by Cindy Clouner

The landscape of higher education has changed in many ways in the past two decades, but one thing that continues is the challenge that colleges and universities face in addressing high-risk drinking.  The potential negative consequences of high-risk drinking are endless and can be compounded when mixed with other drugs, including prescription drugs.  Recognizing this need, Drug Free Action Alliance created the Ohio College Initiative, the nation’s first statewide initiative to address high-risk drinking, in 1996 and has continued to drive this unique collaboration.

A member of the Ohio College Initiative, The Higher Education Center, is located in Stillman Hall at The Ohio State University. (Photo courtesy of osu.edu)

The Ohio College Initiative focuses on decreasing high-risk alcohol use by utilizing environmental prevention strategies, specifically reducing access and availability; reducing marketing and promotion of substances; increasing consistent enforcement of laws and policies; increasing social, recreational, and academic options; and creating a health promoting environment.  These strategies echoed the prevention philosophy of the former Higher Education Center for Alcohol and Other Drug Prevention, considered the nation’s primary resource for college and university prevention programming.   The Higher Education Center was an important ally in the work of the Ohio College Initiative and provided technical assistance and support.  With limited resources, it was imperative that campuses not only relied on each other, but also on the communities in which they were located.  In the first year, 19 institutions created campus-community coalitions to address high-risk drinking.

Almost twenty years later and with 53 member institutions, this pioneering initiative is still in existence. Although high-risk drinking prevention will always be at the heart of the Ohio College Initiative, in recent years many institutions have seen an increase in the number of students using marijuana and misusing prescription drugs.  The need to address these issues in an effective way is evident and with the rebirth of the Higher Education Center in our backyard, there is no better time than now to refocus the collaborative efforts of Ohio’s college campuses.  With a formal partnership between the Higher Education Center and Drug Free Action Alliance, colleges and universities across the state will have access to support, education, technical assistance, and opportunities for networking that will assist them in building strong prevention programs to address not only high-risk drinking, but also the increase in marijuana use and prescription drug misuse among their students.  Members of the Ohio College Initiative will be meeting in May to celebrate this new chapter in its history and learn more about the opportunities it brings.

The Ohio College Initiative is supported by the Ohio Department of Mental Health and Addiction Services.  To learn more about the Ohio College Initiative, please visit DrugFreeActionAlliance.org/ohiocollege.

Cindy Clouner is the Program Manager for the Ohio College Initiative through Drug Free Action Alliance.

Written by Kelsey Kresser

It is an exciting time for pharmacy in Ohio, as several bills have recently been introduced that have the potential to affect the future of pharmacy practice. One issue that has received a lot of attention is naloxone dispensing. As many are already aware, the opioid epidemic is a huge public health concern in Ohio and across the nation. Drug overdose is the leading cause of accidental death in Ohio, which means our citizens are more likely to die from a drug overdose than a motor vehicle accident. This is simply unacceptable.

If a drug user overdoses, naloxone (Narcan) can be used to restore normal breathing and save his or her life. Current law in Ohio allows paramedics and first responders, such as police officers and firefighters, to carry the drug. In 2014, Governor John Kasich also signed House Bill 170 into law, which allowed physicians to prescribe naloxone to active drug users, family members, and friends of those who may be at risk.

An intranasal naloxone kit such as this one can be used in the event of an opioid overdose to reverse respiratory depression and prevent opioid-related death. Image courtesy of CBS News.

Now House Bill 4 has been introduced to the Ohio General Assembly.  HB 4 would allow pharmacists and pharmacy interns in Ohio to dispense naloxone without a prescription. The passage of this law will greatly increase access to this life-saving drug and help combat the opioid epidemic in Ohio. HB 4 has passed through the Ohio House of Representatives unanimously and is currently awaiting action in the Ohio Senate. If the bill is passed, Ohio would be the seventh state to allow pharmacists and pharmacy interns to dispense naloxone without a prescription. [Currently, California, New Mexico, New York, Washington, Rhode Island, and Vermont allow dispensing of naloxone without a prescription.]

This issue is very important to me as a student pharmacist not only because I am an active member in Generation Rx, but also because opioid misuse is likely to be a very important issue throughout my career. Pharmacists are the most accessible health care providers and are instrumental members of the health care team. I was fortunate enough to have the opportunity to give testimony in support of HB 4 to the Ohio Health and Aging Committee, and I was very encouraged by the feedback I received from Ohio’s representatives. Many legislators do not know the education pharmacists receive today, nor do they fully understand the scope of pharmacy practice. Students’ voices are powerful, and legislators listen to students who are passionate about their profession. I encourage student pharmacists across the country to be aware of the issue of naloxone dispensing, as it will likely affect many of us throughout our careers. I hope that by learning about HB 4, you are encouraged by the work that Ohio is doing to put pharmacists in position to combat the opioid epidemic.

