by the perception that prescription medications can help some students get through the day, from studying and sleeping to socializing. The two days of discussion generated strategies for creating on-campus change – recommendations that could be implemented today and in the future, including the following:

• Monthly seminars
• Comprehensive RA training and integration of mentors
• Instituting the practice of forming smaller classes
• Launching an “unplugged day” twice a year
• Investing more research dollars into alternative medicines

Raise the Level of Awareness on Your Campus 

Dialogue participants concluded that we should begin by picking one provocative possibility and then exploit conditions to “viralize” change. So this October, make a commitment to raise the level of awareness about prescription drug abuse, treatment and recovery among students, faculty, staff and parents. Check out the following resources as you build and enhance your prevention and intervention efforts:

• Taking Action to Prevent and Address Prescription Drug Abuse
• Recoveropensdoors.org
• Prescription Drug Abuse Prevention: Resources for Community Action
• The Generation Rx Initiative
• Prevent Rx Abuse: A CADCA Toolkit

To learn more about the HBCU Dialogue and safe medicine use, contact Ray Bullman at NCPIE, 301.340.3940, bullman@ncpie.info, or check out www.talkaboutrx.org.

Photos courtesy of Ray Bullman.

The National Council on Patient Information and Education (NCPIE) has been working toward advancing the safe and appropriate use of medicines since 1992. This October marks NCPIE’s 29^th annual “Talk About Your Medicines” month (originally called “Talk About Prescriptions” Month). This year’s theme is “Let’s Get in Sync.” NCPIE will be in partnership with the American Pharmacists Association Foundation to launch a consumer education campaign encouraging more communication between pharmacists and patients and/or caregivers. The campaign will be looking at areas where there can be more interaction – including pharmacists providing medication counseling and medication synchronization services (in which multiple medicine refills would be available at the same time each month). Synchronization works by utilizing the Appointment Based Model (ABM) and is designed to improve patient adherence. Utilizing this tool allows pharmacists and pharmacy staff members to do medication reviews every month to be aware of therapeutic and adherence issues patients may be facing. This model can help patients achieve better health outcomes – particularly those who have multiple health conditions, are taking multiple medications, and are seeing multiple health care providers. Research has shown better patient adherence with this model, and this model allows the patient to be at the center of the healthcare team.​

A post regarding this topic will be coming later this month!

(Adapted from the National Council on Patient Information and Education, talkaboutrx.org)

These days it is not uncommon to hear about professional athletes getting caught up abusing pain pills, as these stories have almost become commonplace in sports.  Some athletes will do whatever necessary to stay on the field, and pain pills are becoming more widely used to mitigate sports injury discomfort. Unfortunately, while pain pills might work in the short run by allowing athletes to quickly play again, they are also highly addictive and can lead to future problems much bigger than the original injury.

Pain pills in sports

While it may be understandable why professional athletes turn to pain pills (since their careers depend on being healthy enough to play), it is more troubling to see youth athletes using these drugs.  In fact, in too many cases today young athletes who are originally prescribed pain pills from their physician later turn to the streets to buy black market pain pills when their scripts expire.  If black market pain pills become too difficult to find, or cost-prohibitive, heroin then becomes the drug of choice since it is more widely available and cheaper.  Ironically, young athletes who become addicted to pain pills (or heroin) almost always start out by using simply to get back on the field, only later do they become addicted to the drugs due to lacking medical oversight and/or relatively fast physiological addiction.

Possible reasons for this paradigm shift pertaining to more pain pill usage in sports include new norms in sports when it comes to pain management, group dynamics (pressures from teammates to quickly play again), fear of loss of starting position, or fears associated with missing future college athletic opportunities because of injuries that otherwise could be controlled for by using pain pills.  These new pressures, group dynamics, and future sport goals sometimes converge to create a “perfect storm” where otherwise healthy, level-headed kids uncharacteristically consider using dangerous pain pill drugs.

The race for athletic scholarships

Many young athletes (and their parents) begin the journey very early on when it comes to the pursuit of a full-ride DI athletic scholarship.  Though only about 3-4% of all high school student athletes will ever earn a full-ride, hundreds of thousands more will try their best with the hope of being one of the lucky few.  Along the way, it is almost inevitable that injuries will occur, and in some cases the injuries will be so severe that they jeopardize the chances of earning a full-ride.  It is in these instances where some kids (sometimes with parental influence) elect to do whatever is necessary so that the injury is quickly addressed — even if this means abusing pain pills.

Coincidentally, even young athletes with little to no hope of ever earning a full-ride scholarship are also at-risk for unforeseen drug abuse and dependence, mostly because prescription pain pills have almost become commonplace for rehabilitation recovery protocols.    Ironically, this new wave of drug addicts are very different than the traditional recreational drug addict who voluntarily chose to use street drugs to get high — in the case of the addicted athlete, the addiction occurs not because the athlete wants to get high, but instead because of the perceived value in these drugs as they apply to quickly getting back on the field again. 

Train healthy & allow time to heal

Healthy training and injury recovery methodologies in sports need to be closely examined and scrutinized, especially at the youth sport level.  Please check with your physician about the many ways to control for pain aside from prescription pain pills, including relaxation techniques, imagery, physical therapy, and proper rest.  Coming back from sports injuries too soon may cause bigger problems with pain pills and addiction, and might also send an athlete back on to the field too soon (which, ironically, may lead to more permanent long-term damage).

For more information about healthy training in youth sports please visit www.drstankovich.com or follow me on Twitter @Drstankovich.

Photos courtesy of Chris Stankovich.