Pharmacy student Kelsey Kresser testified before the Ohio House of Representatives Health & Aging Committee about HB 4 on February 18, 2015. (Photo courtesy of Ken Hale.)

Kelsey Kresser is a second-year Doctor of Pharmacy candidate at The Ohio State University College of Pharmacy.

The Higher Education Center Leadership team: Standing (left to right) – Kristin Dahlquist, Program Manager; John Clapp, Director; Ken Hale, Associate Director. Seated – Connie Boehm, Associate Director.

College is a seminal time in a young person’s life. It’s a time for intellectual and social growth. It’s a time for the formulation of passions and future professional pathways. It’s an exciting time of experimentation, but there are also hazards on our campuses that sometimes derail students and disrupt the attainment of their great potential. High-risk drinking and the misuse of drugs are among these critical hazards, and our colleges and universities understand the need to create safe environments and educate students about the dangers of alcohol and drug misuse.

The new Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery has been established at the Ohio State University to support colleges and universities in this important work. This partnership between the Colleges of Social Work and Pharmacy and the Office of Student Life provides education and training, research and evaluation, technical assistance, and technology development to help colleges and universities prevent drug and alcohol misuse. We also have a strong emphasis in supporting the establishment of collegiate recovery communities.

The Higher Education Center actually replaces a similar organization that was established through the U.S. Department of Education but lost its funding in 2012. Dr. John Clapp led that effort, and he is the Director of the new Higher Education Center as
well. The Center is developing myriad resources to help college and community leaders develop, implement, and evaluate programs and policies to reduce problems experienced by students related to alcohol and other drug misuse. A few examples of these efforts include the provision of educational webinars and development of innovative tools for screening, brief interventions and referral to treatment (SBIRT). The Center’s website is being established at HECAOD.osu.edu, and you can follow HECAOD on Twitter, Facebook, and Instagram.

Make plans now to join us at the inaugural Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery National Meeting, August 4-6, 2015, at Ohio State’s Blackwell Inn & Conference Center.

Dr. Kenneth M. Hale is Associate Director of the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery.

Photo courtesy of addictiontreatmentmagazine.com

In our local paper a mother grieves the loss of her college son who has died due to a combination of abusing alcohol and one of the popular ADHD stimulants. The official cause of death is listed as alcohol toxicity in the coroner’s report.

Apparently what happened is while the student was devouring significant amounts of alcohol, he was also snorting the prescription stimulant at the same time. This allowed him the ability to ingest more alcohol than he could have normally consumed, due to the stimulant effect of the pharmaceutical.

He simply was not obtaining the true impact of the amount of alcohol he was taking due to the stimulant impact. However, once the alcohol blood level reached a certain point, even the stimulant could not keep him from a tragic death.

The stimulant was obtained either from a friend or dealer and, of course, is relatively a common method to be able to drink more at parties and other social events college aged students attend. Although pain relievers still rank the highest in college student abuse among pharmaceuticals (RADARS® 2014), the deadly combinations of stimulants or benzodiazepines mixed with alcohol may be just as dangerous.

Perhaps the most important thing lost in this article was that it seemed to consider the consumption of large amounts of alcohol to be the rite of passage for college students, with the true villain here being the prescription stimulant. There is probably no doubt that the student would not have died without taking the stimulant with the alcohol, but the opposite would also likely be true.

In 47 years of law enforcement I have seen the devastation of alcohol abuse. In my opinion, alcohol has caused more collaborative damage than all of the other illicit drugs combined, yet with it being legal, I think we all tend to consider it somewhat benign. Of course, taking alcohol in moderation with some common sense, as it is by many, can deter negative things from happening.

Prescription stimulant abuse is nothing new, as it has been used by college students for decades in order to focus on their studies. Much of the abuse we see today of these drugs comes from the parents of young ADHD patients who abused them in their college days and now see a readily available supply in their own children’s prescription. The parents may decide to suspend the doses for the child during summer vacation, but continue to refill if for their own use.

The ample diagnosis of ADHD, and even the strong suggestion of some elementary schools that particular students need to be prescribed the drug before returning to class, helps to fuel the availability of these drugs in America’s medicine cabinets.

Alcohol and the combination of many illicit and pharmaceuticals can be a recipe for disaster. Knowing the dangers of stimulant prescription drugs and alcohol combinations is something all college students should consider before a night on the town.

Commander John Burke is president and owner of Pharmaceutical Diversion Education Inc. (www.rxdiversion.com) and president of National Association of Drug Diversion Investigators (NADDI) (www.naddi.org). He has served as a law enforcement officer for more than 45 years.

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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